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ABSTRACT: Dysphagia, regurgitation and hypersalivation due to local destruction or incessant coughing in the presence of a tracheo-broncho-esophageal fistula become the most important distressing factors in the end stage of malignancies in the upper gastrointestinal tract. Inevitably such patients have a short life expectancy. It is often desirable to avoid the morbidity associated with surgery, radiotherapy or chemotherapy. The non-operative insertion of a prosthesis is increasingly being carried out to palliate malignant dysphagia.
Endoscopy 10/1986; 18 Suppl 3:32-9. · 5.21 Impact Factor
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ABSTRACT: The endoscopic insertion of an endoprosthesis is now a standard procedure in the ultimate palliation of malignant obstructing upper gastrointestinal and biliary malignancy. The commercially available prostheses and introducing devices are adequate for the majority of upper intestinal cancers. For some stricturing lesions, especially when associated with fistula formation, individual adaptation of a tygon prosthesis with extra widening rings is often necessary. Nd: Yag laser vaporisation of mainly exophytic cancerous tissue is mainly indicated for those circumstances which are less amenable to prosthesis insertion such as total luminal obstruction, noncircumferential tumorous involvement, polypoid cancers, excessively necrotic and chronically bleeding tumors, lesions extending within 2 cm of the upper esophageal sphincter, markedly angulated cancers of the cardia with almost horizontal tube positioning and cancerous overgrowth occluding the funnel opening. Overall successful insertion occurs in over 90% of patients. Main complications are perforation 5-8% and early or late dislocation. The procedure related mortality fluctuates around 2 to 4%. Overall results with laser application are roughly comparable. The dysphagia free intervall after laser is only around 6 weeks for the majority of the patients. Transpapillary insertion of a straight Amsterdam-type prosthesis rapidly became a standard procedure for palliation of malignant jaundice. For many patients with pancreatic cancer this endoscopic approach competes favorably with corresponding surgical palliative alternatives. Disappearance of jaundice is to be expected in the vast majority of the patients. The only major unsolved problem remains late clogging with biliary sludge which necessitates insertion of new prostheses. Most problematic to breach are bifurcation tumors. Cholangitis is a major complication if one does not succeed at the first attempt to drain both liver lobes.
Digestive Diseases and Sciences 10/1986; 31(9 Suppl):57S-76S. · 2.12 Impact Factor
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Clinics in gastroenterology 05/1986; 15(2):249-71.
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ABSTRACT: Results of a conservative approach in the treatment of instrumental oesophageal perforation were evaluated in 54 patients. The perforations occurred either during introduction of/or manipulation with fibre-endoscopes (six), during dilatation procedures with metal olives (five), mercury bougies (six) or during pneumodilatation (two) in 19 patients without malignancy and during an intubation procedure of a plastic prosthesis in 35 patients with an inoperable malignant oesophageal narrowing. In the majority of patients (94.4%) the diagnosis of oesophageal perforation was made within two hours. Conservative treatment consisted of nothing by mouth, antibiotics and naso-oesophageal suction. Of the 19 patients without malignancy, 14 were treated conservatively and five by surgery (primary closure and drainage) with no deaths. All patients with an oesophageal perforation caused by palliative intubation received conservative treatment with three deaths (8.6%). Non-surgical treatment of instrumental oesophageal perforation is feasable and acceptable, provided the perforation is detected early, before major contamination has occurred and is indicated in case of perforation in patients with malignancy.
Gut 05/1984; 25(4):398-404. · 10.11 Impact Factor
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ABSTRACT: The results of a conservative treatment of benign esophageal strictures (68 peptic, 21 postsurgical, 2 caustic stenoses, 8 Schatzki rings, 1 esophageal web) were evaluated in 100 patients. Treatment consisted of dilatation either with Eder-Puestove olives or with mercury bougies up to 18-20 mm, or with both. In addition, all patients received antireflux therapy when indicated. The follow-up study lasted from 1-6 yr. The results show that 88 patients became symptom-free. In 4 patients the results were moderate (intermittent dilatation necessary), while there were three failures: all in patients with a severe ulcerating peptic reflux esophagitis with stenosis. They were treated by antireflux surgery. There were eight perforations; all patients survived after surgical (4) and conservative (4) treatment; 3 patients received further dilatation. Conservative dilatory treatment (up to 18-20 mm), combined with antireflux therapy when indicated, offers in general an adequate result in patients with benign esophageal strictures.
Gastroenterology 04/1982; 82(3):487-93. · 11.68 Impact Factor
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Nederlands tijdschrift voor geneeskunde 10/1981; 125(36):1453-6.
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Nederlands tijdschrift voor geneeskunde 01/1981; 124(52):2213-8.
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ABSTRACT: Two hundred patients with obstructing esophagogastric malignancy were treated with positioning of a plastic prosthesis. With the aid of a small caliber fiberendoscope and a pusher tube, the prosthesis was positioned under continuous visual control, using only local anesthesia. Seventy-seven patients had esophageal carcinoma, 25 had pulmonary carcinoma obstructing the esophagus, and 98 had gastric carcinoma. Of the latter, 21 had extensive stomach involvement and 8 had local tumor recurrence after esophagojejunostomy. A bronchoesophageal fistula was present in 17 patients. Complications were bleeding (3), perforation (16) with only one death, and obstruction either due to food impaction (13), tumor overgrowth (17), or reflux esophagitis (5); the latter two conditions were corrected by changing the tube in all cases. Tube migration occurred frequently, but could be prevented by adapting the shape of the prosthesis. The procedure was performed as ultimate palliation in patients unfit for surgical insertion and had a low mortality rate of 2%. In general, there was marked improvement in the quality of life.
Gastroenterology 12/1979; 77(5):1008-14. · 11.68 Impact Factor
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Nederlands tijdschrift voor geneeskunde 07/1979; 123(24):1004-9.
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Nederlands tijdschrift voor geneeskunde 05/1979; 123(16):666-72.
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Nederlands tijdschrift voor geneeskunde 05/1979; 123(17):707-12.
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ABSTRACT: 100 patients with a known history of choledocholithiasis were selected. The main reasons for performing ERCP were the presence of severe jaundice or insufficient information obtained with intravenous cholangiography. Analysis is made of the various complications due to the presence of common bile duct stones. A surprisingly high incidence of choledochoduodenal fistulas was seen; two types of such fistulas can be recognized. A brief discussion is given of etiological factors involved. ERCP is also very useful in the evaluation of surgical anastomosis and complications due to surgery such as narrowing or complete ligation of the common bile duct. Finally, pancreatitis, another complication of choledocholithiasis, is evaluated with ERCP, showing the importance of reflux from the common bile duct into the pancreatic ducts in the etiology of this condition.
Radiologia clinica 02/1978; 47(6):397-411.
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Tijdschrift voor gastro-enterologie 02/1978; 21(1):19-37.
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ABSTRACT: In this partly retrospective and partly prospective study, we examined 200 patients with suspected caustic ingestion. No steroids were administered to the patients involved. Lesions in the esophagus were found in 93 patients. Thirty-two patients with deep circular burns had nasogastric tubes inserted immediately. Of these patients, two developed esophageal strictures, but subsequent dilatation was successful. No stricture formation was observed in the group of patients with noncircular lesions. We feel that this low percentage of stricture formation is due to the use of nasogastric tubes. Since neither the presence nor the severity of esophageal burns is predictable, an endoscopy should be performed in all suspected cases. In the absence of severe pharyngeal lesions, the use of a flexible fiberoptic endoscope is preferable because it also allows examination of the stomach and proximal part of the duodenum.
The Annals of otology, rhinology, and laryngology 94(4 Pt 1):337-41. · 1.05 Impact Factor
