The Experts below are selected from a list of 5490 Experts worldwide ranked by ideXlab platform
Sunghoon Moon - One of the best experts on this subject based on the ideXlab platform.
-
feasibility and safety of placement of a newly designed fully covered self expandable metal stent for refractory benign pancreatic ductal strictures a pilot study with video
Gastrointestinal Endoscopy, 2008Co-Authors: Do Hyun Park, Sunghoon MoonAbstract:Background Painful chronic pancreatitis with main pancreatic ductal strictures is usually managed with endotherapy with a plastic stent. To date, the role of placement of metallic stents, especially uncovered ones in benign pancreatic ductal stricture, has been unsatisfactory as a result of stent dysfunction related to mucosal hyperplasia. Objective We explored the feasibility and safety of temporary placement of a newly designed, fully covered self-expandable metal stent (FCSEMS) in painful chronic pancreatitis and refractory benign pancreatic ductal strictures. Design A prospective pilot and feasibility study. Setting A tertiary academic center. Patients Thirteen patients with chronic painful pancreatitis of alcoholic (8) or idiopathic (5) etiology. Intervention ERCP with temporary FCSEMS placement (2 months). Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. Main Outcome Measurements End points were feasibility, safety, and morbidity. Results Successful FCSEMS placement was performed in all enrolled patients. After immediate placement of FCSEMS, 2 patients had mild acute pancreatitis related mainly to the stricture Dilation Procedure (Soehendra stent retriever or balloon Dilation). Complications associated with stent placement included 5 migrations (39%, 1 proximal and 4 distal) and 2 incidents of cholestatic liver dysfunction associated with the compression of the bile duct orifice by expansion of FCSEMSs. In 1 patient with proximal migration, the stent was repositioned by an inflated retrieval balloon. Additional endoscopic biliary sphincterotomy with or without biliary stenting was performed in 2 patients with cholestatic liver dysfunction. There was no occurrence of pancreatic sepsis among any patients. FCSEMSs were removed from 9 of 9 patients without stent migration (100% [9/9] as per protocol, and 69% [9/13] as intention to treat, respectively). Improvement or resolution of the pancreatic ductal strictures was confirmed in all 13 patients on follow-up ERCP (2 months after stent placement), regardless of stent migration. Limitations Small patient populations without long-term follow-up. Conclusions Two-month placement of FCSEMSs in patients with refractory benign pancreatic ductal strictures may be feasible and relatively safe. However, stent migration was not uncommon. A further investigation with ideal stent design may therefore be needed before recommending FCSEMSs as a therapeutic option for refractory benign pancreatic ductal strictures.
-
feasibility and safety of placement of a newly designed fully covered self expandable metal stent for refractory benign pancreatic ductal strictures a pilot study with video
Gastrointestinal Endoscopy, 2008Co-Authors: Do Hyun Park, Sunghoon Moon, Myunghwan Kim, Sang Soo Lee, Dongwan Seo, Sungkoo LeeAbstract:Background Painful chronic pancreatitis with main pancreatic ductal strictures is usually managed with endotherapy with a plastic stent. To date, the role of placement of metallic stents, especially uncovered ones in benign pancreatic ductal stricture, has been unsatisfactory as a result of stent dysfunction related to mucosal hyperplasia. Objective We explored the feasibility and safety of temporary placement of a newly designed, fully covered self-expandable metal stent (FCSEMS) in painful chronic pancreatitis and refractory benign pancreatic ductal strictures. Design A prospective pilot and feasibility study. Setting A tertiary academic center. Patients Thirteen patients with chronic painful pancreatitis of alcoholic (8) or idiopathic (5) etiology. Intervention ERCP with temporary FCSEMS placement (2 months). Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. Main Outcome Measurements End points were feasibility, safety, and morbidity. Results Successful FCSEMS placement was performed in all enrolled patients. After immediate placement of FCSEMS, 2 patients had mild acute pancreatitis related mainly to the stricture Dilation Procedure (Soehendra stent retriever or balloon Dilation). Complications associated with stent placement included 5 migrations (39%, 1 proximal and 4 distal) and 2 incidents of cholestatic liver dysfunction associated with the compression of the bile duct orifice by expansion of FCSEMSs. In 1 patient with proximal migration, the stent was repositioned by an inflated retrieval balloon. Additional endoscopic biliary sphincterotomy with or without biliary stenting was performed in 2 patients with cholestatic liver dysfunction. There was no occurrence of pancreatic sepsis among any patients. FCSEMSs were removed from 9 of 9 patients without stent migration (100% [9/9] as per protocol, and 69% [9/13] as intention to treat, respectively). Improvement or resolution of the pancreatic ductal strictures was confirmed in all 13 patients on follow-up ERCP (2 months after stent placement), regardless of stent migration. Limitations Small patient populations without long-term follow-up. Conclusions Two-month placement of FCSEMSs in patients with refractory benign pancreatic ductal strictures may be feasible and relatively safe. However, stent migration was not uncommon. A further investigation with ideal stent design may therefore be needed before recommending FCSEMSs as a therapeutic option for refractory benign pancreatic ductal strictures.
Do Hyun Park - One of the best experts on this subject based on the ideXlab platform.
-
feasibility and safety of placement of a newly designed fully covered self expandable metal stent for refractory benign pancreatic ductal strictures a pilot study with video
Gastrointestinal Endoscopy, 2008Co-Authors: Do Hyun Park, Sunghoon MoonAbstract:Background Painful chronic pancreatitis with main pancreatic ductal strictures is usually managed with endotherapy with a plastic stent. To date, the role of placement of metallic stents, especially uncovered ones in benign pancreatic ductal stricture, has been unsatisfactory as a result of stent dysfunction related to mucosal hyperplasia. Objective We explored the feasibility and safety of temporary placement of a newly designed, fully covered self-expandable metal stent (FCSEMS) in painful chronic pancreatitis and refractory benign pancreatic ductal strictures. Design A prospective pilot and feasibility study. Setting A tertiary academic center. Patients Thirteen patients with chronic painful pancreatitis of alcoholic (8) or idiopathic (5) etiology. Intervention ERCP with temporary FCSEMS placement (2 months). Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. Main Outcome Measurements End points were feasibility, safety, and morbidity. Results Successful FCSEMS placement was performed in all enrolled patients. After immediate placement of FCSEMS, 2 patients had mild acute pancreatitis related mainly to the stricture Dilation Procedure (Soehendra stent retriever or balloon Dilation). Complications associated with stent placement included 5 migrations (39%, 1 proximal and 4 distal) and 2 incidents of cholestatic liver dysfunction associated with the compression of the bile duct orifice by expansion of FCSEMSs. In 1 patient with proximal migration, the stent was repositioned by an inflated retrieval balloon. Additional endoscopic biliary sphincterotomy with or without biliary stenting was performed in 2 patients with cholestatic liver dysfunction. There was no occurrence of pancreatic sepsis among any patients. FCSEMSs were removed from 9 of 9 patients without stent migration (100% [9/9] as per protocol, and 69% [9/13] as intention to treat, respectively). Improvement or resolution of the pancreatic ductal strictures was confirmed in all 13 patients on follow-up ERCP (2 months after stent placement), regardless of stent migration. Limitations Small patient populations without long-term follow-up. Conclusions Two-month placement of FCSEMSs in patients with refractory benign pancreatic ductal strictures may be feasible and relatively safe. However, stent migration was not uncommon. A further investigation with ideal stent design may therefore be needed before recommending FCSEMSs as a therapeutic option for refractory benign pancreatic ductal strictures.
-
feasibility and safety of placement of a newly designed fully covered self expandable metal stent for refractory benign pancreatic ductal strictures a pilot study with video
Gastrointestinal Endoscopy, 2008Co-Authors: Do Hyun Park, Sunghoon Moon, Myunghwan Kim, Sang Soo Lee, Dongwan Seo, Sungkoo LeeAbstract:Background Painful chronic pancreatitis with main pancreatic ductal strictures is usually managed with endotherapy with a plastic stent. To date, the role of placement of metallic stents, especially uncovered ones in benign pancreatic ductal stricture, has been unsatisfactory as a result of stent dysfunction related to mucosal hyperplasia. Objective We explored the feasibility and safety of temporary placement of a newly designed, fully covered self-expandable metal stent (FCSEMS) in painful chronic pancreatitis and refractory benign pancreatic ductal strictures. Design A prospective pilot and feasibility study. Setting A tertiary academic center. Patients Thirteen patients with chronic painful pancreatitis of alcoholic (8) or idiopathic (5) etiology. Intervention ERCP with temporary FCSEMS placement (2 months). Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. Main Outcome Measurements End points were feasibility, safety, and morbidity. Results Successful FCSEMS placement was performed in all enrolled patients. After immediate placement of FCSEMS, 2 patients had mild acute pancreatitis related mainly to the stricture Dilation Procedure (Soehendra stent retriever or balloon Dilation). Complications associated with stent placement included 5 migrations (39%, 1 proximal and 4 distal) and 2 incidents of cholestatic liver dysfunction associated with the compression of the bile duct orifice by expansion of FCSEMSs. In 1 patient with proximal migration, the stent was repositioned by an inflated retrieval balloon. Additional endoscopic biliary sphincterotomy with or without biliary stenting was performed in 2 patients with cholestatic liver dysfunction. There was no occurrence of pancreatic sepsis among any patients. FCSEMSs were removed from 9 of 9 patients without stent migration (100% [9/9] as per protocol, and 69% [9/13] as intention to treat, respectively). Improvement or resolution of the pancreatic ductal strictures was confirmed in all 13 patients on follow-up ERCP (2 months after stent placement), regardless of stent migration. Limitations Small patient populations without long-term follow-up. Conclusions Two-month placement of FCSEMSs in patients with refractory benign pancreatic ductal strictures may be feasible and relatively safe. However, stent migration was not uncommon. A further investigation with ideal stent design may therefore be needed before recommending FCSEMSs as a therapeutic option for refractory benign pancreatic ductal strictures.
Sungkoo Lee - One of the best experts on this subject based on the ideXlab platform.
-
feasibility and safety of placement of a newly designed fully covered self expandable metal stent for refractory benign pancreatic ductal strictures a pilot study with video
Gastrointestinal Endoscopy, 2008Co-Authors: Do Hyun Park, Sunghoon Moon, Myunghwan Kim, Sang Soo Lee, Dongwan Seo, Sungkoo LeeAbstract:Background Painful chronic pancreatitis with main pancreatic ductal strictures is usually managed with endotherapy with a plastic stent. To date, the role of placement of metallic stents, especially uncovered ones in benign pancreatic ductal stricture, has been unsatisfactory as a result of stent dysfunction related to mucosal hyperplasia. Objective We explored the feasibility and safety of temporary placement of a newly designed, fully covered self-expandable metal stent (FCSEMS) in painful chronic pancreatitis and refractory benign pancreatic ductal strictures. Design A prospective pilot and feasibility study. Setting A tertiary academic center. Patients Thirteen patients with chronic painful pancreatitis of alcoholic (8) or idiopathic (5) etiology. Intervention ERCP with temporary FCSEMS placement (2 months). Endoscopic removal of FCSEMSs was performed with a snare or rat-tooth forceps. Main Outcome Measurements End points were feasibility, safety, and morbidity. Results Successful FCSEMS placement was performed in all enrolled patients. After immediate placement of FCSEMS, 2 patients had mild acute pancreatitis related mainly to the stricture Dilation Procedure (Soehendra stent retriever or balloon Dilation). Complications associated with stent placement included 5 migrations (39%, 1 proximal and 4 distal) and 2 incidents of cholestatic liver dysfunction associated with the compression of the bile duct orifice by expansion of FCSEMSs. In 1 patient with proximal migration, the stent was repositioned by an inflated retrieval balloon. Additional endoscopic biliary sphincterotomy with or without biliary stenting was performed in 2 patients with cholestatic liver dysfunction. There was no occurrence of pancreatic sepsis among any patients. FCSEMSs were removed from 9 of 9 patients without stent migration (100% [9/9] as per protocol, and 69% [9/13] as intention to treat, respectively). Improvement or resolution of the pancreatic ductal strictures was confirmed in all 13 patients on follow-up ERCP (2 months after stent placement), regardless of stent migration. Limitations Small patient populations without long-term follow-up. Conclusions Two-month placement of FCSEMSs in patients with refractory benign pancreatic ductal strictures may be feasible and relatively safe. However, stent migration was not uncommon. A further investigation with ideal stent design may therefore be needed before recommending FCSEMSs as a therapeutic option for refractory benign pancreatic ductal strictures.
Van Meer Suzanne - One of the best experts on this subject based on the ideXlab platform.
-
Endoscopic management of gastrointestinal motility disorders - part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
'Georg Thieme Verlag KG', 2020Co-Authors: Weusten, Bas Lam, Barret Maximilien, Bredenoord, Albert J, Familiari Pietro, Gonzalez Jan-michel, Van Hooft, Jeanin E, Ishaq Sauid, Lorenzo-zuniga Vicente, Louis Hubert, Van Meer SuzanneAbstract:ESGE recommends the use of a graded pneumatic Dilation protocol in achalasia, starting with a 30-mm Dilation and followed by a 35-mm Dilation at a planned interval of 2 - 4 weeks, with a subsequent 40-mm Dilation when there is insufficient relief, over both a single balloon Dilation Procedure or the use of a larger balloon from the outset.Strong recommendation, high quality of evidence, level of agreement 100 %.ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM).Strong recommendation, very low quality of evidence, level of agreement 87.5 %.ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus.Strong recommendation, low quality of evidence, level of agreement 78.6 %.ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed.Strong recommendation, very low quality of evidence, level of agreement 100 %.ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9 %.ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging Procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial.Strong recommendation, low quality of evidence, level of agreement 100 %.status: publishe
-
Endoscopic management of gastrointestinal motility disorders - part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
'Georg Thieme Verlag KG', 2020Co-Authors: Weusten, Bas L. A. M., Barret Maximilien, Bredenoord, Albert J, Familiari Pietro, Gonzalez Jan-michel, Van Hooft, Jeanin E, Ishaq Sauid, Lorenzo-zuniga Vicente, Louis Hubert, Van Meer SuzanneAbstract:Main Recommendations ESGE recommends the use of a graded pneumatic Dilation protocol in achalasia, starting with a 30-mm Dilation and followed by a 35-mm Dilation at a planned interval of 2-4 weeks, with a subsequent 40-mm Dilation when there is insufficient relief, over both a single balloon Dilation Procedure or the use of a larger balloon from the outset. Strong recommendation, high quality of evidence, level of agreement 100%. ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM). Strong recommendation, very low quality of evidence, level of agreement 87.5%. ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus. Strong recommendation, low quality of evidence, level of agreement 78.6%. ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed. Strong recommendation, very low quality of evidence, level of agreement 100%. ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9%. ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging Procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial. Strong recommendation, low quality of evidence, level of agreement 100%
-
Endoscopic management of gastrointestinal motility disorders - Part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
'Georg Thieme Verlag KG', 2020Co-Authors: Weusten, Bas Lam, Barret Maximilien, Familiari Pietro, Ishaq Sauid, Lorenzo-zuniga Vicente, Louis Hubert, Bredenoord, Albert Jan, Gonzalez, Jan Michel, Van Hooft, Jeanin Elise, Van Meer SuzanneAbstract:Main Recommendations ESGE recommends the use of a graded pneumatic Dilation protocol in achalasia, starting with a 30-mm Dilation and followed by a 35-mm Dilation at a planned interval of 2-4 weeks, with a subsequent 40-mm Dilation when there is insufficient relief, over both a single balloon Dilation Procedure or the use of a larger balloon from the outset. Strong recommendation, high quality of evidence, level of agreement 100%. ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM). Strong recommendation, very low quality of evidence, level of agreement 87.5%. ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus. Strong recommendation, low quality of evidence, level of agreement 78.6%. ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed. Strong recommendation, very low quality of evidence, level of agreement 100%. ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9%. ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging Procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial. Strong recommendation, low quality of evidence, level of agreement 100%.SCOPUS: re.jinfo:eu-repo/semantics/publishe
David J Sugarbaker - One of the best experts on this subject based on the ideXlab platform.
-
combined antegrade and retrograde Dilation a new endoscopic technique in the management of complex esophageal obstruction
Gastrointestinal Endoscopy, 2001Co-Authors: Raphael Bueno, Scott J Swanson, Michael T Jaklitsch, Jeanne M Lukanich, Steven J Mentzer, David J SugarbakerAbstract:Background: Esophageal strictures that cause complete obstruction are often difficult to dilate with standard bougienage techniques. Methods: A new technique was developed and applied, combined antegrade and retrograde Dilation, for dilatation of complex esophageal strictures. The stomach is accessed and an endoscope (9.8 mm diameter) is directed under fluoroscopy in a retrograde fashion into the distal esophagus. A guidewire with a hydrophilic coating is advanced through the stricture and then pulled through the mouth with a simultaneously placed proximal endoscope. The guidewire is then used as a guide for antegrade esophageal dilatation. Results: Ten patients with complex esophageal strictures (with and without fistulas) were treated with this technique. Three required a second combined antegrade and retrograde Dilation Procedure. All strictures were dilated and no perforations occurred. Conclusions: Combined antegrade and retrograde Dilation is a safe and effective technique for Dilation of complex obstructing esophageal lesions.