The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Jeffrey M Marks - One of the best experts on this subject based on the ideXlab platform.
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facilitating gastrotomy closure during natural orifice transluminal endoscopic surgery using tissue anchors
Endoscopy, 2009Co-Authors: Joseph A Trunzo, Leandro Totti Cavazzola, B J Elmunzer, Benjamin K Poulose, Michael F Mcgee, S Schomish, Jeffrey L Ponsky, Jeffrey M MarksAbstract:Background and study aims: Reliable and secure closure of the gastrotomy after natural-orifice transluminal endoscopic surgery (NOTES) remains a critical step for widespread acceptance and use of this mode of surgery. We describe a novel method for gastrotomy closure using endoscopic tissue anchors. Methods: A standard upper endoscopy and wire placement as used for percutaneous endoscopic Gastrostomy placement was performed in five pigs. Prior to gastrotomy, four tissue anchors were placed in four quadrants (1 cm away from the wire). A 12-mm gastrotomy was created endoscopically using a combination of needle-knife and balloon dilation. After transgastric peritoneoscopy, the sutures were approximated using a device knotting element. One additional pair of sutures was placed after evaluation of the gastric closure. The animals underwent in vivo contrast fluoroscopy, methylene blue instillation, and bursting pressure studies for assessment of the closure site. Results: All animals studied showed complete sealing of the gastrotomy site without evidence of leak on fluoroscopic imaging or at final post-mortem intragastric methylene blue instillation. Improved insufflation ability following gastrotomy was also noted using this technique, which enhanced overall visualization during the closure. Conclusion: Positioning tissue anchors prior to creating a NOTES gastrotomy was a feasible and reliable method to perform gastric closure. Follow-up survival studies will be warranted to support these preliminary findings.
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peg rescue a practical notes technique
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jeffrey M Marks, Jeffrey L Ponsky, Jonathan P Pearl, Michael F McgeeAbstract:Dislodged percutaneous endoscopic Gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.
Michael F Mcgee - One of the best experts on this subject based on the ideXlab platform.
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facilitating gastrotomy closure during natural orifice transluminal endoscopic surgery using tissue anchors
Endoscopy, 2009Co-Authors: Joseph A Trunzo, Leandro Totti Cavazzola, B J Elmunzer, Benjamin K Poulose, Michael F Mcgee, S Schomish, Jeffrey L Ponsky, Jeffrey M MarksAbstract:Background and study aims: Reliable and secure closure of the gastrotomy after natural-orifice transluminal endoscopic surgery (NOTES) remains a critical step for widespread acceptance and use of this mode of surgery. We describe a novel method for gastrotomy closure using endoscopic tissue anchors. Methods: A standard upper endoscopy and wire placement as used for percutaneous endoscopic Gastrostomy placement was performed in five pigs. Prior to gastrotomy, four tissue anchors were placed in four quadrants (1 cm away from the wire). A 12-mm gastrotomy was created endoscopically using a combination of needle-knife and balloon dilation. After transgastric peritoneoscopy, the sutures were approximated using a device knotting element. One additional pair of sutures was placed after evaluation of the gastric closure. The animals underwent in vivo contrast fluoroscopy, methylene blue instillation, and bursting pressure studies for assessment of the closure site. Results: All animals studied showed complete sealing of the gastrotomy site without evidence of leak on fluoroscopic imaging or at final post-mortem intragastric methylene blue instillation. Improved insufflation ability following gastrotomy was also noted using this technique, which enhanced overall visualization during the closure. Conclusion: Positioning tissue anchors prior to creating a NOTES gastrotomy was a feasible and reliable method to perform gastric closure. Follow-up survival studies will be warranted to support these preliminary findings.
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peg rescue a practical notes technique
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Jeffrey M Marks, Jeffrey L Ponsky, Jonathan P Pearl, Michael F McgeeAbstract:Dislodged percutaneous endoscopic Gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.
Chienting Liu - One of the best experts on this subject based on the ideXlab platform.
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comparative study of esophageal stent and feeding Gastrostomy jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma
PLOS ONE, 2012Co-Authors: Yenhao Chen, Yichun Chiu, Chenghua Huang, Kunming Rau, Chienting LiuAbstract:Background A malignant tracheoesophageal/bronchoesophageal fistula (TEF) is a life-threatening complication of esophageal squamous cell carcinoma. A feeding Gastrostomy/jejunostomy had been the most common treatment method for patients with TEF before the era of stenting. The aim of this retrospective study is to compare the prognosis of esophageal squamous cell carcinoma patients with TEF treated with an esophageal metallic stent to those treated with a feeding Gastrostomy/jejunostomy. Methods We retrospectively reviewed a total of 1011 patients with esophageal squamous cell carcinoma between 1996 and 2011 at Kaohsiung Chang Gung Memorial Hospital, and 86 patients with TEF (8.5%) were identified. The overall survival and other clinical data were compared between 30 patients treated with an esophageal metallic stent and 35 patients treated with a feeding Gastrostomy/jejunostomy. Results Among the 65 patients receiving either an esophageal metallic stent or a feeding Gastrostomy/jejunostomy, univariate analysis showed that treatment modality with an esophageal metallic stent (P = 0.007) and radiotherapy treatment after fistula diagnosis (P = 0.04) were predictive of superior overall survival. In the multivariate comparison, treatment modality with an esophageal metallic stent (P = 0.026, odds ratio: 1.859) represented the independent predictive factor of superior overall survival. There were no significant differences between groups in mean decrease in serum albumin or mean body weight loss. Compared to the feeding Gastrostomy/jejunostomy group, a significantly higher proportion of patients in the stenting group (53% versus 14%, P = 0.001) were able to receive chemotherapy within 30 days after fistula diagnosis, indicating better infection control in the stenting group. Conclusions Compared with a feeding Gastrostomy/jejunostomy, an esophageal metallic stent significantly improves overall survival in patients with malignant TEF in our retrospective analysis. Esophageal metallic stent placement may be considered the first-line of treatment for patients with malignant TEF.
Aaron M Lipskar - One of the best experts on this subject based on the ideXlab platform.
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modified open technique for laparoscopic Gastrostomy tube placement results in more leakage post operatively than seldinger technique
American Journal of Surgery, 2019Co-Authors: Charlotte Kvasnovsky, Barrie S Rich, Naomiliza Denning, Michelle P Kallis, Aaron M LipskarAbstract:Abstract Background Laparoscopic Gastrostomy tube (GT) placement is a common procedure and frequent cause of morbidity. Some surgeons perform a Seldinger technique (ST), while others perform a modified open technique (MOT). We hypothesized that the modified open technique would result in more complications. Methods A prospective study of primary GT placed 12/2016-06/2018, ensuring at least 6 months follow up. We assessed any episode of granulation tissue, troublesome leaking, tube dislodgment, and infection requiring antibiotic or drainage. Results 92 GT were placed, with 56 were placed as modified open (60.9%). 34 children (37.0%) developed granulation tissue, 18 children (19.6%) experienced tube dislodgment, and 6 children (6.5%) developed a site infection, with no difference depending on technique (P = 0.56, 0.29, and 0.76, respectively). Following ST, 2 children developed leakage (5.6%), whereas 15 children (26.8%) had leakage following the MOT (P = 0.01). Conclusion MOT resulted in significantly more leaks. Other complications were similar between groups. Surgeons choosing MOT should be mindful of the size of gastrotomy at time of surgery, as this may result in increased complications.
B J Elmunzer - One of the best experts on this subject based on the ideXlab platform.
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facilitating gastrotomy closure during natural orifice transluminal endoscopic surgery using tissue anchors
Endoscopy, 2009Co-Authors: Joseph A Trunzo, Leandro Totti Cavazzola, B J Elmunzer, Benjamin K Poulose, Michael F Mcgee, S Schomish, Jeffrey L Ponsky, Jeffrey M MarksAbstract:Background and study aims: Reliable and secure closure of the gastrotomy after natural-orifice transluminal endoscopic surgery (NOTES) remains a critical step for widespread acceptance and use of this mode of surgery. We describe a novel method for gastrotomy closure using endoscopic tissue anchors. Methods: A standard upper endoscopy and wire placement as used for percutaneous endoscopic Gastrostomy placement was performed in five pigs. Prior to gastrotomy, four tissue anchors were placed in four quadrants (1 cm away from the wire). A 12-mm gastrotomy was created endoscopically using a combination of needle-knife and balloon dilation. After transgastric peritoneoscopy, the sutures were approximated using a device knotting element. One additional pair of sutures was placed after evaluation of the gastric closure. The animals underwent in vivo contrast fluoroscopy, methylene blue instillation, and bursting pressure studies for assessment of the closure site. Results: All animals studied showed complete sealing of the gastrotomy site without evidence of leak on fluoroscopic imaging or at final post-mortem intragastric methylene blue instillation. Improved insufflation ability following gastrotomy was also noted using this technique, which enhanced overall visualization during the closure. Conclusion: Positioning tissue anchors prior to creating a NOTES gastrotomy was a feasible and reliable method to perform gastric closure. Follow-up survival studies will be warranted to support these preliminary findings.
