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J Crowe - One of the best experts on this subject based on the ideXlab platform.
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endoscopic balloon sphincteroplasty Papillary dilation for bile duct stones efficacy safety and follow up in 100 patients
Gastrointestinal Endoscopy, 1995Co-Authors: Padraic Mac Mathuna, P White, E Clarke, J Lennon, Raphael B Merriman, J CroweAbstract:Background Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon Papillary dilation or sphincteroplasty as an alternative. Methods We report the outcome in a series of 100 patients in whom balloon sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30). Results During one ERCP session using sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with sphincteroplasty in the remaining 18% was primarily related to large stone size ( > 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No Papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP: these were removed after repeat sphincteroplasty. No clinical evidence of Papillary Stenosis was observed during follow-up. Conclusions Endoscopic balloon Papillary dilation or sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance.
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endoscopic balloon sphincteroplasty for benign Papillary Stenosis an alternative to surgical or endoscopic papillotomy
Irish Journal of Medical Science, 1993Co-Authors: Mac P Mathuna, J Lennon, J CroweAbstract:Benign Papillary Stenosis is an uncommon but well recognised cause of recurrent biliary pain usually in post-cholecystectomy patients characterised by biliary dilatation without bile duct calculi or malignancy. Endoscopic or surgical papillotomy is the recommended treatment but may be associated with a higher complication rate than when performed for bile duct stones. We report 2 cases of Papillary Stenosis treated by endoscopic balloon dilatation or “sphincteroplasty”, as a less traumatic intervention which improved biliary drainage and provided symptomatic relief. Our preliminary experience suggests more widespread evaluation of balloon sphincteroplasty should be considered for Papillary Stenosis.
Mary F Chan - One of the best experts on this subject based on the ideXlab platform.
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long term follow up of endoscopic retrograde cholangiopancreatography sphincterotomy for patients with acquired immune deficiency syndrome Papillary Stenosis
The American Journal of Medicine, 1995Co-Authors: John P Cello, Mary F ChanAbstract:PURPOSE : To evaluate the long-term effects on biliary-type pain and changes in biochemical parameters in patients with AIDS-associated Papillary Stenosis who underwent endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy. PATIENTS AND METHODS : Twenty-five consecutive patients were diagnosed by cholangiography with AIDS-associated Papillary Stenosis using standard criteria. Patients underwent ERCP sphincterotomy and were followed prospectively in the Gastrointestinal or Liver Clinics, San Francisco General Hospital, and by their primary physicians. Post-procedure data was prospectively collected by chart review or in-person or telephone interview, and analyzed using statistical software. RESULTS : All patients presented with severe right upper quadrant and/or mid-epigastric abdominal pain and had marked elevations of serum alkaline phosphatase. Following ERCP sphincterotomy, pain scores decreased significantly for at least 9 months of follow-up. Serum alkaline phosphatase levels, however, remained essentially unchanged. Overall quality of life was difficult to assess, as patients suffered from other AIDS-associated debilitating diseases. CONCLUSIONS : ERCP sphincterotomy, while not without risks, provided significant reduction in pain in patients with AIDS-associated Papillary Stenosis.
Padraic Mac Mathuna - One of the best experts on this subject based on the ideXlab platform.
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The acute and long-term effect of balloon sphincteroplasty on Papillary structure in pigs
Gastrointestinal Endoscopy, 1996Co-Authors: Padraic Mac Mathuna, David Siegenberg, David Gibbons, Daniel Gorin, Michael J. O'brien, Nezem A. Afdhal, Ram ChuttaniAbstract:Abstract Background: Balloon dilation or sphincteroplasty is emerging as a potentially safe and effective alternative to sphincterotomy in the management of bile duct stones. However, concerns related to the possible development of fibrosis or Papillary Stenosis led us to investigate the acute and long-term effects of balloon sphincteroplasty on Papillary structure. Methods: Sixteen pigs (45 to 50 kg) underwent transduodenal cannulation of the bile duct while under general anesthesia. Balloon sphincteroplasty was performed in 10 pigs to a diameter of 8 mm at a pressure of 10 atm. Sphincterotomy was carried out in 3 pigs while 2 other untreated pigs acted as controls. Eleven animals were sacrificed at intervals from 15 to 120 minutes after balloon sphincteroplasty or sphincterotomy. The remaining 5 animals were sacrificed between 6 and 12 weeks later. Histologic sections through the papilla were assessed for evidence of morphologic changes. Results: When compared with controls, sections taken 15 to 120 minutes after balloon sphincteroplasty showed a progressive increase in acute inflammation extending transmurally. Intramucosal, but no transmural, hemorrhage was noted. No architectural distortion or smooth muscle disruption was observed in contrast to the transmural hemorrhage, smooth muscle disruption, and mucosal necrosis seen following sphincterotomy. After 6 to 12 weeks, mild chronic inflammation with follicular hyperplasia was present but no smooth muscle disruption or fibrosis was observed. Conclusion: Balloon sphincteroplasty causes an acute transmural inflammatory response and chronic follicular hyperplasia but is not associated with fibrosis or altered Papillary architecture. (Gastrointest Endosc 1996;44:650-5.)
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endoscopic balloon sphincteroplasty Papillary dilation for bile duct stones efficacy safety and follow up in 100 patients
Gastrointestinal Endoscopy, 1995Co-Authors: Padraic Mac Mathuna, P White, E Clarke, J Lennon, Raphael B Merriman, J CroweAbstract:Background Because sphincterotomy accounts for a major portion of the morbidity and mortality associated with ERCP, we have proposed endoscopic balloon Papillary dilation or sphincteroplasty as an alternative. Methods We report the outcome in a series of 100 patients in whom balloon sphincteroplasty was attempted for bile duct stones up to 20 mm in diameter, with a median follow-up of 16 months (range 6 to 30). Results During one ERCP session using sphincteroplasty alone, the bile duct was cleared in 78%, mechanical lithotripsy being required in 10% for stones greater than 12 mm in diameter. Incomplete duct clearance was achieved in a further 4%, all of whom underwent repeat ERCP with successful duct clearance without recourse to sphincterotomy. Failure to clear the bile duct with sphincteroplasty in the remaining 18% was primarily related to large stone size ( > 15 mm). Sphincterotomy was required to clear the duct in 7%. Another 6% comprised elderly high-risk patients with multiple large stones greater than 15 mm who were treated by stent insertion plus ursodeoxycholic acid. No Papillary hemorrhage was observed; uncomplicated pancreatitis occurred in 5%. During a median follow-up of 16 months, 2% had recurrent symptomatic bile duct stones considered to have been unrecognized following the initial ERCP: these were removed after repeat sphincteroplasty. No clinical evidence of Papillary Stenosis was observed during follow-up. Conclusions Endoscopic balloon Papillary dilation or sphincteroplasty is a safe and effective alternative to sphincterotomy in the management of bile duct stones less than 12 mm; larger stones may require mechanical lithotripsy to facilitate duct clearance.
Joseph E. Geenen - One of the best experts on this subject based on the ideXlab platform.
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su1452 endoscopic ampullectomy of adenoma of the major duodenal papilla mpd long term outcome
Gastrointestinal Endoscopy, 2011Co-Authors: Marc F Catalano, Naeem Aslam, Robbie Taha, Nalini M Guda, Joseph E. GeenenAbstract:Endoscopic Ampullectomy of Adenoma of the Major Duodenal Papilla (MPD): Long-Term Outcome Marc F. Catalano, Naeem Aslam, Robbie Taha, Nalini M. Guda, Joseph E. Geenen Wisconsin Center for Advanced Research, GI Associates, LLC, Milwaukee, WI; Pancreatobiliary, St. Luke’s Medical Center, Milwaukee, WI Adenoma of MPD is more likely to undergo malignant transformation than adenoma elsewhere in duodenum. Pts w/ FAP have increased likelihood of Papillary neoplasm. Treatment of ampullary adenomas is surgical excision. Endoscopic ampullectomy is a relatively new treatment option. Aim: Determine efficacy of endoscopic resection of ampullary adenoma. Methods: Consecutive pts w/ ampullary adenomas over 10yr were reviewed. Criteria for ampullectomy included: previously untreated, endoscopically accessible lesions w/ benign features. Pts w/ biliary or pancreatic extension of lesion were excluded. Imaging suggesting advanced disease (EUS, CT) was an exclusion criteria whereas presence of dysplasia w/o frank carcinoma was not. Ampullectomy technique: Standard polypectomy snare; blended current; dual sphincterotomy (pancreatic & biliary). Pancreatic duct (PD) stent placement was performed to prevent ampullary Stenosis. Endoscopic success determined as complete excision & absence of recurrence during 2yr F/U. Endoscopic failure defined as inability to completely remove lesion, recurrence treated surgically, discovery of carcinoma beyond mucosal layer. Ampullectomy complications; early (pancreatitis, bleeding, perforation) & late (post-ampullectomy Stenosis). Results: 58 pts; 31W; age 20-72 met inclusion criteria. 41 had sporadic adenomas & 17 had FAP. Presenting Sx: jaundice/cholangitis/pain (n 22); acute pancreatitis (AP) (n 11), bleeding (n 6); no Sx (n 19). Mean F/U was 38 mos (24-78). 49 pts (85%) had long-term success & 9 (15%) unsuccessful (initial failure, recurrent adenoma) including 6 initial failures, & 3 recurrences. High grade dysplasia present in 8; 3 had focal adeno CA. Lesions size was 10-40mm. Pts w/ successful ampullectomy had significantly smaller lesions (18.5vs28.3). FAP pts were significantly younger compared to sporadic (32.6vs58.4). FAP pts had significantly smaller lesions compared to sporadic (18.7vs25.2). Success rate in pts w/ FAP (n 17) was 94% (16/17) vs 80% (33/41) for sporadic. Adjunctive thermal ablation was used in 18/ 58 pts in (14 APC, 4 multipolar). Success was similar among pts who had ablation (15/18) vs w/o (34/40). Predictors of success included age 45 &, size of 24 mm. PD stent (5-7 Fr) was placed in all but 2 pts w/ accessible ducts. All but 14 pts underwent biliary stents based on clinically. All stents were removed w/in 8wks. There were 4 procedural complications in 58pts: AP (n 2), bleeding (n 1) & late Papillary Stenosis (n 1). AP occurred only in pts w/o PD stents. Papillary Stenosis occurred more frequently in pts w/o PD stents (50%vs2%). Conclusion: Endoscopic treatment of ampullary adenomas in selective pts is highly successful & safe. Dual sphincterotomy/stenting may prevent postprocedural complications. Adjunctive thermoablation may prevent postampullectomy recurrence.
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endoscopic management of adenoma of the major duodenal papilla
Gastrointestinal Endoscopy, 2004Co-Authors: Marc F Catalano, Joseph E. Geenen, Jeffrey D Linder, Amitabh Chak, Michael V Sivak, Isaac Raijman, Douglas A HowellAbstract:Abstract Background It is well established that adenoma of the major duodenal papilla has a potential for malignant transformation. Standard treatment has been surgical (duodenotomy/local resection, pancreaticoduodenectomy). Endoscopic management is described, but there is no established consensus regarding the approach to papillectomy or the need for surveillance. This study describes endoscopic management and long-term follow-up of Papillary tumors by 4 groups of expert pancreaticobiliary endoscopists. Methods Consecutive patients with Papillary tumors referred to 4 pancreaticobiliary endoscopy centers for evaluation for endoscopic papillectomy were reviewed. For each patient, an extensive questionnaire was completed, which included 19 preoperative and 15 postoperative data points. A total of 103 patients (53 women, 50 men, age range 24-93) who underwent attempted endoscopic resection were included. Of these, 72 had sporadic adenoma, and the remaining patients had familial adenomatous polyposis, including Gardner's variant. Presenting symptoms were jaundice/cholangitis/pain (n=59), pancreatitis (n=18), and bleeding (n=12). Twenty-six patients were asymptomatic. Results Endoscopic treatment was successful, long term, in 83 patients (80%) and failed (initial failure or recurrent tumor) in 20 (20%) patients. Success was significantly associated with older age (54.7 [16.6] vs. 46.6 [21.7] years; p =0.08) and smaller lesions (21.1 [8.3] vs. 29.7 [7.2] mm; p p =0.02). There were 10 initial failures, which was more common for sporadic lesions (7 of 10). The overall success rate for papillectomy was similar in patients who had adjuvant thermal ablation (81%) compared with those who did not (78%). However, recurrence (n=10) was more common in the former group (9 of 10, [90%]; p =0.22). Complications (n=10) included acute pancreatitis (n=5), bleeding (n=2), and late Papillary Stenosis (n=3). Acute pancreatitis was more common in patients who did not have pancreatic duct stents placed (17% vs. 3.3%). Papillary Stenosis was more frequent without short-term pancreatic duct stent placement (15.4% vs. 1.1%), although the difference was not statistically significant, because this complication was infrequent. Conclusions Endoscopic treatment of Papillary adenoma in selected patients appears to be highly successful. The majority can undergo complete resection after ERCP. In expert hands, complications are infrequent and may be avoided by routine placement of a pancreatic duct stent.
Marc F Catalano - One of the best experts on this subject based on the ideXlab platform.
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su1452 endoscopic ampullectomy of adenoma of the major duodenal papilla mpd long term outcome
Gastrointestinal Endoscopy, 2011Co-Authors: Marc F Catalano, Naeem Aslam, Robbie Taha, Nalini M Guda, Joseph E. GeenenAbstract:Endoscopic Ampullectomy of Adenoma of the Major Duodenal Papilla (MPD): Long-Term Outcome Marc F. Catalano, Naeem Aslam, Robbie Taha, Nalini M. Guda, Joseph E. Geenen Wisconsin Center for Advanced Research, GI Associates, LLC, Milwaukee, WI; Pancreatobiliary, St. Luke’s Medical Center, Milwaukee, WI Adenoma of MPD is more likely to undergo malignant transformation than adenoma elsewhere in duodenum. Pts w/ FAP have increased likelihood of Papillary neoplasm. Treatment of ampullary adenomas is surgical excision. Endoscopic ampullectomy is a relatively new treatment option. Aim: Determine efficacy of endoscopic resection of ampullary adenoma. Methods: Consecutive pts w/ ampullary adenomas over 10yr were reviewed. Criteria for ampullectomy included: previously untreated, endoscopically accessible lesions w/ benign features. Pts w/ biliary or pancreatic extension of lesion were excluded. Imaging suggesting advanced disease (EUS, CT) was an exclusion criteria whereas presence of dysplasia w/o frank carcinoma was not. Ampullectomy technique: Standard polypectomy snare; blended current; dual sphincterotomy (pancreatic & biliary). Pancreatic duct (PD) stent placement was performed to prevent ampullary Stenosis. Endoscopic success determined as complete excision & absence of recurrence during 2yr F/U. Endoscopic failure defined as inability to completely remove lesion, recurrence treated surgically, discovery of carcinoma beyond mucosal layer. Ampullectomy complications; early (pancreatitis, bleeding, perforation) & late (post-ampullectomy Stenosis). Results: 58 pts; 31W; age 20-72 met inclusion criteria. 41 had sporadic adenomas & 17 had FAP. Presenting Sx: jaundice/cholangitis/pain (n 22); acute pancreatitis (AP) (n 11), bleeding (n 6); no Sx (n 19). Mean F/U was 38 mos (24-78). 49 pts (85%) had long-term success & 9 (15%) unsuccessful (initial failure, recurrent adenoma) including 6 initial failures, & 3 recurrences. High grade dysplasia present in 8; 3 had focal adeno CA. Lesions size was 10-40mm. Pts w/ successful ampullectomy had significantly smaller lesions (18.5vs28.3). FAP pts were significantly younger compared to sporadic (32.6vs58.4). FAP pts had significantly smaller lesions compared to sporadic (18.7vs25.2). Success rate in pts w/ FAP (n 17) was 94% (16/17) vs 80% (33/41) for sporadic. Adjunctive thermal ablation was used in 18/ 58 pts in (14 APC, 4 multipolar). Success was similar among pts who had ablation (15/18) vs w/o (34/40). Predictors of success included age 45 &, size of 24 mm. PD stent (5-7 Fr) was placed in all but 2 pts w/ accessible ducts. All but 14 pts underwent biliary stents based on clinically. All stents were removed w/in 8wks. There were 4 procedural complications in 58pts: AP (n 2), bleeding (n 1) & late Papillary Stenosis (n 1). AP occurred only in pts w/o PD stents. Papillary Stenosis occurred more frequently in pts w/o PD stents (50%vs2%). Conclusion: Endoscopic treatment of ampullary adenomas in selective pts is highly successful & safe. Dual sphincterotomy/stenting may prevent postprocedural complications. Adjunctive thermoablation may prevent postampullectomy recurrence.
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endoscopic management of adenoma of the major duodenal papilla
Gastrointestinal Endoscopy, 2004Co-Authors: Marc F Catalano, Joseph E. Geenen, Jeffrey D Linder, Amitabh Chak, Michael V Sivak, Isaac Raijman, Douglas A HowellAbstract:Abstract Background It is well established that adenoma of the major duodenal papilla has a potential for malignant transformation. Standard treatment has been surgical (duodenotomy/local resection, pancreaticoduodenectomy). Endoscopic management is described, but there is no established consensus regarding the approach to papillectomy or the need for surveillance. This study describes endoscopic management and long-term follow-up of Papillary tumors by 4 groups of expert pancreaticobiliary endoscopists. Methods Consecutive patients with Papillary tumors referred to 4 pancreaticobiliary endoscopy centers for evaluation for endoscopic papillectomy were reviewed. For each patient, an extensive questionnaire was completed, which included 19 preoperative and 15 postoperative data points. A total of 103 patients (53 women, 50 men, age range 24-93) who underwent attempted endoscopic resection were included. Of these, 72 had sporadic adenoma, and the remaining patients had familial adenomatous polyposis, including Gardner's variant. Presenting symptoms were jaundice/cholangitis/pain (n=59), pancreatitis (n=18), and bleeding (n=12). Twenty-six patients were asymptomatic. Results Endoscopic treatment was successful, long term, in 83 patients (80%) and failed (initial failure or recurrent tumor) in 20 (20%) patients. Success was significantly associated with older age (54.7 [16.6] vs. 46.6 [21.7] years; p =0.08) and smaller lesions (21.1 [8.3] vs. 29.7 [7.2] mm; p p =0.02). There were 10 initial failures, which was more common for sporadic lesions (7 of 10). The overall success rate for papillectomy was similar in patients who had adjuvant thermal ablation (81%) compared with those who did not (78%). However, recurrence (n=10) was more common in the former group (9 of 10, [90%]; p =0.22). Complications (n=10) included acute pancreatitis (n=5), bleeding (n=2), and late Papillary Stenosis (n=3). Acute pancreatitis was more common in patients who did not have pancreatic duct stents placed (17% vs. 3.3%). Papillary Stenosis was more frequent without short-term pancreatic duct stent placement (15.4% vs. 1.1%), although the difference was not statistically significant, because this complication was infrequent. Conclusions Endoscopic treatment of Papillary adenoma in selected patients appears to be highly successful. The majority can undergo complete resection after ERCP. In expert hands, complications are infrequent and may be avoided by routine placement of a pancreatic duct stent.
