The Experts below are selected from a list of 390 Experts worldwide ranked by ideXlab platform
Adam Slivka - One of the best experts on this subject based on the ideXlab platform.
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Pancreas divisum
Current Treatment Options in Gastroenterology, 2001Co-Authors: Asif Khalid, Adam SlivkaAbstract:We offer endoscopic therapy for pancreas divisum only in patients with acute recurrent pancreatitis or chronic pancreatitis, based on studies delineated in this article, which results in response rates of 80% and 50% respectively. We do not offer endoscopic therapy for patients with chronic abdominal pain in the absence of morphologic abnormalities in the pancreatic duct or parenchyma or normal laboratory study results. It has been our experience that the success rate for endoscopic cannulation and therapy directed at the minor papilla in patients with symptomatic pancreas divisum is improved when the procedure is performed with primary intent to treat in patients who have a pre-existing diagnosis of pancreas divisum, as opposed to patients who undergo diagnostic ERCP for idiopathic acute recurrent pancreatitis and are diagnosed with pancreas divisum during the procedure. We cannulate the minor papilla with ultratapered 3-F catheters and 0.018-in soft wires. It is our opinion that minor papilla sphincterotomy offers advantages over chronic stent therapy in treating patients with pancreas divisum. Although both techniques have proven efficacy, chronic stenting requires repeated procedures and results in a high incidence of stent-induced chronic duct changes, both of which can be avoided by performing a minor papillotomy. We use an ultratapered Papillotome with a 20-mm monofilament cutting wire and typically use blended current. The papillotomy is extended to ablate the mucosal mound of the minor papilla typically in a 2-o’clock direction for a distance between 4 and 8 mm, depending on the patient’s anatomy. Following minor papillotomy, we place temporary 5-F pancreatic duct stents to reduce the incidence of postprocedural pancreatitis, which has been demonstrated in pancreatic duct sphincterotomy of the major papilla. These stents usually migrate out after 24 to 72 hours following the procedure. We offer surgical sphincteroplasty to patients in whom minor papillotomy cannot be performed or whose disease relapses after successful endoscopic therapy.
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santorinicele in pancreas divisum diagnosis with secretin stimulated magnetic resonance pancreatography
Abdominal Imaging, 2001Co-Authors: M S Peterson, Adam SlivkaAbstract:A Santorinicele, or cystic dilatation of the dorsal pancreatic duct at the minor papilla, is seen in a small number of patients with pancreas divisum and may indicate obstruction at the minor papilla, a risk factor for pancreatitis. We present a case of a Santorinicele that was diagnosed with secretin-stimulated magnetic resonance pancreatography and treated with minor papillotomy.
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Directed guide wire placement during ERCP using a Papillotome
Gastrointestinal endoscopy, 1996Co-Authors: Adam SlivkaAbstract:scope. Ano the r po ten t ia l pitfall is t h a t i t can somet imes be difficult to advance the wire alongside an exis t ing s t en t t h rough a ve ry t igh t s t r ic ture . In our experience, th is can no rma l ly be achieved a f te r us ing a va r i e ty of guide wires. C a n n u l a t i n g alongside the s t en t t h rough a s t r ic ture m a y be more difficult for hila r s t r ic tures where the re is less leverage avai lab le to app ly to the guide wire. For mos t bi l iary s t en t exchanges , however , i t is qui te easy to cross a mid or dis ta l s t r ic ture wi th a guide wire alongside the existing stent . Apply ing this sna re bes idethe-wire techn ique m a i n t a i n s access across the s t r ic ture , and the reby faci l i ta tes a successful s t en t exchange.
J Dorais - One of the best experts on this subject based on the ideXlab platform.
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Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial.
Endoscopy, 2005Co-Authors: Shou-jiang Tang, Gregory B. Haber, Paul Kortan, Dm Scheider, Maria Cirocco, Simon A. Zanati, M. Ennis, A. Elfant, H. Ter, J DoraisAbstract:BACKGROUND AND STUDY AIMS Failed biliary cannulation occurs in up to 10% of patients undergoing ERCP. There is some controversy as to the safety and efficacy of using precut techniques to achieve biliary cannulation in difficult cases. To date, no randomized trial has compared the success and complication rates of precut with the rates for persistence when biliary cannulation is difficult. The aim of this study was to compare the success rates and complication rates of precut with the success rates and complication rates of persistence in cases of difficult biliary cannulation. PATIENTS AND METHODS Patients without prior sphincterotomy who required biliary cannulation were screened. A "difficult biliary cannulation" was arbitrarily defined as failed cannulation after 12 minutes. These patients were then randomized to continue treatment by needle-knife cut over the roof of the papilla or by persistence with a non-wire-guided, single-lumen Papillotome. "Primary" success was defined as deep cannulation within 15 minutes of randomization. Primary and final success rates and complication rates within 30 days after ERCP were compared. RESULTS Over a 38-month period a total of 642 patients were screened. Patients in whom biliary cannulation was successful within a time period of 12 minutes or less formed the reference group (n = 580). The remainder of the patients were randomly assigned to the "precut" arm (n = 32) or to the "persistence" arm (n = 30). Primary success rates and complication rates were similar in the precut and persistence arms (75% and 4% respectively for the precut arm vs. 73% and 9% for the persistence arm). The final successful cannulation rate in the entire group of 642 patients was 99.5%. CONCLUSIONS In experienced hands, precut papillotomy and persistence in cannulation are equally effective in cases of difficult cannulation, with a similar complication rate.
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A prospective study of the repeated use of sterilized Papillotomes and retrieval baskets for ERCP : Quality and cost analysis
Gastrointestinal endoscopy, 1997Co-Authors: Jonathan Cohen, Gregory B. Haber, Paul Kortan, J Dorais, Dm Scheider, Maria Cirocco, Joanne HabibAbstract:Abstract Background: The impact on instrument quality and cost of the practice of reusing ERCP accessories has not been fully addressed. Methods: Twenty-five new Papillotomes and 15 new retrieval baskets were labeled and evaluated over time by staff blinded to the number of prior uses. Instruments were scored as to their function for the designated task. The cost of this practice was calculated from the purchase price of accessories and the costs of cleaning, sterilization, and disposal, and then compared with the estimated cost of a practice of one-time use of similar instruments. Results: Twenty-five Papillotomes were used 246 times (median 8; mean 9.8). Fifteen retrieval baskets were used 193 times (median 13; mean 12.9). The median survival of both Papillotomes and baskets before being considered inadequate (score Conclusion: The Papillotomes and baskets in this study could be reused reliably and safely multiple times, with considerable cost savings compared with the practice of using disposable instruments.(Gastrointest Endosc 1997;45:122-7.)
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A randomized, controlled study of placement of 10 French tannenbaum biliary stents across malignant strictures with and without sphincterotomy
Gastrointestinal Endoscopy, 1996Co-Authors: Jonathan Cohen, J Dorais, Dm Scheider, Mj Bourke, P Kortan, Gregory B. HaberAbstract:A RANDOMIZED, CONTROLLED STUDY OF PLACEMENT OF IO FRENCH TANNENBAUM BILIARY STENTS ACROSS MALIGNANT STRICTURES WITH AND WITHOUT SPHINCTEROTOMY. JCoben. M. Bourke, J Dorais, D Scbeider, P Kortan, G Haber. The Wellesley Hospital, Toronto, Canada. Purpose: To determine whether an endoscopic biliary sphineterotomy (EBS) is of any benefit in the placement of I0 French biliary stents across malignant biliary strictures in terms o f successful stent placement, efficiency o f technique, complications, aad stent pateney. Methods: Patients with non-hilar malignant strictures who were referred for ERCP were randomized to stent placement with or without EBS. In the sphinetcrotomy group, EBS was performed after obtaining a cholangiogrmn with a single lumen, 5 French Papillotome. A guide catheter with a guide wire was then used to place a wire past the stricture, over which a 10 French Tannenbaura stent (Wilson-Ccok) was placed. In the no-EBS group, a wire-guided Papillotome was used for bile duet cannulation. After the cholangiogram, a wire was advanced across the stricture. The Papillotome was then removed, and the guide catheter and stent were placed. The time required to obtain a eholangiogram, the time from cholangiogram to guide wire placement past the stricture, and the time from wire placement to successful stent deployment were recorded. A successful attempt was defined as stent placement within 30 minutes of attempting eannutation. Patients were telephoned at 3 and 30 days to assess complication rates or evidence of stent occlusion. Results: To date, 7 patients have been randomized into each group. All attempts to place stents were successful. The mean time data were not significantly different: EBS GROUP NO-EBS GROUP CHOLANGIOGRAM 3.8 minutes 7.1 minutes CHOLANGIOGRAM TO WIRE 5.4 minutes 6.4 minutes WIRE TO STENT IN PLACE 3.2 minutes 4.5 minutes TOTAL 12.5 minutes 18 minutes In follow~up (2-16 weeks), stents have remained patent in all but 1 (no EBS) of the surviving patients and were patent at the time of death in 4 of the 5 individuals who have not survived. 1 patient in the EBS group died at 9 weeks with sepsis and jaundice. 4 stents have remained patent for 13 weeks or greater. Conclusion: EBS is not required for the successful placement of a 10 French bilinry endoprostbesis through malignant strictures. Whether EBS makes steat placement significantly easier, and whether stent placement without EBS is associated with fewer complications or longer stent pateney remains to be determined,
Gregory B. Haber - One of the best experts on this subject based on the ideXlab platform.
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Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial.
Endoscopy, 2005Co-Authors: Shou-jiang Tang, Gregory B. Haber, Paul Kortan, Dm Scheider, Maria Cirocco, Simon A. Zanati, M. Ennis, A. Elfant, H. Ter, J DoraisAbstract:BACKGROUND AND STUDY AIMS Failed biliary cannulation occurs in up to 10% of patients undergoing ERCP. There is some controversy as to the safety and efficacy of using precut techniques to achieve biliary cannulation in difficult cases. To date, no randomized trial has compared the success and complication rates of precut with the rates for persistence when biliary cannulation is difficult. The aim of this study was to compare the success rates and complication rates of precut with the success rates and complication rates of persistence in cases of difficult biliary cannulation. PATIENTS AND METHODS Patients without prior sphincterotomy who required biliary cannulation were screened. A "difficult biliary cannulation" was arbitrarily defined as failed cannulation after 12 minutes. These patients were then randomized to continue treatment by needle-knife cut over the roof of the papilla or by persistence with a non-wire-guided, single-lumen Papillotome. "Primary" success was defined as deep cannulation within 15 minutes of randomization. Primary and final success rates and complication rates within 30 days after ERCP were compared. RESULTS Over a 38-month period a total of 642 patients were screened. Patients in whom biliary cannulation was successful within a time period of 12 minutes or less formed the reference group (n = 580). The remainder of the patients were randomly assigned to the "precut" arm (n = 32) or to the "persistence" arm (n = 30). Primary success rates and complication rates were similar in the precut and persistence arms (75% and 4% respectively for the precut arm vs. 73% and 9% for the persistence arm). The final successful cannulation rate in the entire group of 642 patients was 99.5%. CONCLUSIONS In experienced hands, precut papillotomy and persistence in cannulation are equally effective in cases of difficult cannulation, with a similar complication rate.
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A prospective study of the repeated use of sterilized Papillotomes and retrieval baskets for ERCP : Quality and cost analysis
Gastrointestinal endoscopy, 1997Co-Authors: Jonathan Cohen, Gregory B. Haber, Paul Kortan, J Dorais, Dm Scheider, Maria Cirocco, Joanne HabibAbstract:Abstract Background: The impact on instrument quality and cost of the practice of reusing ERCP accessories has not been fully addressed. Methods: Twenty-five new Papillotomes and 15 new retrieval baskets were labeled and evaluated over time by staff blinded to the number of prior uses. Instruments were scored as to their function for the designated task. The cost of this practice was calculated from the purchase price of accessories and the costs of cleaning, sterilization, and disposal, and then compared with the estimated cost of a practice of one-time use of similar instruments. Results: Twenty-five Papillotomes were used 246 times (median 8; mean 9.8). Fifteen retrieval baskets were used 193 times (median 13; mean 12.9). The median survival of both Papillotomes and baskets before being considered inadequate (score Conclusion: The Papillotomes and baskets in this study could be reused reliably and safely multiple times, with considerable cost savings compared with the practice of using disposable instruments.(Gastrointest Endosc 1997;45:122-7.)
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A randomized, controlled study of placement of 10 French tannenbaum biliary stents across malignant strictures with and without sphincterotomy
Gastrointestinal Endoscopy, 1996Co-Authors: Jonathan Cohen, J Dorais, Dm Scheider, Mj Bourke, P Kortan, Gregory B. HaberAbstract:A RANDOMIZED, CONTROLLED STUDY OF PLACEMENT OF IO FRENCH TANNENBAUM BILIARY STENTS ACROSS MALIGNANT STRICTURES WITH AND WITHOUT SPHINCTEROTOMY. JCoben. M. Bourke, J Dorais, D Scbeider, P Kortan, G Haber. The Wellesley Hospital, Toronto, Canada. Purpose: To determine whether an endoscopic biliary sphineterotomy (EBS) is of any benefit in the placement of I0 French biliary stents across malignant biliary strictures in terms o f successful stent placement, efficiency o f technique, complications, aad stent pateney. Methods: Patients with non-hilar malignant strictures who were referred for ERCP were randomized to stent placement with or without EBS. In the sphinetcrotomy group, EBS was performed after obtaining a cholangiogrmn with a single lumen, 5 French Papillotome. A guide catheter with a guide wire was then used to place a wire past the stricture, over which a 10 French Tannenbaura stent (Wilson-Ccok) was placed. In the no-EBS group, a wire-guided Papillotome was used for bile duet cannulation. After the cholangiogram, a wire was advanced across the stricture. The Papillotome was then removed, and the guide catheter and stent were placed. The time required to obtain a eholangiogram, the time from cholangiogram to guide wire placement past the stricture, and the time from wire placement to successful stent deployment were recorded. A successful attempt was defined as stent placement within 30 minutes of attempting eannutation. Patients were telephoned at 3 and 30 days to assess complication rates or evidence of stent occlusion. Results: To date, 7 patients have been randomized into each group. All attempts to place stents were successful. The mean time data were not significantly different: EBS GROUP NO-EBS GROUP CHOLANGIOGRAM 3.8 minutes 7.1 minutes CHOLANGIOGRAM TO WIRE 5.4 minutes 6.4 minutes WIRE TO STENT IN PLACE 3.2 minutes 4.5 minutes TOTAL 12.5 minutes 18 minutes In follow~up (2-16 weeks), stents have remained patent in all but 1 (no EBS) of the surviving patients and were patent at the time of death in 4 of the 5 individuals who have not survived. 1 patient in the EBS group died at 9 weeks with sepsis and jaundice. 4 stents have remained patent for 13 weeks or greater. Conclusion: EBS is not required for the successful placement of a 10 French bilinry endoprostbesis through malignant strictures. Whether EBS makes steat placement significantly easier, and whether stent placement without EBS is associated with fewer complications or longer stent pateney remains to be determined,
Kyusung Rim - One of the best experts on this subject based on the ideXlab platform.
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case series of ercp and est with rotatable Papillotome autotome r in patients with billoth ii gastrectomy
Clinical Endoscopy, 2007Co-Authors: Yonghun Kim, Changil Kwon, Daeyoung Kim, Myungsu Son, Sungpyo Hong, Seonggyu Hwang, Pilwon Park, Kyusung RimAbstract:Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) are the mainstays of the diagnosis and treatment of variable hepatobiliary and pancreatic diseases. The success rate of ERCP and EST in patients who have undergone a Billroth II gastrectomy is lower than in patients with a normal anatomy. Because the view of the ampulla is rotated 180o in patients with Billroth II, several methods (ex, precut biliary needle-knife Papillotome or wire-guided billroth II Papillotome) have been used for endoscopic sphincterotomy instead of a pull-type Papillotome. Using the recently devised pull-type and rotatable Papillotome (Autotome), we performed successful ERCP and EST in 2 patients with a Billroth II gastrectomy without complications. (Korean J Gastrointest Endosc 2007;35:445-450)
J. Mark Lawson - One of the best experts on this subject based on the ideXlab platform.
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Conducted current on guidewires in single lumen Papillotomes
Gastrointestinal Endoscopy, 1991Co-Authors: Philip Schoenfeld, D. Michael Jones, J. Mark LawsonAbstract:An in vitro electrical circuit was designed to measure conducted current in plastic-coated guidewires and standard guidewires inserted in a single lumen Papillotome. Single lumen Papillotomes, which are more flexible than double lumen Papillotomes, require the removal of the guidewire before electrosurgery due to concern over conducted current. In an in vitro electrical circuit, equivalent current was measured in both the Papillotome wire and the standard guidewire. Plastic-coated guidewires did not allow any current flow. The advantages of flexible single lumen Papillotomes and maintenance of deep biliary cannulation over a guidewire may be combined if insulated plastic-coated guidewires are used.
