The Experts below are selected from a list of 90 Experts worldwide ranked by ideXlab platform
R.d. Fanelli - One of the best experts on this subject based on the ideXlab platform.
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Enteroscopic treatment of early postoperative small bowel obstruction
Surgical Endoscopy And Other Interventional Techniques, 2002Co-Authors: K.s. Gersin, J.l. Ponsky, R.d. FanelliAbstract:Background: Early postoperative small bowel obstruction (EPSBO) occurs in 1% of patients undergoing laparotomy and has a mortality rate exceeding 17%. Nasogastric (NG) decompression is successful in avoiding reoperation in 73% of patients. Repeat laparotomy has been recommended when obstruction does not resolve after 14 days of NG decompression. We report four patients with EPSBO treated successfully with Push enteroscopy after failed NG decompression. Methods: Four patients who failed NG decompression underwent Push enteroscopy instead of repeat laparotomy. EPSBO was diagnosed if obstruction lasting more than 14 days developed after initial resolution of postoperative ileus, high NG output persisted postoperatively for 21 days in the absence of sepsis, or radiographic signs of obstruction persisted. Small bowel series or computed tomography were utilized when radiographic assessment was necessary. The Olympus SIF 100 Push Enteroscope was introduced with an overtube using topical anesthesia and intravenous sedation. After maximal insertion, the Enteroscope was withdrawn without evacuation of insufflated air. NG tubes were placed after enteroscopy and patients were followed clinically. Flatus, defecation, and tolerance of a general diet defined resolution of EPSBO. Results: EPSBO resolved 24 to 36 h following enteroscopy, and all patients were discharged on general diets 48 h after return of bowel function. Readmission has not been necessary during 18- to 30-month follow-up. Conclusions: Our experience suggests that Push enteroscopy is successful in treating EPSBO and should be considered prior to reoperation. Push enteroscopy may eliminate the hazards of repeat laparotomy and reduce the morbidity, treatment cost, and lengthy hospital stays associated with this uncommon surgical complication.
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7225 Enteroscopic treatment of early postoperative bowel obstruction.
Gastrointestinal Endoscopy, 2000Co-Authors: K.s. Gersin, J.l. Ponsky, Douglas N. Mellinger, R.d. FanelliAbstract:Introduction: Early postoperative small bowel obstruction (EPSBO) occurs in nearly 1% of patients undergoing laparotomy and has a mortality rate exceeding 17%. Nasogastric (NG) decompression is successful in 78% of patients. Repeat laparotomy has been recommended when obstruction does not resolve after 14 days of NG decompression. We report 4 patients with EPSBO treated successfully with Push enteroscopy after failed NG decompression. Methods: Four patients who failed NG decompression underwent Push enteroscopy instead of repeat laparotomy. EPSBO was diagnosed if obstruction lasting more than 14 days developed after initial resolution of postoperative ileus or high NG output persisted postoperatively for 21 days in the absence of prolonged ileus or sepsis. Small bowel series or CT was utilized when radiographic assessment was necessary. The Olympus SIF 100 Push Enteroscope was introduced with an overtube using topical anesthesia and intravenous sedation. After maximal insertion, the Enteroscope was withdrawn without evacuation of insufflated air. NG tubes were placed after enteroscopy, and the patients followed clinically. Flatus, defecation, and tolerance of diet defined resolution of EPSBO. Results: EPSBO resolved 24-36 hours following enteroscopy, and all patients were discharged on general diets 48 hours after return of bowel function. Readmission has not been necessary during 6-18 month followup. Conclusions: Our experience suggests that Push enteroscopy is successful in treating EPSBO and should be considered prior to re-operation. Repeat laparotomy may not be necessary and Push enteroscopy may reduce patient morbidity, cost, and hospital lengths of stay associated with this uncommon surgical complication.
Francisco C. Ramirez - One of the best experts on this subject based on the ideXlab platform.
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Small bowel bleeding
Current Treatment Options in Gastroenterology, 1999Co-Authors: Francisco C. RamirezAbstract:Most patients with small bowel bleeding present with chronic, recurrent, transfusion-dependent, debilitating disease. Less commonly, an acute gastrointestinal bleeding episode with negative upper and lower endoscopic exams may be the initial presentation. Lesions responsible for small bowel bleeding, on the other hand, include arterio-venous malformations, tumors, and ulcers. The treatment options must therefore be directed to the specific cause of bleeding and its mode of presentation (acute versus chronic; intermittent). Treatment before a specific diagnosis has been reached includes blood transfusions as needed, and chronic iron supplementation. Once the diagnosis of arterio-venous malformations has been made, thermal endoscopic therapy (heater probe, bipolar electrocoagulation, argon plasma coagulation, or laser) with or without injection (epinephrine) is the mainstay treatment option. The same option is available for small bowel ulcers that show stigmata of recent bleeding, eg , a non-bleeding visible vessel or adherent clot, or are actively bleeding at the time of enteroscopy. For the patient with a small bowel tumor thought to be responsible for the bleeding, surgical excision or resection is the treatment of choice. The surgical option is also reserved for those patients with diffuse and multiple lesions, and those with lesions beyond the reach of the Push Enteroscope, which preclude endoscopic therapy. Invasive radiological methods via selective catheterization and vasopressin injection or embolization are reserved for patients with a demonstrable actively bleeding lesion found at the time of the diagnostic work-up, and those who may not be candidates for surgery. For those patients in whom endoscopic therapy or surgery is not amenable ( ie , anatomical location, multiple lesions involving several segments of the small bowel), those who are not surgical candidates and those who have recurrent bleeding after repeat endoscopic or surgical therapies, medical therapy with continuous iron supplementation, avoidance of ulcerogenic drugs ( eg , NSAIDs) and hormonal therapy (for those with arteriovenous malformations) should be considered.
Ronald M Katon - One of the best experts on this subject based on the ideXlab platform.
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total peroral intraoperative enteroscopy for obscure gi bleeding using a dedicated Push Enteroscope diagnostic yield and patient outcome
Gastrointestinal Endoscopy, 1999Co-Authors: Atif Zaman, Brett C Sheppard, Ronald M KatonAbstract:Abstract Background: Intraoperative enteroscopy is an effective diagnostic and therapeutic method in selected patients with obscure gastrointestinal (GI) bleeding. The passage of a colonoscope orally and then rectally or the use of multiple enterotomies, has been used to completely inspect the small bowel. However, the development of dedicated Enteroscopes allows complete inspection using the peroral route. Aim: The aim of the study was to assess the diagnostic yield, patient outcome, and success in reaching the terminal ileum using a video Enteroscope passed orally during intraoperative enteroscopy. Methods: The hospital charts of 12 patients who underwent intraoperative enteroscopy for GI bleeding of obscure origin and 2 patients with a known source (angioectasias) who underwent evaluation to determine extent were retrospectively analyzed. Results: The terminal ileum was reached in 13 of 14 patients (jejunal stricture in 1 patient). Of the patients with bleeding of obscure origin (n = 12) a source was identified in 7 (angioectasias 4, lymphoma 1, carcinoid 1, nevuslike lesion 1). Surgical therapy was performed in these 7 patients and resulted in no further bleeding in 5. Bleeding recurred in 4 of the 5 patients who had no source identified during intraoperative enteroscopy. Of the 2 patients undergoing intraoperative enteroscopy to evaluate extent of angioectasias, additional angioectasias were found in 1 patient; both patients underwent surgical resection, and 1 patient had recurrent bleeding. Complications included serosal tears, 3 (2 requiring resection); avulsion of superior mesenteric vein, 1; postoperative congestive heart failure, 2; azotemia, 1; and prolonged ileus, 1. There were no deaths. Conclusions: The terminal ileum was reached 93% of the time with intraoperative enteroscopy. For patients with GI bleeding of obscure origin the diagnostic yield of intraoperative enteroscopy was 58%. Major operative morbidity occurred in 4 patients. (Gastrointest Endosc 1999;50;506-10.)
André Gossum - One of the best experts on this subject based on the ideXlab platform.
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A prospective comparative study of Push and wireless-capsule enteroscopy in patients with obscure digestive bleeding.
Acta Gastro-enterologica Belgica, 2003Co-Authors: André Gossum, A. Schmit, Axel Hittelet, Erik François, Jacques DevièreAbstract:Objectives : To prospectively compare the global and specific diagnostic yields of Push and wireless videocapsule enteroscopy for small bowel lesions in patients with obscure digestive bleeding after esogastroduodenoscopy and colonoscopy. Methods : The patients studied had unexplained chronic iron-deficient anemia or digestive blood loss after routine investigations. Small bowel investigation was performed first with the wireless-capsule (M2A, Given Imaging) and then with the Push-Enteroscope (Olympus SIF100). Results: Twenty-one patients were included in the protocol (14 females and 7 males), whose mean age was 60 years (range : 18 to 81). All patients had iron-deficient anemia with occult bleeding (n = 16) or overt bleeding (n = 5). A digestive lesion was observed in 14 of 21 cases (66%). Lesions were : esophageal varices (n = 2), reflux esophagitis (n = 1), upper gastrointestinal tract ulcerations (n = 9), intestinal angioectasia (n = 4), ileal varices (n = 1), cecal angioectasia (n = 1) and tumor-like angioma in the jejunum (n = 1). These 19 lesions were discovered by both methods in 10 cases (52%), by Push-enteroscopy only in 6 (31%) and by wireless-capsule endoscopy only in 3 (17%). The global diagnostic yield was therefore slightly but not significantly higher for Push wireless-capsule enteroscopy (61 vs 52% ; NS) and the specific diagnostic yield was similar (20%). Interobserver agreement on the wireless-capsule recordings reached 85% for detection of findings. Conclusions : In patients with obscure digestive bleeding, no significant difference in diagnostic yield was evidenced between Push and wireless-capsule endoscopy. The main advantage of the latter method versus the former was the detection of distal lesions in the small bowel. Wireless-capsule enteroscopy is mandatory for patients with active unexplained bleeding and negative Push-enteroscopy, or for defining the extension of a disease involving, for instance, the presence of angioectasia.
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Diagnostic efficacy of Push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias
Digestive Diseases and Sciences, 1996Co-Authors: Alain Schmit, Michael Adler, Michel Cremer, André GossumAbstract:Gastrointestinal angiodysplasias are the most common cause of obscure chronic digestive blood loss. Push-enteroscopy is likely to detect and to treat vascular lesions. Push-enteroscopy was performed in 83 patients (mean age 62 years) presenting with iron deficiency anemia of obscure origin. A nonrevealing preliminary evaluation included esophagogastroduodenoscopy, colonoscopy and, in 50% of the patients, small bowel barium studies. We employed a 240-cm Olympus Push-Enteroscope (XSIF-100), 11.3 mm in diameter. A potential bleeding lesion was observed in 49 patients (59%). Gastrointestinal angiodysplasias were the most common lesion (33 patients). Electrocoagulation (bicap) of angiodysplasias was performed when accessible and not diffuse (
Michael L Kochman - One of the best experts on this subject based on the ideXlab platform.
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use of a Push Enteroscope improves ability to perform total colonoscopy in previously unsuccessful attempts at colonoscopy in adult patients
The American Journal of Gastroenterology, 1999Co-Authors: Gary R Lichtenstein, Peter Park, William B Long, Gregory G Ginsberg, Michael L KochmanAbstract:Objective: Total colonoscopy with use of a standard adult colonoscope can be difficult in the presence of a redundant or angulated colon. It is often possible to traverse these areas with the use of a thinner, more flexible endoscope. The objective of this study was to evaluate the efficacy of completing total colonoscopy using a Push Enteroscope when a standard colonoscope was unsuccessful. Methods: A prospective analysis was performed for 721 consecutive colonoscopies attempted by two gastroenterologists. Those patients in whom complete colonoscopy was unsuccessful using the standard colonoscope (Olympus CF-100L) had attempts to complete colonoscopy using the Enteroscope (Olympus SIF-100). The extent of each exam was recorded. Additional pathologic findings discovered by the use of the Enteroscope and therapeutic interventions performed were additionally noted. Results: Colonoscopy using an Enteroscope was performed in 32 patients with successful total colonoscopy in 22 patients (68.7%). Additional pathology was noted in nine patients who had successful complete colonoscopy using the Enteroscope; adenomatous polyp (n = 5), adenocarcinoma (n = 1), bleeding source (n = 2), and extent of colitis (n = 1). Total colonoscopy rate using standard adult colonoscope was 93.2% (630 of 676) when cases with poor bowel preparation (n = 23) and obstructing lesions (n = 14) were excluded. When the results of successful colonoscopies with the Enteroscope were included, the overall completion rate of total colonoscopy improved to 96.4% (652 of 676). Conclusion: The use of the Enteroscope to help evaluate patients who have had incomplete colonoscopies with the standard colonoscope increases the diagnostic yield of colonic examination.
