The Experts below are selected from a list of 36 Experts worldwide ranked by ideXlab platform
Anthony N Kalloo - One of the best experts on this subject based on the ideXlab platform.
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intrasphincteric injection of botulinum toxin for suspected sphincter of oddi dysfunction
Gut, 1994Co-Authors: Pankaj J. Pasricha, E P Miskovsky, Anthony N KallooAbstract:Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum toxin was injected into the sphincter of Oddi, by a Sclerotherapy Needle passed through a duodenoscope. In the first patient, intrasphincteric injection of botulinum toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric botulinum toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically.
Pankaj J. Pasricha - One of the best experts on this subject based on the ideXlab platform.
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intrasphincteric injection of botulinum toxin for suspected sphincter of oddi dysfunction
Gut, 1994Co-Authors: Pankaj J. Pasricha, E P Miskovsky, Anthony N KallooAbstract:Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum toxin was injected into the sphincter of Oddi, by a Sclerotherapy Needle passed through a duodenoscope. In the first patient, intrasphincteric injection of botulinum toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric botulinum toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically.
Mitsuyoshi Honjo - One of the best experts on this subject based on the ideXlab platform.
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creation of simulated papillae for endoscopic sphincterotomy and papillectomy training by using in vivo and ex vivo pig model with videos
Gastrointestinal Endoscopy, 2013Co-Authors: Takao Itoi, Takuji Gotoda, Todd H Baron, Atsushi Sofuni, Fumihide Itokawa, Shujiro Tsuji, Takayoshi Tsuchiya, Rena Tanaka, Ryosuke Tonozuka, Mitsuyoshi HonjoAbstract:Background There are few in vivo and ex vivo models for training in endoscopic sphincterotomy (ES) and endoscopic papillectomy (EP). Objective We describe in vivo and ex vivo training pig models that use a simulated papilla for hands-on teaching of ES and EP. Design Animal experiment. Setting A referral center. Materials and Interventions Hyaluronate solution (0.4%) was injected submucosally using a 25-gauge Sclerotherapy Needle to create a submucosal bleb by using porcine in vivo stomach, ex vivo stomach, and ex vivo rectum. ES and EP were then performed by using a pull-type sphincterotome and snare, respectively. Main Outcome Measurement The feasibility of creating a simulated papilla for ES and EP procedures was tested by experienced and nonexperienced ERCP endoscopists. Results Creation of a hemispheroidal bulge was successful in 13 of 17 (76%) areas within an in vivo stomach, 13 of 16 (81%) areas of an ex vivo stomach, and 16 of 16 (100%) areas in an ex vivo rectum. In the in vivo stomach model, ES was successfully and realistically performed on the anterior wall of the stomach rather than in other walls. In the ex vivo stomach model, endoscopists experienced in ERCP and trainees performed ES without difficulty, whereas it was difficult or impossible for nonexperienced trainees to perform ES. In the ex vivo rectum model, all 3 endoscopists were able to complete not only ES but also EP. Limitations Pilot study. Conclusions Although further studies are necessary to evaluate the reproducibility and cost-effectiveness, this novel pig model appears useful for ES and EP training.
William B Silverman - One of the best experts on this subject based on the ideXlab platform.
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modified Sclerotherapy Needle is reliable during sphincterotomy bleed it works when you need it
The American Journal of Gastroenterology, 2000Co-Authors: William B SilvermanAbstract:Modified Sclerotherapy Needle is reliable during sphincterotomy bleed: it works when you need it
E P Miskovsky - One of the best experts on this subject based on the ideXlab platform.
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intrasphincteric injection of botulinum toxin for suspected sphincter of oddi dysfunction
Gut, 1994Co-Authors: Pankaj J. Pasricha, E P Miskovsky, Anthony N KallooAbstract:Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum toxin was injected into the sphincter of Oddi, by a Sclerotherapy Needle passed through a duodenoscope. In the first patient, intrasphincteric injection of botulinum toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric botulinum toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically.