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Glen A Lehman - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of endoscopic dual pancreatobiliary Sphincterotomy in patients with manometry documented sphincter of oddi dysfunction and normal pancreatogram
Gastrointestinal Endoscopy, 2003Co-Authors: Sang Heum Park, Laura Lazzell, Evan L Fogel, Stuart Sherman, James L Watkins, Lois Bucksot, Glen A LehmanAbstract:Background: For patients with sphincter of Oddi dysfunction and abnormal pancreatic basal sphincter pressure, additional pancreatic Sphincterotomy has been recommended. The outcome of endoscopic dual pancreatobiliary sphincteretomy in patients with manometry-documented sphincter of Oddi dysfunction was evaluated. Methods: An ERCP database was searched for data entered from January 1995 to November 2000 on patients with sphincter of Oddi dysfunction who met the following parameters: sphincter of Oddi manometry of both ducts, abnormal pressure for at least 1 sphincter (≥40 mm Hg), no evidence of chronic pancreatitis, and endoscopic dual pancreatobiliary Sphincterotomy. Patients were offered reintervention by repeat ERCP if clinical symptoms were not improved. The frequency of reintervention was analyzed according to ducts with abnormal basal sphincter pressure, previous cholecystectomy, sphincter of Oddi dysfunction type, and endoscopic dual pancreatobiliary Sphincterotomy method. Results: A total of 313 patients were followed for a mean of 43.1 months (median, 41.0 months; interquartile range: 29.8–60.0 months). Immediate postendoscopic dual pancreatobiliary Sphincterotomy complications occurred in 15% of patients. Reintervention was required in 24.6% of patients at a median follow-up (interquartile range) of 8.0 (5.5–22.5) months. The frequency of reintervention was similar irrespective of ducts with abnormal basal sphincter pressure, previous cholecystectomy, or endoscopic dual pancreatobiliary Sphincterotomy method. Of patients with type III sphincter of Oddi dysfunction, 28.3% underwent reintervention compared with 20.4% with combined types I and II sphincter of Oddi dysfunction ( p =0.105). When compared with endoscopic biliary Sphincterotomy alone in historical control patients from our unit, endoscopic dual pancreatobiliary Sphincterotomy had a lower reintervention rate in patients with pancreatic sphincter of Oddi dysfunction alone and a comparable outcome in those with sphincter of Oddi dysfunction of both ducts. Conclusion: Endoscopic dual pancreatobiliary Sphincterotomy is useful in patients with pancreatic sphincter of Oddi dysfunction. Prospective randomized trials of endoscopic biliary Sphincterotomy alone versus endoscopic dual pancreatobiliary Sphincterotomy based on sphincter of Oddi manometry findings are in progress.
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Wire-guided Sphincterotomy.
The American journal of gastroenterology, 1994Co-Authors: Stuart Sherman, Michael Uzer, Glen A LehmanAbstract:Guidewire-assisted techniques have acquired an important role in endoscopic interventions in the pancreaticobiliary tree. The wire-guided sphincterotome allows the endoscopist to maintain direct access to the biliary tree before or after the Sphincterotomy. It has the additional advantages of allowing for more expeditious placement of accessories and being useful in combined percutaneous-endoscopic procedures. There are two basic designs of wire-guided sphincterotomes. The single-channel model has a single lumen for both the cutting wire and guidewire and requires guidewire removal before the application of power. The double-channel model has two separate lumens for the guidewire and stainless steel cutting wire. In vitro data suggest that significant capacitive coupling currents (or short circuits) may occur on the standard Teflon-coated guidewire when used with a double lumen sphincterotome, resulting in electrosurgical burns. Thus, the manufacturers of the double-lumen models recommend removing the Teflon-coated wire before performing Sphincterotomy. Although limited data in humans have been published, it appears that wire-guided Sphincterotomy and standard Sphincterotomy have similar complication rates. More safety information in humans is awaited.
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complications of endoscopic Sphincterotomy a prospective series with emphasis on the increased risk associated with sphincter of oddi dysfunction and nondilated bile ducts
Gastroenterology, 1991Co-Authors: Stuart Sherman, Thomas A Ruffolo, R Hawes, Glen A LehmanAbstract:Abstract Mostly retrospective series with limited use of sphincter of Oddi manometry have indicated that early complications are more common when endoscopic Sphincterotomy is performed for sphincter of Oddi dysfunction than for common duct stones. The current study was undertaken to prospectively evaluate the frequency and type of complications of endoscopic Sphincterotomy performed for sphincter of Oddi dysfunction compared with endoscopic Sphincterotomy performed for other conditions. Four hundred twenty-three patients underwent Sphincterotomy for sphincter of Oddi dysfunction (166), common duct stone(s) (163), tumor (60), and miscellaneous reasons (34). Patients were observed in the hospital for at least 24 hours after the procedure, and 30-day follow-up data were obtained. The overall complication rate was 6.9%, but complications were more frequent when Sphincterotomy was performed for sphincter of Oddi dysfunction than for all other indications (10.8% vs. 4.3%; P = 0.009). Precut Sphincterotomy was more frequently required in the sphincter of Oddi dysfunction group (21.1% vs. 11.7%, P = 0.009) but was no more likely to result in a complication (6.2%) than standard Sphincterotomy. The risk of a complication was considerable for a small-diameter common bile duct (≤ 5 mm), particularly when Sphincterotomy was performed for sphincter of Oddi dysfunction (37.5%). The overall 30-day mortality rate was 1.7%, but the procedure-related mortality rate was believed to be 0.2%. It is concluded that endoscopic Sphincterotomy for sphincter of Oddi dysfunction is more hazardous than for other conditions, particularly when a small common bile duct is present.
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complications of endoscopic Sphincterotomy a prospective series with emphasis on the increased risk associated with sphincter of oddi dysfunction and nondilated bile ducts
Gastroenterology, 1991Co-Authors: Stuart Sherman, Thomas A Ruffolo, Robert H Hawes, Glen A LehmanAbstract:Mostly retrospective series with limited use of sphincter of Oddi manometry have indicated that early complications are more common when endoscopic Sphincterotomy is performed for sphincter of Oddi dysfunction than for common duct stones. The current study was undertaken to prospectively evaluate the frequency and type of complications of endoscopic Sphincterotomy performed for sphincter of Oddi dysfunction compared with endoscopic Sphincterotomy performed for other conditions. Four hundred twenty-three patients underwent Sphincterotomy for sphincter of Oddi dysfunction (166), common duct stone(s) (163), tumor (60), and miscellaneous reasons (34). Patients were observed in the hospital for at least 24 hours after the procedure, and 30-day follow-up data were obtained. The overall complication rate was 6.9%, but complications were more frequent when Sphincterotomy was performed for sphincter of Oddi dysfunction than for all other indications (10.8% vs. 4.3%; P = 0.009). Precut Sphincterotomy was more frequently required in the sphincter of Oddi dysfunction group (21.1% vs. 11.7%, P = 0.009) but was no more likely to result in a complication (6.2%) than standard Sphincterotomy. The risk of a complication was considerable for a small-diameter common bile duct (less than or equal to 5 mm), particularly when Sphincterotomy was performed for sphincter of Oddi dysfunction (37.5%). The overall 30-day mortality rate was 1.7%, but the procedure-related mortality rate was believed to be 0.2%. It is concluded that endoscopic Sphincterotomy for sphincter of Oddi dysfunction is more hazardous than for other conditions, particularly when a small common bile duct is present.
Stuart Sherman - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of endoscopic dual pancreatobiliary Sphincterotomy in patients with manometry documented sphincter of oddi dysfunction and normal pancreatogram
Gastrointestinal Endoscopy, 2003Co-Authors: Sang Heum Park, Laura Lazzell, Evan L Fogel, Stuart Sherman, James L Watkins, Lois Bucksot, Glen A LehmanAbstract:Background: For patients with sphincter of Oddi dysfunction and abnormal pancreatic basal sphincter pressure, additional pancreatic Sphincterotomy has been recommended. The outcome of endoscopic dual pancreatobiliary sphincteretomy in patients with manometry-documented sphincter of Oddi dysfunction was evaluated. Methods: An ERCP database was searched for data entered from January 1995 to November 2000 on patients with sphincter of Oddi dysfunction who met the following parameters: sphincter of Oddi manometry of both ducts, abnormal pressure for at least 1 sphincter (≥40 mm Hg), no evidence of chronic pancreatitis, and endoscopic dual pancreatobiliary Sphincterotomy. Patients were offered reintervention by repeat ERCP if clinical symptoms were not improved. The frequency of reintervention was analyzed according to ducts with abnormal basal sphincter pressure, previous cholecystectomy, sphincter of Oddi dysfunction type, and endoscopic dual pancreatobiliary Sphincterotomy method. Results: A total of 313 patients were followed for a mean of 43.1 months (median, 41.0 months; interquartile range: 29.8–60.0 months). Immediate postendoscopic dual pancreatobiliary Sphincterotomy complications occurred in 15% of patients. Reintervention was required in 24.6% of patients at a median follow-up (interquartile range) of 8.0 (5.5–22.5) months. The frequency of reintervention was similar irrespective of ducts with abnormal basal sphincter pressure, previous cholecystectomy, or endoscopic dual pancreatobiliary Sphincterotomy method. Of patients with type III sphincter of Oddi dysfunction, 28.3% underwent reintervention compared with 20.4% with combined types I and II sphincter of Oddi dysfunction ( p =0.105). When compared with endoscopic biliary Sphincterotomy alone in historical control patients from our unit, endoscopic dual pancreatobiliary Sphincterotomy had a lower reintervention rate in patients with pancreatic sphincter of Oddi dysfunction alone and a comparable outcome in those with sphincter of Oddi dysfunction of both ducts. Conclusion: Endoscopic dual pancreatobiliary Sphincterotomy is useful in patients with pancreatic sphincter of Oddi dysfunction. Prospective randomized trials of endoscopic biliary Sphincterotomy alone versus endoscopic dual pancreatobiliary Sphincterotomy based on sphincter of Oddi manometry findings are in progress.
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Endoscopic pancreatic Sphincterotomy: techniques and complications.
Gastrointestinal endoscopy clinics of North America, 1998Co-Authors: Stuart ShermanAbstract:Endoscopic pancreatic Sphincterotomy of the major and minor papilla has expanded our approach to the management of a variety of pancreatic disorders. Analysis of the complication rates of this therapy is difficult, however, because a variety of techniques are often used in conjunction with the pancreatic Sphincterotomy. This article reviews the techniques and complications of endoscopic pancreatic Sphincterotomy. Based on the currently available data, it appears that the complication rates of pancreatic Sphincterotomy are probably higher than those of biliary Sphincterotomy. Should application of this technique become more widespread, methods to reduce the incidence of post-procedure pancreatitis will demand further investigation.
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Wire-guided Sphincterotomy.
The American journal of gastroenterology, 1994Co-Authors: Stuart Sherman, Michael Uzer, Glen A LehmanAbstract:Guidewire-assisted techniques have acquired an important role in endoscopic interventions in the pancreaticobiliary tree. The wire-guided sphincterotome allows the endoscopist to maintain direct access to the biliary tree before or after the Sphincterotomy. It has the additional advantages of allowing for more expeditious placement of accessories and being useful in combined percutaneous-endoscopic procedures. There are two basic designs of wire-guided sphincterotomes. The single-channel model has a single lumen for both the cutting wire and guidewire and requires guidewire removal before the application of power. The double-channel model has two separate lumens for the guidewire and stainless steel cutting wire. In vitro data suggest that significant capacitive coupling currents (or short circuits) may occur on the standard Teflon-coated guidewire when used with a double lumen sphincterotome, resulting in electrosurgical burns. Thus, the manufacturers of the double-lumen models recommend removing the Teflon-coated wire before performing Sphincterotomy. Although limited data in humans have been published, it appears that wire-guided Sphincterotomy and standard Sphincterotomy have similar complication rates. More safety information in humans is awaited.
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complications of endoscopic Sphincterotomy a prospective series with emphasis on the increased risk associated with sphincter of oddi dysfunction and nondilated bile ducts
Gastroenterology, 1991Co-Authors: Stuart Sherman, Thomas A Ruffolo, R Hawes, Glen A LehmanAbstract:Abstract Mostly retrospective series with limited use of sphincter of Oddi manometry have indicated that early complications are more common when endoscopic Sphincterotomy is performed for sphincter of Oddi dysfunction than for common duct stones. The current study was undertaken to prospectively evaluate the frequency and type of complications of endoscopic Sphincterotomy performed for sphincter of Oddi dysfunction compared with endoscopic Sphincterotomy performed for other conditions. Four hundred twenty-three patients underwent Sphincterotomy for sphincter of Oddi dysfunction (166), common duct stone(s) (163), tumor (60), and miscellaneous reasons (34). Patients were observed in the hospital for at least 24 hours after the procedure, and 30-day follow-up data were obtained. The overall complication rate was 6.9%, but complications were more frequent when Sphincterotomy was performed for sphincter of Oddi dysfunction than for all other indications (10.8% vs. 4.3%; P = 0.009). Precut Sphincterotomy was more frequently required in the sphincter of Oddi dysfunction group (21.1% vs. 11.7%, P = 0.009) but was no more likely to result in a complication (6.2%) than standard Sphincterotomy. The risk of a complication was considerable for a small-diameter common bile duct (≤ 5 mm), particularly when Sphincterotomy was performed for sphincter of Oddi dysfunction (37.5%). The overall 30-day mortality rate was 1.7%, but the procedure-related mortality rate was believed to be 0.2%. It is concluded that endoscopic Sphincterotomy for sphincter of Oddi dysfunction is more hazardous than for other conditions, particularly when a small common bile duct is present.
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complications of endoscopic Sphincterotomy a prospective series with emphasis on the increased risk associated with sphincter of oddi dysfunction and nondilated bile ducts
Gastroenterology, 1991Co-Authors: Stuart Sherman, Thomas A Ruffolo, Robert H Hawes, Glen A LehmanAbstract:Mostly retrospective series with limited use of sphincter of Oddi manometry have indicated that early complications are more common when endoscopic Sphincterotomy is performed for sphincter of Oddi dysfunction than for common duct stones. The current study was undertaken to prospectively evaluate the frequency and type of complications of endoscopic Sphincterotomy performed for sphincter of Oddi dysfunction compared with endoscopic Sphincterotomy performed for other conditions. Four hundred twenty-three patients underwent Sphincterotomy for sphincter of Oddi dysfunction (166), common duct stone(s) (163), tumor (60), and miscellaneous reasons (34). Patients were observed in the hospital for at least 24 hours after the procedure, and 30-day follow-up data were obtained. The overall complication rate was 6.9%, but complications were more frequent when Sphincterotomy was performed for sphincter of Oddi dysfunction than for all other indications (10.8% vs. 4.3%; P = 0.009). Precut Sphincterotomy was more frequently required in the sphincter of Oddi dysfunction group (21.1% vs. 11.7%, P = 0.009) but was no more likely to result in a complication (6.2%) than standard Sphincterotomy. The risk of a complication was considerable for a small-diameter common bile duct (less than or equal to 5 mm), particularly when Sphincterotomy was performed for sphincter of Oddi dysfunction (37.5%). The overall 30-day mortality rate was 1.7%, but the procedure-related mortality rate was believed to be 0.2%. It is concluded that endoscopic Sphincterotomy for sphincter of Oddi dysfunction is more hazardous than for other conditions, particularly when a small common bile duct is present.
Andrew Leahy - One of the best experts on this subject based on the ideXlab platform.
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PTU-028 Balloon Sphincteroplasty after Sphincterotomy: A Safe Way to Ensure a British Society of Gastroenterology ERCP Target is Achieved
Gut, 2016Co-Authors: Paul Wolfson, Salma Bouri, Ruth Sayers, B Macfarlane, Mahmood Shariff, A. King, Andrew LeahyAbstract:Introduction Sphincterotomy and balloon/basket trawl at ERCP is the standard treatment to clear stones from the common bile duct. The BSG in 2014 published a key performance indicator of >75% stone clearance during first ERCP. Balloon sphincteroplasty as an adjunct to Sphincterotomy can increase stone clearance. The aim of this study is to review the success/safety for balloon sphincteroplasty compared to Sphincterotomy alone. Methods Retrospective study between 1 st April 2010–2014 in a large district general hospital of all ERCPs documenting a common bile duct stone. Electronic records were analysed with the following exclusion criteria: anticoagulants, biliary leak, unchecked cardiac device or incomplete follow up. Balloon sphincteroplasty was always performed after a Sphincterotomy, using a Boston Scientific CRE wire guided balloon with a maximal diameter dilation that corresponded to the patient’s mid common bile duct diameter (8–15 mm). Results Total study population was 390 patients. Stone clearance with initial Sphincterotomy alone and balloon/basket trawl was successful in 70% (n = 274) patients. 116 patients underwent additional balloon sphincteroplasty with a success rate of 85.5% (n = 100). The remaining patients underwent mechanical lithotripsy (n = 15) or tertiary care referral (n = 1). Therefore, Sphincterotomy +/- balloon sphincteroplasty achieved stone clearance in 96% (n = 374) of patients. No statistically significant diferences were observed for complication rates when comparing Sphincterotomy alone to balloon sphincteroplasty. Actual complication rates for Sphincterotomy alone/balloon sphincteroplasty were: overall 5%/5.2%; pancreatitis 1%/2.6%; cholangitis 3%/3%; bleeding 3%/0% perforation 0%/0%. Conclusion Balloon sphincteroplasty is an effective and safe adjunct in patients who do not achieve bile duct stone clearance with Sphincterotomy and balloon/basket trawl alone, allowing clearance rates to exceed current guideline recommendations. Reference 1 Wilkinson, et al . BSG ERCP – the way forward, A standards framework. 2014. http://www.bsg.org.uk Disclosure of Interest None Declared
C. S. Richard - One of the best experts on this subject based on the ideXlab platform.
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Internal Sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure
Diseases of the Colon & Rectum, 2000Co-Authors: C. S. Richard, R. Gregoire, E. A. Plewes, R. Silverman, C. Burul, D. Buie, R. Reznick, T. Ross, M. Burnstein, B. I. O'connorAbstract:PURPOSE: This was a multicenter, randomized, controlled trial to compare the effectiveness of topical nitroglycerin with internal Sphincterotomy in the treatment of chronic anal fissure. METHODS: Patients with symptomatic chronic anal fissures were randomly assigned to 0.25 percent nitroglycerin tid or internal Sphincterotomy. Both groups received stool softeners and fiber supplements and were assessed at six weeks and six months. RESULTS: Ninety patients were accrued, but 8 were excluded from the analysis because they refused internal Sphincterotomy after randomization (6), the fissure healed before surgery (1), or a fissure was not observed at surgery (1). There were 38 patients in the internal Sphincterotomy group (22 males; mean age, 40.3 years) and 44 patients in the nitroglycerin group (15 males; mean age, 38.7 years). At six weeks 34 patients (89.5 percent) in the internal Sphincterotomy group compared with 13 patients (29.5 percent) in the nitroglycerin group had complete healing of the fissure ( P =5 × 10^−8). Five of the 13 patients in the nitroglycerin group relapsed, whereas none in the internal Sphincterotomy group did. At six months fissures in 35 (92.1 percent) patients in the internal Sphincterotomy group compared with 12 (27.2 percent) patients in the nitroglycerin group had healed ( P =3 × 10^−9). One (2.6 percent) patient in the internal Sphincterotomy group required further surgery for a superficial fistula compared with 20 (45.4 percent) patients in the nitroglycerin group who required an internal Sphincterotomy ( P =9 × 10^−6). Eleven (28.9 percent) patients in the internal Sphincterotomy group developed side effects compared with 37 (84 percent) patients in the nitroglycerin group ( P
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internal Sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure results of a randomized controlled trial by the canadian colorectal surgical trials group
Diseases of The Colon & Rectum, 2000Co-Authors: C. S. Richard, R. Gregoire, E. A. Plewes, R. Silverman, C. Burul, D. Buie, R. Reznick, T. Ross, M. Burnstein, Brenda I OconnorAbstract:PURPOSE: This was a multicenter, randomized, controlled trial to compare the effectiveness of topical nitroglycerin with internal Sphincterotomy in the treatment of chronic anal fissure. METHODS: Patients with symptomatic chronic anal fissures were randomly assigned to 0.25 percent nitroglycerintid or internal Sphincterotomy. Both groups received stool softeners and fiber supplements and were assessed at six weeks and six months. RESULTS: Ninety patients were accrued, but 8 were excluded from the analysis because they refused internal Sphincterotomy after randomization (6), the fissure healed before surgery (1), or a fissure was not observed at surgery (1). There were 38 patients in the internal Sphincterotomy group (22 males; mean age, 40.3 years) and 44 patients in the nitroglycerin group (15 males; mean age, 38.7 years). At six weeks 34 patients (89.5 percent) in the internal Sphincterotomy group compared with 13 patients (29.5 percent) in the nitroglycerin group had complete healing of the fissure (P=5 × 10−8). Five of the 13 patients in the nitroglycerin group relapsed, whereas none in the internal Sphincterotomy group did. At six months fissures in 35 (92.1 percent) patients in the internal Sphincterotomy group compared with 12 (27.2 percent) patients in the nitroglycerin group had healed (P=3 × 10−9). One (2.6 percent) patient in the internal Sphincterotomy group required further surgery for a superficial fistula compared with 20 (45.4 percent) patients in the nitroglycerin group who required an internal Sphincterotomy (P=9 × 10−6). Eleven (28.9 percent) patients in the internal Sphincterotomy group developed side effects compared with 37 (84 percent) patients in the nitroglycerin group (P<0.0001). Nine (20.5 percent) patients discontinued the nitroglycerin because of headaches (8) or a severe syncopal attack (1). CONCLUSIONS: Internal Sphincterotomy is superior to topical nitroglycerin 0.25 percent in the treatment of chronic anal fissure, with a high rate of healing, few side effects, and low risk of early incontinence. Thus, internal Sphincterotomy remains the treatment of choice for chronic anal fissure.
Paul Wolfson - One of the best experts on this subject based on the ideXlab platform.
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PTU-028 Balloon Sphincteroplasty after Sphincterotomy: A Safe Way to Ensure a British Society of Gastroenterology ERCP Target is Achieved
Gut, 2016Co-Authors: Paul Wolfson, Salma Bouri, Ruth Sayers, B Macfarlane, Mahmood Shariff, A. King, Andrew LeahyAbstract:Introduction Sphincterotomy and balloon/basket trawl at ERCP is the standard treatment to clear stones from the common bile duct. The BSG in 2014 published a key performance indicator of >75% stone clearance during first ERCP. Balloon sphincteroplasty as an adjunct to Sphincterotomy can increase stone clearance. The aim of this study is to review the success/safety for balloon sphincteroplasty compared to Sphincterotomy alone. Methods Retrospective study between 1 st April 2010–2014 in a large district general hospital of all ERCPs documenting a common bile duct stone. Electronic records were analysed with the following exclusion criteria: anticoagulants, biliary leak, unchecked cardiac device or incomplete follow up. Balloon sphincteroplasty was always performed after a Sphincterotomy, using a Boston Scientific CRE wire guided balloon with a maximal diameter dilation that corresponded to the patient’s mid common bile duct diameter (8–15 mm). Results Total study population was 390 patients. Stone clearance with initial Sphincterotomy alone and balloon/basket trawl was successful in 70% (n = 274) patients. 116 patients underwent additional balloon sphincteroplasty with a success rate of 85.5% (n = 100). The remaining patients underwent mechanical lithotripsy (n = 15) or tertiary care referral (n = 1). Therefore, Sphincterotomy +/- balloon sphincteroplasty achieved stone clearance in 96% (n = 374) of patients. No statistically significant diferences were observed for complication rates when comparing Sphincterotomy alone to balloon sphincteroplasty. Actual complication rates for Sphincterotomy alone/balloon sphincteroplasty were: overall 5%/5.2%; pancreatitis 1%/2.6%; cholangitis 3%/3%; bleeding 3%/0% perforation 0%/0%. Conclusion Balloon sphincteroplasty is an effective and safe adjunct in patients who do not achieve bile duct stone clearance with Sphincterotomy and balloon/basket trawl alone, allowing clearance rates to exceed current guideline recommendations. Reference 1 Wilkinson, et al . BSG ERCP – the way forward, A standards framework. 2014. http://www.bsg.org.uk Disclosure of Interest None Declared
