Endoscopic Papillotomy Research Articles

Duodenoscopic papillotomy and gallstone removal.

Using an experimental insulated duodenoscope and a diathermy wire, papillotomy has been performed on 10 patients under diazepam sedation. Seven patients had common bile duct stones (6 following cholecystectomy) and 3 had papillary stenosis. Nine of the patients had severe medical or surgical contraindications to further operative treatment. Papillotomy was successful in all patients, with no significant bleeding or other complications. Repeat endoscopy 6-14 days after papillotomy demonstrated a healed biliary orifice of 7-10 mm diameter. Stones had already passed in 3 of the 7 patients; in 2 others, stones were extracted using balloon catheters or Dormia type baskets. Two larger stones could not be removed; in one of these patients the stone and basket became impacted at the papilla and had to be removed surgically 2 days later. Endoscopic papillotomy is an acceptable alternative to surgery in high risk patients, particularly in the treatment of retained common bile duct stones. If long term results prove satisfactory, the technique will have wider application.

Valeur clinique de la papillotomie par voie endoscopique

Distentionof sphincter and transduodenal papillotomy are routine methods in the surgical treatment of non-malignant papillar stenosis. Because of its good functional results, which have also been confirmed by later controls, transduodenal papillotomy has particularly asserted itself. The darker side of this proceeding is its 4.2 comparatively high percentage of lethality. The first experiments in the field of endoscopic papillotomy show that this method brings the same good results, avoiding laparotomy, than transduodenal papillotomy, and furthermore affords a twice and a half lower lethality.

Manometric Studies during ERCP and Endoscopic Papillotomy

Manometric Studies during ERCP and Endoscopic Papillotomy

The new look into the gastrointestinal tract

Esophagogastroduodenoscopy has proved to be the most accurate method of diagnosing disese of the upper gastrointestinal tract. Endoscopic technics already are being employed for the treatment of gastric polyps. Experimental work on endoscopic treatment of upper gastrointestinal bleeding is under way in several medical centers. A variety of methods are being tested: laser photocoagulation, suture clip placement and the use of bioco+mpatible tissue glues. Endoscopic retrograde cholangiopancreatography now is established as a useful technic in the diagnosis of biliary tract disease. Its diagnostic usefulness in the pancreas is confined to certain diseases in which it is desirable to determine the need for operative intervention. The initial success of endoscopic papillotomy and stone extraction promises further future therapeutic uses for ERCP. Colonoscopy may well prove to be the most useful of the gastrointestinal endoscopic methods. It is particularly helpful in diagnosing colonic cancer, in determining the source of occult colonic bleeding and in providing information regarding idiopathic colonic inflammatory disease. The success of polypectomy indicates the possibility of substituting endoscopic treatment for invasive surgery. Laparoscopy in conscious patients is a well-established technic that is useful in gastroenterology, hepatology, oncology and gynecology. Its usefulness has long been appreciated in other countries and the method merits wide use in the United States. Endoscopy is a rapidly changing and evolving field. This monograph has attempted to outline the current state of the art, but many changes are expected in the next 5-10 years.

Endoscopic papillotomy and removal of gall stones.

Endoscopic papillotomy was attempted in 59 patients with extrahepatic obstruction of the biliary duct system and was actually performed in 50 patients. A special high-frequency diathermy knife was introduced via a duodenoscope into the terminal common bile duct and the roof of the papilla was incised. In 33 out of 39 patients with choledocholithiasis the stones passed into the duodenum spontaneously or were removed endoscopically. Papillary stenosis without ductal stones was successfully treated with this method in eight out of 11 patients. One perforation of the duodenocholedochal junction occurred and was repaired surgically. Endoscopic papillotomy and stone extraction is a relatively safe and effective method of treating extrahepatic jaundice.

Endoscopic Papillotomy

Experimental studies carried out in 11 dogs have shown that, with the aid of a high frequency diathermy probe, satisfactory papillotomies can be performed. On the basis of these results, endoscopic papillotomies have been carried out in 23 patients. Indications for papillotomy were biliary calculi in 11 high-risk patients, in 6 cases calculi overlooked during bile duct surgery, and in 3 patients recurrent calculi after previous cholecystectomy. In 3 patients circumscribed papillary stenosis indicated endoscopic papillotomy. Papillotomy was successful in all 23 cases. In 9 cases the calculi had been passed spontaneously after 3-5 days. In 10 patients the stones had to be extracted using the Dormia basket or a wire loop, and in one patient the stone had to be removed surgically. In one of these patients endoscopic papillotomy was followed by an attack of pancreatitis which subsided after 3 days. Further complications, in particular the occurrence of massive bleeding after papillotomy, were not observed.

Endoscopic Sphincterotomy of the Ampulla of Vater

A 44-year-old woman was admitted with severe epigastric pain and jaundice seven months after cholecystectomy. Retrograde cholangiography revealed a solitary floating stone in the common bile duct. Endoscopic electrosurgical papillotomy was successfully performed and the stone was extracted with a basket-tipped catheter. During a total of 11 papillotomies no complications were noted. Of these cases stones were completely removed in 7. Follow-up observations were negative in regard to stenosis, secondary inflammation of the bile ducts or reflux pancreatitis.

Endoscopic papillotomy and removal of gall-stones: animal experiments and first clinical results (author's transl)

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study