Using resources wisely: determining the indication for staging laparoscopy.
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Ampulla of Vater↗
Biomedical subjects
Bruce Schirmer
Publications and source records attributed to Bruce Schirmer.
Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation.
PURPOSE: To evaluate the efficacy of fluoroscopically guided balloon dilation (FGBD) in patients with symptoms of gastric outlet obstruction following surgery for morbid obesity. MATERIALS AND METHODS: Forty-one FGBDs were performed in 28 patients with symptoms of gastric outlet obstruction following gastric restrictive surgery for morbid obesity. The efficacy of FGBD was determined using five end points: (a) no recurring symptoms for an interval of at least 3 months, or recurring symptoms treated either (b) surgically, (c) with endoscopically guided balloon dilation (EGBD), (d) with FGBD, or (e) medically. RESULTS: Following initial FGBD, 11 of 28 patients (39%) remained asymptomatic during at least 3 months of follow-up. Recurrent dysphagia occurred in 17 patients (60%), who were treated either surgically (n = 3), with EGBD (n = 4), with FGBD (n = 9), or medically (n = 1). Of the nine patients who underwent a second FGBD, two became asymptomatic. The seven patients who remained symptomatic were treated with surgery (n = 3), EGBD (n = 1), or FGBD (n = 3). Of the three patients treated with a third FGBD, one became asymptomatic. Overall, FGBD was effective in 14 (50%) of 28 patients. CONCLUSION: Among patients with symptoms of obstruction following gastric surgery for morbid obesity, 50% experienced relief of symptoms following FGBD.
Adult↗
Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass.
BACKGROUND: Flexible upper endoscopy (FUE) is an important diagnostic and therapeutic tool in the management of upper gastrointestinal diseases. We examined the role of FUE in the management of patients undergoing Roux-en-Y gastric bypass (RYGBP). METHODS: All patients undergoing RYGBP at a single institution from 1986 to 2001 were studied. Preoperative FUE was performed by the surgeon to assess the anatomy of the esophagus, stomach, and duodenum. Since 1997, gastric biopsies were obtained, testing for the presence of H. pylori. Colonized patients were treated preoperatively. Postoperatively, FUE was performed by the surgeon as indicated clinically, for management of symptoms suggesting anastomotic stenosis, upper gastrointestinal bleeding, inflammation, or ulcers. Endoscopic balloon dilatation was performed as indicated. RESULTS: 560 patients underwent RYGBP during the study period. Of these, 536 underwent preoperative FUE. Endoscopic findings changed or altered the operative procedure in 26 patients (4.9%). Preoperative testing for H. pylori was performed on 206 patients, of whom 62 (30.1%) were positive. Patients tested for H. pylori had a lower incidence of postoperative marginal ulcers (n = 5, 2.4%) than did patients who did not undergo such screening (n = 354, 6.8%, P < 0.05). Postoperatively, 54 patients underwent 80 endoscopic balloon dilatations for stenosis of the gastrojejunostomy. In addition, 18 patients underwent 28 FUEs that proved negative for such stenosis. In addition, 64 patients underwent 88 additional diagnostic or therapeutic FUEs in the postoperative period, including investigation of symptoms of pain, bleeding, persistent vomiting, or weight regain. CONCLUSION: Upper endoscopy is a tool which may be used by the surgeon in the preoperative and postoperative management of patients undergoing RYGBP to modify therapy, improve outcomes, and diagnose and treat postoperative complications.
Anastomosis, Roux-en-Y↗