PubMed Health⌕ Search

Biomedical subjects

E J Esber

Publications and source records attributed to E J Esber.

5 recordsLinked to original sources
PubMed1996

The interface of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.

The expanding use of laparoscopic cholecystectomy in conjunction with intraoperative cholangiography and laparoscopic common bile duct exploration has caused a reexamination of the indications of preoperative ERCP. Several studies have demonstrated the benefits of early preoperative ERCP in patients with severe gallstone pancreatitis and acute cholangitis. Those patients with only mild biochemical or radiographic abnormalities suggestive of choledocholithiasis present a clinical dilemma. The optimal diagnostic and therapeutic approach in these patients will depend on the level of expertise of both the biliary endoscopist and laparoscopist. The interface of laparoscopic cholecystectomy and ERCP will continue to evolve as surgeons become more facile with the techniques of laparoscopic common bile duct exploration. When these laparoscopic skills become widely disseminated, the use of ERCP will most likely be relegated to its well-established role in the open cholecystectomy era.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Retroflexion of the sigmoidoscope for the detection of rectal cancer.

Flexible sigmoidoscopy is a procedure that is commonly used by primary care physicians for the evaluation of rectal disorders and for colorectal screening. Retroflexion of the endoscope improves views of the anorectum and rectal vault, which increases the diagnostic yield of sigmoidoscopy. We report three cases of rectal lesions that were not detected when flexible sigmoidoscopy was performed without retroflexion. The lesions were all malignant or premalignant. The illustrative cases demonstrate the value of retroflexion in flexible sigmoidoscopy for the detection of rectal lesions.

Adenocarcinoma↗
PubMed1994

Primary sclerosing cholangitis.

Primary sclerosing cholangitis (PSC) remains a disease of unknown etiology. The close association of PSC and inflammatory bowel disease (IBD), especially ulcerative colitis (UC), has been reconfirmed in numerous studies. Much has been learned about the pathogenesis, although the specific cause remains unknown. Copper overload and chronic hepatic bacterial infection have virtually been excluded as causes of PSC. Cytomegalovirus and reovirus remain under investigation. Familial clustering and HLA subtype similarities are seen in PSC with and without IBD. The finding of antineutrophil cytoplasmic antibodies (ANCA) in patients with PSC and those with UC suggests immunological features in the pathogenesis of PSC. Collected series of patients have better characterized clinical features of PSC. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have provided both diagnostic features and means of therapeutic intervention. Treatment of PSC is symptomatic (pruritus control and vitamin deficiency correction); or experimental (D-penicillamine, ursodeoxycholic acid [UDCA], methotrexate, or corticosteroids). Liver transplantation remains the ultimate treatment for end-stage PSC. Statistical analyses of clinical and laboratory variables in PSC help to determine prognosis and proposed timing for transplantation to achieve maximal longevity and quality of life. PSC affects middle-aged people and is expensive to treat over the natural course of the disease, making it an economically and medically important disease.

Adult↗