[Tangencies between urology and gastroenterology].
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Aged↗
Biomedical subjects
E M Mathus-Vliegen
Publications and source records attributed to E M Mathus-Vliegen.
[Tube feeding and decision policy].
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Decision Trees↗
Intragastric balloons for morbid obesity: results, patient tolerance and balloon life span.
Sixty morbidly obese patients were treated with 88 intragastric balloons. An air-filled intragastric balloon was used, which was permanently connected to an inflation catheter exiting through the nose. Patients were evaluated for loss of body weight and tolerance of the balloon; the balloon was inspected for efficacy and safety. A mean total loss of body weight of 21 kg was obtained after a mean of 39 weeks in 15 men (mean age 37.7 years) and 45 women (mean age 36.2 years), with a mean initial weight of 127.9 kg. The maximum rate of weight loss occurred in the first 6 months, with a steady decrease of 1 kg per week; thereafter the rate declined. Subjective complaints were infrequent and consisted of nasal discomfort or abdominal symptoms. Intolerance in 12 per cent of patients was due to enhanced hunger (one patient), nasal pulling sensation (four patients) and symptomatic ulcer (two patients). Fifteen patients asked for removal of the well functioning balloon after a mean of 169 days; 14 of the 15 balloons were still airtight. Forty balloons failed prematurely. Nine were retrieved orally and 31 were passed per anum, of which 28 passed with mild abdominal cramping, two patients required transabdominal puncture and one needed laparotomy. Even the 40 prematurely removed balloons remained in situ for a mean of 108 days; only one-third showed leakage. As yet, 33 well functioning balloons have been in situ for a mean of 167 days. Well functioning balloons deflated at a rate of 2.3 ml per day. Malfunctioning of the balloon was due to leakage in 12 cases and to clogging of the inflation catheter in three cases. Major complications (8 per cent) included two gastric ulcers and three cases of mild ileus. One ileus patient required surgery (2 per cent). The reported intragastric balloon model is effective and safe. We recommended this type of balloon as a weight reducing adjuvant therapy before bariatric surgery.
Adolescent↗
Intragastric balloon in the treatment of super-morbid obesity. Double-blind, sham-controlled, crossover evaluation of 500-milliliter balloon.
A prolonged randomized, prospective, double-blind, crossover study, including a sham-sham-treated group, was undertaken to evaluate the efficacy and safety of a 500-mL gastric bubble (Ballobes; DOT ApS, Rödovre, Denmark) as an adjunct to diet, physical training, and behavioral modification. Only supermorbidly obese patients who fulfilled the usual criteria for surgery were admitted. A weight loss of 38 kg in the first 17 weeks and another 12 kg in the second 18 weeks could be achieved. The body mass index, the percentage of overweight and the loss in percentage of initial weight, paralleled this impressive weight loss. In the second period, a plateau effect occurred after the massive changes in the first period, and only one third of the changes in all parameters was seen. Stratification into a sham-sham, sham-balloon, balloon-sham, and balloon-balloon group did not show any statistical difference for all parameters between the four groups. The double-blind nature of the study was affirmed by the patient's correct judgment of the presence or absence of a balloon in only 21% of the balloon and 44% of the sham procedures. Gastrointestinal complications were infrequent and consisted of erosions (three patients), asymptomatic reflux oesophagitis (one patient), and asymptomatic gastric ulcer (one patient). Only the latter patient had elevated gastrin levels. One patient could not tolerate the balloon. All balloons remained airtight during both parts of the study for a mean of 123 days. This study confirmed the safety of the balloon, but no additional benefit could be ascribed to the balloon compared with a very low-calorie diet and medical and dietary support.
Adult↗
Analysis of failures and complications of neodymium: YAG laser photocoagulation in gastrointestinal tract tumors. A retrospective survey of 18 years' experience.
Eight years of experience with endoscopic Nd:YAG laser photocoagulation were analyzed in retrospect in an attempt to identify factors relating to both failures and complications of laser therapy, and to delineate its limits and pitfalls in benign and malignant tumors. Three hundred and seventy-eight patients were studied, including 42 with gastroesophageal cancer, 180 with colorectal adenoma and 156 with colorectal malignancy. Patients with gastroesophageal cancer (n = 42) were referred mainly for obstruction in esophageal cancer and for bleeding in gastric cancer, with successful palliation in 86 and 81%. Hemorrhage was the only complication seen, twice during and twice after treatment. Pain, heat and smoke-induced complaints and sometimes temporary increased dysphagia were mentioned. Two white-surfaced tumors did not react at all. Patients with colorectal adenoma (n = 150) were divided into groups according to the size of the lesion. Definitive, histologically documented eradication of adenomatous tissue was achieved in 43% of the extensive, in 69% of the intermediate, and in 97% of the small adenomas. Major complications, mainly stenosis and hemorrhage, occurred in 6.4%, 7.6% and none of the lesions, respectively, and minor complications were seen in 57.4, 30.8 and 13.8%, respectively. Stenosis appeared to be related only to prior electrocoagulation and to excessive delivery of energy. Post-treatment hemorrhage occurred at about day 7. In familial polyposis (n = 30) surveillance of the rectal stump was successful in 84%, with major and minor complications in 4% and 12%. In colorectal cancers (n = 156) treated for palliation of bleeding and obstruction, success was obtained in 91%. major complications (13%) consisted mainly of stenosis and perforation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenoma↗
[Angiodysplasias in the digestive tract and associated cardiovascular diseases].
To clarify the possible relationship between angiodysplasia of the gastrointestinal tract and cardiovascular disease, we performed a retrospective study of 58 consecutive patients. In all patients angiodysplasias were identified endoscopically. The median age was 72 years. Fifty-seven per cent of the patients had some clinically obvious cardiovascular disorder. Mitral valve insufficiency was found more often (21%) than aortic valve stenosis (10%). A high incidence of coronary artery disease (45%) and peripheral artery disease (10%) was noted. These findings do not support the concept that angiodysplasia occurs principally in combination with aortic stenosis. The aetiology of these vascular lesions is presumably multifactorial. The vast majority of the lesions seems to be acquired and at least a subgroup is probably an expression of degenerative processes of aging.
Adult↗
Laser treatment of intestinal vascular abnormalities.
Mucosal vascular abnormalities, including haemangioma, angiodysplasia and telangiectasia, are thought to be responsible for one third of chronic lower gastrointestinal blood loss. One hundred and ninety-one patients were referred for endoscopic diagnosis and treatment of acute or chronic blood loss. In 24 (13%) of patients no bleeding source could be found, in 23 (12%) laser treatment was not indicated and in another 23 (12%) follow-up was insufficient. Of 121 evaluable patients, 107 had angiodysplasia with colonic localisation in 54, 9 had telangiectasia diffusely within the digestive tract, and 5 haemangioma with colonic location in 3. In angiodysplasia effective haemostasis was obtained in 78% with a recurrence rate of 34% at prolonged follow-up, which responded to treatment in 82%. In patients with Rendu-Osler-Weber disease the haemostasis rate was 56%, with recurrence occurring in 33% and a retreatment response in 21%. Colonic haemangioma responded in 67% of cases but there was a high recurrence rate of 67% and a low retreatment response (33%). There were five major complications and all occurred with colonic angiodysplasia (5/54, 9.3%). These included serosal irritation (2), CO2 distension (1) and posttreatment bleeding (2). Minor complications consisted of CO2 retention in one case treated for angiodysplasia, and fever (1) and posttreatment bleeding (2) in haemangioma. Effective and safe haemostasis can be obtained by Neodymium-YAG laser-photocoagulation in often difficult circumstances without perforation or mortality. The method has proven to be indispensible for elderly and inoperable patients with intestinal vascular abnormalities.
Adult↗
[A blood pressure cuff for everybody: a recommendation].
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Adult↗
[Intragastric balloon in the treatment of morbid obesity].
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Adolescent↗
Laser photocoagulation in the palliation of colorectal malignancies.
Besides surgical intervention, there are virtually no palliative treatment modalities available for bleeding and/or obstructing colorectal malignancy. The usefulness and safety of laser photocoagulation was prospectively investigated in 63 patients with colorectal cancer. The merits were evaluated in the treatment of obstruction (16 patients), bleeding (32 patients), and combined hemorrhage and obstruction (15 patients). Luminal patency could be restored in 15 (94%), hemostasis was achieved in 28 (88%), and treatment was effective in 13 (87%) patients with bleeding and obstructing tumors. In the 56 evaluable and initially responding patients, no beneficial long-term results were achieved in six patients, as major complications of (re)stenosis, necessitating colostomy, occurred in three, posttreatment hemorrhage with need for blood transfusion in two, and a pararectal abscess formation was seen in one patient. Except probably for this pararectal abscess, there was no treatment-related death. Transient stenosis and laser-induced bleeding, as minor complications present in 12 (19%), responded favorably upon reinstitution of laser photocoagulation. The beneficial effect of laser photocoagulation was, in general, evident after 2 to 3 sessions. Forty-six patients could be discharged from the hospital and their treatment could be continued in the outpatient clinic. Further hospital admission could be avoided in 39. Laser treatment for palliation of obstructing and/or bleeding colorectal cancer proved to be an efficacious, safe, and rapidly effective therapy. Laser photocoagulation can be considered as a valuable alternative to aggressive surgical intervention in the absence of other conservative treatment modalities in palliation.
Aged↗
Laser photocoagulation in the palliative treatment of upper digestive tract tumors.
The efficacy and safety of laser photocoagulation in the palliative treatment of patients with esophageal and gastric cancer was evaluated in a series of 15 patients. Fourteen patients suffered from adenocarcinoma and 1 from carcinosarcoma. In esophageal tumors, obstruction was present in 6, bleeding in 1, and obstruction and bleeding in 3. Gastric bleeding necessitated treatment in five. All patients suffered from severe end-stage disease. Luminal patency was restored in five patients with esophageal obstruction. Hemostasis was achieved in all bleeding esophageal and gastric cancers. Favorable response was also obtained in two of the three patients with a combination of esophageal obstruction and bleeding. The beneficial effect was remarkable; only a few laser sessions over a short period were needed. All patients could be discharged at short notice, and further laser treatment could be continued on an outpatient basis. Major complications were not encountered. The results in the patients show that laser photocoagulation can be a useful, efficacious, and safe tool in palliation for obstruction and/or bleeding in the upper intestinal tract.
Adult↗
Upper intestinal and biliary tract endoprosthesis.
The endoscopic insertion of an endoprosthesis is now a standard procedure in the ultimate palliation of malignant obstructing upper gastrointestinal and biliary malignancy. The commercially available prostheses and introducing devices are adequate for the majority of upper intestinal cancers. For some stricturing lesions, especially when associated with fistula formation, individual adaptation of a tygon prosthesis with extra widening rings is often necessary. Nd: Yag laser vaporisation of mainly exophytic cancerous tissue is mainly indicated for those circumstances which are less amenable to prosthesis insertion such as total luminal obstruction, noncircumferential tumorous involvement, polypoid cancers, excessively necrotic and chronically bleeding tumors, lesions extending within 2 cm of the upper esophageal sphincter, markedly angulated cancers of the cardia with almost horizontal tube positioning and cancerous overgrowth occluding the funnel opening. Overall successful insertion occurs in over 90% of patients. Main complications are perforation 5-8% and early or late dislocation. The procedure related mortality fluctuates around 2 to 4%. Overall results with laser application are roughly comparable. The dysphagia free intervall after laser is only around 6 weeks for the majority of the patients. Transpapillary insertion of a straight Amsterdam-type prosthesis rapidly became a standard procedure for palliation of malignant jaundice. For many patients with pancreatic cancer this endoscopic approach competes favorably with corresponding surgical palliative alternatives. Disappearance of jaundice is to be expected in the vast majority of the patients. The only major unsolved problem remains late clogging with biliary sludge which necessitates insertion of new prostheses. Most problematic to breach are bifurcation tumors. Cholangitis is a major complication if one does not succeed at the first attempt to drain both liver lobes.
Biliary Tract Neoplasms↗
Therapeutic investigations in primary sclerosing cholangitis.
There is no consensus about the necessity and the possibility of therapy in primary sclerosing cholangitis. In some patients rapid deterioration of liver function may occur due to recurrent cholangitis and cholestasis. In one such patient, we obtained radiological evidence that the cholestasis was caused, not entirely by end-stage fibrotic scarring as interpreted upon surgical exploration, but, at least in part, by biliary stasis secondary to marked irregular narrowing of the extrahepatic bile ducts, together with precipitate formation. Moreover, the biliary ductular narrowing appeared to be partly reversible, indicating that edema and inflammation were responsible for part of the narrowing. These observations prompted us to evaluate topical lavage by nasobiliary drainage, first with saline, and then followed by corticosteroid solution in eight consecutive patients with recurrent cholangitis. Based upon clinical and biochemical evaluation, our preliminary results may be summarized as favorable. However, a large-scale multicenter controlled study will be required to prove the usefulness of this approach.
Adolescent↗
Multiple angiomatous proliferations of ileal stoma following Campylobacter enteritis. Effect of laser photocoagulation.
Multiple polypoid sessile tumors arose at the tip of the ileal stoma of a 37-year-old man, who previously underwent proctocolectomy for ulcerative colitis. The lesions developed shortly after a well-established gastrointestinal infection with Campylobacter jejuni with mucosal ulceration. The histological and ultrastructural examination showed angiomatous proliferations, reminiscent of pyogenic granuloma. The destruction of the tumors by laser photocoagulation was followed by superficial ulcerations of the mucosa, which healed without scarring. Small recurrences, however, could not be prevented.
Adult↗
Nd:YAG laser photocoagulation in colorectal adenoma. Evaluation of its safety, usefulness, and efficacy.
The usefulness, efficacy, safety, and tissue effects of Nd:YAG laser photocoagulation were investigated prospectively in 100 patients. Sixty-seven elderly patients with colorectal adenoma and 21 patients with rectal stump polyps after colectomy and ileorectal anastomosis in familial polyposis were evaluated. We subdivided our patients into those with extensive, intermediate, and small lesions, and we assessed completeness of tumor ablation, recurrence, and complications in all three groups. In the extensive group only 8 patients achieved complete (i.e., gross endoscopic and histologic) tumor ablation, whereas in 18 patients adenomatous tissue persisted or recurred after a tumor-free interval. In the intermediate group complete tumor ablation was achieved in 10 of 22 patients. Small adenomas were completely ablated in 18 of 19 patients. Five instances of carcinoma were detected in each subgroup of nonresponding extensive (18 patients) and intermediate (12 patients) lesions at follow-up. Prior to laser photocoagulation, symptoms such as watery diarrhea, excessive mucous discharge, hypokalemia, dehydration, and hematochezia and iron-deficiency anemia were present in 16 of 26 patients with extensive adenoma and in 13 of 22 patients with intermediate adenoma. Symptoms subsided during the course of treatment in all but 1 patient, even with the absence of complete ablation. Major complications, consisting of bleeding, symptomatic stenosis, or perforation occurred in 11.6% with extensive adenomas, in 9.1% with intermediate adenomas, and in none with small adenomas. Minor complications such as transient asymptomatic stenosis, minor posttreatment hemorrhage, pain, and "serositis" occurred in 30.9% with extensive lesions, in 27.3% with intermediate lesions, and in 10.6% with small lesions. There was no mortality. Treatment of multiple tiny polyps in 21 patients with familial polyposis was easy and efficient, without retraction and scarring, and without complications. We have concluded that laser photocoagulation is safe and uniformly effective in the ablation of small colorectal adenoma and in recurrent polyps in patients with familial polyposis. In patients with intermediate or large adenomas, symptoms are highly responsive to treatment, but complete tumor ablation--as documented upon repeated endoscopy and multiple biopsies--can only be expected in approximately 40%-50% in long-term follow-up. The high incidence of cancers in these two groups (21%) underscores the need for continued surveillance and frequent biopsy. Major and minor complications will occur in 40% in these sizeable lesions, being of clinical importance in only 10%.(ABSTRACT TRUNCATED AT 400 WORDS)
Adenoma↗
Intraoperative endoscopy: technique, indications, and results.
The technique, indications, and results of intraoperative total enteroscopy were evaluated in 10 patients. A good diagnostic and therapeutic result was achieved in two circumstances: chronic recurring blood loss in the elderly and intussusception in young adults with Peutz-Jeghers syndrome. Endoscopic coagulation of vascular abnormalities and polypectomy were accomplished so that bowel resection could be limited.
Adult↗
Laser ablation and palliation in colorectal malignancy. Results of a multicenter inquiry.
The role of laser photocoagulation in the palliative treatment of gastrointestinal tumors was investigated in a multicenter inquiry involving seven laser centers and 181 patients. Patients with colorectal malignancies were divided into three groups: those referred for palliation of obstruction (N = 60), those referred for bleeding (N = 81), and those referred for obstruction and bleeding (N = 40). Good palliation was obtained in 89%, with a complication rate of 9.4% and a laser-related mortality of 1.1%. Tumor response, complication rate, mortality, and duration of survival were less favorable in the group with obstructing tumors when compared to those with bleeding or with bleeding and obstruction. Laser phototherapy should play a role as an alternative to surgery in selected patients with bleeding and/or obstructing colorectal cancer.
Adult↗