BACKGROUND/AIMS: Endoscopic procedures such as sphincterotomy and endobiliary stenting have proved useful to solve postoperative bile leakage. We have assessed the outcome of a series of such patients initially treated with endoscopic sphincterotomy, having reserved stent placement for treatment failures only. METHODOLOGY: Twenty-five consecutive patients referred for endoscopic assessment of postoperative bile leaks and fistulas after cholecystectomy (n = 15), orthotopic liver transplantation (n = 9) and hepatic resection due to cystic hydatid disease (n = 1) underwent endoscopic retrograde cholangiopancreatography and sphincterotomy using a standard papillotome. Sphincterotomy was followed by stone extraction using a Dormia basket if common bile duct lithiasis were present. RESULTS: Bile leaks healed early after endoscopic sphincterotomy in 22 out of 25 patients (88%). Common bile duct stones were also retrieved in 6 of these patients. Bile duct stenosis due to surrounding pancreatic inflammation was demonstrated in two of the patients in which sphincterotomy failed to stop bile leakage. CONCLUSIONS: Endoscopic sphincterotomy alone should at present be considered a highly effective treatment to resolve postsurgical bile leaks unless bile strictures are present.

Adult↗

PubMedDate not supplied

Endoscopic findings in a biennial follow-up program in patients with pernicious anemia.

BACKGROUND/AIMS: It is known that patients with pernicious anemia have a higher risk of gastric neoplasms. However, the optimal endoscopic follow-up in these patients has not been properly defined. This study was aimed to assess the usefulness of an endoscopic follow-up program. METHODOLOGY: We analyzed the endoscopic and histological findings of the first endoscopy performed in a group of 128 patients with the diagnosis of pernicious anemia who were referred to the Endoscopic Unit, and we evaluated the results of the biannual follow-up endoscopies made to 68 of them. RESULTS: The initial endoscopy did not provide evidence of any lesions in 107 patients (83.5%), and polypoid lesions were found in 12 cases (9.4%). The histological results showed gastric dysplasia in 3 patients (2.3%) and carcinoid tumor in 2 cases (1.6%). No cases of gastric carcinoma were found. During the endoscopic follow-up of 68 patients, in 52 of them (76.8%) there were no endoscopic findings, and raised lesions were detected in 8 patients (11.8%). Three cases of gastric dysplasia were found. No cases of gastric carcinoma or carcinoid were detected during the follow-up. CONCLUSIONS: We suggest that a biannual endoscopic follow-up in not useful for the early detection of gastric neoplasms in patients with pernicious anemia.

Adenocarcinoma↗

PubMedDate not supplied

Endoscopic sclerotherapy to arrest uncontrolled variceal bleeding in cirrhotic patients with high surgical risk.

BACKGROUND/AIMS: In 20-50% of patients bleeding from esophageal varices, conservative procedures fail to obtain hemostasis and prevent early recurrence. METHODOLOGY: We retrospectively analyzed the efficacy and safety of endoscopic sclerotherapy in 66 cirrhotic patients with high surgical risk and persistence or recurrence of variceal bleeding in spite of adequate medical treatment (somatostatin and/or balloon tamponade). RESULTS: Emergency sclerosis controlled bleeding in 46 out of 66 patients (70%). The remaining 20 patients underwent additional procedures to arrest the hemorrhage, and 6 died because of massive bleeding. Early rebleeding occurred in 5 patients (10%). The mortality within 2 days, 1 week, and 6 weeks was 9%, 17% and 32%, respectively. Death was attributed to hemorrhage in 9 cases. Sclerotherapy was associated with complications in 9 patients (14%). CONCLUSION: These results suggest that emergency sclerotherapy is a safe and effective procedure in cirrhotic patients with high surgical risk and persistence or recurrence of bleeding after conservative hemostatic procedures.

Adult↗