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J M Canard

Publications and source records attributed to J M Canard.

At least 19 recordsLinked to original sources
PubMed2000

Prospective multicenter study comparing a standard reusable sphincterotome with a disposable triple-lumen sphincterotome.

BACKGROUND: Few data are available on the comparative performance of different types of sphincterotome. The aim of this study was to compare the efficacy of endoscopic sphincterotomy performed with either a reusable, single-lumen sphincterotome or a disposable triple-lumen instrument. METHODS: Seventy-seven consecutive adults requiring endoscopic sphincterotomy were prospectively and randomly assigned treatment with either a standard reusable single-lumen sphincterotome (group A, n = 38) or a disposable triple-lumen sphincterotome with a guidewire (group B, n = 39). The success rate, complications, and cost of the procedure per patient were compared. RESULTS: Deep cannulation was successful in 87% of cases in each group and sphincterotomy was achieved in 76% and 84% of cases in group A and B, respectively (NS). In the endoscopists' opinion the two instruments performed almost equally well. Twelve procedure-related complications occurred: 5 (all hemorrhages) in group A and 7 (1 hemorrhage, 4 cases of pancreatitis and 2 of cholangitis) in group B (NS). Eight reusable sphincterotomes were used with a cost of $61 per patient, compared with 39 disposable sphincterotomes with a cost of $241 per patient (p = 0.02). CONCLUSIONS: A standard reusable sphincterotome is satisfactory for most endoscopic sphincterotomies, and yields a substantial cost savings without compromising the success or safety of the procedure.

Aged↗
PubMed1997

Diagnostic strategies for extrahepatic cholestasis of indefinite origin: endoscopic ultrasonography or retrograde cholangiography? Results of a prospective study.

BACKGROUND AND STUDY AIMS: Due to its lower morbidity, it has been suggested that endoscopic ultrasonography (EUS) might replace endoscopic retrograde cholangiography (ERC) in the management of extrahepatic cholestasis of unknown origin. The present study aimed to compare the diagnostic accuracy of EUS and ERC in the management of cholestasis of unknown origin, taking into account the patient's general status and the necessity of endoscopic therapy. PATIENTS AND METHODS: Sixty-eight patients with cholestasis of unknown origin were studied prospectively. EUS followed by ERC was carried out on a blinded basis by two endoscopists; diagnostic and therapeutic suggestions were made after either examination. During the ERC procedure and before withdrawing the tube, the endoscopist provided the final conclusions and carried out appropriate endoscopic treatment. RESULTS: A correct diagnosis was obtained with EUS and ERC in 94% and in 92% of cases, respectively (not significant). After EUS, diagnostic ERC was necessary for diagnosis and therapy in 24% and 58% of cases, respectively. After ERC, EUS was requested in 41% of cases. The higher the American Society of Anesthesiologists (ASA) grade, the less it was necessary to perform a complementary investigation. In ASA grade 1 patients, endoscopic therapy was suggested in 38% of cases after EUS and in 33% after ERC (not significant); in ASA grade 3 patients, it was suggested in 93% of cases. CONCLUSIONS: The diagnostic sensitivities of EUS and ERC are similar for extrahepatic cholestasis. ERC is first indicated in poor candidates for surgery, since endoscopic therapy is frequently required. In good candidates for surgery, EUS should be carried out first in order to stage a tumor or identify choledocholithiasis.

Adult↗
PubMed1995

Value of endoscopic ultrasonography in the diagnosis of common bile duct stones: comparison with surgical exploration and ERCP.

An accurate and safe preoperative method of imaging the common bile duct is essential for the proper diagnosis of calculous biliary tract disease, especially in the current era of laparoscopic cholecystectomy. The value of endoscopic ultrasonography in detecting common duct stones has been reported, albeit in small series. The aim of this retrospective study was to assess the accuracy of EUS in a large series of patients. We compared EUS to direct cholangiography in the evaluation of 422 patients for common duct stones. Ductal stones were imaged by EUS in 168 patients (43.4%). No complications were encountered. EUS failed in 2.3% of cases, ERCP failed in 8.3%, and surgical exploration failed in 0.5%. Comparison of EUS with surgical exploration in 185 patients showed a sensitivity of 94.9%, a specificity of 97.8%, and an accuracy of 95.9%. EUS was compared to ERCP in 219 patients. All common duct stones found by ERCP were evident by EUS. Concordance was obtained in 91.3% of cases. Review of videotapes disclosed 3 false-positives and 16 unequivocal true-positives. We conclude that EUS is a safe and highly accurate means of detecting common duct stones and should be proposed before laparoscopic cholecystectomy in patients at risk of choledocholithiasis.

Adolescent↗
PubMed1993

AIDS-related cholangiopathy. Critical analysis of a prospective series of 26 patients.

Several types of biliary tract abnormality of undetermined origin have been described among AIDS patients. The aims of this study are: (1) to evaluate whether biliary tree involvement is in fact one or several homogeneous morphological entities, (2) to specify the role of CMV or Cryptosporidium sp. infection, and (3) to evaluate the possible efficacy of treatment. Since ultrasound had revealed abnormality in the biliary tree, 26 consecutive AIDS patients underwent cholangiography. Cholangiograms enabled us to distinguish between two types of biliary tract involvement: (1) gradual and regular stenosis of the terminal portion of the common bile duct associated with dilation but without irregularity of the intrahepatic biliary ducts was present in 27% of our cases, and (2) distal stenosis of the extrahepatic biliary ducts combined with diffuse irregularity of the caliber of the intrahepatic bile ducts was present in 73% of our cases. Concomitant infection by CMV or Cryptosporidium sp. was significantly more frequent when intrahepatic duct irregularities were present (94%) than when absent (14%, P < 0.001). Anti-CMV treatment and sphincterotomy were unsuccessful in treating anomalies of the intrahepatic biliary tract. Conversely, sphincterotomy caused rapid and lasting disappearance of pain in all our patients. In conclusion, biliary tract involvement in AIDS patients is of two types. CMV infection and infection by Cryptosporidium sp. are most frequent when the large intrahepatic ducts are implicated.

AIDS-Related Opportunistic Infections↗
PubMed1988

[Acute cholecystitis after placement of biliary endoprosthesis. Treatment by percutaneous cholecystostomy].

Seven cases of acute cholecystitis (4 women and 3 men, mean age 73 years) were observed in a series of 192 patients treated by endoprosthesis for cancerous obstruction of the bile ducts between october, 1984 and october, 1986. The suspected clinical diagnosis was confirmed by ultrasonography. Cholecystostomy was performed by percutaneous puncture under ultrasonic guidance. A catheter was positioned in the gallbladder by the Seldinger technique in 3 cases and by the trocar technique in 4 cases. Pain in the right hypochondrium was relieved in all patients immediately after emptying of the gallbladder. Five patients were cured. One patient developed purulent peritonitis which was treated by surgery. A female patient died of her pancreatic cancer 3 days after cholecystostomy. Provided a number of precautions are taken to prevent leakage of the infected bile into the peritoneal cavity, percutaneous cholecystostomy is the treatment of choice for acute cholecystitis consecutive to biliary endoprosthesis.

Acute Disease↗
PubMed1987

[Extracorporeal lithotripsy. Preliminary results in 5 patients with calculi of the common bile duct].

Extracorporeal lithotripsy was performed in 5 patients whose stones in the main bile duct could not be extracted despite wide endoscopic sphincterotomy, conventional extraction techniques (basket and balloon catheter) and attempts at mechanical lithotripsy. Fragmentation of the stones was obtained in one session in 4 patients. The fragments were spontaneously expelled in 2 patients, while additional endoscopic manoeuvres (mechanical lithotripsy, extraction after installation of a temporary prosthesis) were necessary in the other 2 patients. Failure in the 5th patient was due to the impossibility to focus the point of convergence of the shock wave on the stones. No complication related to the technique was observed.

Aged↗
PubMed1987

Intracorporeal electrohydraulic shock wave lithotripsy of common bile duct stones: preliminary results in 7 cases.

We performed contact endobiliary electrohydraulic shock wave lithotripsy in 7 high-risk patient with unextractable common bile duct stones after EPT. The lithotripsy electrode was brought into contact with the stone through a percutaneous transhepatic approach in 5 cases and an endoscopic route in 5 cases. Firing of the shock wave was performed under fluoroscopic control in 4 patients and under endoscopic guidance via a transhepatic percutaneous cholangioscopy in 2 and peroral cholangioscopy in one case. Stones were fragmented in all the cases but one. Fragments were evacuated into the duodenum by simple lavage through the transhepatic drain in 5 cases, and by duodenoscopy in one. In 2 patients, hemobilia, which was controlled by transfusions, was observed. This type of percutaneous contact lithotripsy requires multiple maneuvers, which increase the risk and the hospital stay. Extracorporeal shock wave lithotripsy is simpler, but also has disadvantages. Peroral lithotripsy under endoscopic control performed immediately after EPT would be the most practical solution, but this technique implies the use of new fiberscopes and other energy supplies that are easier to handle.

Aged↗