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Biomedical subjects

M Baize

Publications and source records attributed to M Baize.

28 records · Page 2Linked to original sources
PubMedDate not supplied

Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage.

Seventy patients with biliary obstruction secondary to hilar tumors underwent attempted endoscopic internal biliary drainage using large transpapillary stents between December 1981 and March 1986. Placement of one or more stents was successful in 68. The type of stricture and mode of treatment were more important in determining subsequent survival than the type of tumor. In type II and III malignant strictures of the bifurcation of the common hepatic duct and the main hepatic duct, use of two or more stents to achieve complete drainage of the biliary system improves survival compared to incomplete drainage (176 vs. 119 days) and reduces procedure-related mortality and the incidence of early and late cholangitis. Patients with hilar tumors causing type II and III strictures treated with placement of multiple stents have at least as good a prognosis as patients with tumor involving only the common hepatic duct treated with use of a single stent. Once ERCP is performed and palliative endoscopic management of bifurcation tumors is begun, it must completed as soon as possible.

Adenoma, Bile Duct↗
PubMedDate not supplied

Endoscopic biliary drainage in chronic pancreatitis.

Between April 1982 and March 1988, 25 patients with chronic pancreatitis presented with biliary stenosis and significant cholestasis. They were treated by endoprosthesis placement. Nineteen patients had jaundice, and, initially, seven had cholangitis (including three with hepatic abscesses). ERCP was successful in all 25 patients. Cholangitis, cholestasis, and jaundice resolved in all cases after stent placement. Two patients died in the 2 months after treatment. Complete follow-up (mean duration, 14 months, range 7 to 42 months) was available for 19 of the 23 remaining patients. Migration of the stent occurred in 10 patients and stent blockage in 8 patients, with relapsing cholestasis (N = 12), cholangitis (N = 4), or without symptoms (N = 2). Only three of these patients are now asymptomatic without a stent in place after 12 to 72 months. In all of the other cases, stents have been replaced or patients have been treated by surgery. We conclude that endoscopic biliary drainage is an effective treatment for resolving cholangitis or jaundice in patients with chronic pancreatitis and biliary stenosis, but that the results of definitive endoscopic drainage for these patients are less satisfactory because resolution of the stricture after removal of the stent is rarely obtained.

Adult↗
PubMedDate not supplied

Expandable biliary metal stents for malignancies: endoscopic insertion and diathermic cleaning for tumor ingrowth.

Seventeen patients with malignant biliary strictures have been treated by endoscopic insertion of self-expandable metallic prostheses. Two patients received two prostheses inserted simultaneously in both the left and right hepatic ducts for Klatskin tumor type III. Immediate results were satisfactory despite an operative mortality of 18%, and neither early nor late clogging was observed even in patients who presented previously with sludge above plastic stents that were removed. However, among five patients followed for more than 4 months, two presented with obstruction due to tumor ingrowth into the stent through the metallic mesh. Accordingly, initial enthusiasm concerning long-term patency of these stents has decreased. However, we describe a technique of "diathermic cleaning" of tumor ingrowth which can easily restore the stent patency. The advantages of these wire mesh 30 F stents are their easier insertion, better immediate drainage, and absence of dislocation or perforation.

Aged↗
PubMedDate not supplied

Endoscopic stenting for biliary strictures.

A consensus is growing among units that have an experience in both endoscopic and percutaneous stenting techniques that the endoscopic approach of malignant biliary strictures is more comfortable for the patient and provides less complications. This article describes endoscopic biliary drainage in different malignant stenosis of the bile ducts and delineates the respective indications of percutaneous and endoscopic techniques together with the possible combination of these two methods in selected cases. It also tackles the question of the medical surgical approach of the patients, which might, thanks to a better selection, reduce the morbidity and mortality associated with surgery. The indications of biliary stenting in benign strictures, namely post operative or chronic pancreatitis associated biliary stenoses, are also discussed. Recently, new materials became available for endoscopic and percutaneous biliary drainage, and particularly metallic self expanding stents which might provide a better palliation among these patients. If these stents fulfill their promise on longer follow-up, they may replace the conventional stenting devices.

Biliary Tract Neoplasms↗
PubMedDate not supplied

[Emergency intrahepatic shunt via transjugular approach].

We report the case of a cirrhotic 65 year-old woman presenting with persistent and recurrent variceal hemorrhage in spite of endoscopic sclerotherapy with bucrylate, glypressin infusion and balloon tamponade. At the time of intrahepatic shunt placement via the transjugular route, Child-Pugh score was 14 (Child C category) and surgical variceal decompression or liver transplantation were contraindicated. At the end of the procedure, which included the placement of two Palmaz stents, varices were no more opacified and the wedge hepatic venous pressure gradient had decreased from 70%. Evolution of the patient was excellent with a permeable shunt after one month. Emergency placement of intrahepatic shunt with metallic stent has certainly a place in case of failure of initial management of variceal bleeding with pharmacotherapy, sclerotherapy or balloon tamponade.

Aged↗
PubMedDate not supplied

Endoscopic management of chronic pancreatitis.

The indications of endoscopic management for chronic pancreatitis are strictly related to the classification of severe types and to the particular anatomy of the ducts: 1. Impacted or distal calculi: endoscopic pancreatic sphincterotomy (EPS) alone followed by ESWL when extraction fails. 2. Stone(s) and stricture: EPS, ESWL, NPC, and then 10F plastic stenting. 3. Relapsing strictures (with upwards dilatation) after 6 to 12 months stenting: silicone covered self expanding stent in a trial, versus surgical pancreaticojejunostomy. 4. Paraduodenal cyst bulging into the duodenum: ECD. 5. Jaundice and/or cholestasis due to stricture of the intrapancreatic CBD: 10F single or multiple plastic stent for calibration during 3 months. For relapsing cholestasis and stricture, 30F metal mesh stent versus surgical hepaticojejunostomy. The indications of endoscopic management for chronic pancreatitis are specific and require complete imaging and functional check up (ERCP, CT scanner, endosonography, pancreatic function tests). The technique is quite difficult and requires definition fluoroscopy, appropriate devices and experienced team. On this condition, the complication rate is very low and usually medically controlled. Treatment does not compromise any further surgery. Endoscopy allows to avoid or to postpone surgery which indication will become better defined and selected in the future.

Adult↗