Endoscopic incision of a refractory esophageal stricture: novel management with an endoscopic scissors.
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Aged↗
Biomedical subjects
Michelle C Beilstein
Publications and source records attributed to Michelle C Beilstein.
Initial evaluation of a duodenoscope modified to allow guidewire fixation during ERCP.
BACKGROUND: Catheter/guidewire exchanges during ERCP require the coordinated efforts of an endoscopist and endoscopy assistant. A prototype duodenoscope was developed to improve the control of catheter/guidewire exchange by enabling fixation of guidewires at the elevator lever. METHODS: An initial prototype duodenoscope and a subsequent modification of this instrument were used to perform ERCP in 7 and 10 patients, respectively. The following were recorded: total procedure time, fluoroscopy time, catheter/guidewire exchange time, guidewire repositioning, loss of guidewire access, success or failure of fixation, and endoscopist satisfaction. OBSERVATIONS: The initial and the modified prototype duodenoscopes were used in a variety of catheter/guidewire exchanges (n=46). Guidewire fixation was achieved in 75% of catheter/guidewire exchanges with the initial prototype and in 93% with the modified prototype and was reflected in shorter exchange times. Access to the desired duct was not lost during any exchange, and the need for repositioning was eliminated. CONCLUSIONS: A new prototype duodenoscope with an elevator lever that enables guidewire fixation will improve the ease and efficiency of catheter/guidewire exchange during ERCP. Modifications made to the original prototype improved reliability of guidewire fixation.
Cholangiopancreatography, Endoscopic Retrograde↗
Clinical impact of endoscopic ultrasonography on the management of malignancies.
BACKGROUND & AIMS: There are limited data evaluating the clinical impact of endoscopic ultrasonography (EUS). We assessed the impact of EUS on management of known or suspected malignancies. METHODS: Physicians requesting EUS were contacted before the examination and asked: "How would you manage this patient if EUS were not available?" Pre-EUS responses were recorded on standardized forms, and compared with management recommendations as determined by the same requesting physician after EUS. Endosonographers performing the study were blinded to the pre-EUS responses. RESULTS: Responses were obtained from requesting physicians before and after EUS in 90 patients. Requesting physicians were composed of surgeons (33%), non-EUS-performing gastroenterologists (58%), oncologists (3%), internists (4%), and a pulmonologist (1%). After EUS, referring clinicians altered management plans in 46 of 90 patients (51%). By anatomic site, management changes occurred in 12 of 22 patients (56%) undergoing esophageal EUS, 9 of 15 (60%) undergoing gastric EUS, 21 of 43 (49%) undergoing pancreatic EUS, and 4 of 10 (40%) undergoing rectal EUS. There were no significant differences in the frequency of post-EUS management changes with respect to examination site (P = .76). EUS fine-needle aspiration (FNA) altered management in 9 of 20 (45%) patients. Management changes involved less complex or decreased risk-associated approaches in the majority (70%), and included 14 of 50 (28%) patients in whom surgical procedures were no longer planned. CONCLUSIONS: Based on EUS examination findings, clinicians requesting EUS alter patient management in one half of cases, and more often pursue a less-complicated approach. EUS substantially impacts clinical care, and should be used in appropriate settings to guide patient management.
Adult↗
Biliary endoscopy.
Highlighting this year was the National Institutes of Health (NIH) State-of-the-Science Conference on endoscopic retrograde cholangiopancreatography. The panel addressed controversies in biliary endoscopy and set the framework for future funding for clinical research endeavors. With respect to biliary endoscopy, the literature addressed therapy for malignant biliary obstruction, choledocholithiasis, and biliary complications post-liver transplant.
Journal Article↗