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Biomedical subjects

R A Sanowski

Publications and source records attributed to R A Sanowski.

At least 19 recordsLinked to original sources
PubMed1999

Success of repeat ERCP by the same endoscopist.

BACKGROUND: The success rate of repeat endoscopic retrograde cholangiopancreatography (ERCP) by the same endoscopist after a failed initial attempt is unknown. It has been suggested that a repeat examination at a tertiary referral center be performed after an unsuccessful attempt. Our aim was to determine the success rate of repeat ERCP at a different endoscopic session by the same endoscopist and the outcomes among patients with a failed index procedure. METHODS: A review of 500 consecutive ERCP procedures was performed at a teaching institution. RESULTS: The overall initial success rate for cannulation of the duct of interest was 90.8% at index endoscopy. Endoscopy was repeated after 51% unsuccessful procedures, and access to the desired duct was achieved in 87.5% of repeat attempts. A needle knife was used in 21% instances, and its use facilitated cannulation of the duct of interest in 80%. No complications occurred with repeat ERCP. Of the 3 patients who underwent failed repeated ERCP, 1 was not available for the follow-up study, 1 had metastatic cancer, and the other had pancreas divisum. The outcomes among patients who did not undergo repeat ERCP included malignant disease diagnosed with other imaging techniques (35% of patients) and no further admissions or emergency room visits for suspected pancreaticobiliary symptoms (39% of patients). CONCLUSIONS: Repeat ERCP by the same endoscopist yields an 87.5% success rate. This leads to an overall success rate of 95%.

Bile Duct Diseases↗
PubMed1997

Esophageal self-expandable metallic stents--indications, practice, techniques, and complications: results of a national survey.

BACKGROUND: The gastroenterology community's experience with esophageal self-expandable metallic stents (SEMS) is unknown. METHODS: In order to assess indications, perioperative management, and self-reported complications associated with SEMS placement, a survey was mailed to ASGE members. RESULTS: Of 3414 surveys mailed, 212 (6.2%) were completed and returned. One hundred twenty-eight physicians had experience with a total of 434 SEMS. Most physicians practiced in the private sector (72%), and 75% had placed 3 or fewer SEMS. Perceived ease of placement was the most common reason for choosing a SEMS (55%). Fluoroscopic and endoscopic guidance was used by 83% of respondents, and 81% allowed liquid diet after correct position and patency had been confirmed; 56% of respondents discharged their patients within 24 hours of SEMS placement. The rates of failure for full expansion (7.1%), stent misplacement (4.8%), and failure to deploy (3%) were higher than previously reported. Acute patient complications and delayed bleeding occurred less frequently than in reported series but mortality rates were similar. CONCLUSIONS: Ease of placement is the main reason for choosing a SEMS. Differences in complication rates, compared to previous studies on SEMS, may be related to operator experience and protocol requirements. When compared to plastic stents, complications were less frequent.

Equipment Design↗
PubMed1997

A prospective evaluation of the endoscopic spectrum of overtube-related esophageal mucosal injury.

BACKGROUND: Placement of an overtube is required for endoscopic variceal ligation. The spectrum of overtube-related esophageal mucosal injury is unknown. We made a prospective comparison of two types of overtubes and a determination of the frequency, severity, and risk factors for overtube-related injury. METHODS: Two overtubes (60F, 20 cm, "new" overtube; and 60F, 25 cm, "old" overtube) were used and placed using the bougie-assisted technique. Mucosal integrity was documented before and after variceal ligation. Overtube contact time, bands number, setting (emergent versus elective), type of overtube, degree of coagulopathy, and development of symptoms after variceal ligation were recorded. RESULTS: Fifty sessions in 29 patients were analyzed; 24% of sessions were emergent. The old overtube was used in 24 sessions and the new in 26. Mucosal injury occurred in 72% of sessions. Mean overtube contact time was 11.58 +/- 0.97 minutes, the mean number of bands placed per session was 6.4 +/- 0.4, and the mean international normalized ratio was 1.47 +/- 0.06. No risk factors correlated with mucosal injury except for the old overtube, which was associated with tears (p = 0.02). CONCLUSIONS: Mucosal injury related to the overtube is frequent but clinically unimportant. Because mucosal tears occurred significantly more often with the old overtube, we suggest that its use should be avoided.

Adult↗
PubMed1992

Mercury bougie dilation of benign esophageal strictures.

Dilation with mercury filled bougies is the oldest and simplest technique available for treatment of benign esophageal strictures. In the majority of patients, mercury-filled dilators are effective and quite safe. Dilation is successful in 80-90%, and the rate of complication is less then 0.2%. Maloney dilators have superseded Hurst dilators because their tapered, flexible tip allows better guidance of the dilators into the lumen of the stricture. Several cautions are in order when using Maloney dilators. Dilation of difficult strictures should be observed by fluoroscopy to prevent misdirection of the dilator and esophageal perforation. Where possible, Maloney dilators should not be used to treat narrow, elongated, or angulated strictures. Dilation need not be rushed. Treatments may be repeated over months to years, both to achieve symptomatic relief initially and to maintain that state. Finally, patients susceptible to endocarditis require antibiotic prohylaxis prior to treatment.

Dilatation↗
PubMed1992

The effects of inhaled albuterol and oral theophylline on gastroesophageal reflux in patients with gastroesophageal reflux disease and obstructive lung disease.

Patients with gastroesophageal reflux disease may have pulmonary symptoms due to repeated aspiration of gastric contents or reflex bronchospasm during a reflux event. Oral bronchodilators are known to worsen gastroesophageal reflux and may lead to vicious cycle when gastroesophageal reflux causes bronchospasm. The effect of inhaled bronchodilators on gastroesophageal reflux is unknown. We compared the severity of gastroesophageal reflux in patients with documented gastroesophageal reflux disease and obstructive lung disease while they were taking inhaled albuterol or oral theophylline. Nine patients with gastroesophageal reflux disease had 24-hour esophageal pH studies on two separate days approximately 1 week apart. On one study day, the patients received 0.5 mg of albuterol in 2.5 mL of normal saline vias hand-held nebulizer, four times a day. On the other day, the patients received sustained-release theophylline, 200 mg twice a day, or in a dosage taken previously to achieve a serum theophylline level of 55 to 110 mumol/L. The patients had 40% reduction in the total time the pH was less than 4.0 with albuterol than with theophylline (9.7% vs 16.1%). Seven patients had less gastroesophageal reflux while taking albuterol, and two patients had essentially no change. Patients with gastroesophageal reflux disease, who require bronchodilator therapy for obstructive lung disease, have less reflux with inhaled albuterol.

Administration, Inhalation↗
PubMed1991

Monitoring of blood pressure and heart rate during routine endoscopy: a prospective, randomized, controlled study.

Six hundred and eighteen patients were randomized to have automated cardiovascular monitoring or clinical observation during routine endoscopy. Hemodynamic parameters were recorded at 3-min intervals before, during, and after the procedure. Upper gastrointestinal endoscopy resulted in an increased heart rate (HR), while colonoscopy caused a decreased blood pressure (BP) and HR. Hemodynamic aberrations occurred in 71% of monitored patients, including hypotension 6%, hypertension 30%, bradycardia 26%, and tachycardia 32%. Only one-third of the hypotensive episodes were recognized as aberrations, and therapeutic intervention did not improve outcome. No monitored or control patient had an adverse result. Certain hemodynamic changes were directly correlated with the baseline BP or HR and associated with the presence of coronary artery disease, particular medicines with cardiovascular effects and longer procedure duration. We conclude that automated monitoring during routine endoscopy unmasks frequent hemodynamic aberrations that are clinically insignificant. Routine monitoring during endoscopy does not improve outcome.

Aged↗
PubMed1990

Duodenogastric reflux in patients with Barrett's esophagus.

The role of duodenogastric reflux in the pathogenesis of gastroesophageal reflux disease is not clear. Using hepatobiliary scanning techniques, we found evidence of duodenogastric reflux in six of 13 patients with Barrett's esophagus. This compares with only two positive studies in 19 control subjects. This difference is statistically significant (P = 0.038, two-tailed Fisher's exact test). Three of nine patients who had gastroesophageal reflux without Barrett's esophagus had evidence of duodenogastric reflux, a frequency not significantly different from either of the other groups. Gastroesophageal reflux of bile and pancreatic enzymes, in addition to gastric acid may contribute to the greater esophageal damage often seen in Barrett's esophagus. The presence of duodenogastric reflux in these patients may have important pathophysiologic and therapeutic implications.

Barrett Esophagus↗
PubMed1990

Endoscopic retrograde wire-guided brush cytology for diagnosis of patients with malignant obstruction of the bile duct.

A brush was adapted for use over a guide wire to facilitate reliable acquisition of cytological specimens from tight and potentially malignant strictures encountered during ERCP. Cells collected in this manner were assessed for abnormalities indicative of cancer. We have called this technique endoscopic retrograde wire-guided brush cytology (ERWBC). Thirty-nine strictures (24 malignant, 15 benign) in 34 patients were brushed. There were no complications, and all specimens were adequate for evaluation. Sixty percent of patients with cancer were diagnosed by ERWBC. Sensitivity was highest for cholangiocarcinoma (100%), intermediate for pancreatic cancer (60%), and lowest for patients with biliary obstruction due to metastatic disease (22%). There were no false-positive results (specificity, 100%). The positive and negative predictive values were 100% and 58%, respectively, and accuracy for the test was 72%. Collection of cytological specimens using a brush with a wire guide is effective especially for diagnosis of cholangiocarcinoma. A positive result is sufficient evidence for malignancy, and other invasive diagnostic tests are unnecessary. We recommend ERWBC for brushing all strictures of unknown cause during ERCP in an effort to make a diagnosis of cancer.

Adenoma, Bile Duct↗
PubMed1990

Gastroesophageal reflux and sclerotherapy strictures.

The development of esophageal stricture is common following endoscopic variceal sclerotherapy (EVS). Gastroesophageal reflux may be at least partly responsible. Twelve randomly selected male patients underwent chronic EVS for the management of bleeding esophageal varices. Six patients developed strictures during or after EVS, six did not. There were no significant differences between stricture and nonstricture patients during 24 hour esophageal pH monitoring. Three of the six stricture patients and four of the six nonstricture patients had an abnormal amount of reflux. Gastroesophageal reflux occurs frequently in patients undergoing EVS, and it is not likely to play a major role in EVS stricture formation.

Adult↗
PubMed1989

Pancreatic pseudocyst as a cause for secondary achalasia.

Secondary achalasia is commonly due to cancer. Benign causes are rare and an association with pancreatitis has never been made. Our patient presented with clinical, manometric, endoscopic, and radiographic features of achalasia that occurred in conjunction with a pancreatic pseudocyst extending into the mediastinum. Documentation of this unique relationship was made on two occasions after episodes of complicated pancreatitis and was confirmed by restoration of normal esophageal function after drainage of the pseudocyst. Onset of dysphagia occurring in association with pancreatitis suggests the presence of a pseudocyst and secondary achalasia.

Esophageal Achalasia↗