PubMed Health⌕ Search

Biomedical subjects

R P Venu

Publications and source records attributed to R P Venu.

At least 19 recordsLinked to original sources
PubMed2000

Endoscopic transpapillary drainage of pancreatic abscess: technique and results.

BACKGROUND: Pancreatic abscess is one of the serious complications of acute pancreatitis. Traditionally, pancreatic abscess has been treated by operative drainage. Based on experience with endoscopic transpapillary drainage of pseudocysts, a similar technique was used in patients with pancreatic abscess. METHOD: Patients were evaluated by endoscopic retrograde cholangiopancreatography. In those with pancreatic abscess communicating with the main pancreatic duct, pancreatic sphincterotomy, saline irrigation of the abscess cavity, and catheter dilation followed by 10F pancreatic stent placement were done. Instillation of gentamicin and nasopancreatic catheter drainage were used in difficult cases. RESULTS: Of 22 patients with pancreatic abscess, 11 underwent endoscopic transpapillary drainage with technical success in 10 patients (90%); 8 patients (74%) had resolution of pancreatic abscess, clinically and radiographically. Intracavitary instillation of gentamicin and nasopancreatic catheter drainage were used in 2 patients. Two patients in whom endoscopic transpapillary drainage failed underwent operative drainage with a favorable outcome, and the one patient in whom endoscopic treatment was technically unsuccessful underwent successful percutaneous drainage. One patient had mild pancreatitis. CONCLUSION: Endoscopic transpapillary drainage is an effective nonoperative therapy for selected cases of pancreatic abscess and is associated with minimal morbidity and no mortality.

Abdominal Abscess↗
PubMed1999

Autoimmune pancreatitis, pancreatic mass, and lower gastrointestinal bleed.

Autoimmune pancreatitis (AIMP) is a recently described clinical entity causing chronic pancreatitis. It often presents with diffuse enlargement of the pancreas and/or a focal mass at the head of the pancreas causing common bile duct obstruction and jaundice. In most instances, AIMP is mistaken for pancreatic cancer. A number of laboratory abnormalities such as positive antinuclear antibody, hypergammaglobulinemia, and antibody to carbonic anhydrase are often present in these patients. Currently, pancreatic biopsy demonstrating characteristic histopathologic changes is essential to establish the diagnosis. We report the first case of AIMP presenting as a pancreatic tail mass and lower gastrointestinal bleed.

Adult↗
PubMed1998

Endoscopic retrograde cholangiopancreatography under general anesthesia: indications and results.

BACKGROUND: Conscious sedation is usually used during endoscopic retrograde cholangiopancreatography (ERCP). Little is known about the indications and outcomes for ERCP in patients who cannot undergo conscious sedation and therefore require general anesthesia. We retrospectively evaluated the indications and outcome for patients undergoing ERCP who required general anesthesia at four teaching hospitals over a 2-year period. METHODS: Of 1200 ERCPs performed over a 2-year period, 65 patients required general anesthesia. Retrospective chart analysis was undertaken to determine indications and outcomes of ERCP performed under general anesthesia. Eleven patients underwent sphincter of Oddi manometry. RESULTS: The major indication for general anesthesia was substance abuse. Therapeutic intervention was successful in 45 of 48 patients; 6 of the 63 patients had complications, all mild and not related to the anesthesia. Sphincter of Oddi manometry was normal in 7 patients; 4 patients had elevated basal pressures. CONCLUSIONS: ERCP under general anesthesia may be considered when conscious sedation fails to achieve a satisfactory level of sedation for a successful and safe ERCP. Procedure-related complication rates appear to be comparable if not lower with general anesthesia.

Adolescent↗
PubMed1998

Self-expandable metal stents for malignant gastric outlet obstruction: a modified technique.

BACKGROUND AND STUDY AIMS: Endoscopic palliative treatment may be effective in the management of malignant gastric outlet obstruction. However, experience in this area is limited, and the techniques vary widely. In this retrospective study, a uniform technique using nearly identical self-expandable metal stents was employed to assess technical feasibility, safety, and outcome. PATIENTS AND METHODS: Eight patients presenting with clinical findings of gastric outlet obstruction confirmed by upper gastrointestinal radiography underwent endoscopic placement of expandable metal stents. All patients had primary or metastatic malignancy involving the pylorus or duodenum. Endoscopic and Gastrografin-enhanced upper gastrointestinal radiographic evaluations were carried out immediately after stent placement. Complications and clinical outcomes were assessed in each patient. RESULTS: Five patients had extrinsic compression of the descending duodenum due to pancreatic cancer, two had pyloric stenosis from metastatic cancer, and one patient had primary duodenal cancer. Stent placement was successful in all patients, and was followed by clinical improvement. There was one death within 30 days, related to pneumonia. CONCLUSION: Endoscopic self-expandable stent placement appears to be a reasonable therapeutic alternative in patients with malignant gastric outlet obstruction.

Aged↗
PubMed1996

Brush cytology for pancreatic carcinoma: an analysis of factors influencing results.

BACKGROUND: Despite recent advances in cytology brush design, yield of endoscopic brush cytology in suspected pancreatic carcinoma remains low. METHODS: We prospectively evaluated 32 such patients by ERCP to analyze differences in yield based on anatomic location of the pancreatic stricture, and the role of concurrent biliary stricture brush cytology, in improving the overall yield. Endoscopic brush cytology was performed on all strictures following ERCP. A final diagnosis of pancreatic carcinoma was confirmed in all patients. RESULTS: Twenty-three of the 32 patients had positive cytology for pancreatic malignancy (71.9%). Eight patients had positive brushings from biliary strictures alone (25%) and 15 had positive brushings obtained from pancreatic strictures (46.9%). The yield varied widely depending on the anatomic location of the stricture; ampullary, genu, and tail regions had low rates of positive cytology, in part due to technical factors and brush design (1 of 8, 2 of 6, and 1 of 4, respectively). Strictures of the head and body yielded high rates of positive cytology (7 of 8 and 4 of 6, respectively). CONCLUSIONS: The yield of endopancreatic brush cytology is related to the location of malignancy, with overall yield enhanced by concurrent brushing of bile duct strictures.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Saline injection needle-knife sphincterotomy: a preliminary report.

BACKGROUND AND STUDY AIMS: Needle-knife sphincterotomy is an established technique in the management of some patients with biliary tract obstruction. However, the technique can be technically difficult in patients with very small papillae, specially when associated with distorted ampullary and duodenal anatomy. We present here a technique that may enhance successful needle-knife sphincterotomy in this situation. PATIENTS AND METHODS: Eight patients with biliary tract obstruction who had small papillae and distorted ampullary or duodenal anatomy were evaluated. All patients had undergone one or more unsuccessful cannulations prior to referral. All eight patients underwent saline injection of their papillae, creating a bulging papilla, prior to needle-knife sphincterotomy. RESULTS: Seven of the eight patients had successful needle-knife sphincterotomy following saline injection, and endoscopic therapy during the first attempt. In one patient, the procedure was successful at a second attempt 48 hours later. There were no instances of significant complications. CONCLUSION: Saline injection into the papilla prior to needle-knife sphincterotomy may improve success rates in patients with unusually small papillae and distorted ampullary or duodenal anatomy. However, at present this technique should only be attempted by experienced endoscopists. Further studies with larger numbers of patients are required before the safety of this technique can be fully evaluated.

Ampulla of Vater↗
PubMed1995

Periampullary disorders: review of pathophysiology.

The ampulla of Vater is strategically located at the confluence of the terminal end of the bile duct and the pancreatic duct. It is entwined by smooth muscle fibers often referred to as the sphincter of Oddi. As a result, the ampulla demonstrates dynamic motor activity. A variety of structural and functional abnormalities can involve the ampulla and the periampullary region. Disorders involving the ampulla often produce remarkably similar clinical features, such as acute pancreatitis, biliary colic, or jaundice. Therefore, it is important that patients with periampullary disorders are systematically studied using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry, and endoscopic ultrasonography. Common disorders involving the periampullary region and state-of-the-art techniques for diagnosis and treatment of these disorders are discussed.

Ampulla of Vater↗