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Biomedical subjects

W Geels

Publications and source records attributed to W Geels.

5 recordsLinked to original sources
PubMed2001

Placement of PEG tubes through previously placed self-expanding esophageal metal stents.

BACKGROUND: Self-expanding metal stents are frequently used to palliate patients with malignant dysphagia and close tracheoesophageal fistulae. Despite proper stent positioning and deployment, in a subset of patients there is no improvement in dysphagia, closure of tracheoesophageal fistulae, or resolution of anorexia. Such patients may require a PEG tube. It has been suggested that PEG placement through a preexisting esophageal stent is problematic because of the risks of gastrostomy tube impaction within the stent and resultant stent migration. METHODS: Case records were retrospectively reviewed of 9 consecutive patients with indwelling esophageal self-expanding metal stents undergoing attempted PEG. OBSERVATIONS: PEG tube placement was successful in all patients. In 1 patient, the stent migrated distally into the stomach during PEG placement. This was managed endoscopically without further complication. CONCLUSIONS: PEG placement in patients with previously placed esophageal self-expanding metal stents is a relatively safe and feasible procedure, although stent migration may occur.

Aged↗
PubMed1998

How many times can you reuse a "single-use" sphincterotome? A prospective evaluation.

BACKGROUND: The decreasing reimbursement for endoscopic supplies has prompted evaluation of reuse of "single use" items. METHODS: Over a 12.5-month period, numbered sphincterotomes were used for sphincterotomy or as a diagnostic catheter in all patients undergoing endoscopic retrograde cholangiopancreatography. Before first use and after each subsequent use, the resistance of the sphincterotome was measured with an ohmmeter. After each use, the sphincterotome was thoroughly cleaned and gas sterilized. Sphincterotomes that could not be adequately cleaned or would not function properly were discarded. The endoscopist was blinded to the number of prior uses of the sphincterotome. RESULTS: During the study period, 80 sphincterotomes were used 290 times, including use in 162 sphincterotomies. The median number of uses before discarding was 3 and ranged from 0 to 10. The single most common reason for discarding the sphincterotome was breakage of the wire to the handle which occurred after 1 to 9 uses. The sphincterotome did not cut inappropriately in any patient, and no complications were linked to reuse. Equipment costs to our unit were reduced $21,000 by reuse. CONCLUSIONS: "Single use" sphincterotomes can be safely reused multiple times without compromising their use as a diagnostic or therapeutic device.

Cholangiopancreatography, Endoscopic Retrograde↗