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Biomedical subjects

W R Brugge

Publications and source records attributed to W R Brugge.

At least 19 recordsLinked to original sources
PubMed2005

Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy.

BACKGROUND AND STUDY AIMS: The widespread use of cholangioscopy in the management of difficult choledocholithiasis has been limited by the need for two expert operators. This report describes the use of a technique of single-operator duodenoscope-assisted cholangioscopy (SODAC) in the successful management of 75 patients with choledocholithiasis. PATIENTS AND METHODS: The single-operator technique, allowing simultaneous control of both the duodenoscope and cholangioscope, was prospectively studied between June 1999 and June 2001 in the diagnosis and treatment of choledocholithiasis. RESULTS: A total of 109 SODAC procedures were conducted in 75 patients to manage choledocholithiasis. The indications were: firstly, SODAC-guided electrohydraulic lithotripsy (EHL) of stones in which conventional methods, including mechanical lithotripsy, had not been successful (52 SODAC procedures in 26 patients); and secondly, direct visualization of the biliary tree after cholangiography to assess the presence of stones (57 SODAC procedures in 49 patients). The locations and numbers of the stones, but not their size, were predictive of the number of SODAC-guided lithotripsy sessions required. All of the patients were free of stones at the end of the study period, and no complications were recorded. CONCLUSIONS: Single-operator SODAC-guided electrohydraulic lithotripsy was effective in the treatment of difficult cases of choledocholithiasis in which conventional methods had previously failed. The technique may allow increased use of cholangioscopy in the management of choledocholithiasis.

Adult↗
PubMed2001

Detection and tumor staging of malignancy in cystic, intraductal, and solid tumors of the pancreas by EUS.

BACKGROUND: EUS can provide detailed imaging of pancreatic malignancies and direct fine needle aspiration (FNA) of pancreatic masses. The ability of EUS to detect and stage malignancy in cystic and intraductal lesions has not been investigated. Our aim was to determine the sensitivity and specificity of EUS imaging and FNA in detecting and staging of malignancy in solid, cystic, and intraductal lesions of the pancreas. METHODS: The records of 96 patients (46 solid, 26 cystic, 24 intraductal lesions) who underwent EUS followed by surgical exploration over a 3-year period were reviewed. The accuracy of EUS for detecting and staging malignancy was calculated based on the results of surgery and histology. RESULTS: EUS-guided FNA provided evidence of malignancy in solid, cystic, and ductal lesions with sensitivities of 59.5%, 50%, and 60%, respectively. The accuracy of staging by EUS was significantly less for intraductal lesions (47%), compared with cystic (100%) and solid lesions (85%) (p < 0. 05). CONCLUSIONS: EUS can be used to detect malignancy in cystic and intraductal tumors of the pancreas.

Adenocarcinoma↗
PubMed2001

Role of endoscopic ultrasound in the diagnosis of cystic lesions of the pancreas.

Endoscopic ultrasound (EUS) is an ideal imaging technique for pancreatic cystic lesions. Ultrasound is exquisitely sensitive for detecting and characterizing cysts arising in solid organs, and when the transducer is placed on an endoscope, high resolution imaging of the pancreas is achieved. Linear EUS can also guide needle aspiration of pancreatic cystic lesions and through the use of aspiration cytology, cystic tumors of the pancreas can be diagnosed. Since cytology is a relatively insensitive test, cyst fluid tumor markers such as CEA have been employed to improve the sensitivity for the detection of malignancy. Cyst fluid CEA values are uniformly low in serous cystadenomas, higher in mucinous lesions, and markedly elevated in mucinous cystadenocarcinomas. Through the use of these techniques, the ability to detect and diagnose early malignancies of the pancreas will be greatly enhanced.

Cystadenoma, Mucinous↗
PubMed2001

EUS diagnosis of cystic lesions of the pancreas.

BACKGROUND: Cystic tumors of the pancreas are composed of benign, premalignant, malignant, and inflammatory lesions that are traditionally difficult to diagnose. Most of the tumors are initially detected on CT/US scanning, but often the morphological characteristics are insufficient for making a definitive diagnosis. Endoscopic ultrasound (EUS) may be an ideal tool for imaging of these lesions because it can provide highly detailed imaging without interference by bowel or air. Furthermore, EUS can direct fine needle aspiration of the lesions, providing cyst fluid for cytologic examination. The findings of cyst fluid cytology can be complemented by the use of cyst fluid tumor makers such as CEA. Using the morphologic appearance by endosonography, the results of cytology, and tumor marker analysis, EUS can often differentiate between benign, malignant, and inflammatory cystic lesions of the pancreas.

Biomarkers, Tumor↗
PubMed1999

EUS-guided radiofrequency ablation in the pancreas: results in a porcine model.

BACKGROUND: Our aim in this study was to investigate the feasibility and safety of performing radiofrequency (RF) ablation in the pancreas with endoscopic ultrasound (EUS). METHODS: RF was applied to normal pancreatic tissue in 13 anesthetized Yorkshire pigs with specially modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas was localized with EUS and punctured through a transgastric approach. RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic imaging (EUS and CT) and serum amylase and lipase levels were obtained at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic examination was performed. RESULTS: Sixteen ablations were performed. During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually surrounded the tip of the electrode. Immediately after the procedure CT demonstrated 1 cm hypodense foci that did not enhance with iodinated contrast. In pigs killed immediately and 1 to 2 days after ablation, pathologic examination showed discrete, well-demarcated spherical foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule surrounded the coagulated tissue in the remaining 2 pigs. One pig had mild hyperlipasemia, a focal zone of pancreatitis (<1 cm), and later a pancreatic fluid collection. Biochemical parameters were normal in the remaining pigs. Other complications included three gastric and one intestinal burn caused by improper electrode placement. CONCLUSIONS: EUS-guided RF ablation can be used safely to produce discrete zones of coagulation necrosis in the porcine pancreas. Potential clinical uses of this technology include management of small neuroendocrine tumors and possibly palliation of unresectable pancreatic adenocarcinoma.

Animals↗
PubMed1997

The use of endoscopic ultrasonography to reduce the cost of treating ampullary tumors.

BACKGROUND: Local excision of selected ampullary tumors may result in the same benefit as Whipple resection with less morbidity and mortality. The purpose of this study was to determine if endoscopic ultrasonography could aid in the selection of patients for local resection and to determine if there was a significant cost difference between the two surgical procedures. METHODS: In this retrospective study of 32 patients who underwent surgery for ampullary tumors, endoscopic ultrasonography staging was performed in 18 patients. Resected specimens were used to determine pathologic staging. Local disease was defined as stage T2N0 or less. Cost data were available for 20 patients. RESULTS: The sensitivity and specificity of endoscopic ultrasonography for differentiating local from advanced ampullary tumors were both 83%. The median total cost for a local resection was $9314 versus $16,017 for a Whipple resection (p < 0.0017). CONCLUSION: Endoscopic ultrasonography is an effective tool for identifying patients with localized ampullary tumors. The cost of a local resection for ampullary tumors is significantly less than that of a Whipple resection. The use of endoscopic ultrasonography to select patients for local resection may be a cost-effective technique in the management of patients with ampullary tumors.

Adult↗
PubMed1997

Endoscopic ultrasound staging criteria for esophageal cancer.

BACKGROUND: Malignant esophageal masses can be staged with endoscopic ultrasound (EUS) using the TNM staging classification. Several criteria for differentiating between intraesophageal (T1-2) and extraesophageal (T3-4) masses have been described, but highly accurate staging remains difficult. METHODS: This is a blinded evaluation of four specific EUS criteria in 24 patients with esophageal malignancy who underwent esophageal resection after neoadjuvant chemotherapy. Radial EUS was used to evaluate the first 12 patients and curved linear EUS was used in the second half of the group. Using the histology of the resected specimens, the sensitivity, specificity, and accuracy of the EUS criteria after chemotherapy were determined for predicting intraesophageal or extraesophageal invasion. RESULTS: There was no difference in the accuracy rates with radial or linear EUS. Two ultrasound criteria, muscularis disruption and irregular mass border, were found to have low accuracy rates (44% and 50%). The maximal thickness (overall or extraesophageal) of the esophageal mass was found to be highly accurate (79% and 87%) in predicting intraesophageal or extraesophageal extension. pT3-4 masses had a thickness of 16.0 +/- 2 mm, significantly greater than pT1-2 masses, 8.2 +/- 1 mm (p < .01). Using receiver operator characteristics (ROC) curve analysis, mass thickness was found to be more accurate (91% and 94%) than a subjective assessment of staging (73%) (p < .07). CONCLUSIONS: The EUS measurement of a malignant esophageal mass maximal thickness can accurately predict extraesophageal extension.

Adenocarcinoma↗
PubMed1996

Defining the criteria for local resection of ampullary neoplasms.

OBJECTIVES: To delineate factors determined preoperatively, which predict successful local resection of ampullary neoplasms. DESIGN: Retrospective review of case series of the author's experience from 1988 through 1995. The median follow-up of patients with malignancies was 29 months. SETTING: Tertiary care university teaching hospital. PATIENTS: Twenty-seven patients underwent surgery. The decision to perform either an ampullectomy or pancreaticoduodenectomy (PD) was based on the size of the lesion, the presence of a "field defect" (ie, familial polyposis), depth of invasion determined by preoperative endoscopic ultrasound, and extent of pancreatic and bile duct involvement seen on endoscopic retrograde cholangiopancreatography. INTERVENTIONS: Fourteen patients underwent ampullectomy, 12 patients underwent PD, and one patient had a retroperitoneal node biopsy performed without resection of the primary tumor. MAIN OUTCOME MEASURES: Resectability, morbidity, and mortality. RESULTS: Depth of invasion was accurately determined in nine of 12 patients studied by preoperative endoscopic ultrasound. Preoperative endoscopic biopsy specimens were obtained in 21 patients and were inaccurate in seven of 21 cases. The length of stay following local resection was 10.5 +/- 3.7 days vs 15.4 +/- 5.8 days following PD (P=.02). One patient died following PD, and there were no deaths following ampullectomy. Six of 12 patients undergoing PD had postoperative complications vs two of 14 patients undergoing local resection. CONCLUSIONS: Ampullectomy is the procedure of choice for resecting benign lesions smaller than 3 cm, small neuroendocrine tumors, and T1 carcinomas of the ampulla. While endoscopic ultrasonography is helpful in identifying stage T1 lesions suitable for local resection, no preoperative test proved accurate enough to substitute for clinical judgment and intraoperative pathological confirmation.

Adult↗