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At least 613 records · Page 34Linked to original sources
PubMed2002

[Mortality from iatrogenic esophageal perforations is high: experience of 54 treated cases].

OBJECTIVE: To underline the severity of instrumental esophageal perforations and to discuss their management. PATIENTS AND METHODS: Data from patients treated for instrumental esophageal perforation were collected retrospectively from 1980 to 1995 then prospectively since 1995 to 2000. RESULTS: Fifty-four patients were treated for instrumental perforations. Perforation occurred after exploratory endoscopy (n = 24), endoscopic dilation (n = 13), attempted tracheal intubation (n = 5), foreign body extraction (n = 5), treatment of esophageal varices (n = 4), trans-esophageal echocardiography (n = 2), and duodenal prosthesis implantation (n = 1). Clinical manifestations were immediate in 18 cases and delayed in all others, with an interval before treatment ranging from 2 hours to 45 days (mean = 70 hours). All patients were operated after large spectrum antibiotherapy and intensive care, except 3 who were treated medically due to their poor general condition. Fourteen (26%) patients died, including the 3 non-operated ones. CONCLUSION: Instrumental esophageal perforations are associated with a high mortality, probably due to the poor general condition of the patients. Diagnosis of these perforations is often delayed. A good experience of endoscopic maneuveurs and adequate post-endoscopic monitoring could allow earlier surgical treatment with lower mortality.

Adult↗
PubMed1995

A study of the safety and clinical efficacy of esophagogastroduodenoscopy after esophageal, gastric, or duodenal surgery in 60 patients.

OBJECTIVES: Our purpose was to evaluate the safety of esophagogastroduodenoscopy (EGD) after esophageal, gastric, or duodenal surgery, a previously unstudied subject. EGD could promote suture breakdown at sites of anastomoses, ostia, or repair by abrasion or stretch from endoscopic intubation, torque, or insufflation. METHODS: Risks versus benefits of EGD performed within 24 days of upper gastrointestinal surgery were analyzed at five medical centers in 60 study patients and were compared with 120 controls matched for age, sex, and EGD indication. RESULTS: Of 13,170 hospitalized patients undergoing EGD, 60 patients (0.46%) had EGD within 24 days of upper gastrointestinal surgery. EGD indications in study patients included gross upper gastrointestinal bleeding in 24, nausea and vomiting in 23, bright red blood per rectum in four, dysphagia in three, abdominal pain in three, and "other" in three. EGD was performed on average 14.7 +/- 7.2 (SD) days after surgery. EGD provided the diagnosis in 45 (75%) study patients (control rate = 77%, not significantly different, chi 2). In particular, postoperative EGD provided the diagnosis in 20 (83%) of 24 patients with upper gastrointestinal bleeding (control rate = 92%, not significantly different, Fisher's exact test). Thirteen study patients (22%) had upper gastrointestinal lesions directly related to surgery including: anastomotic ulcers in six, anastomotic erosions in six, and an excessively tight Nissen fundoplication in one. One additional patient at EGD had extrinsic duodenal compression attributed to postoperative adhesions. EGD led to surgery in nine and to successful endoscopic therapy in six. No study patient experienced an endoscopic complication. The control group had one endoscopic complication (not significantly different rates, Fisher's exact test). CONCLUSION: In this study, the benefits outweighed the risks of postoperative EGD when performed more than 7 days after surgery: the diagnostic yield was high and the complication rate was low. Indeed, the yield and risks were similar to that of other EGDs. Postoperative EGD identified a surgical complication in about 20% of cases. Clinicians should use discretion and perform postoperative EGD for clinically important indications. EGD is contraindicated when wound dehiscence or bowel perforation is suspected.

Case-Control Studies↗
PubMed1987

Cadmium-manganese interaction in the rat's duodenum.

Five-week-old female albino rats were given different doses of cadmium chloride (0.002-5.0 mg) by gastric intubation daily for 3 or 7 days. Manganese-54 was used as marker to assess manganese transfer through and retention in the duodenal wall by the "everted gut sac" method. No significant differences were found in these parameters between rats receiving no cadmium and those receiving 0.002 mg cadmium daily, irrespective of the period of treatment. A daily dose of 0.02 mg cadmium decreased manganese transfer significantly but only in animals treated with cadmium for 3 days. Daily doses of 0.2 mg cadmium or higher always decreased manganese transfer and intestinal uptake significantly--an effect which was independent of whether the rats were killed on the 4th or on the 8th days of the experiment. On the whole, the effect of cadmium was much more intense in the 3-day-than in the 7-day-treated animals and it was more pronounced on manganese transfer than on its intestinal uptake.

Animals↗
PubMed2005

Therapeutic potential of duodenal electrical stimulation for obesity: acute effects on gastric emptying and water intake.

OBJECTIVES: No satisfactory treatment is available for obesity. Previous animal studies suggested the therapeutic potential of intestinal electrical stimulation for obesity. The aim of this study was to investigate the effects of duodenal electrical stimulation (DES) on gastric emptying and water intake in healthy humans. METHODS: The study was performed in 12 healthy volunteers intubated with a feeding tube in the duodenum under endoscopy. There were three ring electrodes at the end tip of the tube and the two distal electrodes were used for recording and electrical stimulation. On two separate days, each subject underwent a session of DES with various stimulation parameters, a water-intake test with DES or with sham-DES, and a gastric-emptying test with DES or with sham-DES. RESULTS: DES did not induce any noticeable dyspeptic symptoms. The amount of water drunk by the subjects was significantly reduced from 897 +/- 88 ml with sham-DES to 673 +/- 63 ml with DES (p < 0.002). The mean T(50) of gastric emptying was significantly increased from 113.1 +/- 10.0 min with sham-DES to 176.5 +/- 20.8 min with DES state (p < 0.005). The gastric retention at 2 h was increased with DES (42.8 +/- 4.5% vs 61.4 +/- 4.7%; p < 0.02). CONCLUSIONS: DES delays gastric emptying and reduces water intake. It may have a potential application for the treatment of obesity.

Adolescent↗
PubMed1979

[The effects of sphincteroplasty on manometric profile of common bile duct and the duodenum (author's transl)].

A simultaneous manometric monitoring of the common bile duct (CBD) and the duodenum were performed 2 weeks after choledocholithotomy on 15 patients whose common bile ducts were explored without sphincteroplasty and 30 patients with sphincteroplasty. These manometric studies were carried out by open-tip catheters intubated into the CBD and duodenum through the T-tube at the operation. In patients without sphincteroplasty, no effects of the duodenal pressure on a CBD pressure profile were recognized, while a synchronized pressure profile of the CBD and the duodenum was obtained in patients with sphincteroplasty. By stimulation with morphine (Morphine sulfate; 0.17 mg/Kg iv bolus), waxing and waning of the pressured in the CBD without sphincteroplasty were observed with 20 cmH2O in maximum at about 13 minutes after injection. However, in the CBD with sphincteroplasty, scale-over increase of the pressure curve was seen immediately after duodenal contraction caused by morphine stimulation. A direct infusion of 5 ml of 0.1 N hydrochloride to the duodenum causes hyperperistalsis of the duodenum, which made a synchronized pressure profile in the CBD with sphincteroplasty but made no remarkable change in a pressure profile of the CBD without sphincteroplasty. These findings conclude that the sphincter of Oddi plays an important role as a "pressure barrier" between the CBD and the duodenum, and that with the destruction of this sphincter by sphincteroplasty, a pressure profile of the CBD becomes close to that of the duodenum. This simultaneous manometric study of the CBD and the duodenum might be one of most valuable methods for evaluation of completeness of the sphincteroplasty.

Ampulla of Vater↗
PubMed2002

[Enteral tube feeding early after surgery on the stomach and the duodenum].

Experience in enteral tube feeding (ETF) early after stomach resection, gastrectomy, reconstructive surgeries for chronic duodenal obstructions and postgastroresection disorders in 1716 patients is presented. Irrigators were installed in the jejunum during surgery, more rarely--through gastroscope below distal anastomosis. During the first day saline solutions were administered, further--nutritional cocktails. Period of ETF was 5.8 +/- 0.8 days in uncomplicated postoperative period and from 9 to 73 days in postoperative complications. ETF stimulates motor, resorption, synthetic, barrier functions of the small intestine. ETF permits to improve immediate results of stomach and duodenum surgery and to reduce cost of treatment.

Duodenal Obstruction↗
PubMed1982

Parallel gastric emptying of nonhydrolyzable fat and water after a solid-liquid meal in humans.

Our aim was to examine the control of gastric emptying of the oil phase of a mixed solid and liquid meal. Previous studies had shown that liquid dietary fats normally leave the stomach at a slower rate than does water. We wished to determine whether the slower emptying of fats was due to the physical characteristics of food (lower density and greater viscosity than water), to retardation by duodenal feedback mechanisms, or whether both factors contributed. Thus, we quantified the emptying rates of water and sucrose polyester (a nonabsorbable analog of dietary fat) ingested by healthy volunteers as a mixed solid and liquid meal. Gastric emptying was quantified by an intubation-perfusion method incorporating an occlusive jejunal balloon to facilitate recovery. Four phase-specific, nonabsorbable markers were used. [14C[Sucrose octaoleate and polyethylene glycol were incorporated in the meal and traced the lipid and water phases, respectively; [3H]glycerol triether and phenolsulfonphthalein were used as duodenal recovery markers. Sucrose polyester (substituting for dietary fat) was emptied very rapidly, and at about the same rate as was water, in contrast to natural fat, which empties very slowly. Emptying of water was rapid and comparable to that observed after mixed meals containing natural fat. These results imply that gastric emptying of the oil phase is controlled by receptors sensitive to the hydrolytic products of fat digestion and that the slow emptying of dietary fat is not simply due to its lower density.

Adult↗