China
Africa
Explore chapters and articles related to this topic
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
If conservative measures failed, I would then consider more invasive measures beginning with botulinum toxin. In more severe disease, a sphincterotomy can be performed but I would warn the patient of the risk of incontinence. Alternatives to this option include an anal advancement flap.
Cholesterol Feeding and Gallbladder Muscle Contractility
Published in William J. Snape, Stephen M. Collins, Effects of Immune Cells and Inflammation on Smooth Muscle and Enteric Nerves, 2020
Norman W. Weisbrodt, Young Fang Li, Frank G. Moody, Diane Haley-Russell, Stuart I. Myers
We and others have tested the hypothesis that contact of altered bile with the gallbladder mucosa, not the systemic effects, results in reduced contractility. Fridhandler et al.10 and we found that intestinal muscle is not altered by cholesterol feeding.13 The maximal contractile force in response to carbachol, potassium, and calcium (in chemically skinned muscle) was not altered. Furthermore, one of the biochemical steps leading up to contraction, myosin light chain-20 phosphorylation also was not altered. If systemic effects were involved, one might expect changes in intestinal muscle as well. This was not seen. We recently tested the hypothesis another way. If contact with altered bile is the mechanism, then limiting contact should prevent the reduced contractility and formation of stones. Prairie dogs were surgically prepared to divert bile around the gallbladder.14 Another group underwent sphincterotomy, a procedure shown to reduce bile storage in the gallbladder and to prevent stone formation. Each group was further divided so that some animals were fed cholesterol diet and some were fed control diet. After 8 days, gallbladder muscle contractility was determined. Cholesterol feeding had no effect on contractility in those animals with bile diversion. Also, little to no bile and no stones were found in any of their gallbladders. Thus, these studies suggest that the abnormal bile induced by cholesterol feeding must come into contact with the gallbladder mucosa in order to affect function. This indicates a local rather than a systemic effect.
Fissure-in-Ano and Fistula-in-Ano
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Clarence E. Clark, Jacquelyn Seymour Turner
One such example is the use of bran and sitz baths as first-line therapy for acute fissure-in-ano. Jensen et al. (1986) compared bran with sitz baths to topical ointments and showed warm sitz baths plus an intake of unprocessed bran improved healing rates and resolution of symptoms for an acute first episode of posterior anal fissure. For those who have failed medical management, sphincterotomy has been the mainstay of surgical management for decades. The approach to sphincterotomy was defined more clearly by Abcarian et al. (1980) when they compared lateral internal sphincterotomy (LIS) to posterior midline sphincterotomy. Dr. Abcarian, a pioneer in colorectal surgery, showed the importance of lateral internal sphincterotomy regarding not only healing but also in avoiding complications related to posterior defects. In addition, his report concluded that fissurectomy with midline sphincterotomy should be reserved for patients in whom local fistulization has complicated anal fissure.
Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Ming Li, Ao Wang, Shaohua Ren, Zhenyu Wang, Qing Wang, Chengyue Gou, Weichuan Zhao, Li Zhang, Ning Li
Duodenoscopy was performed with the patient in the left lateral and prone positions under general anesthesia or sedation. The tension of the duodenal papilla and the shape of its orifice were observed when the duodenoscope entered the descending duodenum. High tension was defined as a substantially dilated papilla, disappearance of the papillary folds, and a serosa that appeared smooth and shiny in appearance; low tension was defined as a slightly dilated or non-dilated papilla that had visible folds and a serosa that was not smooth in appearance. Endoscopic sphincterotomy was performed using an arcuate knife or needle-shaped knife according to the ability of the endoscopist to confirm the impaction of a stone in the papilla and the position of the stone. The size of the stone removed by sphincterotomy was measured using the known length of the operating instruments as a scale (the length from the tip to the first mark of both the arcuate knife and needle-knife is 0.5 cm; Figure 1(A,B)). Next, cholangiography was carried out to measure the diameter of the common bile duct and assess whether stones were present in the proximal portion of the common bile duct. Finally, an endoscopic nasobiliary drainage tube or, if necessary, an endoscopic retrograde pancreatic drainage tube were placed.
Safety and efficacy of different techniques in difficult biliary cannulation at endoscopic retrograde cholangiopancreatography
Published in Hospital Practice, 2022
Ankit Dalal, Chaiti Gandhi, Gaurav Patil, Nagesh Kamat, Sehajad Vora, Amit Maydeo
In five recent meta-analyses [23–27], the cannulation rates, PEP with standard cannulation versus early precut were compared. Four of the five studies did not find any significant difference in SBC success rates, while the other study found an increased SBC success rates among those undergoing early precut [27]. A recent meta-analysis showed similar results with lower complication rate using early precut [24]. Two studies revealed that as compared to conventional pull-type biliary sphincterotomy without a stent, needle-knife biliary sphincterotomy over a pancreatic stent was safer with success rate of 94.1%, and complication rate of 4.4% [28,29]. Precut has remained at the crest in difficult cases for majority of the endoscopists across the world, however, owing to the minimal increase in the report of adverse events it continues to be viewed as a less favored option.
Device profile of the EXALT Model D single-use duodenoscope for endoscopic retrograde cholangiopancreatography: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Dean Ehrlich, V. Raman Muthusamy
Muthusamy et al. conducted the first human clinical evaluation of the EXALT duodenoscope [28]. Initially, 13 patients underwent a ‘roll-in’ maneuver to ensure the proceduralists could achieve adequate duodenoscope passage and positioning in the 2nd duodenum. Subsequently, 60 patients underwent ERCP procedures. Almost half of the patients had a prior biliary sphincterotomy. Of the 60 patients in whom ERCP was attempted, 58 procedures (96.7%) were successfully completed with the EXALT device while 2 procedures (3.3%) required crossover to a reusable duodenoscope. In one of these crossover patients, cannulation was unsuccessful with the reusable duodenoscope as well until an advanced cannulation technique (precut sphincterotomy) was utilized. Most procedures were ASGE grades 2 and 3 in difficulty. Of note, 90.1% of patients who were approached to consent for the trial were agreeable to participating in the study, despite the fact that the device had not achieved FDA-approval at the time, suggesting a high likelihood that patients will be receptive to this new technology.