David B. Falkenstein

Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Diagnosis of Pancreatic Inflammatory Disease

The clinical value of endoscopic retrograde cholangiopancreatography (ERCP) was evaluated in 63 patients by comparing the initial clinical diagnosis with pancreatographic findings. ERCP was of considerable diagnostic value and permitted early and precise differentiation of pancreatic inflammatory disease.

Endoscopic retrograde cholangiopancreatography in the dog: a model for training and research

A canine model for training and research in endoscopic retrograde cholangiopancreatography is proposed. Similarities to human endoscopic appearance and anatomy allowed successful cannulation of duodenal papillae in 4 of 10 dogs.

Choledochocele: Radiologic diagnosis and endoscopic management

A case of choledochocele, missed during exploratory laparotomy but managed by endoscopic biliary surgery, is presented.

Persistent pneumoperitoneum after percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG), as described by Gauderer, Ponsky, and Izant/has achieved widespread recognition and application as an alternative to operative gastrostomy. The avoidance of celiotomy, its simplicity and low cost, as well as the minimal risks and complications of the procedure highlight the attractiveness of PEG.1-6 Several recent reports have described the occurrence of pneumoperitoneum after PEG.•• These papers have demonstrated pneumoperitoneum to be selflimited, resolving within 1 week, and it was concluded that recognition of the benign nature of this transient complication should temper the enthusiasm for operative intervention. We report a patient who developed a massive tension pneumoperitoneum following PEG that persisted for 5 weeks, finally prompting laparotomy.

Repetitive endoscopic accidents and instrument malfunction

The retroflexed tips of peroral endoscopes became impacted on passage into the esophagus in 4 patients. In 3 instances, the impacted endoscope could be advanced to the stomach, straightened, and withdrawn; in 1 instance the retroflexed tip could only be firmly extracted, resulting in a cervical esophageal perforation. The cause of these misadventures was found to be laxity in the tip-control mechanism. The likelihood of such complications may be minimized by regular inspection and maintenance of endoscopic instruments.

Influence of Endoscopic Manipulation and Patient Position on Cholangiographic Interpretation in Endoscopic Retrograde Cholangiopancreatography

The authors describe the influence of patient position and distorting forces during endoscopy on endoscopic retrograde cholangiography. For accurate diagnosis, radiographs must be taken after withdrawal of the endoscope and rotation of the patient to the supine position.