Dj Geenen

Endoscopic therapy for benign bile duct strictures

Endoscopic therapy was attempted in 25 patients with benign strictures of the bile duct. In 23 patients, treatment involved endoscopic balloon dilation of the stricture zone or balloon dilation plus endoprosthesis placement. In 22 of 25 patients (88%), there was benefit from the endoscopic treatment. In 20 of 23 patients, there was significant radiographic improvement (p less than 0.001) in the diameter of their stricture following endoscopic therapy. All patients with elevated liver enzymes demonstrated rapid improvement following treatment. There was no significant morbidity or mortality associated with endoscopic treatment of benign biliary tract strictures. Follow-up study (mean, 4 +/- 0.3 years) discloses no recurrence of symptoms or elevated enzymes indicative of recurrent strictures. The treatment of benign bile duct strictures by a combination therapy of balloon dilation and stent placement provides a safe and effective treatment modality and an alternative to operative intervention.

Clinical presentation and short-term outcome of endoscopic therapy of patients with symptomatic incomplete pancreas divisum

BACKGROUND The clinical significance of incomplete pancreas divisum (IPD) has not been fully described. In this study we report the clinical presentation and results of endoscopic treatment of the 32 (0.6%) patients with IPD seen at our center over a 10-year period. METHODS The study population consisted of 24 women and 8 men (mean age 42 years, range 13 to 82 years). Ten (31%) patients presented with acute recurrent pancreatitis, 5 (16%) with chronic pancreatitis, and 3 (9%) with pancreatic type pain. Detailed history, laboratory tests, US, CT, and ERCP excluded other etiologies for their symptoms. The remaining 14 (44%) presented with biliary problems. The 18 symptomatic patients with IPD were treated as follows: 8 received dorsal duct stents, 3 underwent minor papilla endoscopic sphincterotomy and dorsal duct stent placement, 4 had minor papilla dilatation only, and 3 had ventral duct stents placed. RESULTS Patients were then followed for recurrence of pancreatitis and pancreatic-type pain. Mean follow-up was 15.5 months (range 3 to 30 months). Six (60%) of the patients with acute recurrent pancreatitis and 4 (80%) with chronic pancreatitis benefitted from the endoscopic therapy. However, only 1 (33%) of the patients with pancreatic-type pain benefitted. CONCLUSION The clinical presentation and response to endoscopic therapy of patients with ICP appeared to be similar to that of patients with complete pancreas divisum.

ERCP induced acute pancreatitis: Risk assessment based on diagnostic and specific therapeutic cases

ERCP INDUCED ACUTE PANCREATITIS: RISK ASSESSMENT BASED ON DIAGNOSTIC AND SPECIFIC THERAPEUTIC CASES. MF Catalano, JE Geenen, MI Schmalz, GK Johnson, DJ Geenen, WJ Hogan, and Midwest Pancreaticobiliary Group. St. Lukes Medical Center, Milwaukee, WI. Panereat~ is the most common major complication of diagnostic and therapeutic ERCT. Studies have reported the incidence of pancreatitis to be between 1-15% of all patient undergoing ERCP. The mechanism of injury during ERCP is unknown but likely includes chemical, thermal and mechanical factors. The rate of pancreatitis for specific therapeutic ERCP procedures has not been fully stratified. METHODS: The results of 2,954 patients undergoing ERCP for diagnostic 0,069) and therapeutic (1,885) were reviewed for cases of pancreatitis requiring hospitaliration. ~ t i c eases included sphincter of Oddi manometry (SOM) alone (315) or with sphincterotomy (176), sphineterotomy alone (571) or with stoat (225), stem alone (323), and others (266). Although other complications occurred including bleeding, perforation, and cholangitis; these were not considered in this study. Diagnosis of pancreatitis was defined as typical abdominal pain associated with elevation of amylase > 2 times normal values. RESULTS: Frequency of panereatitis in diagnostic cases was 4.7% compared to 10.9% in therapeutic eases. Rate of pancreatitis for specific therapeutic eases ranged from 6.0 to a high of 27.3%.