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Featured researches published by G.N.J. Tytgat.


Gut | 1996

Treatment of bile duct lesions after laparoscopic cholecystectomy.

Jacques J. Bergman; G R van den Brink; E. A. J. Rauws; L. T. De Wit; H. Obertop; Kees Huibregtse; G.N.J. Tytgat; D. J. Gouma

From January 1990 to June 1994, 53 patients who sustained bile duct injuries during laparoscopic cholecystectomy were treated at the Amsterdam Academic Medical Centre. There were 16 men and 37 women with a mean age of 47 years. Follow up was established in all patients for a median of 17 months. Four types of ductal injury were identified. Type A (18 patients) had leakage from cystic ducts or peripheral hepatic radicles, type B (11 patients) had major bile duct leakage, type C (nine patients) had an isolated ductal stricture, and type D (15 patients) had complete transection of the bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) established the diagnosis in all type A, B, and C lesions. In type D lesions percutaneous cholangiography was required to delineate the proximal extent of the injury. Initial treatment (until resolution of symptoms and discharge from hospital) comprised endoscopy in 36 patients and surgery in 26 patients. Endoscopic treatment was possible and successful in 16 of 18 of type A lesions, five of seven of type B lesions, and three of nine of type C lesions. Most failures resulted from inability to pass strictures or leaks at the initial endoscopy. During initial treatment additional surgery was required in seven patients. Fourteen patients underwent percutaneous or surgical drainage of bile collections, or both. After endoscopic treatment early complications occurred in three patients, with a fatal outcome in two (not related to the endoscopic therapy). During follow up six patients developed late complications. All 15 patients with complete transection and four patients with major bile duct leakage were initially treated surgically. During initial treatment additional endoscopy was required in two patients. Early complications occurred in eight patients. During follow up seven patients developed stenosis of the anastomosis or bile duct. Reconstructive surgery in the early postoperative phase was associated with more complications than elective reconstructive surgery. Most type A and B bile duct injuries after laparoscopic cholecystectomy (80%) can be treated endoscopically. In patients with more severe ductal injury (type C and D) reconstructive surgery is eventually required in 70%. Multidisciplinary approach to these lesions is advocated and algorithms for treatment are proposed.


Gut | 1998

Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region

Marco J. Bruno; E. B. Haverkort; G P Tijssen; G.N.J. Tytgat; D J van Leeuwen

Background—Impeded flow of pancreatic juice due to mechanical obstruction of the pancreatic duct in patients with cancer of the pancreatic head region causes exocrine pancreatic insufficiency with steatorrhoea and creatorrhoea. This may contribute to the profound weight loss that often occurs in these patients. Aims—To investigate whether pancreatic enzyme replacement therapy prevents this weight loss. Patients—Twenty one patients with unresectable cancer of the pancreatic head region with suspected pancreatic duct obstruction, a biliary endoprosthesis in situ, and a Karnofsky performance status greater than 60. Methods—Randomised double blind trial of eight weeks with either placebo or high dose enteric coated pancreatin enzyme supplementation. All patients received dietary counselling. Results—The mean difference in the percentage change of body weight was 4.9% (p=0.02, 95% confidence interval for the difference: 0.9 to 8.9). Patients on pancreatic enzymes gained 1.2% (0.7 kg) body weight whereas patients on placebo lost 3.7% (2.2 kg). The fat absorption coefficient in patients on pancreatic enzymes improved by 12% whereas in placebo patients it dropped by 8% (p=0.13, 95% confidence interval for the difference: –6 to 45). The daily total energy intake was 8.42 MJ in patients on pancreatic enzymes and 6.66 MJ in placebo patients (p=0.04, 95% confidence interval for the difference: 0.08 to 3.44). Conclusions—Weight loss in patients with unresectable cancer of the pancreatic head region and occlusion of the pancreatic duct can be prevented, at least for the period immediately after insertion of a biliary endoprosthesis, by high dose enteric coated pancreatin enzyme supplementation in combination with dietary counselling.


The New England Journal of Medicine | 1995

The Genetic Basis of the Reduced Expression of Bilirubin UDP-Glucuronosyltransferase 1 in Gilbert's Syndrome

[No Value] Chowdhury; S Gantla; A Deboer; Ba Oostra; Dick Lindhout; G.N.J. Tytgat; Plm Jansen; Rpjo Elferink; Nr Chowdhury


Gastroenterology | 1996

Effects of Ursodeoxycholate and cholate feeding on liver disease in FVB mice with a disrupted mdr2 P-glycoprotein gene

Cm Van Nieuwkerk; Rp Elferink; A. K. Groen; Roelof Ottenhoff; G.N.J. Tytgat; Koert P. Dingemans; Ma Van Den Bergh Weerman; G.J.A. Offerhaus


British Journal of Surgery | 1997

Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy.

Marco J. Bruno; Judocus J. J. Borm; F. J. Hoek; B. Delzenne; A. F. Hofmann; J. J. M. de Goeij; E. A. van Royen; T. M. van Gulikt; L. Th. de Wit; D. J. Goumat; D.J. van Leeuwen; G.N.J. Tytgat


Clinical Science | 1994

Heterogeneity of Human Gallbladder Mucin in Bile

M. J. A. Van Wijland; J. H. Klinkspoor; L. T. De Wit; R. P. J. Oude Elferink; G.N.J. Tytgat; A. K. Groen


Current Opinion in Gastroenterology | 1997

The role of mdr2 P-glycoprotein in hepatobiliary lipid transport

Ronald P. J. Oude Elferink; G.N.J. Tytgat; Albert K. Groen


Netherlands Journal of Medicine | 1995

Influence of dietary cholate and ursodeoxycholate on liver pathology in mdr2 knockout mice

C.M.J. von Nieuwkerk; Roelof Ottenhoff; M. von Wijland; K.P. Dingemans; M.A. von den Bergh Weerman; G.N.J. Tytgat; G.J.A. Offerhaus; A. K. Groen; R.P.J. Oude Elferink


Integrated Medical and Surgical Gastroenterology | 2004

Liver cysts and abscesses. "Surgical aspects"

K.P. de Jong; M.H.A. Bemelmans; Jjb van Lanschot; D. J. Gouma; Plm Jansen; E. A. Jones; Wr Schouen; G.N.J. Tytgat


Integrated Medical and Surgical Gastroenterology | 2004

Adverse effects of chemo-radiotherapy

H.J.T. Rutten; P.B. Soeters; O.W.M. Mijer; Walter L. Vervenne; Jjb van Lanschot; D. J. Gouma; Plm Jansen; E. A. Jones; Wr Schouen; G.N.J. Tytgat

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D. J. Gouma

University of Amsterdam

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Plm Jansen

University of Groningen

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A. K. Groen

University of California

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