Krisztina Tari

Transgastric gastro-jejunal anastomosis with flexible endoscope on a biosynthetic model

INTRODUCTION In the last few years the rapid development of flexible endoscopies has opened new possibilities in minimal invasive procedures. With the help of these techniques the exposure, the risk of complications and the healing period of the patient might be reduced. One of these procedures is the transgastric intervention. Through an incision on the wall of the stomach, the endoscope could be led into the abdominal cavity, where several interventions can be performed. The aim of the study was to examine the technical feasibility and the success of the formation of gastro-jejunal anastomosis. Meanwhile the difficulties of the method could be explored in order to introduce this method in human use. METHOD A lifelike biosynthetic model was made from a slaughtered domestic pigs gastrointestinal tract (stomach and the first few jejunum loops) which was fixed onto a plastic frame. Two single-channel gastroscopes were inserted into the stomach. On the wall of the stomach an approximately 2 centimetres wide incision was made by the electrocoagulator with a needle-knife. Through it the first jejunum loop was grasped by a foreign-body forceps and then was retracted into the stomach. Subsequently the jejunum loop was held safely with the first endoscope. Parallel to it an incision was made on the jejunum by the electrocoagulator. The authors managed to securely unite the open edges of the gastric wall and the jejunum with endoclips. RESULT The model was good for practising. The anastomosis is technically feasible and was successfully made on biosynthetic porcine model using the transgastric route. Although the incisions both on the gastric wall and on the jejunum loop were made easily, the fixing of the anastomosis might be questionable. CONCLUSION It was revealed that more experiments and the development of new, special instruments are needed in order to conduct the anastomosis safely.

PEG fixation of an upside-down stomach using a flexible endoscope: case report and review of the literature.

Introduction: Upside-down stomach usually is asymptomatic in adults, but sometimes it can cause regurgitation, vomiting, and weight loss. This condition has an incidence increasing with age thus increasing the risk of surgical intervention. Case Report: A 90-year-old man was admitted with dysphagia, postprandial regurgitation, and an 18 kg weight loss in the past year. Gastroscopy revealed a significantly dilated, cranky esophagus and an upside-down stomach. The diagnosis was confirmed by a barium swallow and computed tomography. The stomach was repositioned with a gastroscope using insufflation and an &agr;-loop maneuver under fluoroscopic guidance. A percutaneous endoscopic gastrostomy tube was then inserted to fix the stomach. The patient was discharged on the first postinterventional day. He gained 6 kg in the next 2 months. Discussion: High-risk patients with upside-down stomach can be managed by endoscopic repositioning of the stomach and percutaneous endoscopic gastrostomy fixation. This is a useful alternative therapeutic intervention. There have been 14 similar cases being reported in the literature.

Transgastricus gastrojejunalis anastomosis készítése flexibilis endoszkóppal bioszintetikus modellen

INTRODUCTION In the last few years the rapid development of flexible endoscopies has opened new possibilities in minimal invasive procedures. With the help of these techniques the exposure, the risk of complications and the healing period of the patient might be reduced. One of these procedures is the transgastric intervention. Through an incision on the wall of the stomach, the endoscope could be led into the abdominal cavity, where several interventions can be performed. The aim of the study was to examine the technical feasibility and the success of the formation of gastro-jejunal anastomosis. Meanwhile the difficulties of the method could be explored in order to introduce this method in human use. METHOD A lifelike biosynthetic model was made from a slaughtered domestic pigs gastrointestinal tract (stomach and the first few jejunum loops) which was fixed onto a plastic frame. Two single-channel gastroscopes were inserted into the stomach. On the wall of the stomach an approximately 2 centimetres wide incision was made by the electrocoagulator with a needle-knife. Through it the first jejunum loop was grasped by a foreign-body forceps and then was retracted into the stomach. Subsequently the jejunum loop was held safely with the first endoscope. Parallel to it an incision was made on the jejunum by the electrocoagulator. The authors managed to securely unite the open edges of the gastric wall and the jejunum with endoclips. RESULT The model was good for practising. The anastomosis is technically feasible and was successfully made on biosynthetic porcine model using the transgastric route. Although the incisions both on the gastric wall and on the jejunum loop were made easily, the fixing of the anastomosis might be questionable. CONCLUSION It was revealed that more experiments and the development of new, special instruments are needed in order to conduct the anastomosis safely.

Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban

INTRODUCTION AND AIM In the treatment of colorectal endometriosis a multidisciplinary laparoscopic resection is suggested, for this reason the correct selection of bowel infiltration is essential before surgery. PATIENTS AND METHOD Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. In endoscopically confirmed cases multidisciplinary surgery was performed, the remaining patients were operated by a gynecologic team only. RESULTS Endometriosis was endoscopically confirmed in 224 patients (58.49%), 108 of them underwent multidisciplinary operation, the negative 135 cases received gynaecological surgery. Bowel endometriosis was confirmed in 103 out of 108 cases intraoperatively, while in 8 cases of the sigmoidoscopically negative patients bowel infiltration was diagnosed intraoperatively by the gynaecological team. Complete sigmoidoscopy was performed in 43.47% of the cases. Intraluminal endometriosis was found in 4.91%, secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis) in 26.06% and suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. CONCLUSION Sigmoidoscopy performed by an experienced gastroenterologist is a highly sensitive examination for the diagnosis of bowel endometriosis. Orv. Hetil., 2017, 158(7), 264-269.Absztrakt: Bevezetes es celkitűzes: A colorectalis rendszert erintő endometriosis ellatasa multidiszciplinaris laparoszkopos teammel javasolt. A belinfiltracio preoperativ felismerese ehhez elengedhetetlen. Betegek es modszer: 2009–2015 kozott prospektiven 383, endometriosissal diagnosztizalt betegnel tortent sigmoideoscopia. Intraluminalis endometriosis, fali infiltraciora jellemző masodlagos jelek (falmerevseg, benyomat, megtoretes, vizsgalat alatti fajdalom, suffusio) kerultek feldolgozasra. Műteti indikacio eseten a pozitiv esetek multidiszciplinaris, a negativ esetek nőgyogyasz altal vegzett műteten estek at. Eredmenyek: 224 (58,49%) pozitivnak talalt beteg kozul 108-nal multidiszciplinaris műtet tortent, a negativnak bizonyult esetek kozul 135 ginekologiai műteten esett at. 108-bol 103 betegnel a műtet soran is igazolodott a bel erintettsege, mig a negativ esetek kozul nyolc esetben volt jelentős belinfiltracio. Teljes sigmoideoscopias vizsgalat 43,4%-ban volt kivitelezhető. Intraluminalis endometri...

Removal of sessile recidiv rectal polyp with endoscopic submucosal dissection. Case report and review of the literature

UNLABELLED With the development of flexible endoscopy, removal of the large sessile polyps and superficial malignant tumors that do not exceed the layer muscular mucosa has become todays major challenge. Earlier in various types of mucosectomy performed with such indication it was difficult to control the depth and the lateral margin of the resection surface. Tumors larger than 20 mm could only be removed with the application of the piecemeal technique. PATIENT AND METHOD 64-year-old female patients large sessile polyp had been removed earlier with piecemeal technique followed by mucosectomy. On the area of these interventions a recidiv adenoma was found and for this reason endoscopic submucosal dissection was applied. RESULT The procedure took 55 minutes, and only small volume of bleeding was detected during the intervention. The postoperative period was uneventful, one day later the patient left the hospital. Vertical and lateral resection surface were free of tumor histologically. CONCLUSION The endoscopic submucosal dissection is suitable for the removal of the large sessile polyp, which could not be successfully removed with earlier techniques.Az intraluminalis invaziv endoszkopia fejlődesevel a nagy, sessilis polipok, a muscularis mucosa reteget nem meghalado malignus tumorok eltavolitasa jelent napjainkban kihivast. A korabban ilyen indikacioval vegzett mucosectomiak kulonboző formainal nehezseget okozott a melysegi es lateralis reszekcios szelek kontrollja, a 20 mm-nel nagyobb elvaltozasok pedig csak piecemealtechnikaval voltak eltavolithatok. Beteganyag: 64 eves nőbeteg nagy, korabban piecemealtechnikaval, majd mucosectomiaval eltavolitott sessilis rectumpolipjanak helyen eszlelt recidiv elvaltozas eltavolitasat vegeztuk endoszkopos submucosus dissectiot alkalmazva. Eredmenyek: Az 55 percig tarto beavatkozas soran csak minimalis verzes jelentkezett. A beavatkozas soran szovődmenyt nem eszleltunk, a beteg egynapos obszervacio utan panaszmentesen tavozott. A szovettani vizsgalat szerint az elvaltozas eltavolitasa vertikalisan es lateralisan is az epben tortent. Kovetkeztetes: Az endoszkopos submucosus dissectio olyan elvaltozasok radikalis eltavolitasara is alkalmas, melyek a korabban alkalmazott technikakkal nem voltak sikeresen reszekalhatok. | With the development of flexible endoscopy, removal of the large sessile polyps and superficial malignant tumors that do not exceed the layer muscular mucosa has become today’s major challenge. Earlier in various types of mucosectomy performed with such indication it was difficult to control the depth and the lateral margin of the resection surface. Tumors larger than 20 mm could only be removed with the application of the piecemeal technique. Patient and method: 64-year-old female patient’s large sessile polyp had been removed earlier with piecemeal technique followed by mucosectomy. On the area of these interventions a recidiv adenoma was found and for this reason endoscopic submucosal dissection was applied. Result: The procedure took 55 minutes, and only small volume of bleeding was detected during the intervention. The postoperative period was uneventful, one day later the patient left the hospital. Vertical and lateral resection surface were free of tumor histologically. Conclusion: The endoscopic submucosal dissection is suitable for the removal of the large sessile polyp, which could not be successfully removed with earlier techniques.

Sessilis recidív rectumpolip miatt végzett endoszkópos submucosus dissectio.Esetismertetés és irodalmi áttekintés@@@Removal of sessile recidiv rectal polyp with endoscopic submucosal dissection. Case report and review of the literature

UNLABELLED With the development of flexible endoscopy, removal of the large sessile polyps and superficial malignant tumors that do not exceed the layer muscular mucosa has become todays major challenge. Earlier in various types of mucosectomy performed with such indication it was difficult to control the depth and the lateral margin of the resection surface. Tumors larger than 20 mm could only be removed with the application of the piecemeal technique. PATIENT AND METHOD 64-year-old female patients large sessile polyp had been removed earlier with piecemeal technique followed by mucosectomy. On the area of these interventions a recidiv adenoma was found and for this reason endoscopic submucosal dissection was applied. RESULT The procedure took 55 minutes, and only small volume of bleeding was detected during the intervention. The postoperative period was uneventful, one day later the patient left the hospital. Vertical and lateral resection surface were free of tumor histologically. CONCLUSION The endoscopic submucosal dissection is suitable for the removal of the large sessile polyp, which could not be successfully removed with earlier techniques.Az intraluminalis invaziv endoszkopia fejlődesevel a nagy, sessilis polipok, a muscularis mucosa reteget nem meghalado malignus tumorok eltavolitasa jelent napjainkban kihivast. A korabban ilyen indikacioval vegzett mucosectomiak kulonboző formainal nehezseget okozott a melysegi es lateralis reszekcios szelek kontrollja, a 20 mm-nel nagyobb elvaltozasok pedig csak piecemealtechnikaval voltak eltavolithatok. Beteganyag: 64 eves nőbeteg nagy, korabban piecemealtechnikaval, majd mucosectomiaval eltavolitott sessilis rectumpolipjanak helyen eszlelt recidiv elvaltozas eltavolitasat vegeztuk endoszkopos submucosus dissectiot alkalmazva. Eredmenyek: Az 55 percig tarto beavatkozas soran csak minimalis verzes jelentkezett. A beavatkozas soran szovődmenyt nem eszleltunk, a beteg egynapos obszervacio utan panaszmentesen tavozott. A szovettani vizsgalat szerint az elvaltozas eltavolitasa vertikalisan es lateralisan is az epben tortent. Kovetkeztetes: Az endoszkopos submucosus dissectio olyan elvaltozasok radikalis eltavolitasara is alkalmas, melyek a korabban alkalmazott technikakkal nem voltak sikeresen reszekalhatok. | With the development of flexible endoscopy, removal of the large sessile polyps and superficial malignant tumors that do not exceed the layer muscular mucosa has become today’s major challenge. Earlier in various types of mucosectomy performed with such indication it was difficult to control the depth and the lateral margin of the resection surface. Tumors larger than 20 mm could only be removed with the application of the piecemeal technique. Patient and method: 64-year-old female patient’s large sessile polyp had been removed earlier with piecemeal technique followed by mucosectomy. On the area of these interventions a recidiv adenoma was found and for this reason endoscopic submucosal dissection was applied. Result: The procedure took 55 minutes, and only small volume of bleeding was detected during the intervention. The postoperative period was uneventful, one day later the patient left the hospital. Vertical and lateral resection surface were free of tumor histologically. Conclusion: The endoscopic submucosal dissection is suitable for the removal of the large sessile polyp, which could not be successfully removed with earlier techniques.

Sessilis recidív rectumpolip miatt végzett endoszkópos submucosus dissectio. Esetismeftetés és irodalmi áttekintés

UNLABELLED With the development of flexible endoscopy, removal of the large sessile polyps and superficial malignant tumors that do not exceed the layer muscular mucosa has become todays major challenge. Earlier in various types of mucosectomy performed with such indication it was difficult to control the depth and the lateral margin of the resection surface. Tumors larger than 20 mm could only be removed with the application of the piecemeal technique. PATIENT AND METHOD 64-year-old female patients large sessile polyp had been removed earlier with piecemeal technique followed by mucosectomy. On the area of these interventions a recidiv adenoma was found and for this reason endoscopic submucosal dissection was applied. RESULT The procedure took 55 minutes, and only small volume of bleeding was detected during the intervention. The postoperative period was uneventful, one day later the patient left the hospital. Vertical and lateral resection surface were free of tumor histologically. CONCLUSION The endoscopic submucosal dissection is suitable for the removal of the large sessile polyp, which could not be successfully removed with earlier techniques.Az intraluminalis invaziv endoszkopia fejlődesevel a nagy, sessilis polipok, a muscularis mucosa reteget nem meghalado malignus tumorok eltavolitasa jelent napjainkban kihivast. A korabban ilyen indikacioval vegzett mucosectomiak kulonboző formainal nehezseget okozott a melysegi es lateralis reszekcios szelek kontrollja, a 20 mm-nel nagyobb elvaltozasok pedig csak piecemealtechnikaval voltak eltavolithatok. Beteganyag: 64 eves nőbeteg nagy, korabban piecemealtechnikaval, majd mucosectomiaval eltavolitott sessilis rectumpolipjanak helyen eszlelt recidiv elvaltozas eltavolitasat vegeztuk endoszkopos submucosus dissectiot alkalmazva. Eredmenyek: Az 55 percig tarto beavatkozas soran csak minimalis verzes jelentkezett. A beavatkozas soran szovődmenyt nem eszleltunk, a beteg egynapos obszervacio utan panaszmentesen tavozott. A szovettani vizsgalat szerint az elvaltozas eltavolitasa vertikalisan es lateralisan is az epben tortent. Kovetkeztetes: Az endoszkopos submucosus dissectio olyan elvaltozasok radikalis eltavolitasara is alkalmas, melyek a korabban alkalmazott technikakkal nem voltak sikeresen reszekalhatok. | With the development of flexible endoscopy, removal of the large sessile polyps and superficial malignant tumors that do not exceed the layer muscular mucosa has become today’s major challenge. Earlier in various types of mucosectomy performed with such indication it was difficult to control the depth and the lateral margin of the resection surface. Tumors larger than 20 mm could only be removed with the application of the piecemeal technique. Patient and method: 64-year-old female patient’s large sessile polyp had been removed earlier with piecemeal technique followed by mucosectomy. On the area of these interventions a recidiv adenoma was found and for this reason endoscopic submucosal dissection was applied. Result: The procedure took 55 minutes, and only small volume of bleeding was detected during the intervention. The postoperative period was uneventful, one day later the patient left the hospital. Vertical and lateral resection surface were free of tumor histologically. Conclusion: The endoscopic submucosal dissection is suitable for the removal of the large sessile polyp, which could not be successfully removed with earlier techniques.

Transgastricus gastrojejunalis anastomosis készítése flexibilis endoszkóppal bioszintetikus modellen@@@Transgastric gastro-jejunal anastomosis with flexible endoscope on a biosynthetic model

INTRODUCTION In the last few years the rapid development of flexible endoscopies has opened new possibilities in minimal invasive procedures. With the help of these techniques the exposure, the risk of complications and the healing period of the patient might be reduced. One of these procedures is the transgastric intervention. Through an incision on the wall of the stomach, the endoscope could be led into the abdominal cavity, where several interventions can be performed. The aim of the study was to examine the technical feasibility and the success of the formation of gastro-jejunal anastomosis. Meanwhile the difficulties of the method could be explored in order to introduce this method in human use. METHOD A lifelike biosynthetic model was made from a slaughtered domestic pigs gastrointestinal tract (stomach and the first few jejunum loops) which was fixed onto a plastic frame. Two single-channel gastroscopes were inserted into the stomach. On the wall of the stomach an approximately 2 centimetres wide incision was made by the electrocoagulator with a needle-knife. Through it the first jejunum loop was grasped by a foreign-body forceps and then was retracted into the stomach. Subsequently the jejunum loop was held safely with the first endoscope. Parallel to it an incision was made on the jejunum by the electrocoagulator. The authors managed to securely unite the open edges of the gastric wall and the jejunum with endoclips. RESULT The model was good for practising. The anastomosis is technically feasible and was successfully made on biosynthetic porcine model using the transgastric route. Although the incisions both on the gastric wall and on the jejunum loop were made easily, the fixing of the anastomosis might be questionable. CONCLUSION It was revealed that more experiments and the development of new, special instruments are needed in order to conduct the anastomosis safely.