The authors discuss the incidence of perforation related to endoscopic retrograde cholangio-pancreatography, which is relatively uncommon (0.3-1%) among other types of complications. Perforations can be classified into three types based on their forms and locations. Having reviewed the literature the authors conclude that the most common type is periampullary perforation and the less frequent one is peritoneal perforation. The former usually heals after conservative treatment, while the latter needs an operation. The authors emphasize the important prognostic role of timely diagnosis and surgical treatment if alarming signs (peritoneal, septic) are present. Known predisposing factors, when the procedure needs more careful attention, are also summarized (postoperative status, needle knife papillectomy, intramural contrast media, long lasting examination). After reviewing their own cases, the authors establish that the incidence of perforation in their own centre was four per thousand (10/2400), out of which nine were periampullar and one peritoneal type. In 6 cases operation was necessary, and there was no mortality. The authors conclude that individually tailored therapy can largely reduce the 30-40% mortality rate reported in earlier studies.
AIM: The authors have aimed at confirming or excluding gluten sensitivity in infertile couples. PATIENTS AND METHODS: Between 2004 and 2010, at our outpatient clinics of immunology, both partners of 223 couples, who had striven for having a child unsuccessfully, underwent history taking, physical examination, laboratory and immuno-serologic tests including anti-tissue-transglutaminase antibody (anti-tTG), as well as deep duodenal biopsy in antibody-carrying patients. RESULTS: Antibodies against tissue transglutaminase were positive in 6/223 female patients of whom the diagnosis of celiac disease was histologically confirmed in 3/223 cases (1.34%). Of the male patients 2/223 (0.9%) have proven to be carriers of the antibody; histology was pathognomonic in both of them. Curiously, one of the male patients with celiac disease has been the partner of a woman who also had celiac disease diagnosed by the authors. In the followup period, a female patient and the female member of the couple with celiac disease gave birth to healthy newborns after spontaneous conception, as the result of a strictly kept gluten-free diet, as well as occasional treatments of acetylsalicylate for antiphos-pholipid syndrome or levothyroxine for latent hypothyroidism due to autoimmune thyroiditis. CONCLUSION: The results underline that it is worth performing a screening for celiac disease in both partners of couples assessed due to the lack of success in having a child, as infertility can be ceased by an appropriate diet.
The postoperative complications of the biliary tract, such as leakages and strictures, traditionally had been managed surgically, but from the 90s they are usually treated via endoscopic route. These complications occur most frequently after laparoscopic surgeries. Whenever biliary leakage is suspected, close collaboration between endoscopists and surgeons is needed. Immediate visualization of the biliary tract by ERCP is mandatory to confirm the diagnosis and to locate the exact site of the lesion. Various endoscopic techniques have been proved effective in treating post-cholecystectomy biliary leaks. The crucial point is to equalize the duodenal and the biliary pressures, allowing flow of the bile into the duodenum, advancing the healing of the lesion. This can be achieved with a simple endoscopic sphincterotomy or endoscopic sphincterotomy with subsequent insertion of a plastic stent. These methods seem to be equally suitable; however, for greater lesions stent placement is advisable. For strictures multiple stenting is the effective method, and the long standing effects also seem to be good.
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