Over the last few years, a new method, neither medical nor surgical, has been developed for treating often difficult-to-treat chronic pancreatitis. In the case of obstructive pancreatitis, endoscopy permits both drainage and calculus extraction. Even encrusted concrements and calcifications can be removed from the pancreatic duct with the aid of extracorporeal shockwave lithotripsy. The first aim is to relieve pain by restoring a free flow of secretion. Perhaps the use of endoscopic treatment in the early stages will break the vicious circle of chronic inflammation and ultimate gland destruction.
Endoscopic placement of a naso-vesicular catheter was successful in 90% (45/50) of patients with cholecystolithiasis. The first 7 patients were treated by MTBE dissolution alone. Dissolution was discontinued after a maximum of 14 days, as only two patients were rendered stone free. In one patient, 3 tiny pigment stones were sucked out through the catheter, and in another inoperable patient a pigtail endoprosthesis was finally inserted into the gallbladder. In the remaining 36 patients, combined ESWL and MTBE dissolution therapy was carried out. Treatment was broken off by one patient after one week, and interrupted in another due to catheter dislodgement. After an average of 10 days with 1-9 ESWL sessions (average: 3) complete stone clearance was achieved in 60% (20/34) of patients. Fourteen of the patients who completed treatment, and the one with catheter dislodgement still have sludge in the gallbladder, which is being treated with oral bile acids. The procedure-related complication rate was 10% (3 pancreatitis, 1 cystic duct perforation and 1 guidewire impaction). The mortality rate was zero. There was no evident complication due to either ESWL or MTBE dissolution.
In cases of portal hypertension, the fundus of the stomach is second to the esophagus as the most likely area for varices, at a frequency of about 10%, in all patients having esophageal varices. It is relatively rare, probably due to the individual vascular anatomy rather than the level of portal pressure. The authors' experience shows that fundal varices appear more frequently with prehepatic block than intrahepatic.
We present a simple technique for the fixation of esophageal tubes. The endoprosthesis is anchored to a thin polyethylene catheter which is passed transnasally and attached to the ear. This method of treatment effectively prevents dislodgement. It is also suitable for placing a tube into the esophagus when the stenosis essential for anchorage is absent, for example in large fistulae, perforations, or suture dehiscence.
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