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| 2. |
- Kullman, Eric, et al.
(författare)
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Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
- 2010
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Ingår i: GASTROINTESTINAL ENDOSCOPY. - : Elsevier Science B. V., Amsterdam. - 0016-5107 .- 1097-6779. ; 72:5, s. 915-923
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Tidskriftsartikel (refereegranskat)abstract
- Background: Covered biliary metal stents have been developed to prevent tumor ingrowth. Previous comparative studies are limited and often include few patients. Objective: To compare differences in stent patency, patient survival, and complication rates between covered and uncovered nitinol stents in patients with malignant biliary obstruction. Design: Randomized, multicenter trial conducted between January 2006 and October 2008. Setting: Ten sites serving a total catchment area of approximately 2.8 million inhabitants. Patients: A total of 400 patients with unresectable distal malignant biliary obstruction. Interventions: ERCP with insertion of covered or uncovered metal stent. Follow-up conducted monthly for symptoms indicating stent obstruction. Main Outcome Measurements: Time to stent failure, survival time, and complication rate. Results: The patient survival times were 116 days (interquartile range 242 days) and 174 days (interquartile range 284 days) in the covered and uncovered stent groups, respectively (P = .320). The first quartile stent patency time was 154 days in the covered stent group and 199 days in the uncovered stent group (P = .326). There was no difference in the incidence of pancreatitis or cholecystitis between the 2 groups. Stent migration occurred in 6 patients (3%) in the covered group and in no patients in the uncovered group (P = .030). Limitations: Randomization was not blinded. Conclusions: There were no significant differences in stent patency time, patient survival time, or complication rates between covered and uncovered nitinol metal stents in the palliative treatment of malignant distal biliary obstruction. However, covered stents migrated significantly more often compared with uncovered stents, and tumor ingrowth was more frequent in uncovered stents.
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- Björnsson, Bergthor, et al.
(författare)
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Early endoscopic treatment of blunt traumatic pancreatic injury
- 2015
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Ingår i: Scandinavian Journal of Gastroenterology. - : TAYLOR and FRANCIS LTD. - 0036-5521 .- 1502-7708. ; 50:12, s. 1435-1443
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Forskningsöversikt (refereegranskat)abstract
- Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.
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| 7. |
- Borch, Kurt, 1944-, et al.
(författare)
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Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma
- 2000
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 87:5, s. 618-626
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are indications that some features of gastric carcinoma are changing, with a possible impact on prognosis. The aim of this study was to examine any changes in type, location, stage, resection rate, postoperative mortality rate or prognosis for patients with gastric carcinoma in a well defined population. Methods: During 1974-1991, 1161 new cases of gastric adenocarcinoma were diagnosed in Ostergotland County, Sweden. Tumour location, Lauren histological type, tumour node metastasis (TNM) stage, radicality of tumour resection and postoperative complications were recorded after histological re-evaluation of tissue specimens and examination of all patient records. Dates of death were obtained from the Swedish Central Bureau of Statistics. Time trends were studied by comparing the intervals 1974-1982 (period 1) and 1983-1991 (period 2). Results: The proportion of diffuse type of adenocarcinoma increased (from 27 to 35 per cent), while that of mixed type decreased (from 16 to 9 per cent) and that of intestinal type was unchanged. The proportion of tumours located in the proximal two-thirds of the stomach increased (from 32 to 42 per cent) and the proportion of patients with tumours in TNM stage IV decreased (from 32 to 25 per cent). Overall tumour resection rates were unchanged, although the proportion of radical total gastrectomies increased (from 36 to 50 per cent). Excluding tumours of the cardia or gastric remnant after previous ulcer surgery, the 5-year relative survival rate after radical resection increased from 25 to 36 per cent and the postoperative mortality rate decreased for both radical (from 11 to 4 per cent) and palliative (from 18 to 6 per cent) resection. Conclusion: The patterns of tumour histology, location and stage of gastric carcinoma have changed in the authors' region. These changes were paralleled by a significant improvement in survival and postoperative mortality rates.
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- Enochsson, L, et al.
(författare)
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Laparoscopic vs open appendectomy in overweight patients
- 2001
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 15:4, s. 387-392
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Tidskriftsartikel (refereegranskat)abstract
- Background: Laparoscopic appendectomy (LA) has been associated with a faster recovery and less postoperative pain than the open technique. However, few data are available on the clinical outcome of LA in overweight patients. Methods: A group of 106 patients with a body mass index (BMI) > 26.4, representing the upper quintile of 500 prospectively randomized patients, were included in the study. They were randomized to undergo either laparoscopic or open appendectomy (OA). Operating and anesthesia times, postoperative pain, complications, hospital stay, functional index (1 week postoperatively), sick leave, and time to full recovery were documented. Results: In OA, the operating time for overweight patients was significantly longer than that for patients in the normal weight range (40 vs 35 min, p < 0.05). In LA, there was no difference in operating time between the normal and overweight patients. Overweight patients who underwent LA had longer operating and anesthesia times than their OA counterparts (55 vs 40 min, p < 0.001, and 125 vs 100 min, p < 0.001, respectively). Postoperative pain was significantly greater in overweight patients who underwent OA than in those treated with the laparoscopic technique. Postoperative pain was also significantly greater in overweight patients subjected to OA than in patients of normal weight after 4 weeks, the clinical significance may, however, be of less importance since the values are low (0.26 vs 0.09, p < 0.05). There were no significant differences between the two operating techniques in terms of complications. Hospital stay was longer for overweight patients than for normal-weight patients undergoing OA (3.0 vs 2.0, p < 0.01). The functional index did not differ between any group of patients. Sick leave was longer for overweight patients who underwent OA than for normal-weight patients treated with the same technique (17 vs 13 days, p < 0.01). In the laparoscopic group, however, there were no differences between the overweight and normal-weight patients. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group (22 vs 15 days, p < 0.001). Conclusion: In this study, overweight patients who were submitted to LA had less postoperative pain and a faster postoperative recovery than overweight patients who had OA. LA also abolished some of the negative effects that overweight had on operating time, hospital stay, and sick leave with the open technique. However, anesthesia and operating times were significantly longer in LA for both overweight patients and those with a normal BMI.
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| 11. |
- Halldestam, Ingvar, et al.
(författare)
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Incidence of and potential risk factors for gallstone disease in a general population sample
- 2009
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Ingår i: BRITISH JOURNAL OF SURGERY. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 96:11, s. 1315-1322
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several epidemiological studies have been published, but there are few reports on relations between gallstone incidence, symptomatology and risk factors. Methods: Of 621 randomly selected individuals aged 35-85 years in a general population who been screened previously, with ultrasonography and found to have no gallbladder stones, 503 (81.0 per cent) were re-examined after a minimum interval of 5 years. At baseline and re-examination, heredity for gallstone disease was explored and body mass index, digestive symptoms including abdominal pain, quality of life, alcohol and smoking habits, use of non-steroidal anti-inflammatory drugs and oestrogen, parity and blood lipid levels were recorded. Results: Forty-two (8.3 per cent) of the 503 subjects developed stones. Subjects were followed for a total of 3025.8 person-years, yielding an incidence for newly developed gallstones of 1.39 per 100 person-years. A positive association for gallstone development,was found only for length of follow-up and plasma low-density lipoprotein-cholesterol levels at baseline. Weekly alcohol consumption was inversely related to gallstone development. Conclusion: The incidence of gallstones in this population was 1.39 per 100 person-years. Gallstone development was related to length of follow-up and LDL-cholesterol levels, and inversely related to alcohol consumption.
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| 18. |
- Kullman, Eric, 1952-
(författare)
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Trends and current clinical aspects of complicated gallstone disease - with special reference to endoscopic treatment
- 1993
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Time trends regarding incidence, management, and outcome of acute (AC) and elective cholecystectomy (EC), as well as symptomatic (cholangitis, pancreatitis, jaundice) and asymptomatic (detected accidentally during cholecystectomy) common bile duct (CBD) stones were studied during the time period 1970-1986 in a welldefined Swedish population. From period I (1970-1978) to period II (1979-1986) there was a four-fold increase in the ratio of AC (period I: mean 10/100,000/year, period II: mean 30/100,000/year) to EC (period 1: mean 190/100,000/year, period II: mean 120/100,000/year). For both AC and EC the fraction of patients older than 70 years increased significantly with time. For AC, the female to male ratio decreased significantly from 2.6 to 1.0. The duration of history and frequency of previous hospital stay for gallstone disease decreased significantly for both groups. The postoperative morbidity did not change, whereas the postoperative mortality after AC decreased significantly. Postoperative mortality was significantly higher after AC than EC in both periods. Complications occurred less frequently among patients with a short history of gallstone symptoms than among those with a long history.During the same time periods, there was a significant increase in the incidence of symptomatic CBD stones (8 - 20 cases/100,000 inhabitants/year), and a slight decrease in the incidence of asymptomatic CBD stones (12- 10 cases/lOO cholecystectomies/year). The fraction of patients older than 70 years increased from 31% to 60% for patients with symptomatic CBD stones and from 17% to 27% for patients with asymptomatic CBD stones. In period 11 endoscopic sphincterotomy (EST) accounted for 81 % of all primary procedures performed in patients with symptomatic CBD stones. Type of treatment disregarded, the frequency of clinically overt retained CBD stones increased from 7 % to 22 %. Overall, the frequency of general complications decreased significantly,mainly due to a decrease in the group with symptomatic CBD stones. The frequency of procedure related complications also decreased in the symptomatic group, whereas it increased in the asymptomatic group. Theoverall mortality rate decreased significantly. The total time of stay in hospital decreased by 48 % for patients with symptomatic CBD stones and 23 %for those with asymptomatic stones.EST for retained or recurrent CBD stones after cholecystectomy was performed in 128 patients with an overall success rate of 92 %. Late bile duct complications (recurrent stones and/or stenosis) occurred in seven patients at a median time of 20 months after EST and were best treated with repeat EST. To minimize short-term complications, efforts to extract all stones and confirmation of CBD clearance is mandatory at the initialprocedure. EST is safe and efficient as the first procedure of choice in patients with retained and recurrent CBD stones.EST was performed in 148 patients with CBD stones and the gallbladder left in situ with an overall success rate of 88 %. The median observation time in 118 patients discharged with the gallbladder in situ was 42 months. Complications necessitating acute surgery arose from the remaining gallbladder in seven patients (6 %) at a median of 14 months after EST. Another six patients (5 %) underwent elective cholecystectomy at a median of 21 months after EST. A stone bearing gallbladder left in situ after EST does not appear to be an additional risk factor for future complications compared to the natural history in patients with verified cholelithiasis. Leaving the gallbladder in situ after EST is justified in elderly and frail patients. Surgery should be restricted to patients in whom symptoms develop.The occurrence of bacteremia in association with diagnostic or therapeutic ERCP were studied in 180 patients undergoing 194 examinations, and it occurred in 15 % and 27 %, respectively. There was no correlation between the occurrence of bacteremia and the duration of the procedure. The frequency of complications in patients with bacteremia did not diffef from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP.Extracorporeal shock wave lithotripsy (ESWL) was performed in 28 patients with problematic CBD stones and 9 patients with intrahepatic duct (IHD) stones. The overall fraction of successfully treated patients was 89 %, with no major complications or mortality. It is concluded that ESWL is a safe and efficient treatment modality for CBD and IHD stones after failed endoscopic treatment. It further extends the number of patients with bile duct stones who can be treated by non-surgical means.
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| 19. |
- Nilsson, Andreas, et al.
(författare)
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Sedation during endoscopic retrograde cholangiopancreatography : A randomised controlled study of patient-controlled propofol sedation and that given by a nurse anaesthetist
- 2015
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 50:10, s. 1285-1292
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Different regimens are used for sedation during ERCP (endoscopic retrograde cholangiopancreatography). Our objectives were to compare safety, ease of treatment, time to recovery and patients’ experiences using PCS (patient-controlled sedation) with propofol as well as sedation given by a nurse anaesthetist (ACS) with propofol or midazolam during ERCP.Material and methods: The study included 281 adults in 301 procedures. The PCS group (n=101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n=100) had 2-8 mg/kg/hour of propofol infused, with the target for sedation being Level 3 of the Observer’s Assessment of Alertness/Sedation scale (OAA/S). The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required.Results: PCS and ACS increased the ease of the procedure and reduced the numbers of sedation failures compared to midazolam sedation (ACS n=0; PCS n=4; midazolam n=20). The ACS group had more deeply sedated patients (OAA/S Level 2), desaturations and obstructed airways than the PCS and midazolam groups. Over 90% of all patients had recovered (Aldrete score≥9) by the time they returned to the ward. PCS resulted in the least fatigue and pain after the procedure. Patients’ preference for PCS and ACS were the same.Conclusion: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, tended to be the safest and was almost as effective as ACS in ensuring a successful examination.
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| 21. |
- Tibbling Grahn, Lita, et al.
(författare)
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Gastric bile monitoring : An in vivo and in vitro study of bilitec reliability
- 2002
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 37:11, s. 1334-1337
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Tidskriftsartikel (refereegranskat)abstract
- Background: It has been claimed that the combination of bile and hydrochloride acid (HCl) has a noxious effect on intestinal mucosa. The aim was to study the reliability of the Bilitec 2001 method in monitoring the presence of bile in repeated tests and at different pH and water dilutions. Methods: 24-h esophageal pH and gastric Bilitec monitoring were performed twice with an interval of 6 weeks in 23 patients with symptomatic gastroesophageal reflux (GER). In vitro tests of pH and Bilitec recordings were performed with different mixtures of bile, HCl and water. Results: Gastric bile was present in 37% of the recording time, 28% during day time and 47% during nights. No significant difference was found between the two test occasions. The maximum bile concentration in the stomach was significantly lower in patients with severe pathological GER than in those with normal GER. When concentrated bile was diluted with the same volume of HCl, the pH level fell below 4. The maximum absorption limit with Bilitec in concentrated bile was gradually reduced with decreasing pH. The Bilitec technique recorded the presence of bile even at a pH of 1.4, but not if the bile was diluted with water at a ratio of 1:100 or more. Conclusions: Bilitec gastric recordings show the same clinical result when repeated under standardized conditions. The Bilitec technique is not reliable for monitoring the amount and concentration of bile in the stomach. Bile reflux cannot be monitored with the pH recording technique.
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