Diseases of the Upper Gastrointestinal Tract and Small Bowel

2017 ◽  
pp. 501-518
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Upper Gastrointestinal Tract ◽  
Upper Gastrointestinal

scholarly journals ‘Short’ Double-Balloon Enteroscope for Endoscopic Retrograde Cholangiopancreatography in Patients with a Surgically Altered Upper Gastrointestinal Tract

2011 ◽  
Vol 25 (11) ◽  
pp. 615-619 ◽  
Author(s):  
S Cho ◽  
P Kamalaporn ◽  
G Kandel ◽  
P Kortan ◽  
N Marcon ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Upper Gastrointestinal Tract ◽  
Papilla Of Vater ◽  
Endoscopic Retrograde ◽  
Bilioenteric Anastomosis ◽  
Double Balloon ◽  
Surgically Altered Anatomy ◽  
Working Length ◽  
Upper Gastrointestinal

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge for endoscopists in patients with surgically altered anatomy of the upper gastrointestinal tract. Double-balloon enteroscopes (DBEs) have revolutionized the ability to access the small bowel. The indication for its therapeutic use is expanding to include ERCP for patients who have undergone small bowel reconstruction. Most of the published experiences in DBE-assisted ERCP have used conventional double-balloon enteroscopes that are 200 cm in length, which do not permit use of the standard ERCP accessories. The authors report their experience with DBE-assisted ERCP using a ‘short’ DBE in patients with surgically altered anatomy.METHODS: A retrospective review of patients with previous small bowel reconstruction who underwent ERCP with a ‘short’ DBE at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (Toronto, Ontario) between February 2007 and November 2008 was performed.RESULTS: A total of 20 patients (10 men) with a mean age of 57.9 years (range 26 to 85 years) underwent 29 sessions of ERCP with a DBE. Six patients underwent Billroth II gastroenterostomy, seven patients Roux-en-Y hepaticojejunostomy, five patients Roux-en-Y gastrojejunostomy, one patient Roux-en-Y esophagojejunostomy and one patient a Whipple’s operation with choledochojejunostomy. Some patients (n=12 [60%]) underwent previous attempts at ERCP in which the papilla of Vater or bilioenteric anastomosis could not be reached with either a duodenoscope or pediatric colonoscope. All procedures were performed with a commercially available DBE (working length 152 cm, distal end diameter 9.4 mm, channel diameter 2.8 mm). The procedures were performed under conscious sedation with intravenous midazolam, fentanyl and diazepam, except in one patient in whom general anesthesia was administered. Either the papilla of Vater or bilioenteric anastomosis was reached in 25 of 29 cases (86.2%) in a mean duration of 20.8 min (range 5 min to 82 min). Bile duct cannulation was successful in 24 of 25 cases in which the papilla or bilioenteric anastomosis was reached. Therapeutic interventions were successful in 15 patients (24 procedures) including sphincterotomy (n=7), stone extraction (n=9), biliary dilation (n=8), stent placement (n=9) and stent removal (n=8). The mean total duration of the procedures was 70.7 min (range 30 min to 117 min). There were no procedure-related complications.CONCLUSION: DBEs enable successful diagnostic and therapeutic ERCP in patients with a surgically altered anatomy of the upper gastrointestinal tract. It is a safe, feasible and less invasive therapeutic option in this group of patients. Standard ‘long’ DBEs have limitations of long working length and the need for modified ERCP accessories. ‘Short’ DBEs are equally as effective in reaching the target limb as standard ‘long’ DBEs, and overcomes some limitations of long DBEs to result in high success rates for endoscopic therapy.

Upper gastrointestinal and hepatobiliary surgery

2016 ◽  
Author(s):  
Alison Smith
Keyword(s):  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Gall Bladder ◽  
Bile Ducts ◽  
Signs And Symptoms ◽  
Upper Gastrointestinal Tract ◽  
Hepatobiliary Surgery ◽  
Hepatobiliary System ◽  
Upper Gastrointestinal

The upper gastrointestinal tract consists of the oesophagus, stomach, and the duodenum, which is the first section of the small bowel where pancreatic digestive juices and bile mix with food. The term hepatobiliary refers to the liver, gall bladder, and bile ducts. This chapter provides an overview of the conditions affecting the upper gastrointestinal tract and the hepatobiliary system, including the signs and symptoms, investigations, and treatments.

Intraluminal Pressures from the Upper Gastrointestinal Tract

1957 ◽  
Vol 32 (6) ◽  
pp. 1013-1024 ◽  
Author(s):  
E. Clinton Texter ◽  
Hubbard W. Smith ◽  
Hugo C. Moeller ◽  
Clifford J. Barborka
Keyword(s):  
Gastrointestinal Tract ◽  
Upper Gastrointestinal Tract ◽  
Upper Gastrointestinal
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