• Title/Summary/Keyword: Endoscopic management

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Endoscopic Management of Supraglottic Stenosis with KTP-532 Laser (KTP-532 레이저에 의한 성문상부 협착증 치험)

  • Choi, Jong-Ouck;Jun, Byung-Sun;Kang, Hee-Joon;Baek, Seung-Kuk;Choi, Geun;Jung, Kwang-Yoon;Chu, Hyung-Ro
    • Korean Journal of Bronchoesophagology
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    • v.5 no.2
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    • pp.153-158
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    • 1999
  • Background and Objectives : The treatment of supraglottic stenosis remains a challenging problem in the field of otolaryngology due to its association with dyspnea, dysphagia, and frequent recurrence. Any satisfactory treatment is not yet known. The author experienced six cases of supraglottic stenosis and report the successful treatment of five cases by repeated endoscopic laryngeal excision with KTP-532 laser under suspension layngoscopy. Materials and Methods : Six adults who were treated for supraglottic stenosis between March 1994 and December 1998 at the Department of Otoloaryngology-Head and Neck Surgery, Korea University Medical Center were studied retrospectively. The patients were placed under general anesthesia followed by endoscopic laryngeal excision with KTP-532 laser under supension laryngoscopy. The scar tissue and granulation tissue were visualized with an operating microscope, and then removed using KTP-532 laser (15watts, continuous mode). Intraoperative local steroid(Triamcinolone ) was injected in all cases after the stenotic portions were removed. Results : Endoscopic excision was performed in five cases ; among the five cases, cricoid cartilage was concomitantly removed in two cases, and epiglottis was removed in one case. Satisfactory swallowing and airway respiration were possible in all five patients who underwent endoscopic widening. Conclusion : The treatment of supraglottic stenosis is different from that of tracheal or glottic stenosis in that supraglottic stenosis is mainly developed in membraneous form. Repeated laser excision and local steroid injection under suspension laryngoscopy is an effective and recommend able method for the treatment of supraglottic stenosis.

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Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases

  • Yoon Suk Lee;Jae-Young Jang;Jun Yong Bae;Eun Hye Oh;Yehyun Park;Yong Hwan Kwon;Jeong Eun Shin;Jun Kyu Lee;Tae Hee Lee;Chang Nyol Paik
    • Clinical Endoscopy
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    • v.56 no.4
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    • pp.499-509
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    • 2023
  • Background/Aims: This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability. Methods: Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs. Results: Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 3 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals. Conclusions: The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

Risk Stratification for Patients with Upper Gastrointestinal Bleeding (상부위장관 출혈 환자에서 위험의 계층화와 이에 따른 치료 전략)

  • Lee, Bong Eun
    • The Korean journal of helicobacter and upper gastrointestinal research
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    • v.18 no.4
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    • pp.225-230
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    • 2018
  • Upper gastrointestinal (GI) bleeding (UGIB) is the most common GI emergency, and it is associated with significant morbidity and mortality. Early identification of low-risk patients suitable for outpatient management has the potential to reduce unnecessary costs, and prompt triage of high-risk patients could allow appropriate intervention and minimize morbidity and mortality. Several risk-scoring systems have been developed to predict the outcomes of UGIB. As each scoring system measures different primary outcome variables, appropriate risk scores must be implemented in clinical practice. The Glasgow-Blatchford score (GBS) should be used to predict the need for interventions such as blood transfusion or endoscopic or surgical treatment. Patients with GBS ${\leq}1$ have a low likelihood of adverse outcomes and can be considered for early discharge. The Rockall score was externally validated and is widely used for prediction of mortality. The recently developed AIMS65 score is easy to calculate and was proposed to predict in-hospital mortality. The Forrest classification is based on endoscopic findings and can be used to stratify patients into high- and low-risk categories in terms of rebleeding and thus is useful in predicting the need for endoscopic hemostasis. Early risk stratification is critical in the management of UGIB and may improve patient outcome and reduce unnecessary health care costs through standardization of care.

Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control

  • Willian Ferreira Igi;Victor Lira de Oliveira;Ayah Matar;Diogo Turiani Hourneaux de Moura
    • Clinical Endoscopy
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    • v.57 no.3
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    • pp.309-316
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    • 2024
  • The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article comprehensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern exists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongoing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to support its routine use in clinical practice.

Anatomical endoscopic enucleation of the prostate for bladder outlet obstruction: a narrative review

  • Kim, Tae Hyo;Song, Phil Hyun
    • Journal of Yeungnam Medical Science
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    • v.39 no.1
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    • pp.12-17
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    • 2022
  • Anatomical endoscopic enucleation of the prostate (AEEP) differs from other endoscopic modalities for bladder outlet obstruction (BOO) because it extracts the whole benign prostatic hyperplasia component. AEEP has been launched for almost 40 years as a first-line treatment method for BOO regardless of prostate size according to several guidelines. However, it remains underperformed worldwide. In this review article, we elaborate on the advantages and disadvantages of AEEP compared to other surgical modalities for BOO to investigate its efficacy and safety as a gold standard surgical management option for males with BOO.

A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection (코카콜라 주입 치료를 병용하여 내시경으로 분쇄 치료한 거대 위석 1예)

  • Jung, Min Suk;Lee, Jang Won;Lee, Seung Hyun;Kim, Dong Hyun;Byun, Sang Hwan;Kim, Yeong Muk
    • Journal of Yeungnam Medical Science
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    • v.30 no.1
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    • pp.62-65
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    • 2013
  • Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar ($4{\times}2.5$ cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.

Heart Failure Occurred during Endoscopic Transthoracic Sympathetic Cauterization -A case report- (흉강경하 교감신경절 소작술중 발생한 심부전 -증례 보고-)

  • Lee, Youn-Woo;Yoon, Duck-Mi;Ahn, Eun-Kyoung;Seouk, Mi-Ja
    • The Korean Journal of Pain
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    • v.9 no.1
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    • pp.235-238
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    • 1996
  • Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q-wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronary spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.

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Development of Peripheral Devices on the Endoscopic Surgery System (내시경 수술시스템의 주변장치 개발)

  • Lee, Young-Mook;Song, Chul-Gyu;Lee, Sang-Min;Kim, Won-Ky
    • Proceedings of the KOSOMBE Conference
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    • v.1995 no.05
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    • pp.164-166
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    • 1995
  • The objectives of study are to develop a peripheral device on the endoscopic surgery system. These systems are consist of the following units. They are a color monitor of high resolution, light source, computer system and endoscopic camera with a C-mount head, irrigator, color video printer, Super VHS recorder and a system rack. The color monitor is a NTSC monitor for monitoring the image projected of the surgical section. The lightsource is necessary to irradiate the interior of a body via an optic fiber, The light projector will adapt the brightness in accordance with changing distance from the object. A miniature camera using a color CCD chip and computer system is used to capture and control an image of the surgical section[1]. The video printer is a 300 DPI resolution using thermal sublimation methods, which is developed by Samsung Electronics Co., Ltd. The specification of the endoscopic data management system is consist of storage of a captured image and pathological database of patients [2-4].

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Emergency Neuroendoscopic Management of Third Ventricular Neurocysticercosis Cyst Presented with Bruns Syndrome : Report of Two Cases and Review of Literature

  • Teegala, Ramesh;Rajesh, K. Ghanta;Raviprasad, V. Yerramsetty;Chennappa, Yemba
    • Journal of Korean Neurosurgical Society
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    • v.55 no.3
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    • pp.173-177
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    • 2014
  • Neurocysticercosis is the commonest parasitic disease of the human central nervous system. The incidence of intra ventricular form of neurocysticercosis (NCC) is less common accounting 10-20% that of total central nerve system cysticercosis. Intra ventricular NCC is complicated due, to its high incidence of acute hydrocephalus caused by ball valve mechanism. The only reliable tool for diagnosis of NCC is by neuroimaging with CT or MRI. MRI preferred over CT because of its high specificity and sensitivity. In emergency situations like acute hydrocephalus one can proceed with emergency endoscopic surgery. Through the endoscopic view, intra ventricular NCC (IVNCC) has distinguished morphological features like the full moon sign. This feature not only helps in identification of IVNCC, but also guides in further endoscopic treatment strategy. Authors report two cases of 3rd ventricular NCC with acute hydrocephalus managed with emergency endoscopy. Authors have discussed the clinical features, intra operative endoscopic findings and role of endoscopy in emergency surgery for NCC with acute hydrocephalus.