9 research outputs found
Endoscopic Retrograde Cholangiopancreatography Treatment of Cholecystitis: Possible? Yes; Practical??
Classically, until now, the management of cholecystitis has consisted of immediate and judicious
clinical assessment of the affected patient, interpolating into the assessment of the physical findings
and results from appropriate laboratory, x-ray, and scanning techniques (sonography and scintigraphy)
to formulate a clinical impression. Usually, after the diagnosis has been established, the patient
is subjected to a cholecystectomy, although the timing of the surgery may vary depending on the
clinical condition of the patient. Alternatives to this management (cholecystectomy, medical management)
scheme have been suggested, but these are dependent upon the clinical condition ofthe patient
and considerations of risks. Percutaneous drainage of the gallbladder or cholecystostomy is
sufficient enough to provide drainage, relieve obstruction, and the consequences of infection, i.e.,
sepsis, and prevent perforation. A contributory role of endoscopic retrograde cholangiopancreatography
(ERCP) in this schema has not been a consideration. An ERCP is rarely employed for therapy
(or diagnosis) when cholecystitis is suspected but it might assume a more significant role if it is considered
an efficacious alternative in specific conditions. We have had the unusual experience of managing
11 patients with cholecystitis employing ERCP and its therapeutic modalities, i.e.,
sphincterotomy, selective cannulation of the cystic duct, and relieving obstruction of that structure
by catheter displacement of an obstructing stone. Endoscopic techniques providing decompression
of the gallbladder are described, and the feasibility of utilizing endoscopic procedures for treatment
of cholecystitis will be given consideration
Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia
Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of
the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from
vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In
our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously
placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline
to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared
in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9
bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive
in only 4 of the 12. We recommend this method of sampling from material contained within prostheses
as an adjunct when previous brushings, washings, or biopsies are negative