- Email: [email protected]
Pneumatic perforation of the ileum
30.
31.
32. 33. 34. 35.
36. 37. 38. 39.
40.
41. 42. 43. 44. 45. 46.
47. 48.
49.
50.
M, et al. Expandable esophagea] stents: initial experience with a n e w Nitinol steht. Gastrointest Endosc 1994;40:614-21. Vermeijden JR, Bartelsman JFWM, Focken P, Meijer RCA, Tytgat GNJ. Self-expanding metal stents for palliation of esophagocardial malignancies. Gastrointest Endosc 1995;41: 58-63. Bethge N, Sommer A, Gross U, von Kleist D, Vakil N. Human tissue responses to metal stents implanted in vivo for palliation of malignant stenoses. Gastrointest Endosc 1996;43:596602. Neuhaus H, Hoffman W, Dittler HJ, Niedermeyer HP, Classen M. Implantation of self-expanding esophageal metal stents for palliation of malignant dysphagia. Endoscopy 1992;24:405-10. Grundy A. The Strecker esophageal stent in the management of oesophageal strictures: techniques of insertion and early clinical experience. Clin Radiol 1994;49:421-4. Wagner HJ, Stinner B, Schwerk WB, Hoppe M, Klose KJ. Nitinol prostheses for the treatment of inoperable malignant esophageal obstruction. J Vasc Interv Radiol 1994;5:899-904. Den Hartog Jager FCA, Bartelsman JFWM, Tytgat GNJ. Palliative treatment ofobstructing esophagogastric malignancy by endoscopic positioning of a plastic prosthesis. Gastroenterology 1979;77:1008-14. Hordijk ML, Dees J, ran Blankenstein M. The management of malignant esophagorespiratory fistulas with a cuffed prosthesis. Endoscopy 1990;22:241-4. Liakakos TK, Ohri SK, Townsend ER, Fountain SW. Palliative intubation for dysphagia in patients with carcinoma of the esophagus. Ann Thorac Surg 1992;53:460-3. Watson A. A study of the quality and duration of survival following resection, endoscopic intubation and surgicalintubation in oesophageal carcinoma. Br J Surg 1982;69:585-8. Loizou LA, Grigg D, Atkinson M, Robertson C, Bown SG. A prospective comparison of laser therapy and intubation in endoscopic palliation for malignant dysphagia. Gastroenterology 1991;100:1303-10. Barr H, Krasner N, RaoufA, Walker RJ. Prospective randomized trial of laser therapy only and laser therapy followed by endoscopic intubation for the palliation of malignant dysphagia. Gut 1990;31:253-8. Ogilvie AL, Dronfie]d MW, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasm at fiberoptic endoscopy. Gut 1982;23:1060-7. Diamantes T, Mannell A. Oesophageal intubation for advanced esophageal cancer; the Baragwanath experience 1977-1981. Br J Surg 1983;70:555-7. Haynes JW, Miller PR, Steiger Z, Leichman LP, Kling GA. Celestin tube use: radiographic manifestations of associated complications. Radiology 1984;150:41-4. Lishman AH, Dellipiani AW, Devlin HB. The insertion of oesophagogastric tubes in malignant oesophageal s t r i c t u r e s : endoscopy or surgery? Br J Surg 1980;67:257-9. Sarr MG, Harper PH, Kettlewell MGW. Peroral pulsion intubation of malignant esophageal strictures using a fiberoptic technique. Am Surg 1984;50:437-40. Spinelli P, Cerrai FG, Ciuffi M, Ignomirelli O, Meroni E, Pizzetti P. Endoscopic stent placement for cancer of the lower esophagus and gastric cardia. Gastrointest Endosc 1994;40: 455-7. Függer R, Niederle B, Jantsch H, Schiessel R, Schulz F. Endoscopic tube implantation for the palliation of malignant esophageal stenosis. Endoscopy 1990;22:101-4. Gasparri G, Casalegno PA, Camandona M, Dei Poli M, Salizzoni M, Ferrarotti G, et al. Endoscopic insertion 0f248 prosthes e s in inoperable carcinoma of the esophagus and eardia: short-term and long-term results. Gastrointest Endosc 1987; 33:354-6. Kozarek RA, Ball TJ, Brandabur JJ, Patterson DJ, Low D, Hill L, et al. Expandable versus conventional esophageal prosthes e s : easier insertion may not preclude subsequent stent-related problems. Gastrointest Endosc 1996;43:204-8. Goldin E, Beyar M, Safra T, Globerman O, Cracium I, Wengrower D, et al. A new self-expandable, nickel-titanium coil stent for esophageal obstruction: a preliminary report. Gastrointest Endosc 1994;40:64-8.
442 GASTROINTESTINAL ENDOSCOPY
Letters to the Editor Pneumatic perforation of the ileum To the Editor: We were delighted to find the article by Felig et al. 1 on the subject of unexplained right colon mucosal bleeding at colonoscopy in the October 1996 issue of Gastrointestinal Endoscopy. We have h a d similar experiences in a small community hospital. Most o f o u r cases, as noted by Felig et al., were difficult colonoscopies with r e d u n d a n c y of the sigmoid colon and associated multiple wide-mouthed diverticula. Perforation of the cecum occurred in two cases. In all of these cases there were hemorrhagic a r e a s in the right colon with normal intervening mucosa. The resected segments did not show a n y signfficant pathology. We believed t h a t the perforations were secondary to excessive air insufflation. To prevent this complication, we minimize air insufflation and abandon the procedure when difficulty is encountered. Rao R. Meka, MD Southem Medical Clinic Valley, A/abama
REFERENCE 1. Felig DM, Brand MH, Vendor R. Unexpected right colon mucosal bleeding on colonoscopy. Gastrointest Endosc 1996; 44:471-3.
Diagnostic laparoscopy: is it "safe" in the hands of our surgical colleagues? To the Editor: We r e a d with interest the recent articles by Poniachik et a l J and Schrenk et al. 2 In the first article the authors studied the role of laparoscopy in the diagnosis of cirrhosis. In their study, a total of 434 diagnostic laparoscopies were performed by trainee hepatologists without any complications. In the second article Schrenk et al. 2 studied the mechanism, m a n a g e m e n t , a n d prevention of laparoscopic bowel injuries. This study was conducted by a surgical group and involved a total of 4672 laparoscopic procedures. One h u n d r e d fifty-eight diagnostic laparoscopies were performed in which t h e r e were t h r e e bowel injuries requiring laparotomies, a r a t e of 1.9%. This is in contrast to the absence of any complications in 434 similar procedures performed by hepatologists in the s t u d y by Poniachek et al. 1 Diagnostic laparoscopy u n d e r local a n e s t h e s i a is reasonably safe. 35 Arnong its complications, gastrointestinal perforation is distinctly rare. It can occur during either induction of pneumoperitoneum or insertion of the laparoscopic trocar. I n a review by H e n n i n g and Look, 6 a survey of 46,364 VOLUME 45, NO. 5, 1997
31.
32. 33. 34. 35.
36. 37. 38. 39.
40.
41. 42. 43. 44. 45. 46.
47. 48.
49.
50.
M, et al. Expandable esophagea] stents: initial experience with a n e w Nitinol steht. Gastrointest Endosc 1994;40:614-21. Vermeijden JR, Bartelsman JFWM, Focken P, Meijer RCA, Tytgat GNJ. Self-expanding metal stents for palliation of esophagocardial malignancies. Gastrointest Endosc 1995;41: 58-63. Bethge N, Sommer A, Gross U, von Kleist D, Vakil N. Human tissue responses to metal stents implanted in vivo for palliation of malignant stenoses. Gastrointest Endosc 1996;43:596602. Neuhaus H, Hoffman W, Dittler HJ, Niedermeyer HP, Classen M. Implantation of self-expanding esophageal metal stents for palliation of malignant dysphagia. Endoscopy 1992;24:405-10. Grundy A. The Strecker esophageal stent in the management of oesophageal strictures: techniques of insertion and early clinical experience. Clin Radiol 1994;49:421-4. Wagner HJ, Stinner B, Schwerk WB, Hoppe M, Klose KJ. Nitinol prostheses for the treatment of inoperable malignant esophageal obstruction. J Vasc Interv Radiol 1994;5:899-904. Den Hartog Jager FCA, Bartelsman JFWM, Tytgat GNJ. Palliative treatment ofobstructing esophagogastric malignancy by endoscopic positioning of a plastic prosthesis. Gastroenterology 1979;77:1008-14. Hordijk ML, Dees J, ran Blankenstein M. The management of malignant esophagorespiratory fistulas with a cuffed prosthesis. Endoscopy 1990;22:241-4. Liakakos TK, Ohri SK, Townsend ER, Fountain SW. Palliative intubation for dysphagia in patients with carcinoma of the esophagus. Ann Thorac Surg 1992;53:460-3. Watson A. A study of the quality and duration of survival following resection, endoscopic intubation and surgicalintubation in oesophageal carcinoma. Br J Surg 1982;69:585-8. Loizou LA, Grigg D, Atkinson M, Robertson C, Bown SG. A prospective comparison of laser therapy and intubation in endoscopic palliation for malignant dysphagia. Gastroenterology 1991;100:1303-10. Barr H, Krasner N, RaoufA, Walker RJ. Prospective randomized trial of laser therapy only and laser therapy followed by endoscopic intubation for the palliation of malignant dysphagia. Gut 1990;31:253-8. Ogilvie AL, Dronfie]d MW, Ferguson R, Atkinson M. Palliative intubation of oesophagogastric neoplasm at fiberoptic endoscopy. Gut 1982;23:1060-7. Diamantes T, Mannell A. Oesophageal intubation for advanced esophageal cancer; the Baragwanath experience 1977-1981. Br J Surg 1983;70:555-7. Haynes JW, Miller PR, Steiger Z, Leichman LP, Kling GA. Celestin tube use: radiographic manifestations of associated complications. Radiology 1984;150:41-4. Lishman AH, Dellipiani AW, Devlin HB. The insertion of oesophagogastric tubes in malignant oesophageal s t r i c t u r e s : endoscopy or surgery? Br J Surg 1980;67:257-9. Sarr MG, Harper PH, Kettlewell MGW. Peroral pulsion intubation of malignant esophageal strictures using a fiberoptic technique. Am Surg 1984;50:437-40. Spinelli P, Cerrai FG, Ciuffi M, Ignomirelli O, Meroni E, Pizzetti P. Endoscopic stent placement for cancer of the lower esophagus and gastric cardia. Gastrointest Endosc 1994;40: 455-7. Függer R, Niederle B, Jantsch H, Schiessel R, Schulz F. Endoscopic tube implantation for the palliation of malignant esophageal stenosis. Endoscopy 1990;22:101-4. Gasparri G, Casalegno PA, Camandona M, Dei Poli M, Salizzoni M, Ferrarotti G, et al. Endoscopic insertion 0f248 prosthes e s in inoperable carcinoma of the esophagus and eardia: short-term and long-term results. Gastrointest Endosc 1987; 33:354-6. Kozarek RA, Ball TJ, Brandabur JJ, Patterson DJ, Low D, Hill L, et al. Expandable versus conventional esophageal prosthes e s : easier insertion may not preclude subsequent stent-related problems. Gastrointest Endosc 1996;43:204-8. Goldin E, Beyar M, Safra T, Globerman O, Cracium I, Wengrower D, et al. A new self-expandable, nickel-titanium coil stent for esophageal obstruction: a preliminary report. Gastrointest Endosc 1994;40:64-8.
442 GASTROINTESTINAL ENDOSCOPY
Letters to the Editor Pneumatic perforation of the ileum To the Editor: We were delighted to find the article by Felig et al. 1 on the subject of unexplained right colon mucosal bleeding at colonoscopy in the October 1996 issue of Gastrointestinal Endoscopy. We have h a d similar experiences in a small community hospital. Most o f o u r cases, as noted by Felig et al., were difficult colonoscopies with r e d u n d a n c y of the sigmoid colon and associated multiple wide-mouthed diverticula. Perforation of the cecum occurred in two cases. In all of these cases there were hemorrhagic a r e a s in the right colon with normal intervening mucosa. The resected segments did not show a n y signfficant pathology. We believed t h a t the perforations were secondary to excessive air insufflation. To prevent this complication, we minimize air insufflation and abandon the procedure when difficulty is encountered. Rao R. Meka, MD Southem Medical Clinic Valley, A/abama
REFERENCE 1. Felig DM, Brand MH, Vendor R. Unexpected right colon mucosal bleeding on colonoscopy. Gastrointest Endosc 1996; 44:471-3.
Diagnostic laparoscopy: is it "safe" in the hands of our surgical colleagues? To the Editor: We r e a d with interest the recent articles by Poniachik et a l J and Schrenk et al. 2 In the first article the authors studied the role of laparoscopy in the diagnosis of cirrhosis. In their study, a total of 434 diagnostic laparoscopies were performed by trainee hepatologists without any complications. In the second article Schrenk et al. 2 studied the mechanism, m a n a g e m e n t , a n d prevention of laparoscopic bowel injuries. This study was conducted by a surgical group and involved a total of 4672 laparoscopic procedures. One h u n d r e d fifty-eight diagnostic laparoscopies were performed in which t h e r e were t h r e e bowel injuries requiring laparotomies, a r a t e of 1.9%. This is in contrast to the absence of any complications in 434 similar procedures performed by hepatologists in the s t u d y by Poniachek et al. 1 Diagnostic laparoscopy u n d e r local a n e s t h e s i a is reasonably safe. 35 Arnong its complications, gastrointestinal perforation is distinctly rare. It can occur during either induction of pneumoperitoneum or insertion of the laparoscopic trocar. I n a review by H e n n i n g and Look, 6 a survey of 46,364 VOLUME 45, NO. 5, 1997