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Despite its relative safety (in comparison with surgery), and undoubted role in many clinical circumstances, biliary sphincterotomy is the most dangerous procedure routinely performed by endoscopists. Complications occur in about 10% of patients; 2 to 3% have a prolonged hospital stay, with a risk of dying. This document is an attempt to provide guidelines(More)
Knowledge of the junction of the cystic and common hepatic duct is essential for endoscopic management of biliary tract disease. The cystic and common hepatic ducts were evaluated retrospectively in cholangiograms obtained for a variety of indications in 524 persons. The cysticohepatic junction was adequately visualized in 70%. Medial junctions were noted(More)
Pancreatograms of 102 patients with proved normal pancreatic status were reviewed to establish normal standards of pancreatic ductal morphology, and precise details of ductal course, position, length, caliber, and variant anatomy were analyzed. The ampulla was found at the level of the second lumbar vertebra in 75% of cases, while the pancreatic duct(More)
A prospective, uncontrolled trial of the use of a prototype mechanical lithotripter was performed in 116 patients at nine centers. Standard endoscopic approaches had failed to remove all stones, primarily because of large size (80% of patients). For 92% of patients, common bile duct stones were successfully captured and fragmented following the use of this(More)
Pseudomonas aeruginosa was present in bile cultures from 10 patients who had undergone previous endoscopic retrograde cholangiopancreatography in 1984. After environmental cultures and review of instrument disinfection, we traced the infections to a single endoscope contaminated with P. aeruginosa, serotype 10. Although the instrument had been cleaned(More)
BACKGROUND Pulse oximetry, used to monitor oxygen saturation during endoscopy, does not directly measure hypoventilation. Study goals were to determine whether transcutaneous carbon dioxide (PtcCO(2)) monitoring during endoscopic retrograde cholangiopancreatography (ERCP) prevents severe hypoventilation and to assess the accuracy of clinical observation and(More)
Choledochal cyst is a congenital malformation of the biliary tree that is unusual but by no means rare. During a 13-year period, we encountered eight patients with choledochal cysts who were evaluated with cholangiopancreatography. All of our cases showed an anomalous union of the pancreatic duct and common bile duct, resulting in a long common channel.(More)
Several alternative schedules of cleaning and disinfection of flexible fiberoptic endoscopes were evaluated during actual use in paired endoscopy suites. Thorough mechanical cleaning with detergent and alcohol was compared with the same cleaning with the addition of 5-, 10-, or 20-min immersion of the endoscope insertion tube in 2% alkaline glutaraldehyde(More)
Self-expanding wire mesh stents have been developed for endoscopic placement across malignant biliary strictures, but tumor ingrowth may limit the usefulness of open mesh stents. We reasoned that coating the wire mesh might prevent tumor ingrowth. Tissue response to covered and uncovered stents was compared in dogs. Stents were surgically placed in the bile(More)