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Chatzimavroudis G, Kotoreni G, Pavlidis T, Gotti K, Papaziogas V. OC-054 LONG-TERM OUTCOMES OF POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS RELEASE (TAR) IN LARGE AND OTHER COMPLEX VENTRAL HERNIAS: A SINGLE-SURGEON EXPERIENCE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The application of component separation techniques for the repair of large and other complex ventral hernias, has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these very demanding ventral hernias.
Material & Methods
A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR technique between January 2016 and May 2021 was performed. Selection of the type of inserted mesh was based on the risk of developing surgical site infection (SSI) and other surgical site occurrences (SSOs). Preoperative, intraoperative, and postoperative data were analyzed.
Results
A total of 167 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 156 (93.4%) had a history of previous abdominal surgery, 42 (25.1%) had a history of SSI and 11 (6.6%) had active fistulas, of which nine involved previous implanted meshes. Postoperatively, SSOs were presented in 12 patients (7.2%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 3 years, only one recurrence has been observed.
Conclusions
With a wound complication rate of less than 8% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of large and other complex ventral hernias.
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Affiliation(s)
- G Chatzimavroudis
- 2nd Surgical Department, School of Medicine and Complex Hernia and Abdominal Wall Reconstruction Center, Aristotle University of Thessaloniki and European Interbalkan Medical Center , Thessaloniki , Greece
| | - G Kotoreni
- 2nd Surgical Department, School of Medicine and Complex Hernia and Abdominal Wall Reconstruction Center, Aristotle University of Thessaloniki and European Interbalkan Medical Center , Thessaloniki , Greece
| | - T Pavlidis
- 2nd Surgical Department, School of Medicine and Complex Hernia and Abdominal Wall Reconstruction Center, Aristotle University of Thessaloniki and European Interbalkan Medical Center , Thessaloniki , Greece
| | - K Gotti
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - V Papaziogas
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Chatzimavroudis G, Kyriakidou D, Hadjichristou E, Tsompanis D, Atmatzidis S, Raptis D, Kiroplastis K, Papaziogas V. V-030 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR OF A RIGHT SPIGELIAN HERNIA USING BIOSYNTHETIC (N-BUTYL CYANOACRYLATE) GLUE FOR MESH FIXATION AND PERITONEAL FLAP CLOSURE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Spigelian hernia consists one of the most uncommon anterolateral abdominal wall hernias (<1%). The defect occurs at the spigelian fascia which is located lateral to rectus abdominis muscle along the linea semilunaris and is comprised of the transversus abdominis and internal oblique aponeuroses. Most commonly the defect is located at or below the level of arcuate line. Its diagnosis may be challenging because the aponeurosis of external oblique remains intact, leading to an intraparietal hernia, with no obvious bulge on inspection or even palpation of the abdominal wall in many cases. Computed tomography (CT) is the most reliable imaging method to diagnose a spigelian hernia. Due to the high risk of strangulation, surgery should be advised to all patients with spigelian hernia. Surgery can be performed either by open or by minimally invasive techniques.
In this video we present the case of a 54-year-old female patient suffering from a symptomatic right spigelian hernia. The diagnosis was suspected during clinical examination and was confirmed with CT. The patient underwent a laparoscopic transabdominal preperitoneal repair. During the procedure, a peritoneal flap was created; the content of the hernia sac, composed from preperitoneal fat, was completely reduced; the defect was closed with 2/0 PDS sutures; a PVDF mesh, measuring 14 cm by 12 cm, was placed in the preperitoneal area and fixed with N-butyl cyanoacrylate glue; the peritoneal flap was closed also with glue.
The patient had an unremarkable postoperative period and was discharged on the first postoperative day in good clinical condition.
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Affiliation(s)
- G Chatzimavroudis
- 2nd Surgical Department, School of Medicine and Complex Hernia and Abdominal Wall Reconstruction Center, Aristotle University of Thessaloniki and European Interbalkan Medical Center , Thessaloniki , Greece
| | - D Kyriakidou
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - E Hadjichristou
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - D Tsompanis
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - S Atmatzidis
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - D Raptis
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - K Kiroplastis
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - V Papaziogas
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Atmatzidis S, Chatzimavroudis G, Raptis D, Hatzibougias D, Voloudakis N, Kotoreni G, Pavlidis T, Penlidis M, Koutelidakis IM, Papaziogas B. Solitary Soft-Tissue Metastasis of a Pancreatic Adenocarcinoma 2 Years After Curative Resection: Report of a Rare Case and a Literature Review. Am J Case Rep 2022; 23:e934951. [PMID: 35969513 PMCID: PMC9393052 DOI: 10.12659/ajcr.934951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patient: Female, 74-year-old
Final Diagnosis: Soft tissue metastasis from pancreatic adenocarcinoma
Symptoms: Palpable, hard and painful mass, with rapid growth, located in the posterior aspect of the upper left thigh
Medication: —
Clinical Procedure: —
Specialty: Surgery
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Affiliation(s)
- Stefanos Atmatzidis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Dimitrios Raptis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Dimitris Hatzibougias
- microDiagnostics LP, Private Surgical & Molecular Pathology Laboratory, Thessaloniki, Greece
| | - Nikolaos Voloudakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Georgia Kotoreni
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Triantafillos Pavlidis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Michail Penlidis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Ioannis M. Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Basilios Papaziogas
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
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Kapoulas S, Papalois A, Papadakis G, Tsoulfas G, Christoforidis E, Papaziogas B, Schizas D, Chatzimavroudis G. Safety and efficacy of absorbable and non-absorbable fixation systems for intraperitoneal mesh fixation: an experimental study in swine. Hernia 2022; 26:567-579. [PMID: 33400026 DOI: 10.1007/s10029-020-02352-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Choice of the best possible fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of the present study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. METHODS Fourteen Landrace swine were utilized in the study. The experiment included two stages. Initially, four pieces of mesh (Ventralight ™ ST) sizing 10 × 5 cm were placed and fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. These defects were repaired primarily with absorbable suture before mesh implantation. Each mesh was anchored with a different tack device between Absorbatack™, Protack™, Capsure™, or Optifix™. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy via U-shaped incision to obtain the measurements for the outcome parameters. The primary endpoint of the study was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. RESULTS Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Capsure™ tacks had higher peel strength when compared to Absorbatack™ (p = 0.028); Protack™ (p = 0.043); and Optifix™ (p = 0.009). No significant differences were noted regarding the extent of visceral adhesions (Friedman's test p value 0.854), the adhesion quality (Friedman's test p value 0.506), or the mesh shrinkage (Friedman's test p value = 0.827). Four out of the ten animals developed no adhesions at all 2 months after implantation. CONCLUSION Capsure™ fixation system provided higher peel strength that the other tested devices in our swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.
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Affiliation(s)
- S Kapoulas
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- , Flat 318, Centenary Plaza, 18 Holliday Street, Birmingham, B11TW, UK.
| | - A Papalois
- ELPEN Pharmaceuticals Research and Experimental Centre, Pikermi, Greece
| | - G Papadakis
- Department of Renal Transplant and Access Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - G Tsoulfas
- 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - E Christoforidis
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - D Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - G Chatzimavroudis
- 2nd Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
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Chatzimavroudis G, Kotoreni G, Kostakis I, Voloudakis N, Christoforidis E, Papaziogas B. Outcomes of posterior component separation with transversus abdominis release (TAR) in large and other complex ventral hernias: a single-surgeon experience. Hernia 2021; 26:1275-1283. [PMID: 34668108 DOI: 10.1007/s10029-021-02520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Over the last years, great advances in the repair of abdominal wall hernias have dramatically improved patients' outcomes. Especially for large and other complex ventral hernias, the application of component separation techniques has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these demanding ventral hernias. METHODS A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR between January 2016 and December 2019 was performed. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS A total of 125 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 116 (92.8%) had a history of previous abdominal surgery, 27 (21.6%) had a history of SSI and nine (7.2%) had active fistulas. Postoperatively, SSOs were presented in 11 patients (8.8%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 2.5 years, only one recurrence was observed. CONCLUSIONS With a wound complication rate of less than 9% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of massive and other complex ventral hernias. The combination of knowledge of the abdominal wall anatomy at a proficient level, proper training, and adoption of a strict prehabilitation program are considered prerequisites for the successful management of such demanding hernias.
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Affiliation(s)
- G Chatzimavroudis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece. .,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece.
| | - G Kotoreni
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece
| | - I Kostakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - N Voloudakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - E Christoforidis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
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Raptis D, Savvides E, Langas G, Chatzimavroudis G, Papaziogas B. Neuroendocrine neoplasm of the cystic duct: report of two cases and literature review. Hippokratia 2021; 25:141-144. [PMID: 36683907 PMCID: PMC9851141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neuroendocrine neoplasm (NEN) of the cystic duct (CD) is an extremely rare entity, with misty clinical manifestation and incidental, in most cases, diagnosis. Due to its rarity, several dilemmas arise concerning the optimal treatment of this type of malignancy. CASE DESCRIPTION We report two cases of histologically confirmed NENs of the CD from our institution. Furthermore, we present a literature review focusing on the treatment type and likelihood of recurrence. The two patients underwent laparoscopic cholecystectomy (CCE) due to cholelithiasis and were both diagnosed with well-differentiated Grade 1 (G1) NEN. The first patient did not undergo further treatment as the surgical margins were clear. Regarding the second patient, complementary resection of the CD remnant was performed since the histopathological diagnosis indicated positive surgical margins. Active postoperative surveillance was suggested, and both patients remain disease-free to date. In the literature, we identified 22 previous cases of NENs of CD. Since there are still no standard guidelines, various surgical plans were adopted, varying from simple CCE to hepatic lobectomy and Roux en Y hepaticojejunostomy. Postoperative surveillance is reported for up to four years. Regardless of the implicated treatment plan, no patient was diagnosed with recurrent malignancy and the mortality rate was very low (1/22). CONCLUSION We propose that cholecystectomy with ligation of the CD proximal to its junction with the common hepatic duct is an adequate oncological treatment for G1 NENs of the CD. When preoperative or perioperative suspicion for malignancy is made, a frozen section of the CD should be sent for pathological examination to confirm radical resection (R0). Nevertheless, there is a need for further research that could validate our findings. HIPPOKRATIA 2021, 25 (3):141-144.
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Affiliation(s)
- D Raptis
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Savvides
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Langas
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Chatzimavroudis
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Papaconstantinou D, Garoufalia Z, Kykalos S, Nastos C, Tsapralis D, Ioannidis O, Michalinos A, Chatzimavroudis G, Schizas D. Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand's hernia): a systematic review of the literature. Hernia 2020; 24:951-959. [PMID: 32451789 DOI: 10.1007/s10029-020-02215-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH). METHODS A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020. RESULTS In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death. CONCLUSION AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.
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Affiliation(s)
- D Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece.
| | - Z Garoufalia
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - S Kykalos
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - C Nastos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece
| | - D Tsapralis
- Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece
| | - O Ioannidis
- Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital George Papanikolaou, Thessaloniki, Greece
| | - A Michalinos
- Department of Anatomy, European University of Cyprus, Nicosia, Cyprus
| | - G Chatzimavroudis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Schizas D, Katsaros I, Karatza E, Theochari NA, Kykalos S, Nastos C, Michalopoulos N, Avgerinos DV, Chatzimavroudis G, Arkadopoulos N. Pericardial hernias in adults: a systematic review of the literature. Interact Cardiovasc Thorac Surg 2020; 30:353-358. [PMID: 31808516 DOI: 10.1093/icvts/ivz292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity whose symptoms vary considerably. The objective of this study was to evaluate the clinical manifestations of and the optimal surgical treatments for pericardial hernias. METHODS PubMed and the Cochrane bibliographical databases were searched (last search: 20 April 2019) for studies on pericardial diaphragmatic hernias in the adult population. RESULTS Eighty studies met our inclusion criteria and reported on 85 patients (62 men and 23 women) with a mean age of 55.86 ± 15.79 years (mean ± standard deviation) presenting with a pericardial hernia at health care facilities. The leading aetiology was trauma (56.5%) followed by iatrogenic interventions (30.6%). The most common herniated organs were the transverse colon (49.4%) and the greater omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was recorded, whereas the mortality rate reached 2.4%. CONCLUSIONS Pericardial hernia is a rare disease characterized by abdominal organs herniating into the pericardium. It requires a high degree of suspicion for early diagnosis, and all medical professionals should be encouraged to report such cases to clarify the best available therapeutic approach.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Elli Karatza
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikoletta A Theochari
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Constantinos Nastos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Michalopoulos
- Fourth Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian, New York, NY, USA
| | - Grigoris Chatzimavroudis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Schizas D, Apostolou K, Krivan S, Kanavidis P, Katsaros I, Vailas M, Koutelidakis I, Chatzimavroudis G, Pikoulis E. Paraduodenal hernias: a systematic review of the literature. Hernia 2019; 23:1187-1197. [PMID: 31006063 DOI: 10.1007/s10029-019-01947-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
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Affiliation(s)
- D Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - K Apostolou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece.
| | - S Krivan
- Department of Upper Gastrointestinal and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, UK
| | - P Kanavidis
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Katsaros
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - M Vailas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Koutelidakis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - G Chatzimavroudis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - E Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Anastasiadis S, Georgakis N, Xanthis A, Gatopoulou A, Anastasiadou K, Kountouras J. A retrospective comparative study of argon plasma versus polypectome snare tip coagulation: effect on recurrence rate after resection of large laterally spreading type lesions. Ann Gastroenterol 2019; 32:178-184. [PMID: 30837791 PMCID: PMC6394265 DOI: 10.20524/aog.2019.0359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background Endoscopic mucosal resection (EMR) is an established technique for treating large laterally spreading type (LST) lesions ≥20 mm. The aim of our study was to compare the use of argon plasma (APC) versus snare-tip coagulation on the recurrence rate of large LST lesions. Methods All patients with large LST lesions resected by EMR between January 2006 and December 2014 were enrolled. After piecemeal resection, patients underwent either APC or snare-tip coagulation of the rim of the resection area and any residual adenomatous tissue. Follow up included colonoscopy and biopsies. Medical records, including characteristics of patients and polyps, complications and recurrence were retrieved and collected. Results One hundred one patients were included in the final analysis. They were divided into the APC group (n=50) and the snare-tip coagulation group (n=51). The 2 groups were similar concerning patients’ characteristics, size of polyps and histology. Post-polypectomy coagulation syndrome was observed in 8 patients (7.9%) (APC group: n=5 and snare tip group: n=3). EMR-related bleeding occurred in 9 patients (8.9%) (APC group: n=4 and snare tip group: n=5). Total recurrence rate was 14.85% (16% and 13.7% in APC and snare-tip groups, respectively, P=0.34). Conclusion The effectiveness of snare-tip coagulation is comparable with that of APC with respect to recurrence rate after resection of large LST lesions. It thus represents a cost-effective alternative to APC.
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Affiliation(s)
| | - Georgia Lazaraki
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Grigoris Chatzimavroudis
- 2 Surgical Department, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Sotiris Anastasiadis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Nikolaos Georgakis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Andreas Xanthis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Anthi Gatopoulou
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Kiriaki Anastasiadou
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Jannis Kountouras
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
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Katsinelos P, Lazaraki G, Anastasiadis S, Chatzimavroudis G, Katsinelos T, Terzoudis S, Gatopoulou A, Doulberis M, Papaefthymiou A, Kountouras J. The impact of selective serotonin receptor inhibitors on post-endoscopic sphincterotomy bleeding, alone or with concurrent aspirin or nonsteroidal anti-inflammatory drugs. Ann Gastroenterol 2019; 32:614-619. [PMID: 31700239 PMCID: PMC6826081 DOI: 10.20524/aog.2019.0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/18/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy, G. Gennimatas General Hospital (Panagiotis Katsinelos, Grigoris Chatzimavroudis)
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
- Correspondence to: Panagiotis Katsinelos, MD, PhD, Associate Professor of Gastroenterology, Department of Endoscopy, Ippokration Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, e-mail:
| | - Georgia Lazaraki
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
| | - Sotiris Anastasiadis
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
| | - Grigoris Chatzimavroudis
- Department of Endoscopy, G. Gennimatas General Hospital (Panagiotis Katsinelos, Grigoris Chatzimavroudis)
| | - Taxiarchis Katsinelos
- Pharmacology, Aristotle University, Thessaloniki (Taxiarchis Katsinelos), Thessaloniki, Greece
| | - Sotiris Terzoudis
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
| | - Anthi Gatopoulou
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
| | - Michael Doulberis
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
| | - Apostolis Papaefthymiou
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
| | - Jannis Kountouras
- Endoscopy, Ippokration Hospital, Aristotle University Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Sotiris Anastasiadis, Sotiris Terzoudis, Anthi Gatopoulou, Michael Doulberis, Apostolis Papaefthymiou, Jannis Kountouras)
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12
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Terzoudis S, Gatopoulou A, Xanthis A, Anastasiadis S, Anastasiadou K, Georgakis N, Tzivras D, Kountouras J. The impact of age on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ann Gastroenterol 2017; 31:96-101. [PMID: 29333073 PMCID: PMC5759619 DOI: 10.20524/aog.2018.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background: With advancing age there is progressive pancreatic atrophy and fibrosis, leading to tissue destruction and chronic pancreatitis that has been found to be protective against post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, there are no reports regarding the potential effect of the aging pancreatic changes on the incidence and severity of PEP. Therefore, the aim of the present study was to investigate the impact of senile changes in the pancreas on the incidence and severity of PEP. Methods: A total of 2688 patients who underwent the first therapeutic ERCP at a single center were included in the final analysis of the study. Patients were classified into two groups: 1644 patients aged ≤75 years (mean age 61.56+1.26 years), group A; and 1044 patients aged >75 years (mean age 81.97+4.29 years), group B. Patients’ files were identified using a retrospective database linked to the endoscopy reporting system. Patients’ characteristic, endoscopic findings, details of intervention and rate and severity of PEP were evaluated. Results: No significant differences between the two groups were observed with regard to ERCP indication, patient- and technique-related risk factors for PEP, presence of periampullary diverticulum, and type of therapeutic intervention. The incidence of PEP was 5.2% in group A and 4% in group B (P=NS) with comparable grades of severity. All episodes of pancreatitis had full recovery with conventional treatment. One death occurred from respiratory arrest in each group of patients. Conclusion: This study shows that the pancreatic changes associated with aging do not influence the incidence and severity of PEP.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Georgia Lazaraki
- Department of Gastroenterology, Theagenion Anticancer Hospital (Georgia Lazaraki), Greece
| | - Grigoris Chatzimavroudis
- 2 Surgical, School of Medicine, Aristotle University of Thessaloniki, G. Gennimatas General Hospital (Grigoris Chatzimavroudis), Thessaloniki, Greece
| | - Sotiris Terzoudis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Anthi Gatopoulou
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Andreas Xanthis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Sotiris Anastasiadis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Kiriaki Anastasiadou
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Nikos Georgakis
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Dimitris Tzivras
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
| | - Jannis Kountouras
- Department of Gastroenterology, 2 Clinic of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital (Panagiotis Katsinelos, Sotiris Terzoudis, Anthi Gatopoulou, Andreas Xanthis, Sotiris Anastasiadis, Kiriaki Anastasiadou, Nikos Georgakis, Dimitris Tzivras, Jannis Kountouras), Greece
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Katsinelos T, Georgakis N, Anastasiadou K, Gatopoulou A, Zeglinas C, Psarras K, Kountouras J. Impact of nitroglycerin and glucagon administration on selective common bile duct cannulation and prevention of post-ERCP pancreatitis. Scand J Gastroenterol 2017; 52:50-55. [PMID: 27690682 DOI: 10.1080/00365521.2016.1228117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Easy common bile duct (CBD) cannulation is associated with low complication rate. This study aimed to investigate the potential impact of nitroglycerin and glucagon administration on selective CBD cannulation and prevention of post-ERCP pancreatitis. METHODS A prospective single center, double-blind randomized study in which a total of 455 patients were randomly assigned to CBD cannulation by receiving 6 puffs (2.4 mg) sublingual nitroglycerin and glucagon 1 mg intravenously (n = 227, group A) or 6 puffs sterile water and 20 mg hyoscine-n-butyl bromide intravenously (n = 228, group B). After ERCP, patients were followed for the development of drugs' side-effects and post-ERCP complications. RESULTS There were no statistically significant differences between the two groups regarding demographic data and ERCP findings. Success rate of selective CΒD cannulation was 95.15% in group A versus 82.29% in group B (p < .001). Time required for CBD cannulation was 2.82 ± 2.31 min in group A versus 4.27 ± 3.84 min in group B (p = .021). Needle-knife papillotomy was used in 11 (4.85%) patients of group A and 39 (17.11%) patients of group B (p = .001). The frequency of post-ERCP pancreatitis was significantly lower in group A than in group B (3.08% versus 7.46%, p = .037). No difference was observed between the two groups with regard to the occurrence of post-procedure hemorrhage. There was no procedure-related mortality; no adverse event related to the combination regimen was observed. CONCLUSIONS Combined nitroglycerin and glucagon administration achieves a high selective CBC cannulation rates with concomitant reduction of post-ERCP pancreatitis incidence. However, further relative large-scale studies are needed to confirm our findings before definite conclusions can be drawn (Clinical trial registration number: NT: 4321).
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Affiliation(s)
- Panagiotis Katsinelos
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Georgia Lazaraki
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Grigoris Chatzimavroudis
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Taxiarchis Katsinelos
- c Department of Pharmacology , Medical School of Aristotle University , Thessaloniki , Greece
| | - Nikos Georgakis
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Kyriaki Anastasiadou
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Anthi Gatopoulou
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Christos Zeglinas
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Kyriakos Psarras
- b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
| | - Jannis Kountouras
- a Division of Gastroenterology, Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece.,b Second Department of Internal Medicine , Ippokration Hospital, Medical School of Aristotle University , Thessaloniki , Greece
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14
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Katsinelos P, Lazaraki G, Gkagkalis S, Chatzimavroudis G, Anastasiadou K, Georgakis N, Giouleme O, Zavos C, Kountouras J. A fully covered self-expandable metal stent anchored by a 10-Fr double pigtail plastic stent: an effective anti-migration technique. Ann Gastroenterol 2016; 30:114-117. [PMID: 28042247 PMCID: PMC5198235 DOI: 10.20524/aog.2016.0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/27/2016] [Indexed: 12/24/2022] Open
Abstract
Background Fully covered self-expandable metal stents (FCSEMS) have been used successfully in the treatment of malignant and benign biliary strictures. However, stent migration is a major complication. We investigated the efficacy of anchoring FCSEMS with a 10-Fr double-pigtail plastic stent to prevent migration in patients with biliary strictures. Methods Between January 2012 and May 2013, 10 patients with malignant biliary strictures and one patient with a suprapapillary benign biliary stenosis were enrolled in the study. The primary endpoint of the study was to record the migration rate of FCSEMS. Results The placement of FCSEMSs and the anchoring with a 10-Fr double-pigtail plastic stent were successful in all patients. During a median follow-up period of eight months, proximal or distal migration of FCSEMS was not observed. No procedural complications related to the placement of FCSEMS and/or the anchoring plastic stent were recorded. Conclusions The placement of an anchoring 10-Fr double-pigtail stent is a simple and effective anti-migration technique for FCSEMS in patients with malignant biliary strictures.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Stergios Gkagkalis, Grigoris Chatzimavroudis, Olga Giouleme)
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Stergios Gkagkalis, Grigoris Chatzimavroudis, Olga Giouleme)
| | - Stergios Gkagkalis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Stergios Gkagkalis, Grigoris Chatzimavroudis, Olga Giouleme)
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Stergios Gkagkalis, Grigoris Chatzimavroudis, Olga Giouleme)
| | - Kiriaki Anastasiadou
- Second Department of Internal Medicine, Ippokration Hospital, Medical School, Aristotle University of Thessaloniki (Kiriaki Anastasiadou, Nikos Georgakis, Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
| | - Nikos Georgakis
- Second Department of Internal Medicine, Ippokration Hospital, Medical School, Aristotle University of Thessaloniki (Kiriaki Anastasiadou, Nikos Georgakis, Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
| | - Olga Giouleme
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Georgia Lazaraki, Stergios Gkagkalis, Grigoris Chatzimavroudis, Olga Giouleme)
| | - Christos Zavos
- Second Department of Internal Medicine, Ippokration Hospital, Medical School, Aristotle University of Thessaloniki (Kiriaki Anastasiadou, Nikos Georgakis, Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
| | - Jannis Kountouras
- Second Department of Internal Medicine, Ippokration Hospital, Medical School, Aristotle University of Thessaloniki (Kiriaki Anastasiadou, Nikos Georgakis, Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
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Katsinelos P, Kountouras J, Chatzimavroudis G, Lazaraki G, Terzoudis S, Gatopoulou A, Mimidis K, Maris T, Paroutoglou G, Anastasiadou K, Georgakis N. Factors predicting a positive capsule endoscopy in past overt obscure gastrointestinal bleeding: a multicenter retrospective study. Hippokratia 2016; 20:127-132. [PMID: 28416909 PMCID: PMC5388513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Capsule endoscopy (CE) remains the examination of choice for the investigation of obscure gastrointestinal bleeding. Although the factors predicting positive CE findings in the overall obscure gastrointestinal bleeding have been investigated, the clinical characteristics that predict a positive CE in patients with past overt obscure gastrointestinal bleeding (OOGIB) have not been systematically studied. METHODS Between September 2004 and December 2013, 262 patients underwent CE for evaluation of past OOGIB after negative upper and lower endoscopy, and other diagnostic modalities. Patients' records were retrospectively reviewed to assess the factors that could possibly predict positive CE findings. RESULTS Two hundred and twenty four patients with a median age of 70 years (range: 17-87) were enrolled in the final analysis and were divided into two groups; those who had positive (group A: 118 patients) and those who had negative CE findings (group B: 106 patients). The overall diagnostic yield of CE was 52.68 %. Multivariate analysis demonstrated that age >65 years, anticoagulant use, antiplatelet use, and non-steroidal anti-inflammatory drugs use were independent predictive factors for positive findings on CE. Of the 118 patients with positive CE, therapeutic interventions were performed in 56 patients (47.46 %). Recurrence of bleeding presented in nine patients of group B compared with 39 patients of group A (p <0.001). CONCLUSIONS Certain clinical characteristics predict a positive CE in patients with past OOGIB. Patients with OOGIB and negative CE had a considerably lower rebleeding rate, and further invasive investigational procedures may be adjourned or may not be required, though such recommendation warrants further validation. Hippokratia 2016, 20(2): 127-132.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - J Kountouras
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Chatzimavroudis
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - G Lazaraki
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - S Terzoudis
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - A Gatopoulou
- 2 Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, Greece
| | - K Mimidis
- 1 Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, Greece
| | - T Maris
- Department of Gastroenterology, G.Papanikolaou General Hospital, Thessaloniki, Greece
| | - G Paroutoglou
- Department of Gastroenterology, University Hospital of Thessaly, Larissa, Greece
| | - K Anastasiadou
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Georgakis
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sousos N, Vlachaki E, Anastasiadou K, Boura P, Venizelos I, Chatzimavroudis G, Katsinelos P. Diffuse gastric plasmacytoma involvement in multiple myeloma. Endoscopy 2016; 47 Suppl 1 UCTN:E197. [PMID: 26062145 DOI: 10.1055/s-0034-1377537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Nikolaos Sousos
- Hematology Laboratory, Second Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Ippokratio," Thessaloniki, Greece
| | - Efthimia Vlachaki
- Hematology Laboratory, Second Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Ippokratio," Thessaloniki, Greece
| | - Kyriaki Anastasiadou
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Ippokratio," Thessaloniki, Greece
| | - Panagiota Boura
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Ippokratio," Thessaloniki, Greece
| | - Ioannis Venizelos
- Department of Pathology, General Hospital of Thessaloniki "Ippokratio," Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, General Hospital of Thessaloniki "G. Gennimatas," Thessaloniki, Greece
| | - Panagiotis Katsinelos
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Ippokratio," Thessaloniki, Greece
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Galanis I, Chatzimavroudis G, Christopoulos P, Makris J. Prospective Randomized Trial of Simple Drainage vs. Drainage and Initial Fistula Management for Perianal Abscesses. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2161-069x.1000382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Zavos C, Kountouras J. The endoscopic morphology of major papillae influences the selected precut technique for biliary access. Gastrointest Endosc 2015; 81:1056. [PMID: 25805488 DOI: 10.1016/j.gie.2014.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/09/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Panagiotis Katsinelos
- Department of Medicine, Second Medical Clinic, Aristotle University of ThessalonikI, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Georgia Lazaraki
- Department of Medicine, Second Medical Clinic, Aristotle University of ThessalonikI, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Grigoris Chatzimavroudis
- Department of Medicine, Second Medical Clinic, Aristotle University of ThessalonikI, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Christos Zavos
- Department of Medicine, Second Medical Clinic, Aristotle University of ThessalonikI, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of ThessalonikI, Ippokration Hospital, Thessaloniki, Macedonia, Greece
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Katsinelos P, Lazaraki G, Chatzimavroudis G. An unusual case of obscure gastrointestinal bleeding in a patient with neurofibromatosis type 1. Clin Gastroenterol Hepatol 2015; 13:A24-5. [PMID: 25445769 DOI: 10.1016/j.cgh.2014.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/05/2014] [Accepted: 10/07/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, School of Medicine, Aristotle University of Thessaloniki G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, School of Medicine, Aristotle University of Thessaloniki G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, School of Medicine, Aristotle University of Thessaloniki G. Gennimatas General Hospital, Thessaloniki, Greece
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Lazaraki G, Chatzimavroudis G, Katsinelos P. Recent advances in pharmacological treatment of irritable bowel syndrome. World J Gastroenterol 2014; 20:8867-8885. [PMID: 25083060 PMCID: PMC4112893 DOI: 10.3748/wjg.v20.i27.8867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/13/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a highly prevalent functional disorder that reduces patients’ quality of life. It is a chronic disorder characterized by abdominal pain or discomfort associated with disordered defecation in the absence of identifiable structural or biochemical abnormalities. IBS imposes a significant economic burden to the healthcare system. Alteration in neurohumoral mechanisms and psychological factors, bacterial overgrowth, genetic factors, gut motility, visceral hypersensitivity, and immune system factors are currently believed to influence the pathogenesis of IBS. It is possible that there is an interaction of one or more of these etiologic factors leading to heterogeneous symptoms of IBS. IBS treatment is predicated upon the patient’s most bothersome symptoms. Despite the wide range of medications and the high prevalence of the disease, to date no completely effective remedy is available. This article reviews the literature from January 2008 to July 2013 on the subject of IBS peripherally acting pharmacological treatment. Drugs are categorized according to their administration for IBS-C, IBS-D or abdominal pain predominant IBS.
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Katsinelos P, Lazaraki G, Gkagkalis A, Gatopoulou A, Patsavela S, Varitimiadis K, Mimidis K, Paroutoglou G, Koufokotsios A, Maris T, Terzoudis S, Gigi E, Chatzimavroudis G, Zavos C, Kountouras J. The role of capsule endoscopy in the evaluation and treatment of obscure-overt gastrointestinal bleeding during daily clinical practice: a prospective multicenter study. Scand J Gastroenterol 2014; 49:862-70. [PMID: 24940823 DOI: 10.3109/00365521.2014.889209] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Capsule endoscopy (CE) is most commonly performed to evaluate obscure gastrointestinal bleeding (GIB). However, at present the role of CE in patients with obscure-overt GIB especially during daily clinical practice is unknown. The aim of the present study was to investigate the diagnostic yield and the impact of CE on the management of patients with obscure-overt GIB. MATERIAL AND METHODS Between January 2007 and December 2011 we prospectively included all patients with obscure-overt GIB who underwent CE after negative bidirectional endoscopy. CE findings revealing the cause of bleeding, type of therapeutic intervention and clinical variables associated with positive CE and recurrence of GIB were evaluated. RESULTS One hundred and eighteen patients with a median age of 66 years (range 8-89 years) were enrolled in the final analysis. The overall diagnostic yield of the CE was 66.9%. The most common findings were angiodysplasias (33.1%), followed by ulcer (23.7%), and tumors (6.8%). Age (p = 0.001) and cardiovascular disease (p = 0.007) were significant clinical variables predicting the higher incidence of angiodysplasias. Specific therapeutic interventions were undertaken in 54 patients with positive CE (68.4%). Recurrence of GIB was observed in one patient with negative CE (2.6%) and 16 patients with positive CE (20.3%). Univariate and multivariate analysis showed high age and no therapeutic intervention as significant factors associated with recurrent bleeding. CONCLUSIONS CE represents a promising diagnostic method in the investigation of obscure-overt GIB, with significant impact on its clinical management in daily clinical practice.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Katsinelos P, Gkagkalis S, Chatzimavroudis G, Zavos C, Kountouras J. Rectovesical fistula treated by glue injection plus endoclipping technique. Endoscopy 2014; 45 Suppl 2 UCTN:E238. [PMID: 24008443 DOI: 10.1055/s-0032-1308945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G Gennimatas General Hospital, Thessaloniki, Greece
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Zavos C. Closure of an iatrogenic rectal perforation with the endoloop/clips technique in a purse-string fashion. Ann Gastroenterol 2014; 27:264. [PMID: 24975426 PMCID: PMC4073026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/09/2013] [Indexed: 11/14/2022] Open
Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece,
Correspondence to: Dr Panagiotis Katsinelos, Assistant Professor of Gastroenterology, Head, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Ethnikis Aminis 41, Thessaloniki, Greece, Tel.: +30 2310 963341, Fax: +30 2310 210401, e-mail:
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Zavos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Gkagkalis S, Vasiliadis I, Papaeuthimiou A, Terzoudis S, Pilpilidis I, Zavos C, Kountouras J. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol 2014; 27:65-72. [PMID: 24714755 PMCID: PMC3959534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 07/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is now the exclusive endoscopic therapeutic modality for biliary as well as pancreatic diseases. The aim of the present study was to investigate patient- and procedure-related risk factors for post-ERCP complications in a large-scale study of procedures performed by a single experienced endoscopist. METHODS This is a retrospective cohort study which included a total of 2,715 therapeutic ERCPs enrolled in the final analysis. Potential important patient- and procedure-related risk factors for overall post-ERCP complications, pancreatitis and post-endoscopic sphincterotomy (ES) bleeding were investigated by univariate and multivariate analyses. RESULTS Following the first therapeutic ERCP, 327 patients suffered complications; pancreatitis was observed in 132 (4.9%) patients, hemorrhage in 122 (4.5%) patients, cholangitis in 63 (2.3%) patients, perforation in 3 (0.11%) patients, and basket impaction in 7 (0.26%) patients. History of acute pancreatitis was more common in patients with post-ERCP complications (P<0.001). Female gender, young age (<40 years), periampullary diverticulum, suspected sphincter of Oddi dysfunction, metal stent placement, opacification of main pancreatic duct and suprapapillary fistulotomy were not found to be risk factors for overall post-ERCP complications and post-ERCP pancreatitis (PEP). Multivariate analysis showed a history of acute pancreatitis, difficult cannulation, needle-knife papillotomy, transpancreatic sphincterotomy, opacification of first and second class pancreatic ductules and acinarization as independent risk factors for overall complications and PEP, whereas antiplatelet and anticoagulation drug use were not found to be independent risk factors for post-ES bleeding. CONCLUSIONS The results of this study demonstrate that the endoscopist's experience reduces patient- and procedure-related risk factors for post-ERCP complications.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis),
Correspondence to: Panagiotis Katsinelos, MD, PhD, Ass. Professor of Gastroenterology, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Tel/Fax: +30 2310 963341, e-mail:
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Stergios Gkagkalis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Ioannis Vasiliadis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Apostolos Papaeuthimiou
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Sotiris Terzoudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Ioannis Pilpilidis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Stergios Gkagkalis, Ioannis Vasiliadis, Apostolos Papaeuthimiou, Sotiris Terzoudis, Ioannis Pilpilidis)
| | - Christos Zavos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
| | - Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
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Katsinelos P, Gkagkalis S, Chatzimavroudis G, Zavos C, Kountouras J. Are selective serotonin reuptake inhibitors (SSRIs) a risk factor for post-polypectomy bleeding? Endoscopy 2013; 45:681. [PMID: 23881812 DOI: 10.1055/s-0033-1344219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Atmatzidis S, Chatzimavroudis G, Dragoumis D, Katsiba D, Makris J, Atmatzidis K. "Double bubble" sign: an uncommon radiologic manifestation of a metastatic lobular carcinoma of the breast to retroperitoneum. Breast J 2013; 19:542-3. [PMID: 23848278 DOI: 10.1111/tbj.12162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stefanos Atmatzidis
- 2nd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, G.Gennimatas General Hospital, Thessaloniki, Greece
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Katsinelos P, Gkagkalis S, Fasoulas K, Chatzimavroudis G, Zavos C, Kountouras J. Innocent unilateral facial swelling after endoscopic sphincterotomy. Ann Gastroenterol 2013; 26:93. [PMID: 24714372 PMCID: PMC3959506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 07/18/2012] [Indexed: 10/26/2022] Open
Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Stergios Gkagkalis, Kostas Fasoulas, Grigoris Chatzimavroudis,
Correspondence to: Panagiotis Katsinelos, MD, PhD, Ass. Professor of Gastroenterology, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Tel. - Fax: +30 2310 963341, e-mail:
| | - Stergios Gkagkalis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Stergios Gkagkalis, Kostas Fasoulas, Grigoris Chatzimavroudis
| | - Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Stergios Gkagkalis, Kostas Fasoulas, Grigoris Chatzimavroudis
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital (Panagiotis Katsinelos, Stergios Gkagkalis, Kostas Fasoulas, Grigoris Chatzimavroudis
| | - Christos Zavos
- 2nd Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
| | - Jannis Kountouras
- 2nd Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras), Thessaloniki, Greece
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Katsinelos P, Lazaraki G, Kountouras J, Chatzimavroudis G, Zavos C, Terzoudis S, Tsiaousi E, Gkagkalis S, Trakatelli C, Bellou A, Vasiliadis T. Prevalence of Barrett's esophagus in Northern Greece: A Prospective Study (Barrett's esophagus). Hippokratia 2013; 17:27-33. [PMID: 23935340 PMCID: PMC3738273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Barrett's esophagus(BE) is a premalignant condition associated with chronic gastro-esophageal reflux disease (GERD). As only a small proportion of BE progresses to malignancy, it is important to study BE prevalence to prevent adenocarcinoma. MATERIALS AND METHODS Between January 2007 and December 2010, all consecutive individuals who underwent routine upper endoscopy were prospectively recruited. Patients referred for GERD were excluded from the study. Clinical and endoscopic data were collected. RESULTS A total of 1,990 patients (mean age 47.48±13.4 years; 52.8% males) were included. Of them, 496 (24.9%) reported GERD. Erosive esophagitis (EE) was found in 221 participants (11.1%, 193 patients with LA grade A and 28 patients with LA grade B). Overall 31 of 1494 participants not reporting reflux symptoms (2.07%) suffered from silent GERD. BE was diagnosed in 75 participants (3.77%), four (5.3%) with long-segment BE and 71 (94.7%) with short-segment BE. Low-grade dysplasia was noticed in 1 patient with long-segment BE. Hiatal hernia (HH) was found in 196 patients (9.8%), and mean HH length was 3.22 ± 0.2 cm. BE was correlated to EE, GERD and the presence of HH (p= 0.0167, <0.001 and 0.017, respectively) whereas it was not associated with age, alcohol consumption and smoking (p= 0.057, 0.099 and 0.06, respectively). BE was not correlated with Helicobacter pylori infection (p=0.542). CONCLUSION The prevalence of BE was 3.77% in a Greek population undergoing upper endoscopy not referred for GERD. Long-segment BE was very uncommon (0.2%) whereas 2.07% of patients not reporting symptoms suffered from silent GERD.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece
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Atmatzidis S, Chatzimavroudis G, Dragoumis D, Tsiaousis P, Patsas A, Atmatzidis K. Gastric schwannoma: a case report and literature review. Hippokratia 2012; 16:280-282. [PMID: 23935300 PMCID: PMC3738740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Schwannomas are generally benign, slow growing tumors, which can originate from any nerve that has a Schwann cell sheath. Digestive tract schwannomas are rare and are usually asymptomatic. We present the case of a 48-year-old woman with a symptomatic submucosal tumour of the gastric antrum. The patient underwent partial gastrectomy and the histological and immunohistochemical findings of the resected specimen established the diagnosis of schwannoma.
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Affiliation(s)
- S Atmatzidis
- 2 Surgical Department, Medical School, Aristotle University of Thessaloniki, "G.Gennimatas" General Hospital, Thessaloniki, Greece
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Katsinelos P, Fasoulas K, Paroutoglou G, Chatzimavroudis G, Beltsis A, Terzoudis S, Katsinelos T, Dimou E, Zavos C, Kaltsa A, Kountouras J. Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: a randomized, double-blind, placebo-controlled trial. Endoscopy 2012; 44:53-9. [PMID: 22198776 DOI: 10.1055/s-0031-1291440] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Pancreatitis is the most common complication of therapeutic endoscopic retrograde cholangiopancreatography (ERCP), and many pharmacoprophylactic approaches have been suggested, though not without controversy. The aim was to investigate the impact of combined therapy with diclofenac plus somatostatin on reducing the frequency and severity of post-ERCP pancreatitis (PEP). PATIENTS AND METHODS A prospective, double-blind, placebo-controlled trial was conducted in two tertiary referral centers, with 540 eligible patients randomized to receive either combined therapy with diclofenac 100 mg rectally 30 to 60 minutes before ERCP plus somatostatin 0.25 mg/h for 6 hours (group A), or a placebo suppository identical in appearance to the diclofenac along with saline solution (group B). Patients were clinically evaluated and serum amylase levels were determined before ERCP and at 6 and 24 hours post-procedure. Standardized criteria were used to diagnose and grade the severity of PEP. Adverse events were recorded prospectively. RESULTS There were no statistical differences between the groups regarding demographic data, ERCP findings, and procedure risk factors for PEP. The overall incidence of acute pancreatitis was 7.2 %. The PEP rate was significantly lower in the patients who received the combination therapy than in controls (4.7 % vs. 10.4 %, P = 0.015). Previous history of acute pancreatitis (P = 0.001), pancreatic opacification of first-class branches and beyond (P = 0.008), and absence of pharmacoprophylaxis (P = 0.023) were identified as independent risk factors for PEP in multivariate analysis. CONCLUSION Although combined prophylactic therapy with diclofenac plus somatostatin was promising in reducing frequency of PEP, further comparative large-scale studies are needed to confirm our findings before definitive conclusions can be drawn.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Fasoulas K, Beltsis A, Katsinelos T, Dimou E, Arvaniti M, Charsoula A, Gourvas V, Atmatzidis S, Chatzimavroudis G, Katsinelos P. Efficacy of colchicine in the treatment of mesenteric panniculitis in a young patient. Saudi J Gastroenterol 2012; 18:146-8. [PMID: 22421723 PMCID: PMC3326978 DOI: 10.4103/1319-3767.93825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mesenteric panniculitis (MP) is a rare inflammatory and fibrotic disease of the mesentery of unknown etiology. It has various clinical and radiological manifestations, posing a diagnostic challenge for clinicians. Its diagnosis is indicated via radiologic imaging and is usually confirmed via peritoneal biopsies. We describe a case of a patient with histopathologically proven MP, in which steroid dependence was successfully managed with colchicine.
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Affiliation(s)
- Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | - Athanasios Beltsis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Eleni Dimou
- Department of Pharmacy, Aristotle University of Thessaloniki, Greece
| | - Mary Arvaniti
- Department of Radiology, Central Hospital, Thessaloniki, Greece
| | - Anna Charsoula
- Department of Radiology, Central Hospital, Thessaloniki, Greece
| | - Victor Gourvas
- Department of Histopathology, Central Hospital, Thessaloniki, Greece
| | - Stefanos Atmatzidis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Greece,Address for correspondence: Prof. Panagiotis Katsinelos, Assistant Professor of Gastroenterology Head, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece. E-mail:
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Katsinelos P, Gatopoulou A, Gkagkalis S, Fasoulas K, Beltsis A, Zavos C, Terzoudis S, Lazaraki G, Chatzimavroudis G, Vasiliadis I, Kountouras J. A prospective analysis of factors influencing fluoroscopy time during therapeutic ERCP. Ann Gastroenterol 2012; 25:338-344. [PMID: 24714062 PMCID: PMC3959413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/25/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fluoroscopy time (FT) in endoscopic retrograde cholangiopancreatography (ERCP) has a linear relationship with radiation exposure to endoscopist, personnel and patients. The aim of this prospective study was to investigate the factors influencing the FT during ERCP. PATIENTS AND METHODS Between January 2010 and August 2011, patients with naïve papilla undergoing therapeutic ERCP were included in the study. Patient and procedural factors affecting fluoroscopy duration were investigated. RESULTS During the study period 549 ERCP records were included in the final analysis. The mean procedural time and FT were 19.53±7.61 min and 48.82±26.43 sec, respectively. There was no effect of age or gender on FT. Univariate analysis showed choledocholithiasis (+17.92 sec; 95%CI: 12.73-23.11, p<0.001), multiple stones (+21.21 sec; 95%CI: 14.31-30.35, p<0.001), stone size >10 mm (+27.514 sec; 95%CI: 16.62-35.71; p<0.001), precut technique (+12.46 sec; 95%CI: 6.32-18.60; p<0.001), periampullary diverticulum (+33.36 sec; 95%CI: 28.49-38.23; p<0.001), mechanical lithotripsy (+31.14 sec; 95%CI: 24.67-37.61; p<0.001) and mechanical lithotripsy plus stent placement (+42.41 sec; 95%CI: 31.93-52.89; p<0.001) to be associated with longer FT. Multivariate analysis identified choledocholithiasis (+13.24 sec; 95%CI: 4.44-22.04; p=0.003), multiple stones (+19.51 sec; 95%CI: 11.72-26.78; p<0.001), stone size >10 mm (+23.95 sec; 95%CI: 14.35-29.45; p<0.001), needle-knife papillotomy (+17.26 sec; 95%CI: 7.77-26.75; p<0.001), periampullary diverticulum (+21.99 sec; 95%CI: 17.81-26.16; p<0.001) and mechanical lithotripsy plus stent placement (+20.39 sec; 95%CI: 7.38-33.40; p=0.002) to prolong FT. CONCLUSIONS The identified factors influencing the FT may help endoscopists take appropriate precautions during ERCP to significantly decrease FTs.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Anthi Gatopoulou
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Stergios Gkagkalis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Athanasios Beltsis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Christos Zavos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras)
| | - Sotiris Terzoudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Ioannis Vasiliadis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Aristotle University of Thessaloniki (Panagiotis Katsinelos, Anthi Gatopoulou, Stergios Gkagkalis, Kostas Fasoulas, Athanasios Beltsis, Sotiris Terzoudis, Georgia Lazaraki, Grigoris Chatzimavroudis, Ioannis Vasiliadis
| | - Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital (Christos Zavos, Jannis Kountouras)
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Katsinelos P, Papaziogas B, Chatzimavroudis G, Katsinelos T, Dimou E, Atmatzidis S, Beltsis A, Terzoudis S, Kamperis E, Lazaraki G. Secondary rectal linitis plastica as first manifestation of urinary bladder carcinoma. Ann Gastroenterol 2012; 25:173-175. [PMID: 24714188 PMCID: PMC3959401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 11/16/2022] Open
Abstract
Secondary rectal linitis plastica is a very rare malignancy with poor prognosis. Diagnosis is difficult because of nonspecific clinical and endoscopic findings and negative biopsies in most cases owing to the fact that the mucosa is frequently unaffected. We herein describe a 68-year-old man who presented with a six-month history of tenesmus and constipation. Endoscopy revealed a narrow distal rectum with an indurated, cobblestone appearance of mucosa. Multiple biopsies and fine-needle aspiration were negative for malignancy. Abdominal MRI and transrectal ultrasonography showed findings compatible with rectal linitis plastica. He underwent rectal extirpation with total cystectomy and lymph nodes dissection. Histology demonstrated secondary rectal linitis plastica due to a poorly differentiated urinary bladder carcinoma. We emphasize the endoscopic and endosonographic features and the difficulty to establish a preoperative diagnosis of secondary rectal linitis plastica.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki),
Correspondence to: Panagiotis Katsinelos, MD, PhD, Ass. Prof. of Gastroenterology, Head, Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 546 35, Thessaloniki, Greece, Tel: +30 2310 963341, Fax: +30 2310 210401, e-mail:
| | - Basilis Papaziogas
- 2nd Surgical Department (Basilis Papaziogas, Grigoris Chatzimavroudis, Stefanos Atmatzidis), Medical School, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki),2nd Surgical Department (Basilis Papaziogas, Grigoris Chatzimavroudis, Stefanos Atmatzidis), Medical School, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Taxiarchis Katsinelos
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki)
| | - Eleni Dimou
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki)
| | - Stefanos Atmatzidis
- 2nd Surgical Department (Basilis Papaziogas, Grigoris Chatzimavroudis, Stefanos Atmatzidis), Medical School, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Athanasios Beltsis
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki)
| | - Sotiris Terzoudis
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki)
| | - Eustathios Kamperis
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki)
| | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit (Panagiotis Katsinelos, Grigoris Chatzimavroudis, Taxiarchis Katsinelos, Eleni Dimou, Athanasios Beltsis, Sotiris Terzoudis, Eustathios Kamperis, Georgia Lazaraki)
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Katsinelos P, Fasoulas K, Beltsis A, Chatzimavroudis G, Paroutoglou G, Maris T, Mimidis K, Koufokotsios A, Terzoudis S, Atmatzidis S, Kaltsa A, Kapetanos D, Kamperis E, Zavos C, Kountouras J, Belou A. Diagnostic yield and clinical impact of wireless capsule endoscopy in patients with chronic abdominal pain with or without diarrhea: a Greek multicenter study. Eur J Intern Med 2011; 22:e63-6. [PMID: 21925046 DOI: 10.1016/j.ejim.2011.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Wireless capsule endoscopy has become the gold standard for the examination of small bowel. However, its role in the evaluation of patients suffering from chronic abdominal pain is not yet clearly defined. We conducted an open-label prospective multi-center study to evaluate the yield and clinical outcome of capsule endoscopy in patients with chronic abdominal pain with/without diarrhea. METHODS Seventy-two patients with chronic (>3months) abdominal pain with/without diarrhea in whom the underlying pathology could not be diagnosed by conventional modalities, underwent capsule endoscopy in either of the 6 participating centers. Patients were then followed up for clinical outcomes. RESULTS The overall diagnostic yield of capsule endoscopy was 44.4%. More specifically, its diagnostic yield was 21.4% in patients with abdominal pain and negative inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), 66.7% in patients with abdominal pain and positive inflammatory markers, 0% in patients with abdominal pain, diarrhea and negative inflammatory markers, and 90.1% in patients with abdominal pain, diarrhea and positive inflammatory markers. Both univariate and multivariate regression analyses showed that abnormal C-reactive protein and erythrocyte sedimentation rate were significant factors related with positive capsule endoscopy findings. CONCLUSIONS Chronic abdominal pain with/without diarrhea should be accompanied by elevated inflammatory markers to be regarded as a valid indication for capsule endoscopy. The yield of capsule endoscopy in such patients is reasonably high and clinical outcomes of patients treated with capsule endoscopy findings as a guide are significant.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Thessaloniki, Greece.
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Fasoulas K, Chatzimavroudis G, Atmatzidis S, Vasiliadis I, Katsinelos P. A novel technique to treat a major bile duct leak. Surg Laparosc Endosc Percutan Tech 2011; 21:299. [PMID: 21857486 DOI: 10.1097/sle.0b013e31821f8c16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chatzimavroudis G, Christopoulos P, Atmatzidis S, Papadakis G, Nalbanti P, Papaziogas B, Koutelidakis I, Atmatzidis K. Pica: an uncommon cause of acute abdominal pain in children. Indian J Pediatr 2011; 78:886-7. [PMID: 21328077 DOI: 10.1007/s12098-011-0376-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
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Katsinelos P, Chatzimavroudis G, Zavos C, Pilpilidis I, Fasoulas K, Papaziogas B, Kountouras J. Video capsule endoscopy findings in subacute superior mesenteric vein thrombosis. Hippokratia 2011; 15:275-277. [PMID: 22435030 PMCID: PMC3306039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Subacute superior mesenteric vein thrombosis is a rare ischemic intestinal disease which is often characterized by delayed diagnosis due to obscure clinical picture. CASE REPORT A 67-year-old woman who presented chronic abdominal pain with mild nausea due to superior mesenteric vein thrombosis was submitted to video capsule endoscopy. We describe, for the first time, the video capsule endoscopy findings in this patient. CONCLUSION We emphasize the role of this new technology in the diagnosis of suspected ischemic intestinal diseases.
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Katsinelos P, Fasoulas K, Terzoudis S, Chatzimavroudis G, Zavos C, Kountouras J. Spondylodiscitis complicating cholangitis caused by stent occlusion. Gastrointest Endosc 2011; 73:1326-8. [PMID: 21628020 DOI: 10.1016/j.gie.2011.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 01/03/2011] [Indexed: 12/11/2022]
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Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Terzoudis S, Pilpilidis I, Paroutoglou G. Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older. Endoscopy 2011; 43:128-33. [PMID: 21108173 DOI: 10.1055/s-0030-1255934] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND STUDY AIM The aim of this observational prospective study was to evaluate the safety of outpatient therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in a very elderly cohort. PATIENTS AND METHODS A total of 600 patients were included in the study between June 2006 and June 2009. All underwent first therapeutic ERCP and were scheduled to be discharged on the same day following a postprocedure observation period of 6 hours. Of the 600 patients, 123 patients (group A) were re-admitted due to postprocedure complications that presented during the observation period, and 477 patients (group B) were discharged on the same day. Concomitant diseases, details of ERCP procedures, complications, and outcomes were all evaluated. The accuracy of the 6-hour postprocedure observation period, clinical criteria in predicting those patients aged 80 years and older in whom all therapeutic ERCP can be performed on an outpatient basis, and costs saved were all assessed. RESULTS There was a statistical difference in incidence of concomitant diseases between groups A and B (group A 84.5 % vs. group B 74.6 %; P = 0.020). However, there was no difference between the groups with regard to indication for ERCP and type of intervention. There was no difference in postprocedure complication rate between very elderly patients and younger patients (< 80 years), except for prolonged sedation or hypotension, which occurred more frequently in older (≥ 80 years) than in younger (< 80 years) patients (7.6 % vs. 3.2 %; P = 0.037). In group B, complications necessitating re-admission after the 6-hour observation period occurred in 10 patients (2.09 %) (patients ≥ 80 years 0.8 % and patients < 80 years 2.5 %). The costs saved by performing the procedure on an outpatient basis was calculated as 150 € per patient. CONCLUSION Outpatient therapeutic ERCP with postprocedure observation of 6 hours is a safe and cost-effective procedure in a significant proportion of very elderly patients.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, Central Hospital, Thessaloniki, Greece.
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Katsinelos P, Beltsis A, Chatzimavroudis G, Paikos D, Paroutoglou G, Kapetanos D, Terzoudis S, Lazaraki G, Pilpilidis I, Fasoulas K, Atmatzidis S, Zavos C, Kountouras J. Endoscopic management of occluded biliary uncovered metal stents: A multicenter experience. World J Gastroenterol 2011; 17:98-104. [PMID: 21218089 PMCID: PMC3016687 DOI: 10.3748/wjg.v17.i1.98] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/13/2010] [Accepted: 07/20/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents (SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.
METHODS: A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs. The technical success of performed treatment in occluded SEMSs, the patency of the stent, the need for re-intervention and the financial costs of each treatment were analyzed.
RESULTS: Fifty four patients were included in the analysis; 21 received Hanaro, 19 Wallstent and 14 Flexus. For the relief of obstruction, a plastic stent was inserted in 24 patients, a second SEMS in 25 and mechanical cleaning was performed in 5 patients. The overall median second patency rates between second SEMSs and plastic stents did not differ (133 d for SEMSs vs 106 d for plastic stents; P = 0.856). Similarly, no difference was found between the overall survival of SEMS and plastic stent groups, and no procedure-related complications occurred. Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.
CONCLUSION: Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs; insertion of plastic stents appears to be the most cost-effective strategy.
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Katsinelos P, Chatzimavroudis G, Terzoudis S, Patsis I, Fasoulas K, Katsinelos T, Kokonis G, Zavos C, Vasiliadis T, Kountouras J. Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience. Med Princ Pract 2011; 20:60-5. [PMID: 21160216 DOI: 10.1159/000322071] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study assessed the diagnostic yield of capsule endoscopy (CE) and its impact on patients with obscure gastrointestinal bleeding (OGIB). SUBJECTS AND METHODS Between May 2007 and May 2009, 63 patients with OGIB (overt bleeding: 25, and occult blood loss with chronic ferropenic anemia: 38) and normal upper and lower endoscopy were studied by CE. Demographic characteristics, prior diagnostic tests, CE findings, therapeutic interventions, medical treatment and clinical outcomes following CE were evaluated. RESULTS The overall diagnostic yield was 44.44% of patients and included findings of angiectasia in 11 (17.46%) patients, nonsteroidal anti-inflammatory drugs enteropathy in 6 (9.52%) patients, celiac disease in 3 (4.76%) patients, tumors in 2 (3.17%) patients, and a variety of other diagnoses ranging from varices to ulcers (due to congenital afibrinogenemia and amyloidosis). The diagnostic yield was notably higher in overt bleeders (15/25, 60%) compared to occult bleeders (13/38, 34.21%; p = 0.044), and in patients with overt bleeding who had CE within the first 10 days (14/16, 87.5%) after the bleeding episode in comparison to overt bleeders who underwent CE >10 days after the bleeding episode (2/16, 11.1%; p < 0.0001). During follow-up (11.8 ± 7 months), CE findings led to specific therapy that resolved the underlying disease or improved the clinical condition in 45 of 63 patients, thus having a positive clinical impact of 71.43%. CONCLUSION CE has a high diagnostic yield and a positive influence on clinical management in a significant proportion of patients with OGIB. These data further support the role of CE in routine clinical practice.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece
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Katsinelos P, Tziomalos K, Fasoulas K, Paroutoglou G, Koufokotsios A, Mimidis K, Terzoudis S, Maris T, Beltsis A, Geros C, Chatzimavroudis G. Can capsule endoscopy be used as a diagnostic tool in the evaluation of nonbleeding indications in daily clinical practice? A prospective study. Med Princ Pract 2011; 20:362-7. [PMID: 21576998 DOI: 10.1159/000324548] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 12/05/2010] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic yield of capsule endoscopy (CE) and its impact on treatment and outcome in patients without bleeding indications. SUBJECTS AND METHODS One hundred and sixty-five nonbleeding patients were enrolled in the study. The most common indications for CE were chronic abdominal pain alone (33 patients) or combined with chronic diarrhea (31 patients) and chronic diarrhea alone (30 patients). Among the 165 patients, 129 underwent CE for evaluation of gastrointestinal symptoms and 36 for surveillance or disease staging. RESULTS CE findings were positive, suspicious and negative in 73 (44.2%), 13 (7.9%) and 79 (47.9%) of cases, respectively. The diagnostic yield was highest in patients with refractory celiac disease (10/10, 100%) and suspected Crohn's disease (5/6, 83.3%), followed by patients with chronic abdominal pain and chronic diarrhea (13/31, 41.9%), established Crohn's disease (2/6, 33.3%), chronic diarrhea alone (8/30, 26.7%), chronic abdominal pain alone (8/33, 24.2%) and other indications (3/13, 23.1%) (p < 0.005). The CE findings led to a change of medication in 74 (47.7%) patients, surgery in 15 (9.7%), administration of a strict gluten-free or other special diet in 13 (8.4%) and had other consequences in 11 (6.7%). Management was not modified in 42 (27.1%) patients. Among symptomatic patients (n = 129), 29 (22.5%) were lost to follow-up. The remaining 100 patients were followed up for 8.7 ± 4.0 months (range 2-19). Among the latter, resolution or improvement of symptoms was observed in 86 (86%) patients, no change in 11 (11%) and 3 (3%) died. All 86 patients who experienced resolution or improvement of their symptoms had a modification of their management after CE; only 7/11 patients whose symptoms did not change (63.6%) and 2/3 patients who died (66.7%) had a modification of management (p < 0.001). CONCLUSIONS CE appears to be a useful tool in the evaluation of patients with nonbleeding indications. The outcome of most patients with negative findings was excellent.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Ethnikis Amnis 41, Thessaloniki, Greece.
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Katsinelos P, Chatzimavroudis G, Lazaraki G, Fasoulas K. Extensive necrosis of duodenum after injection sclerotherapy of a bleeding duodenal ulcer with 5% ethanolamine. Ann Gastroenterol 2011; 24:336. [PMID: 24713782 PMCID: PMC3959329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/17/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece,
Correspondence to: Panagiotis Katsinelos, Ass. Prof. of Gastroenterology, Head, Department of Endoscopy and Motility Unit, “G. Gennimatas” General Hospital, Thessaloniki, Greece; tel: 00302310963341, fax: 00302310211241, e-mail:
| | | | - Georgia Lazaraki
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece
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Fasoulas K, Katsinelos P, Arvaniti M, Chatzimavroudis G. Epiploic appendagitis: an overlooked entity by clinicians. Ann Gastroenterol 2011; 24:221. [PMID: 24713774 PMCID: PMC3959305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/05/2011] [Indexed: 10/28/2022] Open
Affiliation(s)
- Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece (Kostas Fasoulas, Panagiotis Katsinelos, Grigoris Chatzimavroudis)
| | - Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece (Kostas Fasoulas, Panagiotis Katsinelos, Grigoris Chatzimavroudis),
Correspondence to: Panagiotis Katsinelos, Ass. Professor of Gastroenterology, Head, Department of Endoscopy and Motility Unit, G.Gennimatas General HospitalThessaloniki, Greece, tel: 00302310963341, fax: 00302310211241, e-mail:
| | - Mary Arvaniti
- Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (Mary Arvaniti)
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece (Kostas Fasoulas, Panagiotis Katsinelos, Grigoris Chatzimavroudis)
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Fasoulas K, Zavos C, Chatzimavroudis G, Trakateli C, Vasiliadis T, Ioannidis A, Kountouras J, Katsinelos P. Eleven-year experience on the endoscopic treatment of post-cholecystectomy bile leaks. Ann Gastroenterol 2011; 24:200-205. [PMID: 24713781 PMCID: PMC3959309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/05/2011] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Bile leak is a common and serious complication of cholecystectomy with endotherapy being an established method of treatment. This retrospective study presents the 11-year experience of a referral center in endoscopic management of post-cholecystectomy bile leaks. METHODS During the period between January 2000 and December 2010, records of patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for suspected post-cholecystectomy bile leaks were reviewed for evidence of clinical presentation of bile leaks, cholangiographic findings, type of endoscopic intervention, procedural complications and post-procedure follow-up. RESULTS Seventy-one patients with suspected post-cholecystectomy bile leak were referred for ERCP. Common bile duct (CBD) cannulation was successful in 70 patients (98.59%). Complete transection of CBD was diagnosed in 4 patients; they were treated with surgery. A leak from the cystic duct stump was demonstrated in 49 patients (74.24%), from the ducts of Luschka in 4 (6.06%), from the gallbladder bed in 2 (3.03%), from the CBD in 7 (10.61%) and from the common hepatic duct (CHD) in 4 patients (6.06%). Endoscopic sphincterotomy (ES) plus endoprosthesis was performed in 64 patients (96.97%). A 12-year-old girl with a leak from cystic duct stump was successfully treated with stenting without ES and one patient with leak from gallbladder bed underwent only ES. Endoscopic intervention failed to treat a leak from CHD in one patient. During the follow-up, three patients developed bile duct stricture. Two were treated endoscopically and one with hepaticojejunostomy. CONCLUSIONS ES plus large-bore straight plastic biliary stent placement is a safe and effective intervention in post-cholecystectomy bile leaks.
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Affiliation(s)
- Kostas Fasoulas
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos)
| | - Christos Zavos
- Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece (Christos Zavos, Jannis Kountouras)
| | - Grigoris Chatzimavroudis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos)
| | - Christina Trakateli
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos)
| | - Themistoklis Vasiliadis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos)
| | - Aristidis Ioannidis
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos)
| | - Jannis Kountouras
- Department of Gastroenterology, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece (Christos Zavos, Jannis Kountouras)
| | - Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece (Kostas Fasoulas, Grigoris Chatzimavroudis, Christina Trakateli, Themistoklis Vasiliadis, Aristidis Ioannidis, Panagiotis Katsinelos),
Correspondence to: Panagiotis Katsinelos, Ass. Professor of Gastroenterology, Head, Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital Thessaloniki, Greece, tel: 00302310963341, fax: 00302310211241, e-mail:
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Katsinelos P, Paroutoglou G, Kountouras J, Chatzimavroudis G, Zavos C, Terzoudis S, Katsinelos T, Fasoulas K, Gelas G, Tzovaras G, Pilpilidis I. Partially covered vs uncovered sphincterotome and post-endoscopic sphincterotomy bleeding. World J Gastroenterol 2010; 16:5077-83. [PMID: 20976845 PMCID: PMC2965285 DOI: 10.3748/wjg.v16.i40.5077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To prospectively compare partially covered vs uncovered sphincterotome use on post-endoscopic biliary sphincterotomy (ES) hemorrhage and other complications.
METHODS: All patients referred for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to undergo ES either with a partially covered or an uncovered sphincterotome. Both patient and technical risk factors contributing to the development of post-ES bleeding were recorded and analyzed. The characteristics of bleeding was recorded during and after ES. Other complications were also compared.
RESULTS: Three-hundred and eighty-seven patients were recruited in this study; 194 patients underwent ES with a partially covered sphincterotome and 193 with conventional uncovered sphincterotome. No statistical difference was noted in the baseline characteristics and risk factors for post-ES induced hemorrhage between the 2 groups. No significant difference in the incidence and pattern of visible bleeding rates was found between the 2 groups (immediate bleeding in 24 patients with the partially covered sphincterotome vs 19 patients with the uncovered sphincterotome, P = 0.418). Delayed bleeding was observed in 2 patients with a partially covered sphincterotome and in 1 patient with an uncovered sphincterotome (P = 0.62). No statistical difference was noted in the rate of other complications.
CONCLUSION: The partially covered sphincterotome was not associated with a lower frequency of bleeding. Also, there was no difference in the incidence of other significant complications between the 2 types of sphincterotome.
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Katsinelos P, Paroutoglou G, Chatzimavroudis G, Terzoudis S, Zavos C, Gelas G, Pilpilidis I, Kountouras J. Prospective randomized study comparing double layer and Tannenbaum stents in distal malignant biliary stenosis. Acta Gastroenterol Belg 2010; 73:445-450. [PMID: 21299153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND STUDY AIMS This prospective randomized study compared the patency and effective drainage rate of two stents with different materials but similar design, in the palliation of inoperable malignant biliary obstruction. PATIENTS AND METHODS A total of 49 patients (26 women, mean age 72.55 +/- 10.75 years, range: 48-91 years) with obstructive jaundice due to inoperable malignant stricture of the distal common bile duct without previous drainage procedure, were randomly assigned to receive 10F Double Layer (DLS) (n = 24) or 10F Tannenbaum (TAN) (n = 25) biliary plastic stent. The diagnosis included pancreatic cancer (n = 33), cholangiocarcinoma (n = 8), ampullary cancer (n = 7) and metastatic lymphadenopathy (n = 1). The duration of stent patency, the effective drainage, and the adverse events were analyzed. RESULTS Stent placement was successful in all patients with minor complications. The overall median patency rates between the two groups did not differ (107.5 days for DLS group vs. 101 days for TAN group ; p = 0.066). Effective drainage rate at the end of second week was 95.8% for DLS group and 96% for TAN group, (p = 1.00). Proximal stent migration occurred in one patient with TAN stent. CONCLUSIONS The present study demonstrated that both DLS and TAN stents are comparable in terms of placement, overall stent patency, and complications.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece
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Lazaraki G, Katsinelos P, Nakos A, Chatzimavroudis G, Pilpilidis I, Paikos D, Tzilves D, Katsos I. Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study. Surg Endosc 2010; 25:628-35. [PMID: 20644961 DOI: 10.1007/s00464-010-1236-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 01/23/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety of placing self-expandable metal stents (SEMSs) without fluoroscopy for palliation of malignant esophageal or esophagogastric strictures. METHODS From January 2003 to June 2008, a prospective observational study investigated the placement of covered proximal-release Ultraflex stents without fluoroscopy in nonoperable malignant esophageal and esophagogastric strictures. The technical success as well as the early and late complications (perforation, migration, severe gastroesophageal reflux, hematemesis, and reobstruction due to tissue ingrowth or overgrowth) were recorded. Dysphagia before and after stent placement was scored on a 5-point scale. All the patients were observed monthly in the outpatient clinic or by telephone contact until death. RESULTS The study enrolled 89 patients (16 women; mean age, 69.54±7.1 years) with dysphagia due to inoperable esophageal or esophagogastric malignant strictures (29 squamous cell cancers, 52 adenocarcinomas, and 8 obstructive malignant extrinsic compressions). The mean stricture length was 6.2±2.8 cm. Endoscopic deployment was achieved for 83 patients (93.2%), with accurate stent positioning in all the patients except one. An adequate relief of symptoms was noted for 82 of the patients (92.1%). During the follow-up period, 36 patients (43.4%) had recurrent dysphagia, caused by tumor overgrowth in 32 cases and stent migration in 4 cases, after an average time of 82 days (range 67-216 days). A stent-in-stent procedure was performed in 27 cases. For two patients, a third stent-in-stent needed to be placed after 85 and 216 days, respectively. CONCLUSION In most cases, SEMSs can be accurately and safely positioned without fluoroscopy for palliative treatment of malignant esophageal dysphagia.
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Affiliation(s)
- Georgia Lazaraki
- Department of Gastrointestinal Oncology, Theagenion Cancer Hospital, Al. Simeonidi 2 str, 54007, Thessaloniki, Greece.
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Katsinelos P, Chatzimavroudis G, Terzoudis S, Fasoulas K. The endoloop-clips technique for closure of large iatrogenic colonic perforations. Endoscopy 2010; 42:343; author reply 344. [PMID: 20354944 DOI: 10.1055/s-0029-1244025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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