scholarly journals A270 AMPULLARY MORPHOLOGY PREDICTS SUCCESS AND POST-PROCEDURE COMPLICATIONS IN PRIMARY NEEDLE-KNIFE FISTULOTOMY FOR BILIARY CANNULATION IN ERCP: RESULTS OF A PROSPECTIVE CASE SERIES

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 147-148
Author(s):  
S Hew ◽  
C Taylor ◽  
L Hookey ◽  
R Bechara
Keyword(s):  
Visual Analysis ◽  
Case Series ◽  
Biliary Cannulation ◽  
Regular Type ◽  
Needle Knife ◽  
Cannulation Success ◽  
Type 3 ◽  
The Impact

Abstract Background Biliary cannulation is often the most challenging component of successful ERCP. Needle-knife fistulotomy (NKF) involves incising directly into the intra-duodenal portion of the bile duct, away from the native orifice, to achieve direct biliary access. This technique is usually performed when standard cannulation is unsuccessful, however recently, has been shown by our group to be a potentially effective and safe method to achieve biliary access as the primary approach. It has also been demonstrated that ampullary morphology influences cannulation success. Aims This study aims to assess the impact of ampullary morphology on the success and complications of NKF. Methods A retrospective visual analysis was performed of the ampullary morphology collected prospectively as part of our original NKF study (NCT03698266). Endoscopic videos and photos were reviewed to classify the ampulla into one of four types, as per a validated classification system. Ampullas were either Type 1 (regular), Type 2 (small), Type 3 (protruding or pendulous) or Type 4 (creased or ridged). Outcomes examined included: time to cannulation, proceduralist-perceived difficulty and complications. Results Of the 71 patients enrolled in the NKF study, 66 had video or photographs of the ampulla to facilitate classification. There were 35 (52%) Type 1 ampullas, 16 (24%) Type 2 and 14 (21%) Type 3 and one (1%) Type 4 ampullas. 65 out of the 66 (98.4%) patients had successful biliary access after primary NKF. The mean time to cannulation in all patients was 5.3 minutes (range 0.25–27 minutes). There were 3 cases of post-ERCP pancreatitis (PEP) (4.5%) and 3 cases of post-ERCP bleeding (4.5%). Compared to Type 1 ampullas, there was a no significant increase in time to cannulation in Type 2 and Type 3 ampullas using NKF (Type 1 4.7 vs. Type 2 7.1 vs. Type 3 6.4 minutes, p = NS). Only one patient with a Type 2 ampulla was rated as ‘low difficulty’ by the proceduralist performing NKF. Nevertheless, successful NKF was achieved in 15 out of 16 Type 2 ampullas (93.8%). There was 100% success rate in biliary access for Type 3 ampullas, previously shown to more challenging using conventional cannulation techniques. All cases of PEP occurred in patients with Type 2 ampullas. Conclusions As with the impact on conventional cannulation, ampullary morphology may influence outcomes of NKF. It appears that small, Type 2 ampullas with a short intra-duodenal segment makes NKF more challenging and may be associated with a higher rate of PEP. Unlike conventional cannulation, Type 3 ampullas are similar to Type 1 ampullas in ease of NKF access. Funding Agencies None

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Influence of sediment distribution on the relationships among reservoir yield, spill, and evaporation losses

2018 ◽  
Vol 23 (5) ◽  
pp. 849-856
Author(s):  
Jody Campos ◽  
Iran Eduardo Lima Neto ◽  
Ticiana Marinho Studart ◽  
José Nilson Beserra Campos
Keyword(s):  
Semiarid Region ◽  
Sediment Distribution ◽  
Brazilian Semiarid ◽  
Evaporation Losses ◽  
Brazilian Northeast ◽  
Type 3 ◽  
The Impact ◽  
Reservoir Yield

ABSTRACT This study shows how the sedimentation process in reservoirs affects the yield-spill-evaporation losses in reservoirs of Ceará State, Brazilian Northeast. Reservoirs are assumed to have, initially, inverted conical shape. Three forms of sedimentation were investigated: type 1, with deposition occurring parallel to the wetted perimeter; type 2, deposition distributed proportionally to the water depth; and, type 3, deposition concentrated in the reservoir bottom. These sedimentation patterns were found in many reservoirs in Ceará, with capacity ranging from about 0.5 to 100 hm3. Nevertheless, type 2 pattern was the most frequent. In this paper, five large reservoirs, over 100 hm3, were studied using Monte Carlo approach, and considering the silting over the time horizon. It was found that sediment distribution can significantly affect the yield-spill-evaporation trade-off on large reservoirs. Type 1 results have the lowest impact on reservoir yield, followed by type 2 and type 3. For Cedro reservoir, the yield would go to zero in 2115, assuming a type 3 deposition pattern. These results reinforce the need for monitoring sedimentation in large reservoirs in the Brazilian semiarid region. In addition, this study provides a relatively simple methodology to predict the impact of siltation on reservoir yield-spill-evaporation relationships, for the three most found patterns of sedimentation.

scholarly journals Influence of emphysema distribution on pulmonary function parameters in COPD patients

2015 ◽  
Vol 41 (6) ◽  
pp. 489-495 ◽  
Author(s):  
Helder Novais e Bastos ◽  
Inês Neves ◽  
Margarida Redondo ◽  
Rui Cunha ◽  
José Miguel Pereira ◽  
...  
Keyword(s):  
Smoking History ◽  
Copd Patients ◽  
Predominant Type ◽  
Lower Lung ◽  
Distribution Type ◽  
Type 3 ◽  
The Impact ◽  
Minute Walk

ABSTRACT OBJECTIVE: To evaluate the impact that the distribution of emphysema has on clinical and functional severity in patients with COPD. METHODS: The distribution of the emphysema was analyzed in COPD patients, who were classified according to a 5-point visual classification system of lung CT findings. We assessed the influence of emphysema distribution type on the clinical and functional presentation of COPD. We also evaluated hypoxemia after the six-minute walk test (6MWT) and determined the six-minute walk distance (6MWD). RESULTS: Eighty-six patients were included. The mean age was 65.2 ± 12.2 years, 91.9% were male, and all but one were smokers (mean smoking history, 62.7 ± 38.4 pack-years). The emphysema distribution was categorized as obviously upper lung-predominant (type 1), in 36.0% of the patients; slightly upper lung-predominant (type 2), in 25.6%; homogeneous between the upper and lower lung (type 3), in 16.3%; and slightly lower lung-predominant (type 4), in 22.1%. Type 2 emphysema distribution was associated with lower FEV1, FVC, FEV1/FVC ratio, and DLCO. In comparison with the type 1 patients, the type 4 patients were more likely to have an FEV1 < 65% of the predicted value (OR = 6.91, 95% CI: 1.43-33.45; p = 0.016), a 6MWD < 350 m (OR = 6.36, 95% CI: 1.26-32.18; p = 0.025), and post-6MWT hypoxemia (OR = 32.66, 95% CI: 3.26-326.84; p = 0.003). The type 3 patients had a higher RV/TLC ratio, although the difference was not significant. CONCLUSIONS: The severity of COPD appears to be greater in type 4 patients, and type 3 patients tend to have greater hyperinflation. The distribution of emphysema could have a major impact on functional parameters and should be considered in the evaluation of COPD patients.

scholarly journals Anatomical Variants of the Infraorbital Canal: Implications for the Prelacrimal Approach to the Orbital Floor

2019 ◽  
Vol 34 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Lifeng Li ◽  
Nyall R. London ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau
Keyword(s):  
Infraorbital Nerve ◽  
Orbital Floor ◽  
Surgical Approaches ◽  
Direct Exposure ◽  
Infraorbital Canal ◽  
Anatomic Variants ◽  
Type 3 ◽  
The Impact

Background The infraorbital nerve (ION) and its canal are important landmarks during surgical approaches to the orbital floor and pterygopalatine fossa. However, variations in the anatomy of the infraorbital canal and its corresponding neurovascular bundle may impact the access. Objective To investigate anatomic variants of the infraorbital canal from a prelacrimal endoscopic perspective and to explore the impact of these variants on exposing the lateral orbital floor. Methods Ten cadaveric specimens (20 sides) were dissected through an endonasal prelacrimal approach. Anatomic variants of the ION including location, branching pattern, and relationship to the infraorbital artery were assessed. The need for ION transposition to increase exposure of the lateral orbital floor was also investigated. Results Incidence of previously described Types 1, 2, and 3 ION variants were 30.0%, 60.0%, and 10.0%, respectively. Although the orbital floor could be directly accessed in Type 1 and Type 3 IONs, transposition of the ION was necessary to expose the lateral orbital floor in 5 of 12 sides (42%) for Type 2 ION. Bony dehiscence of the orbital floor was identified in 8 of 20 sides (40%) and branching of the ION in 2 of 20 sides (10%). Conclusion Anatomic variations of the infraorbital canal impact surgical exposure of the orbital floor via a prelacrimal approach. Type 1 and Type 3 ION variants allow a direct exposure of the entire orbital floor. A Type 2 ION may require transposition of the nerve to adequately expose the lateral orbital floor.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Introduction We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Morphological Typing of Endometrial Adenocarcinoma as the Basis of the Natural History of the Tumor.

1974 ◽  
Vol 60 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Marcello Filotico ◽  
Mario Trabucco ◽  
Francesco Faggiano ◽  
Giovanni Mannarini ◽  
Silvana Grasso
Keyword(s):  
Natural History ◽  
Endometrial Adenocarcinoma ◽  
Case Series ◽  
Endocrine Treatment ◽  
Morphological Criterion ◽  
History Of ◽  
Type 3

Current ideas on Müllerian tumors of the ovary are applied to the classification of endometrial adenocarcinomas, which are divided into four main histotypes: Type 1 or homologous or endometrioid (65 % of cases); Type 2 or Fallopianlike (15.8 %); Type 3 or cervical-like (13.4%) and Type 4 or unclassifiable (5%). This classification aims to provide a useful morphological criterion for forecasting the sensitivity of endometrial adenocarcinomas to endocrine treatment with progestational agents. Type 1 accounts for about 80 % of all adenocarcinomas of the endometrium in the fifth decade of life, which is supposed to be the period most exposed to estrogenic stimulation. These adenocarcinomas represent only 14 % of all endometrial adenocarcinomas. The above results are based on a 155-case series.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.Method A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results

2019 ◽  
pp. 81-89
Author(s):  
Larisa Dmitrievna Popovich ◽  
Svetlana Valentinovna Svetlichnaya ◽  
Aleksandr Alekseevich Moiseev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Economic Benefits ◽  
Test Results ◽  
Self Monitoring ◽  
Patients With Diabetes ◽  
The Impact

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc). Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes. Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model. Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes. Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

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