Alain Sibille - Academia.edu (original) (raw)

Papers by Alain Sibille

Research paper thumbnail of 25-Gauge histology needle versus 22-Gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathies

A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ... more A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ProCore; Cook Medical, Bloomington, Indiana, USA) has been developed, which features a hollowed-out reverse bevel to trap core samples. However, data on the differences between the diagnostic yield of the 25G EchoTip ProCore and that of a 22G standard needle are limited. This pilot study included 27 patients referred during an 11-month period for EUS-FNA of pancreatic masses and enlarged lymph nodes adjacent to the upper gastrointestinal tract. Each lesion was punctured once by both a 25G EchoTip ProCore needle and a 22G standard needle (EchoTip; Cook Medical) with capillary sampling. Blinded histocytologic analyses were conducted. The final diagnosis was based on FNA findings of malignant cells, pathologic analysis of the surgical specimen, and/or radiologic and clinical follow-up of at least 7 months. A total of 28 EUS-FNA procedures targeting masses of the pancreas (n = 19) and lymph nodes (n = 9) were performed. No complications were encountered. Single-pass sensitivity rates for pancreatic and lymph node malignancy were equal for the needle types: 89.5 % (95 %CI 66.82 - 98.39) and 66 % (95 %CI 24.1 - 94), respectively. There were no significant differences between the needles in terms of EUS visualization (P = 0.125), amount of blood contamination (P = 0.705), macroscopic quantity of the material (P = 0.858), quality of the cytology (P = 0.438), and adequacy and accuracy of the cell block material (P = 0.220). Both needles were safe and successful in terms of a high diagnostic yield, with similar histocytologic results. The results of this study were presented at Digestive Disease Week (DDW) 2014, Chicago, Illinois. This trial was registered at ClinicalTrials.gov (B027201316271).

Research paper thumbnail of Bwge XXVI-Eus-Guided Fna Using a 25-GAUGE Procore Histology Needle Versus a 22-GAUGE Standard Cytology Needle

Acta Gastro Enterologica Belgica, 2014

Research paper thumbnail of Bwge XXVI-Expanding the Horizons of Eus : Diagnosis of Non-Digestive Pathologies

Acta Gastro Enterologica Belgica, 2014

Research paper thumbnail of Does endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides adequate material for cytology and biochemical analysis?

Acta gastro-enterologica Belgica, 2013

Research paper thumbnail of 25-GAUGE Histology Needle Versus 22-GAUGE Cytology Needle in Endoscopic Ultrasonography-Guided Sampling of Pancreatic Lesions and Lymphadenopathy

Endoscopy International Open, 2014

A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ... more A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ProCore; Cook Medical, Bloomington, Indiana, USA) has been developed, which features a hollowed-out reverse bevel to trap core samples. However, data on the differences between the diagnostic yield of the 25G EchoTip ProCore and that of a 22G standard needle are limited. This pilot study included 27 patients referred during an 11-month period for EUS-FNA of pancreatic masses and enlarged lymph nodes adjacent to the upper gastrointestinal tract. Each lesion was punctured once by both a 25G EchoTip ProCore needle and a 22G standard needle (EchoTip; Cook Medical) with capillary sampling. Blinded histocytologic analyses were conducted. The final diagnosis was based on FNA findings of malignant cells, pathologic analysis of the surgical specimen, and/or radiologic and clinical follow-up of at least 7 months. A total of 28 EUS-FNA procedures targeting masses of the pancreas (n = 19) and lymph nodes (n = 9) were performed. No complications were encountered. Single-pass sensitivity rates for pancreatic and lymph node malignancy were equal for the needle types: 89.5 % (95 %CI 66.82 - 98.39) and 66 % (95 %CI 24.1 - 94), respectively. There were no significant differences between the needles in terms of EUS visualization (P = 0.125), amount of blood contamination (P = 0.705), macroscopic quantity of the material (P = 0.858), quality of the cytology (P = 0.438), and adequacy and accuracy of the cell block material (P = 0.220). Both needles were safe and successful in terms of a high diagnostic yield, with similar histocytologic results. The results of this study were presented at Digestive Disease Week (DDW) 2014, Chicago, Illinois. This trial was registered at ClinicalTrials.gov (B027201316271).

Research paper thumbnail of Expanding the horizons of endoscopic ultrasound: diagnosis of non-digestive pathologies

Gastroenterology Report, 2014

Endoscopic ultrasound (EUS) is mainly used for the evaluation and sampling of mediastinal and abd... more Endoscopic ultrasound (EUS) is mainly used for the evaluation and sampling of mediastinal and abdominal lymph nodes, luminal and submucosal lesions of the upper and lower gastrointestinal tract, as well as in the diagnostic approach for pancreatic, biliary and liver disease. However, several non-digestive pathologies may be encountered as well, expanding the diagnostic potential of EUS. In this article, we present nine examples of extra-digestive abnormalities detected by means of EUS, including pathologies of the thyroid gland, mediastinal and abdominal vessels, lungs, kidney and the urinary bladder. The purpose of this article is to review the capabilities of EUS beyond routine evaluation of gastrointestinal organs.

Research paper thumbnail of Characterization of extracorporeal ablation of normal and tumor-bearing liver tissue by high intensity focused ultrasound

Ultrasound in Medicine & Biology, 1993

Treatment parameters of extracorporeal high intensity focused ultrasound (HIFU) were analysed in ... more Treatment parameters of extracorporeal high intensity focused ultrasound (HIFU) were analysed in normal and tumor-bearing rabbit liver. HIFU was generated with a I MHz transducer and energy was provided by a 7.5 kW power amplifier. In vivo experiments were conducted on 74 New Zealand rabbits. Normal rabbits and rabbits bearing an intrahepatic VX2 tumor were used. In group 1, spatial peak temporal peak (SPTP) intensities ranging from 1470 to 5500 W cm -2 and exposure times from 0.5 to 5 s were tested at a constant depth in the liver; in group 2, the output power was adjusted as a function of the target depth in order to keep constant the focal in situ intensity in the liver; in group 3 (liver tumors), the focal in situ intensity was 1365 W cm -2 in eight rabbits and 500 W cm -2 in nine. In groups 1, 2 and 3, rabbits were sacrificed 48 h after the treatment. Groups 4 and 5 were designated for analysis of the lesion in the normal liver 4 weeks after treatment at 1000 W cm -2 and 3000 W cm -2 SPTP intensities, respectively. In normal rabbits, the lesion volume increased with exposure time at constant intensity; there was a negative correlation between intensity and exposure time (group 1). When the output power was adjusted as a function of the path length, the lesion size was nearly constant (group 2). In VX2 rabbits, tumor destruction rates were significantly higher in rabbits treated at 500 W cm -~ than in rabbits treated at 1365 W cm -2 (p < 0.05; group 3). As in the normal liver, the lesion volume increased with the exposure time at constant intensity. HIFU lesions treated at 1000 W cm -2 (SPTP) healed as thin fibrous scars, and no severe complication occurred (group 4); at 3000 W cm -2 (SPTP), scars were larger and perforation of a neighboring organ was seen in 7 of 11 rabbits (group 5).

Research paper thumbnail of Covered self-expandable metal stent with angled flare ends for drainage of infected walled-off pancreatic necrosis

Research paper thumbnail of Single operator endoscopic ultrasound-assisted rendezvous for the treatment of pancreaticocutaneous fistula

Research paper thumbnail of Extracorporeal Ablation of Liver Tissue by High-Intensity Focused Ultrasound

Oncology, 1993

High-intensity focused ultrasound (HIFU) may produce a well-delineated lesion of coagulation necr... more High-intensity focused ultrasound (HIFU) may produce a well-delineated lesion of coagulation necrosis in deep organs, by means of an extracorporeal transducer. Applications of this method to the liver in animal models have been studied for many years. The effects of HIFU on the normal liver parenchyma and on hepatic tumors are reviewed. In the normal rabbit liver in vivo we showed the relation between intensity levels and exposure times and the need to adapt intensity to the depth of the target. No severe complications were observed when an intensity of 1,000 W/cm2 was used. HIFU is a noninvasive method for the local destruction of liver tumors. In experimental models, safety and efficacy were demonstrated. HIFU may be interesting for the treatment of some human liver tumors.

Research paper thumbnail of Extracorporeal high-intensity focused ultrasound for VX2 liver tumors in the rabbit*1

Hepatology, 1995

High-Intensity Focused Ultrasound (HIFU) can produce radical tissue necrosis. We wanted to assess... more High-Intensity Focused Ultrasound (HIFU) can produce radical tissue necrosis. We wanted to assess tumor destruction, proliferation, and tumorigenesis after HIFU, in an animal model of hepatic tumor. New Zealand rabbits bearing VX-2 solitary liver tumors were treated with extracorporeal HIFU under ultrasound (US) guidance and standardized conditions. Groups differed only for the administration of either one or two consecutive HIFU procedures. Tissue destruction was assessed by stereomicroscopy and planimetry, cell proliferation was estimated by in vivo intra-arterial injection of 1200 muCi [3H]thymidine, and tumorigenesis was tested by reimplantation of treated or untreated pieces of liver tumors into the thighs of nontumor-bearing animals. Mortality was 0. Tumor destruction rates were 76.3% +/- 16% after one procedure and 94.2% +/- 7.3% after two procedures. Nuclear staining was heavy in control tumors and was absent in treated tumors. Untreated hepatic tumors induced measurable tumors at 3 weeks in thighs of all recipients, 7.8 +/- 2.4 cm3 in volume. Hepatic tumors treated with one HIFU procedure induced tumors in the thigh of recipients in 31.3% of cases (0.47 +/- 0.06 cm3), and those treated with two HIFU procedures induced tumors in 0% even after 8 weeks of follow-up. In conclusion, HIFU allows a noninvasive approach to the destruction of liver tumors in this model, with little toxicity but significant effects on proliferation and tumorigenesis. The repetition of HIFU procedures may improve results.

Research paper thumbnail of Mo1418 Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 25-Gauge Procore™ Histology Needle Versus a 22-Gauge Standard Cytology Needle in the Differential Diagnosis of Solid Lesions and Lymphadenopathies

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Should biopsies be taken from ectopic gastric mucosa in the upper esophagus?

Gastrointestinal Endoscopy, 1997

Research paper thumbnail of An easier method for percutaneous endoscopic gastrojejunostomy tube placement

Gastrointestinal Endoscopy, 1998

The current procedures for percutaneous endoscopic gastrojejunostomy (PEG-J) tube placement requi... more The current procedures for percutaneous endoscopic gastrojejunostomy (PEG-J) tube placement require fluoroscopy and are time consuming. We describe a new, simple method. Ten patients had a PEG-J tube placed by the new method. After placement of a percutaneous endoscopic gastrostomy (PEG) tube using standard technique, the PEG tube was pushed up to the pylorus to make it easier to place the jejunal tube into the duodenum without looping in the stomach. Fluoroscopy was not used. The position of the tube was confirmed by a plain x-ray film of the abdomen. The mean time required for PEG placement and jejunal tube placement was 9.0 and 8.2 minutes, respectively. In all patients the tip of the jejunal tube was at the ligament of Treitz. In one patient the jejunal tube formed a loop in the duodenum, but this was reduced by spontaneous forward migration. In another patient, the tube migrated back into the stomach after 1 week. The method described allows easier PEG-J placement without fluoroscopy.

Research paper thumbnail of Video demonstration of the introducer-type percutaneous gastrostomy system

Gastrointestinal Endoscopy, 2014

In patients with head and neck cancer, the original pullthrough PEG has an increased risk of impl... more In patients with head and neck cancer, the original pullthrough PEG has an increased risk of implantation at the PEG site. This limitation led to the development of the PEXACT (Fresenius, Kabi, Germany) gastrostomy system. The stomach is filled with air, and the site of puncture is located by means of light transillumination and finger indentation. Local anesthesia is administered. A gastropexy of the anterior gastric wall to the ventral abdominal wall is performed with the help of the introducer needle, which is inserted in the lumen of the stomach. The loop is opened, and the suture is passed inside it ( , available online at www.giejournal.org). The suture is then retrieved, and the first suture is applied. The procedure is repeated for the second gastropexy suture. A small incision is made between these 2 sutures, and a trocar with a peel-away sheet is introduced into the stomach. The trocar is removed, a 5F PEG tube is progressed through the sheet, and the balloon is inflated with 5 mL of sterile water. The peel-away sheath and the sutures are removed, and the retaining plate is placed. Administration of water via the gastrostomy tube is permitted after 12 hours, and enteral feeding is started after 24 hours.

Research paper thumbnail of Biliary stent migration presenting as a recurrent pilonidal abscess with underlying rectocutaneous fistula

Research paper thumbnail of Endoscopic Nd:YAG treatment of superficial gastric carcinoma: Experience in 18 western inoperable patients

Gastrointestinal Endoscopy, 1995

Research paper thumbnail of 25-Gauge histology needle versus 22-Gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathies

A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ... more A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ProCore; Cook Medical, Bloomington, Indiana, USA) has been developed, which features a hollowed-out reverse bevel to trap core samples. However, data on the differences between the diagnostic yield of the 25G EchoTip ProCore and that of a 22G standard needle are limited. This pilot study included 27 patients referred during an 11-month period for EUS-FNA of pancreatic masses and enlarged lymph nodes adjacent to the upper gastrointestinal tract. Each lesion was punctured once by both a 25G EchoTip ProCore needle and a 22G standard needle (EchoTip; Cook Medical) with capillary sampling. Blinded histocytologic analyses were conducted. The final diagnosis was based on FNA findings of malignant cells, pathologic analysis of the surgical specimen, and/or radiologic and clinical follow-up of at least 7 months. A total of 28 EUS-FNA procedures targeting masses of the pancreas (n = 19) and lymph nodes (n = 9) were performed. No complications were encountered. Single-pass sensitivity rates for pancreatic and lymph node malignancy were equal for the needle types: 89.5 % (95 %CI 66.82 - 98.39) and 66 % (95 %CI 24.1 - 94), respectively. There were no significant differences between the needles in terms of EUS visualization (P = 0.125), amount of blood contamination (P = 0.705), macroscopic quantity of the material (P = 0.858), quality of the cytology (P = 0.438), and adequacy and accuracy of the cell block material (P = 0.220). Both needles were safe and successful in terms of a high diagnostic yield, with similar histocytologic results. The results of this study were presented at Digestive Disease Week (DDW) 2014, Chicago, Illinois. This trial was registered at ClinicalTrials.gov (B027201316271).

Research paper thumbnail of Bwge XXVI-Eus-Guided Fna Using a 25-GAUGE Procore Histology Needle Versus a 22-GAUGE Standard Cytology Needle

Acta Gastro Enterologica Belgica, 2014

Research paper thumbnail of Bwge XXVI-Expanding the Horizons of Eus : Diagnosis of Non-Digestive Pathologies

Acta Gastro Enterologica Belgica, 2014

Research paper thumbnail of Does endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides adequate material for cytology and biochemical analysis?

Acta gastro-enterologica Belgica, 2013

Research paper thumbnail of 25-GAUGE Histology Needle Versus 22-GAUGE Cytology Needle in Endoscopic Ultrasonography-Guided Sampling of Pancreatic Lesions and Lymphadenopathy

Endoscopy International Open, 2014

A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ... more A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ProCore; Cook Medical, Bloomington, Indiana, USA) has been developed, which features a hollowed-out reverse bevel to trap core samples. However, data on the differences between the diagnostic yield of the 25G EchoTip ProCore and that of a 22G standard needle are limited. This pilot study included 27 patients referred during an 11-month period for EUS-FNA of pancreatic masses and enlarged lymph nodes adjacent to the upper gastrointestinal tract. Each lesion was punctured once by both a 25G EchoTip ProCore needle and a 22G standard needle (EchoTip; Cook Medical) with capillary sampling. Blinded histocytologic analyses were conducted. The final diagnosis was based on FNA findings of malignant cells, pathologic analysis of the surgical specimen, and/or radiologic and clinical follow-up of at least 7 months. A total of 28 EUS-FNA procedures targeting masses of the pancreas (n = 19) and lymph nodes (n = 9) were performed. No complications were encountered. Single-pass sensitivity rates for pancreatic and lymph node malignancy were equal for the needle types: 89.5 % (95 %CI 66.82 - 98.39) and 66 % (95 %CI 24.1 - 94), respectively. There were no significant differences between the needles in terms of EUS visualization (P = 0.125), amount of blood contamination (P = 0.705), macroscopic quantity of the material (P = 0.858), quality of the cytology (P = 0.438), and adequacy and accuracy of the cell block material (P = 0.220). Both needles were safe and successful in terms of a high diagnostic yield, with similar histocytologic results. The results of this study were presented at Digestive Disease Week (DDW) 2014, Chicago, Illinois. This trial was registered at ClinicalTrials.gov (B027201316271).

Research paper thumbnail of Expanding the horizons of endoscopic ultrasound: diagnosis of non-digestive pathologies

Gastroenterology Report, 2014

Endoscopic ultrasound (EUS) is mainly used for the evaluation and sampling of mediastinal and abd... more Endoscopic ultrasound (EUS) is mainly used for the evaluation and sampling of mediastinal and abdominal lymph nodes, luminal and submucosal lesions of the upper and lower gastrointestinal tract, as well as in the diagnostic approach for pancreatic, biliary and liver disease. However, several non-digestive pathologies may be encountered as well, expanding the diagnostic potential of EUS. In this article, we present nine examples of extra-digestive abnormalities detected by means of EUS, including pathologies of the thyroid gland, mediastinal and abdominal vessels, lungs, kidney and the urinary bladder. The purpose of this article is to review the capabilities of EUS beyond routine evaluation of gastrointestinal organs.

Research paper thumbnail of Characterization of extracorporeal ablation of normal and tumor-bearing liver tissue by high intensity focused ultrasound

Ultrasound in Medicine & Biology, 1993

Treatment parameters of extracorporeal high intensity focused ultrasound (HIFU) were analysed in ... more Treatment parameters of extracorporeal high intensity focused ultrasound (HIFU) were analysed in normal and tumor-bearing rabbit liver. HIFU was generated with a I MHz transducer and energy was provided by a 7.5 kW power amplifier. In vivo experiments were conducted on 74 New Zealand rabbits. Normal rabbits and rabbits bearing an intrahepatic VX2 tumor were used. In group 1, spatial peak temporal peak (SPTP) intensities ranging from 1470 to 5500 W cm -2 and exposure times from 0.5 to 5 s were tested at a constant depth in the liver; in group 2, the output power was adjusted as a function of the target depth in order to keep constant the focal in situ intensity in the liver; in group 3 (liver tumors), the focal in situ intensity was 1365 W cm -2 in eight rabbits and 500 W cm -2 in nine. In groups 1, 2 and 3, rabbits were sacrificed 48 h after the treatment. Groups 4 and 5 were designated for analysis of the lesion in the normal liver 4 weeks after treatment at 1000 W cm -2 and 3000 W cm -2 SPTP intensities, respectively. In normal rabbits, the lesion volume increased with exposure time at constant intensity; there was a negative correlation between intensity and exposure time (group 1). When the output power was adjusted as a function of the path length, the lesion size was nearly constant (group 2). In VX2 rabbits, tumor destruction rates were significantly higher in rabbits treated at 500 W cm -~ than in rabbits treated at 1365 W cm -2 (p < 0.05; group 3). As in the normal liver, the lesion volume increased with the exposure time at constant intensity. HIFU lesions treated at 1000 W cm -2 (SPTP) healed as thin fibrous scars, and no severe complication occurred (group 4); at 3000 W cm -2 (SPTP), scars were larger and perforation of a neighboring organ was seen in 7 of 11 rabbits (group 5).

Research paper thumbnail of Covered self-expandable metal stent with angled flare ends for drainage of infected walled-off pancreatic necrosis

Research paper thumbnail of Single operator endoscopic ultrasound-assisted rendezvous for the treatment of pancreaticocutaneous fistula

Research paper thumbnail of Extracorporeal Ablation of Liver Tissue by High-Intensity Focused Ultrasound

Oncology, 1993

High-intensity focused ultrasound (HIFU) may produce a well-delineated lesion of coagulation necr... more High-intensity focused ultrasound (HIFU) may produce a well-delineated lesion of coagulation necrosis in deep organs, by means of an extracorporeal transducer. Applications of this method to the liver in animal models have been studied for many years. The effects of HIFU on the normal liver parenchyma and on hepatic tumors are reviewed. In the normal rabbit liver in vivo we showed the relation between intensity levels and exposure times and the need to adapt intensity to the depth of the target. No severe complications were observed when an intensity of 1,000 W/cm2 was used. HIFU is a noninvasive method for the local destruction of liver tumors. In experimental models, safety and efficacy were demonstrated. HIFU may be interesting for the treatment of some human liver tumors.

Research paper thumbnail of Extracorporeal high-intensity focused ultrasound for VX2 liver tumors in the rabbit*1

Hepatology, 1995

High-Intensity Focused Ultrasound (HIFU) can produce radical tissue necrosis. We wanted to assess... more High-Intensity Focused Ultrasound (HIFU) can produce radical tissue necrosis. We wanted to assess tumor destruction, proliferation, and tumorigenesis after HIFU, in an animal model of hepatic tumor. New Zealand rabbits bearing VX-2 solitary liver tumors were treated with extracorporeal HIFU under ultrasound (US) guidance and standardized conditions. Groups differed only for the administration of either one or two consecutive HIFU procedures. Tissue destruction was assessed by stereomicroscopy and planimetry, cell proliferation was estimated by in vivo intra-arterial injection of 1200 muCi [3H]thymidine, and tumorigenesis was tested by reimplantation of treated or untreated pieces of liver tumors into the thighs of nontumor-bearing animals. Mortality was 0. Tumor destruction rates were 76.3% +/- 16% after one procedure and 94.2% +/- 7.3% after two procedures. Nuclear staining was heavy in control tumors and was absent in treated tumors. Untreated hepatic tumors induced measurable tumors at 3 weeks in thighs of all recipients, 7.8 +/- 2.4 cm3 in volume. Hepatic tumors treated with one HIFU procedure induced tumors in the thigh of recipients in 31.3% of cases (0.47 +/- 0.06 cm3), and those treated with two HIFU procedures induced tumors in 0% even after 8 weeks of follow-up. In conclusion, HIFU allows a noninvasive approach to the destruction of liver tumors in this model, with little toxicity but significant effects on proliferation and tumorigenesis. The repetition of HIFU procedures may improve results.

Research paper thumbnail of Mo1418 Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 25-Gauge Procore™ Histology Needle Versus a 22-Gauge Standard Cytology Needle in the Differential Diagnosis of Solid Lesions and Lymphadenopathies

Gastrointestinal Endoscopy, 2014

Research paper thumbnail of Should biopsies be taken from ectopic gastric mucosa in the upper esophagus?

Gastrointestinal Endoscopy, 1997

Research paper thumbnail of An easier method for percutaneous endoscopic gastrojejunostomy tube placement

Gastrointestinal Endoscopy, 1998

The current procedures for percutaneous endoscopic gastrojejunostomy (PEG-J) tube placement requi... more The current procedures for percutaneous endoscopic gastrojejunostomy (PEG-J) tube placement require fluoroscopy and are time consuming. We describe a new, simple method. Ten patients had a PEG-J tube placed by the new method. After placement of a percutaneous endoscopic gastrostomy (PEG) tube using standard technique, the PEG tube was pushed up to the pylorus to make it easier to place the jejunal tube into the duodenum without looping in the stomach. Fluoroscopy was not used. The position of the tube was confirmed by a plain x-ray film of the abdomen. The mean time required for PEG placement and jejunal tube placement was 9.0 and 8.2 minutes, respectively. In all patients the tip of the jejunal tube was at the ligament of Treitz. In one patient the jejunal tube formed a loop in the duodenum, but this was reduced by spontaneous forward migration. In another patient, the tube migrated back into the stomach after 1 week. The method described allows easier PEG-J placement without fluoroscopy.

Research paper thumbnail of Video demonstration of the introducer-type percutaneous gastrostomy system

Gastrointestinal Endoscopy, 2014

In patients with head and neck cancer, the original pullthrough PEG has an increased risk of impl... more In patients with head and neck cancer, the original pullthrough PEG has an increased risk of implantation at the PEG site. This limitation led to the development of the PEXACT (Fresenius, Kabi, Germany) gastrostomy system. The stomach is filled with air, and the site of puncture is located by means of light transillumination and finger indentation. Local anesthesia is administered. A gastropexy of the anterior gastric wall to the ventral abdominal wall is performed with the help of the introducer needle, which is inserted in the lumen of the stomach. The loop is opened, and the suture is passed inside it ( , available online at www.giejournal.org). The suture is then retrieved, and the first suture is applied. The procedure is repeated for the second gastropexy suture. A small incision is made between these 2 sutures, and a trocar with a peel-away sheet is introduced into the stomach. The trocar is removed, a 5F PEG tube is progressed through the sheet, and the balloon is inflated with 5 mL of sterile water. The peel-away sheath and the sutures are removed, and the retaining plate is placed. Administration of water via the gastrostomy tube is permitted after 12 hours, and enteral feeding is started after 24 hours.

Research paper thumbnail of Biliary stent migration presenting as a recurrent pilonidal abscess with underlying rectocutaneous fistula

Research paper thumbnail of Endoscopic Nd:YAG treatment of superficial gastric carcinoma: Experience in 18 western inoperable patients

Gastrointestinal Endoscopy, 1995