Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died. conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.
<b>Introduction.</b> Colonoscopy is now widely accepted as a gold standard for detection of pre-malignant lesions, mainly adenomatous polyps. Their removal reduces the risk for colorectal cancer in patients with adenomatous polyps. <b>Aim.</b> This study aimed at evaluating the efficiency and safety of colonoscopic polypectomies which were performed between 2001 and 2007. <b>Materials and methods.</b> A retrospective analysis of the course and results of polypectomies which were performed during 2970 colonoscopies on patients admitted to hospital with symptoms of colorectal pathology. <b>Results and discussion.</b> Total colonoscopy, i.e. with caecal intubation, was performed in 2602 (91%) cases. Colonoscopic polypectomies were performed during 628 (21.5%) examinations. Single polyps were found in 346 (55.1%) cases and multiple polyps in 282 (44.9%). The total number of removed polyps amounted to 901. Out of that number 690 (76.5%) were adenomas and 173 (23.5%) presented features of the so-called advanced pathology. In 26 (2.8%) cases, the detected adenomas coexisted with colorectal cancer and were removed preoperatively. Post-polypectomy bleeding occurred in 15 (2.3%) cases but only 2 patients required surgical treatment because of the inability to stop the bleeding by an endoscopic procedure. Moreover, out of 268 rectal polyps, 19 (7%) unpedunculated polyps were removed surgically (18 of them by trans-anal excision). <b>Conclusions.</b> The effectiveness of this method was high. Polyps were detected and removed in the course of more than 20% of colonoscopic examinations. Polypectomies were relatively complications-free, although in 2 (0.28%) cases surgical treatment was necessary to stop post-polypectomy bleeding due to the inability to stop the bleeding from the polyp stalk endoscopically. Some rectal polyps (7%) had to be removed surgically. Preoperative endoscopic clearance of large bowel polyps, coexisting with neoplastic tumours, facilitated the adjustment of the resection margin in the subsequent colorectal cancer surgery.
Colonoscopy is currently accepted as the golden standard in the detection of pre-malignant lesions, and reduction of the incidence of colorectal cancer in patients with adenomatous polyps. the aim of the study was to determine the diagnostic value of colonoscopy in case of patients with clinical symptoms suggesting the possibility of colorectal pathology, as well as evaluate the technical aspects and results of colonoscopic polypectomies, considering the efficacy and safety of the abovementioned procedures. Material and methods. Retrospective analysis of the course and results of the polypectomies performed during 3638 colonoscopies was undertaken, considering patients with suspicion of colorectal pathology. Results. Complete colonoscopy with cecal intubation was performed in 3310 (91%) cases. Colonoscopic polypectomies were performed during 806 (22.1%) examinations. Single polyps were detected in 459 (56.9%) cases, while multiple lesions in 347 (43.1%) cases. The total number of removed polyps amounted to 1184. There were 882 (74.6%) adenomas of which 225 (25.5%) were considered as an advanced pathology. Moreover, the pathologist detected 4 malignant polyps with features of adenocarcarcinoma. In case of 30 examinations, adenomas coexisted with colorectal cancer and were removed preoperatively. Post-polypectomy bleeding was observed after 15 (1.7%) polypectomies, although only two patients required surgery. Moreover, amongst the 343 rectal polyps, 19 (6%) non-pedunculated lesions were surgically removed (18 of them by means of the trans-anal approach). conclusions. The method proved effective and the polyps were detected and removed in more than 22% of the colonoscopic examinations. In two (0.28%) cases surgical intervention was required, in order to stop post-polypectomy bleeding from the polyp's peduncle. Some of the rectal polyps (6%) had to be surgically removed. Preoperative endoscopic "clearance" of large bowel polyps, facilitated the adjustment of the resection margin in subsequent colorectal cancer surgery.
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