BACKGROUND/AIMS: Early enteral nutrition (EEN) has benefits in reducing infectious complication, length of stay (LOS) and preserving liver function. There are few data about the effect of EEN in the patients who had total gastrectomy. The aim of this randomized and prospective study was to evaluate the effect of EEN after total gastrectomy on nutritional status, liver function, complications and LOS, compared to total parenteral nutrition (TPN) in patients with gastric cancer. METHODS: Among 56 patients with gastric cancer, 36 and 20 were randomly assigned to EEN and TPN groups, and finally 17 and 16 completed EEN and TPN schedules, respectively. The nutritional parameters, liver function, LOS and abdominal symptoms were compared between 2 groups on pre-operative day and post-operative 7th day. RESULTS: There was no significant difference in the nutritional parameters, liver function between EEN and TPN groups. Vomiting and abdominal distention were more frequent in EEN than TPN group (2 vs. 0 cases, p=0.485; 1 vs. 0 case, p=1.000, respectively), while increased AST, ALT and total bilirubin were more common in TPN than EEN group (4 vs. 2 cases, p=0.398; 1 vs. 0 case, p=0.485, respectively without statistical significance). LOS was shorter in EEN than TPN group without statistical significance (12 vs. 13 days, p=0.289). CONCLUSIONS: No significant differences were found in the nutritional status parameters, liver function, complications and LOS between EEN and TPN groups on 7th day after total gastrectomy. Further large scale studies on the advantages and disadvantages of EEN after total gastrectomy are warranted.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; *Enteral Nutrition ; Female ; Gastrectomy ; Humans ; Length of Stay ; Male ; Middle Aged ; *Parenteral Nutrition, Total ; Postoperative Care ; Prospective Studies ; Stomach Neoplasms/*surgery

The orifice of duodenal papilla is only about 1 mm in diameter. As much as 2,000 ml of bile and pancreatic juice pass through its sphincter zone into the duodenum each day. Since the sphincter of Oddi regulates the flow of bile and pancreatic juice, a disorder of the sphincter can disturb the smooth outflow of bile and pancreatic juice and produce secondary abnormalities in the biliary tract or the exocrine pancreas. (continue...)
Bile ; Biliary Tract ; Duodenum ; Humans ; Manometry* ; Pancreas, Exocrine ; Pancreatic Ducts* ; Pancreatic Juice ; Pancreatitis, Chronic* ; Sphincter of Oddi

The orifice of duodenal papilla is only about 1 mm in diameter. As much as 2,000 ml of bile and pancreatic juice pass through its sphincter zone into the duodenum each day. Since the sphincter of Oddi regulates the flow of bile and pancreatic juice, a disorder of the sphincter can disturb the smooth outflow of bile and pancreatic juice and produce secondary abnormalities in the biliary tract or the exocrine pancreas. (continue...)
Bile ; Biliary Tract ; Duodenum ; Humans ; Manometry* ; Pancreas, Exocrine ; Pancreatic Ducts* ; Pancreatic Juice ; Pancreatitis, Chronic* ; Sphincter of Oddi

A 56-year-old man who had suffered from intermittent right upper quadrant abdominal pain for 6 months and jaundice for 2 months was admitted for evaluation. Endoscopic retrograde cholangio-pancreatography showed filling defect which suggested tumor. Peroral choledo-choscopy was performed which showed polypoid tumor of the common hepatic duct and biopsy reported as papiilary adenocarcinoma. So segmental resection of the bile duct including removal of tumor with Roux-en Y hepaticojejunostomy was performed successfully.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Bile Ducts ; Biopsy ; Hepatic Duct, Common* ; Humans ; Jaundice ; Middle Aged

A 56-year-old man who had suffered from intermittent right upper quadrant abdominal pain for 6 months and jaundice for 2 months was admitted for evaluation. Endoscopic retrograde cholangio-pancreatography showed filling defect which suggested tumor. Peroral choledo-choscopy was performed which showed polypoid tumor of the common hepatic duct and biopsy reported as papiilary adenocarcinoma. So segmental resection of the bile duct including removal of tumor with Roux-en Y hepaticojejunostomy was performed successfully.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Bile Ducts ; Biopsy ; Hepatic Duct, Common* ; Humans ; Jaundice ; Middle Aged

Herpetic esophagitis is a rare disease occuring mostly ie immunocompromised and cancer patient. It is also documented as self-limiting esopbagitis in young healthy adults. We report here a 30- year-old immunocompetent male patient with esophageal ulceration. Heryetic esophagitis was diagnosed by characteristic endoscopic and microscopic findings. And the diagnosis was confirmed by electron microscopic appearance. This immunocompetent patient recovered spontaneously with symptomatic treatment only. And repeat endoscopy and histology confirmed absence of herpes infection.
Adult ; Diagnosis ; Endoscopy ; Esophagitis* ; Humans ; Male ; Rare Diseases ; Ulcer

For many years ERCP has been contraindicated in acute pancreatitis. The injection of contrast medium. which may cause hyperamylasemia and occasionally an attack of acute pancreatitis even in normal indivisuals, was allowed only two to three weeks after subsidence of symptoms. Gallstone disease is one of the most common etilogical factors in pancreatitis and migration or impaction of gallstone in the ampulla of Vater causes pancreatitis. (continue...)
Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde* ; Gallstones ; Hyperamylasemia ; Pancreatitis*

Recently, the capability cannulating the ampulla of Vater through the endoscope makes it possible introduce the recording ctheter deeply into the common bile and main pancreatic duct. Using these techniques, several authors have measured intraductal pressures in controls and in patients with various biliary and pancreatic diseases. Csendes et al. (continue...)
Ampulla of Vater ; Bile ; Endoscopes ; Humans ; Manometry* ; Pancreatic Diseases ; Pancreatic Ducts ; Sphincter of Oddi*

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most useful diagnostic tool in biliary and pancreatic disease. However, ERCP cannot be performed successfully in all patients. Cannulation failure is the most common cause of failure of ERCP. Mechanical pathologies, such as peri-Vater diverticulum, cancer of the papilla of Vater, and impacted stone were the common causes of cannulation failure. We experienced two cases of carcinoma of the papilla of Vater in whom cholangiography and insertion of the nasobiliary tube were performed througth an artificial choledoehoduodenal fistula made by a needle type diathermy knife, beacuse cannulation to the duct was failed due to the tumor.
Catheterization ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diathermy ; Diverticulum ; Fistula* ; Humans ; Needles ; Pancreatic Diseases ; Pathology

We report the case of a 44-year-old woman underwent cholecystectomy with two common bile duct stones (2.6 x 1,9 cm and 1.6 X 1.0 cm) which failed to be captured by endoscopic mechanical lithotriptor. However, those were successfully dia-integrated with extracorporeal shock wave lithotripsy (ESWL), permitting subsequent endosaopic extraction using the Dormia basket of the fragments without complication; In our experience, ESWL is considered to be a new and safe method to treat patients with common bile duct stone which cannot be removed by endoscopic mechanical lithotripsy.
Adult ; Cholecystectomy ; Common Bile Duct* ; Female ; Humans ; Lithotripsy* ; Shock*