Showing papers by "Todd H. Baron published in 2001"

Expandable Metal Stents for the Treatment of Cancerous Obstruction of the Gastrointestinal Tract

Abstract: Expandable metal stents have been approved by the Food and Drug Administration for the treatment of gastrointestinal obstruction due to cancer. Although they have not been approved for use in benign disease, there are specific clinical indications for which expandable metal stents may be beneficial. This article reviews the uses of expandable metal stents for gastrointestinal obstruction due to cancer. General Concepts Gastrointestinal stents are placed by gastroenterologists under endoscopic guidance with the aid of fluoroscopy or by interventional radiologists using fluoroscopic guidance alone. Expandable metal stents are made of metal alloys and have varying shapes and sizes, depending on . . .

Improved Diagnostic Yield of Endoscopic Biliary Brush Cytology by Digital Image Analysis

Abstract: Objective To evaluate the accuracy of digital image analysis (DIA) for distinguishing between benign and malignant strictures of the biliary tract. Patients and Methods Our pathology databank was used to identify all biliary brush cytology specimens obtained during endoscopic retrograde cholangiopancreatography between June 1997 and June 1999. Corresponding medical records were reviewed to determine whether patients had benign or malignant strictures. Strictures were further classified into benign strictures with negative routine cytology, malignant strictures with negative routine cytology, and malignant strictures with positive routine cytology. Papanicolaou-stained smears of available brush cytology specimens were destained and then restained with Feulgen dye. Nuclear images were quantified for DNA content without knowledge of stricture type. DNA histograms were generated and ploidy results compared with the class of stricture. Results We analyzed 27 specimens from 69 confirmed benign or malignant strictures. Assuming that the presence of any aneuploid cells indicated malignancy, the sensitivity of DIA was 85%. Furthermore, aneuploid cells were detected by DIA in 13 of 16 specimens in which routine cytology was unrevealing. Conclusions Ploidy assessment by DIA has potential to enhance the sensitivity of diagnosing malignant strictures compared with routine cytology alone.

Endoscopic Palliation of Malignant Dysphagia

Abstract: Esophageal cancer is the primary cause of malignant dysphagia, a major cause of morbidity and mortality. In patients with esophageal cancer that is unresectable at the time of diagnosis, palliation is the major goal. Surgical treatment as well as radiation and chemoradiation therapy are traditional approaches for such patients. Endoscopic therapy is useful for patients with poor performance status, those in whom other treatments have failed, and those with tracheoesophageal fistulas. In recent years, self-expanding metal stents have become an important new endoscopic treatment modality for palliation of malignant dysphagia in a wide range of patients. Appropriate patient selection is paramount when a mode of palliation for malignant dysphagia is being selected. Although various treatment options exist for palliation of malignant dysphagia, comparative studies among these modalities are needed.