Effectiveness of a ligating device for endoscopic surgery

A new detachable snare for hemostasis in the removal of large polyps or other elevated lesion was developed by the author (Olympus Ligating Device). It allows ligation to be performed through the channel of an endoscope using a nonconductive loop that can be detached from the ligator. At Sakura National Hospital, endoscopic ligation with this device was performed in 80 patients from May 1989 to January 1994. The purpose of the procedure was preventive hemostasis prior to the endoscopic resection of large elevated lesions in 71 patients and for control of hemorrhage in 9 patients. The elevated lesions were polyps in 69 patients and submucosal tumor in 2, being pedunculated in 36 and semipedunculated in 35. The maximum diameter of these lesions ranged from 15 to 40 mm (mean: 23 mm), being greater than 20 mm in 57 cases. The 9 patients undergoing endoscopic ligation for hemorrhage had bleeding polypectomy stumps (n = 5), bleeding polyps (n = 3), and a bleeding esophageal varix (n = 1). Endoscopic ligation achieved the complete prevention of hemorrhage following the resection of elevated lesion in 63/71 patients (88.7%) and, in combination with a HX-3L clip, allowed endoscopic resection to be performed in 70/71 patients (98.6%). In the 9 patients with bleeding lesions, complete hemostasis was achieved without complications.     

Endoscopic resection of laterally spreading tumours of the large intestine using a distal attachment.

BACKGROUND AND STUDY AIMS: Among colorectal neoplasms, laterally spreading tumors (LSTs) are lesions over 10 mm in diameter that are low in height and grow superficially. As most LSTs are adenomas or mucosal carcinomas, endoscopic resection is desirable, but this has been not easy because of their flat and wide shape. The aim of this study was to explore the usefulness of a distal attachment to the endoscope in the endoscopic resection of LSTs. PATIENTS AND METHODS: The study population consisted of 23 patients with an LST of the large intestine. Using a distal attachment fitted to the distal end of the endoscope, saline solution with a low concentration of epinephrine was injected underneath the lesion. The lesion was snared and drawn into the cap using the suction function of the endoscope, and then ligated and resected using electrocautery. RESULTS: The size of the lesions ranged from 1 cm to 5cm. Endoscopic resection was completed in 22 of 23 patients. Resection in one segment was successful in 15 of 22 patients; in the remaining seven patients, piece-meal resection was done. Pathological investigation showed hyperplasia in one patient, adenoma in 20 (with mild atypia 1, moderate atypia 11, severe atypia 8), and mucosal carcinoma in one patient. Complications occurred in two patients, with one instance of perforation and another of bleeding. Both were successfully treated with endoscopic clipping. Recurrent adenoma was detected in one patient. CONCLUSION: We conclude that the distal attachment was very useful for endoscopically resecting LSTs of the large intestine.     

大肠息肉内镜下治疗术后并发症分析

目的：探讨内镜下治疗大肠息肉并发症的预防措施。方法：2005-01-2011-01住院内镜下治疗大肠息肉患者741例,分别采用单纯高频电切除术和高频电切除息肉前行预处理两种方法对大肠息肉进行治疗观察其并发症的发生情况。结果：行预处理的大肠息肉术后并发症的发生率较未处理的明显降低。结论：对于大息肉及巨大息肉,内镜下切除前应采取干预措施以预防出血、穿孔等并发症的发生,值得临床推广。     

Efficacy of a distal attachment in endoscopic resection of colorectal polyps situated behind semilunar folds

BACKGROUND AND STUDY AIMS: It is difficult, dangerous, and time consuming to resect colorectal polyps situated behind the semilunar folds. The aim of this study was to examine the efficacy of a distal attachment in the endoscopic resection of these polyps. PATIENTS AND METHODS: The study group consisted of 11 patients, each with a colorectal polyp situated behind a semilunar fold, and of which the base was invisible without the use of a distal attachment. With the attachment fitted to the distal end of the endoscope, we pressed the semilunar fold situated at the anal side of the polyp so that the polyp, including its base, could be brought within the visual field. Maintaing the optimal position, we snared, ligated, and resected all polyps by electrocautery. RESULTS: The polyps were of sessile type in eight patients and pendunculated type in three, with a diameter ranging from 7 to 18 mm (mean 11 mm). Although the base of the polyp was invisible under conventional observation, pressing the fold brought good visualization. The optimal position for snaring the polyp was secured by fine endoscopic adjustment, and the polyps were easily resected in all patients. CONCLUSION: We conclude that the distal attachment is a simple but very valuable tool in the endoscopic resection of colorectal polyps situated behind the semilunar folds, and recommend its routine use in both diagnostic and therapeutic colonoscopy.     

内镜下高频电切术、氩离子束凝固术及黏膜切除术治疗结肠息肉的有效性和安全性

目的 探讨和分析内镜下高频电切术、氩离子束凝固术（APC）及黏膜切除术在结肠息肉治疗中的应用价值。方法 选取2017年6月－2018年6月该院行内镜下手术治疗的310例（息肉442枚）结肠息肉患者作为研究对象,根据患者病情分为内镜下高频电切术组150例（息肉203枚）、内镜下APC组40例（息肉66枚）和内镜下黏膜切除术（EMR）组120例（息肉173枚）,并分别对3组患者的临床治疗情况、生活质量改善情况和并发症发生情况进行比较和分析。结果 内镜下APC组总有效率95.00%和EMR组总有效率96.67%均较内镜下高频电切术组明显提高,而无效率5.00%和3.33%均明显降低,两两比较,差异有统计学意义（P < 0.05）。内镜下APC组和EMR组主观症状、生理功能、心理情绪、社会活动和消化病生存质量指数（GLQI）总分均较内镜下高频电切术组明显提高,两两比较,差异有统计学意义（P < 0.05）。EMR组患者出血和穿孔等并发症总发生率（0.83%）较内镜下高频电切术组明显降低,两组比较,差异有统计学意义（P < 0.05）。EMR组患者出血和穿孔等并发症总发生率较内镜下APC组略有降低,两组比较,差异无统计学意义（P > 0.05）。结论 内镜下APC和EMR在结肠息肉患者临床疗效、生存质量和安全性方面均优于内镜下高频电切术。     

内镜黏膜下剥离术治疗广基结直肠息肉的护理配合

目的探讨内镜黏膜下剥离术(ESD)治疗广基结直肠息肉的护理方法。方法对17例广基结直肠息肉患者行ESD治疗,护理方法包括进行充分的术前准备,术中配合及术后病情观察。结果所有患者均一次性剥离病灶,其中术后延迟出血1例,予内镜下成功止血,术中穿孔1例,行内镜下钛夹夹闭治疗,术后恢复良好。结论精心的围术期护理配合,有助于手术的顺利进行,可降低患者的并发症发生率,加速疾病的康复。     

内镜下大肠巨大息肉切除术的配合和护理

[目的]总结内镜下高频电切除大肠巨大息肉术的配合和护理.[方法]回顾性分析25例内镜下高频电切除大肠巨大息肉术病人的临床资料.[结果]本组病人术程顺利,术中、术后均未发生穿孔、出血等并发症.[结论]加强内镜下大肠巨大息肉切除术的配合和护理可减少并发症的发生,保证手术的成功.     

内镜下治疗246例大肠有蒂大息肉的临床分析

目的 探讨如何选择大肠有蒂大息肉圈套电切除方式.方法 回顾性分析2016年1月-2020年1月246例(259枚息肉)在厦门市中医院行大肠有蒂大息肉(直径≥1.0 cm)圈套电切除治疗患者的内镜和病理资料,统计内镜下黏膜切除术(EMR)组、钛夹组和尼龙绳组内镜下治疗操作成功率、息肉整块切除率、完整切除率、治愈性切除率和...     

内镜黏膜下剥离术治疗巨大结直肠侧向发育型肿瘤的临床研究

目的评价内镜黏膜下剥离术(ESD)治疗巨大结直肠侧向发育型肿瘤(LST)中的疗效和安全性。方法对150例病灶直径4 cm的结直肠LST的临床资料进行回顾性总结,分析LST形态分型、部位、病理结果、整块切除率、完全切除率和并发症。结果 150例患者中,颗粒型87例(58.0%),非颗粒型63例(42.0%)。部位分别为直肠109例(72.7%),乙状结肠13例(8.7%),降结肠5例(3.3%),横结肠8例(5.3%),升结肠13例(8.7%),盲肠2例(1.3%)。低级别上皮内瘤变23例,高级别上皮内瘤变104例,黏膜内癌7例,黏膜下癌16例。整块切除率为92.7%(139/150),完全切除率89.3%(134/150)。术中出血8.0%(12/150),术后出血1.3%(2/150),穿孔率为2.0%(3/150),术后狭窄2.0%(3/150)。结论非颗粒型巨大结直肠LST恶变率大。ESD治疗巨大结直肠LST是安全有效的。     

Piecemeal endoscopic aspiration mucosectomy for large superficial intramucosal tumors of the stomach

BACKGROUND AND STUDY AIMS: As endoscopic techniques continue to develop, endoscopic mucosal resection is increasingly being used in the treatment of intramucosal gastric tumors. The aim of this study was to explore the feasibility of piecemeal endoscopic aspiration mucosectomy for large superficial intramucosal tumors of the stomach. PATIENTS AND METHODS: The study group consisted of five consecutive patients with large superficial intramucosal tumors of the stomach, 4 cm or more in diameter. Piecemeal endoscopic aspiration mucosectomy using a cap-fitted panendoscope was carried out. The initial resection was undertaken at the oral side of the lesion. Subsequent resections were carried out along the anal margin of the previous resection site, until the marks around the boundary of the tumor completely disappeared. RESULTS: The shape of the tumors was slightly elevated in four cases and slightly depressed in one. The mean diameter of the tumors was 4.8 cm. The diameters of the resected specimens ranged from approximately 1.0 cm to 2.3 cm. The numbers of piecemeal resection procedures needed per lesion ranged from five to 18 (mean 11). The visual field was well ensured by the cap, and the tumors were macroscopically completely resected without any complications in all patients. The final histological diagnoses in the specimens were adenoma in one case and mucosal carcinoma in adenoma in four. One patient had residual or recurrent tumor, and received full treatment with additional endoscopic procedures. CONCLUSIONS: Piecemeal endoscopic aspiration mucosectomy is a simple and very useful technique for treating large superficial intramucosal tumors of the stomach.     

内镜食道静脉瘤套扎器治疗直肠神经内分泌肿瘤的疗效分析

目的评估超声内镜结合内镜食道静脉瘤套扎器行内镜下圈套器法黏膜切除术(EMR-L)治疗直肠神经内分泌肿瘤(NENs)的临床有效性、安全性以及技术的可行性。方法回顾性分析北京世纪坛医院消化内科2015年11月-2017年11月收治的13例直肠NENs患者临床资料,治疗前均行超声内镜检查,后进行EMR-L切除病变。观察患者内镜表现、EMR-L操作过程及其并发症、病理结果,术后定期结肠镜随访。结果 13例患者顺利完成EMR-L切除病变,耗时10 min 36 s~52 min 21 s,平均(21.9±10.6)min。1例患者发生急性出血,予药物喷洒及钛夹封闭创面治疗后出血停止。无急性或迟发性直肠出血、穿孔等并发症。结论应用内镜食道静脉瘤套扎器行EMR-L可有效、安全的切除小于1.0 cm的直肠NENs,同时治疗费用较食管静脉曲张连环套扎器少,有很好的临床应用价值。     

Early-stage small-bowel adenocarcinoma: a review of local endoscopic therapy

Early adenocarcinomas in the small intestine are a rare entity. Most adenocarcinomas in the small intestine are diagnosed at a more advanced stage. After surgical resection, only 3 - 10 % are found in stage T1 and 0 - 3 % in stage Tis (high-grade intraepithelial neoplasia), resulting in an overall 3 - 13 % rate of early-stage small-intestinal adenocarcinomas. The diagnosis of early small-intestinal carcinoma by endoscopy is still very rare, although it will probably improve with the development of new endoscopic techniques. At present there have been only two studies and a few case reports on the treatment of early duodenal carcinoma by endoscopic resection. No major complications such as massive bleeding or perforation occurred in the studies and case reports, which show that endoscopic resection is a safe and effective treatment for early duodenal cancers that have not invaded the submucosa. Endoscopic resection can be carried out with reduced costs and lower morbidity and mortality rates in comparison with surgery.     

内镜黏膜冷切除术和热切除术在结直肠6~10 mm无蒂息肉治疗中的疗效对比

目的：探讨黏膜下注射后内镜黏膜冷切除术和黏膜热切除术在治疗结直肠直径6~10 mm无蒂息肉中的疗效。方法：选取2016年1月至2017年6月江阴市中医院收治的因结直肠无蒂息肉（6~10 mm）拟行内镜切除的110例患者，共131枚息肉，随机分为冷切除组和热切除组。所有患者均于术中采用靛胭脂、生理盐水混合液进行黏膜下注射。分析2组患者病变完整切除率、手术时间、手术相关并发症发生率（包括术中出血或穿孔及术后1个月内迟发性出血或穿孔）及术后半年内息肉残留或复发率。结果：冷切除组55例患者，共62枚息肉，热切除组55例，共69枚息肉。2组息肉大小、位置、内镜形态和病理类型差异无统计学意义。冷切除组平均手术时间较热切除组明显缩短[（2.2±1.1）min vs（3.6±1.4）min，P<0.001]。冷切除组息肉完整切除率为95.2%，热切除组息肉完整切除率为91.3%，差异无统计学意义（P=0.599）。冷切除组术中出血1例，术后出血1例；热切除组术中出血2例，术中穿孔1例，术后出血1例，2组并发症差别无统计学意义（P=0.675）。术后半年复查肠镜，无息肉残留或复发。结论：黏膜下注射后内镜黏膜冷切除术是传统冷切除术的有效改良，可作为结直肠6~10 mm无蒂息肉的有效切除方式。     

Endoscopic resection of large colonic lipomas assisted by a prototype single-use Endoloop device

Colonic lipomas are benign adipose tumors that occasionally cause symptoms. Endoscopic resection of large lipomas may be associated with the risk of hemorrhage or perforation. Experience with endoscopic resection of colonic lipomas with the assistance of a prototype single-use ligating Endoloop device, with a detachable snare unit, has not been previously reported. Three patients with a total of four large symptomatic colonic lipomas successfully underwent endoscopic resection with the aid of this device. One patient had self-limiting minor rectal bleeding which settled without consequence. All patients were well on follow-up, with resolution of their symptoms. This novel endoscopic technique should be considered during resection of large lipomas (> 10 mm diameter) to reduce the potential risk of bleeding.     

Pneumothorax following endoscopic submucosal dissection of a rectal tumor

Endoscopic submucosal dissection is a useful alternative to endoscopic mucosal resection and surgery for en bloc resection of colorectal tumors. However, the technique is considered to be difficult, and potential complications include perforation and postoperative bleeding. In this case report, we present a case of a 63-year-old woman who developed pneumothorax after endoscopic submucosal dissection of a rectal tumor.     

Grasping-forceps-assisted endoscopic submucosal dissection using a novel irrigation cap-knife for large superficial early gastric cancer

The technique of endoscopic submucosal dissection (ESD) needs special skills and involves a long procedure. We therefore developed a new type of dissection knife, the irrigation cap-knife (the Kume cap-knife attachment, which uses a fixed snare), that facilitates ESD by just sliding over the muscle layer with a coagulating current. The ESD procedure using the irrigation cap-knife was performed in seven patients with intramucosal gastric cancer. The tumor was separated from the surrounding normal mucosa using the insulated-tip knife. Submucosal dissection was then performed by pushing our device along the muscle layer while applying a coagulating current, at the same time as a grasping forceps, deployed through the accessory channel, was used to push the lesion away from the muscle layer. The rate of en bloc resection was 100% (7/7). The irrigating cap-knife was extremely useful for ESD of large intramucosal cancers in the stomach.     

结直肠息肉经内镜摘除术后并发出血的危险因素分析

目的分析结直肠息肉经内镜摘除术后并发出血的危险因素。方法以该院收治的342例行内镜摘除术治疗的结直肠息肉患者为研究对象,统计该组患者经内镜摘除术后并发出血的发生率。并将该组患者分为并发出血组和未并发出血组,以术后并发出血为因变量,以可能诱发患者术后出血的相关因素(性别、年龄、合并糖尿病、合并高血压、高血脂史、饮酒史、息肉发生位置、息肉病理分型、息肉大小、息肉形态和息肉数量)为自变量,先进行单因素回归分析,再运用Logistic回归分析工具进行多因素分析。结果该组342例患者术后并发出血的发生率为7.60%(26/342)。单因素分析结果显示,并发出血组患者合并高血压者比例高于未并发者(P0.05),合并高血脂史者比例高于未并发者(P0.05),息肉直径2.0 cm者比例高于未并发者(P0.05),息肉形态有蒂息肉者比例高于未并发者(P0.05)。多因素分析结果显示,高血压、合并高血脂、息肉直径2.0 cm、息肉形态有蒂息肉均为结直肠息肉经内镜摘除术后并发出血的危险因素(P0.05)。结论结直肠息肉经内镜摘除术后并发出血的危险因素包括高血压、合并高血脂、息肉直径2.0 cm、息肉形态为有蒂息肉。     

内镜下治疗结肠息肉168例的疗效观察

目的对内镜下切除的168例结肠息肉病例进行分析,以寻求肠息肉的恰当治疗方法。方法对168例结肠息肉病例采用不同的方法进行内镜下息肉切除术。结果本组168例共计278枚息肉经治疗后均获成功,成功率达100%。直径〈1.0 cm息肉及所有长蒂息肉术中无严重出血、穿孔、烧灼伤等并发症。结论内镜下结肠息肉切除术具有简单、安全、创伤小、痛苦少、恢复快等优点,效果满意。     

内镜止血夹治疗急性上消化道大出血的临床研究

目的：检验内镜止血夹对急性上消化道大出血的止血疗效，并初步探讨其影响疗效的相关因素，方法：采用Olympus SHX-5LR-1止血夹置放器和MD850内镜止血夹，止血夹以直角夹闭出血病灶，结果：18例急性上消化道大出血均获得即时止血，无1例发生再出血和并发症，结论：内镜止血夹为急性上消化道大出血提供了一种损伤小，止血成功率和安全性高的治疗方法。     

内镜黏膜下剥离术围手术期护理

目的：探讨内镜黏膜下剥离术围手术期护理措施。方法：总结术前护理、术中护理、术后护理、健康宣教等护理方法。结果：56例患者均达到完全切除,切缘及基底无残留。1例发生术中食管穿孔,予钛夹封闭,2例发生术后迟发出血,急诊内镜止血成功,其余53例无并发症发生,所有患者通过护理人员精心护理与观察康复出院。结论：内镜黏膜下剥离术围手术期护理对该手术的成功起到了非常重要的作用,值得临床护士重视。