内镜下"开窗术"治疗胃肠道脂肪瘤七例

我们收治的7例胃肠道脂肪瘤中男5例，女2例，年龄为48～65岁，平均年龄56．8岁。所有病人至少具有上腹痛、腹胀、便秘、腹泻中的一种症状而就诊。内镜检查显示：所有7例病变均为黏膜丘状隆起，黏膜表面光滑，呈淡黄色。肿块质地柔软，用活检钳探触可见随即出现的局部凹陷。超声内镜检查示：肿块都是高回音团块，质地均匀、边界清楚，位于黏膜下层，没有延续至固有肌层。诊断为胃肠道黏膜下良性病变，提示黏膜下脂肪瘤。其中胃1例，结肠6例。瘤体直径最大为2．0cm，最小为0．5cm，一般为0．5～1．0cm。根据胃镜和超声内镜检查诊断为：胃肠道平坦型脂肪瘤。     

消化道脂肪瘤的内镜下治疗

消化道脂肪瘤是一种良性的，缓慢生长的非上皮性肿瘤，通常呈单发生。近年来，很多报道认为内镜下治疗胃肠道脂肪瘤是一种有效的外科手术替代疗法，然而对此仍存在争议，因为切除直径达到2cm或更大的脂肪瘤出现穿孔和出血的风险很大。从1972-1992年，我院成功地内镜下切除黏膜下肿瘤超过100例。在此基础上从1993年6月     

内镜黏膜下剥离术治疗有症状的结肠巨大脂肪瘤

探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗有临床症状的结肠巨大脂肪瘤（≥5 cm）的疗效和安全性。2018年12月—2021年12月,上海市东方医院消化内镜科收治巨大结肠脂肪瘤患者8例,患者均成功行ESD完整切除,完整切除率100%,切除病变长径5.5~9.0 cm,平均6.0 cm。ESD操作耗时25~80 min,平均41 min。术中极少量出血均通过热活检钳电凝止血成功,2例术中发生小穿孔,均成功缝合。患者术后无腹痛、发热,亦无迟发性出血或迟发性穿孔;住院时间3~5 d,平均3 d;随访8~36个月,无一例病灶残留或复发。可见,ESD治疗结肠巨大脂肪瘤安全有效,可避免行外科手术切除。     

双腔内镜下尼龙绳结扎治疗回肠末端巨大脂肪瘤1例

正胃肠道脂肪瘤是一种较少见的良性非上皮性肿瘤,常无临床症状,通常在内镜检查或外科手术中意外发现。近来随着胃肠镜检查的普及,脂肪瘤的发现率明显提高。一般无症状瘤体小的脂肪瘤不需要特殊治疗,而对于有症状瘤体直径≥2 cm者应作治疗[1-2]。我科曾收治1例回肠末端巨大脂肪瘤患者,综合评估后行双腔内镜下尼龙绳结扎治疗,取得良好的临床效果,报告如下。1 病例介绍患者男,51岁,2016-12-01因里急后重感半年余,来我院查肠镜示末端回肠     

老年胃肠道癌内镜治疗

老年人胃肠癌,不管是早期还是进展期,都是有相当一部分患者不适合或不愿意作外科手术治疗。对于这一部分患者来说,近20多年发展起来的消化系内镜诊疗技术,给他们带来了福音。通过内镜对胃肠癌进行药物注射、高频电圈套摘除、冷冻治疗、激光照射及微波凝固治疗等,早期癌可以得到根治,进展癌可以达到部分根治或部分缓解症状、延长生命的目的。目     

胃肠道血管畸形的内镜下特点

胃肠道血管畸形是引起不明原因消化道出血的原因之一。我院１９７６年至１９９３年共行内镜检查５２０４７例，检出胃肠道血管畸形１２３例，内镜检出率为０．２４％。其中行胃镜检查３９２０７例，检出血管畸形４６例（０．１２％）；行全大肠镜检查３４９４例，检出血管畸形４９例（１．４０％），病变在大肠的分布为：盲肠１８％，升结肠１５％，横结肠１９％，降结肠１６％，乙状结肠２１％，直肠１１％；行乙状结肠镜检查９３４６例，检出血管畸形２８例（０．３０％）。在１２３例胃肠道血管畸形中引起消化道出血４６例（３７．４％）。根据内镜下形态可将其分为四型。内镜检查为本病的首选诊断方法。     

内镜黏膜下剥离术治疗胃肠道肿瘤的护理与配合

内镜黏膜下剥离术（ESD）是由内镜黏膜切除术（EMR）发展而来的一项治疗胃肠道肿瘤的微创切除新技术,可以实现病变的大块和完整切除。国内ESD的开展尚处起步阶段,现将我们进行ESD治疗的护理操作配合情况,报道如下。     

Clinical evaluation of submucosal colonic lipomas： Decision making

Even lipomas are the most common mesenchymal benign tumors of the gastrointestinal tract, symptomatic colonic presentation is rare. Herein, we evaluated four patients suffering from various size of colonic lipomas and approached by different therapeutic modalities.     

Frequently overlooked and rarely listened to： Music therapy in gastrointestinal endoscopic procedures

To elucidate the role of music therapy in gastrointestinal endoscopic procedures following the conflicting outcomes reported in two recent studies. The findings of our recent meta-analysis that examined this matter were discussed in the context of later studies. Our meta-analysis illustrated the beneficial effects of music therapy on patient anxiety levels when used as a single measure of relaxation and analgesia. Beneficial effects were also shown on analgesia and sedation requirements and procedure duration times when used as an adjunct to pharmacotherapy. These findings are in agreement with those of both studies excluded from analysis and those that followed it. Music therapy is an effective tool for stress relief and analgesia in patients undergoing gastrointestinal endoscopic procedures.     

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures： A three year prospective study

AIM: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.5-1.5 mg/kg). Arterial blood pressure (BP) was monitored at 3 min intervals and heart rate and oxygen saturation (SpO2) were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS: A statistically significant reduction in mean arterial pressure was demonstrated (P<0.001) when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients (0.5%). Oxygen saturation decreased from 96.5% to 94.4 % (P<0.001). A critical decrease in oxygen saturation (<90%) was documented in 27 patients (2.4%). CONCLUSION: Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effects if carefully titrated. All the patients (and especially ASA III group) require monitoring and care of an anes- thesiologist.     

Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy： Endoscopic findings, clinical management and outcome

AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy. The purpose of this study was to describe the causes and clinical outcome of these patients. METHODS: From January 1999 to October 2003, 111 patients with acute upper gastrointestinal bleeding (AUGIB) were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001 with AUGIB who were not taking warfarin. RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P<0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604 (5.1%) patients not receiving anticoagulants (P=0.0001). The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%) patients not taking a great dose of NSAIDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported. Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy. CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants. Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.     

Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection

Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old m...     

Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps

Although uncommon, sporadic nonampullary duodenal adenomas have a growing detection due to the widespread of endoscopy. Endoscopic therapy is being increasingly used for these lesions, since surgery, considered the standard treatment, carries significant morbidity and mortality. However, the knowledge about its risks and benefits is limited, which contributes to the current absence of standardized recommendations. This review aims to discuss the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of these lesions. A literature review was performed, using the Pubmed database with the query: “(duodenum or duodenal) (endoscopy or endoscopic) adenoma resection”, in the human species and in English. Of the 189 retrieved articles, and after reading their abstracts, 19 were selected due to their scientific interest. The analysis of their references, led to the inclusion of 23 more articles for their relevance in this subject. The increased use of EMR in the duodenum has shown good results with complete resection rates exceeding 80% and low complication risk (delayed bleeding in less than 12% of the procedures). Although rarely used in the duodenum, ESD achieves close to 100% complete resection rates, but is associated with perforation and bleeding risk in up to one third of the cases. Even though literature is insufficient to draw definitive conclusions, studies suggest that EMR and ESD are valid options for the treatment of nonampullary adenomas. Thus, strategies to improve these techniques, and consequently increase the effectiveness and safety of the resection of these lesions, should be developed.     

Opportunity costs of gastrointestinal endoscopic training in Canada

BACKGROUND

No data exist to define the opportunity costs related to instruction in endoscopic procedures in Royal College of Physicians and Surgeons of Canada-accredited teaching centres. Academic and institutional administrators expect staff to achieve acceptable performance standards. There is a need to measure some of the effects of training activity in the establishment of such standards.

OBJECTIVE

To measure the effect of resident training in colonoscopy on real procedure times and, as a secondary goal, to estimate procedural losses related to the process of training.

METHODS

Real procedure times for ambulatory colonoscopy in a single academic, hospital-based endoscopy unit were documented. Times for certified endoscopy instructors functioning solo were compared with times for procedures involving trainees at several levels of colonoscopic experience. Procedural reductions associated with resident training were estimated based on the parameters derived from the results. The analysis was executed retrospectively using prospectively collected data.

RESULTS

Resident training prolonged procedure times for ambulatory colonoscopy by 50%. The trainee effect was consistent, although variable in degree, among a variety of endoscopy instructors. Such increased procedure times have the potential to reduce case throughput and endoscopist remuneration.

CONCLUSIONS

Resident training in colonoscopy in a Canadian certified training program has significant negative effects on case throughput and endoscopist billings. These factors should be considered in any assessment of performance in similar training environments.     

Rare gastrointestinal lymphomas: the endoscopic investigation

Gastrointestinal lymphomas represent up to 10%of gastrointestinal malignancies and about one third of nonHodgkin lymphomas.The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma.However,the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization.Due to their rarity and the multifaceted histology,an endoscopic classification has not been validated yet.This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up,according to the involved site and lymphoma subtype.Existing,new and emerging endoscopic technologies have been examined.In particular,we investigated the diagnostic,prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas,lymphomatous polyposis and mantle cell lymphoma,follicular lymphoma,plasma cell related disease,gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract.Contrarily to more frequent gastrointestinal lymphomas,data about rare lymphomas are mostly extracted from case series and case reports.Due to the data paucity,a synergism between gastroenterologists and hematologists is required inorder to better manage the disease.Indeed,clinical and prognostic features are different from nodal and extranodal or the bone marrow(in case of plasma cell disease)counterpart.Therefore,the approach should be based on the knowledge of the peculiar behavior and natural history of disease.     

The role of surgery in the treatment of endoscopic complications

As the number, diversity, and complexity of endoscopic complications has increased, so too has the number, diversity, and complexity of operative interventions required to treat them. The most common complications of endoscopy in general are bleeding and perforation, but each endoscopic modality has specific nuances of these and other complications. Accordingly, this review considers the surgical complications of endoscopy by location within the gastrointestinal tract, as opposed to by complication types, since there are many complication types that are specific for only one or few locations, such as buried-bumper syndrome after percutaneous endoscopic gastrostomy and pancreatitis after endoscopic retrograde cholangiopancreatography, and since the management of a given complication, such as perforation, may be vastly different in one area than in another area, such as perforations of the esophagus versus the retroperitoneal duodenum versus the intraperitoneal duodenum. It is hoped that this review will provide guidance for gastroenterologists considering a particular procedure, either to assess the risks for surgical complications in preparation for patient counseling, or assist in assessing a patient who seems to be having a severe complication, or to learn what operation might be required to treat a given complication and how that operation might be performed. As with many operations, those for the treatment of endoscopic complications are typically performed only when less invasive, nonoperative strategies fail.