微探头超声内镜诊断及套扎治疗食管静脉瘤的价值

目的 探讨微探头超声内镜(MPS)诊断及套扎治疗食管静脉瘤的价值.方法 对48例胃镜检查疑诊为食管静脉瘤的患者采用MPS检查,23例较大的食管静脉瘤患者采用套扎治疗.结果 食管静脉瘤MPS表现为扁平状或类圆形无回声区,起源于黏膜下层.套扎治疗后无1例出现出血、穿孔等严重并发症者,8周后复查胃镜静脉瘤消失,局部未见明显病变.结论 MPS能准确诊断食管静脉瘤,套扎治疗安全、有效.     

经内镜注射组织粘合剂治疗食管胃脉曲张

为评价内镜下注射组织粘合剂治疗食管胃静脉曲张疗效。方法对３９例食管胃静脉曲张出血注射组织粘合剂患者进行分析，孤立性胃静脉曲张１１例，食管，胃静脉曲张硬化治疗后残留胃静脉曲张２１例，断流术后胃静脉曲张出血１例，食管胃静脉曲张以胃静脉曲张为主６例。     

食管孤立性静脉瘤56例报告

我院1989年1月至2001年6月胃镜检查9 373例患者,其中诊断食管孤立性静脉瘤56例,检出率0.6%.现报告如下.     

孤立性食管静脉瘤

病例患者男,７８岁。因疑有食管裂孔疝而行胃镜检查,发现有静脉瘤。内镜超声检查显示其中１个呈４．８ｍｍ×４．８ｍｍ大小,未予治疗,随诊观察。讨论日本内镜名词命名为：孤立性静脉扩张（ｓｏｌｉｔａｒｙｖｅｎｏｕｓｄｉｌａｔａｔｉｏｎ）定义：食管孤立性蓝色或...     

肝硬化合并上消化道出血急诊胃镜诊疗经验

目的探讨急诊胃镜在肝硬化合并上消化道出血患者诊疗中的价值。 方法回顾性分析2019年1月至2019年12月期间收治及诊断明确为肝硬化合并上消化道出血,并行急诊胃镜检查及治疗的患者的临床资料。 结果本研究共纳入患者2 766例次,所有患者均成功行急诊胃镜检查,其中内镜下可见出血部位的2 178例次(78.74%)、未见出血部位的588例次(21.26%)。明确出血部位的患者中,食管胃静脉曲张破裂出血1 256例次(57.67%),其中行内镜下组织胶、硬化或套扎治疗者1 183例次(1 145例成功行内镜下止血、38例内镜下止血失败,均补充行三腔两囊管压迫止血后好转)。 结论急诊胃镜是肝硬化合并上消化道出血行之有效的治疗方法,在积极改善一般情况、病情稳定后,应尽快行急诊胃镜检查治疗,可快速明确病因、控制病情,并获得良好的疗效,应在临床上推广。     

孟氏液在内镜下硬化治疗食管静脉曲张并发出血中的应用

目的观察孟氏液在内镜下硬化治疗食管静脉曲张并发出血中的作用。方法选取宁夏人民医院2013年2月-2015年2月肝硬化食管静脉破裂出血的患者116例。行内镜下硬化治疗,退针后出血46例,对其采用15%孟氏液局部喷洒,观察其瞬间止血及后期止血效果。结果 46例在行内镜下硬化治疗中出血的患者喷洒15%孟氏液后出血点处立即形成凝固物,未再出血,术后1周观察患者血压、脉搏,检查便潜血及血常规也未见活动性出血迹象。1周后复查胃镜出血处针眼已消失,持续有效率100%。结论孟氏液局部喷洒治疗有效率为100%,而且方法简单,取材容易,不良反应少,患者经济负担轻,是治疗硬化治疗出血并发症的最佳选择。     

内镜下硬化剂治疗食管静脉曲张破裂出血临床研究

目的观察食管静脉曲张破裂出血内镜下硬化剂治疗的疗效。方法对21例食管静脉曲张破裂出血并进行内镜下硬化剂治疗的患者进行回顾性分析。结果急诊硬化治疗8例,止血成功率87.5%,近期再次出血率12.5%,并发症发生率25%。择期硬化治疗13例,止血成功率92.3%,近期再次出血率8.3%,并发症发生率7.7%。结论内镜下硬化剂注射是食管静脉曲张破裂出血的有效治疗方法,更适合于预防再出血。     

急诊内镜下硬化治疗食管静脉曲张破裂大出血12年回顾

目的探讨急诊内镜下硬化治疗食管静脉曲张破裂大出血近期止血效果,分析其术后相关并发症及可能机制。方法收集苏州大学第三附属医院2003年1月-2014年12月急诊内镜下硬化治疗食管静脉曲张破裂大出血523例次的临床资料,回顾性分析其止血率、再出血率及并发症情况。结果急诊内镜下硬化治疗523例次,483例次止血成功,急诊止血率92.4%。硬化治疗后72 h~1周再出血105例次,再出血率20.1%。急诊内镜下硬化治疗患者中,出现中-高热48例,胸痛者45例,早期并发症发生率17.8%。结论急诊内镜下硬化治疗简便、高效,近期并发症少,对于食管静脉曲张破裂大出血患者可作为急诊止血首选方案。     

Dieulafoy病19例诊治分析

目的探讨Dieulafoy病的发病情况、临床特征、诊断与治疗。方法收集我院1996年~2008年7月间收治的上消化道出血病人1 470例,对其中检出的19例Dieulafoy病病例的临床特征、内镜下表现及治疗方法进行回顾性分析。结果Dieulafoy病约占上消化道出血的1.3%,19例Dieulafoy病中,病灶位于胃底5例,胃体10例,胃窦部2例,贲门部1例,十二指肠球部1例,其中17例均于胃镜下可直接见破裂血管,有10例可见活动性出血。病灶直径1.0~3.0 mm。于内镜下行病灶黏膜下局部注射5%鱼甘油酸钠,1例因再出血予手术治疗。结论Dieulafoy病是上消化道大出血的少见而重要的病因,该病诊断主要依靠胃镜检查,通过内镜早期诊断和治疗可以取得很好的疗效。     

内镜超声检查对食管平滑肌瘤的诊治价值

目的 探讨内镜超声检查(EUS)对食管平滑肌瘤的诊治价值.方法 分析研究经EUS诊断为食管平滑肌瘤患者的临床表现及血清学、常规胃镜、EUS等检查结果.将EUS的诊断结果与内镜或手术切除的组织病理诊断结果进行比较.治疗后随访2～36个月,平均14.3个月,以观察疾病复发情况.结果 EUS诊断食管平滑肌瘤191例.患者的临床表现、血清学检查、常规胃镜和螺旋CT对食管平滑肌瘤无特异性诊断作用.116例分别接受内镜(111例)或外科手术(5例)摘除治疗,101例术后组织病理确诊为食管平滑肌瘤,EUS对该病的诊断准确率为87%.随访75例未治疗者和116例治疗者,发现前者病灶无明显变化,后者术后无复发.结论 食管平滑肌瘤是一种良性肿瘤,EUS对该病的诊治具有较高的临床价值.     

Endoscopic injection sclerotherapy for 1,000 patients with esophageal varices: a nine-year prospective study.

We report here the results of endoscopic injection sclerotherapy performed in 1,000 consecutively treated Japanese patients with esophageal varices. This prospective study covered the period from 1982 to 1990. Variceal bleeding was controlled in 215 (97.7%) of 220 patients. Esophageal varices were completely eradicated in 778 patients (77.8%); the mean number of sessions was 4.2. In only 3 of the 778 patients did esophageal varices of the same size recur. Small, dilated, venous vessels that required additional sclerotherapy in follow-up endoscopy at 3-mo intervals appeared in 171 (22.2%) of 778 patients. The cumulative nonbleeding rate at 5 yr was 94.5% in patients in whom the varices had been eradicated. Deaths caused by upper gastrointestinal bleeding accounted for 2.6% of cases, whereas the rates of liver failure and hepatoma were 4.6% and 47.3%, respectively. The 5-yr cumulative survival rate was 54.1% in patients without concomitant hepatoma; it was 12.0% in patients with hepatomas. Multivariate analysis showed that hepatoma, Child classification, indication (acute, elective or prophylactic) and eradication were independent factors that significantly influenced survival time. This study clearly shows that close follow-up with endoscopy and complete eradication lead to significant reduction in bleeding from esophageal varices and reduction of mortality related to this bleeding.     

Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation

OBJECTIVES: The aim of this study was to compare the incidence and endoscopic management of esophageal stricture formation, significant ulcer bleeding, massive esophageal hematoma, and perforation resulting from endoscopic band ligation or sclerotherapy of esophageal varices. METHODS: Consecutive esophagogastroduodenoscopies in which band ligation or sclerotherapy was performed for acute or obliterative therapy were entered into a computerized endoscopy database during a 7-yr period. Patients were excluded if they died within 72 h of treatment session from complications unrelated to the procedure. Sclerotherapy was performed using a 25-gauge needle with 1.5% sodium tetradecyl sulfate and banding was primarily performed with a Wilson-Cook 6 or 10 shooter. Complications were assessed at scheduled endoscopy and outpatient clinic visits, review of quality assurance data tallied on a monthly basis, and patient records. RESULTS: Two hundred twenty-one cases of sclerotherapy were performed in 59 patients compared to 110 cases of band ligation in 52 patients. Five patients were excluded because of death within 72 h of the procedure. The incidence of complications from sclerotherapy:banding on a per patient basis included: esophageal stricture formation 25.6%:1.9%, ulcer bleed 25.4%:5.7%, esophageal perforation 2.2%:0%, and massive esophageal hematoma 1.6%:0%. A significant difference in complications between sclerotherapy and band ligation was noted for both stricture formation (p < 0.0005) and ulcer bleeding (p < 0.0001). The majority of ulcer bleeds required no therapeutic intervention, whereas stricture formation required multiple dilation sessions. CONCLUSIONS: Band ligation has a significantly lower incidence of stricture formation and ulcer bleeding compared to sclerotherapy. The majority of complications can be managed with endoscopic interventions.     

内镜外套管在辅助急诊内镜治疗食管胃静脉曲张出血中的作用研究

目的 探讨内镜外套管在辅助急诊内镜治疗食管胃静脉曲张破裂出血中的作用.方法 选择临床诊断为肝硬化门静脉高压食管胃静脉曲张破裂出血患者62例作为治疗组,采用外套管辅助急诊内镜注射硬化剂治疗.另选择同期行常规急诊内镜治疗的62例食管胃静脉曲张破裂出血患者作对照组,比较两组治疗效果.结果 治疗组62例患者在行急诊内镜止血中先用外套管压迫止血均获成功,止血效率为100%,显著高于对照组的80.65%（P＜0.05） 治疗组食管胃静脉曲张注射后消失率为59.32%显著高于对照组7.27%（P＜0.05）.胸痛和食管溃疡、总住院天数、总医疗费用,治疗组显著低于对照组（P＜0.05）.结论 应用外套管辅助急诊内镜注射硬化剂治疗食管胃静脉曲张出血可提高治疗效率,减少患者负担.     

内镜下无水酒精硬化治疗肝硬化并发食管静脉曲张45例

目的探讨内镜下硬化治疗食管静脉曲张的疗效。方法对我院45例肝硬化并发食管静脉曲张的患者，在内镜下用无水酒精行96次静脉内注射。结果30例大出血时紧急硬化治疗，注射后出血立即停止者28例（93．3％），无效者2例（6．7％）。15例预防注射。全部患者总有效者41例（91．1％），无效者4例（8．9％）。结论无水酒精硬化治疗食管静脉曲张具有价廉，局部视野清晰，值得推广应用。     

Cost-effectiveness analysis of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy for the prevention of recurrent esophageal variceal bleeding

For the prevention of recurrent esophageal variceal bleeding, studies show that patients treated with transjugular intrahepatic portosystemic shunt (TIPS) have lower rebleeding rates compared with endoscopic therapy. However, TIPS is associated with higher rates of portosystemic encephalopathy and possibly higher costs. The aim of this study was to conduct a cost-effectiveness analysis comparing TIPS with endoscopic sclerotherapy and endoscopic ligation for the prevention of recurrent esophageal variceal bleeding. Data for rates of rebleeding, death, complications, and crossover from endoscopy to TIPS were obtained from the literature. Costs for procedures and hospitalizations were obtained from two medical centers. Sensitivity analyses were performed varying probabilities of key variables. The patient population consisted of a hypothetical cohort of cirrhotic patients successfully treated for esophageal variceal bleeding with endoscopic sclerotherapy who received prophylactic sclerotherapy, ligation, or TIPS over 1 year. Endoscopic patients would receive propranolol. Mortality was similar for the three groups. The number of bleeds per patient for sclerotherapy, ligation, and TIPS would be 0.39, 0.32, and 0.07, respectively. The total annual costs per patient for sclerotherapy, ligation, and TIPS were $23,459, $23,111, and $26,275, respectively. The incremental cost per bleed prevented for TIPS compared with sclerotherapy and ligation was $8,803 and $12, 660, respectively. The incremental cost per bleed prevented for TIPS compared with sclerotherapy or ligation was sensitive to the cost of TIPS and the TIPS stenosis rate. Ligation had lower costs and lower recurrent bleeding rates than sclerotherapy. Compared with endoscopic therapy, TIPS leads to lower recurrent variceal bleeding rates and it is more cost effective in the short term for the prevention of recurrent esophageal variceal bleeding.     

Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, has been shown to be superior to sclerotherapy in adult patients with cirrhosis. To determine the efficacy and safety of endoscopic sclerotherapy and ligation, the 2 methods were compared in a randomized control trial in 49 children with extrahepatic portal venous obstruction who had proven bleeding from esophageal varices. Twenty-four patients were treated with sclerotherapy and 25 with band ligation. No significant differences were found between the sclerotherapy and ligation groups in arresting active index bleeding (100% each) and achieving variceal eradication (91.7% vs. 96%, P =.61). Band ligation eradicated varices in fewer endoscopic sessions than did sclerotherapy (3.9 +/- 1.1 vs. 6.1 +/- 1.7, respectively, P <.0001). The rebleeding rate was significantly higher in the sclerotherapy group (25% vs. 4%, P =.049), as was the rate of major complications (25% vs. 4%, P =.049). After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy (17.4% vs. 10%, P =.67). In conclusion, variceal band ligation in children is a safe and effective technique that achieves variceal eradication more quickly, with a lower rebleeding rate and fewer complications compared with sclerotherapy.     

A case of multiple gastrointestinal stromal tumor of the jejunum which was diagnosed by capsule endoscopy

More than 90% cases of chronic gastrointestinal bleeding can be diagnosed by upper endoscopy and/or colonoscopy, and therefore, obscure gastrointestinal bleeding has been defined as bleeding of unknown origin that persists after these conventional endoscopic evaluation. Gastrointestinal stromal tumors (GISTs) are rare tumors, but the most common form of mesenchymal tumors of the gastrointestinal tract. Small bowel is the second most common primary site for GISTs, and accounts for 2-10% of chronic bleeding sites. GISTs usually present as a sporadic and solitary tumor, and a minority of the cases of multiple GISTs are discovered as forms of hereditary or idiopathic tumor syndromes. Small bowel tumor has been difficult to diagnose because of absence of accurate and proper diagnostic tools. Recently developed wireless capsule endoscopy helps in the diagnostic work-up of small bowel diseases. We report a case of multiple jejunal GISTs presenting melena in a 39-year-old male, which was diagnosed with wireless capsule endoscopy.     

Endoscopic findings in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a UK primary care database

SUMMARY.  Gastroesophageal reflux disease (GERD) may be accompanied by erosive complications that are diagnosed by endoscopy. This study aimed to describe the characteristics of patients newly diagnosed with GERD who are referred for endoscopy, and the factors associated with esophageal endoscopic findings. This study included patients aged 2–79 years with a first recorded diagnosis of GERD in 1996, as identified in a previous cohort study in the UK General Practice Research Database. The rate and results of endoscopy were recorded. Unconditional logistic regression analysis was used to estimate the odds ratios and 95% confidence intervals for the relationship between a range of factors and endoscopy and its findings. Of the 7159 patients with a new GERD diagnosis, 805 (11%) underwent endoscopy close to the time of first consultation for GERD. Endoscopic findings indicative of esophageal damage were recorded in 73% of these patients. Esophageal endoscopic findings were significantly more likely in males, older patients, and individuals with a history of peptic ulcer disease or gastrointestinal bleeding. Use of acid-suppressive drugs, particularly proton pump inhibitors, was inversely associated with erosive endoscopic findings. Patients with erosive endoscopic findings were more likely to start a new course of treatment with a proton pump inhibitor. In conclusion, relatively few patients are referred for endoscopy close to the first consultation for GERD, and the majority of these individuals have esophageal findings. Male gender, increasing age and a history of bleeding were risk factors for esophageal complications.     

Endoscopic findings in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a UK primary care database

Gastroesophageal reflux disease (GERD) may be accompanied by erosive complications that are diagnosed by endoscopy. This study aimed to describe the characteristics of patients newly diagnosed with GERD who are referred for endoscopy, and the factors associated with esophageal endoscopic findings. The study included patients aged 2-79 years with a first recorded diagnosis of GERD in 1996, as identified in a previous cohort study in the UK General Practice Research database. The rate and results of endoscopy were recorded. Unconditional logistic regression analysis was used to estimate the odds ratios and 95% confidence intervals for the relationship between a range of factors and endoscopy and its findings. Of the 7159 patients with a new GERD diagnosis, 805 (11%) underwent endoscopy close to the time of first consultation for GERD. Endoscopic findings indicative of esophageal damage were recorded in 73% of these patients. Esophageal endoscopic findings were significantly more likely in males, older patients, and individuals with a history of peptic ulcer disease or gastrointestinal bleeding. Use of acid-suppressive drugs, particularly proton pump inhibitors, was inversely associated with erosive endoscopic findings. Patients with erosive endoscopic findings were more likely to start a new course of treatment with a proton pump inhibitor. In conclusion, relatively few patients are referred for endoscopy close to the first consultation for GERD and the majority of these individuals have esophageal findings. Male gender, increasing age and a history of bleeding were risk factors for esophageal complications.     

A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices

Reported incidences of bacteremia after endoscopy with esophageal variceal sclerotherapy are conflicting. A prospective controlled study was conducted to determine the frequency of bacteremia after emergency endoscopy with esophageal variceal sclerotherapy compared with frequency after elective esophageal variceal sclerotherapy and after emergency endoscopy in patients with upper gastrointestinal bleeding from nonvariceal sources. A total of 126 endoscopies were studied in 72 patients. Groups consisted of (a) emergency endoscopy without esophageal variceal sclerotherapy, 37 sessions with 36 patients; (b) elective esophageal variceal sclerotherapy, 33 sessions with 14 patients; and (c) emergency esophageal variceal sclerotherapy, 56 sessions with 36 patients. Blood cultures were obtained before and 5 and 30 minutes after endoscopy. There was a higher frequency of preendoscopic bacteremia in emergency esophageal variceal sclerotherapy (13%) than in emergency endoscopy alone (0%) (P = 0.02). Clinically significant bacteremia in emergency esophageal variceal sclerotherapy was observed in 7 of 56 (13%) sessions, compared with 0 of 33 in elective esophageal variceal sclerotherapy (P = 0.03) and 1 of 36 (3%) in emergency endoscopy alone (P = 0.45). Of these cases, 3 (5.4%) were potentially caused by emergency esophageal variceal sclerotherapy, but not clinically significant postendoscopic bacteremia was attributable to the procedure in the other groups.