Partially covered vs uncovered sphincterotome and post-endoscopic sphincterotomy bleeding

AIM: To prospectively compare partially covered vs uncovered sphincterotome use on post-endoscopic biliary sphincterotomy (ES) hemorrhage and other complications. METHODS: All patients referred for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to undergo ES either with a partially covered or an uncovered sphincterotome. Both patient and technical risk factors contributing to the development of post-ES bleeding were recorded and analyzed. The characteristics of blee...     

Current developments in natural orifices transluminal endoscopic surgery: an evidence-based review

Tremendous advances have been made in recent years addressing the key obstacles to safe performance and introduction of human natural orifice transluminal endoscopic surgery (NOTES). Animal studies have focused on identifying optimal solutions to these obstacles, in particular methods of creating transluminal access,safe closure of the point of access, and development of a multitasking platform with dedicated instruments. Whether the performance data generated from these animal studies can be reproduced in ...     

原发性硬化性胆管炎27例临床病理特点分析

目的 总结原发性硬化性胆管炎(PSC)的临床病理特点,提高临床医师对该病的认识.方法 回顾性分析27例PSC患者的临床资料并随访患者当前情况.临床资料主要包括各项肝功能指标、自身抗体及免疫球蛋白,影像学及病理学检查结果将PSC患者分为大胆管型或小胆管型;治疗措施包括药物、内镜及手术治疗,治疗3～6个月后,ALT≤1.5倍、Tbil≤2倍、ALP≤2.5倍正常上限为有效.大胆管型PSC与小胆管型PSC的疗效比较采用非参数检验CMH法,P＜0.05为差异有统计学意义.结果 27例PSC患者中,男性7例,女性20例,平均年龄47.6岁.大胆管型PSC 18例,小胆管型PSC 9例.主要临床表现为黄疸(85.2%)、瘙痒(48.1%)、乏力(68.4%)、腹痛(40.7%)及发热(14.8%);常见体征包括:肝大(44.4%)、脾大(48.1%)、腹水(14.8%)等;胆红素升高10倍以上者占30.8%,IgG异常率81.8%、抗核抗体阳性率69.6%、抗中性粒细胞胞浆抗体阳性率52.9%;合并溃疡性结肠炎者占22.2%,干燥综合征患者占22.2%.经药物、内镜或手术治疗后,部分病例病情缓解,3例死亡;小胆管型PSC的疗效优于大胆管型PSC(66.7%比33.3%,x2=4.173,P=0.041).结论 本组少数PSC患者合并溃疡性结肠炎.小胆管型PSC治疗效果优于大胆管型PSC,提示早期诊治的必要性.     

内镜下胆总管取石术患者不同时期生存质量比较分析

Objective To investigate the influence of endoscopic retrograde cholangiopancreatography (ERCP) on life quality of patients with common bile duct stones. Methods The life quality of 35 patients, who underwent ERCP because of common bile duct stones, were assessed by GIQLI questionnaires before, 2 and 6 weeks after the procedure. Results The mean GIQLI score of patients before ERCP was 99. 9, which was significantly increased to 112. 2 and 121.9 at 2 and 6 weeks after ERCP (P ＜0. 01 ). At 6weeks after ERCP, the GIQLI score was similar to that of normal population. Conclusion ERCP can improve the life quality of patients with common bile duct stones.     

中西医结合治疗慢性鼻窦炎与鼻息肉临床分析

目的探讨中医治疗慢性鼻窦炎、鼻息肉低复发率的方法。方法96例慢性鼻窦炎、鼻息肉患者经鼻内窥镜手术后,予以中药内服2-3周、中药熏鼻治疗15天、6-12个月后观察疗效。结果痊愈68例,好转19例,无效9例;总有效率为90.6%。结论中药治疗是慢性鼻窦炎、鼻息肉术后低复发率的有效方法。     

Autofluorescence imaging for predicting development of metachronous gastric cancer after Helicobacter pylori eradication

Background and Aims: Although Helicobacter pylori eradication decreases the incidence of metachronous gastric cancer after endoscopic treatment for early gastric cancer (EGC), metachronous cancer still develops after successful eradication, particularly in patients with severe corpus gastritis. We investigated whether the extent of atrophic fundic gastritis diagnosed by autofluorescence imaging (AFI) videoendoscopy is predictive of development of metachronous gastric cancer after H. pylori eradication in patients treated with endoscopic submucosal dissection (ESD) for EGC. Patients and Methods: A total of 82 patients who underwent ESD for EGC from 2003 to 2006, who received eradication therapy participated in this study. The extent of chronic atrophic fundic gastritis was evaluated by AFI and categorized into closed and open type. The main outcome was the incidence of metachronous gastric cancer detected by annual surveillance endoscopy. Results: During a median observation period of 55 months, metachronous gastric cancer developed in 12 of 82 patients (14.6%). Multivariate Cox's proportional hazard analysis revealed that open‐type, atrophic fundic gastritis diagnosed by AFI was significantly associated with development of metachronous gastric cancer (hazard ratio: 4.88, 95% confidence interval [CI]: 1.32–18.2, P = 0.018) after adjustment for age, sex, histological intestinal metaplasia, serum pepsinogen level, and H. pylori status. Conclusions: Metachronous EGC developed after successful H. pylori eradication, and extensive atrophic fundic gastritis diagnosed by AFI was a significant predictor, thus it could identify patients undergoing ESD for EGC who still required intensive surveillance after eradication.     

Myocardial ischemia during endoscopic retrograde cholangiopancreatography: An overlooked issue with significant clinical impact

Background and Aim: The occurrence of peri‐procedural myocardial ischemia with endoscopic retrograde cholangiopancreatography (ERCP) has been documented, but its significance remains controversial. This study aimed to investigate the incidence and risk factors of myocardial ischemia during ERCP procedures and to analyze the potential association between myocardial ischemia and post‐ERCP complications. Methods: Ambulatory 24‐h ST‐segment monitoring from 30 min prior to 24 h after ERCP was obtained on 71 patients from September 2006 to August 2007. Changes in vital signs during ERCP, post‐ERCP complications, and their outcomes were recorded and analyzed. Results: Cardiac ischemia occurred in 13 patients (18.3%) during ERCP and one patient developed myocardial infarction. More patients in the ischemic group (38.5%) than in the non‐ischemic group (5.2%) had ST‐T changes in pre‐ERCP resting electrocardiography (P < 0.01). Hypotension during ERCP was found only in the ischemic group (15.4% vs 0%; P = 0.03). Patients with cardiac ischemia during ERCP had a significantly higher rate of elevated serum amylase and lipase levels (53.8% vs 15.5%; P < 0.01) and post‐ERCP pancreatitis (30.8% vs 6.9%; P = 0.03). Multivariable logistic regression analysis revealed that cardiac ischemia during ERCP (OR: 5.21, P = 0.050) and pancreatic duct cannulation (OR: 5.7, P = 0.036) were independent predictors for post‐ERCP pancreatitis. Conclusions: ST‐T changes on resting electrocardiography and intra‐procedural hypotension are risk factors of myocardial ischemia during ERCP. Post‐ERCP hyperamylasemia, hyperlipasemia, and pancreatitis were associated with myocardial ischemia during ERCP.     

内镜黏膜下剥离术风险控制的初步探讨

[目的]通过内镜黏膜下剥离术(ESD)治疗消化道病变,探讨手术风险控制方法.[方法]2008年3月～2010年8月内镜检查发现的消化道病灶病例作为入选对象,共131例.术前行染色内镜和超声内镜检查,确定病变范围和深度,常规行术前评估.手术步骤:(1)应用氩气刀(APC)于病灶边缘标记;(2)于病灶边缘标记点外侧进行多点黏膜下注射;(3)切开病变外侧缘周围黏膜;(4)于病灶黏膜下层进行剥离;(5)创面处理.观察手术时间、黏膜下注射液体量、手术前后血红蛋白水平变化、手术成功率及并发症发生率.[结果]切除标本最大直径平均(3.61±0.99)cm; 术中平均黏膜下注射量为(29.2±11.53)mL;平均手术操作时间(68.70±31.69)min; 手术完整剥离成功率95.4%;穿孔发生率3.1%.[结论]采取综合措施可有效减少并发症的发生率,有利于并发症的及时处理,有效地控制手术风险.     

鼻内镜下复发性鼻一鼻窦内翻性乳头状瘤的手术径路选择

摘要目的：探讨复发性鼻一鼻窦内翻性乳头状瘤鼻内镜下各种手术径路的选择和治疗效果。方法：回顾性分析1999年11月-2007年1月本院耳鼻咽喉头颈外科17例鼻内镜下经3种不同手术径路治疗的复发性鼻-鼻窦内翻性乳头状瘤患者的临床资料。其中鼻内镜单纯鼻内径路手术6例,鼻内镜辅助柯-陆径路手术10例,鼻内镜辅助鼻侧切开径路手术1例。结果：随访21～105个月,2例术后复发（11．8％）,均为鼻内镜单纯鼻内径路手术组,鼻内镜辅助柯-陆径路手术组和鼻内镜辅助鼻侧切开径路手术组未见1例复发。结论：鼻内镜辅助鼻外径路手术可能是治疗复发性鼻-鼻窦内翻性乳头状瘤的有效方法。