Complications of surgical endoscopy

Background: This study examines the notion that gastrointestinal endoscopy performed by supervised surgical residents is safe. Methods: We reviewed all gastrointestinal endoscopic procedures performed by surgical residents with faculty supervision for complications and deaths occurring up to 30 days following the procedures. Results: The overall complication rate for 9,201 upper and lower endoscopy procedures was 1.4% and 0.42%, respectively. Overall mortality rate was 0.76% for upper endoscopy and 0.6% for lower endoscopy. No mortality was a direct result of a procedure-related complication. Intestinal perforation, drug overdose, bleeding, and aspiration were the most common procedure-related complications. Each resident completed an average of 75 upper endoscopies and 79 lower endoscopies during their training period. Conclusions: Gastrointestinal endoscopy can be performed safely by surgical residents with appropriate supervision. The higher morbidity and mortality of upper endoscopy are most likely related to the underlying disease rather than the procedure. Awareness of common complications and application of appropriate precautions and instruction are critical for minimizing complications. Received 25 March 1996/Accepted: 24 April 1996     

超声内镜与胃镜检查对上消化道黏膜下肿瘤的诊断效果分析

目的探讨超声内镜与胃镜对上消化道黏膜下肿瘤的诊断效果。方法选择2015年3月至2018年2月确诊的60例上消化道黏膜下肿瘤患者,均行胃镜检查和超声内镜检查,分析其与病理检查的符合率以及超声内镜检查的回声特点,并记录超声内镜检查的敏感性和特异性。结果以病理检查结果为标准,超声内镜检查的符合率为90.00%,明显高于胃镜检查的73.33%(P <0.05)。超声内镜检查对黏膜肌层肿瘤诊断的敏感性为90.32%,特异性为93.55%;对黏膜下层肿瘤诊断的敏感性为93.33%,特异性为93.75%;对固有肌层肿瘤诊断的敏感性为85.71%,特异性为97.87%。结论与胃镜检查相比,超声内镜在上消化道黏膜下肿瘤中的诊断价值更高,能够对病变的性质、部位及来源作出准确的诊断。     

残胃癌的外科治疗

目的：分析和总结残胃癌外科治疗结果。方法：回顾分析１９８６年至１９９７年间我院收治的１９例残胃癌的临床表现、治疗及生存结果。结果：残胃癌缺乏相对特异的症状。５３８％患者术前有不同程度的贫血。手术切除率及根治切除率分别为７８９％和６８４％。手术并发症率为２６３％。该组总５年生存比率及１３例根治手术后的５年生存比率分别为２３５％和３６４％。该组４例Ⅰ期、Ⅱ期病例术后均得到长期生存;９例Ⅲ期、Ⅳ期病例根治术后１年、２年、５年生存比率分别为７７８％、４４４％、２２２％。５例行姑息或探查术病例,其术后生存均不到１年。结论：积极外科手术尤其是根治手术是残胃癌有效治疗手段,对于早期病变,术后有良好的预后;对于中晚期病例,可延长生命,部分病例仍可能得到长期生存。早期诊断是提高预后的关键。残胃手术并发症相对较多。改善患者术前营养状况是降低并发症的重要方面     

延髓损伤可能会引发局限型和广泛型急性胃粘膜出血

目的：通过动物实验，观察延髓损伤引起胃粘膜出血的表现形式和特点。方法：对１９只成年健康杂种狗，进行延髓一侧性损伤手术（１３只）和对照假损伤性手术（６只）；在损伤后，对胃粘膜表现进行胃镜的动态观察。结果：延髓损伤，可引起胃粘膜出血，而且发生率很高，达１００％；胃粘膜出血的严重程度及其预后有轻、重不同。结论：分析观察结果后认为：胃粘膜出血分可能有局限型和广泛型两个类型；延髓损伤的严重程度与胃粘膜出血的类型密切相关。     

无痛内镜与普通内镜检查临床对比研究

目的:评价在麻醉下实施内镜检查的效果及安全性。方法:选择行胃镜和结肠镜检查的患者各60例,分为3组,分别应用丙泊酚、丙泊酚联合芬太尼静脉麻醉(观察组)及常规操作(对照组)检查,对检查过程中患者血压、心率、血氧饱和度及检查成功率、检查反应进行观察分析。结果:与对照组比较,各观察组中患者收缩压、心率在检查中均下降,差异有统计学意义(P<0.05),血氧饱和度无明显变化。对照组患者在检查中收缩压、心率均较检查前增加,差异有统计学意义(P<0.05)。观察组在检查后愿意再次接受检查者明显增多。结论:应用麻醉方法行内镜检查是安全、舒适、有效和无痛苦的。     

COX-2抑制剂联合高频电凝电切治疗Peutz-Jeghers综合征胃息肉的临床研究

目的：观察塞来昔布结合胃镜下息肉切除术治疗Peutz-Jeghers综合征胃息肉的效果。方法将42例Peutz-Jeghers综合征胃息肉患者随机分为塞来昔布联合胃镜治疗组和胃镜治疗组,每组21例。塞来昔布联合胃镜治疗组于胃镜下高频电凝、电切治疗后口服塞来昔布800 mg/d,疗程为12个月;胃镜治疗组行胃镜下高频电凝、电切息肉切除术,疗程为12个月。两组均每4个月复查胃镜1次,观察息肉的数目、病理类型。结果塞来昔布联合胃镜治疗组于治疗后4、8、12个月胃息肉消退率分别为94.5%、91.8%和89.8%,而胃镜治疗组分别为83.0%、63.7%和49.3%,两组比较差异有统计学意义（P＜0.01）。息肉的异型增生较单纯的电凝电切治疗后明显减少,差异有统计学意义（P＜0.05）。结论塞来昔布联合胃镜下高频电凝电切治疗Peutz-Jeghers综合征胃息肉效果肯定,且优于单纯胃镜下息肉切除的治疗方法。     

丙泊酚联合瑞芬太尼用于胃镜检查对上消化道蠕动的影响

目的：探讨丙泊酚联合瑞芬太尼应用在无痛胃镜检查中的麻醉效果及对上消化道蠕动情况影响。方法选择行无痛胃镜检查的患者130例,采用随机数字表法分为观察组和对照组,对照组采用丙泊酚麻醉,观察组联合瑞芬太尼进行麻醉,记录麻醉效果。结果观察组麻醉优良率为93．85％,对照组麻醉优良率为80．00％,组间差异有统计学意义（χ2＝5．481,P ＜0．05）。观察组丙泊酚用量（1．73±0．24）mg／kg、患者清醒时间（5．91±1．03）min、离院时间（14．58±2．79）min,对照组丙泊酚用量（3．06±0．57）mg／kg、患者清醒时间（9．44±1．87）min、离院时间（22．05±4．86）min,组间差异均有统计学意义（t ＝17．337、13．330、10.747,均 P ＜0．05）。上消化道蠕动观察组轻度36例、中度24例、剧烈5例,对照组轻度23例、中度27例、剧烈15例,组间差异有统计学意义（χ2＝5．376,P ＜0．05）。结论丙泊酚联合瑞芬太尼应用在无痛胃镜检查中麻醉效果优于单纯丙泊酚麻醉,对患者上消化道系统影响小,丙泊酚用量少,可缩短患者清醒时间和离院时间,值得在临床上推广应用。     

One- or two-operator techniques for oesophago-gastro-duodenoscopy in unsedated patients: A comparative prospective randomized study

BackgroundThe standard oesophago-gastro-duodenoscopy procedure is performed with a single endoscopist (SE). Nurse-assisted (NA) oesophago-gastro-duodenoscopies have not yet been studied. We aimed to evaluate the efficacy of an NA endoscopy compared to an SE endoscopy.MethodsA prospective, single-center, randomized trial, in which 500 adult patients were divided into two groups. In the first group, patients underwent an endoscopy with an SE. In the second group, the endoscopy was performed with an NA. The ease of the procedure (scores 1–4; 1 difficult, 2 satisfactory, 3 easy, 4 very easy), evaluation of patient satisfaction (scores 1–4; 1 uncomfortable, 2 satisfactory, 3 comfortable, 4 very comfortable), total time of the procedure and vocal cord observation were determined as quality indicators.ResultsMean patient satisfaction scores in groups 1 and 2 were 2.98 ± 0.79 and 3.11 ± 0.78, respectively (p = 0.043), with uncomfortable ratings in 5.2% vs 4%, satisfactory in 16.8% vs 13.2%, comfortable in 53.2% vs 50.4%, and very comfortable in 24.8% vs 32.4% of patients in groups 1 and 2, respectively. Retching rates during the procedure were 54.4% and 45.2% (p = 0.040) in groups 1 and 2, respectively. No differences were seen in vocal cord observation (54.4% vs 56.0%), total procedure time (2.35 ± 1.56 vs 2.41 ± 1.48 min) and easy score (3.26 ± 0.603 vs 3.25 ± 0.64) in groups 1 and 2 for the procedures. Very easy, easy, satisfactory, and difficult ratings were given by 33.6% vs 34.8%, 60.4% vs 56.4%, 4.8% vs 7.6% and 1.2% vs 1.2% of groups 1 and 2, respectively.ConclusionsCompared with the conventional method, the assisted endoscopic technique provides more comfort and less gag reflex without increasing the processing time or difficulty of performing the procedure.     

Documento de posicionamiento de la AEG,la SEED y la SEAP sobre calidad de la endoscopia digestiva alta para la detección y vigilancia de las lesiones precursoras de cáncer gástrico

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.     

高清胃镜下早期胃癌筛检策略的单中心前瞻性研究

目的　验证高清胃镜下早期胃癌筛检策略的效能。方法　前瞻性纳入2018年12月—2019年1月在解放军总医院第七医学中心行胃镜检查的849例年龄≥35岁的患者。在胃镜检查时,从未感染过幽门螺杆菌者对任何可疑病灶活检;溃疡型病灶于溃疡边缘活检;萎缩区域外,贲门部对白光下呈红色的病灶活检,非贲门部对具有清晰边界或白光下呈白色的病灶活检;萎缩区域内,隆起型病灶中具有清晰边界或顶部有不规则凹陷者活检,平坦/凹陷型病灶中边界不规则或窄带光下呈赭色者活检。此外,可对不符合上述策略但认为有必要活检的任何病灶进行活检。其后根据活检或手术病理,对胃癌高危患者进行胃镜随访,分析该策略对胃部早期肿瘤性病变的检出及漏诊情况,明确该策略的敏感度和阳性预测值。结果　共对548例患者的781处病灶进行了活检。在符合上述策略的327处病灶中,诊断上皮肿瘤性病灶16处（4.9%,16/327）,其中高级别肿瘤10处（3.1%,10/327）;而在不符合上述策略的454处病灶中,诊断上皮肿瘤性病灶仅1处（0.2%,1/454）,无高级别肿瘤。该筛检策略对胃上皮肿瘤性病灶和高级别肿瘤的阳性预测值均高于不符合策略而取活检者（4.9%比0.2%,χ2=19.49,P<0.001;3.1%比0,P<0.001）。共有146例（17.2%,146/849）患者接受胃镜随访,随访中发现2处黏膜内高级别肿瘤,符合筛检策略。该筛检策略在初次胃镜检查中检出了84.2%（16/19）的上皮肿瘤性病灶和83.3%（10/12）的高级别肿瘤。结论　高清胃镜下早期胃癌筛检策略可以高效地检出早期胃癌。