ABSTRACT
Objective To determine the incidence and clinical factors associated with bleeding after endoscopic submucosal dissection (ESD) of gastric mucosal lesions.Methods Clinical,endoscopic and pathological data of 223 lesions in 215 ESD patients between January 2009 and October 2011 were collected.The following factors associated with bleeding were analyzed:( 1 ) patient-related factors:sex,age,concomitant diseases including hypertension and diabetes mellitus,history of administration of anticoagulants or antiplatelet agents; (2) lesion-related factors:size,location,ulcer or scar findings,macroscopic types and pathological types; (3) procedure-related factors:en-bloc resection,spray of porcine fibrin sealant and operation time. Results Thirteen patients (13 lesions ) developed bleeding after ESD,among whom 7(53.8％) occurred within 24 hours after the procedure,5 (38.5％) within 1 week and 1 (7.7％) on the sixteenth day after ESD.Univariate and multivariate analysis revealed that lesion size ( ≥5 cm; odds ratio 8.663 ; 95％ CI:2.081 - 36.075) was an independent risk factor for bleeding.Conclusion Lesion size is the independent risk factor for bleeding after ESD,so careful preparation and close monitoring are required during and after ESD.In the meantime efforts should be made to identify and exactly demarcate lesions to minimize the size of resected specimens and reduce the risk of bleeding after ESD.
ABSTRACT
Objective To evaluate the influence of different cannulation technique in endoscopic retrograde cholangiopanereatography (ERCP) on success rate, risk of post-ERCP complication and operation time of the procedure. Methods The data of 120 patients who underwent ERCP from June 2000 to June 2008 because of biliary duct disorders were retrospectively studied. Conventional carmulation technique was applied in 60 patients and guide-wire eannulation was used in other 60. The success rate, total time of ERCP operation and the incidence of post-ERCP complications including acute pancreatitis and biliary system infec-tion within 7 days were assessed. Results Compared with conventional carmulation technique, selective can-nulation with a standard ERCP catheter under the assistance of guide-wire proved a higher success rate and a shorter operation time (P<0.05). Incidences of postoperative pancreatitis and infection with conventional cannulation were 10.0% (6/60) and 23.3% (14/60), respectively, while with guide-wire assisted cannu-lation were 3.3% (2/60) and 10.0% (6/60), respectively. No complication of bleeding was observed in either group. Conclusion Guide-wire assisted cannulation in ERCP can shorten operation time, improve success rate and reduce post-ERCP complications. Further evaluations are warranted.
ABSTRACT
Objective To evaluate the application of RX rapid exchange biliary system in(endoscopic retrograde cholangiopancreatography,ERCP)treatment for patients with bile duct stone.Methods 154 patients were divided into traditional devices group(76 cases)or RX system group(78 cases)according to the size of bile duct stone and state of patients randomizly,then guide wire loss rates,catheter/guide wire exchange times and easy degree of buskets and ballons inserted to bile duct was recorded respectively during procedure,all parameters was analyized by Chi-square methods or t test.Results The guide wire loss rates(%) of RX group was obviously lower than that of traditional devices group(2.2?1.4 vs 9.5?2.8,P0.05).Conclusion RX system is shorten the time and convenience the operation in ERCP for treating patients with common bile duct stone,as well as improve the therapy efficiency.