Endoscopic submucosal dissection for rectal carcinoid tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the clinical value of endoscopic submucosal dissection(ESD)for rectal carcinoid tumors.</p><p><b>METHODS</b>Endoscopic miniprobe ultrasonography was performed in patients with rectal submucosal tumors under colonoscope. ESD was carried out with the needle knife for lesions diagnosed as rectal carcinoid as following: (1)Fluid was injected into the submucosal layer in the rectum to elevate the lesion from the muscle layer. (2)The surrounding mucosa of the lesion was pre-cut. (3)The connective tissue of the submucosa beneath the lesion was dissected.</p><p><b>RESULTS</b>Five rectal carcinoids ranged from 0.4 to 1.2 cm and the mean resected size was 1.1 cm. All rectal carcinoid tumors were verified by pathological examination with lateral and basal resection margins free of tumor. The mean ESD procedure time (from fluid injection to complete dissection) was 35 min (ranged from 20 to 45 min). Minor bleeding occurred in all of the tumors, and none of patients had massive hemorrhage requiring blood transfusion or emergency colonoscopy due to hematochezia after ESD. One patient had subserosal emphysema due to deep tearing of the muscle layer, and recovered after several days' conservative treatment. All patients were followed up with colonoscopy 1 month after ESD,which confirmed the healing of artificial ulcers.</p><p><b>CONCLUSIONS</b>ESD is a novel endoscopic treatment that makes it possible to resect the whole rectal carcinoids. Rectal carcinoid tumors can now be treated by ESD to achieve the same therapeutic effect as operation.</p>

Endoscopic interventional treatment of malignant gastrointestinal obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and clinical value of endoscopic interventional treatment of malignant gastrointestinal obstruction.</p><p><b>METHODS</b>With the aid of X ray, 32 cases with malignant gastrointestinal obstruction were treated with endoscopic metal stenting. There were 8 cases with gastric outlet obstruction, 7 with duodenal obstruction, 13 with rectal obstruction, and 4 with sigmoid obstruction.</p><p><b>RESULTS</b>Among the 32 patients, metal stenting was successfully performed in 30 cases (93.7%, and obstructive symptoms were relieved within 1-3 days. Metal stent placement was permanent in 15 cases with gastric outlet or duodenal obstruction. Twelve cases with colorectal obstruction received stent placement as palliative treatment, while other 3 cases underwent subsequent elective surgical resection. Metal stent placement failed in one case with recurrent rectal carcinoma, and perforation occurred in another one case with wide spread metastatic sigmoid colon carcinoma and Hartmann operation was performed. During the follow-up period, no stent migration was detected.</p><p><b>CONCLUSION</b>Endoscopic interventional treatment of malignant gastrointestinal obstruction is a feasible, safe, effective and well tolerated method. It can reduce the patients trauma and pain, and improve the quality of life.</p>

Clinical value of percutaneous endoscopic gastrostomy and jejunostomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy(PEJ).</p><p><b>METHODS</b>From June 1996 to April 2005, clinical data of 121 patients treated with PEG or PEJ were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 121 patients experienced 134 times of PEG or PEG plus PEJ, including 90 cases (103 times) treated with PEG and 31 patients treated with PEG plus PEJ. Thirteen patients treated with PEG had fistula replacement 6-10 months after PEG. All patients had quick nutrition recovery after fistula tube insert,therefore parenteral nutrition was not required. No severe complications occurred in all patients after 10 months of following-up. Four patients had subcutaneous infection around fistula 4-10 days after PEG.</p><p><b>CONCLUSION</b>PEG and PEJ are safe and new methods for gastrointestinal decompression and enteral nutrition, which can be substitutes for nasogastric tube.</p>