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Objective:To compare the efficacy and safety of a new type of plastic biliary stent modified based on the pigtail nasobiliary duct and the common plastic biliary stent for hilar cholangiocarcinoma.Methods:Data of a total of 38 patients with obstructive jaundice caused by hilar cholangiocarcinoma who received endoscopic retrograde cholangiopancreatography (ERCP) palliative treatment at the Endoscopy Center, General Hospital of Northern Theater Command from June 2018 to December 2020 were collected, including 20 cases using the new type of plastic biliary stent (the new stent group), and 18 cases using the common plastic stent (the common stent group). Patients were followed up to May 30, 2021. The procedure time, hospital stay, postoperative biliary infection incidence, the bilirubin decrease, and the patency time of the stents in the two groups were compared.Results:The procedure time was 19.85±1.07 minutes in the new stent group and 22.00±3.38 minutes in the common stent group, respectively, showing no significant difference between them ( t=1.26, P=0.607). The lengths of hospital stay of the two groups were 11.45±2.39 days and 11.33±3.51 days, respectively, showing no significant difference between them ( t=-0.52, P=0.938). The median margins of total bilirubin reduction in the two groups were 122.85 μmol/L and 96.25 μmol/L, respectively, with significant difference ( Z=-2.03, P=0.042). The incidence of long-term cholangitis of the new stent group was significantly lower than that of the common stent group [10.0% (2/20) VS 44.4% (8/18), P=0.027]. The patency time of the new stent group was significantly longer than that of the common stent group (109.45±32.67 days VS 82.11±20.95 days) with significant difference ( t=2.23, P=0.032). Conclusion:In the palliative treatment of hilar bile duct obstruction, the new plastic bile duct stent modified based on pigtail type can reduce the incidence of long-term cholangitis and prolong the patency of bile duct stent compared with the common stent group.
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Purpose To assess right ventricular function and synchronous acute response in patients with chronic cardiac failure after cardiac resynchronization therapy (CRT) using equilibrium radionuclide angiography (ERNA).Materials and Methods Twenty-four chronic cardiac failure patients who accepted CRT were included (CRT group) and twenty healthy participants were also selected as the control group.ERNA was performed before and within 48 h after pacemaker implantation to calculate both right ventricular ejection fraction (RVEF) and RV dyssynchrony.RV dyssynchrony was defined as the standard right ventricular phase shift and right ventricular phase standard deviation (RVPS and RVPSD).Results The postoperative RVEF,RVPS and RVPSD in CRT group were significantly improved (P＜0.05).Fifteen patients (62.5％) were classified as acute responders,based on a reduction of at least 15％ in LV end-systolic volume immediately after CRT.The baseline RVEF in responders was higher than that in nonresponders (P＜0.05),while the RVPS and RVPSD were lower (P＜0.05).The postoperative RVPS and RVPSD decreased (P＜0.05),and the RVEF increased (P＜0.05) in both responders and nonresponders after pacemaker implantation,indicating that the right ventricular function and dyssynchrony in CRT group were both improved.Conclusion This study showed a significant improvement in RV ventricular systolic function and synchrony immediately after CRT.ERNA allows assessment of changes in RVEF and RV dyssynchrony before and after CRT implantation.
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Objective To evaluate the diagnostic and therapeutic effect of endoscopy on pharyngeal papillomas. Methods Data of patients with pharyngeal papillomas diagnosed and treated by endoscopy be?tween March 2009 and December 2014 were analyzed retrospectively, including dissection, treatment and follow?up results. Results The rate of endoscopic diagnosis of pharyngeal papillomas was 0?9%( 65/6 927) . Endoscopic biopsy forceps resection was performed successfully in 54 patients. Other patients ( n=11) were treated by endoscopic snare resection. There was hemorrhage of different degrees after resec?tion. Argon hemostasis was used in 6 patients for errhysis after resection. Supportive treatment was not given and no severe hemorrhage or death was seen. A total of 41 patients were followed up and endoscopic examina?tion was performed 2 months later. Pharyngeal papillomas were found again at the same site in two patients and endoscopic biopsy forceps resection was performed. Pharyngeal papillomas were not found in these two patients in the next endoscopic examination. Conclusion Endoscopy is a safe and effective diagnosis and treatment method for pharyngeal papillomas.
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Objective:To explore the prognostic value of CysC and NT‐proBNP in patients with non‐ST elevation a‐cute coronary syndrome (NSTE‐ACS) .Methods :A total of 166 NSTE‐ACS patients hospitalized in our hospital from Jan 2012 to Dec 2012 were selected .They were followed up for 12 months ,then general data ,levels of CysC , NT‐proBNP ,hsCRP and cTnI etc .and incidence rate of MACE were recorded and measured .According to MACE occurrence during follow‐up or not ,156 cases were divided into non‐MACE group (n=137) and MACE group (n=19) ,risk factors for MACE in NSTE‐ACS patients were analyzed ,receiver operator characteristic curve (ROC) was performed ,and the optimal cutoffs of related indexes predicting MACE occurrence in these patients were analyzed . Results :Compared with non‐MACE group ,there were significant rise in age [ (60.26 ± 10.45) years vs .(64.16 ± 11.21) years] ,levels of CysC [ (1.02 ± 0.11) mg/L vs .(1.15 ± 0.12) mg/L] ,NT‐proBNP [ (251.97 ± 89.65) pg/ml vs .(347.93 ± 107.29) pg/ml] ,hsCRP [ (14.69 ± 3.53) mg/L vs .(17.13 ± 3.68) mg/L] and cTnI [ (0.36 ± 0.46) ng/ml vs .(0.90 ± 0.88) ng/ml] in MACE group ,P0.7 [CysC:0.784 ,95% CI:0.687~0.881 ;NT‐proBNP:0.753 ,95% CI :0.639~0.867] , and it′s analysis indicated that CysC=1.07 mg/L and NT‐proBNP=279.60 pg/ml were their optimal cutoff predicting MACE .Kaplan‐Meier survival curves with above two cutoffs as risk stratification cutoff indicated that survival time of high risk group was significantly shorter than that of low risk group (P<0.05) .Conclusion:Serum CysC and NT‐proBNP levels are independent predictors assessing prognosis in NSTE‐ACS patients .
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Objective To investigate the features and clinical value of endoscopic ultrasonography and colonoscopy for appendix mucocele. Methods The patients with mucocele of appendix who were diagnosed by endoscopic ultrasonography and colonoscopy in three hospitals all underwent surgery from January 2008 to March 2015. Appendix mucocele in these patients was confirmed by postoperative pathology and clinical data were retrospectively analyzed. Results A total of 22 patients with appendix mucocele were analyzed retrospectively. The average size of intralumen mucocele was 1. 84±1. 42 cm (0. 6-4. 5 cm) . The colonscopic finding of appendiceal mucocele showed submucosal protuberance at the appendiceal orifice with smooth surface. The appendiceal orifice was found at the edge of appendiceal mucocele. Endoscopic ultrasonogrphy showed low echo with smooth cyst wall in 8 patients, mixed equal echo and low echo in 14 cases. Appendicectomy was performed in 11 patients and resection of ileocecum in 11 others. Conclusion Endoscopic ultrasonography and colonoscopy are valuable for diagnosis and treatment in appendiceal mucocele.
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Objective To investigate the current popularity of ERCP training in China.Methods A questionnaire-based survey was performed on a professional survey website.A total of 48 questions were designed,including personal information,training information,current status of ERCP performance and sug-gestions to ERCP training.The questionnaire was completed anonymously by physicians who fulfilled full-time ERCP training in any Chinese endoscopy center for at least 1 year before.Results A total of 464 phy-sicians,from all the regions of mainland China,among which 362 people completed all the questions.More than two thirds trainees thought that they had got fruitful training and 27.4% trainees had their ERCP vol-umes greatly increased and 64.3% trainees increased practice.According to related index,the physicians who were competent in routine ERCP performance were 84.5%,with outstanding operators of 12.2%.Con-clusion China has made great progress in the training program of ERCP technique in recent decades,but problems still remain such as various admission standard,insufficient training duration,incomprehensive program,as well as lack of evaluation and follow-up system.
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Objective To investigate clinical features and treatment strategy for pancreatic duct stent displacement complicated with acute pancreatitis.Methods Ten cases of pancreatic duct stent displacement complicated with acute pancreatitis were retrospectively analyzed.All the cases were confirmed by lab examination,X-ray examination,endoscopy and computed tomography (CT) examination.After operation,the clinical symptoms of patients were observed.Time consumed for stent removing and blood amylase level before endoscopic retrograde cholargio-pancreatography (ERCP) and 1st,4th,7th day after ERCP were recorded.Clinical features,the time of stent displacement,time of clinical cure and therapeutic strategy were summarized.Results The average age of the ten cases (four male and six female) was 55.9 years.All the displaced pancreatic duct stents were pancreatic duct stent with side wing,length five to seven cm.Obstruction was observed in one case.The end of the pancreatic duct stent of two cases dislocated at the neck of pancreats,seven cases at the head of pancreas and one at the body of pancreas.Ten cases presented with abdominal pain,seven with nausea and vomiting and one with fever.The average time of the occurrence of pancreatic duct stent displacement was 2.9 months.All the stents were successfully taken out,which of two cases were removed with balloon,seven cases with forcep and one with snare,and the average time duration was 17.7 min.After the stents taken out,pancreatic duct stent was replaced in one case and the left nine cases received nasal-pancreatic drainage treatment.After the operation,no severe complications such as pseudocyst of pancreas,pancreatic abscesses,pancreatic necrosis and gastrointestinal bleeding were observed in all the patients.Average blood amylase level at 1st,4th and 7th day after ERCP was 508 U/L,137 U/L and 86 U/L,respectively.The average time of recovery was 6.7 days,and the average time of keeping the nasal-pancreatic tube was 8.6 days.Conclusions For patients with pancreatic duct stent displacement complicated with acute pancreatitis,it is safe and effective to take out the stent and perform pancreatic duct drainage by ERCP as soon as possible,which could improve the symptoms in a short time.
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Objective To assess the curative effect of endoscopic resection for patients with duode-nal bulb carcinoid.Methods Data of 17 patients with duodenal bulb submucosal tumor who underwent en-doscopic dissection in our department and confirmed as duodenal bulb carcinoid by postoperative pathology from Jun 2009 to Jun 2012 were retrospectively analyzed.Seventeen patients included 1 1 men and 6 women with the mean age of 36. 3 ±8. 4.Results All patients underwent preoperative diagnosis of endoscopic ultrasonography(EUS).Four cases were diagnosed as heterotopic pancreas and 13 cases carcinoid.The size of tumor was from 4 to 10 millimeter.Cap-assisted endoscopic mucosal resection (EMR-C)were used in all patients successfully.No complications were found during or after the operation.Postoperative pathology con-firmed 6 cases of duodenal bulb carcinoid.The accuracy of EUS preoperative diagnosis was 76. 5%.The average follow-up time was 20. 5 ±12. 4 months.Metastases and recurrence had not been found.Conclusion EUS can confirm the invasive depth of duodenal submucosal tumors and estimate the indication of endo-scopic excision.EUS can not give a preoperative qualitative diagnosis of duodenal submucosal tumors.Endo-scopic hyaline cap excision is a safe and sufficient method for duodenal bulb carcinoid.
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As an aging society,China has an increasing number of elderly patients (≥80 years).Given the characteristics of pancreatico-biliary diseases in elderly patients,therapeutic endoscopic retrograde cholangiopancreatography (TERCP)has become the main approach for these patients.When TERCP is performed in elderly patients with pancreaticobiliary diseases,a more detailed strategy is needed in addition to active preoperative evaluation and emergency treatment of medical and surgical complications.TERCP provides a good therapy for elderly patients with pancreaticobiliary diseases,and it is simple,safe,and convenient.
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Objective To investigate clinical effect of combined laparoscopic and endoscopic submucosal resection for the gastric antrum-body tumors originated from the muscularis propria.Methods A total of 8 patients with gastric antrum-body tumors originated from the muscularis propria were treated by combined laparoscopic and endoscopic submucosal resection from Jan 2013 to Apr 2014.All patients were diagnosed as having gastric antrum-body tumors originated from the muscularis propria by preoperative endoscopic ultrasonography.Endoscopy showed that the surface mucosa of tumors were normal in all patients.Tumors were found in the gastric antrum-body front wall in 4 cases,and in the back wall in 2 cases,and in the lesser omental bursa in 1 case,and in the greater omental bursa in 1 case.The tumors size was from 1.5 to 3.5 cm,averaging (2.4 ± 0.7) cm.The therapeutic procedure included three phases.The lesion was first exposed with laparoscopy.Then,the fluid was injected into the submucosa in the part of tumor by endoscopy.Finally the tumor was resected by laparoscopy.These patients were followed up and analyzed retrospectively.Results Combined laparoscopic and endoscopic submucosal resection was successfully performed in all patients.All tumors were resected completely.Sever bleeding,infection or death were not found in any patients.Postoperative pathology and immunohistochemistry staining confirmed 6 stromal tumors and 2 neurofibroma.All patients were followed up for 6 months,and there was no recurrent case.Gastric mucosa and function were normal in all patients.Conclusion Combined laparoscopic and endoscopic submucosal resection is a simple,safe and effective method for gastric antrum-body tumors originated from the muscularis propria,and leads to little complication.
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Objective To observe the clinical effects of external application of Chinese medicine ion introduction through acupiont in the prevention and treatment of hyperamylasemia and pancreatitis following endoscopic retrograde cholangio pancreatography (ERCP). Methods Three hundred subjects were divided into treatment group and control group randomly, and treated with routine therapy after surgery, moreover, treatment group was treated with external application of Chinese medicine ion introduction through acupiont. The incidence of hyperamylasemia and pancreatitis, the time of serum amylase returned to normal in patients with hyperamylasemia and pancreatitis was observed, and the abdominal pain after ERCP was scored. Results Excluding 17 cases according to the exclusion criteria, the treatment group included 142 cases and the control group included 141 cases. The hyperamylasemia and pancreatitis happened less frequently in the treatment group than in control group, but there was no significant difference (P>0.05). The time of serum amylase returned to normal in patients with pancreatitis was (4.25±0.95)d in treatment group and (5.28±1.11)d in control group, with no significant difference (P>0.05). The time of serum amylase returned to normal in patients with hyperamylasemia was (2.88 ± 0.78)d in treatment group and (3.81±1.62)d in control group, showed a significant difference (P<0.05). The score of abdominal pain was 0.95±1.04 in treatment group and 1.21±1.12 in control group, showed a significant difference (P<0.05). Conclusion External application of Chinese medicine ion introduction through acupoint can promote the recovery of the patients postoperative ERCP combined with hyperamylasemia or pancreatitis, and can better alleviate abdominal pain.
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Objective To investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of adult biliary ascariasis.Methods Clinical data of 19 cases of adult biliary ascariasis diagnosed and treated with ERCP during Jan 2005 to Dec 2012 were retrospectively analyzed.Results Among the 19 adult patients with biliary ascariasis,11 were male,and the mean age was (62.7± 10.8) years.Eight cases lived in the countryside,7 cases in the integration of urban and rural area,and 4 cases in urban area.All cases had histories of eating raw fruits and vegetables.Living worms were found in 9 cases.Four cases were complicated with common bile duct stones.Petrification of residual dead worms in the common bile duct was found in 10 cases.All ascariasis and residual bodies were removed successfully by ERCP.There were no postoperative complications except for 3 cases of hyperamylasemia.Conclusions Adult biliary ascariasis commonly occurs in the elderly,and is frequently complicated with common bile duct stones.ERCP is efficacious in treating biliary ascariasis.
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ObjectiveTo study the diagnostic value of double balloon endoscopy (DBE) for gastrointestinal disease.MethodsClinical data of 53 patients with suspected intermediate gastrointestinal diseases who underwent DBE procedures were retrospectively analyzed for detection rate,complications and the incidence of adverse reactions.ResultsAll of 53 patients underwent successful DBE,Procedures were performed via mouth ( n =26),anus ( n =9 ) and the combined routes ( n =18 ).And definite diagnosis was made in 46 cases (86.79％),including upper gastrointestinal (above ligament of Treitz) disease in 3 cases (5.66％),intermediate gastrointestinal disease in 41 cases (77.36％ ) and lower gastrointestinal disease in 2 cases (3.77％).All 53 patients were tolerant to the operation and anesthesia.No severe complications like bleeding,perforation,intestinal torsion,mesenteric tear,pancreatitis or anesthetic accident occured.Several patients showed abdominal flatulence,transient abdominal pain.Some patients in oral route reported slight throat discomfort or slight nasal bleeding.Incarceration occurred in 1 case due to friction of endotracheal intubation and the silicone tube,which was released after deflation and removed out.2 patients showed mild diarrhea with low fever,and the symptoms were self-healing without special treatment in 48 h.ConclusionDBE is of high diagnostic value for gastrointestinal diseases with a high safety.
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ObjectiveTo retrospectively evaluate the clinical efficacy of endoscopic submucosal tunnel resection for esophageal leiomyoma originating from muscularis propria.MethodsA total of 16 patients with esophageal mass originating from muscularis propria were recruited with informed consents from January 2011 to November 2011,and underwent esophageal submucosal tunneling endoscopic resection.ResultsAll lesions were completely resected.Histological examinations confirmed the diagnosis of leiomyona,and immunohistochemical staining indicated active hyperplasia in 9 cases.Intraoperative mediastinal,subcutaneous and retroperitoneal emphysema occurred in one patient,and the patient recovered one week later.No other complications or death were recorded.The patients were followed up for six months on average,and no cases of recurrence were found.ConclusionEndoscopic submncosal tunnel resection of esophageal leiomyoma originating from the muscularis propria is a minimally invasive,safe and effective procedure.
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ObjectiveTo investigate the clinical value of endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria.Methods Clinical date of 18 patients with gastric fundus-cardiac submucosal tumors originating from muscularis propria who underwent endoscopic esophageal submucosal tunnel resection from January 2011 to December 2011 were retrospectively collected and analyzed.ResultsAll lesions were successfully and completely resected in 18 patients,with sizes ranging from 0.7 cm to 7.2 cm,mean (2.43 ± 1.91 ) cm.Pneumoretroperitoneum,pneumomediastinum and pneumohypoderma occured during the procedure in 2 cases,but spontaneously resolved in 3 days.Fever with increased WBC within 24 h after the procedure occurred in one patient,and was cured in two days with antibiotics.There were no severe complications including bleeding,perforation or death.All patients could have liquid diet 3 days later after the operation.Follow-up endoscopy at 1 week after the operation showed a healing of esophageal incision.ConclusionEndoscopic esophageal submucosal tunnel resection is a safe and effective method for gastric fundus-cardiac submucosal tumors originating from the muscularis propria,lessening the difficulty of traditional endoscopic resection.
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Objective To investigate the clinical value of endoscopic biliary stent drainage for obstructive jaundice due to hepatic portal metastatic carcinoma. Methods Patients with obstructive jaundice arising from hepatic portal metastatic carcinoma were selected and treated with consent by plastic endoscopic bile duct stents since 2006. Success rate and survival were evaluated. A total of 38 patients with obstructive jaundice were treated and analyzed. Hepatic portal metastatic carcinoma included 13 cases of liver cancer, 3gallbladder carcinoma, 14 gastric carcinoma, 2 esophageal carcinoma, 1 ileum adenocarcinoma and 5 pancreatic carcinoma. Results Stents were successfully placed in all patients and jaundice rapidly subsided after the endoscopic procedure. Follow-up life span was 92-521 days, mean 264. 42 ± 104. 41 days. During follow-up, biliary stents were replaced in 5 patients in 3-14 months ( mean 8. 6 ± 4. 1 months) because of stent displacment in 1 case, biliary stone obstruction in 2 cases and carcinomatous obstruction in 2 others.Conclusion For patients with obstructive jaundice arising from hepatic portal metastatic carcinoma, endoscopic biliary stent drainage is effective and can prolong life span to some degree.
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Objective To investigate the therapeutic effects of endoscopy for palliative treatment of advanced pancreatic cancer. Methods A typical case of un-resectable advanced pancreatic cancer was reviewed, who underwent obstruction of upper gastrointestinal tract, obstructive jaundice and alimentary tract hemorrhage subsequently. The patient received multiple placement of intestinal tract stents, common bile duct stents and hemostatic treatment endoscopically. Because of the obstruction of upper gastrointestinal tract, jejunalostomy and retrograde endoscopy through the orificium fistulae were performed to place bile duct stents. Results The patient survived for 10 months with good life quality after diagnosis, obstruction of upper gastrointestinal tract, obstructive jaundice and alimentary tract hemorrhage were cured and didn't recur till death.Conclusion Therapeutic endoscopy, safe and effective, is the first choice for advanced pancreatic cancer complicated with obstruction of digestive tract (including gastrointestinal tract, bile duct and pancreatic duct).
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Objective To investigate the effects of valproic acid ( VPA) on cell proliferation and cell cycle in human pancreatic cancer cell line PaTu8988 in vitro. Methods PaTu8988 cells were treated with VPA in concentration of 0, 0.2, 1.0 or 5.0 mmol/L for 24 h and 48 h respectively. Cell viability was measured by WST-8 assay. Cell cycles were detected by flow cytometery. Dimethyl sulfoxide added to the medium was used as blank control group, while PBS added to the medium was used as PBS group. Results After VPA treatment for 24 h, the inhibition rate of VPA 5.0 mmol/L group was 18.9% , which was significantly higher than those in control group, PBS group and VPA 0.2, 1.0 mmol/L group (0, 4.4% , 6.8%, 6.1% , P <0.05). After 48 h, the inhibition rates of VPA 1.0, 5.0 mmol/L were 12.9%, 25.9% , which was significantly higher than those in control group, PBS group and VPA 0.2 mmol/L group (0, 6.2% , 4.6% , P <0.01). After VPA treatment for 24 h, the proportions of G2 phase cell in VPA 1.0, 5.0 mmol/L group were ( 26.57 ± 1.88) % , ( 34.11 ± 4.74 ) % , which was significantly higher than those in PBS group, control group, VPA 0.2 mmol/L group [(10.72 ± 2.02)% , ( 13.53 ± 2.28)% , (13.81 ±2.40)%, P <0.01 ], the changes 48 h after VPA treatment was consistent with the changes 24 h after VPA treatment. Conclusions VPA may significantly suppress the cell proliferation of human pancreatic cancer cell line PaTu8988, and induce cell cycle arrest in G2 phase in a time and dose-dependent manner.
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Objective To investigate the therapeutic effects of Tongxinluo and its influence on the expression of CD40 and CD40L in artherosclerosis rabbits. Methods 60 male rabbits were divided into three groups randomly,20 of each group: normal control group, model group and Tongxinluo group. The rabbits in model group and Tongxinluogroup were used to prepare the atherosclerosis model induced by high-cholesterol diet. The levels of ET-1, NOwere measurde. Before and 12 weeks after durg treatment,serum total cholesterol ,plaque areas and ratios of intima/media thickness were detected. The expression of CD40 and CD40L mRNA were determinated by quantitive RT-PCR. Results Serum total cholesterol level of Tongxinluo group was decreased compared with model group ( P < 0. 05 ), and they were both much higher than those of normal control group ( P < 0. 01 ); as compared with the model group, aortic plaque areas and ratios of intima/media thickness in Tongxinluo group reduced significantly [ (0.56 ± 0. 07) vs ( 1.16±0.08),P<0.01;(36.88±2.38)% vs (76.58 ±2.86) %,P <0. 0l] ;The expression of CD40 and CD40L mRNA also decreased in Tongxinluo group with statistic significance[ (0.798 ± 0.115 )、 (0. 592 ± 0. 132) vs (0.686±0. 132) 、(0.498 ±0. 108) ,P <0. 01 ) ]. Conclusion Tongxinluo had the ability to anti-artherosclerosis and its possible mechanism was down-regulate the expression of CD40 and CD40L.
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nd hypermethylation of HHIP was detected in pancreatic juice,which may be a useful marker in the diagnosis of PCa.