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Objective:To investigate the risk factors of restenosis after dilation of anastomotic stenosis in patients with esophageal cancer surgery.Methods:Clinical data of 997 patients who underwent endoscopic dilation due to anastomotic stenosis after esophageal cancer radical surgery in the Affiliated Huai′an First Hospital of Nanjing Medical University from June 2015 to July 2021, were retrospectively analyzed. There were 486 cases receiving single dilation (single dilation group) and 511 cases receiving more than two dilations (multiple dilation group). The risk factors of restenosis were explored using univariate and multivariate logistic regression analysis.Results:There were 682 males and 315 females with a median age of 65 years, the median distance between the stenosis and incisor was 20 (20, 22) cm, the median stenosis diameter was 4 (3, 5) mm, and the median stenosis diameter after dilation was 11 (11, 13) mm. Univariate analysis showed that there were significant differences in the distance of the stenosis and incisor ( Z=-2.303, P<0.05), stenosis diameter ( Z=-4.637, P<0.05) and stenosis diameter after dilation ( Z=-5.773, P<0.05) between single and multiple dilation groups. Stratified multivariate logistic regression showed that for male patients, risk of multiple dilations dropped by approximately 3% for every 1-mm increase in the distance between the stenosis and incisor ( OR=0.97, 95% CI:0.93-1.00, P=0.047); the risk of multiple dilations decreased by about 15%, for every 1-mm increase in stenosis diameter ( OR=0.85, 95% CI:0.76-0.94, P=0.004); the risk of multiple dilations decreased by about 13% for every 1-mm increase in stenosis diameter after dilation ( OR=0.87, 95% CI:0.78-0.96, P=0.007). For females patients under 60 years old, the risk of multiple dilations decreased by about 31%, for every 1-mm increase in stenosis diameter after dilation ( OR=0.69, 95% CI:0.47-0.98, P=0.049); for female patients≥60 years old, the risk decreased by about 5%, for every 1-year increase in age ( OR=0.95, 95% CI:0.91-1.00, P=0.037), risk of multiple dilations dropped by 17%( OR=0.83, 95% CI:0.70-0.99, P=0.039) for every 1 mm increase in stenosis diameter after dilation. Stratified smooth curve fitting indicated that the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm were risk factors for multiple dilations. Conclusions:The study indicates that patients with the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm may need multiple dilations; and the first dilation should expand the stenosis diameter to 12 mm or above as far as possible to reduce the risk of restenosis in patients receiving esophageal cancer radical surgery.
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Objective To study the effectiveness and safety of different endoscopic papillary balloon dilation time in treatment of common bile duct stones. Methods 45 patients with common bile duct stones received ERCP treat﹣ment, and they were randomly divided into short-term and long-term balloon dilatation group, then compared opera﹣tive time, intraoperative and postoperative complication rate, hospitalization days and the total cost of hospitalization between the two groups. Results Short-term group included 22 people, the long term group included 23 people, there were no significant difference in stones' size, number and diameter of common bile duct between the two groups (P> 0.05), however, the success rate of surgery, time of stones' extraction, intraoperative complications and postoperative fistula were significant differences (P<0.05). Conclusion Long-term balloon dilation during ERCP for treatment of common bile duct stones can improve the success rate of stone removal and reduce complications.
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Objective To evaluate the efficacy of itopride hydrochloride combined with alpha-lipoic acid in treatment of diabetic gastroparesis.Methods One hundred and ten patients with diabetic gastroparesis were randomly assigned to two groups.Sixty patients received α-lipoic acid plus itopride (α-lipoic acid 0.6 g intravenously for 14 d plus itopride 50 mg orally t.i.d), and 50 cases received oral itopride only.The clinical symptoms including postprandial abdominal fullness, belching, acid reflux, anorexia, nausea and vomiting were observed;the gastric emptying rate was tested, and plasma motilin and serum ganstrin levels were measured groups, before and after two weeks of treatment.Results The clinical symptom scores of combination therapy group (4.62 ± 3.46 vs.12.26-± 3.43) and control groups (5.43-± 3.65 vs.12.31-± 3.37) were improved after treatment.The overall effective rate of combination group was 91.6％ and that of itopride therapy group was 78.0％ (x2 =4.098, P ＜ 0.05).Gastric emptying rate of combination group [(76.9 ± 9.7) ％ vs.(37.3 ± 10.2) ％] was increased more markedly than that ofitopridegroup[(57.2-± 10.4)％ vs.(36.8-± 11.2)％] (t =10.221, P ＜0.05).Plasma motilin and serum ganstrin levels in combination group [(640.2 ± 64.4) ng/L vs.(554.0 ± 67.6) ng/L, (152.6 ± 20.3)ng/L vs.(96.8 ± 22.2)ng/L] were reduced more markedly than those in itopride group [(636.3 ±66.4)ng/L vs.(589.4 48.3)ng/L, (153.5-± 19.4) ng/L vs.(120.9 ± 19.7)ng/L] respectively (t =3.100, 5.959, all P ＜ 0.05).Conclusion For patients with diabetic gastroparesis, α-lipoic acid and itopride combination therapy can significantly improve symptoms and gastric emptying rate, decrease motlin and gastrin levels;and the efficacy of combination therapy is better than that of itopride monotherapy.
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Body mass index [BMI] has been demonstrated to be associated with serum uric acid [SUA] level in many developed countries, however, there is still a lack of large sample study in Jiangsu Province, one of the most economically developed regions in China, where fat-rich diet is common. Through retrospective analysis in healthy subjects, we determined the association of BMI with hyperuricemia risk. Data of 39,736 participants from January 2011 to June 2013 in China were analyzed for parameters including physical examinations and biochemical blood analysis. On univariate analysis, SUA was positively correlated with age, SBP, DBP, BMI, FPG, red blood cell count, hemoglobin, white blood cell count, platelet, cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ALT, AST, bilirubin, albumin, BUN and creatinine. SUA was significantly elevated in a linear fashion as BMI increased, and SUA in obesity was significantly higher than underweight. The prevalence of hyperuricemia remained approximately 2.98 times greater among individuals with overweight, and 5.96 times greater among obesity, compared to individuals with underweight. There is a positive relationship between BMI and SUA among healthy subjects in Jiangsu province, China
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Humans , Male , Female , Body Mass Index , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Objective To investigate the value of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) for the diagnosis and therapy of gastric ectopic pancreas.Methods A total of 86 patients who were suspicion diagnose with gastric ectopic pancreas received ESD or STER in hospital,and the therapeutic effect and safety were followed-up.Results Fifty-four gastric ectopic pancreas patients were definitely diagnosed by postoperative pathology.Of the 54 patients,43 cases were located at the gastric antrum,7 cases were located at gastric fundus and gastric corpus juncture,4 cases were located at gastric corpus.Forty-five cases received ESD,9 cases received STER,rate of completely resection was 88.9％ (48/54),6 cases had a little tissue residual after resection.One case (1.9％,1/54) happened postoperative delay-bleeding,intraoperative and postoperative perforation was not found.During 1-32 months followed up,recurrence was not found.Conclusion ESD could excise the whole lesion to offer an accurate pathology diagnose,meanwhile good for treatment,ESD is an effective and relatively safe method for gastric ectopic pancreas,STER may be a new approach for gastric ectopic pancreas.
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Objective To investigate the correlation between electrogastrogram and gastric emptying in functional dyspepsia (FD) patients.Methods Fifty-one patients with FD were detected by polygraf ID 4-channel electrogastrogram(EGG) analysis system and solid radiopaque marker 5 h after a solid meal.Results 31.4％ (16/51) patients showed delayed gastric emptying(GE),and 72.5％(37/51) patients showed abnormal EGG.The rate of GE between normal EGG patients and abnormal EGG patients had no significant difference(P ＞ 0.05).In patients who had both abnormal EGG and delayed GE,EGG abnormality mainly exhibited dysrhythmia and the dominant frequency of EGG was normal.Some patients also exhibited non enhanced postprandial dominant power.The rate of GE among mild,moderate and severe symptom patients had no significant difference (P ＞ 0.05).The rate of abnormal EGG in severe symptom patients was significantly higher than that in mild and moderate symptom patients [92.9％ (13/14) vs.62.5％ (10/16),66.7％(14/21)] (P ＜0.05).The rate of abnormal EGG in mild and moderate symptom patients had no significant difference (P ＞ 0.05).The rate of GE between Helicobacter pylori (Hp) positive patients and Hp negative patients had no significant difference (P ＞ 0.05).The rate of abnormal EGG in Hp positive patients was significantly higher than that in Hp negative patients [90.0％ (18/20) vs.61.3％ (19/31)] (P ＜ 0.05).The rate of GE and the rate of abnormal EGG had no significant difference between patients with and without active gastritis(P ＞ 0.05).Conclusions The abnormality of EGG plays an important role in the pathogenesis of FD.There is no significant relationship between EGG and GE.The patients with severe symptom and with Hp positive have higher abnormal EGG percentage.Gastritis has no significant correlation with EGG or GE.
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Objective To investigate the diagnostic value of tumor marker measurement in biliary juice obtained during endoscopic retrograde cholangiopancreatography (ERCP) in differential diagnosis of suspected biliary-pancrentic diseases.Methods ERCP was performed in patients with suspected biliarypancreatic lesions that could not be diagnosed by routine methods including ultrasonography,MRCP,blood biochemistry and serum tumor marker test,and biliary juice was obtained to measure tumor markers including CEA and CA199.A total of 29 patients with definitive diagnosis were recruited and divided into benign and malignant groups.Serum biochemical findings and tumor markers were compared between 2 groups.The diagnostic value of uhrasonography,EUS,MRCP,ERCP and ERCP combined with biliary tumor markers were also compared.Results There was no significant difference in serum biochemical findings,serum CEA,serum CA19-9 or biliary CA19-9 between 2 groups,while the average biliary CEA in malignant group was significandy higher than that in benign group (P＜0.001).The accuracy of ERCP combined with biliary tumor markers in diagnosing suspected biliary-pancreatic diseases was 69.0%,which was higher than that of ultrasonography (6.9%),MRCP (37.9%) and ERCP (41.4%),respectively.Conclusion The diagnostic accuracy of suspected biliary-pancreatic diseases can be improved through ERCP combined with biliary CEA test,which is helpful in differential diagnosis between benign and malignant lesions.