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To investigate the feasibility and safety of endoscopic trans-gastric cholecystolithotomy(ETGC) combined with endoscopic retrograde cholangiopancreatography (ERCP) for cholecystolithiasis and choledocholithiasis. Data of patients with cholecystolithiasis and choledocholithiasis who underwent ETGC after ERCP in Zhongshan Hospital Affiliated to Fudan University from November 2018 to April 2019 were analyzed. Six patients with cholecystolithiasis and choledocholithiasis, 4 males and 2 females, were included in this study.The interval between ERCP and ETGC ranged from 1 to 77 days (median 5 days). All the 6 patients successfully completed ETGC after ERCP, with a surgical success rate of 100%. All the patients had multiple cholecystolithiasis and one patient was complicated with gallbladder polyps.The ETGC operation time was 22-100 min (median 65 min), and the length of hospital stay was 3-9 d (median 6.5 d). Two patients had dull pain in the upper abdomen and increased body temperature after surgery. Abdominal ultrasound in one patient suggested local effusion in the right upper abdomen.Both patients improved after conservative treatment.None of the patients had cholecystitis and cholangitis related symptoms such as right upper abdominal pain or fever during postoperative follow-up, and the follow-up rate was 100%with median follow-up time of 18 month.All the 6 patients underwent abdominal ultrasound examination after surgery. No recurrence occurred in 5 patients. One of the patients showed cholesterol crystals in the gallbladder wall and bile mud deposition.ETGC combined with ERCP is safe and feasible for cholecystolithiasis and choledocholithiasis.
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Objective To investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones. Methods The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized. Results In the 84 cases of cholecystolithiasis, there were 19 cases ( 22. 6％) of single stone, 53 cases ( 63. 1％) of multiple stones, and 12 cases ( 14. 3％) of gallstones with gallbladder polyps. A total of 82 patients ( 97. 6％) successfully completed ETGC with median operation time of 88 min. Ten patients ( 12. 2％) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up ( follow-up rate was 93. 9％, 77/82 ) . Residual stones were found in 2 cases ( 2. 6％, 2/77 ) . Stone recurrence was discovered in 4 cases ( 5. 2％, 4/7 ) , and 2 cases ( 2. 6％, 2/77 ) had cholesterol crystallization in gallbladder. Conclusion ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.
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Objective@#To investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones.@*Methods@#The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized.@*Results@#In the 84 cases of cholecystolithiasis, there were 19 cases (22.6%) of single stone, 53 cases (63.1%) of multiple stones, and 12 cases (14.3%) of gallstones with gallbladder polyps. A total of 82 patients (97.6%) successfully completed ETGC with median operation time of 88 min. Ten patients (12.2%) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up (follow-up rate was 93.9%, 77/82). Residual stones were found in 2 cases (2.6%, 2/77). Stone recurrence was discovered in 4 cases (5.2%, 4/7), and 2 cases (2.6%, 2/77) had cholesterol crystallization in gallbladder.@*Conclusion@#ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.
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Objective To explore the clinical effect of endoscopic retrograde cholangiopancreatography (ERCP) for elderly patients with periampullary diverticula accompanied with choledocholithiasis.Methods The retrospective cross-sectional study was conducted.The clinical data of 297 elderly patients with age ＞70 years and periampullary diverticula accompanied with choledocholithiasis who were admitted to the Zhongshan Hospital affiliated to Fudan University between January 2013 and January 2016 were collected.All the patients received lithotomy by ERCP after completion of preoperative preparation,and then underwent symptomatic treatment.Observation indicators included:(1) treatment results:cannulation time,success rate of cannulation and success rate of stones removed;(2) surgical complications:hemorrhage,perforation and pancreatitis;(3) follow-up results.All patients were followed up by outpatient examination and telephone interview up to December 2016.Follow-up included postoperative delayed perforation,patients' survival,further attack of acute cholangitis and reoperation for removing stones.Measurement data with normal distribution were represented as x ± s,and measurement data with skewed distribution were described as M (range).Results (1) Treatment results:all the 297 patients underwent successful lithotomy by ERCP,with a cannulation time of (5±4)minutes and a success rate of cannulation of 100.00％ (297/297).Of 297 patients,292 had one-off success of stones removed,with a one-off success rate of 98.32％ (292/297),and 5 received partial stones removed due to choledocholithiasis combined with acute cholangitis.(2) Surgical complications:4 patients were complicated with immediate hemorrhage during intraoperative endoscopic sphincterotomy (EST).Bleeding of 1 patient was cauterized by biopsy forceps,and 3 patients had simplex JHY-BAL compression hemostasis.Two patients with postoperative delayed hemorrhage had successful hemostasis by biopsy forceps with metal hemostatic clip under endoscope after emergency duodenoscopy.One patient with intraoperative perforation was cured by conservative treatment.Two patients with severe acute pancreatitis underwent continuous gastrointestinal decompression combined with maintenance therapy of somatostatin,and then received endoscopic ultrasound-guided puncture and drainage for pseudocyst around the pancreas,with a stable symptoms of pancreatitis after 4 weeks.(3) Follow-up results:all the 297 patients were followed up for 6-12 months,with a median time of 8 months.During follow-up,292 patients had healthy survival,without recurrences of cholangitis and bile duct stone,and no delayed perforation and death were detected.Five patients underwent the second time lithotomy by ERCP after 2-3 months postoperatively.Conclusion Lithotomy by ERCP is safe and effective in the treatment of elderly patients with periampullary diverticula accompanied with choledocholithiasis.
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Objective To evaluate the efficacy of a new endoscopic suturing device(OverStitchTM, Apollo Endosurgery, USA)for gastrointestinal wall defect after endoscopic full?thickness resection (EFTR). Methods Clinical data of the patients with submucosal tumors who underwent endoscopic suturing closure of gastrointestinal wall defect at the Endoscopy Center of Zhongshan Hospital from April 2015 to June 2015 were retrospectively analyzed. Results Five patients were included in this research with 4 lesions located in stom?ach and 1 lesion located in descendent duodenum. The mean diameter of lesions was 3?? 2 cm (ranging 2?? 0?5?? 0 cm). All patients underwent complete closure and none of them was converted to laparoscopic surgery or laparotomy. The mean repairing time was 16?? 6 min (ranging 11?? 0?22?? 0 min). The mean postoperative hospi?talization time was 5 days ( ranging 4?6 d). Two patients complained about slight abdominal pain and elevated body temperature. CT showed minor pleural effusion in one case. These patients received antibiotics, were on gastrointestinal decompression and asked to maintain the semi?supine position and discharged after 3 to 4 days. Conclusion Endoscopic suturing closure of gastrointestinal wall defect with the OverStitchTM en?doscopic suturing device is technically fast, feasible and safe.
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Objective To evaluate clinical efficacy and safety of endoscopic radial incision( ERI) for benign stricture of esophageal anastomosis. Methods Clinical data of 17 patients with benign stricture of e?sophageal anastomosis undergoing ERI from October 2013 to September 2014 were retrospectively studied. Im?provement of clinical symptom and treatment?related complication or discomfort were intensively analysed. Re?sults All 17 patients successfully received ERI procedures, and the mean operating time was 10 minutes with a mean of 4 incisions. Obvious bleeding and mis?cut of normal mucosa occurred in 1 case, and this patient was cured by endoscopic hemostasis, gastrointestinal decompression and administration of antibiotics. Heartburn oc?curred in 5 patients and disappeared spontaneously without other complications or discomfort. Dysphagia score decreased from 3?11 to 0?90 in the second day after ERI(P0?05 ) . Conclusion ERI is simple, safe and effective for treating benign stricture of esophageal anastomosis.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of gastrointestinal cysts.</p><p><b>METHODS</b>Clinicopathological data of 40 patients with gastrointestinal cyst undergoing ESD in our center during January 2008 and February 2012 were analyzed retrospectively. Complications, en bloc resection rate, and local recurrence were assessed.</p><p><b>RESULTS</b>Eight lesions located in the esophagus, 11 in the stomach, 5 in the duodenum, and 16 in the colorectum. Thirty-seven lesions were successfully resected with ESD in an en bloc fashion (92.5%). During the operation, one perforation was encountered in the ascending colon and was clipped; one massive hemorrhage occurred in the esophagus and was treated with balloon compression. Postoperative pathological examination revealed cyst samples were intact without lesions in lateral and basal resection margins. Local recurrence was not found in 36 patients during a median postoperative follow-up of 9.7 months (range, 6-12 months).</p><p><b>CONCLUSION</b>ESD is a safe and effective procedure for the treatment of gastrointestinal cysts.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Cysts , General Surgery , Digestive System Neoplasms , General Surgery , Endoscopy , Mucous Membrane , General Surgery , Retrospective StudiesABSTRACT
ObjectiveTo study the diagnostic and therapeutic value of endoscopy for gastrointestinal (GI) schwannoma.MethodsWe retrospectively studied data of 13 patients who underwent endoscopy and were confirmed as having GI schwannoma by pathology in our hospital during January 2006 and July 2011.ResultsSchwannoma of 8 patiets located in stomach,3 in esophagus and 2 in colon.Endoscopic ultrasonography showed schwannoma originated from muscularis propria,characterized by hypoecho.Twelve patients received endoscopic treatment,and 11 were successfully removed.The en bloc resection rate was 91.7％.Among them,6 were treated by endoscopic submucosal excavation,4 by endoscopic full-thickness resection and one by submucosal tunnel endoscopic resection.Another patient with schwannoma located in esophagus with a maximum diameter of 4.7 cm was transferred to thoracic surgery since the tumor had a wide base even after partial resection.No bleeding,inflammation or abscess occurred.The average follow-up time was 23.3 ± 10.8 months ( range,6-36 months).No metastasis or recurrence was found during follow-up.ConclusionEndoscopy and endoscopic ultrasonography,safe and efficacious,are valuable for the diagnosis and treatment of GI schwannoma.
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Objective To evaluate the clinical efficacy and safety of metallic hemoclips in the treatment of gastric defects during endoscopic full-thickness resection. Methods Patients with submucosal tumors derived from the muscularis propria and adhesion of the gastric serosa diagnosed by EUS and CT were enrolled in the study.A total of 62 patients,22 males and 40 females,mean age 58.5 years,were recruited into the present study from June 2009 to December 2010,in which 37 patients were with tumors in gastric fundus,20 in gastric body and 5 in antrum.All patients were treated with endoscopic full-thickness resection.After the operation,metallic hemoclips were used to close the defects through endoscopic biopsy channel.The closure success rate with metallic hemoclips were assessed.The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures.Results All patients underwent endoscopic full-thickness resection.Uncontrollable bleeding occurred in 1 patient,who subsequently underwent emergent laparoscopic surgery and was excluded from the study.Metallic hemoclips were applied to close defects in 57 patients,and metallic hemoclips combined with omentum obstruction in 4 patients.The overall success rate was 100％ in 61 patients.Endoscopic follow-up was completed in all patients in average of 4.4 months.The clinical wound healing rate was 100％.No complications such as fever,abdominal pain were found in 2months after the procedures.Conclusion Application of metallic hemoclips during endoscopic full-thickness resection for gastric defects is a safe and effective technique.
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ObjectiveTo evaluate the clinical efficacy and safety of nylon ligation combined with endoscopic high-frequency electric snare for the treatment of colorectal polyps.MethodsThe clinical data of 345 patients with colorectal polyps who received the treatment of nylon ligation combined with endoscopic high-frequency electric snare at the Zhongshan Hospital of Fudan University from January 2006 to January 2011 were retrospectively analyzed.Complications including bleeding and perforation were observed.Postoperative wound healing and local residual recurrence were assessed during follow-up.ResultsA total of 362 colorectal polyps were successfully removed.The mean diameter of the colorectal polyps was 2.7 cm (range,1.5-4.0 cm). Operative bleeding occurred in 1 patient,and perforation in 1 patient.The results of histological examination showed that 93.6％(339/362) colorectal polyps were adenoma,17 were hyperplastic polyps,5 were inflammatory polyps,and caneeration of colorectal polyps in 1 patient was detected.Endoscopic follow-up was completed in 334 patients at the first month after operation,and 9 patients with residual benign colorectal polyps received endoscopic resection.No residue or recurrence was found in the other patients.Endoscopic follow-up was completed in 308 patients at the second months after operation,and no residue or recurrence was found.The overall effective rate was 97.1％ (299/308).ConclusionEndoscopic nylon ligation combined with endoscopic high-frequency electric snare is effective and safe for the treatment of colorectal polyps.
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Objective To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for achalasia (AC). Methods The clinical data of 8 patients diagnosed as having AC and receiving POEM at our center from August 2010 to December 2010 were reviewed. The patients were 16-62 years old, mean 43yr, whose disease courses lasted for 2-20 years, mean 8.4 years. The key procedures of POEM were as the following, esophageal mucosal incision, submucosal tunneling by endoscopic submucosal dissection ( ESD), endoscopic myotomy of the circular muscle and closure of mucosal entry by hemostatic clips. Results All the 8 patients underwent POEM successfully. The mean operation time was 68.5 min ( ranging 45-115 min). The mean submucosal tunneling length was 9.5 cm ( ranging 8-13 cm). The average length of endoscopic myotomy of inner circular muscle was 8.5cm ( ranging 7-11 cm). No severe complications related to POEM occurred. Patients were followed up for 1-4 months ( mean 2. 5 months). Dysphagia was relieved significantly during the follow-up in 7 patients. But dysphagia and vomiting re-occurred in one patient 15 days after the operation. Endoscopy revealed a submucosal fistula, which was managed by incision. Conclusion As a new minimally invasive therapy for AC, POEM is very effective to relieve dysphagia in a short term. However, further observation is needed to evaluate long-term efficacy and complications.
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ObjectiveTo evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal (GI) submucosal tumors (SMTs) originating from the muscularis propria (MP) layer.MethodsA total of 26 upper GI-SMTs originating from the MP layer were treated by STER after endoscopic ultrasonography (EUS) and CT examination.The lesions were localized endoscopically and a submucosal tunnel was created to expose the tumor.The lesion was then resected under direct endoscopic view and the mucosal incision site was closed with hemostatic clips.ResultsOf the 26 SMTs,14 were located at esophagus,7 at cardia and 5 at stomach,with 11 originated from superficial MP layer and 15 from deep MP layer ( including 2 gastric SMTs adherent with serosa).All lesions were successfully resected by STER with an en bloc resection rate of 100％.The average operation time was 68.5 min ( range 25-145min).Four to six (mean five) hemostatic clips were used to close the mucosal incision site.The average lesion size was 1.8 cm ( range 1.0-3.2 cm).The pathology results were 17 leiomyomas,7 stromal tumors (GISTs),1 glomus tumor and 1 Schwannoma.All resected lesions showed both lateral and vertical tumorfree margins.Subcutaneous emphysema occurred in 2 patients (7.7％ ).One patient (3.8％ ) developed left pneumothorax and subcutaneous emphysema,and 2 others (7.7％) pneumoperitoneum.All of them recovered uneventfully on conservative treatments.No delayed bleeding,GI tract leakage or secondary peritoneal/thoracial infection occurred.None of the 26 cases developed submucosal hematoma or infection.No tumor residual or recurrence was found during follow-up period (range 3-9 months).ConclusionSTER is a safe,efficacious and feasible new method for providing accurate histopathological evaluations,as well as radical treatments for upper GI-SMTs from the MP layer.It can regain the mucosal integrity of the GI tract,preventing leakage and secondary infection.
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Objective To evaluate the safety, indications and clinical efficacy of single balloon enteroscopy (SBE) for diagnosis of small bowel diseases. Methods Data of 30 patients (21 males and 9 females) with suspected small bowel diseases, who underwent SBE from June to September 2009, were retrospectively studied to analyze the access, procedure time and complications of SBE. Results A total of 35 SBE procedures were performed on 30 patients. Procedures were performed via oral, anal and the combined routes in 15, 10 and 5 cases, respectively, and definite diagnosis was made in26 cases (86. 7% ). The average access times via oral and anal routes were 49.7 min and 48. 6 min, respectively. Patietns showed normal vital signs during the procedures. No such procedure-related complications as cadiovascular events, severe abdominal pain, bleeding or perforation, were observed. Conclusion SBE is a safe and reliable diagnostic modality of high clinical value for small bowel diseases.
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Objective To evaluate the clinical efficacy and safety of 4 types of endoscopic nylon ligation in the treatment of submucosal tumors in upper gastrointestinal tract. Methods Those with submucosal tumors located in esophagus, stomach or duodenum were enrolled in the study. All patients were treated with endoscopic nylon ligation, which included direct ligation, ligation with a transparent cap, ligation with dual-channel endoscope, and ligation in combination with endoscopic submucosal dissection (ESD).The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures. Results A total of 128 patients were recruited into the present study from June 2006 to December 2008. The tumors were in esophagus in 28 patients, in stomach in 82 and in duodenum in 18. Direct ligation was applied in 3 patients, ligation with a transparent cap in 105, ligation with a dual-channel endoscope in 8, and ligation plus ESD in 12. Endoscopic follow-up was completed in 111 patients. Reduced lesion size was observed in 16 patients ( 14. 4% ), residue nylon in 16 ( 14. 4% ) and no lesion in 71 others (63.9%). The overall effective rate was 92.8%. No delayed perforation or bleeding occurred. Conclusion Endoscopic ligation with nylon thread in combination with other assistant approaches is effective and safe for the treatment of submucosal tumors in upper gastrointestinal tract.
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Objective To determine the efficacy and safety of endoscopic submucosal dissection(ESD) for local residual and recurrent lesions in digestive tract after endoscopic mucosal resection (EMR).Methods From June 2006 to November 2007, 15 patients with local residual and recurrent lesions of digestive tract after EMR underwent ESD. The procedures of ESD were as follows: normal saline was injected into the sub-to elevate the lesions from the muscle layer, and the mucosa around the lesions were pre-cut, then the connective tissue of the submucosa beneath the lesions was dissected, and the scar beneath the lesion was re-sected along the plane of the submucosa with a Hook-knife. Results The mean diameter of 15 residual and re-current lesions after EMR were 2. 3 era(0.8 ～ 3. 5 cm), of which 6 lesions were located in stomach, 3 in colon and 6 in rectunm. All cases showed negative lifting sign due to scar formation. Fourteen lesions were completely re-sected and the overall resection rate was 93.3%(14/15). It was pathologically confirmed that 13 cases showed no tumor involvement in lateral and basal resection margins, and the complete resection rate was 86.7% (13/15).The mean operation time was 87 min(ranging from 60 to 155 min). Minor bleeding occurred during ESD in all ca-ses, but there was no postoperative bleeding. Two cases had free air in abdominal cavity due to deep dissection,but recovered with conservative treatment after ESD without surgical involvement. The perforation rate was 13.3%(2/15). The mean follow-up period was 13 months and no recurrence was recorded. Conclusion ESD proves to be a novel, safe and effective procedure for local residual and recurrent lesions after previous EMR, which makes it possible to resect the lesions completely and provide precise pathological information.