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Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries “achalasia,” “peroral endoscopic myotomy,” and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected.The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.
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Background: Intestinal mucosal barrier function is closely related to the prognosis of patients with severe acute pancreatitis (SAP). Protecting intestinal mucosal barrier function has become the key of treatment of SAP. Aims: To explore the relationship between autophagy and intestinal mucosal barrier function in SAP and the effect of autophagy inhibitor 3-MA. Methods: SD rats were randomly divided into sham operation (SO) group, acute necrotizing pancreatitis (ANP) group and 3-MA group. Each group was further divided into 3 subgroups: 3, 6 and 12 hours after surgery. HE staining was used to observe the pathological changes of pancreatic and intestinal tissue. Blood amylase was detected; serum endotoxin and intestinal fatty acid-binding protein (I-FABP) were determined by ELISA; protein expression of Beclin-1 was examined by Western blotting. Results: Compared with SO group, pathological score of pancreatic and intestinal tissue, blood amylase, endotoxin and I-FABP were significantly increased at each time points in ANP group (P<0.05), while protein expression of Beclin-1 was significantly decreased (P<0.05), and all above-mentioned indices were time-dependent (P<0.05). After treatment with 3-MA, above-mentioned indices were significantly ameliorated (P<0.05). Conclusions: In SAP, intestinal autophagy gradually increases with the progress of disease. After intervention with 3-MA, intestinal autophagy decreases and damage of intestinal mucosal barrier function is alleviated, suggesting that intestinal autophagy is related to the damage of intestinal mucosal barrier function of SAP, and 3-MA has an inhibitory effect.
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Objective To compare the clinical efficacy of refined mirabilite vs.Chaishao Chengqi Decoc-tion in treating sever acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS). Methods 60 cases of SAP complicated with ACS were divided into treatment group(n = 32) and control group (n=28) with random number table.The treatment group was given the nasal feeding and enema with refined mira-bilite base on routine western medicine treatment. The control group was given the nasal feeding and enema with Chaishao Chengqi Decoction. The 2 groups were compared with respect to the changes of the APACHEⅡ scores, intra-abdominal pressure,endotoxin,calcitonin(PCT),tumor necrosis factor alpha(TNF-α),recovery time of bowel sound,self-defecation recovery time,length of stay and hospitalization expenses. Results After 7 days of treatment,the intestinal permeability index(endotoxin) and the related indicators(PCT,TNF-α) were significantly lower than before treatment in both groups(P<0.05).The abdominal pressure of both groups at days 1,3 and 7 days after treatment was significantly lower than before treatment(P < 0.05) but the difference between the two groups had no statistical significance(P > 0.05). In the 3rd and 7th days of the treatment,APACHEⅡ scores were significantly lower than before treatment(P<0.05),but the difference between the two groups was not statis-tically significant in the score(P>0.05).The two groups showed no significant difference in the recovery time of bowel sound,self-defecation recovery time,length of stay and hospitalization expenses(P > 0.05). Conclusions Refined mirabilite as adjuvant therapy in SAP with ACS,can effectively reduce the internal pressure,promote the intestinal function recovery,protect the intestinal mucosal barrier function,reduce intestinal bacteria and endotox-in translocation and the complications of infection.It has a similar clinical effect as Chaishao Chengqi Decoction to the recovery of the disease.
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Astract: Objective To explore the efifcacy and safety of endoscopic tissue adhesive injection in treatment of gastric variceal bleeding from liver cirrhosis.Methods Object of study are 92 cirrhotic patients (72 male/20 female) in hospital, who had been diagnosed with gastric varices bleeding from June 2014 to May 2016. Child-Pugh score at presentation for cirrhotic patients was A-28; B-36; C-28. According to endoscopic classiifcation of gastric varices, GEV1 were detected in 80 patients, GEV2 in 12. All patients were treated with endoscopic hypertonic glucose tissue adhesive ‘sandwich’ injection.Result Successful injection rate was 100.0% in 92 patients, among which 40 patients had accepted emergency endoscopic treatment and the immediate hemostasis rate was 100.0%. 65 patients were Having gastroscope review after the injection six months, 22 patients were significantly effective, accounting for 33.8%; 38 patients were effective, accounting for 58.4%; 5 patients were invalid, accounting for 7.7%. All the patients were followed up in 1 to 24 months. The late-rebleeding rate was 2.2%. None of them were having early-rebleeding or dead; Complications the incidence of rebleeding rate which caused by removing the needles which trapped in the varices was 2.2%. The incidence of chest pain rate was 4.3%, the bloating rate was 6.5% and the ulceration rate was 15.2%. There was no complications like fever, infection, stomachache, embolism and so on.Conclusion With low rebleeding rate and light side-effect, endoscopic tissue adhesive injection in the treatment of gastric variceal bleeding caused by cirrhosis portal hypertension has really good effect.
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ObjectiveTo investigate the clinical features and treatment of severe acute pancreatitis (SAP) complicated by pancreatic abscess (PA). MethodsThe clinical data of 17 SAP patients with PA who were admitted to Affiliated Hospital of Luzhou Medical College from January 1, 2005 to August 25, 2015 were analyzed retrospectively. The clinical manifestations, therapeutic methods, and outcome were summarized. ResultsOf all the 17 patients, 12 patients underwent surgical operation, among whom 9 were cured, 1 experienced postoperative intestinal fistula, and 2 experienced recurrence of abscess and underwent the surgery again (1 died of multiple organ failure), and the mean hospital stay was (108.29±52.37) d; 5 patients underwent percutaneous catheter drainage, among whom 4 were cured, and 1 underwent surgical treatment due to inadequate drainage, and the mean hospital stay was (53.03±6.71) d. ConclusionAdequate drainage should be performed once a confirmed diagnosis of PA is made, and appropriate drainage methods should be selected based on the patient′s actual condition. Minimally invasive treatment has a good effect, a short length of hospital stay, and few complications, and holds promise for clinical application.