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Objective:To investigate the clinical efficacy and safety of balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) for esophageal varices in patients with cirrhosis.Methods:From December 2020 to April 2021, cirrhotic patients with esophageal varices who planned to receive endoscopic treatment in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University were selected and randomly divided into the trial group (treated with bc-EIS) and the control group [treated with endoscopic variceal ligation (EVL)] through computer randomization. The varices eradication rate, rebleeding rate and postoperative adverse reactions in the two groups were studied.Results:During the study, 93 cases were initially included according to inclusion criteria, among which 9 cases were excluded by exclusion criteria. Finally, 84 cases were included for data analysis, with 42 cases in each group. The esophageal varices eradication rate after the first treatment in the trial group was 88.10% (37/42), which was significantly higher than that in the control group [33.33% (14/42)] ( χ2=26.40, P<0.001). The esophageal varices eradication rate after 1 to 2 times and 1 to 3 times of treatment in the trial group were both significantly higher than those in the control group [97.62% (41/42) VS 40.48% (17/42), χ2=29.47, P<0.001; 100.00% (42/42) VS 45.24% (19/42), P<0.001]. The maximum follow-up period was 6 months, and none of the patients had rebleeding in the trial group, and the rebleeding rate in the control group was 4.76% (2/42) ( P=0.494). The incidence of thoracic and abdominal discomfort, nausea and vomiting, and abdominal distension in the trial group and control group were 26.19% (11/42) and 35.71% (15/42) ( χ2=0.51, P=0.474), 2.38% (1/42) and 7.14% (3/42) ( χ2=0.26, P=0.608), and 4.76% (2/42) and 11.90% (5/42) ( χ2=0.62, P=0.430), respectively. No other adverse events such as infection, dysphagia, perforation, esophageal tracheal fistula, esophageal stenosis, or ectopic embolism occurred in any group. Conclusion:Bc-EIS is effective and safe for the treatment of esophageal varices in patients with cirrhosis, with a one-time varices eradication rate of more than 85%, and can be completely eradicated after 1 to 3 times of treatment.
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Objective:To evaluate the risks and benefits of endoscopic ligation and tissue adhesive injection for tortuous gastric varices.Methods:A total of 193 patients with esophagogastric varices, who underwent endoscopic variceal ligation or endoscopic tissue adhesive injection in Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from June 2015 to June 2020, were included in the retrospective analysis. These cases were connected vessels (type Le and gf based on LDRf standard) of tortuous gastric varices (F1 in Hashizume standard). According to the treatment, the patients were divided into three groups: gastric fundus and esophageal ligation group (endoscopic ligation of gastric fundus and esophageal varices, 32 cases), tissue adhesive group (endoscopic tissue adhesive injection of gastric varices, endoscopic ligation of esophageal varices, 71 cases) and esophageal ligation group (endoscopic ligation of esophageal varices, 90 cases). The re-bleeding rate, the effectiveness rate, the significant effectiveness rate and complications of the three groups were compared.Results:The rates of re-bleeding in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 18.75% (6/32), 12.68% (9/71) and 3.33% (3/90), respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=6.110, P<0.016). The effectiveness rates of the three groups were all 100.00%. The significant effectiveness rates in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 37.50% (12/32), 25.35% (18/71) and 14.44% (13/90), respectively. There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=7.702, P<0.016). No pulmonary infection, hepatic encephalopathy, spontaneous bacterial peritonitis or perforation occurred in the three groups.The incidences of chest pain or abdominal pain in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 18.75% (6/32), 11.27% (8/71) and 2.22% (2/90), respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=10.524, P<0.016). There was no significant difference in the incidence of fever, nausea or vomiting among the three groups ( P>0.05). Conclusion:Simultaneous endoscopic ligation of gastric fundus and esophageal varices, and endoscopic tissue adhesive injection of gastric varices combined with endoscopic ligation of esophageal varices is of no benefit for patients with tortuous gastric varices, but endoscopic ligation of esophageal varices alone may yield more benefit.
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Objective:To explore the efficacy and safety of inflatable balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) in the treatment of esophago-gastric fundal varices (EGV).Methods:From June 12 to September 12, 2020, at the First Affiliated Hospital of Anhui Medical University, 38 patients with EGV who underwent bc-EIS were prospectively selected, the amount and the injection points of sclerosing medication were calculated, whether the injection point was bleeding during operation (no bleeding, oozing, spurting), whether compression was needed to stop bleeding (no need, needle sheath compression to stop bleeding, transparent cap compression to stop bleeding), early rebleeding after operation (72 h to 6 weeks after operation), delayed bleeding (six weeks after operation) were observed, and the number of treatments to achieve the complete elimination of varices were recorded. The postoperative follow-up period was one, three and six months to evaluate the efficacy and complications of bc-EIS. Descriptive methods were used for statistical analysis.Results:Among the 38 patients with EGV, there were 24 males and 14 females, aged (53.2±11.3) years old (ranged from 30 to 79 years old). During bc-EIS operation, the dosage of sclerosing medication of each patient was (20.03 ±7.49) mL (ranged from 6 to 40 mL), and the injection points of sclerosing medication were 4.97±1.83 (ranged from 2 to 10). The rates of complete disappearance of varices after the first, second and third time of bc-EIS were 71.1% (27/38), 89.5% (34/38) and 100.0% (38/38), respectively. Among the 38 patients with EGV, no postoperation varices related rebleeding occurred. During the follow-up two patients had hematemesis and melena within one month after operation. The endoscopic diagnosis was gastric varices bleeding below the cardia, which was improved after tissue glue injection under endoscopy. No severe adverse reactions such as fever, spontaneous bacterial peritonitis, hepatic encephalopathy, ectopic embolism, or death occurred in all patients after bc-EIS treatment.Conclusions:The dosage of sclerosing medication in bc-EIS is reduced by half compared with the recommended amount in the guidelines, and the injection point bleeding is less, moreover, the rate of complete disappearance rate of esophageal varices is more than 70% after the first treatment.
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Objective@#To investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices.@*Methods@#A total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study. The cases were divided into bleeding group (n=54) and non-bleeding group (n=153) according to the presence or absence of rebleeding within 6 months after treatment. The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis.@*Results@#Univariate analysis showed that gender composition, age, presence or absence of portal vein thrombosis, smoking history, drinking history (P=0.05), hypertension, platelet count, total bilirubin level, albumin level, alanine aminotransferase level, prothrombin time, degree of esophageal varices, and surgical methods were not significantly different (all P≥0.05) between the bleeding group and the non-bleeding group. There were significant differences in diabetes, hemoglobin level, blood glucose level, ascites composition, and liver function grade composition between the two groups (all P<0.05). Combined diabetes (yes/no), hemoglobin levels, blood glucose levels, ascites (none-mild/medium-severe), liver function Child-Pugh classification (Grade A/B-C), and history of drinking (yes/no) were included in multivariate analysis, and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices (P=0.008, OR=2.973, 95%CI: 1.322-6.689).@*Conclusion@#After endoscopic treatment of liver cirrhosis patients with esophageal varices, rebleeding is more likely to occur in patients complicated with diabetes.
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Objective:To investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices.Methods:A total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study. The cases were divided into bleeding group (n=54) and non-bleeding group (n=153) according to the presence or absence of rebleeding within 6 months after treatment. The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis.Results:Univariate analysis showed that gender composition, age, presence or absence of portal vein thrombosis, smoking history, drinking history ( P=0.05), hypertension, platelet count, total bilirubin level, albumin level, alanine aminotransferase level, prothrombin time, degree of esophageal varices, and surgical methods were not significantly different (all P≥0.05) between the bleeding group and the non-bleeding group. There were significant differences in diabetes, hemoglobin level, blood glucose level, ascites composition, and liver function grade composition between the two groups (all P<0.05). Combined diabetes (yes/no), hemoglobin levels, blood glucose levels, ascites (none-mild/medium-severe), liver function Child-Pugh classification (Grade A/B-C), and history of drinking (yes/no) were included in multivariate analysis, and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices ( P=0.008, OR=2.973, 95% CI: 1.322-6.689). Conclusion:After endoscopic treatment of liver cirrhosis patients with esophageal varices, rebleeding is more likely to occur in patients complicated with diabetes.
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Objective To investigate the clinical efficacy of endoscopic variceal ligation (EVL) in the treatment of type 1 gastroesophageal varices (GOV1).Methods From July 2016 to May 2017,at the First Affiliated Hospital of Anhui Medical University,NO.2 People's Hospital of Fuyang City and the Sixth People's Hospital of Shenyang,the efficacy of EVL in the treatment of patients with GOV1 were retrospectively analyzed.The number of ligation rings,emergency (bleeding within 24 hours) hemostasis,successful hemostasis,early rebleeding (from 72 hours to six weeks after operation),delayed rebleeding (at six weeks after operation) and disappearance of gastroesophageal varices were observed.Patients were followed up for six to 16 months and postoperative complications of EVL were evaluated.Results There were 61 patients with GOV1 (40 males and 21 females),and the mean age was (50.9±10.9) years.The number of ligation during EVL operation was one to six (mean 3.8 ± 1.9).Seven patients with active bleeding were all successfully achieved emergency hemostasis.One case had rebleeding in 72 hours after operation,and the hemostatic rate was 98.3 ％ (60/61).The early rebleeding rate was 11.5 ％ (7/61),the delayed rebleeding rate was 4.9％ (3/61),and the total rebleeding rate was 16.4％ (10/61).The disappearance rate of gastroesophageal varices was 85.2％ (52/61).The complication rate was 21.3％ (13/61).No post-ligation ulcer bleeding,spontaneous bacterial peritonitis and perforation were observed in all patients.Conclusions EVL can effectively control the acute hemmorrhage of GOV1 type gastric varices.The postoperative rebleeding rate and complication rate are low.However,the disappearance rate of varices is high.
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Objective To evaluate the clinical efficacy and safety of endoscopic selective varices devascularization.Methods From November 2015 to July 2017,at the First Affiliated Hospital of Anhui Medical University,282 patients with liver cirrhosis complicated with gastroesophageal varices who underwent endoscopic treatment were selected and divided into traditional treatment group (n=102) and selective treatment group (n=180).The patients of traditional treatment group were treated with tissue glue "sandwich method" (lipiodol-tissue glue-lipiodol),and the patients of selective treatment group were treated with modified " sandwich method" (lauromacrogol-tissue glue-0.9％ sodium chloride solution).After operation,all the patients were followed up for three months.The rates of remarkable efficacy,efficacy,improvement,rebleeding and complications were compared between the two groups respectively.T test,chi-square test and rank sum test were performed for groups comparison.Results One month after operation,the rates of remarkable efficacy and efficacy of the traditional treatment group and the selective treatment group were 46.1％ (47/102) and 20.6％ (21/102),and 67.8％ (122/180) and 30.0％ (54/180),respectively.The results of rank sum test indicated that the differences in rates of remarkable efficacy and efficacy between two groups were statistically significant (Z=-5.428,bilateral P＜0.05).The improvement rate of the selective treatment group was higher than that of the traditional treatment group (97.8％,176/180 vs.66.7％,68/102),and the difference was statistically significant (x2-54.048,P＜ 0.05).At two weeks and three months after operation,the rebleeding rate of traditional treatment group was higher than that of selective treatment group (10.8 ％,11/102 vs.3.3 ％,6/180;21.6％,22/102 vs.7.2％,13/180),and the difference was statistically significant (x2 =6.380 and 12.327,both P＜0.05).No serious complications occurred in both groups.There was no statistically significant difference in overall complication rate between selective treatment group and traditional treatment group (37.8％,68/180 vs.30.4％,31/102;x2 =1.559,P-0.212).Conclusion The treatment with endoscopic selective varices devascularization shows good efficacy and safety,and is worth further study.
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Objective To evaluate the long?term efficacy of transjugular intrahepatic portosystemic shunt(TIPS)for gastric variceal bleeding. Methods A retrospective analysis was performed on the data of 65 cirrhotic patients with type 1 isolated gastric variceal bleeding in the First Affiliated Hospital of Anhui Medical University from January 2014 to January 2016.Patients were divided into two groups,TIPS treatment group(n=28),and gastric variceal obturation(GVO)treatment group(n=37). The long?term follow?up results of the two groups were compared. Results Operations of the two groups were succeed. Postoperative complications in the TIPS group and GVO group were 7.14%(2/28)and 13.51%(5/37), respectively, (P=0.801).Nine cases(32.14%)had mild hepatic encephalopathy in the TIPS group,and no occurred in the GVO group. During the 20.18 ± 6.90 months of follow?up in the TIPS treatment group, 2(7.14%) patients died, and the cumulative rebleeding?free rate at 6, 12 and 18 months was 88.4%, 83.7% and 76.1%,respectively.During the 16.14±6.03 months of follow?up in the GVO treatment group,5(13.51%) patients died, and the cumulative rebleeding?free rate at 6, 12 and 18 months was 86.5%, 70.2% and 60.9%,respectively. The survival rate between the two groups had no significant difference(P=0.690). There was a statistically significant difference in the cumulative non?bleeding rate in 18 months of follow up(log?rank test,χ2=6.304,P=0.012). Conclusion TIPS is superior to GVO for controlling gastric variceal bleeding in the long run,but clinicians should be vigilant to the occurrence of hepatic encephalopathy after operation.
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Objective To evaluate the clinical efficacy and safety of endoscopic selective varices devascularization. Methods A retrospective analysis was performed on the data of 153 cirrhosis patients with esophagogastric varices undergoing endoscopic treatment. The traditional treatment group with 70 cases underwent traditional "sandwich method"(lipiodol?tissue adhesive?lipiodol), and the selective treatment group with 83 cases was treated by modified"sandwich method"(lauromacrogol?tissue adhesive?saline)with selective varices devascularization.The improvement rate,effective rate,significant effective rate,rebleeding rate and complications were compared between the two groups.Results One month after treatment,28 cases (47.8%)were significant effective and 15 cases(19.6%)were effective in the traditional treatment group;and 48 cases(60.0%)were significant effective and 24 cases(20.0%)were effective in the selective treatment group. The difference on effective rate and significant effective rate was statistically significant (rs=-0.260,P=0.001). Improvement rate of the traditional treatment group and selective treatment group was 61.4%(43/70)and 86.7%(72/83)respectively,and the difference was statistically significant(χ2=11.626,P=0.001).Within two weeks after treatment, the rebleeding rate of the two group was 8.57%(6/70)and 4.82%(4/83), respectively, and there was no significant difference(bilateral P=0.514, unilateral P=0.271). Within three months after treatment, the rebleeding rate of the traditional treatment group was significantly higher than that of the selective treatment group[21.4%(15/70)VS 9.3%(8/83),χ2=4.133,P=0.042]. No serious complications occurred in the two groups. The incidence of overall complication of the selective treatment group was slightly higher than that of the traditional treatment group [33.7%(28/83)VS 27.1%(19/70)], but the difference was not statistically significant(P>0.05). Conclusion Endoscopic selective varices devascularization has good efficacy and safety, and is worthy of further study.
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Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)combined with stomach and esophageal variceal embolization(SEVE)for gastric variceal haem-orrhage,and the efficacy with or without a gastrorenal shunt. Methods A total of 52 patients with gastric variceal bleeding history and portal hypertension treated with TIPS combined with SEVE were included from October 2013 to March 2015.Patients were divided into two groups according to preoperateive CT angiogra-phy,27 cases with gastric variceal haemorrhage associated with a gastrorenal shunt in group A,and 25 gastric varices bleeding cases without gastrorenal shunt in group B. During the follow-up,the incidence of the total rates of rebleeding,TIPS primary patency and hepatic encephalopathy,and the survival rates were compared between group A and group B. Results In all patients,the average portal vein pressure decreased from 36. 50±7. 00 cmH2 O(1 cmH2 O= 0. 098 kPa)before operation to 28. 15±6. 27 cmH2 O after TIPS combined with SEVE,with significant difference(t= 10. 357,P= 0. 001). Fifty two patients were followed up for 1 to 18 months(1-18 months in group A;1-15 months in group B).The total rates of rebleeding,TIPS primary patency,hepatic encephalopathy and survival were 11. 54%(6/ 52),86. 54%(45/ 52),11. 54%(6/ 52) and 92. 31%(48/ 52),respectively. There were no significant differences between the two groups in the total rates of rebleeding[11. 11%(3/ 27)VS 12. 00%(3/ 25),P = 1. 000],TIPS primary patency[88. 89%(24/ 27)VS 84. 00%(21/ 25),P= 1. 000],hepatic encephalopathy[14. 81%(4/ 27)VS 8. 00%(2/ 25), P= 0. 738]or total survival rate[92. 59%(25/ 27)VS 92. 00%(23/ 25),P = 1. 000]after TIPS combined with SEVE. Conclusion TIPS combined with SEVE is effective for gastric varices,and equally effective in the treatment of both gastric variceal haemorrhage associated with a gastrorenal shunt and gastric varices bleeding without gastrorenal shunt.
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Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastroesophageal variceal embolization (SEVE) in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm .Methods From October 2013 to December 2014 ,the clinical data of 18 patients with portal hypertension caused gastroesophageal variceal bleeding and treated by TIPS combined with SEVE were collected . The difference of portosystemic pressure gradient between before and after operation was observed ,and Child‐Pugh score before and after operation was also evaluated .The hemostasis in 24 hours ,TIPS patency ,the occurrence of hepatic encephalopathy(HE) ,rebleeding ,hepatic failure ,mortality and the change of liver function and thrombocytopenia were recorded after operation .Student′s t‐test or analysis of variance was performed for statistical analysis of measurement data .Results In the 18 patients ,the average portal vein pressure decreased from (34 .23 ± 6 .35) cmH2O (1 cmH2O= 0 .098 kPa) before operation to (25 .69 ± 6 .89) cmH2O after TIPS combined with SEVE ,and the difference was statistically significant (t=7 .572 , P0 .05) .Conclusion TIPS combined with SEVE in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm could effectively control bleeding ,and no ectopic embolism happened .
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Objective To explore the risk factors of esophageal gastric varices in patients with primary biliary cirrhosis (PBC ) .Methods From January 2008 to November 2014 ,112 PBC patients underwent gastroscopy examination and among them 24 received liver biopsy .The correlation between esophageal gastric varices and histological stage ,age ,gender ,anti‐centromere antibodies (ACA) ,platelet (PLT ) , albumin (Alb ) , total bilirubin (TBil ) , alkaline phosphatase (ALP ) , γ‐glutamyl‐transferase (GGT ) ,aspartate‐aminotransferase (AST ) ,alanine‐aminotransferase (ALT ) ,prothrombin time (PT ) and Mayo score was analyzed .Logistic regression analysis was used to identify independent risk factors predicting esophageal gastric varices in PBC patients .Results Among 112 patients with PBC ,varices was found in 62 patients (51 pure esophageal varices ,nine esophageal gastric varices and two pure gastric varices) .Among 24 patients with liver biopsy ,15 had varices (two at early histological stage Ⅰ and Ⅱ , 13 at later histological stage Ⅲ and Ⅳ ) .The ACA positive rate ,PT ,TBil and Mayo score of patients with varices were higher than those of patients without varices ;while Alb ,GGT and PLT were lower than those of patients without varices , and the differences were statistically significant (all P < 0 .01) . Multivariate Logistic regression analysis revealed that positive ACA (odds ratio (OR) = 8 .759 ,95%cofidence interval (CI) :1 .308 to 58 .637) ,Mayo score over 4 .52 (OR = 8 .941 ,95% CI :1 .145 to 69 .809) ,PLT count less than 96 .5 × 109 /L (OR = 10 .410 ,95% CI :2 .344 to 46 .224) ,TBil level over 26 .62 μmol/L(OR = 14 .348 ,95% CI :2 .945 to 69 .913) were independent risk factors predicting varices . Conclusion ACA positive ,PLT count less than 96 .5 × 109 /L ,TBil level over 26 .62 μmol/L and Mayo score over 4 .52 can help to predict esophageal gastric varices in patients with PBC .
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To research the risk factors of portal vein thrombosis( PVT) in liver cirrhosis patients. 110 cirrhotic pa-tients with ( n =39 ) or without ( n =71 ) PVT diagnosed were enrolled. 12 common ultrasonographic and serum markers were analyzed. SPSS software was used for statistic analysis. Single factor analysis and Logistic regression model analysis showed that fibrinogen was the independent risk factor of portal vein thrombosis( PVT) in liver cir-rhosis patients. Fibrinogen should be monitored in patients with cirrhosis to prevent and find the occurrence of portal vein thrombosis.
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It is of great importance to measure the lesion area in scientific research and clinical practice. The present study aims to solve barrel distortion and measure lesion area with the technology of computer visualization. With the ultimate purpose to obtain the precise lesion area, the study, based on the original endoscopy system and digital image processing technology, dealt with the correction of barrel distortion by lens adjustment, calculated the gastric ulcer area with the aid of Qt database and finally developed an image processing software--Endoscope Assistant (EAS). The results showed that the EAS was accurate in vitro. It was employed to measure the gastric ulcer area of 45 patients and the results were compared with the traditional formula method. It could be well concluded that this technology is safe, accurate and economical for measuring gastric ulcer area.
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Humans , Algorithms , Gastroscopy , Methods , Image Enhancement , Image Processing, Computer-Assisted , Methods , Software , Stomach Diseases , Diagnosis , PathologyABSTRACT
BACKGROUND:In recent years, monitoring the pressure in the human body, especial y esophageal variceal pressure, becomes a hot spot. A lot of progress has been achieved regarding fiber optical sensors for measurement of the pressure in the human body. OBJECTIVE:To briefly review the fiber optical sensor applications in the human body. METHODS:A computer-based online retrieval was performed to search papers in CNKI periodical ful-text database and PubMed database (from January 1983 to March 2013) using the key words of“fiber optical sensor, pressure, measurement”in Chinese and English, respectively. After excluding objective-independent and repetitive papers, 40 papers were included for further analysis. RESULTS AND CONCLUSION:Compared with traditional sensors, fiber optical sensors, which have advantages in high sensitivity, large dynamic range, fast response, tolerance to electronic interference, explosion proofing, fireproofing and corrosion protection, have been used to measure esophageal variceal pressure, intracranial pressure, pharyngeal pressure, pediatric airway pressure, cardiovascular&blood pressure, intervertebral disc pressure, intrauterin pressure in childbirth, pressure in the colon, plantar pressure and shear force as wel as other pressures in the human body. Fiber optical sensors have been used more widely in pressure monitoring. With the development of production technology and device performance, fiber optical sensors wil further promote the rapid development of medical science in the near future.
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Objective To explore an accurate,objective and simple method for barrel distortion correction and lesion area measurement by assistance of computer.Methods The software of Panaroma tool was employed to correct barrel distortion of endoscopy and Image J to measure lesion size and manage the relative measurement error.Computed measurement in vitro of lesion area was established,firstly,by identification of correction factor of Panorama tool to minimize measurement error; then by determination of influence of object distance change between the lens and the image.This measurement was used on patients with gastric ulcer for focal area.Results were compared with those of traditional method.Results Number of 0.1was determined to be the correction factor for barrel distortion of endoscopy.Prior to the correction of the barrel distortion,the relative error of measurement gradually increased with the increasing distance between endoscopy and the image.However,different object distances did not exert influence on the relative measurement error when barrel distortion was corrected by Panaroma tool ( P =0.141 ).A total of 50 foci of gastric ulcer were measured,results from combinational treatment of Panorama tool and Image J showed the areas (35.0 ± 5.0) mm2 were significantly larger than those determined by traditional method [ ( 29.1 ± 4.1 ) mm2,P =0.000 ],with a correlation coefficient of 0.988.Conclusion Computed endoscopic lesion measurement is a relatively accurate,objective and simple method to determine the area of gastric lesions.
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Objective To evaluate the clinical reliability and feasibility of computerized endoscopic balloon manometry in vitro and in vivo, in measurement of pressure of esophageal varices. Methods Computerized endoscopic balloon manometry was used to measure the pressure of variceal model with different diameter (3 mm, 6 mm and 8 mm) and intraluminal pressures (ranging from 8 to 36 mm Hg), and the findings were compared with actual pressures. The technique was also applied in 23 patients with liver cirrhosis and esophageal varices, and its correlation with hepatic venous pressure gradient and other factors related with varices bleeding. Results The study in vitro showed that the measured intraluminal pressure was correlated significantly with the actual value ( r ≥ 0. 993, P ＜ 0. 001 ) without obvious measurement bias(95% CI = -0.13 cm H2O to 0. 33 cm H2O). The measurement in 23 patients were success with little variation coefficient (r≥0. 998) between repeated procedures. Regression analysis showed a good correlation between variceal pressure and hepatic venous pressure gradient (r=0. 858, P ＜ 0. 001 ). A higher variceal pressure was strongly associated with presence of previous bleeding episodes, vascular diameter and presence of red color signs, but did not correlate with the parameter of Child-Pugh classification ( t = 0. 31, P =0. 76). Conclusion Computerized endoscopic balloon manometry is reliable and feasible to examine esophageal variceal pressure, and is very likely to be a valuable clinical index for variceal bleeding.
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Objective To prospectively study the main risk factors of variceal bleeding in cirrhotic patients. Methods Fifty-seven patients with liver cirrhosis and esophageal varices who had never experienced variceal bleeding were followed up for 12 months. The patients underwent measurements of esophageal variceal pressure by non-invasive endoscopic balloon technique. The endpoint of the study was the presence of a variceal hemorrhage. The relationship between variceal hemorrhage and endoscopic findings including varices, variceal pressure, Child-Pugh status, ascites, and etiology of cirrhosis was studied. Results Thirty-four patients (59.6% ) developed a variceal hemorrhage. In univariate analysis, the level of variceal pressure (P= 0. 001), the size of varices (P=0. 006), and the endoscopic red color sign on the variceal wall (P=0. 012) predicted higher risks of variceal hemorrhage. The multiple logistic regression revealed that variceal pressure was a major predictor of the risk for a first variceal bleeding (OR=2. 817, P=0. 003). The area under the receiver operating characteristic (ROC) of variceal pressure for predicting variceal bleeding was 0. 98, and the variceal pressure cutoff value was 25.3 mm Hg (1 mm Hg=0. 133 kPa) with both specificity and sensitivity of 91 %. Conclusion The level of variceal pressure is a major predictor for variceal bleeding in cirrhotic patients.
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Non-invasive manometry of esophageal varices is a cynosure of researchers. This paper develops a method based on computer vision. Experiments results reveal that correct pressure value can be got quickly.
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Aged , Female , Humans , Male , Middle Aged , Algorithms , Artificial Intelligence , Electronic Data Processing , Esophageal and Gastric Varices , Manometry , Methods , Pattern Recognition, Automated , Venous PressureABSTRACT
Objective To develop a digital video system for esophageal variceal manometry and to evaluate its reliability. Methods The system consists of esophageal variceal manometer, pressure transducer, video capture card and special computer programs. An artificial esophagus containing water-filled latex tube was designed, in which the pressure had been measured by this system in vitro. The pressures of esophageal varices had been measured by using the method in five patients. Results In vitro study, a good correlation was showed between the actual pressure and measured pressure in the artificial varices with different diameter (3,6,9 mm)(r=0.975, P