ABSTRACT
Objective:To evaluate the efficiency and safety of modified endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) with moderate hiatus hernia.Methods:A total of 30 patients with rGERD with moderate hiatus hernia (3-5 cm) diagnosed at the Department of Gastroenterology of Northern Jiangsu People's Hospital from June 2017 to June 2020 were randomly divided into 2/3 circumferential mucosal resection group ( n=15) and 3/4 circumferential mucosal resection group ( n=15) using random number table method, and received modified ARMS of the corresponding mucosal resection range. The GERD symptoms, esophagitis under endoscopy, 24 h pH results, and lower esophageal sphincter (LES) resting pressure were compared before and after the procedure. The therapeutic effect and complications of the two groups were analyzed. Results:In 2/3 resection group, the GERD questionnaire scores (9.53±0.36 VS 11.93±0.57, t=6.874, P<0.001), acid exposure time (19.81%±1.72% VS 31.45%±2.78%, t=8.020, P<0.001) and the DeMeester score based on 24 h esophageal pH monitoring (40.98±4.55 VS 55.33±5.65, t=6.408, P<0.001) at 6 months after the treatment showed a significant reduction compared with those before. In 3/4 resection group, the GERD questionnaire scores (9.0±0.57 VS 12.47±0.68, t=8.650, P<0.001), acid exposure time (20.07%±2.19% VS 29.96%±3.00%, t=7.444, P<0.001) and the DeMeester score (33.67±3.47 VS 51.17±6.03, t=4.973, P<0.001) at 6 months after the treatment were lower than those before. There was no significant difference in the GERD questionnaire scores ( t=0.790, P=0.436), acid exposure time ( t=0.093, P=0.926) or the DeMeester score ( t=1.278, P=0.212) between the two groups at 6 months after treatment. In the two groups, there was no significant difference in the ratio of esophagitis grade C and D (10/15 VS 5/15, χ2=3.894, P=0.063; 8/15 VS 4/15, χ2=2.778, P=0.125) or LES resting pressure [3.29 (2.66,8.29) mmHg VS 3.98 (3.67,9.43) mmHg, P=0.334;5.78 (1.9,8.46) mmHg VS 5.88 (3.28,8.99) mmHg, P=0.125] before and after the treatment. No postoperative delayed bleeding or perforation was observed. The incidence of postoperative esophageal stenosis of 2/3 resection group was lower than that of the other group (1/15 VS 6/15, χ2=4.658, P=0.021). Conclusion:Modified ARMS is effective for controlling reflux symptoms and esophageal acid exposure in rGRED patients with moderate hiatus hernia (3-5 cm), but cannot significantly increase the postoperative resting pressure of LES. Compared with 3/4 circumferential mucosal resection, 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.
ABSTRACT
Objective:To evaluate the efficiency and safety of endoscopic anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease (rGERD) in the absence of hiatus hernia (HH).Methods:Among 28 rGERD patients adimitted to Gastrointestinal Medical Center, Subei People's Hospital from Jan 2018 to Jun 2020 16 underwent endoscopic mucosal resection (EMR) and 12 did endoscopic submucosal dissection (ESD), The GERD symptoms, endoscopy, 24-h pH monitoring results, manometry, were compared before and after the procedure.Results:ARMS was successfully performed in all 28 patients. Three months after ARMS, 19 patients discontinued the use of pump inhibitors (PPIs), while 9 patients reduced their PPI dose. The GERD questionnaire scores, the median gastroesophageal flap valve grade, the median DeMeester score and acid exposure time based on 24 h esophageal pH monitoring were significantly lower than those before treatment [6.5±2.5 vs.13.4±3.1, 1(1-2) vs.3(1-3), 14.8(8.2-30) vs.34.6(16.2-60.7), 4.4%(1.3%-7.9%) vs. 8.7%(6.2%-13.9%),all P<0.01]. Esophageal sphincter pressure increased after ARMS, from (9.0±3.2) mmHg to (15.5±5.5) mmHg ( t=0.159, P<0.01). The operation time used in ESD was (66.9±4.5) minutes compared to EMR [(29.1±2.0) minutes]( t=13.911, P<0.001). The treatment cost of ESD was (19.9±1.6) thousand yuan vs. for EMR [(9.0±1.6) thousand yuan]( t=58.411, P<0.001). There were no major complications in both groups. Conclusions:ARMS is safe and effective for treatment of rGERD in the absence of HH, and EMR is less time-consuming and more acceptable technique.
ABSTRACT
Objective:To evaluate the efficiency and safety of endoscopic submucosal tunnel dissection (ESTD) on treatment of early esophageal cancer with submucosal fibrosis.Methods:In the Department of Gastroenterology of Northern Jiangsu People′s Hospital from June 2015 to Feburary 2018, data of 87 patients undergoing ESTD or endoscopic submucosal dissection (ESD) for early esophageal cancer or precancerous lesion were collected with inclusion criteria of cancer size less than 1/3 circumference with submucosal fibrosis, which was confirmed by pathology. According to the degree of submucosal fibrosis, 60 patients had mild fibrosis (31 underwent ESTD and 29 underwent ESD), and 27 patients had severe fibrosis (16 underwent ESTD and 11 underwent ESD). The dissection speed, en bloc resection rate, complete resection rate, and the complications (including bleeding, muscularis injury, perforation, neck subcutaneous emphysema and esophageal stenosis) were compared between the two methods of dissection in the groups with same degree of submucosal fibrosis.Results:For patients with mild submucosal fibrosis, ESTD had a higher en bloc resection rate (96.8%, 30/31) and complete resection rate (96.8%, 30/31), and lower muscularis injury rate (6.5%, 2/31) than those of ESD [82.8% (24/29), 75.9% (22/29), and 17.2% (5/29), respectively, all P<0.05]. There was no difference in the dissection speed, incidence of intraoperative bleeding, perforation and postoperative esophageal stenosis between the two methods (all P>0.05), and no postoperative delayed bleeding or neck subcutaneous emphysema occurred. For patients with severe submucosal fibrosis, ESTD had a higher dissection speed (12.3±2.8 mm 2/min), and lower incidence of intraoperative bleeding (12.5%, 2/16), muscularis injury (18.8%, 3/16), perforation (6.3%, 1/16) and neck subcutaneous emphysema (6.3%, 1/16) than those of ESD [7.1±3.2 mm 2/min, 54.5% (6/11), 54.5% (6/11), 27.3% (3/11), and 27.3% (3/11)]. There was no difference in en bloc resection rate, complete resection rate, and the incidence of postoperative esophageal stenosis between the two methods, and no postoperative delayed bleeding occurred. Cancer recurred locally in 2 patients undergoing ESD and 1 patient undergoing ESTD at 12 months after the operation, and 1 patient undergoing ESTD developed metachronous cancer at 24 months after the operation. Conclusion:ESTD is safe and effective for endoscopic management of early esophageal cancer or precancerous lesion with submucosal fibrosis. Compared with standard ESD, the advantage of ESTD is more efficient for patients with mild submucosal fibrosis, and is safer for patients with severe submucosal fibrosis.
ABSTRACT
Objective:To compare the clinical effect of domestic and imported omeprazole injection in the treatment of peptic ulcer bleeding.Methods:According to the random sequence generated by the computer,118 patients who were treated in digestive department of our hospital from April 2013 to May 2015 were randomly divided into 2 groups,59 cases in each group.The control group was given treatment of imported drug losec,while the study group was given treatment of domestic drug aoxikang,and two groups were treated continuously for 7 days.The incidences of gastrointestinal reactions,dizziness and palpitations,the average treatment time,and clinical therapeutic effects were compared,in addition,the costs of treatment in the two groups were analyzed.Results:There were no significant differences in the incidences of gastrointestinal reactions,dizziness and palpitations and the average treatment time between the study group and the control group (P＞0.05).There was no significant difference between the two groups in the treatment effect after rank sum test (P＞0.05).The total effective rates (96.61％ vs 94.91％) were equivalent,the differences were not statistically significant (P＞0.05),but the costs of using domestic drugs were lower than that of imported drugs.Conclusion:The clinical curative effects of domestic aoxikang and imported losec in treatment of peptic ulcer bleeding have no significant difference,which can have a good therapeutic effect,but the economy of aoxikang is more better.
ABSTRACT
[ ABSTRACT] Interstitial cells of Cajal ( ICC) is the pacemaker in the gastrointestinal tract , which is closely as-sociated with the formation of slow wave and the regulation of gastrointestinal motility .As the pacemaker of gastrointestinal tract, the activation of pacing signal is triggered by the local calcium oscillation in the ICC .The change of calcium concen-tration can activate many relevant ion channels , such as NSCC, ANO1, VGCC, HCN channels and potassium channels , which can generate a large number of pacing current to form the slow wave and then propagated by the gap junction between the ICC networks and smooth muscle cells to make the peristalsis of gastrointestinal tract in autonomic rhythm .However, the mechanism of these ion channels in the pacemaker activity is still unclear , so we refer to make a review about the re-search progress on these pacemaker channels in this article to illuminate the mechanism of pacemaker activity in ICC .
ABSTRACT
Objective To investigate the impact of pancreatic duct stenting as a preventive measure for post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation.Methods Clinical data of 64 patients with biliary tract disease from January 2008 to December 2015 was prospective analyzed. All the patients were randomly divided into observation group and control group. Patients in observation group received pancreatic stent placement, while patients in control group was not received pancreatic stent placement and nasal duct. Postoperative monitoring items included abdominal pain, blood amylase. Then record and compare the incidence of acute pancreatitis, pancreatitis severity rating, abdominal pain score, Ranson score, amylase recovery time between the two groups.Results Observation group had ifve cases of PEP, the rate was 15.6 %, including mild four cases (12.5 %), medium one case (3.1 %); the control group had 13 cases of PEP, the rate was 40.6 %, including mild six cases (18.8 %), medium four cases (12.5 %), severe three cases (9.4 %). PEP observation group was signiifcantly lower than the control group (P < 0.05). Mild, medium and severe PEP were lower than the control group, in which the severe PEP was signiifcantly lower than the control group (P < 0.05). Ranson score of the observation group was (1.2 ± 0.4), significantly lower than the control group (2.5 ± 1.2) (P < 0.05); the observation group amylase average recovery time was (3.0 ± 0.6) d, it is also signiifcantly lower than the control group (5.8 ± 1.4) d (P < 0.01). No bleeding and perforation complications occurred.Conclusion Pancreatic stenting can effectively prevent the incidence of PEP, reduce postoperative pain, improve patient recovery.
ABSTRACT
Objective To investigate the expression of doublecortin-like kinase 1 (DCLK1) in colorectal cancer and colorectal adenomas,and it's role in the development and progression of colorectal carcinoma,and explore the relationship of the DCLK1 expression and prognosis in colorectal cancer patients with diabetes medical history.Methods Expression of DCLK1 in 70 cases of colorectal cancers,70 cases of para-carcinoma tissues,and 35 cases of tubulovillous adenomas were detected by immunohistochemical method.Results (1) The DCLK1 high expression rate in colorectal cancers was 41.4％ (29/70),and 45.7％ (16/35) in tubular villous adenomas,both significantly higher than the para-carcinoma tissues (4.3％;3/70) (P ＜0.01).(2) DCLK1 high positive expression had statistical significance with pathological grading (P ＜ 0.01),infiltration depth (P ＜ 0.05),lymph node metastasis (P＜ 0.05),vascular invasion (P ＜0.05),and distant metastasis (P ＜0.01).(3) There was no obvious correlation between the Diabetes medical history,expression of DCLK1,and prognosis of patients.Conclusions DCLK1 has high positive expression in colorectal carcinomas,and may have certain significance for the early clinical diagnosis and prognostic judgment of colorectal cancers.The expression of DCLK1 and prognosis of colorectal cancers has no obvious correlation with diabetes medical history.
ABSTRACT
Objective To evalute and compare the efficacy and safety of epinephrine-saline submu-cosal injection of different concentrations on endoscopic submucosal dissection (ESD),and to discuss the best concentration of submucosal injection.Methods A total of 128 patients who underwent ESD were ran-domly assigned to submucosal normal saline injection group (group A,n =32),0.001% epinephrine-saline injection group (group B,n =32),0.002% epinephrine-saline injection group (group C,n =32),and 0.004% epinephrine-saline injection group (group D,n =32).The incidence of bleeding during and after ESD were counted,the blood preasure and heart rate of preoperative and intraoperative,the amount of sub-mucosal injection,the time of operation were observed.Results ESD was successfully performed on all pa-tients.There were no difference in highest blood preasure and fastest heart rate between preoperative and in-traoperative results of each group.No perforation or intraoperative acute massive bleeding occurred.Intraop-erative acute minimal bleeding during ESD occurred in 9 patients in group A and 3 in group B,2 in group C and 2 in group D (P <0.05),but there were no differences among group B,C and D.The amount of submu-cosal injection of group A was(39.5 ±10.8)ml,which was more than that of group B(29.4 ±9.4)ml,group C(27.3 ±8.2)ml and group D(20.4 ±11.8)ml with significant difference.There were no differences a-mong group B,C and D,but there was less in group D than group B.The operation time of group A was(82.3 ±24.78 minutes),which was longer than that of group B (60.7 ±25.35minutes),group C (54.7 ± 31.72minutes)and group D(59.2 ±28.49 minutes),but there was no difference among B,C and D group. Conclusion Epinephrine-saline submucosal injection assiting ESD is safe and effective and reduces the op-eration time and bleeding than normal saline.The increase of the epinephrine-saline concentrations has not been found to be more beneficial.
ABSTRACT
Objective To explore the clinical diagnostic value of narrow-band imaging combined with magnification chromoendoscopy for suspicious neoplasia lesions of early gastric cancer.Methods A total of 115 patients which had been diagnosed as having suspicious lesions byconventional endoscopy were enrolled from Jan.2010 to Dec.2012.They were observed by magnifying endoscopy(C-WLI), magnifying endoscopy combined with narrow-band imaging (ME-NBI), magnification chromoendoscopy and magnification chromoendoscopy combined with narrow-band imaging, respectively.The lesion outline sharpness, opening of the gland sharpness and microvascular morphology sharpness were recorded and the subtypes of opening of the gland and microvascular morphology were compared.The histological examination was performed on the most significant changes in lesion site and the accuracy, sensitivity and specificity of the four procedures were calculated.Results The score of outline sharpness was 377 and the score of pit sharpness was 458 by magnification chromoendoscopy combined with narrow-band imaging, higher than those of ME-NBI (340 and 408 respectively) and magnification chromoendoscopy (354 and 386 respectively) (P ＜ 0.05), significantly higher than those of C-WLI (276 and 280 respectively) (P ＜ 0.01).The score of microvascular morphology sharpness was 380 by magnification chromoendoscopy combined with narrow-band imaging,higher than that of ME-NBI (348, P ＜ 0.05), C-WLI (267, P ＜ 0.01) and magnification chromoendoscopy (280, P ＜ 0.01).The detection rate of C type by magnification chromoendoscopy combined with narrow-band imaging was higher than that by magnification chromoendoscopy (93.0％ VS 79.7％, P ＜ 0.05).The accuracy, sensitivity and specificity of magnification chromoendoscopy combined with narrow-band imaging was 92.17％, 88.33％ ,96.36％ respectively.Conclusion Narrow-band imaging endoscopy combined with pigment amplification can yield more clear image of the microvascular morphology and opening of the gland, significantly improve the lesion detection rate, reduce the missing rate, and is worthy of further clinical observation and promotion.
ABSTRACT
Diabetes mellitus( DM)affects almost the whole digestive tract. Approximately 75% of the diabetic patients suffer from gastrointestinal motility disorders. The precise mechanism of diabetic gastrointestinal motility disorders is not fully clear. Its pathogenesis is considered to be multifactorial and related with autonomic neuropathy,smooth muscle myopathy and lesions of interstitial cells of Cajal. Advanced glycation end products( AGEs ) are derived from the nonenzymatic reaction of glucose with proteins,lipids or nucleic acids in vivo. Hyperglycemia in DM is a favourite for formation of AGEs, and excessive accumulation of AGEs contributes to the complications of DM such as diabetic nephropathy and diabetic vascular lesions. However,the correlation of AGEs with diabetic gastrointestinal motility disorders is seldom reported. In this review article,the roles and possible mechanisms of AGEs in diabetic gastrointestinal motility were summarized.
ABSTRACT
Objective To investigate the psychological status of diarrhea type irritable bowel syndrome (D-IBS) patients overlapped with functional dyspepsia (FD) and its relationship with the changes of brain-gut peptides and cytokines levels.Methods A total of 190 D-IBS FD overlapped patients and 30 healthy controls were selected and all of them completed the questionnaire.The adult psychological testing system was applied for the Symptom Checklist (SCL-90) assessment.Plasma levels of 5-hydroxytryptamine (5-HT),somatostatin (SS),vasoactive intestinal peptide (VIP),endothelin (ET),interleukin (IL)-10 and IL-12 were measured in 59 randomly selected patients.Single factor analysis of variance and LSD test were performed for statistical analysis.Results In D-IBS-FD overlapped patients,the plasma 5 HT levels of the D-IBS patients and the FD patients were (1906.83±676.88) μg/L and (1745.53±653.23) μg/L respectively,both of them were significant higher than those of control group [(1289.44±918.45) μg/L,LSD test,both P＜0.05].However the levels of VIP and IL-10 were significant lower than those of control group (LSD test,both P＜0.01).In D-IBS patients,the plasma level of SS was significantly lower than that of control group (LSD test,P=0.025); the level of ET was significantly higher than that of control group and FD patients (LSD test,both P＜0.05).In D-IBS-FD overlapped patients,the scores of anxiety,depression and opponent were higher than those of control group (F=5.114,4.555 and 10.285,all P＜0.05).The plasma VIP and SS levels of patients with anxiety or depression were lower than those of control group (LSD test,both P＜0.05).The plasma VIP level was lower than that of patients without psychological disorders (LSD test,P=0.005).The plasma ET level of patients with disease course over five years was significantly higher than that of patients with disease course less than one year or between one and five years (LSD test,both P＜0.05),and the IL-10 level was significantly lower than that of patients with disease course less than one year (LSD test,P=0.004).Conclusions There were sub-healthlated with disease course,psychological disorder,the increased plasma 5-HT level and the decreased IL-10 level.There was close correlation between the lower gastrointestinal symptoms and the decreased levels of VIP,SS and the increased level of ET.
ABSTRACT
Endoscopic ultrasonography has been widely used in the diagnosis of digestive system disease,and has great important diagnostic significance in the differential diagnosis of the upper gastrointestinal mucosa or submucosal lesions,as well as to distinguish the gastrointestinal intracavitary and extracavitary lesions.At the same time,EUS can more accurately judge the depth of tumor invasion and the surrounding lymph node metastasis,which has great value in the preoperative TNM staging of esophageal cancer and gastriccancer,the judgment of resectability and the prognosis.We summarized the result of EUS in the upper gastrointestinal disease in our hospital.
ABSTRACT
Purpose:To investigate the cyclooxygenase-2(COX-2) expression in gastric carcinoma and investigate the effects of COX-2 expression on P-glycoprotein. Methods:The expression of COX-2 and P-glycoprotein was examined by immunohistochemical staining in 48 cases of gastric carcinoma and 10 cases of normal gastric tissues. Results:There was no positive signal of COX-2 detected in normal gastric tissue. The positive expression rate of COX-2 was 60.4 %(29/48) in gastric carcinoma. The expression of COX-2 was correlated with TNM stage and lymph node metastasis (P
ABSTRACT
Objective:To investigate the effects of Chinese Medicinals with right supporting and phlegm transforming actions on albumin synthesis and secretion of fibrous hepatic cells of rat in vitro. Methods: Amygdalin, the water soluble extract of Radix Salviae Miltiorrhizae, lordyceps, and colchicine were used to act on fibrous hepatic cells of rat produced by primary monolayer culture in vitro. The results were determined by ELISA method. Results: Besides colchicine, the others amygdalin and cordyceps. Cordyceps, the water soluble extract of Radix Salviae Miltiorrhizae) showed the obvious raising actions on albumin synthesis and secretion of fibrous hepatic cells of rat ( P