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Background/Aims@#Previous studies reveal that immune-mediated neuroinflammation plays a key role in the etiology of esophageal achalasia. However, the understanding of leucocyte phenotype and proportion is limited. This study aim to evaluate the phenotypes of leukocytes and peripheral blood mononuclear cells transcriptomes in esophageal achalasia. @*Methods@#We performed high-dimensional flow cytometry to identified subsets of peripheral leukocytes, and further validated in lower esophageal sphincter histologically. RNA sequencing was applied to investigate the transcriptional changes in peripheral blood mononuclear cells of patients with achalasia. Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT) was used for estimating the immune cell types. A differential gene expression analysis was performed and the differential expressed genes were subjected to gene ontology, Kyoto Encyclopedia of Genes and Genomes network, protein-protein interaction network construction. @*Results@#An imbalance between innate and adaptive immune cells occurred in achalasia. Specifically, neutrophils and CD8+ T cells increased both in peripheral blood and lower esophageal sphincter in achalasia. Eosinophils decreased in peripheral blood but massively infiltrated in lower esophageal sphincter. CIBERSORT analysis of peripheral blood mononuclear cells RNA sequencing displayed an increased prevalence of CD8+ T cells. 170 dysregulated genes were identified in achalasia, which were enriched in immune cells migration, immune response, etc. Proton pump inhibitor analysis revealed the intersections and gained 7 hub genes in achalasia, which were IL-6, Toll-like receptor 2, IL-1β, tumor necrosis factor, complement C3, and complement C1q A chain. @*Conclusion@#Patients with achalasia exhibited an imbalance of systematic innate and adaptive immunity, which may play an important role in the development of achalasia.
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Objective:To summarize the thoracic and abdominal CT presentations after endoscopic full-thickness resection (EFR) and to analyze its significance in the evaluation and management of postoperative complications.Methods:Data of 82 patients who underwent gastrointestinal EFR at the Endoscopy Center of Zhongshan Hospital, Fudan University and received a chest and/or abdominal CT within 1 week from September 2016 to September 2021 were collected retrospectively. The patients were divided into the intervention group ( n=38) and the control group ( n=44) according to the presence or absence of special postoperative interventions or prolonged hospital stays. The differences in the incidence of abnormal CT presentations between the two groups were analyzed. Risk factors for abnormal CT presentation were explored by multifactorial analysis. Results:Among the 82 patients, the main CT presentations were pneumoperitoneum in 51 patients (62.2%), abdominal and pelvic effusion in 30 patients (36.6%), pneumothorax in 5 (6.1%), pleural effusion in 43 (52.4%), and pulmonary inflammation in 16 (19.5%). The incidence of pelvic and abdominal effusions ( W=637.48, P=0.031) and pleural effusions ( W=622.06, P=0.031) in CT was higher in the intervention group than that in the control group. Age was an independent risk factor for air-related complications after EFR (>60 years old VS ≤60 years old: OR=0.17, 95% CI: 0.05-0.56, P=0.002). Conclusion:CT presentations of pelvic and abdominal effusion and pleural effusion after EFR is of great significance in suggesting complications, while patients with other CT presentations often do not require special intervention or prolonged hospital stay. Postoperative CT in elderly patients is less likely to detect air-related complications.
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Objective:To investigate the diagnostic and therapeutic value of one-time biliopancreatic-duct-imaging-system (eyeMax)-assisted endoscopic retrograde appendicitis therapy (ERAT) for children.Methods:A total of 11 children who were diagnosed as having uncomplicated acute appendicitis by imaging in Xi′an Children′s Hospital from August to November 2022 were enrolled. All patients received subscope-assisted ERAT. Subscope was intubated into the appendix cavity to observe the mucosa directly. Appendicitis was treated through cleansing, fecalith extraction, stent drainage. The clinical manifestations under subscope were recorded, as well as the treatment success rate, intubation success rate, the effective rate, complication incidence during and after the operation.Results:The age of 11 children was 7.93±2.67 years old. Appendix intubation was successful in all patients. Congestion and swelling of the mucosa in appendiceal orifice and appendix cavity were seen under the subscope in 11 children. There were 6 cases with appendiceal fecaliths, 8 cases with pus and 6 cases with luminal distortion or stenosis. Perforation was observed in 1 case during the operation and no other complication occurred. All patients were treated under subscope, including flushing appendiceal cavity (11 cases), fecalith extraction with extraction basket (3 cases), and appendiceal drainage with stenting (2 cases). The symptoms and signs were relieved after the operation, and the effective rate within 48 hours was 10/11. There were no procedure-related complications or recurrence during postoperative follow-up for 1 week to 4 months.Conclusion:Acute appendicitis could be diagnosed by observing the appendix cavity directly under one-time biliopancreatic-duct-imaging-system-assisted ERAT, and also could be treated with the system, where appendix could be preserved and radiation damage could be avoided with safety and effectiveness.
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The radial force of the degradable esophageal stent before and after degradation is one of the important indicators for effective treatment of esophageal stricture. Based on a combination of in vitro experiments and finite element analysis, this paper studies and verifies the biomechanical properties of a new type of degradable esophageal stent under different esophageal stricture conditions. Under radial extrusion conditions, the maximum stress at the port of the stent is 65.25 MPa, and the maximum strain is 1.98%; The peak values of stress and strain under local extrusion and plane extrusion conditions both appear in the extrusion area and the compression expansion area at both ends, which are respectively 48.68 MPa, 46.40 MPa, 0.49%, 1.13%. The maximum radial force of the undegraded stent was 11.22 N, and 97% and 51% of the maximum radial force were maintained after 3 months and 6 months of degradation, respectively. The research results verify the safety and effectiveness of the radial force of the new degradable esophageal stent, and provide a theoretical basis for the clinical treatment of esophageal stricture.
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Humans , Esophageal Stenosis/surgery , Finite Element Analysis , Mechanical Phenomena , StentsABSTRACT
Objective:To review publications in the field of digestive endoscopic minimally-invasive resection in the past 10 years in and outside China.Methods:Literature of digestive endoscopic minimally-invasive resection in the Web of Science and CNKI databases from January 1, 2011 to July 17, 2021 was retrieved. VOSviewer 1.6.11 was used for clustering and time series analysis of countries, institutions, authors and keywords, and drawing evidence-based visualization maps, so as to analyze the cooperation among countries, academic institutions and researchers, to compare the differences in research topics between Chinese and English databases, and to predict the future research hot spots and directions.Results:A total of 22 834 English articles and 4 636 Chinese articles were included. Over the past 10 years, the number of Chinese and English publications has been growing steadily, and most of them were published in professional journals. The publications were mainly from China, Japan, South Korea and the United States, where all exceeded 2 000. The National Cancer Center of Japan had 497 publications, ranking the first among all institutions. The cooperation between academic institutions showed obvious regional characteristics, and the inter-institutional and interpersonal cooperation needed improvement. In terms of keyword clustering, there was no significant difference between Chinese and English publications, but there were two additional clusters in Chinese publications, endoscopic nursing and submucosal tumor. Overlays analysis of key words showed that endoscopic surgery, tunneling technique, and submucosal tumor could be hot spots and future directions.Conclusion:Digestive endoscopic minimally-invasive resection has experienced a vigorous development in the past 10 years with a growing number of Chinese and English publications. China is playing an increasingly important role on the international stage. The advanced nature of research focus in Chinese publications is comparable to that in English publications, yet also showing Chinese characteristics. In the future, more efforts should be taken to strengthen regional cooperation and focus on research hot spots.
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Objective:To investigate the short-term clinical efficacy of laparo-gastroscopic esophagectomy (LGE).Methods:The retrospective and descriptive study was conducted. The clini-copathological data of 11 patients with esophageal cancer who underwent LGE in the Zhongshan Hospital of Fudan University from June 2020 to October 2021 were collected. There were 8 males and 3 females, aged (68±4)years. Sorted by operation time, the sentinel lymph nodes navigation (SLN) was performed since the sixth patient in the cohort, and abdominal surgery and neck surgery were performed simultaneously to complete LGE. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect death of patients during postoperative 30 days. Patients were followed up during postoperative 30 days. Measurement data with normal distribution were represented as Mean± SD, and count data were described as absolute numbers. Results:(1) Surgical situations. Of the 11 patients, 5 cases received SLN with satisfactory visualization, 6 cases did not receive SLN, 1 case terminated the operation as sentinel lymph nodes biopsy showing positive results and the rest of 10 cases completed LGE successfully without conversion to thoracotomy. The operation time and tumor diameter of the 10 patients completing LGE was (204±27)minutes and (2.5±1.0)cm, respec-tively. (2) Postoperative situations. Of the 10 patients completing LGE, 2 cases had pulmonary complications after surgery and recovered well with symptomatic treatment, and none of patient had anastomotic leakage or other serious complication. Results of postoperative histopathological examination showed squamous cell carcinoma in the 10 patients completing LGE. Nine patients were classified as T1b?3N0M0 stage and 1 patient was classified as T1bN1M0 stage. Ten patients completing LGE had R 0 resection and the number of lymph nodes dissected was 14±4. There were 3 cases with nerve bundle invasion, 2 cases with vascular invasion and 5 cases without nerve bundle and vascular invasion. The postoperative treatment time at intensive care unit and duration of hospital stay of the 10 patients completing LGE were (4.0±2.4)days and (7.2±1.5)days. (3) Follow-up. The 10 patients completing LGE were followed up and none of them died during the postoperative 30 days. Conclusions:LGE is safe and feasible. Combined with SLN can guarantee the oncology effect of surgery.
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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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To evaluate the efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for patients with metastases to the pancreas.Data on patients with pancreatic lesions who underwent EUS-FNA and confirmed as having metastases to the pancreas at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2015 to November 2020 were retrospectively analyzed.Characteristics of patients, EUS performance, pathological results, and follow-up were reviewed and analyzed. A total of 11 patients were diagnosed of metastasis to pancreas by EUS-FNA.The primary tumor mainly came from kidney (4/11) and lung (4/11), and the rest from colon (1/11), breast (1/11) and bladder (1/11), respectively. EUS performance of metastases to the pancreas mostly presented homogeneous hypoecho (10/11)with unclear margin (6/11). Enlarged lymphnodes were noticed in nearly half of the patients (5/11). The time span from detection of primary tumor to metastases ranged from 6 days to 27 years. EUS-FNA is effective in the diagnosis of metastases to the pancreas.
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Objective:To evaluate the safety and efficacy of a novel endoscopic anastomosis clip for the stomach perforation via an animal trial.Methods:Six pigs were used as experimental animals, and two perforation models (10-20 mm in diameter) were created by an endoscopic needle-knife in the stomach of each pig. The perforations were then closed by the novel detachable endoscopic anastomosis clip. The animal survival and healing of the lesions were recorded. All the clips were taken out 30 days after operation through endoscopy. Half of the animals were immediately after clip extraction and the other half of the animals survived for another 30 days owing to observation.Results:All clips were implanted successfully and all lesions healed during 30 days after the operation. All animals survived. The clip natural shedding rate was 33.3%(4/12), and the rest of clips were successfully disassembled and removed. All animals were alive 30 days after clip removal with lesions healed.Conclusion:The novel anastomosis clip is safe and effective in animal experiments with easy to operate. It could be recommended for further clinical research with good clinical prospect.
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To study the clinical effect of non-ampullary duodenal mucosal lesions treated by endoscopic resection. A retrospective analysis was performed on the data of 58 cases of duodenal non-ampullary mucosal lesions treated by endoscopic resection from January 2016 to June 2019 from 3 hospitals. Among 58 cases, 27 lesions (46.6%) were located in the duodenal bulb and 31 (53.4%) in the duodenal descending part (including the ball-drop boundary). Forty-six patients (79.3%) received endoscopic mucosal resection, 7 (12.1%) received endoscopic submucosal dissection and 5 (8.6%) received pre-cut endoscopic mucosal resection. Few postoperative complications were found except for 1 case of intraoperative bleeding, 1 case of delayed bleeding 2 days after surgery, 1 case of lesion residual and 2 cases of postoperative abdominal pain. No perforation occurred. Endoscopic treatment of non-ampullary duodenal mucosal lesions is safe and effective.
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Objective:To evaluate high resolution esophageal manometry (HREM) in peroral endoscopic myotomy (POEM) for pediatric achalasia of cardia (AC).Methods:Data of 30 AC children who received POEM in Xi′an Children′s Hospital from January 2013 to September 2019 were reviewed. HREM was performed before and 6 months after POEM. Preoperative and postoperative lower esophageal sphincter pressure (LESP), 4-second integrated relaxation pressure (4sIRP), Eckardt scores and nutritional status were compared.Results:Children with AC aged between 4-14 years. Postoperative LESP was 5.50±1.13 mmHg (1 mmHg=0.133 kPa), which was significantly lower than that before operation (26.23±4.47 mmHg) with significant difference ( t=-24.623, P<0.001). Postoperative median 4sIRP was 5 mmHg, which was 20 mmHg lower than that before operation (25 mmHg) with significant difference ( Z=-4.786, P<0.001). Postoperative median Eckardt symptom score decreased significantly compared with that before (1 VS 8, Z=-4.796, P<0.001). Severe malnutrition of the AC children improved evidently to normal( Z=-5.166, P<0.001). Conclusion:POEM can significantly improve the characteristics of esophageal dynamics in children with AC, and HREM can be an important indicator for follow-up evaluation of POEM.
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Objective:To evaluate the safety, efficacy and long-term survival of endoscopic submucosal dissection (ESD) for colorectal precancerous lesions and early cancer in the elderly over 80 years old.Methods:Clinical data of colorectal precancerous lesions and early cancer treated with ESD from January 2007 to December 2014 at Endoscopy Center of Zhongshan Hospital, Fudan University were retrospectively analyzed. A total of 721 patients with 778 lesions were included in this study. These patients were stratified by age: the super-elderly group (≥80 years old, 55 patients, 7.6%) and the non-super-elderly group (<80 years old, 666 patients, 92.4%). The outcomes of ESD, complication incidences, pathological characteristics, and long-term survival were compared between the two groups.Results:Except that the incidence of chronic concomitant diseases in the super-elderly group was significantly higher than that in the non-super-elderly group [54.5% (30/55) VS 31.5% (210/666), P<0.001], other baseline characteristics were not significantly different ( P>0.05). There were no significant differences in the complete resection rate [93.1%(54/58) VS 95.3%(686/720)], the R0 resection rate [89.7% (52/58) VS 93.2% (671/720)], the curative resection rate [84.5% (49/58) VS 90.3% (650/720)], the complication incidence [5.5% (3/55) VS 2.7%(18/666)], or the median hospitalization (2.98 days VS 2.54 days) between the two groups (all P>0.05). The three-year overall survival rates of the super-elderly group and non-super-elderly group were 95.8% and 98.0%, respectively, and the five-year overall survival rates were 85.1% and 97.4%, respectively. Conclusion:Colorectal ESD is safe and effective for elderly patients (age ≥80 years old) despite a significantly higher incidence of chronic concomitant diseases than that in the non-super-elderly patients.
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Objective:To investigate the safety and efficacy of knife assisted polypectomy (KAP) in the treatment of colorectal pedicle polyps (Paris type 0-Ⅰp).Methods:A retrospective analysis was conducted on the data of 42 patients with colorectal pedicle polyps who were treated with KAP at Endoscopy Center of Zhongshan Hospital of Fudan University and Xuhui District Central Hospital from May to September 2019. Procedure time and complication rates were used to assess the effects of KAP.Results:A total of 48 polyps were found in 42 cases. The median diameter of polyps was 2.0 cm(0.8-3.5 cm). The mean operating time was 11.3±1.1 min. All patients had no severe bleeding or perforation during operation and no delayed bleeding, delayed perforation or electrocoagulation syndrome after operation. Postoperative pathology showed that the margins of all cases were negative.Conclusion:KAP operation is safe and efficient, but long-term efficacy still needs further clinical verification.
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Objective:To investigate the indication of pre-cut-endoscopic mucosal resection (pre-cut-EMR) on the treatment of colorectal laterally spreading tumors (LSTs).Methods:A retrospective study was performed on data of colorectal LSTs patients, who underwent pre-cut-EMR in Wuxi Second People’s Hospital and Zhongshan Hospital from January 2014 to June 2019. The relationships between the clinical characteristics of the lesions and the success rate and complications of pre-cut-EMR were analyzed.Results:Data of 132 colorectal LSTs cases were included in the study. Morphology of 29 (22.0%) LSTs were homogeneous granular type, 43 (32.6%) LSTs were mixed non-granular type, 58 (43.9%) LSTs were flat elevated type, and 2 (1.5%) LSTs were pseudo-depressed type. The diameter of lesions was 2.3±1.5 cm (ranged from 2.0 cm to 5.0 cm). Among the 132 LSTs, 36 (27.3%) tumors were located in rectum, 15 (11.4%) in sigmoid colon, 10 (7.6%) in descending colon, 17 (12.9%) in splenic flexure of colon, 21 (15.9%) in transverse colon, 24 (18.2%) in hepatic flexure of colon, 6 (4.5%) in ascending colon, and 3 (2.3%) in cecum. The histopathological diagnoses of the 132 LSTs included low grade intraepithelial neoplasia in 58 cases (43.9%), high grade intraepithelial neoplasia in 69 cases (52.3%), intramucosal carcinoma in 2 cases (1.5%), and canceration in 3 cases (2.3%). Pre-cut-EMR was achieved in all 132 patients, and the operation time was 25.3±13.6 min (ranged 20-65 min). The rate of en bloc resection and complete resection were 95.5% (126/132) and 100.0% (132/132), respectively. Two cases (1.5%) had intraoperative perforation, and were both located in the sigmoid colon with the diameter of 4.0 cm and 4.5 cm, respectively. Twelve cases (9.0%) had immediate bleeding during operation, and 2 cases (1.5%) had delayed bleeding after operation. Patients had been followed up for 6-24 months, the wound healed well after operation, and no local recurrence was found.Conclusion:Pre-cut-EMR is an effective and safe therapy for colorectal LSTs with diameter less than 4.0 cm.
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Objective:To evaluate the efficacy and safety of endoscopic trans-gastric gallbladder-preserving polypectomy in treatment of gallbladder polyps.Methods:A retrospective analysis was performed on data of 25 patients with gallbladder polyps who underwent endoscopic trans-gastric gallbladder-preserving polypectomy in the endoscopy center of Zhongshan Hospital from September 2017 to August 2019. Completion of operation, operation time, postoperative hospital stay, complications and follow-up results of patients were obtained and analyzed.Results:There were 13 cases of single polyp and 12 cases of multiple polyps, 13 cases of simple gallbladder polyps, and 12 cases of polyps and gallstones. The maximum diameter of polyps was 0.2-1.5 cm. The procedure failed in 1 patient (4%) because of the severe adhesion of abdominal cavity and disappearance of gallbladder when passing through the gastric wall. Twenty-four patients (96%) were successfully treated with endoscopic trans-gastric gallbladder-preserving polypectomy. The operation time was 67.1±26.8 min (35-140 min). The median hospital stay was 4 d (2-5 d). No severe adverse events including delayed bleeding, delayed perforation, diffuse peritonitis or abdominal abscess occurred. During the median follow-up time of 8 months (0-23 months), no patient was lost, no recurrence of polyps and no severe adverse events related to metal clips occurred.Conclusion:Endoscopic trans-gastric gallbladder-preserving polypectomy shows good short-term efficacy and is technically feasible, however, long-term outcome still requires further research.
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Objective@#To evaluate the feasibility and short-term efficacy of a novel and simplified closure method developed by our team for the defect closure after endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMT) in the gastric wall.@*Methods@#A prospective single-arm clinical study was used. Inclusion criteria: (1) the lesion was located in the fundus or the greater curvature of the stomach, and was confirmed to originate from the muscularis propria layer; (2) the diameter of the tumor was ≤3.5 cm, and the tumor had no extensive adhesion to the peritoneal tissues and organs in extraperitoneal cavity; (3) the tumor had no malignant features under ultrasound endoscopy; (4) the patient agreed to participate in the study; (5) patients with severe complications were excluded. Based on the above criteria, 20 patients with gastric SMT at the Endoscopy Center of Zhongshan Hospital of Fudan University from January 2015 to March 2018 were enrolled in this study, including 5 males and 15 females with mean age of 61.1 (38 to 70) years. Grasping forceps-assisted endo-loop snare ligation device which is called "Shao-Mai" method was used to close the defect site. All the patients underwent EFTR and "Shao-Mai" method to perform defect closure. After successful tumor resection by EFTR, an endo-loop was anchored onto the edge of the gastric defect with grasping forceps assistance and closed tightly. The observation indicators included tumor size, en bloc resection, operation time, postoperative complications and hospital stay. The follow-up indicators included tumor residual, local recurrence, and metachronous lesions.@*Results@#All the 20 lesions were located in the muscularis propria with a size of 0.5-3.5 (mean 1.4) cm. Three of them were located in the greater curvature of the mid-upper gastric body, 17 were located in the fundus. The endoscopic "Shao-Mai" closure was successfully performed after EFTR in all the 20 cases. Endoscope was used uniquely through the entire process, without laparoscopic assistance. The operative time was 20-100 (mean 43.8) minutes, while the "Shao-Mai" closure procedure took a range of 3-30 (mean 10.1) minutes. The en bloc resection rate was 100%. The pathological diagnosis included 17 gastrointestinal stromal tumors and 3 leiomyomas. No major complications occurred during or after surgery. All the patients were discharged 1-11 (mean 3.1) days after operation. The wounds of all the cases were healed completely six months after operation and only scar was observed without ulcer. No residual lesion, tumor recurrence or metastasis, leakage or fistula of digestive tract were found during the follow-up period of 15-54 (median 41) months.@*Conclusion@#The endoscopic "Shao-Mai" closure method is a simplified novel way, which is feasible, effective, and safe for closing the gastric defect after EFTR.
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Objective@#To study the role of virtual gastroscopy simulator in the examination of clinical practice skills of gastrointestinal specialists.@*Methods@#A multi-center empirical study was carried out. In June 2018, ninety participants from three tertiary care teaching hospitals in China, including Zhongshan Hospital of Fudan University, Shanghai Tongji Hospital and Xiangya Hospital of Central South University, took part in the examination. Participants were selected as follows: 30 specialists without any experience of gastroscopy exams, 30 with basic knowledge (gastroscopy exams <500 cases) and 30 with good skill (gastroscopy exams ≥500 cases). These 90 students participated in this empirical study after theoretical study and simulator training. Among them, 50 (55.6%) were undergraduates, 25 (27.8%) masters, and 15 (16.7%) doctors; 42 (46.7%) were residents, 39 (43.3%) attending physicians, and 9 (10.0%) deputy chief physicians. The assessment was divided into two parts. The first part was to use the simulator (GI mentor II) for ballooning within 10 minutes, with a total score of 40 points. The second part was a complete gastroscopy exam on the simulator, including preparation before gastroscopy exam, gastroscopy exam, post - exam management and related knowledge quiz. The difficulty and discrimination of the assessment plan were evaluated by the extreme grouping method parameters (difficulty P definition: <0.3 was difficult, 0.3 to 0.7 was medium, ≥0.7 was easy; discrimination degree D definition: <0 was poor, 0 to 0.2 was medium, ≥0.2 was good), and by comparing the virtual gastroscopy assessment scores of different experience, academic, and professional title groups. The score analysis of the student group was expressed using the mastering rate (the average score divided by the total score). The data of the normal distribution was represented by (mean±SD) (range), and the data of the nonnormal distribution was represented by M (P25, P75). Kruskal-Wallis non-parametric test was used for comparison between groups.@*Results@#The total score of 90 students was (82.9±10.9) (55.8 to 99.0), and the mastering rate was 82.9%. The overall difficulty of the first and the second parts were 0.78 and 0.76, respectively, and the difficulty level was easy. The overall discrimination of the first and the second parts were 0.70 and 0.67, respectively, and the discrimination was good. The stratified analysis was performed according to the professional title. The median score was 83.2 (75.5, 89.0) in the residents, 82.5 (71.7, 93.6) in the attending physicians, and 93.5 (88.5, 99.0) in the deputy chief physicians, and the difference was statistically significant (H=6.213, P=0.045). According to the stratification analysis of academic qualifications, the median score was 81.7 (73.0, 87.5) in participants with undergraduate degree, 91.0 (79.0, 95.0) in those with master degree and 88.0 (81.7, 93.5) in those with doctor degree, whose difference was statistically significant (H=9.233, P=0.010). The stratified analysis of the second part showed that the median scores of the "operational process" part of the low, medium and high basis group were 33.0 (30.5, 36.5), 34.0 (32.0, 36.0) and 37.0 (35.0, 37.5), respectively, whose difference was statistically significant (H=7.603, P=0.022). The median scores of the "operational process" section of the resident, attending physician, and deputy chief physician were 33.0 (30.5, 35.0) points, 36.0 (34.0, 37.5) points and 37.0 (37.0, 37.5) points, respectively, whose difference was statistically significant (H=18.563, P=0.001).@*Conclusions@#The virtual gastroscopy simulator can reflect the true level of gastroscopy exam skills of the students. The examination questions are moderately difficult, and there is a good discrimination of the exam.
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Objective To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for superficial hypopharyngeal neoplasm. Methods Clinicopathological data of 9 patients, who received ESD for superficial hypopharyngeal neoplasm in Zhongshan Hospital affiliated to Fudan University from September 2015 to March 2018,were retrospectively analyzed. Results Nine patients including 7 males and 2 females with mean age of 61. 2 years (48-80 years) were included. The mean diameter of lesions was 16. 3 mm (5-27 mm),and the mean operation time was 52. 2 min(30-90 min). No bleeding, perforation, emphysema or dyspnea during or after ESD occurred. The mean length of hospitalization was 4. 6 days ( 3-7 days). Pathology indicated 1 high grade intraepithelial neoplasia and 8 squamous cell cancer, and all cases of squamous cell cancer were constrained within lamina propria. One patient had positive horizontal margin and received radiotherapy. No recurrence, metastasis or stenosis was found during 10. 2 months (3-29 months)of follow-up. Conclusion ESD is a safe and effective option for superficial hypopharyngeal neoplasm.
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Objective To promote best discharge practice in sedated patients′ following endoscopic procedures in an endoscopy center in Shanghai, China. Methods A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Eight audit criteria that were representative of best practice recommendations for discharge following endoscopic sedation procedures were used. A baseline audit was conducted followed by the implementation of multiple strategies, determined by the key stakeholders. The project was finalized with a follow-up audit to determine change in practice. Results Improvements in practice were observed for all eight criteria. The most significant improvements were in the following: completion of an organizational policy, the minimum discharge criteria, patient has met minimum discharge criteria before being discharged (all from 0% to 100% compliance), and giving verbal and written instructions (from 12% to 100% compliance). Criteria 4 (the authority to discharge), 6 (staff training and education) and 7 (being accompanied by family) achieved the least improvement in compliance rates, as baseline measures already showed a high degree of compliance. The compliance rate for criterion 8 (medical file) attained 88%. Conclusion This protocol utilized a clinical audit process leading to improvements in practice behavior related to patient discharge following endoscopic sedation procedures. A continuous cycle of audit and re-audit will be required in the future to maintain high quality standards.
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Objective To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis.Methods Data of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively.The number of dilation,complications rate,short-term effects and recurrence rate of stenosis were analyzed.Results Thirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months),including 10 (27.8％) patients of grade 1 stenosis,15 (41.7％) of grade 2 stenosis,and 11 (30.5％) of grade 3 stenosis.The anastomotic distance from anus was 3-24 cm (median 6 cm).The 36 patients underwent 80 times of EBD with mean time of 2.22.Among them,69.4％ (25/36) cases received 1-2 times and 30.6％ (11/36) received 3 times or more.During the EBD operation,14 (17.5％) patients had minor bleeding,and intraoperative or postoperative perforation did not appeared.Postoperative obstructive symptoms were relieved in all patients.The anastomotic diameter was greater than 20 mm and EBD treatment was successful.Postoperative follow-up was 22-76 months (median 44 months).Four (11.1％) patients had recurrence of anastomotic benign stenosis at 7,11,18,and 63 months after the last time of EBD,respectively,and the symptoms were improved after the second treatment.Conclusion EBD is safe and effective in treating benign colorectal anastomotic stenosis,with better short-term and long-term outcomes.