ABSTRACT
To evaluate the value of forward-return way in endoscopic resection for the treatment of gastric fundus stromal tumor, patients with gastric fundus stromal tumor in muscularis propria diagnosed by endoscopy and endoscopic ultrasonography at the Department of Digestive Endoscopy of the Fourth Affiliated Hospital of China Medical University from June 2020 to June 2021 were prospectively enrolled in the study. All patients were treated with endoscopic full-thickness resection under general anesthesia with endotracheal intubation. The success of forward-return way, endoscopic procedure, operation performance, pathological classifications and complications were analyzed. A total of 12 patients were enrolled. All of them were confirmed as having stromal tumor by postoperative pathology, with 10 of very low risk and 2 of low risk. Forward-return way was successful in 9 patients and failed in 3 patients. Nine patients were successfully treated with endoscopic procedure eventually. No intraoperative bleeding occurred in any patient. In endoscopic resection, the scores of same direction of forward and backward, endoscopic field of view, and endoscopic body stability were all 2.00 points. Forward-return way has clinical application value for the endoscopic treatment of gastric fundus stromal tumor.
ABSTRACT
Objective:To evaluate the intelligent performance measurement system for colonoscopy.Methods:Nine endoscopists from Renmin Hospital of Wuhan University were randomly assigned to the quality control group and the control group based on inclusion and exclusion criteria by the random number table. In the pre-quality-control stage (from April 20, 2019 to May 30, 2019), colonoscopic data acquired by the enrolled endoscopists were collected. In the training stage (June 1-30, 2019), the quality control group was trained on the quality control knowledge and the use of intelligent gastrointestinal endoscopy performance measurement system; but the control group was only trained on the quality control knowledge.In the post-quality-control stage (from July 1, 2019 to August 20, 2019), a weekly quality feedback was given to endoscopists of the quality control group, while the endoscopists of the control group had no quality control report.Then, the colonoscopic data acquired by enrolled endoscopists were prospectively collected during the period. The primary endpoint was adenoma detection rate. The secondary endpoints were withdrawal time, polyp detection rate and cecal intubation rate.Results:Four endoscopists were assigned to the quality control group and five to the control group. A total of 1 471 colonoscopic procedures were analyzed. The detection rates of adenoma and polyp in the quality control group increased with feedbacks[13.7% (45/329) VS 7.1% (24/338), χ2=55.796, P<0.001; 48.9% (161/329) VS 40.2% (136/338), χ2=4.071, P=0.044], while there were no significant differences in the control group [9.3% (37/398) VS 9.1% (37/406), χ2=0.329, P=0.566; 33.9% (135/398) VS 33.0% (134/496), χ2=3.616, P=0.057]. The withdrawal time in the quality control group increased with feedbacks[5.9 (3.9, 7.3) min VS 4.1 (2.8, 6.1) min, Z=6.965, P<0.001], while there was no significant difference in this variable in the control group [3.9 (2.7, 6.1) min VS 3.6 (2.6, 5.8) min, Z=1.355, P=0.175]. Conclusion:The intelligent performance measurement system for gastrointestinal endoscopy with feedbacks can monitor and improve the colonoscopic quality.
ABSTRACT
Objective To evaluate the performance of the Sendai Guidelines,Fukuoka Guidelines and Pancreatic Cystic Lesions Management Guidelines (Chinese guidelines) in predicting malignant mucinous pancreatic cystic neoplasms (PCN).Methods A retrospective analysis of 196 patients,who received surgery and were pathologically identified as PCN or intraductal papillary mucinous neoplasms (IPMN),underwent surgical resection in Ruijin Hospital affiliated with Shanghai Jiao Tong University from January 2003 to April 2017 was performed.The differences on clinical and pathological parameters between malignant mucinous and benign mucinous PCN were compared.The accuracy,sensitivity,specificity,positive predictive value (PPV)and negative predictive value (NPV) of the indications for surgery in the Sendai,Fukuoka and Chinese Guidelines in predicting malignant mucinous PCN were calculated.Results Of 196 patients,39 patients (19.9％) were confirmed as malignant tumors and 157 patients (80.1％) were confirmed as benign tumors by pathology.There were significant differences on age,symptoms (abdominal pain,jaundice or pancreatitis),tumor solid composition,pancreatic duct diameter,tumor site,tumor diameter ＞3 cm,and serum CA199 level between malignant and benign patients (all P ＜0.05).But there were no significant differences on gender distribution,tumor diameter,mural nodules and the proportion of mucinous cystic neoplasm (MCN)and intra-ductal papillary mucinous neoplasm (IPMN).165 patients (84.2％) met the Sendai Guidelines,153 patients (78.1％) met the Chinese guideline,and only 61 patients (31.1％) met the Fukuoka Guidelines.All 39 patients with malignant tumors met the indications in Sendai Guidelines and Chinese guidelines,and only 35 patients had the indication for surgery in the Fukuoka Guidelines.The accuracy,sensitivity,specificity,PPV and NPV of the Fukuoka Guidelines for predicting the malignancy were 84.7％,89.7％,83.4％,57.4％ and 97.0％,compared to 35.7％,100％,19.8％,23.6％ and 100％ for the Sendai and 41.8％,100％,27.4％,25.5％ and 100％ for the Chinese guidelines,respectively.Conclusions The performance of the Chinese guideline is slightly better than the Sendai Guidelines,while both of them can lead to a larger number of patients undergoing unnecessary surgical resection.Though the rate of missed diagnosis could reach 10.3％,the Fukuoka Guidelines gets the highest accuracy.
ABSTRACT
BACKGROUND:Recently, electrospun materials have been extensively applied in the drug delivery system. OBJECTIVE:To overview the application prospect of electrospun materials in drug delivery systems. METHODS:A computer-based search of PubMed and NCBI databases was performed for literatures about the research progress of electrospinning in tissue engineering and chemotherapy published within the past 10 years using the keywords of“electrospinning, drug delivery system, nanofibers, electrospun materials”.RESULTS AND CONCLUSION:Compared with traditional materials, electrospun stents hold good versatility and control able parameters, thus granting its unique advantage under various physiological conditions. Current drug-loaded materials composed of natural products, synthetic polymers and blended materials;as to drugs, there are antibiotics, chemotherapy medication, DNA and protein. Electrospun materials have been used in tissue engineering, cancer chemotherapy and wound healing. We focus on not only the application progress of electrospun materials in traditional treatments, but also its usage, condition-control ed drug release and living-cel carrying. Electrospun materials combined with various drug-loaded present a broad prospect.
ABSTRACT
OBJECTIVE:To evaluate the effects of clinical pharmacist participating in clinical consultation,and to provider ref-erence for clinical pharmacists participating in clinical practice. METHODS:436 cases/times of clinical consultation in which clini-cal pharmacists participated in Zhengzhou Seventh People’s Hospital from 2012 to 2015 were analyzed statistically. RESULTS:2012-2015,the number of clinical consultation in the hospital showed rising tendency;23 departments applied the consultation, among which top 5 were endocrinology department,gynaecology department,neurosurgery department,neurology department and orthopedics department. The reasons for consultation mainly were the formulation of therapy plan (430 cases/times,accounting for 97.95%). The consultation suggestions were adjusting drug types(303 cases/times,69.17%). Consultation suggestions were adopt-ed completely in 405 cases/times(92.89%). There were 307 cases/times of effective outcome,with effective rate of 75.80%(307/405). CONCLUSIONS:Clinical pharmacists participated in clinical consultation is helpful to optimize therapy plan,play a positive play on the safety of drug use. Clinical pharmacists should further learn clinical medical and pharmaceutical knowledge and summa-rize the experience of clinical practice to improve the quality of consultation.
ABSTRACT
Objective To evaluate the diagnostic and therapeutic effect of endoscopy on pharyngeal papillomas. Methods Data of patients with pharyngeal papillomas diagnosed and treated by endoscopy be?tween March 2009 and December 2014 were analyzed retrospectively, including dissection, treatment and follow?up results. Results The rate of endoscopic diagnosis of pharyngeal papillomas was 0?9%( 65/6 927) . Endoscopic biopsy forceps resection was performed successfully in 54 patients. Other patients ( n=11) were treated by endoscopic snare resection. There was hemorrhage of different degrees after resec?tion. Argon hemostasis was used in 6 patients for errhysis after resection. Supportive treatment was not given and no severe hemorrhage or death was seen. A total of 41 patients were followed up and endoscopic examina?tion was performed 2 months later. Pharyngeal papillomas were found again at the same site in two patients and endoscopic biopsy forceps resection was performed. Pharyngeal papillomas were not found in these two patients in the next endoscopic examination. Conclusion Endoscopy is a safe and effective diagnosis and treatment method for pharyngeal papillomas.
ABSTRACT
Objective To investigate the features and clinical value of endoscopic ultrasonography and colonoscopy for appendix mucocele. Methods The patients with mucocele of appendix who were diagnosed by endoscopic ultrasonography and colonoscopy in three hospitals all underwent surgery from January 2008 to March 2015. Appendix mucocele in these patients was confirmed by postoperative pathology and clinical data were retrospectively analyzed. Results A total of 22 patients with appendix mucocele were analyzed retrospectively. The average size of intralumen mucocele was 1. 84±1. 42 cm (0. 6-4. 5 cm) . The colonscopic finding of appendiceal mucocele showed submucosal protuberance at the appendiceal orifice with smooth surface. The appendiceal orifice was found at the edge of appendiceal mucocele. Endoscopic ultrasonogrphy showed low echo with smooth cyst wall in 8 patients, mixed equal echo and low echo in 14 cases. Appendicectomy was performed in 11 patients and resection of ileocecum in 11 others. Conclusion Endoscopic ultrasonography and colonoscopy are valuable for diagnosis and treatment in appendiceal mucocele.
ABSTRACT
Objective To assess the curative effect of endoscopic resection for patients with duode-nal bulb carcinoid.Methods Data of 17 patients with duodenal bulb submucosal tumor who underwent en-doscopic dissection in our department and confirmed as duodenal bulb carcinoid by postoperative pathology from Jun 2009 to Jun 2012 were retrospectively analyzed.Seventeen patients included 1 1 men and 6 women with the mean age of 36. 3 ±8. 4.Results All patients underwent preoperative diagnosis of endoscopic ultrasonography(EUS).Four cases were diagnosed as heterotopic pancreas and 13 cases carcinoid.The size of tumor was from 4 to 10 millimeter.Cap-assisted endoscopic mucosal resection (EMR-C)were used in all patients successfully.No complications were found during or after the operation.Postoperative pathology con-firmed 6 cases of duodenal bulb carcinoid.The accuracy of EUS preoperative diagnosis was 76. 5%.The average follow-up time was 20. 5 ±12. 4 months.Metastases and recurrence had not been found.Conclusion EUS can confirm the invasive depth of duodenal submucosal tumors and estimate the indication of endo-scopic excision.EUS can not give a preoperative qualitative diagnosis of duodenal submucosal tumors.Endo-scopic hyaline cap excision is a safe and sufficient method for duodenal bulb carcinoid.
ABSTRACT
Objective To investigate clinical effect of combined laparoscopic and endoscopic submucosal resection for the gastric antrum-body tumors originated from the muscularis propria.Methods A total of 8 patients with gastric antrum-body tumors originated from the muscularis propria were treated by combined laparoscopic and endoscopic submucosal resection from Jan 2013 to Apr 2014.All patients were diagnosed as having gastric antrum-body tumors originated from the muscularis propria by preoperative endoscopic ultrasonography.Endoscopy showed that the surface mucosa of tumors were normal in all patients.Tumors were found in the gastric antrum-body front wall in 4 cases,and in the back wall in 2 cases,and in the lesser omental bursa in 1 case,and in the greater omental bursa in 1 case.The tumors size was from 1.5 to 3.5 cm,averaging (2.4 ± 0.7) cm.The therapeutic procedure included three phases.The lesion was first exposed with laparoscopy.Then,the fluid was injected into the submucosa in the part of tumor by endoscopy.Finally the tumor was resected by laparoscopy.These patients were followed up and analyzed retrospectively.Results Combined laparoscopic and endoscopic submucosal resection was successfully performed in all patients.All tumors were resected completely.Sever bleeding,infection or death were not found in any patients.Postoperative pathology and immunohistochemistry staining confirmed 6 stromal tumors and 2 neurofibroma.All patients were followed up for 6 months,and there was no recurrent case.Gastric mucosa and function were normal in all patients.Conclusion Combined laparoscopic and endoscopic submucosal resection is a simple,safe and effective method for gastric antrum-body tumors originated from the muscularis propria,and leads to little complication.
ABSTRACT
ObjectiveTo investigate the clinical value of endoscopic esophageal submucosal tunnel resection of gastric fundus-cardiac tumors originating from muscularis propria.Methods Clinical date of 18 patients with gastric fundus-cardiac submucosal tumors originating from muscularis propria who underwent endoscopic esophageal submucosal tunnel resection from January 2011 to December 2011 were retrospectively collected and analyzed.ResultsAll lesions were successfully and completely resected in 18 patients,with sizes ranging from 0.7 cm to 7.2 cm,mean (2.43 ± 1.91 ) cm.Pneumoretroperitoneum,pneumomediastinum and pneumohypoderma occured during the procedure in 2 cases,but spontaneously resolved in 3 days.Fever with increased WBC within 24 h after the procedure occurred in one patient,and was cured in two days with antibiotics.There were no severe complications including bleeding,perforation or death.All patients could have liquid diet 3 days later after the operation.Follow-up endoscopy at 1 week after the operation showed a healing of esophageal incision.ConclusionEndoscopic esophageal submucosal tunnel resection is a safe and effective method for gastric fundus-cardiac submucosal tumors originating from the muscularis propria,lessening the difficulty of traditional endoscopic resection.
ABSTRACT
ObjectiveTo retrospectively evaluate the clinical efficacy of endoscopic submucosal tunnel resection for esophageal leiomyoma originating from muscularis propria.MethodsA total of 16 patients with esophageal mass originating from muscularis propria were recruited with informed consents from January 2011 to November 2011,and underwent esophageal submucosal tunneling endoscopic resection.ResultsAll lesions were completely resected.Histological examinations confirmed the diagnosis of leiomyona,and immunohistochemical staining indicated active hyperplasia in 9 cases.Intraoperative mediastinal,subcutaneous and retroperitoneal emphysema occurred in one patient,and the patient recovered one week later.No other complications or death were recorded.The patients were followed up for six months on average,and no cases of recurrence were found.ConclusionEndoscopic submncosal tunnel resection of esophageal leiomyoma originating from the muscularis propria is a minimally invasive,safe and effective procedure.
ABSTRACT
Objective To investigate the clinical value of endoscopic biliary stent drainage for obstructive jaundice due to hepatic portal metastatic carcinoma. Methods Patients with obstructive jaundice arising from hepatic portal metastatic carcinoma were selected and treated with consent by plastic endoscopic bile duct stents since 2006. Success rate and survival were evaluated. A total of 38 patients with obstructive jaundice were treated and analyzed. Hepatic portal metastatic carcinoma included 13 cases of liver cancer, 3gallbladder carcinoma, 14 gastric carcinoma, 2 esophageal carcinoma, 1 ileum adenocarcinoma and 5 pancreatic carcinoma. Results Stents were successfully placed in all patients and jaundice rapidly subsided after the endoscopic procedure. Follow-up life span was 92-521 days, mean 264. 42 ± 104. 41 days. During follow-up, biliary stents were replaced in 5 patients in 3-14 months ( mean 8. 6 ± 4. 1 months) because of stent displacment in 1 case, biliary stone obstruction in 2 cases and carcinomatous obstruction in 2 others.Conclusion For patients with obstructive jaundice arising from hepatic portal metastatic carcinoma, endoscopic biliary stent drainage is effective and can prolong life span to some degree.
ABSTRACT
Objective To investigate the therapeutic effects of endoscopy for palliative treatment of advanced pancreatic cancer. Methods A typical case of un-resectable advanced pancreatic cancer was reviewed, who underwent obstruction of upper gastrointestinal tract, obstructive jaundice and alimentary tract hemorrhage subsequently. The patient received multiple placement of intestinal tract stents, common bile duct stents and hemostatic treatment endoscopically. Because of the obstruction of upper gastrointestinal tract, jejunalostomy and retrograde endoscopy through the orificium fistulae were performed to place bile duct stents. Results The patient survived for 10 months with good life quality after diagnosis, obstruction of upper gastrointestinal tract, obstructive jaundice and alimentary tract hemorrhage were cured and didn't recur till death.Conclusion Therapeutic endoscopy, safe and effective, is the first choice for advanced pancreatic cancer complicated with obstruction of digestive tract (including gastrointestinal tract, bile duct and pancreatic duct).
ABSTRACT
Objective To evaluate the clinical value of endoscopic palliative stents drainage in patients with unresectable carcinoma at pancreas head.Methods Endoscopic stents placement was Derformed in 197 patients with unresectable pancreas head carcinoma,from August 2003 to August 2007,and the clinieal data was studied retrospectively.Results Bile duct obstruction was present in all patients.in which 126 were accompanied with dilation of distal pancreatic duct,91 with atrophy of pancrea body and tail. Stent placement in pancreatic duct Was performed in 108 patients with a Success rate of 96.4%,and placement in bile duct was performed in all patients with a success rate of 99.0%.In 195 patients with successful stent placement,jaundice dissolved after the procedure.Of 101 patients who had abdominal pain,complete pain alleviation Was achieved in 98,partially alleviation achieved in 3. Serum amylase level increased after the operation in 24 cases,which resumed tO normal value after corresponding managements.All Datients received a lifelong follow-up at mean duration of 373.57±157.35 days,with a longest survival time of 842 days.Conclusion Endoscopic palliative stents drainage is safe and effective in patients with unresectable Dancre.atie carcer,which miight increase survival rate and improve life quality.
ABSTRACT
Objective To evaluate the diagnostic and therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) in biliary papillomatosis. Methods Data of 6 patients, who underwent ERCP and diagnosed as biliary papillomatosis from 2000 to 2008, were retrospectively analyzed. Results There were 3 males and 3 females, with the mean age of onset at 72.8 years (range 52-83 years). Recurrent cholangitis and jaundice were common presentations in all patients, with 5 patients having right upper abdominal pain and 3 others exhiting fever and algor. History of partial hepatectomy was observed in 2 patients. Endoscopic findings included dilated papillary orifice with mucin discharge in 5 patients and papillary-occupying lesion in 1 patient. Multiple filling defects in the lumen of the biliary system in dilated common bile duct were detected in all patients, accompanied with extra-hepatic ducts dilatation in 3, right intra-hepatic duct dilatation in 1, and major pancreatic duct dilation in 1. Of 6 patients, 5 underwent multiple ERCP, inclucling stents and endoscopic nasobiliary drainage (ENBD), and have survived for 10-30 months. Another 83-year-old patient underwent palliative endoscopic treatment with balloons, baskets and ENBD, but died of cholangitis 10 days after the procedure. Conclusion This case series reports the typical endoscopic findings of biliary papiliomatosis. For inoperable or postoperative recurrent patients, endoscopic palliative treatment is a safe, convenient and effective procedure.
ABSTRACT
Objective To evaluate the efficacy and clinical application value of endoscopic transpapillary cyst drainage(ETCD)on huge pancreatic pseudocysts(HPP)and pancreatic abscess.Methods According to unification standard from 2003 Jun to 2006 Jun,to select 10 disquisitive cases,in which patients with uninfected HPP were 8 cases and that with infected HPP was 1 case,and pancreatic abscess was 1 case.ETCD was adopted in all cases.The clinical treatment process and the change of relative investigation subjects were retrospectively studied.Results Endoscopic transpapillary treatment failed in 1 case,postoperative infection of HPP occurred in 2 cases and acute pancreatitis was found in 1 case.Mean follow-up was 16.5 months in 8 cases.Finally,four patients had complete resolution of HPP,3 cases had partial resolution,and the remains cavity of HPP was formed in 1 caes.Acute grave pancreatitis were cured in 2 cases and Chronic pancreatitis had resolution in 6 cases.Conclusion ETCD was safe and efficient in HPP and pancreatic abscess.Postoperative infection of HPP was the familiar complication,and obstruction of drainage path of HPP was major cause.So the crux of complications precaution and treatment was that the drainage path of HPP was unhindered.
ABSTRACT
Objective To explore the experience on using duodenoscope to treat hepatolithiasis through normal physiological ways.Methods ERCP,EST were used firstly,then removed calculus of the extrahepatic bile duct.Endoscopic papillary balloon dilatation was used if there was stenosis of bile duct.Removed calculus when it had been crushed in the hepatic duct.Injected decoction to dissolve calculus through endoscopic nasobiliary drainage,or inserted the endoscopic retrograde biliary drainage when the calculus was hard to removded.Results 101 cases of calculus in the extrahepatic bile duct were all removed.215 cases of hepatolithiasis were cleaned out at first time.9 cases were cured 1 week after dissolving calculus through endoscopic nasobiliary drainage.59 cases carried out ERBD,and 21 of them were cured 3 months later,37 patients were still in regular follow-up.33 cases with stenosis of bile duct were treated by endoscopic papillary balloon dilatation,19 of them were cured,the others were inserted with the endoscopic retrograde biliary drainage.19 cases of cholangitic abscess were cured by endoscopic nasobiliary drainage.Conclusion Using duodenoscope to treat hepatolithiasis through normal physiological ways is safe and effectic.
ABSTRACT
Objective To evaluate the MRI diagnostic value for truncus arteriosus, and to improve the non invasive diagnostic level. Methods Twelve cases of truncus arteriosus were examined by X ray, Ultracardiography, and MRI, and all were confirmed by cardioangiography (CAG). Among them, 6 cases were confirmed by operation. Results Truncus arteriosus was classified and diagnosed accurately by MRI in 10 cases, and MR could show the intracardic structure and the site at which the pulmonary artery originated from truncus arteriosus. Conclusion MRI had the definite applied value, and could remedy the shortcoming of echocardiography on the classification and diagnosis of truncus arteriosus. The combined usage of MRI and echocardiography could improve the clinical non invasive diagnostic level of truncus arteriosus.
ABSTRACT
Objective To evaluate the clinical results from different endoscopic treatments of patients with chronic pancreatitis. Methods Thirty-seven cases of chronic pancreatitis had accepted endoscop-ie treatments were analvzed retrospectively. Results All cases were diagnosed clearly by ERCP showing different degree of pancreatic duct dilatation. Among them 21 cases had pancreatic duct stricture, 9 cases pancreatie duet ealeification. EPS in 18 cases and EST in 37 cases, basket extraction pancreatic duct stones in 6 eases, PDSD in 17 cases, NPD in 5 cases were conducted. The abdominal pain in 34 cases disappeared or markedly relieved alter treatment. Conclusion Endoseopie treatments have the advantages of safe, less-trauma and effectiveness. The combination of different endoscopic treatments improved evidently the current state of chronic pancreatitis treatment, thereby the therapeutic results.
ABSTRACT
Objective To evaluate the effects of endoscopic treatment on chronic pancreatitis. Methods 33 cases with chronic pancreatitis having received endoscopic treatment in a 2 years' period were retrospectively analyzed. The diagnosis was confirmed in all the patients by clinical examination, lab tests, CT, ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). According to the patients' condition, various treatment measures including endoscopic pancreatic sphincterotomy (EPS), endoscopic papillo-sphincterotomy (EST), pancreatic stenting (PS), pancreatic stone extraction, naso-pancreatic drainage (ENPD), pancreatic duct stricture dilation, etc, were used individually or jointly. Results 18 cases received EPS and 27 underwent EST. Pancreatic duct stone extraction by basket or balloon was performed in 6 cases, PS in 13, ENPD in 5, and pancreatic duct dilatation in 9 cases. The endoscopic drainage by transgastric placement of a stent was done in a patient with a huge pseudocyst. Abdominal pain disappeared or markedly relieved in 29 cases after treatment. Marked improvement after treatment was shown by lab examination and imaging. Conclusion The combined application of various treatment measures for chronic pancreatitis through endoscopic approach is a safe, minimal-invasive and effective procedure.