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Objective To investigate the correlation of clinicopathological parameters and prognosis with serum and pancreatic cancer tissue klotho. Methods Immunohistochemistry EnVision two step method was used to assess klotho protein expression of a tissue microarray ( TMA) of 79 pairs of pancreatic tissue and normal surrounding tissue. The serum klotho levels in 39 pancreatic cancer patients and 39 healthy controls who had matched clinical data were measured by ELISA. The relationships between the expression of klotho and the clinicopathological features and survival were analyzed. Results Klotho expression positivity in pancreatic cancer tissue was significantly higher than that in adjacent normal tissues (59. 5％ vs 96. 3％);serum level of klotho was markedly higher in pancreatic cancer patients than that in control group [(670. 30 ± 82. 24)pg/ml vs (310.35 ± 34.65) pg/ml], and both the difference was statistically significant (P<0.001). Klotho expression was negatively associated with tumor clinical stage and lymph node metastasis (P<0. 05), and the expression of klotho did not correlate with patients' gender, age, tumor size, location, local invasion depth and the like. The median survival time in pancreatic cancer patients with positive klotho expression were longer than that in in pancreatic cancer patients with negative klotho expression [(48. 31 ± 6. 94) months vs (19. 50 ±6. 78)months], and the difference was statistically significant (P<0. 01). ROC analysis on serum klotho gave a cutoff value of 376. 51 pg/ml to diagnosis pancreatic cancer with a sensitivity of 84. 6％ and specificity of 87. 2％. Conclusions Klotho level in serum and tissue of pancreatic cancer patients was closely correlated with clinicopathological parameters and prognosis, which may be a potential biomarker for pancreatic cancer.
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[Summary] Benign esophageal strictures can arise from various causes and mainly induce dysphagia .Commonly , the majority of benign esophageal strictures can achieve long-term relief through about three dilation sessions .However, some refractory benign esophageal strictures require other treatments , such as endoscopic stent placement and intralesional drug injection , but these treatments just attain short-time satisfactory results with a disappointingly low rate of long-term improvement.Recently, biodegradable stents and drug-eluting stents are developing and have obtained the positive effects .In this paper , we performed a review about the treatment of benign esophageal strictures .
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Objective To evaluate the safety and efficacy of an endoscopic dilation in association with the intramuscular injection of either mitomycin C for benign esophageal strictures. Methods A total of 89 patients with benign esophageal strictures were retrospectively divided into 3 groups, including 30 cases of dilation combined with mitomycin C injection (mitomycin C group) , 29 of dilation combined with dexamethasone injection (dexamethasone group) and 30 of dilation with saline injection (dilation group). The successful rate, complications and the clinical effect in the 3 groups were compared. Results The 89 patients all successfully received the procedure, with the endoscopic and clinical release. No massive hemorrhage occurred. In mitomycin C group, 1 case with major complication (perforation) and 7 minor complication occurred;9 and 7 cases with minor complication occurred in dexamethasone group and dilation group, respectively. There were no significant difference of the complications in the 3 groups (P<0. 05). The mean dysphagia-free period was 5. 25±1. 18 months in the mitomycin C group, 4. 46±1. 53 months in the dexamethasone group, and 3. 03±1. 62 months in the dilation group (P<0. 05). Conclusion Endo-scopic dilation with or without the intramuscular injection of either mitomycin C or dexamethasone are safe and effective. Dilation combined with drug injection may prolong the esophageal dysphagia-free period. Furthermore, mitomycin C injection may have the dominant effect.
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Objective To study the safety and feasibility of endobiliary intraductal radiofrequency ablation (RFA) to reopen occluded self-expandable metal stents in patients with malignant biliary obstruction.Methods 11 patients with malignant biliary obstruction and blocked metal stents were prospectively studied.During ERCP, after biliary cannulation, the blocked metal stents underwent RFA using a bipolar radiofrequency probe which was introduced into the stenotic bile duct via a guide wire.This was followed by a balloon to repeatedly remove debris and then endoscopic nasobiliary drainage.The patients were closely observed and followed up.Results RFA was successfully carried out in all the patients and patencies were achieved when compared with pre-RFA.The median post-RFA luminal diameter of the strictures showed significant improvement: 6 (4 ～ 10) mm versus 2 (0 ～ 5) mm, and the mean post-RFA total bilirubin level decreased sharply : (39.4 ± 8.7) μ mol/L versus (130.1 ± 38.2) μmol/L.Following this intervention, 3 patients developed fever, which were controlled with conservative therapy.There was no mortality, haemorrhage, bile duct perforation or bile leak.Of the 11 patients, 3 were dead and 6 were alive at a median follow-up of 187 (75 ～ 304) days.The median stent patency was 135 (75 ～ 203) days and the median survival was 278 (75 ～ 304) days.Four patients had their stents patent at the time of the last follow-up or death.Seven patients had their stents blocked on 113, 124, 154, 203, 96, 135 and 112 days post-procedure.Condusions Endobiliary intraductal RFA is technically feasible and safe to reopen occluded metal stents in malignant biliary obstruction.This efficacy needs to be confirmed by future randomized studies.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic purse-string suture (EPSS) with metallic clips and endoloop for the gastric wall defect after postoperative perforation.</p><p><b>METHODS</b>Clinical data of 25 patients with gastric tumors(1 of gastric adenocarcinoma, 24 of gastric gastrointestinal stromal tumor, GIST) undergoing EPSS in Jiangsu Province People's Hospital and The Second Affiliated Hospital of Nanjing Medical University from January 2013 to May 2014 were retrospectively analyzed. During the procedure, EPSS was performed in 8 cases with perforation after endoscopic submucosal dissection(ESD), and in 17 cases with active perforation after endoscopic full-thickness resection.</p><p><b>RESULTS</b>Twenty-five patients underwent EPSS successfully. The procedure time was 35.0-75.0(49.8±10.1) min. No severe operational and postoperative complications occurred. Tumor resection margin were all negative. Time to withdraw gastrointestinal decompression drainage tube was 1-3(1.3±0.8) d. Postoperative hospital stay was 2-10(4.8±2.1) d and total cost was 10-31(19±0.5) thousand Yuan. One month after the procedure, all the patients received follow-up with no complaint of discomfort, and endoscopy confirmed that all the lesions healed.</p><p><b>CONCLUSION</b>EPSS with metallic clips and endoloop is effective and safe to close the gastric wall defect after full-thickness resection.</p>
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Humans , Adenocarcinoma , Digestive System Surgical Procedures , Gastrointestinal Stromal Tumors , Gastroscopy , Postoperative Complications , Postoperative Period , Retrospective Studies , Stomach Neoplasms , SuturesABSTRACT
The morbidity and mortality of tumors of digestive system is much higher in recent years .Realizing diagnosis of early phase tumors can improve the surgical resection rate and prolong survival time of patients .Compared with traditional diagnosis methods, multiphoton microscopy has got an obvious improvement in the penetration depth .Furthermore, phototoxicity and photo-bleaching has been largely reduced .Combining with the second harmonic microscopy , the change of collagen fibers can be observed in the organization.MPM can achieve early diagnosis of cancer at the cellular level .Therefore, multiphoton microscopy , with the imaging characteristics of unique high resolution , real-time, nondestructive , deeply spectral resolution , is of great potential in the diagnosis of early stage tumors of digestive system .Based on the latest research results , this review summarizes the latest progress of multiphoton microscopy diagnosing early phase of gastrointestinal tumor .
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ObjectiveTo assess the effectiveness and safety of target-controlled infusion (TCI) of remifentanil during remedial endoscopic retrograde cholangiopancreatography (ERCP) in the elderly patients.Methods390 patients (aged 65 years and over) undergoing ERCP were divided into two groups: remifentanil group (n =175) and lidocaine group (n =215). Remifentanil group were anaesthetized by TCI with remifentanil as method of sensible analgesia,while lidocaine group were anaesthetized by lidocaine as conventional local anesthesia.Arterial blood pressure,heart rate and oxygen saturation (SpO2) were monitored during ERCP.The memory and feeling of pain during operation and side effects after operation were followed up. ResultsThe statistical differences in changes of blood pressure,heart rate and SpO2 were not found between the two groups.There were 165 cases(94.3 ％) with satisfactory anaesthetization,10 cases (5.7 ％ ) with mild and endurable pain and 7 cases(6.7％) with side effects of circulation and respiration during operation,while these symptoms improved after symptomatic treatment in remifentanil group.In lidocaine group,there were 25 cases(8.6 ％ ) with side effects of circulation and respiration during operation,most of patients were obviously uncomfortable,2 cases (1.8％) were intolerant of operation. Conclusions Targetcontrolled infusion of remifentanil during ERCP in the elderly is safe,effective and worthy of clinical popularization.
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BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a serious, life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The aim of this study was to collect demographic data and clinical, laboratory and microbiological characteristics of PLA patients treated between 2000 and 2010. We also aimed to collect information regarding our management experience of these cases. METHODS: As a retrospective review, 47 patients with PLA in a tertiary referral center were examined to determine their demographic characteristics, clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. RESULTS: Cryptogenic PLA was the most frequently identified type of PLA, while benign biliary tract disease was the most frequently identifiable cause of PLA (18/47 patients; 38.3%). Leukocytosis and elevated alanine transaminase were common laboratory findings and were observed in 35 (74.5%) and 22 (46.8%) patients, respectively. Increased fibrinogen was also detected in 11 of 15 investigated cases (73.3%). Notably, infection-induced thrombocytopenia occurred in 8 patients (17%). Diabetes mellitus was associated with the occurrence of infection induced shock when compared to the non-diabetic group (p<0.05). Patients with two or more comorbid diseases had longer hospitalizations when compared to patients with one comorbid disease or those without comorbidities (p<0.001). The number of days needed to establish diagnosis was correlated with the length of hospitalization (p<0.001). The overall hospital mortality rate was 2.1% (1/47). CONCLUSIONS: Characteristics of PLA patients from the past 10 years are presented. The number of days needed to establish a PLA diagnosis was correlated with the length of the hospital stay. The hospital stay of PLA patients can be further improved by early diagnosis and effective treatments during the early stages of PLA progression.
Subject(s)
Humans , Alanine Transaminase , Asian People , Biliary Tract Diseases , Clinical Audit , Comorbidity , Diabetes Mellitus , Early Diagnosis , Fibrinogen , Hospital Mortality , Hospitalization , Length of Stay , Leukocytosis , Liver Abscess, Pyogenic , Retrospective Studies , Shock , Tertiary Care Centers , Thrombocytopenia , Treatment OutcomeABSTRACT
The optimal bariatric surgery is still not acquired although the obesity epidemic has become a worldwide problem. The recentness studies on obesity focused on mass balance regulated by central nervous system, in which an important circuit is vagus nerve. This review provides progress on obesity mediated by vagus nerve simulation and vagal blocking.
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Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients over 80 years old with biliary-pancreatic diseases. Methods One hundred and twenty patients over 80 years old who underwent ERCP between January 2004 and April 2008 were retrospectively analyzed. The clinical efficacy, safety and complication were observed and followed up. Results One hundred and seventeen patients successfully underwent therapeutic ERCP and the success rate was 97.5%. All diseases of the patients included cholangiocarcinoma in 22 cases, duodenal papilla carcinoma in 3 cases, pancreatic carcinoma in 8 cases, acute pancreatitis in 15 cases, chronic pancreatitis in 5 cases, acute suppurative cholangitis in 9 cases and choledocholithiasis in 58 cases. During the procedure of ERCP, 3 cases failed to insert the duodenoscope, 3 cases were found hemobilia and 2 cases were found acute pancreatitis. Conclusions Therapeutic ERCP is effective and safe in elderly patients over 80 years. Age is not the contraindication of therapeutic ERCP.
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Objective To explore the efficacy of endoscopic therapy for common bile duct stones in the elderly. Methods From July 2003 to June 2006,421 elderly patients with common bile duct stones were treated in the Danyang People's Hospital(112 cases) and the Second Affiliated Hospital of Nanjing Medical University(309 cases).The clinical data of the patients were retrospectively analyzed Results ERCP was completed in all the 421 patients,of which 27 was converted to a pre-cut sphincterotomy because of difficulties in the deep cannulation of the bile duct.The diagnosis of common duct stones was confirmed during the operation in all the cases,and 46 of them were found complicated with cholecystolithiasis.Of the patients,266 patients had one stone,107 had two,and 48 had three or more.The calculi were removed using basket directly in 283 patients,balloon catheter in 122,lithotrity in 10,and plastic stent placement without calculus removal in 6.The stones were removed completed at the first operation in 392 cases,and the other 23 cases received a second operation after endoscopic nasobiliary drainage.Errhysis occurred in 20 patients during the pre-cut sphincterotomy,and was healed by locally sprinkling or injecting noradrenaline(1:10 000),or electric coagulation.Six patients had hemorrhage from the incision on the duodenal papilla 48 hours after the operation,and were cured by using submucous injection of noradrenaline(1:10 000,4 cases) or titanium clipper(2 cases).34 patients had a transient increase of serum amylase without abdominal pain;10 patients developed mild pancreatitis and then was cured by fasting,inhibiting pancreatic secretion and pancreatic enzyme activities,anti-inflammation therapy,and rehydration;4 patients developed cholangitis,and was cured by anti-inflammation therapy.All the patients were discharged without complications.342 of the patients were followed up for 6-12 months,4(1.2%) of them had recurrence of stones and was treated with endoscopy,3(0.9%) had cholangitis and received anti-inflammation therapy.In the 6 patients with plastic stent,the stones were dissolved in 2 of them in half a year.Conclusions Endoscopic therapy is safe and efficient for common bile duct stones in the elderly and is associated with a low rate of complications.
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Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( ? 2 =19.5 and 16.33; P
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Objective To evaluate the therapeutic effects of titanium clips occlusion for the defects and complications caused by endoscopic mucosal resection(EMR).Methods Totally 62 patients with protuberant lesions in the esophagus or gastrointestinal tract(≤15 mm in diameter) were treated by EMR in our hospital.During the operation,69 lesions were cut and the surgical defects were clipped using titanium clips.The intra-and post-operative complications of the patients were reviewed.Six weeks after the treatment,the patients received re-examination by endoscopy to observe the healing of the mucosal defects.Results The 69 lesions in the 62 cases were resected completely.At each defect,1-3 titanium clips were used,no perforation or hemorrhage occurred in the patients.Endoscopy performed in 6 weeks showed that all the defects were healed without ulcer,stenosis or recurrence.The titanium clips dropped 65 of the defected mucosa.Conclusion Titanium clips is effective and safe for defects caused by endoscopic mucosal resection.
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Objective To study on the value and safety of early endoscopic retrograde cholangiopan-creatography (ERCP)and endoscopic sphincterotomy (EST) in acute biliary pancreatitis. Methods Ninety-two patients with acute biliary pancreatitis underwent early ERCP (within 72 hours) and received endoscopic therapy (ERCP group). Another 40 patients with acute biliary pancreatitis were treated conservatively without ERCP (control group). The disappearance of abdominal pain, decrease of serum amylase level, the mean days and costs of hospitalization and complications were observed in all patients. Results In ERCP group, all patients were performed EST, stones in 72 choledocholithiasis patients had been removed with net-basket or air pocket. Ten cases of severe acute biliary pancreatitis received endoscopic pancreatic duct stents drainage. Ninety two cases of acute biliary pancreatitis received endoscopic nasal catheter bile drainage. The days of the disappearance of abdominal pain, the decrease of serum amylase levels, the cost of the hospitalization and the days of the hospitalization were significantly shorter in the early ERCP group than in the control group. The mortalities in ERCP and control group were 8. 3% and 33. 3% respectively. Conclusion Early ERCP endoscopic therapy is a safe procedure has the superiorities in lowering the mortality, hospital days and expense.
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Objective To study the technique of placemen t of Nitinol stent for relieving malignant pylorus or duodenal obstruction, and to assess its clinical effectiveness.Methods In this group the strictures were caused by gastric car cinoma at the antrum (n=2), anastomosis site of previous gastrojejunostomy (n=2 ), gastric carcinoma at the cardia (n=4), colon cancer (n=1), pancreatic cancer (n=3) and duodenal cancer (n=4). Under fluoroscopic guidance the Nitinol stent w as inserted into pylorus or duodenal obstruction sites via oral cavity in all ca ses. Complications and clinical status were investigated during the study period .Results Successful stent placement was achieved in 15 cases. Tw o patients had undergone double stent placement (pylorus stent and bile duct ste nt). The rate of improvement in abdominal distention and vomiting 1 week after p rocedure was 73 3% and 86 7% respectively. Procedure-related complications ne ver occurred.Conclusion Nitinol alloy network stent is a safe and efficaciou s method for palliating malignant pylorus or duodenal obstruction, and improves patient's living quality.