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ObjectiveTo investigate the safety and efficacy of endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips in the treatment of cirrhotic patients with gastric varices and gastric-renal shunt （GRS）. MethodsThe patients who attended Beijing Ditan Hospital， Capital Medical University， due to liver cirrhosis and gastric varices from February to June 2023 were enrolled， and all patients were confirmed to have GRS and received endoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips. The primary evaluation index was alleviation or disappearance of varicose veins after surgery， and the secondary evaluation indices were surgical completion and complications. ResultsA total of 11 patients were enrolled in this study， among whom there were 7 male patients and 4 female patients， with a median age of 55 years. Of all patients， 1 had Child class A liver function， 7 had Child class B liver function， and 3 had Child class C liver function. The maximum （median） diameter of the shunt was 8 mm， and the minimum （median） diameter of the shunt was 4 mm. The median blood flow velocity of the target vessel was 11 cm/s before treatment and 5 cm/s after occlusion with metal clips. The median amount of tissue adhesive injected was 2 mL， and the amount of lauromacrogol used was 1 mL. Disappearance of blood flow signals was observed in all patients after surgery （100%）， and the success rate of surgery was 100%. No patient experienced rebleeding after follow-up for 6 weeks. Gastroscopy at 1 month after surgery showed that gastric varices were eradicated or almost disappeared in 9 patients and were alleviated in 2 patients. ConclusionEndoscopic ultrasound-guided tissue adhesive injection with the assistance of metal clips is a feasible， safe， and effective treatment method for cirrhotic patients with gastric varices and GRS.
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Objective@#To analyze the effect of a new type of metal clip hemostat in bleeding under endoscopic colonic polypectomy.@*Methods@#From January 2016 to December 2017, 298 cases of colonic polypectomy hemorrhage patients in the Third People's Hospital of Hangzhou were studied, and they were randomly divided into study group (149 cases) and control group (149 cases) according to the digital table.The control group was given general hemostat and hemostatics, and the study group was given new metal clips and hemostatic drugs under endoscopy.The hemostasis rate, the prognosis in the near and long term and the score of the severity of clinical symptoms at different treatment time points (T0-before treatment, T1-12h after treatment, T2-24h after treatment and T3-48h after treatment) were compared and analyzed in the two groups.@*Results@#The immediate hemostasis rate (86.58%), effective hemostasis rate (73.15%) and complete hemostasis rate (66.44%) in the control group were significantly lower than those in the study group (100.00%, 93.29% and 89.93%), and there were statistically significant differences in bleeding rates between the two groups (χ2=21.439, 21.629, 24.104, all P<0.05). The fecal occult blood clearance time [(3.54±0.18)d], bowel sound recovery time [(5.21±0.45)d] and hospitalization time [(8.42±0.75)d] of the study group were significantly shorter than those of the control group [(4.16±0.27)d, (7.18±0.26)d and (9.65±1.27)d], the differences were statistically significant between the two groups(t=23.322, 46.270, 10.180, all P<0.05). The rebleeding rate[(6.71%)(10/149)], complication rate[(3.36%)(5/149)] and mortality[(0.00%)(0/149)] in the study group were all lower than those in the control group [26.85%(40/149), 8.05%(12/149), 6.71%(10/149), 2.01%(4/149)], the differences were statistically significant between the two groups (χ2=21.629, 3.057, 1.755, 3.031, all P<0.05). The difference of clinical symptom severity score of the two groups at T0 was not obvious (P>0.05). The scores of clinical symptoms of the two groups at T1, T2 and T3 were decreased in turn, and the scores in the study group were all lower than those in the control group(t=77.562, 54.816, all P<0.05).@*Conclusion@#After bleeding in patients with colonic polyp electrotomy, the hemostatic rate of the new metal clip after endoscopic hemostasis is significantly improved, the curative effect is stable, the recurrence rate of bleeding is low, and the clinical application value is high.
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Objective To analyze the effect of a new type of metal clip hemostat in bleeding under endoscopic colonic polypectomy.Methods From January 2016 to December 2017,298 cases of colonic polypectomy hemorrhage patients in the Third People's Hospital of Hangzhou were studied,and they were randomly divided into study group (149 cases) and control group (149 cases) according to the digital table.The control group was given general hemostat and hemostatics,and the study group was given new metal clips and hemostatic drugs under endoscopy.The hemostasis rate,the prognosis in the near and long term and the score of the severity of clinical symptoms at different treatment time points (T0-before treatment,T1-12h after treatment,T2-24h after treatment and T3-48h after treatment) were compared and analyzed in the two groups.Results The immediate hemostasis rate (86.58％),effective hemostasis rate (73.15％) and complete hemostasis rate (66.44％) in the control group were significantly lower than those in the study group (100.00％,93.29％ and 89.93％),and there were statistically significant differences in bleeding rates between the two groups (x2 =21.439,21.629,24.104,all P ＜ 0.05).The fecal occult blood clearance time [(3.54 ± 0.18) d],bowel sound recovery time [(5.21 ± 0.45) d] and hospitalization time [(8.42 ± 0.75)d] of the study group were significantly shorter than those of the control group [(4.16 ± 0.27)d,(7.18 ± 0.26)d and (9.65 ± 1.27)d],the differences were statistically significant between the two groups (t =23.322,46.270,10.180,all P ＜ 0.05).The rebleeding rate [(6.71％) (10/149)],complication rate [(3.36％) (5/149)] and mortality[(0.00％) (0/149)] in the study group were all lower than those in the control group [26.85％ (40/149),8.05％ (12/149),6.71％ (10/149),2.01％ (4/149)],the differences were statistically significant between the two groups (x2 =21.629,3.057,1.755,3.031,all P ＜ 0.05).The difference of clinical symptom severity score of the two groups at T0 was not obvious (P ＞ 0.05).The scores of clinical symptoms of the two groups at T1,T2 and T3 were decreased in turn,and the scores in the study group were all lower than those in the control group(t =77.562,54.816,all P ＜ 0.05).Conclusion After bleeding in patients with colonic polyp electrotomy,the hemostatic rate of the new metal clip after endoscopic hemostasis is significantly improved,the curative effect is stable,the recurrence rate of bleeding is low,and the clinical application value is high.
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Objective To investigate the correlations between the displacements of surgical clips,skin markers and the gross tumor volume (GTV) delineated by surgical clip and seroma based on fourdimensional computed tomography (4DCT) during normal breathing.Methods On each of the 10 respiratory phases of 4DCT with 15 patients of breast cancer,the surgical cavity,which was defined as GTV and formed by both surgical clips and seroma,all surgical clips in the cavity,and skin markers on the skin were delineated by the same radiation oncologist.The center displacements of GTV,selected boundary surgical clips and skin markers in the left-right (LR),anterior-posterior (AP),and superior-inferior (SI) directions were recorded and analyzed by Pearson method.Results In the AP direction,there was a positive correlation between the displacements of the GTV and the inner clip (r =0.643,P =O.013).In the SI direction,the displacement of GTV was positively correlated with those of the lower clip and the skin marker at anterior body midline (r =0.857 and 0.643,P =0.002 and 0.013).In the LR and AP directions,there was a positive correlation between the displacements of the outer clip and the ipsilateral skin marker (r =0.757 and 0.697,P =0.001 and 0.025),but they were negatively correlated with each other in the SI direction (r =-0.647,P =0.043).In the AP direction,there was a positive correlation between the displacements of the inner clip and the skin marker at the anterior body midline (r =0.738,P =0.015).Conclusions The correlations between the displacement of GTV delineated by surgical clips and seroma and the displacements of surgical slips and skin markers vary under different conditions,and so does the correlation between the displacements of surgical clips and skin markers.
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Objective To evaluate the feasibility and safety of endoscopic intraluminal closure of small colon perforation with metal clips in porcine model.Methods A 2 cm full-thickness colon perforation was made in 4 bama mini-pigs.One did not receive local closure as a control, while 3 others underwent closure with bi-and tri-arm clips, one of which received additional fibrin glue injection after closure.Necropsy was done on day 14 after the procedure, and dye leak test, peritoneal fluid bacteria culture and histological examination were performed.During the 2 week observation period, the body temperature and blood leukocytes count were recorded and compared.Results Endoscopic closure of the colon perforation was technically successful in all 3 pigs.The body temperature and blood leukocyte count of these pigs were both lower than those of the control.Necropsy showed that the perforation in control pig was not completely closed and with multiple adhesions around.Perforation complete closure and pathological healing without adhesion were observed in 2 pigs with clip closure only, while adhesion and incomplete pathological healing was detected in the other one with clip closure plus fibrinogen injection (P＜0.05).Conclusion Endoscopic intraluminal closure of a 2 cm colon perforation with metal clips is feasible and safe, while further study is needed to evaluate the effect of combined local fibrinogen injection.