Comparison of endoscopic retrograde cholangiopancreatography assisted with colonoscope and enteroscope in patients with history of Roux-en-Y anastomosis (with video) / 中华消化内镜杂志

Objective:To compare the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) assisted with colonoscope and enteroscope in patients with history of Roux-en-Y anastomosis.Methods:A retrospective study was performed on the data of 70 patients who underwent ERCP assisted with standard colonoscope or single balloon enteroscope after Roux-en-Y reconstruction in Hangzhou Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020. Patients were divided into the standard colonoscopy group ( n=43) and the single balloon enteroscopy group ( n=27) according to endoscopy. The success rates of insertion, intubation and ERCP, and incidence of complications were compared. Results:A total of 81 ERCP procedures were performed in 70 patients. The insertion success rates of the standard colonoscopy group and the single balloon enteroscopy group were 91.8% (45/49) and 78.1% (25/32), respectively, showing no significant difference ( χ2=2.04, P=0.153). The success rates of primitive papilla intubation in the two groups were 74.1% (20/27) and 1/6, showing significant difference ( P=0.016). The ERCP success rates of the standard colonoscopy group and the single balloon enteroscopy group were 75.5% (37/49) and 59.4% (19/32), showing no significant difference ( χ2=2.36, P=0.124). The post operative complication incidences of the standard colonoscopy group and the single balloon enteroscopy group were 4.1% (2/49) and 9.4% (3/32), showing no significant difference ( χ2=0.25, P=0.620). Conclusion:ERCP assisted with standard colonoscope and single balloon enteroscope is safe and effective in patients after Roux-en-Y anastomosis. Standard colonoscopic ERCP can become an endoscopy solution for patients with biliary tract disease after Roux-en-Y reconstruction.

Effect of nutritional status and comfortability of early postoperative diet of patients following sedated colonoscopic polypectomy / 中国实用护理杂志

Objective:To investigate the effect of nutritional status and comfortability of early postoperative diet of patients following sedated colonoscopic polypectomy.Methods:A total of 300 patients who undergoing sedated colonoscopic polypectomy were randomly divided into normal group and experimental group 1, group 2, with 100 cases in each group. The control group received total fasting with intravenous infusion, oral clear fluids were begun up on the first postoperative day and solid foods on the fourth day. In the experimental group 1 and group 2, clear fluids were begun up to six hours or two hours after surgery, respectively, followed by semi-liquid on the first postoperative day, and solid food three days later. The clinical outcomes such as time of first defecation, hospitalization time, abdominal pain, hypoglycemial reaction, bleeding volume and nausea/vomiting was recorded between three groups. In addition, the nutritional status and comfortability was compared by using serum albumin detection and Visual Analogue Scale (VAS), respectively.Results:The time of first defecation were (22.46±2.96) hours and (21.54±2.17) hours in the experimental group 1 and group 2, significantly shorter than that in the control group (26.37±4.87) hours; meanwhile, the time of first defecation were significantly decreased in the experimental group 2 compared to the experimental group 1, the difference was statistically significant ( F value was 51.812, P<0.05). The rate of hypoglycemial reaction were 5.10% (5/98) and 2.04% (2/98) in the experimental group 1 and group 2, significantly lower than that in the control group 13.40% (13/97), the difference was statistically significant ( χ2 value was 10.582, P<0.05). After 5th day of surgery, the level of serum albumin were (36.16±6.44) g/L and (36.55±6.57) g/L in the experimental group 1 and group 2, significantly higher than those in the control group (33.97±5.91) g/L, the difference was statistically significant ( F value was 4.732, P<0.05). However, there was no significant difference in the VAS scores among the three groups ( P>0.05). Conclusion:Two hours after sedated colonoscopic polypectomy oral feeding can obviously promote the recovery of gastrointestinal function, which does not increase the occurrence of postoperative complications, and promote the postoperative recovery of the patients.

The application of quantitative immune fecal occult blood test for the screening of colorectal cancer in health check?up participants / 中华健康管理学杂志

Objective To evaluate the application value of quantitative immune fecal occult blood test (FOBT) in colonoscopy for the screening of colorectal cancer in health check-up participants. Methods The subjects were selected from July 2017 to June 2018 in the Health Management Center of the Second Affiliated Hospital of Suzhou University. The subjects were the healthy individuals who chose quantitative immune FOBT or chemical method plus immunogold double-method FOBT (referred to as"double-method FOBT"), excluding those who had interfering factors. Individuals with a positive result in primary screening were selected and conducted with colorectal cancer by colonoscopy. If the polyploidy lesions were observed during colonoscopy, the biopsy or excision was performed, and the pathological diagnosis was performed. The positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy were compared between the two methods. Quantitative immunoassay FOBT was analyzed in different gender, age group, physical examination nature, positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy. Results 18 728 people chose quantitative immunoassay FOBT and 6 212 people chose double-method FOBT at the same time. There was no significant difference in gender and age between the two groups (all P>0.05), which was comparable. The detection rate of quantitative immune FOBT was higher than double-method FOBT (74.62% vs 32.23%, P<0.001). The positive rate of quantitative immune FOBT in primary screening was lower than double-method FOBT (4.11% vs 5.34%, P=0.003). The colonoscopy screening rate in positive population by quantitative immune FOBT was higher than double-method FOBT (27.83% vs 13.08%, P=0.001). These differences were statistically significant. The detection rate of total lesions by colonoscopy was 71.88% in positive population by quantitative immune FOBT. It was 42.86% in double-method FOBT. There was no statistical difference between the two methods (P=0.05). The detection rates of quantitative immune FOBT were significantly different among different genders, ages and physical properties (all P<0.001). The detection rate was higher in males than in females (79.14% vs 68.75%). The detection rate was highest in the group between 40 and 59 years old (79.96%). The individual detection rate was higher than the group (90.08% vs 66.07%). The positive rates in primary screening were significantly different among different ages (P=0.001).It was highest in the group aged 60 or above (5.59%). The colonoscopy screening rate in positive population by quantitative immune FOBT was highest in the group aged 50 or above (36.96%). The detection rate of inflammatory lesions were significantly different among different ages (P<0.001). The detection rate of colorectal cancer in males was higher than in females (11.11% vs 0.00%, P=0.009). In addition, with the increasing of fecal occult blood value, the detection rate of cancer was increased (P=0.041). Conclusion The quantitative immune FOBT is an ideal non-invasive examination for early screening of colorectal cancer. It has important application values.

Combined Use of Single-balloon Enteroscope and Colonoscope for Self-expandable Metal Stent Placement in Patients with Malignant Small Intestinal Obstruction: a Single-center Comparative Clinical Observation / 华中科技大学学报（医学）（英德文版）

Small intestinal obstruction is a common complication of primary gastrointestinal cancer or metastatic cancers.Patients with this condition are often poor candidates for surgical bypasses,and placement of self-expanding metal stent (SEMS) can be technically challenging.In this study,we examined the feasibility of combined application of single-balloon enteroscope (SBE) and colonoscope for SEMS placement in patients with malignant small intestinal obstruction.Thirty-four patients were enrolled in this study,among which 22 patients received SEMS placement by using SBE and colonoscope,while the other 12 patients received conservative medical treatment.The patients were followed up for one year.Stent placernent was technically feasible in 95.5％ (21/22).Clinical improvement was achieved in 86.4％ (19/22).For the 19 clinical success cases,the average time of benefits from a gastric outlet obstruction scoring system (GOOSS) increase ≥1 was 111.9±89.5 days.For the 12 patients receiving conservative medical treatment,no significant improvement in GOOSS score was observed.Moreover,a significant increase of Short-Form-36 health survey score was observed in the 19 patients at time of 30 days after stent placement.By Kaplan-Meier analysis,a significant survival improvement was observed in patients with successful SEMS placement,compared with patients receiving conservative medical treatment.Taken together,combined use of SBE and colonoscope makes endoscopic stent placement feasible in patients with malignant small intestinal obstruction,and patients can benefit from it in terms of prolonged survival and improved quality of life.

Training in Endoscopy: Enteroscopy

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.

Balloon-assisted enteroscopy for biliary and pancreatic diseases after complex gastrointestinal surgery / 中华消化内镜杂志

Objective To explore the endoscopic managements for biliary and pancreatic diseases in patients with the history of complex gastrointestinal surgery.Methods Data of four patients who underwent balloon-assisted enteroscopy after complex digestive surgeries (2 patients underwent Roux-en-Y reconstruction,2 others Whipple reconstruction) were retrospectively collected.One patient with bilio-intestinal anastomosis was explored by double-balloon enteroscope (DBE),and balloon-assisted enteroscopy combined with ERCP was used for other 3 patients.Results Therapeutic ERCP was successfully performed on one patient,and the diagnosis of 3 others were confirmed.No operation-related complications such as bleeding or perforation was observed.Conclusion Balloon-assisted enteroscopy combined with ERCP is an important diagnostic and therapeutic method for biliary and pancreatic diseases in the patients after complex gastrointestinal surgery.

Enteroscopia de doble balón para el diagnóstico de las enfermedades del intestino delgado en los niños / Double-balloon enteroscope for the diagnosis of small intestine diseases in children

INTRODUCCIÓN. La enteroscopia de doble balón (EDB) es un nuevo método que permite la visualización completa de la luz del intestino delgado. La presente investigación se realizó con el objetivo de evaluar la experiencia en la realización de esta técnica en niños atendidos en el Servicio de Endoscopia Pediátrica del Instituto Cubano de Gastroenterología. MÉTODOS. Se realizó un estudio descriptivo retrospectivo para evaluar la seguridad, eficacia y extensión de exploración de la enteroscopia de doble balón en el diagnóstico de las enfermedades del intestino delgado en niños. Para ello fueron estudiados 8 pacientes con examen físico y complementarios negativos de enfermedad del intestino delgado, atendidos entre noviembre de 2008 y octubre de 2009. En 3 de los 8 pacientes existía la sospecha clínica y radiológica de enfermedad de Crohn; en otros 3, la sospecha de tumor de intestino delgado y los restantes fueron atendidos por presentar sangramiento oculto de origen intestinal. RESULTADOS. Se practicaron 7 procedimientos por vía retrógrada y 2 por vía anterógrada; a un paciente se le realizó enteroscopia total empleando ambas vías. La duración media de la EDB por vía oral fue de 62,5 min, con un intervalo de 60 a 65 min y por la vía anal fue de 50,7 min, con intervalo de 45 a 60 min. En todos los casos se logró identificar alguna lesión que explicara los síntomas. CONCLUSIËN. La enteroscopia de doble balón es un método seguro para el diagnóstico de enfermedades del intestino delgado en los niños

INTRODUCTION. The double balloon enteroscope (DBE) is a new method allows the whole visualization of the small intestine lumen. The objective of present research was to assess the experience in the carrying out of this technique in children seen in the Pediatric Endoscopy Service of the Cuban Institute of Gastroenterology. METHODS. A retrospective and descriptive study was conducted to assess the accuracy, effectiveness and extent of the double balloon enteroscope screening in the diagnosis of small intestine diseases in children. Eight patients were studied by means of physical examination and negative complementary ones of small intestine disease, seen between November, 2008 and October, 2009. In three patients there was the clinical and radiological suspicion of Crohn's disease; in other three the suspicion of small intestine tumor and remainder were seen due to hidden bleeding of intestinal origin. RESULTS. Seven procedures were applied by retrograde route and two by the anterograde one, other patient undergoes total enteroscopy using both routes. The main extent of the oral DBE was of 62,5 min with an interval of 60 to 65min and by anal route it was of 50,7 min with an interval of 45 to 60 min. In all cases it was possible to identify some lesion explaining the symptoms. CONCLUSION. Double balloon enteroscope is a safe method for the diagnosis of small intestine disease in children

Effect of propofol used for painless enteroscope on cognitive function / 中国医师杂志

Objective To study the effect of propofol used for outpatient painless enteroscope on cognitive function.Methods One hundred and twenty ASAⅠ~Ⅱpatients scheduled for enteroscope were randomly divided into three groups .Propofol was given 1.5mg/kg(groupⅠ), 2mg /kg (group Ⅱ) or 2.5 mg/kg ( group Ⅲ) intravenously .The enteroscope was inserted when patient showed unconsciousness and no reaction to dictation .SpO2 was kept above 95%96% throughout enteroscope .All patients received neurobehavioral cognitive status examination ( NCSE ) and mini-mental state examination ( MMSE ) test 1 hour before enteroscope examination and 5 minutes,30 minutes, 1 hour after enteroscope examination was o-ver and must finish it within 15 min.The enteroscope examination time , vital signs, analgesia effects and intraoperative awareness were record .Results The ability of memory and calculation at 5 minutes after en-teroscope examination showed a statistical difference between group Ⅰ and ⅡorⅢ( P 0.05 ) , The ability of memory and calcu-lation at 30 minutes, 1 hour after enteroscope examination there was no significant difference in three groups ( P >0.05 ) .In all patients ,the MMSE scores at 5 minutes after enteroscope examination were significant-ly lower than the baseline value ( P 0.05 ) .The NCSE and MMSE scores at 3hour, 12 hour after enteroscope examination there was no significant difference between in group I and II or Ⅲ( P >0.05).Conclusion Propofol 1.5mg/kg used for painless enteroscope examination has no effect on cognitive function .MMSE and NCSE are suitable for evaluation of outpatient's cognitive func-tion.