Diagnosis and treatment of esophageal foreign body: Operation or endoscopy? / 中国胸心血管外科临床杂志

@#Objective    To summarize our experience in the treatment of esophageal foreign bodies. Methods    A retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years. Results    There were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157). Conclusion    The sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.

Clinical observation of rimazolom for painless gastroscopy sedation in outpatients / 中国药房

OBJECTIVE To obser ve the efficacy and safety of rimazo lom for painless gastroscopy sedation in outpatients. METHODS Totally 84 patients who underwent painless gastroscopy were collected from the outpatient department of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from March to June in 2021. By random number table method combined with envelope allocation concealment method ，they were randomly divided into observation group and control group ，with 42 cases in each group. The patients in the observation group were slowly injected with Sufentanil citrate injection 0.1 μg/kg+Rimazole toluenesulfonate for injection 0.2 mg/kg. Patients in the control group were slowly injected with Sufentanil citrate injection 0.1 μg/kg+ Propofol emulsion injection 2 mg/kg. Gastroscopy was performed after the patient ’s consciousness disappeared. The sedative efficiency，sedative onset time ，recovery time and the occurrence of adverse drug reaction were observed in 2 groups. The heart rate（HR），mean arterial pressure （MAP），pulse oxygen saturation （SpO2），modified observer ’s assessment of alertness/sedation （MOAA/S）score and Narcotrend score were recorded in 2 groups after entering the room （T0），after anesthesia induction （T1）， when gastroscope entered the throat （T2），at the end of gastroscope withdrawal （T3），5 min after gastroscopy （T4）. RESULTS There was no significant difference in the effective rate of sedation （100％），the incidence of respiratory depression ， nausea and vomiting between the two groups （P＞0.05）. The qq.com onset time of sedation in the observation group was longer than control group ，and the recovery time and the incidence ofhypotension，hypotension to be tre ated，injection pain and bradycardia in observation group were significantly shorter or lower than control group （P＜0.05）. At T 0，there was no significant difference in HR ，MAP，SpO2，MOAA/S score or Narcotrend score between two groups （P＞0.05）. From T 1 to T 4，the HR of control group was significantly lower than that of the same group at T 0，and significantly lower than observation group at the same time（P＜0.05）. From T 1 to T 3，the MAP of two groups were significantly lower than the same group at T 0（P＜0.05），but there were no significant differences between two groups and between T 4 and T 0（P＞0.05）. There was no significant difference in SpO 2 at different time points between two groups and HR at different time points in observation group （P＞0.05）. From T 1 to T 3，MOAA/S score and Narcotrend score of two groups were significantly lower than the same group at T 0，while the MOAA/S score and Narcotrend score at T 1 and T 3 and Narcotrend score at T 3 of observation group were significantly higher than control group at the same time （P＜0.05），and the Narcotrend score of observation group at T 2 was significantly lower than control group at the same time（P＜0.05）；at T 4，there were no significant differences in MOAA/S score and Narcotrend score between two groups （P＞ 0.05）. CONCLUSIONS Remazolam shows good sedative effect and safety for painless gastroscopy.

Application value of paper towel combined with 360° horizontal turning over method in preoperative preparation of gastroscopy / 中国实用护理杂志

Objective:To investigate the effect of paper towel combined with 360° horizontal turning over method on the field of vision, operation time and detection of small lesions before gastroscopy, so as to improve the detection rate of early gastrointestinal cancer.Methods:The outpatients and inpatients who voluntarily accepted gastroscopy in the First Affiliated Hospital of Shandong First Medical University from May to October 2020 were enrolled. A prospective randomized controlled study was used. They were divided into the experimental group (paper towel group combined with 360° horizontal turning over) and the control group (routine) according to the random number table. Finally, a total of 948 patients were included, including 487 cases in the experimental group and 461 cases in the control group. The visual field clarity, operation time, rinse times, detection of micro lesions and detection of early cancer of the two groups were compared.Results:The scores of gastric mucosa clarity (fundus, body, antrum and whole stomach) in experimental group were (1.61 ± 0.79), (1.18 ± 0.56), (1.01 ± 0.36), (3.20 ± 0.51) points, which were significantly lower than (2.56 ± 0.82), (2.01 ± 0.65), (1.98 ± 1.10), (5.05 ± 0.89) points in control group. The difference was statistically significant ( t values were 0.02-0.07, all P<0.05). The operation time of the experimental group was (5.91 ± 0.41) min, which was significantly shorter than (6.80 ± 0.72) min of the control group, and the difference was statistically significant ( t=-7.46, P<0.05). The number of flushing in the experimental group was 67 times, accounting for 13.8%, which was significantly lower than 144 times in the control group, accounting for 31.2%, and the difference was statistically significant ( χ2=54.78, P<0.05). The number of microlesions in the experimental group was 398 cases, which was higher than 245 cases in the control group. The difference was statistically significant ( χ2=8.43, P<0.05). For biopsy pathology, the detection of precancerous lesions or early carcinomas in the experimental group (56 cases) was significantly higher than that in the control group (24 cases), and the difference was statistically significant ( χ2=6.45, P<0.05). Conclusions:The application of paper towel combined with 360° horizontal turning over method before gastroscopy can significantly improve the clarity of gastroscope field of vision, shorten the operation time, increase the detection rate of small lesions, and effectively improve the detection rate of early gastrointestinal cancer, which is a simple and practical preoperative preparation method.

Analysis of microbiota characteristics in tumor tissues sampled under gastroscope / 中华微生物学和免疫学杂志

Objective:To investigate the characteristics of bacterial community in upper gastrointestinal tumors.Methods:The study population was patients with upper gastrointestinal tumors (esophageal cancer and gastric cancer). Gastroscopy was performed on the enrolled patients ( n=17), and the specimens were taken from the tumor sites. At the same time, non-tumor tissues more than 4 cm away from the tumor tissues were taken as the control. After total DNA was extracted and purified, high-throughput 16S DNA gene sequencing was used to detect the microbiota in tumor tissues and control tissues. Bioinformatics analysis was carried out and the differences between groups were compared. Results:16S DNA PCR showed that there was no significant difference in bacterial load between tumor tissues and control tissues. The α-diversity and β-diversity indexes showed that the community composition of the two groups was similar; the samples were discrete and the colony composition was different, but there was no significant difference between the two groups. The results of Venn diagram showed that there were more operational taxonomic units (OTUs) in non-tumor tissues than in tumor tissues (2 068 vs 1 358), indicating that the bacterial species in normal tissues were more abundant than those in tumor tissues. Compared with the control tissues, the percentages of Prevotellaceae ( Prevotella), Lactobacaceae ( Lactobacillus) and Fusobacteriaceae ( Fusobacterium) in tumor tissues were relatively higher (the average percentage was more than twice that of the control). Further paired comparison of the top ten bacteria in the family and genus abundance of the two groups of samples showed that Pseudomonas decreased significantly in tumor tissues at the family ( P=0.041) and genus ( P=0.041) levels, while Prevotella was significantly enriched in tumor tissues at the family ( P=0.031) and genus ( P=0.007) levels. Conclusions:The bacterial community in the tumor microenvironment of the upper gastrointestinal tumor changed, and the species enriched in the tumor site were mainly oral common anaerobic bacteria, such as Prevotellaceae ( Prevotella), Lactobacaceae ( Lactobacillus) and Fusobacteriaceae ( Fusobacterium), especially Prevotellaceae ( Prevotella).

Design of Magnamosis System for Endoscopic Tissue Clamping / 中国医疗器械杂志

Based on the principle of magnetic anastomosis technique, the design of magnetic anastomosis system for endoscopic tissue clamping is proposed. The system includes a semi-ring magnet, a special structure transparent cap and a detachable push rod. With the help of the existing digestive endoscopy and endoscopic tissue gripper, the endoscopic close clamping and anastomosis of the bleeding or perforated tissue can be completed. After the anastomosis, the magnet falls off and is discharged through the digestive tract. Animal experiments showed that the system was easy to use, the fistula was clamped firmly, the magnet was discharged for 7~21 days, and there was no magnet retention and digestive tract obstruction. Further safety verification, optimization of endoscopic operation, the system can be used in clinical trial.

Clinical Effect of Kangfuxin Solution Combined with Almagate Suspension on Complication of Gastroscope Biopsy / 中国实验方剂学杂志

Objective:To observe the clinical effect of Kangfuxin solution combined with Almagate suspension on the complication of gastroscope biopsy. Method:Totally 276 cases of chronic superficial gastritis gastroscope biopsy were divided into treatment group and control group randomly. Treatment group was treated by Kangfuxin solution combined with Almagate suspension，while the control group was given no precautionary measures as usual. Then the patients received the abdominal symptom score and fecal occult blood test（FOBT）after 1 week. Result:The cases with abdominal pain，burning sensation and stool occult blood in the control group were more than the treatment group significantly（P<0.05）. The patients' abdominal symptom score in control group was higher than that before the gastroscope biopsy，and that was lower in treatment group（P<0.05）. And the patients' abdominal symptom score of the control group was significantly higher than that of the treatment group after the gastroscope biopsy（P<0.05）. Compared with the Helicobacter pylori（HP）-infected subgroup，the incidences of early satiety and ventosity in the control group were higher than those of the treatment group（P<0.05）. The abdominal symptom score of the patients infected with helicobacter pylori（HP）in control group was significantly higher than that before the gastroscope biopsy and in the treatment group（P<0.05）. Conclusion:Kangfuxin solution combined with Almagate suspension is safe and effective in preventing complications of gastroscope biopsy，especially for patients infected with HP. The method could avoid exacerbating clinical symptoms.

Observation of the effect of comprehensive internal medical treatment including gastric endoscopy on patients with bezoar / 中国综合临床

Objective To investigate the effect of comprehensive internal medical treatment including gastric endoscopy on patients with bezoar. Methods From 2010 to 2016,a retrospective study was conducted on fifty?two patients admitted to Beijing Shijitan Hospital, Capital Medical University. Results The main accompanying diseases were hypertension,coronary heart disease,diabetes mellitus and so on. Food that are easy to induce bezoar : banana, persimmon, hawthorn, chestnut, etc. The treatment included endoscopic treatment, intravenous proton pump suppression, and oral Coca?Cola and bicarbonate solution. The bezoar in two patients after 3 weeks of medical treatment were still not dissolved,finally surgery were performed. One patient's pathology showed early cardiac adenocarcinoma. Five patients had incomplete intestinal obstruction, after fasting and gastrointestinal decompression, and the bezoars were excreted through feces. All patients were cured without death. Conclusion Gastroscopy is a timely treatment that can help diagnose and treat gastric bezoar. The main predisposing factors include hypertension, coronary heart disease, diabetes mellitus and so on. Endoscopic treatment,intravenous proton pump inhibitor,sodium bicarbonate and Coca?Cola could dissolve most bezoar. We should be alert to the possibility of early cancer.

Comparison of electronic gastroscope and rigid endoscope on removal of esophageal incarceration foreign bodies / 中国内镜杂志

Objective To evaluate the efficacy and economy of electronic gastroscope and rigid endoscope on removal of esophageal incarceration foreign bodies. Methods Data of 60 patients with incarceration esophageal foreign body who underwent endoscopic removal of foreign bodies from June 2013 to June 2017 were retrospectively analyzed. They were divided into study group (n = 30) and control group (n = 30) based on the therapy way. The study group was given electronic gastroscope, and the control group was given rigid endoscope. Anesthesia method, success rate of therapy, incidence of endoscopy complication, hospitalization time and average cost of hospitalization were recorded. Results 13patients of study group received local anaesthesia, and 17 patients received intravenous anesthesia, all patients of control group received endotracheal intubation anesthesia. Success rate of therapy between the two group showed no significant difference (96.67% vs 100.00%, P > 0.05). There was no significant difference of the incidence of endoscopy complication between the two group (0.00% vs 3.33%, P > 0.05). Hospitalization time showed no significant difference between the two group [(1.70 ± 1.39) vs (2.20 ± 1.10) d, P > 0.05]. The average cost of hospitalization in study group was (2 022.00 ± 1 787.45) Yuan RMB, which was significantly lower than that of control group (5 078.00 ± 930.57, P < 0.05). Conclusion Both the way of electronic gastroscope and rigid endoscope are safe and efficient in removal of esophageal foreign bodies, but the former has more advantages in simplicity and economical efficiency.

Clinical features of esophageal foreign bodies difficult to remove by gastroscopy / 中华全科医师杂志

Objective To analyze the clinical features of esophageal foreign body(EFB) difficult to remove by gastroscopy.Methods The clinical data of 159 patients with EFBs treated in Renmin Hospital of Wuhan University from January 2013 to April 2017 were analyzed retrospectively.Among 159 cases,the EFBs were removed by gastroscopy in 101 cases(gastroscope group)and removed by non-gastroscope method in 58 cases (non-gastroscope group),including 42 cases removed by esophagoscopy and 16 cases by surgery.The general information of patients,the types of EFB,the condition of impaction,treatments and outcomes of the two groups were analyzed.Results There was no significant difference in age and sex between gastroscope group and non-gastroscope group (P ＞ 0.05).The food typeEFBs included fish bone (n =77),chicken bone (n =45),jujube seeds (n =15),food bolus (n =4);and the non-food type FEBs included spectecleslens (n =2),bottle cap (n =11),denture (n =5).More than one half of FBs were located in the upper esophagus:63.4％ (64/101) in gastroscope group and 66.7％ (28/42) in esophagoscope subgroup;however,EFBs were mostly located in the middle esophagus in surgery subgroup (62.5％,10/16).In gastroscope group and esophagoscope subgroup,the sharp EFBs of length-diameter ＞ 2 cm were rare(n =4,3.9％ and n =3,7.1％),but were common in the surgery group (n =9,56.3％).The EFBs were successfully removed in all patients without massive hemorrhage or death.In gastroscope group (n =101),93 cases had mucosal abrasion and bleeding,5 cases had mild active bleeding,and 1 case had esophageal fistula.In surgical removal (n =16) there were 4 cases of esophageal perforation and postoperative inflammation,3 cases of mediastinal inflammation and 2 cases of mediastinal abscess.Inesophagoscopic removal group (n =42),there were 2 cases of esophageal muscle layer abscess,1 case of esophageal fistula and 1 case of pulmonary infection.Conclusions The most common type of EFBs is of food source.Foreign bodies in the upper and middle segments of the esophagusare difficult to remove with gastroscopy.In case of a sharp foreign body embedded in the middle esophagus,surgical removal is preferred to avoid severe sequences.

Psychological intervention on the anxiety of patients under gastroscope examination / 中国内镜杂志

Objective To explore the psychological intervention on the anxiety of patients under gastroscope examination. Methods According to the self-rating Anxiety Scale (SAS), 100 patients with anxiety disorder were randomly divided into observation group 50 cases, a control group of 50 cases, check the two groups of patients before, during and after adopt routine health education, observation group given psychological intervention at the same time, compared the two groups of patients with anxiety, check the time and satisfaction. Results After the psychological intervention, the scores of self-rating anxiety scale of observation group were significantly lower than those of control group, there were signiifcant differences (P<0.05), check time was shortened obviously, the difference was statistically signiifcant (P<0.05), satisfaction was also signiifcantly better than the control group the difference was statistically significant (P <0.05). Conclusion Psychological intervention can reduce the anxiety level of patients with gastroscope, shorten the examination time of gastroscope, increase the ability of patients to understand the disease, improve patient satisfaction.

Dieulafoy disease in a child:a case report and literature review / 临床儿科杂志

Objectives To explore the clinical diagnosis and treatment of Dieulafoy disease in children. Method The clinical features, endoscopic features and treatment of Dieulafoy disease in a child were reviewed. Results The 2-year-5-month old girl was admitted due to hematemesis for 7 hours. She was diagnosed of Dieulafoy disease by the typical endoscopic appearance. Gastroscopy showed that the lesion was located in gastric angle which was the predilection position of Dieulafoy disease. The small red blood vessels in the central part of the erosion area was exposed on the mucosal surface. The high frequency electrocoagulation under gastroscope was performed and effect was definite. Conclusion Dieulafoy disease is rare in children and lacks obvious clinical features. Endoscopic treatment has definite effect with little trauma and is the first choice of treatment.

Half-effective dosage of etomidate for combined remifentanil used in elderly patients in gastroscope / 临床麻醉学杂志

Objective To determine ED50 and ED9 5 of etomidate for combined remifentanil used in elderly patients in gastroscope.Methods Twenty-three patients were scheduled to receive gastros-copy aged 65-78 years old including males 13 and females 10,weighting 45-76 kg and ASA Ⅰ-Ⅲ. They were slowly injected remifentanil 0.3 μg/kg,and then etomidate 0.20 mg/kg,gastroscopy was performed after their eyelash reflex disappeared.The dosage of etomidate were determined by modified up-and-down methods,0.20 mg/kg was initial dosage.During the gastroscope,restlessness, frowning,swallowing,choking cough could be seen.The adjacent experimental interval dosage was 0.05 mg/kg,the trial was ended when there was the seventh cross-sectional,and determined the ED50 and ED9 5 of etomidate and (95%confidence interval)of them for gastroscope with probability a-nalysis methods.Results The ED50 of etomidate was 0.1 7 mg/kg and 95%CI 0.14-0.21 mg/kg,and the ED9 5 was 0.23 mg/kg,95%CI 0.20-0.42 mg/kg respectively.Conclusion The ED50 and ED9 5 of etomidate combined with remifentanil used for elderly patients for gastroscope respectively are 0.1 7 mg/kg and 0.23 mg/kg.

Comparison between propofol used alone and in combination with opioids for sedation during gastroscopy / 临床麻醉学杂志

Objective To study the effects of propofol used alone and in combined with opioids in gastroscopy,in order to select the more suitable anesthesia protocol.Methods A total of 285 pa-tients undergoing gastroscopy were selected in April ,201 5 in our hospital,including 105 males,180 females,ranging from 18 to 65 years old,weighing 40-90 kg,falling the category of ASA Ⅰ or Ⅱ. According to random number table,subjects were divided into four groups:dezocine group(group D, n =76),fentanyl group (group F,n =87),oxycodone group (group O,n = 71 )and control group (group C,n =5 1).Each group was implemented the corresponding anesthesia.SBP,DBP,HR,SpO 2 in baseline(T0 ),1(T1 ),3(T2 ),5(T3 )min after entering gastroscope were recorded.Choking cough, body movement,extra propofol,awakening time and inspecting time were observed.Results Among four groups,there was no statistical significance in age,gender,weight,blood pressure,heart rate and oxygen saturation and other general information.There were more cases given extra propofol in group C than in the other three groups (P <0.01 ).While for the experimental groups,there were more cases needing extra propofol in group O than in group D and group F (P < 0.01 ).The incidences of body movement and choking cough in group C were higher than those in the other three groups (P <0.01 ).Compared with the group C,dosage of propofol ,awakening time in the three groups,especially in group D,were much lower (P < 0.01 ).Conclusion Propofol in combination with opioids for sedation during painless gastroscopy can alleviate adverse reaction caused by propofol used alone.The more suitable anesthesia protocol is propofol with dezocine.

Clinical application of electronic gastroscope in diagnosing gastric ulcer patients / 中国医学装备

Objective:To analyze and evaluate the electronic gastroscope clinical application in diagnosing gastric ulcer patients, providing theoretical basis to clinical treatment.Methods: The research objects were our hospital digestive internal medicine treating and diagnosed 148 cases gastric ulcer patients, all patients were doing electronic gastroscopy. Retrospectively analyzed electronic gastroscope biopsy results and compared the results with the pathological diagnosis results, evaluating electronic gastroscopy accuracy in the diagnosis of gastric ulcer patients.Results: One hundred and forty-eight cases gastric ulcer patients, pathological diagnosis results were benign, diagnostic accuracy was 100%. Electronic gastroscope showed that 140 benign gastric ulcer patients, diagnosis accuracy rate was 94.6%. Among them, the gastric perforation 58 cases, accounting for 39.2%, hemorrhage 62 cases, accounting for 41.9%; pyloric obstruction 49 cases, accounting for 33.1%, combined two kinds of lesions and more than 37 cases, accounting for 25.0%.Conclusion: Electronic gastroscopy can observe the fine structure of the gastric mucosa, accurately identify gastric ulcer patients, having high accuracy in diagnosis of gastric ulcer patients and widely clinical application worth.

Analysis of operative approaches and their curative effect in gastric stromal tumor / 肿瘤研究与临床

Objective To explore the operative approaches of gastric stromal tumor,and to evaluate the treatment effect of various operation methods. Methods The clinical and pathological data of 96 cases of gastric stromal tumor treated in People's Hospital of Shanxi Medical University from Jan 2011 to Jun 2015 were analyzed retrospectively. 16 cases got laparoscopic resection, 48 cases got gastroscope and laparoscopic combined resection, and 42 cases got open resection. Results For patients with tumor diameter 0.05). For patients with tumor diameter > 5 cm, the operation time, intraoperative blood loss, postoperative hospitalization days, postoperative complications, and postoperative metastasis of mortality in the laparoscopic group didn't have the advantage compared with the laparotomy group (P > 0.05). Conclusion Different diameter of gastric stromal tumor should adopt different surgical methods and ways, the indication is strict, otherwise easy to cause tumor residual or disseminated planting.

Correlation of Traditional Chinese Medical Syndrome Patterns of Reflux Esophagitis with Esophagus Mucosal Performance Under Gastroscope and Gastrointestinal Hormones / 广州中医药大学学报

Objective To explore the correlation of modern medical examination indexes with the traditional Chinese medical syndrome types of reflux esophagitis ( RE) , thus to supply evidence for the standardization of syndrome differentiation. Methods Seventy-six RE patients who met the inclusion criteria were enrolled into the study. And then we investigated the correlation of traditional Chinese medical syndrome types with endoscopicmucosal performance grading, plasma Ghrelin content, esophageal mucosal substance P ( SP) and vasoactive intestinal peptide (VIP) . Results (1) Syndrome patterns of RE showed certain correlation with the endoscopic mucosal performance (P<0.01) . Endoscopic mucosal performance grade 0-Ⅲ corresponded to the syndromes of gallbladder heat attaching stomach, liver-stomach disharmony/phlegm-qi blocking middle energizer, hepatogastric stagnant heat, middle energizer deficiency with reversed flow of qi, respectively. ( 2) The plasma Ghrelin content of RE patients with syndrome of phlegm-qi blocking middle energizer was lower than that of the patients with other syndrome patterns, and the difference was significant compared with the syndromes of hepatogastric sta gnant heat, liver-stomach disharmony, and gallbladder heat attaching stomach ( P<0.05 or P<0.01) . ( 3 ) The expression level of SP in the esophageal mucosa was the highest in the syndrome of hepatogastric stagnant heat, and was the lowest in the syndrome of phlegm-qi blocking middle energizer; expression level of VIP in the esophageal mucosa was the highest in the syndrome of middle energizer deficiency with reversed flow of qi, and was the lowest in the syndrome of hepatogastric stagnant heat ( P<0.05 or P<0.01) . Conclusion Traditional Chinese medical syndrome types of RE have correlation with endoscopic mucosal performance and immunohistochemical detection results for gastrointestinal hormones, which will be beneficial to the estimation of the development and severity of RE.

Use of a Double-Channel Gastroscope Reduces Procedural Time in Large Left-Sided Colonic Endoscopic Mucosal Resections

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) of large colorectal lesions is associated with increased procedural time. The objective of this study was to evaluate the effect of double-channel gastroscope (DCG) use on the procedural time of EMRs in the rectosigmoid area. METHODS: All EMRs for sessile or flat rectosigmoid lesions > or =2 cm performed between July 2011 and September 2012 were retrospectively analyzed. RESULTS: There were 55 lesions > or =2 cm in the rectosigmoid area in 55 patients, of which 26 were removed by EMR using a DCG (DC group) and 29 by using an ordinary colonoscope or gastroscope (OS group). The mean size of the removed polyps, morphology, adverse effects, and other parameters were similar between the two groups. The mean procedural time was significantly lower in the DC group than in the OS group (24.4+/-18.3 minutes vs. 36.3+/-24.4 minutes, p=0.015). Moreover, in a subgroup of patients with polyps >40 mm, the statistical difference in the mean procedural time between the DC and OS groups was even more pronounced (33+/-21 minutes vs. 58.7+/-20.6 minutes, p=0.004). CONCLUSIONS: Our data suggest that the use of a DCG in the resection of large nonpedunculated rectosigmoid lesions significantly reduces the procedural time.

Clinical observation of lafutidine treated in curing peptic ulcer / 中国综合临床

Objective To observe the clinical efficacy and safety of application of lafutidine treated in curing peptic ulcer.Methods Eighty-four patients with peptic ulcer were randomly assigned to receive either lafutidine(10 mg) twice daily in 42 patients of cured group or lansoprazole (30 mg) once daily for 4 weeks in 42 patients of control group.Ulcer healing rate and clinical performance were examined after treatment.Results The first,third and seventh day of peptic ulcer healing rate were 38.09％ (16/42), 71.42％ (30/42) and 90.47％ (38/42) in the lansoprazole group and 23.81％ (10/42), 76.19％ (32/42) and 85.71％ (36/42) in the lafutidine group.There were no siginificant difference between two groups (P =0.157,0.620, 0.736).Gastroscope examination showed the complete healing rate, average healing rate and general clinical effectiveness were 61.90％(26/42) ,30.95％(13/42) and 97.61％(41/42) in the lansoprazole group,while the number for lafutidine group were 57.14％ (24/42), 28.57％ (12/42) and 95.23％ (40/42).There were no siginificant difference between two groups (P =0.657, 0.811, 1.000).No severe side-effect was occurred in both groups.Conclusion Use Lafutidine to cure peptic ulcer can promote healing effectively, improve patients' clinical symptoms which is similar to lansoprazole.

Comparison of endoscopic ultrasonography and CT scan for patients with esophageal carcinoma / 重庆医学

Objective To evaluate the guidance value of endoscopic ultrasonography (EUS) and CT scan in preoperative clinical staging for diagnosis and treatment of esophageal cancer .Methods 68 patients with esophageal cancer were randomly divided into EUS group and CT group using a random numbers table(34 cases in each group) .Patients in EUS group were examined by EUS , patients in CT group were examined by CT scan ,and staged according to the TNM (2003) staging system ,and were compared with surgical pathologic findings .Results The accuracy rates of T staging by EUS were 0(0/2) for Tis ,75 .0% (3/4) for T1 ,75 .0% (6/8) for T2 ,86 .7% (13/15) for T3 ,80 .0% (4/5) for T4 ,and the totle accuracy rate was 76 .5% (26/34) for T ;those of N staging were 71 .4% (5/7) for N0 ,75 .0% (9/12) for N1 ,0(0/11) for N2 ,0(0/4) for N3 ,and the totle accuracy rate was 41 .2% (14/34) for N .The accuracy rate of T staging by CT scan were 0(0/1) for Tis ,33 .3% (2/6) for T1 ,28 .6% (2/7) for T2 ,78 .6% (11/14) for T3 ,83 .3% (5/6) for T4 and the totle accuracy rate was 58 .8% (20/34) for T ,the difference was statistically significant com-pared with the EUS group(P<0 .05);those of N staging were 77 .8% (7/9) for N0 ,76 .9% (10/13) for N1 ,66 .7% (4/6) for N2 , 50 .0% (3/6) for N3 and the totle accuracy rate was 70 .6% (24/34) for N ,the difference was statistically significant compared with the EUS group (P<0 .05) .Conclusion The accuracy rate of EUS are higher for diagnosis in esophageal cancer and preoperative T staging .The accuracy rate of CT scan are higher for the preoperative N staging .EUS combined with CT scan has great significance for choosing ideal therapy plan for esophageal cancer ,and for estimating prognosis of esophageal cancer .

Thoracic sympathectomy by Natural Orifice Trans Umbilical Surgery (NOTUS) for woman patients with palmar hyperhidrosis / 中华消化内镜杂志

Objective To investigate the clinical value of transumbilical endoscopic thoracic sympathectomy on women patients with palmar hyperhidrosis.Methods A total of 25 consecutive women patients with palmar hyperhidrosis underwent transumblical thoracic sympathectomy with ultra-thin endoscope.The operative data,including duration of operation,intra-operative and postoperative complications were recorded.Results The procedure was performed successfully in all 25 patients with a mean operative time of 64 min(58-113 min).No umbilical hernia,diaphragmatic hernia,Horner's syndrome or hemothorax were observed.Minor pneumothorax was found in postoperative chest X-ray in 3 patients,all of which were completely resolved with conservative treatment.All patients recovered to their normal life at 1 week after discharge.The scar was small and hidden in umbilical with no visible incisions.After a follow-up of 4 to 12 months,all patients' hands sweating symptoms completely disappeared,axillary sweat symptoms completely resolved in 6 patients,significantly improved in 4 and mildly improved in 1.Conclusion Transumbilical thoracic sympathectomy with ultrathin flexible endoscope is a safe and effective option for women patients with severe palmar hyperhidrosis,which provides excellent cosmetic outcomes.