Résumé
Objective:To explore the reasonable withdrawal time at different colonic segments.Methods:It was a prospective observational study involving 465 patients who underwent colonoscopy from November 2019 to November 2020 at our endoscopy center. Colonoscopy records in our center from July 2017 to September 2017 were retrospectively analyzed as a validation set.Results:The cut-off values of withdrawal time at ascending colon, transverse colon, descending colon, and sigmoid colon and rectum determined by receiver operating characteristic (ROC) curve were 77 s, 61 s, 56 s, and 109 s, respectively. At the ascending colon, the adenoma detection rate (ADR) was significantly higher (17.3% VS 2.8%, P<0.001) when the colonoscopy withdrawal time was ≥77 s. When the withdrawal time was ≥61 s at the transverse colon (6.9% VS 2.8%, P=0.036), that over 59 s at the descending colon (6.3% VS 1.7%, P=0.019), and that ≥109 s at the sigmoid colon and rectum (31.0% VS 7.9%, P<0.001), the ADR was significantly higher. Multivariate analysis showed that withdrawal time of ≥77 s at the ascending colon ( OR=6.427, P<0.001), those ≥56 s at the descending colon ( OR=3.564, P=0.045) and ≥109 s at the sigmoid colon and rectum ( OR=5.073, P<0.001) were independent risk factors for the increase of ADR. In the validation set, when the withdrawal times at the ascending colon, the transverse colon, the descending colon, and the sigmoid colon and rectum were ≥77 s, 61 s, 56 s, and 109 s, respectively, the total ADR (48.3% VS 17.6%, OR=2.952, P<0.001) and polyp detection rate (PDR) (63.2% VS 23.0%, OR=4.191, P<0.001) significantly increased. There were no significant differences in ADR ( P=0.563) or PDR ( P=0.770) compared with those where withdrawal time was over 6 min. Conclusion:The ADR and PDR significantly increase when the withdrawal times are ≥77 s at the ascending colon, ≥61 s at the transverse colon, ≥56 s at the descending colon, and ≥109 s at the sigmoid colon and rectum.
Résumé
Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease (IBD) patients with comorbid autoimmune disease (AD) and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn's disease (CD)+AD group (n=16),CD group (n=26),ulcerative colitis (UC)+AD group (n=38) and UC group (n=48).Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups (all P＞0.05).The most common concomitant AD of IBD was rheumatoid arthritis (20.4％,11/54) and ankylosing spondylitis (13.0％,7/54).The proportion of mild active patients of CD+ AD group was lower than that of CD group (2/16 vs 53.8％ (14/26),x2 =7.180,P=0.007),while the proportion of severe active patients was significantly higher that of CD group (6/16 vs 0,x2 =8.519,P=0.004).There was no statistically significant difference in moderate active patients between the two groups (P=0.808).Main type of patients of UC+ AD group (76.3 ％,29/38) and UC group (68.8 ％,33/48) were moderate active patients.There was no statistically significant difference in disease stage and location (all P＞0.05).The incidence of extraintestinal manifestations of IBD+AD group (55.6 ％,30/ 54) was significantly higher than that of IBD group (9.5 ％,7/74,x2 =32.279,P＜0.01),and the main manifestation was arthritis (37.0％ (20/54) vs 5.4％ (4/74),x2=20.504,P＜0.01).The rate of glucocorticoid and immunosuppressant application in IBD+AD group was higher than that of IBD group (40.7％ (22/54) vs 17.6％(13/74),x2 =8.438,P=0.004;20.4％(11/54) vs 0,x2=14.000,P＜ 0.01).Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.
Résumé
Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction.Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nanjing Medical University.Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients.The outcomes assessed included diet scores,time to diet,length of hospital stay,treatments fees and complications.Results Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome with significant higher GOOSS score compared with that before treatment (P ＜0.05),but score improves faster in stenting group.Clinical success for endoscopic stenting and surgical gastrojejunostomy was 96.6％ and 92.9％ respectively,and technical success was 100％ for both of them.Endoscopic stenting group was found to have lower early complication rate(3.4％ VS 23.8％,P ＜0.05),higher late complication rate(24.1％ VS 6.9％,P ＜0.05),less time to diet,hospital stay and treatment fees(all P value ＜ 0.05)than surgical gastrojejunostomy group.The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group.There were no significant differences in complication between two groups (27.6％ VS 11.9％,P ＞ 0.05).Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome effectively and safely,but endoscopic stenting improves GOOSS scores more rapid with less time to diet,less early complication rate and easy-dealing late complications,also it needs less hospital stay and fees.It's a better choice for patients with less survival expectation.