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Objective:To investigate the optimal emergency endoscopy timing in patients with esophagogastric variceal bleeding (EGVB).Methods:The clinical data of patients with EGVB emergency endoscopy in Renmin Hospital of Wuhan University from December 2018 to November 2020 were collected and analyzed. According to the time interval from admission to the start of emergency endoscopy, they were divided into emergency endoscopy group (<6 h, n=115) and early endoscopy group (6-24 h, n=57). The baseline data, clinical efficacy and postoperative situation of the two groups were compared, and the risk factors of 6-week mortality of EGVB emergency endoscopy were analyzed by univariate and multivariate analysis. Results:In terms of baseline characteristics, there were no significant differences in age, gender, causes, shock index, model for end-stage liver disease (MELD) score, charlson complication index (CCI) score, portal hypertension related complications between the two groups ( P<0.05). However, the albumin (ALB) in emergency endoscopy group was significantly lower than that in early endoscopy group ( P<0.001). There were significant differences in Child Pugh grading and Child Pugh score between the two groups ( P=0.002, P=0.001). In terms of endoscopic efficacy, the detection rate of bleeding site in emergency endoscopy group was significantly higher than that in early endoscopy group (90.4% and 73.7%, P<0.05). There was no significant difference in operation duration, immediate hemostasis success rate, 5-day rebleeding rate, rescue treatment demand and 6-week mortality between the two groups ( P>0.05). There was no significant difference in bleeding related death between the two groups ( P>0.05). In addition, there was no significant difference in blood product consumption, intensive care unit (ICU) stay and total hospital stay between the two groups ( P>0.05). Multivariate analysis showed that Child Pugh grade C ( P=0.018), MELD score ( P=0.005) and CCI score ( P=0.001) were independent risk factors for 6-week death outcome of EGVB patients, while emergency endoscopic intervention time was not related to 6-week death outcome ( P=0.5). Conclusions:The efficacy of early endoscopic intervention is no worse than that of emergency endoscopic intervention, except for the identification of bleeding site. Child-Pugh grade C, MELD score, and CCI score are the independent risk factors for 6-week mortality, while the timing of emergency endoscopy is not associate with 6-week mortality in EGVB patients.
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Objective:To investigate the predictive value of 3-hour post-endoscopic retrograde cholangiopancreatography (ERCP) serum amylase and lipase levels for postoperative pancreatitis (PEP).Methods:Clinical data of patients who underwent ERCP from June 2017 to December 2018 in our hospital were retrospectively analyzed. Risk factors of PEP were examined with univariate and multivariate analysis. Receiver operator characteristic (ROC) curve for 3-h postoperative serum amylase and lipase was generated and the optimal cut-off levels for PEP prediction were calculated.Results:A total of 491 patients were enrolled in this study, and 29 patients developed PEP. Compared with the uncomplicated group, female gender [75.9% (22/29) vs. 49.1% (227/462)], pancreatogram [65.5% (19/29) vs. 32.0% (148/462)], pancreatic duct cannulation [27.6% (8/29) vs. 11.7% (54/462)] and coronary heart disease [17.2% (5/29) vs. 4.5% (21/462)] accounted for a significant higher proportion in PEP group (χ 2=7.79, 13.63, 6.25, 6.42, all P<0.05), while logistic regression analysis revealed that only pancreatic duct cannulation was an independent risk factor ( OR=3.574, 95 %CI: 1.315-9.713, P<0.05). Areas under the ROC curve of serum amylase and lipase at 3 h were 0.897 (95 %CI: 0.842-0.951, P<0.01) and 0.915 (95 %CI: 0.881-0.948, P<0.01), respectively ( Z=0.550, P>0.05). For amylase, ideal sensitivity(93.1%) and specificity(93.3%) could be obtained as cut-off levels>1.0 and 3.0 times the upper limit reference (ULR), respectively. Correspondingly, as cut-off levels for lipase>2.5 and 6.0 times the ULR, the sensitivity was 93.1% and specificity was 91.3%, respectively. Conclusion:Three-hour postoperative serum amylase and lipase are both ideal indicators for predicting PEP with similar clinical value.
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Objective To evaluate the safety and efficacy of a new magnetic anchoring and guidance system on endoscopic submucosal dissection(ESD)in pig models. Methods Two skilled operators performed ESD at the rectum part of 2 pigs with the help of a new magnetic anchoring and guidance system. The dissection time,dissection rate per unit time, en-bloc resection rate and complications were analyzed. Results Five simulated lesions underwent ESD with the help of the magnetic anchoring and guidance system. The dissection time was 26.6 min and the dissection rate was 0.38± 0.1 cm2/min. All the lesions were dissected totally. There was no perforation or delayed bleeding. Conclusion The new magnetic anchoring and guidance system is effective and safe for pig rectal ESD. It can effectively expose submucosal layer,and assist resection under the endoscopic observation.
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To evaluate the efficacy of the prophylactic use of diclofenac in prevention of hyperamylasemia and hyperlipasemia in patients undergoing double-balloon enteroscopy (DBE).One hundred and sixteen patients undergoing peroral DBE were enrolled in the study.Total 121 procedures were performed,in 56 procedures diclofenac sodium 50 mg was administered by rectum 1 h before the peroral DBE (intervention group) and in 65 procedures no medication was given (control group).Serum amylase and lipase levels were measured before and 4 h,24 h after the procedure.At 4 h after DBE the incidence rates of hyperamylasemia and hyperlipasemia in intervention and control groups were 33.9％,38.5％ (P ＞ 0.05) and 21.4％,36.9％ (P ＞0.05),respectively.At 24 h after DBE,the incidence rates of hyperamylasemia and hypedipasemia in intervention and control groups were 19.6％,24.6％ (P ＞ 0.05) and 10.7％,15.4％ (P ＞ 0.05),respectively.Mild acute pancreatitis developed in one patient and gastrointestinal hemorrhage occurred in another patient.Hyperamylasemia and hyperlipasemia is common and transient after double-balloon enteroscopy,and rectal administration of diclofenac sodium cannot effectively reduce the incidence.
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Two cases of hepatic cavernous hemangioma underwent transcatheter arterial embolization and the bile duct damage occurred after operation.Chemical cholecystitis developed in one case,gallbladder necrosis in another and hilar bile duct stricture occurred in both cases.Thirty reported cases of destructive damage of bile duct induced by transcatheter arterial embolization were found from searching PubMed databases and CNKI net.The main complications included acute cholecystitis,hepatonecrosis,biliary cirrhosis and bile duct damage.The literature review indicates that thanscatheter arterial embolization may cause severe bile duct damage and should be chosen and operated with caution.