Efficacy and safety of placing nasoenteral feeding tube with transnasal ultrathin endoscope in critically ill patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope.</p><p><b>METHODS</b>Totally 49 patients, involving 46 (93.9%) being American Society of Anesthesiologists Physical Status (ASA-PS) grade III (n = 3) and grade IV (n = 43), in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed.</p><p><b>RESULTS</b>The tube was placed at or beyond the Treitz's ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 (93.9%) cases by transnasal method and 3 (6.1%) cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was (6.2 +/- 5.6) minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was (12.3 +/- 2.1) minutes. In the period of nasoenteral tube placement, the average systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and average pulse oxygen saturation (SpO(2)) did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose.</p><p><b>CONCLUSION</b>The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.</p>

Application endoscopic mucosal resection to therapy early gastrointestinal cancer and precancerous lesion / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the clinical value of endoscopic mucosal resection (EMR) on early gastrointestinal cancer and precancerous lesion.</p><p><b>METHODS</b>The EMR data of 42 lesions from 28 patients, collected from Apr. 2001 to Dec. 2005, were retrospectively analyzed. All the lesions were confirmed histologically before and after operation.</p><p><b>RESULTS</b>Forty-two lesions were removed by the EMR from 28 patients. Lesion types observed under endoscopy were as follows: type I 9 lesions (type Isp 2 lesions, type Is 7 lesions), type II 33 lesions (type IIa 23 lesions, type IIa + IIc 4 lesions, type IIb 6 lesions). Thirty-eight EMRs were performed by using snare resection techniques and 4 EMRs by using suction cap-assisted techniques. The size of lesions changed from 0.6 cm x 0.6 cm to 3.0 cm x 3.5 cm. Complete resections were achieved in 36 of 40, among them, 2 lesions were divided into 2 pieces and 1 lesion was divided into 3 pieces. Post-EMR histopathologic evaluation revealed the following</p><p><b>RESULTS</b>carcinoma in 4 lesions, high-grade dysplasia (HGD) in 11 lesions, middle-grade dysplasia (MGD) in 17 lesions, adenoma in 6 lesions, non-adenoma in 2 lesions. The pathology match rate between local biopsy and EMR was 60.0%. The detection rates of cancer, HGD and MGD by EMR were higher than that by routine biopsy. No serious complications were seen in this study.</p><p><b>CONCLUSION</b>Endoscopic mucosal resection has significant impact on the endoscopic intervention treatment of early cancer and precancerous lesion in digestive tract.</p>

Expression of glutathione S-transferase-pi and DNA topoisomerase II alpha and their implications in colorectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of GST-pi and Topo II-alpha, and their relationships with clinicopathological parameters in colorectal carcinoma.</p><p><b>METHODS</b>The expression of GST-pi and Topo II-alpha were detected by avidin-biotin-peroxide complex (ABC) method in tumor specimens, matched paratumor tissues from 60 cases with colorectal carcinoma and normal colonic tissues from 15 cases.</p><p><b>RESULTS</b>The expression rates of GST-pi and Topo II-alpha were 90.0% and 86.7% respectively in tumor tissues, significantly higher than those in matched paratumor tissues and normal tissues (P< 0.01). The expressions of GST-pi and Topo II-alpha were associated with cellular differentiation, Dukes stage and lymph node metastasis (all P< 0.01), but not with tumor size and histological type (all P > 0.05). The expression level of GST-pi was significantly higher in poorly differentiated tumors than that in well differentiated tumors. The expression level of Topo II-alpha in well-differentiated tumors were stronger than that in poorly differentiated tumors.</p><p><b>CONCLUSIONS</b>The detection of GST-pi and Topo II-alpha expressions may be helpful to judge the malignant behavior, metastasis and prognosis in human colorectal carcinoma.</p>