Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years' experience of 635 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric varices (GV) are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate (BC), the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years' practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients.</p><p><b>METHODS</b>From January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The "sandwich method" and the "modified sandwich method" were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up.</p><p><b>RESULTS</b>A total of 635 GV cases treated with endoscopic injection using BC were collected, most of them (90.2%) suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions (95.2%). Complications occurred in 32 cases (5.2%), including hemorrhage due to early expulsion of tissue glue (3.1%), septicemia (1%) and ectopic thrombosis (0.5%), such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance (76.9%), collapse (17.3%) or remnants (5.8%) of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding (8.0%) and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1, 2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively.</p><p><b>CONCLUSIONS</b>Endoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized oil.</p>

Combination of transgastric and transcolonic routes for natural orifice translumenal endoscopic surgery(NOTES) / 中华消化内镜杂志

Objective To explore the feasibility,advantages and disadvantages of combined trans- gastric and transcolonic routes for NOTES.Methods A female swine was used in this study.Transgastric entrance was the first,followed by transeolonie entrance.A dual-channel endoscope was inserted through the porcine mouth into the gastric cavity and penetrated into the peritoneal cavity through the puncture and bal- loon dilatation of the gastric wall.Then under direct visualization through the transgastric approach,the other endoseope was advanced into the peritoneum.Using the two endoscopes inside the peritoneal cavity,collabo- rative peritoneoseopy was performed by the two endoscopists.After the examination the incisions in the stom- ach and the colon wall were closed with Endoclips.The animal was sacrificed for post-mortem examination with particular attention to the entrance sites and presence of any complications related to the access or to ma- nipulations inside the peritoneal cavity.Results No hemorrhage oecurred during the puneture and balloon dilatation or bow-knife cutting of the gastric wall or the eolonic wall.The liver was damaged while a needle knife penetrated the gastric wall.On the contrary,no organs were damaged during the needle knife penetra- ted the eolonic wall under direet visualization through the transgastric approach.It was difficult to find the gallbladder or the oviduct with a"single arm",but it was easy to see them with the double routes.It was easier to close the colonic incision than to close the gastrie wall with Endoclips.Conclusion Combined transgastric and transcolonic route for NOTES is feasible and it seems to be easier to show a target compared with a single route.