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Duodenal varices are an uncommon disease which occurs along the entire gastrointestinal tract outside the esophagus or stomach.Among ectopic varices,duodenal varices are the most common one.Cirrhosis,hepatic portal hypertension,extrahepatic portal vein occlusion and vasculitis contribute to the pathogenesis of ectopic variceal formation.The unusual pathophysiology,location,diversity and uncertain curative effect of DV are associated with its low detection rate and high mortality of patients.Therefore,the diagnosis and treatment of DV is one of the tough problems in clinical practice.This article reviews the current research advances in pathophysiology,diagnosis and treatment of duodenal varices to provide reference for clinical practice.
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Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastrointestinal cancer. However, the steep learning curve of standard ESD procedures makes it less widely applied in clinical practice. Therefore, various traction devices and techniques have been applied previously to facilitate ESD, such as clip-with-line method, Spring-assisted method, S-O clip method, magnetic anchor method, and robot-assisted method. These methods create a clear field of vision and allow dissections to be performed more quickly and safely. In this article, we will discuss various techniques for achieving tractions during ESD on clinical decision, and their advantages and disadvantages.
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Humanos , Dissecação , Mucosa Gástrica , Segurança , Instrumentos Cirúrgicos , TraçãoRESUMO
Gastrointestinal endoscopy plays a major diagnostic and therapeutic role in most gastrointestinal disorders.However,limited data of clinical safety is available in pregnant patients.Large studies,preferably prospective,with follow-up of fetal outcome are needed to determine fetal safety of endoscopy.This article briefly analyzed the literature on the research progress of gastrointestinal endoscopy during pregnancy,which offered an evident base for diagnosis and treatment in digestive diseases.
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<p><b>OBJECTIVE</b>To investigate the risk factors of gastroesophageal varices rebleeding after therapeutic endoscopy.</p><p><b>METHODS</b>Medline,EMBASE and the China Biology Medicine Database were searched for literature published between January 2000 to May 2013 on topics related to risk factors of gastroesophageal varices rebleeding after therapeutic endoscopy. Data from each study that meet the requirements for analysis were extracted and subjected to meta-analysis.</p><p><b>RESULTS</b>Sixteen studies were collected for use in this meta-analysis. The odds ratio (OR) value of portal vein embolus was 7.88 (P<0.00001). The OR value of beta-blockers or nitrate medications was 0.53 (P=0.0008). The standardized mean difference (SMD) value of number of ligation points was 0.94 (P<0.01). The SMD value of albumin in the subgroup with follow-up time of less than or equal to 14 days was-0.89 (P<0.00001), while the SMD value of prothrombin time in the subgroup with follow-up time of less than or equal to 14 days was 1.78 (P<0.00001).</p><p><b>CONCLUSIONS</b>Portal vein embolus, hepatocellular carcinoma, diameter of the portal vein, Child-Pugh classification C, moderate/excessive ascites, prothrombin time, and number of ligation points were risk factors of gastroesophageal varices early rebleeding after therapeutic endoscopy. Portal vein embolus, hepatocellular carcinoma, and diameter of the portal vein were risk factors of gastroesophageal varices long-term rebleeding after therapeutic endoscopy. Beta blockers or nitrate medications were protective factors of gastroesophageal varices rebleeding after therapeutic endoscopy.</p>
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Humanos , Carcinoma Hepatocelular , China , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Ligadura , Neoplasias Hepáticas , Veia Porta , Fatores de RiscoRESUMO
Minichromosome maintenance protein 7 (MCM7) is an important regulator of DNA replication,and plays an important role in replication initiation and elongation steps.Recent studies show that MCM7 is closely related with the formation and growth of digestive tumors.The detection of MCM7 protein can provide new ideas for the early diagnosis,treatment and prognosis of the digestive tumors.
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Objective To observe the efficacy and safety of endoscopic ultrasonography submucosal resection for treatment of gastric muscularis propria mesenchymal tumor.Methods Endoscopic ultrasonography preliminary diagnosis of 19 cases were diagnosed stromal tumors originating from gastric muscularis propria layer,the endoscopic ultrasonography diagnosis the source,echo,size,blood supply,etc.than treated by endoscopic submucosal excavation.To observe the therapeutic effect and complications.Results Eighteen patients were the full excavation,1 patient was failed.Intraoperative perforation was seen in 2 cases,the wound was healed by the titanium clamp.A small amount of bleeding happened in operation and bleeding was stopped by hot biopsy forceps or argon coagulation.No delayed bleeding happened.Conclusion Submucosal resection for gastric muscularis propria mesenchymal tumors is safe and effective,endoscopic ultrasonography has important value in the strict assessment.
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Objective To investigate the expression of ERBB3 protein,which encoded by ERBB3 gene,in gastric cancer(intestinal type and diffuse type)as well as the normal tissue,and to elucidate the possible role of ERBB3 gene in the progress of gastric cancer.Methods 65 samples of gastric cancer tissue(of which 43 samples were intestinal type and 22 were diffuse type,classified according to the Lauren patho-classification)and 65 samples of normal tissue(control group)were investigated immunohistochemically.The expression of ERBB3 in both control group and gastric cancer group was determined.Comparisons were made according to different pathological types and TNM clinical stages within and between groups.Results 7 of 65 samples(10.8%)in gastric cancer group were found to over-express the ERBB3 protein,while only 1 of 65 samples(1.6%)in control group was found to over-express the ERBB3 protein.Statistical differences(P
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Objective To study the possible molecular mechanism of the damage of HepG2 cell line induced by low concentration of ethanol and ultraviolet irradiation. Methods Hepatoma cell line (HepG2) was exposed to low concentration of ethanol and ultraviolet irradiation, then the changes in cell cycle, the expression of p53 and p21, the correlation between expression of p53 and p21 and cell cycle were analyzed. Results The expression of p53 and p21 was greatly increased, and the cell cycle was found to be blocked at G_0-G_1/G_2-M after ultraviolet irradiation. The cell cycle block of G_2-M and the increased expression of p21 were observed when exposed to low concentration of ethanol, while the expression of p53 showed no significant changes. Cell apoptosis was increased when the cells were exposed to the both injury factors. Conclusion Low concentration of ethanol and ultraviolet irradiation can affect cell cycle and the process of cell apoptosis through activation of different molecular mechanism.
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Objective To probe into the application of argon laser photo-coagulation (APC) in interventional endoscopic treatment of digestive diseases. Method 62 patients suffering from digestive diseases were treated with interventional endoscopic treatment with the aid of APC, including 393 cases of gastrointestinal polyps, 122 cases of gastritis verrucosa, 5 cases of Barrett's esophageal ulcer and 42 cases of hemorrhage of digestive tract. The effectiveness of the treatment was observed. Result For 350 cases of gastrointestinal polyp, in which the diameter of the polyp was less than 5 mm, the lesions were eliminated when checked by endoscopy 3 months after APC treatment, the curative ratio was 100%. For 43 cases of gastrointestinal polyps, in which the diameter of the polyp was larger than 5 mm, no residual lesions were found in 38 cases, and remarkable improvement was found in another 5 cases of Peutz-Jeghers syndrome. For 122 case of gastritis verrucosa, 116 cases recovered thoroughly, the curative ratio reached 95.1%. In 42 cases of hemorrhage of digestive tract, no hemorrhage was found in 41 cases after APC treatment. In 5 cases of Barrett′s esophageal ulcer treated with APC accompanied by PPIs, squamous cell epithelium was found to have recovered as shown by endoscopy and biopsy 3 months after the treatment, and no recurrence 12 months later. Conclusion APC can be widely used in digestive diseases including gastrointestinal polyps, hemorrhage of digestive tract, Barrett's syndrome, gastritis verrucosa, etc. APC has a special value for the treatment of gastrointestinal polyp when the diameter of the polyp was less than 5 mm, and also gastritis verrucosa.
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Objective:To investigate the effects of mucosal strengthening treatment on preventing recurrence of closedvarices. Methods: In 264 patients with esophageal varices obliteration by banding ligation and sclerotherapy, of 136 patientswere gone on to treat with strengthening mucosa, and 128 patients without strengthening treatment. All patients had beenobserved out of hospital for 1-13 years. Results: There were no recurrence and rebleeding of esophageal varices in the groupwith strengthening treament. But in the group without strengthening treatment, 25 patients (19. 5%) had isolated or strip-like varices with red colour signI small veins grew thick and part of mucosa appeared clear hyperaemia in 21 patients(16.4% ); 6 patients (4.7% ) rebleeded. There were significant differences between two groups (P