A national questionnaire survey on endoscopic treatment for gastroesophageal varices in portal hypertension in China / 中华消化内镜杂志

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Value of endoscopic retrograde cholangiopancreatography for the diagnosis and treatment of pediatric pancreaticobiliary maljunction / 中华消化内镜杂志

Objective:To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis and treatment of pediatric pancreaticobiliary maljunction (PBM).Methods:Data of 40 pediatric patients under 14 with PBM diagnosed and treated by ERCP at Department of Gastroenterology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from November 2012 to September 2022 were collected. PBM types, ERCP-related diagnosis and treatment, adverse events and prognosis were retrospectively analyzed.Results:Nineteen cases were P-B type (joining of common bile duct with pancreatic duct), 17 were B-P type (joining of pancreatic duct with common bile duct), and 4 were complex type. Forty children with PBM underwent 50 ERCP-related operations, among which 48 procedures succeeded. One case failed during cannulation of ERCP, replaced by rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP) afterwards. There were no serious postoperative adverse events such as bleeding, perforation or death. Thirty-four patients (85%) were followed up successfully, among which 14 underwent further surgery and 20 continued conservative treatment.Conclusion:ERCP is the golden standard to diagnose pediatric PBM, and it is also safe and effective treatment for PBM.

Clinical characteristics analysis of multiple clustered polyps in the ileocecal region(9 cases) / 中国内镜杂志

Objective To analyze the etiology and clinical characteristics of multiple clustered polyps in the ileocecal region.Methods Nine patients with multiple clustered polyps only in the ileocecal region found from 2017 to 2022 were retrospectively collected,and their etiology and clinical characteristics were analyzed.Results There were 9 patients with multiple clustered polyps in the ileocecal region in this group.There were 7 males and 2 females.The age of onset was 28～73 years old,52(40.0,62.5)years old.There were 8 cases of abdominal discomfort or abdominal pain,4 cases of chronic diarrhea,2 cases of mucous stool and 1 case of dry stool.The number of polyps ranged from 4～17,and the diameter of polyps ranged from 0.2～1.0 cm.Pathological examination showed chronic inflammation of ileocecal mucosa with polyp formation in 8 cases,and canalicular adenoma with mild dysplasia in 1 case.7 cases ate more red meat food or processed products.6 cases had repeat colonoscopy,and 3 cases had recurrence.Conclusion Multiple clustered polyps appearing only in the ileocecal region are a special type of polyps closely related to inflammation,and endoscopic surgery is recommended followed by attention to control inflammation.

Progress in Diagnosis and Endoscopic Treatment of Esophageal Leiomyoma / 胃肠病学

Esophageal leiomyoma is the most common benign tumor of the esophagus,usually asymptomatic.With the development and widespread application of endoscopic ultrasonography technology,its detection rate has been increasing year by year.Its diagnostic methods have evolved from initial esophagography and chest electronic computed tomography,to endoscopic ultrasonography,endoscopic ultrasonography-guided fine-needle aspiration,and endoscopic ultrasonography-guided fine-needle biopsy.The technology is constantly updated,and the diagnostic accuracy is constantly improving.The treatment methods have also shifted from previous open chest surgery to thoracoscopic surgery,and in recent years,there has been a shift towards ultra minimally invasive techniques such as endoscopic mucosal resection,endoscopic submucosal dissection,endoscopic submucosal excavation,endoscopic full-thickness resection,and submucosal tunnel endoscopic resection.This article provides a review of the diagnosis and endoscopic treatment progress of esophageal leiomyoma.

Study on Use of Somatostatin in Prevention of Rebleeding After Endoscopic Secondary Prophylaxis of Gastroesophageal Varices / 胃肠病学

Background:Gastrointestinal bleeding is caused by factors such as poor platelet and coagulation function,and damage to varicose veins during endoscopic secondary preventive treatment in cirrhosis patients with gastroesophageal varices.At present,there is no clear standard for the use of somatostatin and its analogues after endoscopic secondary preventive treatment.Aims:To investigate the clinical value of somatostatin in preventing rebleeding after endoscopic secondary prophylaxis in patients with gastroesophageal varices.Methods:Clinical data of cirrhotic patients with gastroesophageal varices underwent endoscopic secondary prevention(endoscopic variceal ligation,endoscopic injection sclerotherapy,endoscopic cyanoacrylate injection)from Sept.2020 to Aug.2023 in this region were retrospectively analyzed.And patients were divided into group A(conventional therapy)and group B(conventional therapy+somatostatin).The prognosis(rebleeding rate,mortality rate),treatment benefit(length of stay,hospitalization cost)and blood indicators of the two groups were compared.Results:There was no significant difference in bleeding rate 3 days and 6 weeks after surgery between group A and Group B(P>0.05),and no death occurred after surgery.Hospital stay and hospitalization cost in group A were significantly decreased than in group B(P<0.05).No significant difference in incidence of adverse reaction was found between the two groups(χ2=3.21,P>0.05).No significant differences in hemoglobin,platelets,creatinine and liver function Child grade 6 weeks after surgery in group A and group B were found when compared with before surgery(P>0.05),while D-Dimer level was significantly decreased(P<0.05).Conclusions:For patients with gastroesophageal varices,endoscopic secondary preventive surgery can be performed according to the characteristics of blood flow after preoperative CT examination,and somatostatin can be unnecessary after surgery to improve treatment compliance and reduce the economic burden of patients.

Clinical analysis of 12 cases of refractory thoracogastric-airway fistulas treated with modified mushroom-shaped occluder / 中华消化杂志

Objective:To evaluate the efficacy and safety of modified mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas.Methods:From March 1, 2022 to June 30, 2023, 12 patients with refractory thoracogastric-airway fistulas underwent the placement of modified mushroom-shaped occluder at the Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University were enrolled. The baseline clinical data of patients such as gender, age, course of disease, and fistula diameter were recorded. The data of operation and follow-up, such as operation time and method, intraoperative and postoperative complications were also collected. The occlusion efficacy at 1 month and 6 months after surgery, as well as the improvement of body mass index (BMI) and scores of the short form 36 (SF-36) were analyzed. Paired t test and non-parametric test were used for statistical analysis. Results:There were 10 males and 2 females among the 12 patients. The median age was 66.5 years old (ranged from 53.0 to 69.0 years old), the median course of disease was 7.5 months (ranged from 3.0 to 39.0 months), and the diameter of fistula was (9.3±3.4) mm. The occluder placements were successful in all the 12 patients, with 6 cases intracavitary release and 6 extracavitary release. The operation time was (30.9±9.9) min and the time of occluder placement was (3.5±1.3) min. One patient had minor (<2 mL) bleeding during the operation and 2 patients reported mild foreign body sensation but tolerable after operation. All patients resumed oral feeding and nasojejunal tubes were removed before discharge. The follow-up time of 12 patients was (11.3±1.7) months. The initial effective occlusion rate was 11/12, and the complete occlusion rate was 9/12. Two patients died but neither were related to the procedure or instruments. The BMI of 12 patients at 1 month after surgery was (18.5±1.9) kg/m 2, which was higher than that before operation ((17.6±2.3) kg/m 2), the BMI at 6 months after operation was (20.3±2.5) kg/m 2, which was higher than that at 1 month after operation, and the differences were statistically significant ( t=-4.15 and -4.45, P=0.002 and 0.001). The scores of 8 domains of SF-36 including physical functioning, general health, vitality, mental health, role-physical, bodily pain, social functioning and role-emotional of 12 patients before operation, at 1 month after operation and 6 months after operation were 49.6±13.6, 63.3±13.5 and 75.4±8.6, 17.1±11.2, 33.2±14.5 and 56.0±12.2, 30.0±12.6, 45.0±13.5 and 67.5±8.7, 41.3±18.7, 52.0±15.4 and 68.0±8.2, 0.0 (0.0 to 75.0), 25.0 (0.0 to 100.0) and 50.0 (25.0 to 100.0), 87.8 (44.0 to 100.0), 90.8 (57.0 to 100.0) and 100.0 (94.0 to 100.0), 12.5 (0.0 to 50.0), 50.0 (37.5 to 75.0) and 81.3 (50.0 to 87.5), 0.0 (0.0 to 100.0), 66.7 (33.3 to 100.0) and 100.0 (33.3 to 100.0), respectively. The scores of 8 domains at 1 month after operation were all higher than those before operation, and the differences were statistically significant ( t=-5.25, -5.32, -4.87 and -2.51, Z=-2.97, -2.20, -3.11 and -3.00; all P<0.05). The scores of 8 domains at 6 months after operation were all higher than those at 1 month after operation, and the differences were statistically significant ( t=-4.34, -7.48, -7.10 and -4.64, Z=-2.49, -2.20, -2.97 and -2.07; all P<0.05). Conclusion:The clinical application of the improved mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas is effective and relatively safe.

Clinical analysis of 8 cases of refractory upper gastrointestinal fistula treated with endoscopic injection of autologous platelet rich plasma / 中华消化杂志

Objective:To evaluate the safety and efficacy of endoscopic injection of autologous platelet rich plasma(PRP)in the treatment of refractory upper gastrointestinal fistula(RUGF).Methods:From June 1, 2022 to March 1, 2023, at the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University, 8 RUGF patients who received PRP treatment were enrolled. The baseline data such as gender, age, course of disease, and body mass index, etc. as well as the PRP treatment-related data such as the time of first treatment, length of hospital stay after the first treatment, and adverse events were recorded. The postoperative follow-up lasted till 6 months after the first treatment to assess fistula healing, and to record body mass index and health survey short form. Paired t-test and non-parametric test were used for statistical analysis. Results:Among the 8 RUGF patients, there were 7 males and 1 female. The median age was 58.5 years old (ranged from 27.0 to 75.0 years old), and the median duration of the disease was 14 months (ranged from 4 to 120 months). The maximum diameter of the fistula was(4.50±2.62) mm, the concentration multiple of PRP was (4.02±0.48) times. The operation time of the first endoscopic PRP treatment was (21.88±4.52) min; the median length of the first postoperative hospital stay was 2 days (ranged from 1 to 2 days), and the median total number of treatment was 4 (ranged from 1 to 5). The healing time was (2.57±1.72) months, 7 RUGF patients healed within 6 months after the first treatment, and the fistula was narrowed in 1 patient. There were no adverse events during or after the operation. After 6 months of treatment, the body mass index and the scores of 8 dimensions of the health survey short form which included physical functioning, physical role functioning, body pain, general health, vitality, social functioning, emotional role functioning and mental health were all higher than those before treatment ((20.91±2.15) kg/m 2 vs. (18.67±3.21) kg/m 2, 86.88±13.35 vs. 58.13±20.34, 100 (0 to 100) vs. 0(0 to 100), 83.06±11.74 vs. 56.94±28.86, 67.88±26.77 vs. 31.88±13.08, 81.88±13.87 vs. 46.25±24.02, 76.56±22.60 vs. 37.50±26.73, 100 (0 to 100) vs. 0 (0 to 100), 78.00±17.37 vs. 51.50±22.77), and the differences were statistically significant ( t=-3.40 and -3.87, Z=2.06, t=-3.03, -4.26, -4.73 and -6.06, Z=-2.06, t=-4.32; P=0.012, 0.006, 0.039, 0.019, 0.004, 0.002, 0.001, 0.039 and 0.003). Conclusion:Endoscopic injection of autologous PRP for the treatment of RUGF is safe and effective, and has a significant promotion effect on the healing of small (maximum diameter ≤ 6 mm) fistula.

Clinical observation on curative effect of endoscopic ligation for gastric submucosal tumors / 中国内镜杂志

Objective To explore the efficacy and safety of endoscopic ligation in treatment of gastric submucosal tumors(diameter≤1 cm).Methods Clinical data of 177 patients with gastric submucosal tumors who received endoscopic therapy from October 2020 to July 2022 were retrospectively analyzed.Patients were divided into endoscopic submucosal dissection(ESD)group(n = 142)and endoscopic ligation group(n = 35)according to different endoscopic treatment methods,and the operation time,intraoperative complications,postoperative hospital stay,surgical cost,complete lesion resection,postoperative complications and pathology of the two groups were compared.Results The operative time of the ESD group was(33.23±8.55)min,which was significantly longer than that of the endoscopic ligation group(24.85±5.96)min.The intraoperative bleeding was ERB-c1 and no ERB-c2 of the ESD group,which was better than that of the endoscopic ligation group,and the operative cost was(24 615.08±5 678.32)yuan,significantly more than that of the endoscopic ligation group(21 319.26±7 235.95)yuan,the differences were statistically significant(P＜0.05).There was no significant difference in the intraoperative perforation rate,postoperative hospitalization time and postoperative follow-up time between the two groups(P＞0.05).No surgical transfer,serious infection,delayed hemorrhage and perioperative death occurred in both groups,and no tumor recurrence,metastasis and death were found.Conclusion Endoscopic ligation has the advantages of relatively safe,efficient,less blood loss and low cost,but it has the risk of bleeding which is difficult to predict.Therefore,it is particularly important to select appropriate treatment after adequate evaluation.

Initial experience with endoscopic urethral caruncle electrosurgery using a modified homemade urethral extender / 中国内镜杂志

Objective To investigate the clinical results of plasma electrosurgery in elderly female patients with urethral caruncle using a modified homemade urethral extender.Methods 28 patients with urethral caruncle were admitted from January 2019 to December 2022,all with modified homemade urethral extender-assisted plasma electrosurgery,and the patients'operative time,length of hospital stay,catheter retention time and occurrence of postoperative complications were analyzed.Results All the 28 patients in this group completed the operation successfully with the assistance of homemade urethral extender,no conversion to open surgery.The operation time was 15～40 min,with an average of(24.4±6.4)min.The catheter retention time was 3～7 d,with an average of(5.1±1.1)d.The hospitalization time was 4～8 d,with an average of(6.5±1.0)d.After removal of catheter,all urination was clear,no recent complications such as urinary incontinence and urination difficulty,and all had pathology suggestive of urethral caruncle.Follow up time was 2～22 months,with an average of(11.8±6.5)months,no long-term complications such as urethral stricture and recurrence of urethral caruncle occurred.Conclusion Endoscopic treatment of urethral caruncle with a modified homemade urethral extender is one of the safe and effective treatments that deserves clinical promotion.

Argón plasma: respuesta terapéutica y calidad de vida en pacientes con proctitis actínica crónica hemorrágica / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: La proctitis actínica crónica hemorrágica (PACH) se presenta secundaria a la radioterapia pélvica. La coagulación con argón plasma (APC) es una terapéutica eficaz, segura, de fácil uso y relativo bajo costo. Objetivo: Describir la respuesta terapéutica a corto y largo plazo del APC en pacientes con PACH, así como evaluar la calidad de vida antes y después de la intervención. Material y Métodos: Estudio observacional, prospectivo de serie de casos en 46 pacientes con PACH, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso entre 2017 y 2020. Se emplearon medidas de resumen y comparación de medias (t de Student pareada) para la hemoglobina inicial y final, así como para los puntajes de calidad de vida aplicados antes y después de la intervención. Para determinar el tiempo libre de resangrado se utilizó l Método de Kaplan-Meier. Se estimó una significación menor a 0.05 para un intervalo de confianza de 95 por . Resultados: Se necesitó una media de 3,6 ± 2,394 sesiones de APC. La media de hemoglobina se incrementó 1,9 g/L. La respuesta terapéutica a corto plazo se observó en 100 por ciento de los pacientes y a largo plazo en 91,3 . La media de puntaje para la calidad de vida descendió en 12,065 puntos (p˂ 0,00), La percepción global percibida se incrementó en una media de 7.326 puntos (p˂ 0,00). Conclusiones: El APC tiene buena respuesta terapéutica a corto y largo plazo con pocas sesiones y bajo número de complicaciones, con mejoría de la calidad de vida de los pacientes(AU)

Introduction: Chronic hemorrhagic radiation proctitis (CHRP) appears secondary to pelvic radiotherapy. Argon plasma coagulation (APC) is an effective, safe, easy-to-use, and relatively inexpensive therapy. Objective: To describe the short- and long-term therapeutic response of APC in patients with CHRP, as well as to evaluate the quality of life before and after the intervention. Material and Methods: Observational, prospective case series study of 46 patients with CHRP, treated at the National Center for Minimally Access Surgery between 2017 and 2020. Summary measures and comparison of means (paired Student's t-test) were used for baseline and final hemoglobin, as well as for the quality of life scores applied before and after the intervention. The Kaplan-Meier method was used to determine the recurrence free time. A level of significance less than 0.05 was estimated for a 95 por ciento confidence interval. Results: A mean of 3,6 ± 2,394 APC sessions was required. The mean hemoglobin increased 1,9 g / L. Short-term therapeutic response was observed in 100 % of patients, and long-term in 91,3 por ciento. The mean score for quality of life decreased by 12,065 points (p˂ 0,00). The perceived global perception increased by a mean of 7,326 points (p˂ 0,00). Conclusions: APC has a good therapeutic response in the short and long term with few sessions and a low number of complications, with an improvement in the quality of life of the patients(AU)

Management of anastomotic leakage after laparoscopic surgery for adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing at home and abroad. Laparoscopic surgery has gradually become the main means of surgical treatment of this kind of tumor. However, due to the special anatomical position of the tumor, the high position away from the broken esophagus and the narrow space in the mediastinum, laparoscopic anastomosis has the characteristics of difficult anastomosis and high anastomosis position. There is a high risk of anastomotic leakage after operation, which may cause serious consequences. Early identification of anastomotic leakage and unobstructed drainage by various means are the key to treatment. With the development of endoscopic technology, endoscopic methods such as covered stent and vacuum-assisted closure further improve the treatment efficacy. As a salvage measure, surgical treatment can achieve good treatment outcome, while accompanied by risk of complications and mortality, so we must strictly grasp the indications.

Clinical analysis of 10 cases of refractory tracheoesophageal fistula treated with novel double disc-shaped gastrointestinal occluder / 中华消化杂志

Objective:To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder (hereinafter referred to as occluder) in treatment of refractory tracheoesophageal fistula (TEF).Methods:From July 1, 2020 to January 31, 2021, 10 patients with refractory TEF treated with occluder at Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University were collected. The patients′ clinical data such as gender, age, body mass index and fistula diameter were recorded. The success rate of operation, intraoperative and postoperative complications, operation time, postoperative hospital stay, efficacy of fistula closure and postoperative recovery were analyzed. The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation. Paired t test was used for statistical analysis. Results:Among the 10 TEF patients, there were 7 males and 3 females, the median age was 64.5 years old (ranged from 49.0 to 78.0 years old), the body mass index was (18.0±2.5) kg/m 2 and the diameter of the fistula was (1.2±0.6) cm. Occluder placement was successful in all patients. The operation time was (17.6±7.8) min (ranged from 7.0 to 30.0 min). Two cases had little bleeding during the operation, and there was no bleeding after the operation. The postoperative hospital stay was (5.9±4.0) d (ranged from 1.0 to 12.0 d). Among the 10 TEF patients, fistula of 5 patients were completely blocked, 4 cases were partially blocked and 1 case was ineffectively blocked, the effective rate of blocking was 9/10. One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients, and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm. The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients, the occluder was displaced in 1 patient and the occluder was removed and treated with enteral nutrition. One patient died due to the recurrence of esophageal cancer. The Karnofsky score of TEF patients 3 months after operation and the body mass index of TEF patients 1 month and 3 months after operation were higher than those before operation (70.0±34.0 vs. 46.0±10.7, (19.32±2.59) and (19.73±2.92) kg/m 2 vs. (18.03±2.50) kg/m 2), and the differences were statistically significant ( t=-3.09, -2.37 and -2.82, all P<0.05). Conclusions:Gastrointestinal occluder is safe and effective in the treatment of refractory TEF.

Challenges and innovations of minimally invasive percutaneous endoscopic therapy for cervical degenerative spondylosis / 西安交通大学学报(医学版)

With further mastery of endoscopic technology， our team has gradually explored a series of endoscopic procedures to treat various types of cervical spondylosis by combining basic research and clinical needs. The procedures， including anterior， posterior and lateral approaches through the cervical spine， have been able to treat most of the common clinical cervical spine diseases. For cervical spondylosis combined with cervical spine sequence abnormalities and poor stability， endoscopic reconstructive surgery is the direction of our efforts. We will continue to learn from advanced experience， explore unfamiliar areas and promote the technology so that we will be able to finally fulfil the wish of Chinese people to receive minimally invasive surgical treatment for cervical spondylosis in China.

A long-term follow-up of endoscopic diagnosis and treatment for pancreas divisum with chronic pancreatitis in children / 中华消化内镜杂志

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment of pancreas divisum (PD) combined with chronic pancreatitis (CP) in children.Methods:Data of patients under 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2010 to January 2020 were retrospectively analyzed. The general information, endoscopic procedures and follow-up of the children were recored. The number of acute pancreatitis attacks, visual analogue scale (VAS) scores of the abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 19 children diagnosed as having PD with CP underwent 82 ERCP procedures with the mean number of 4.31 (1-9). The mean number of pancreatic stent replacement was 3.21 (0-8). The success rate of minor papilla cannulation was 97.6% (80/82) with the pain relief rate of 89.5% (17/19) after the first ERCP. ERCP-related complication rate was 4.9% (4/82)without transference to surgery. The mean follow-up time was 55.8 months (9-114 months). The median number of acute pancreatitis attacks decreased from 3.0 to 0 compared with that before the procedure ( Z=-3.839, P<0.001) and the median VAS score decreased from 6 to 1 ( Z=-3.748, P<0.001), both of which had significant difference. However, the median diameters of main pancreatic duct were both 0.35 cm before and after procedure with no significant difference ( Z=-0.699, P=0.484). Conclusion:ERCP is safe and effective to diagnose and treat pediatric patients with PD with CP.

A prospective clinical study of endoscopic foam sclerotherapy combined with rubber band ligation in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids (with video) / 中华消化内镜杂志

Objective:To evaluate the safety and long-term effectiveness of endoscopic foam sclerotherapy (FS) combined with endoscopic rubber band ligation (ERBL)in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids.Methods:Consecutive patients diagnosed as having grade Ⅱ-Ⅲ internal hemorrhoids in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January to December 2020 were prospectively enrolled in the study, and randomly divided into ERBL group and FS combined with ERBL group. The 24 h visual analogue scale (VAS) for pain and 1-week degree of bleeding were evaluated after the treatment. After follow-up of 6 months, the effectiveness of treatment was evaluated.Results:A total of 84 patients with age of 54.4±7.9 years were enrolled, 57.1% (48/84) males, and 73.8% (62/84)grade Ⅱ internal hemorrhoids. Forty-three patients were assigned to the ERBL group and 41 to the FS combined with ERBL group. There was no significant difference between the two groups in baseline data ( P>0.05). In the FS combined with ERBL group, the mean amount of polidocanol foam was 13.8±2.5 mL, the mean number of injection site was 4.7±1.2, and the median scores of VAS was 0 (0, 3), which was significantly lower than that of ERBL group [2 (0, 4), Z=-2.116, P=0.034]. The bleeding rate 1 week after treatment in the ERBL and FS combined with ERBL group were 20.9% (9/43) and 29.3% (12/41), respectively, and mild bleeding was the main symptom. There was no significant difference between the two groups in the bleeding degree ( U=807.0, P=0.378). After 6 months of follow-up, the total effective rates in the ERBL group and the FS combined with ERBL group were 81.4% (35/43) and 90.2% (37/41), respectively ( U=684.5, P=0.044). Conclusion:FS combined with ERBL can effectively relieve post-treatment perianal pain, and improve the long-term effectiveness.

Long-term outcomes of endoscopic retrograde cholangiopancreatography for pancreas divisum with chronic pancreatitis in adults / 中华消化内镜杂志

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreas divisum(PD)with chronic pancreatitis (CP) in adults.Methods:Data of patients older than 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2008 to January 2020 were retrospectively analyzed, i. e.the general information, ERCP procedures and follow-up data of the patients. The number of acute pancreatitis attacks, visual analogue scale (VAS) of abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 61 patients diagnosed as having PD with CP underwent 301 ERCP procedures with the median number of 4(3.0-6.5). The median number of pancreatic stent replacement was 3 (2-6). The success rate of the first minor papilla cannulation was 90.2% (55/61), and the total success rate of minor papilla cannulation was 98.0% (295/301). The efficacy rate of the first ERCP was 82.0% (50/61). ERCP-related complication rate was 2.7% (8/301). The median follow-up time was 54 months (31.0-97.5 months). The median number of acute pancreatitis attacks decreased from 2.40 to 0 ( Z=-6.726, P<0.001) compared with that before ERCP. The median VAS decreased from 7 to 2 ( Z=-6.621, P<0.001). The median pancreatic duct diameter decreased from 5.0 mm to 4.0 mm ( Z=-2.330, P=0.020). However, the mean weight increased from 56.04±10.75 kg to 58.62±10.79 kg ( t=-5.285, P<0.001)one year after the procedure. Conclusion:ERCP is safe and effective in the diagnosis and treatment of PD with CP in adults.

Clinical application research of a novel gastrointestinal occluder device for endoscopic closure of gastrobronchial fistula (with video) / 中华消化内镜杂志

To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.

Research progress on long-term outcomes of endoscopic surgery for esophageal diseases / 中国胸心血管外科临床杂志

@#Esophageal diseases include esophageal malignant diseases and benign diseases, with a high incidence in our country. Along with the development of the endoscopic technique, many of them which required medical treatment or surgery in the past can now be cured by endoscopic surgery. This article is an overview of long-term follow-up of endoscopic surgery for the common esophageal disease, such as early squamous cell carcinoma, esophageal stricture, achalasia and submucosal tumor of the esophagus.

Effects of early endoscopic therapy on inflammatory factors and efficacy in elderly patients with acute biliary pancreatitis / 中华内分泌外科杂志

Objective:To evaluate the inflammatory factors effects of early endoscopic therapy for elderly patients with acute biliary pancreatitis (ABP) and its clinical efficacys.Methods:206 elderly patients with ABP admitted from Jan. 2010 to Dec. 2019 were divided into observation group (102 cases) and the control group (104 cases) according to treatment method. The observation group received endoscopic retrograde cholangiopancreatography (ERCP) , endoscopic sphincterotomy (EST) and endoscopic naso-biliary drainage (ENBD) , while the control group received conventional treatment. Clinical symptoms, changes of inflammatory factors, complications and prognosis were observed in each group.Results:CRP, SAA, IL-6, IL-8 and TNF-a after treatment were significantly lowered than those before treatment ( P<0.05) . In addition, the levels of CRP, SAA, IL-6, IL-8 and TNF-a in the observation group were significantly lower than those in the control group ( P<0.05) . The time to abdominal pain extinction, time to fever cessation, hospital stay in observation group were (3.92±1.54) , (3.63±1.41) , and (14.35±2.46) d, significantly less than those in the control group [ (5.81±1.72) , (5.45±2.13) , (19.37±3.12) d, P<0.05]. APACHE Ⅱ score of the observation group was (10.02±2.67) point after treatment, significantly lower than that in the control group [ (12.35±3.62) point, t=4.42, P<0.05]. The incidence of complications in the observation group was 10.78% after treatment, significantly lower than that in the control group [ (24.03%) , χ2=6.27, P< 0.05]. The mortality in the observation group was 1.96%, lower than 4.81% in the control group, with no statistical significance. Conclusion:Early endoscopic therapy is safe and highly effective for elderly patients with ABP, with the advantages of shorter hospital stay, quicker subsided inflammation, and lower incidence of complications.

The indications, efficacy and safety of endoscopic treatment of upper urinary tract urothelial carcinoma / 中华泌尿外科杂志

Objective:To summarize the preliminary clinical experience of endoscopic treatment of upper urinary tract urothelial carcinoma, and to analyze its indications and efficacy.Methods:The clinical data of 14 patients underwent endoscopic treatment for upper urinary tract urothelial carcinoma in our hospital from December 2014 to December 2019 were retrospectively analyzed. Among them, there were 5 males and 9 females, with a median age of 75.5(44-84) years. There were 11 patients with hematuria, 2 patients with flank pain and one asymptomatic patient. Five patients had a history of bladder cancer and one had a history of contralateral UTUC. There were 4 patients with solitary kidney, 3 patients with renal insufficiency, 1 patient with bilateral renal pelvis carcinoma, 4 patients prohibitory to nephroureterectomy because of poor general condition (American Society of Anesthesiologists score ≥3), and 2 patients were pathologically diagnosed as low-grade non-invasive urothelial carcinoma and requested renal preservation therapy. A total of 15 renal units included. The main tumor sites were renal pelvis in 6 renal units, upper calyx in 4 renal units, middle calyx in 3 renal units, and lower calyx in 2 renal units. The median tumor diameter was 2.0 (0.8-4.0) cm. All patients were diagnosed with urothelial carcinoma by preoperative computed tomography (CT/CTU), magnetic resonance imaging (MRI), and cytological or pathological biopsy. In 13 patients, ultrasond-guided percutaneous renal access and tract dilation were performed to establish a F24 standard tract. The tumor tissues were vaporized by 1470 semiconductor laser (60-80 W) or thulium laser (15-20 W) under nephroscopy, and electrocoagulation was used to coagulate the bleeding when necessary. Two patients were treated with felxible ureteroscope, under which tumor ablation was performed with 200 μm holmium laser fiber, and neodymium laser was used for hemostasis. The range of tumor vaporization ablation included 0.5-1.0 cm normal renal pelvis mucosa around the tumor, deep to the fatty layer of renal sinus. Biopsy was taken again at the base of the wound after vaporization ablation when necessary.Results:In this study, six sites were pathological high grade, 9 sites were pathological low grade tumors. Eight were in pathological T a stage, 5 in T 1 stage, and 2 in T 2 stage. The median blood loss was 20.0 (2-50) ml. There were 5 postoperative complications, including one patient with fever (body temperature >38.5℃) and 4 patients with hemorrhage requiring blood transfusion (postoperative hemoglobin <70 g/L) with 2-4 U suspended red blood cells.No patient underwent embolization. The median follow-up time were 31(11-70)months. Ten patients experienced recurrence, and the median time to recurrence was 11.3 (4-41) months. Four of them received conservative treatment after recurrence, including immunotherapy and radiotherapy in 1 patient, systemic chemotherapy in 1 patient, and watchful waiting in 2 patients. Three of them received repeated endoscopic treatment after recurrence, including 2 patients with percutaneous nephroscopic laser ablation and 1 patient with transurethral resection of bladder tumor, all of them survived during the follow-up period. Three patients underwent full-length nephroureterectomy after recurrence, 2 died and 1 survived during the follow-up period. Six patients eventually died, and the median time of death after surgery was 21(9-33) months. Five of them died from tumor-specific death and one died from gastric perforation. The median tumor-free survival interval were11 (4-41) months during the follow-up period. The 2-year tumor-specific survival rate was 78.6%, 50% for high-grade patients and 100% for low-grade patients. Conclusions:In patients who were in early stage (≤T 2) and intolerant to the nephroureterectomy, or with solitary kidney, renal insufficiency, or bilateral tumors, endoscopic treatment could be used as an alternative treatment approach for upper urinary tract epithelial carcinoma, especially for low-grade non-invasive patients.