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Cold resection of colonic polyps is an important tool that reduces the incidence of colon cancer. Cold loop polypectomy is a safe and effective technique in colonic lesions smaller than 10 mm and cold mucosectomy with submucosal injection is a growing technique for the resection of non-pedunculated lesions between 10 and 19 mm. Post polypectomy bleeding is an infrequent complication in cold resection, but its recognition is key to reduce the impact of its consequences. The use of hemostatic clips is one of the methods preferred by endoscopists for the management of immediate post polypectomy bleeding, however its usefulness in the prevention of late bleeding is uncertain. In recent years, both meta-analysis and cost- effectiveness studies have concluded that the use of hemoclips does not reduce the incidence of late post-polypectomy bleeding, so their use should be reserved only for high-risk patients.
La resección fría de pólipos colónicos es una importante herramienta que reduce la incidencia de cáncer de colon. La polipectomía con asa fría es una técnica segura y efectiva en lesiones colónicas menores de 10 mm y la mucosectomía fría con inyección submucosa es una técnica en auge para la resección de lesiones no pediculadas entre 10 a 19 mm. El sangrado pospolipectomía es una complicación infrecuente en la resección fría, pero su reconocimiento es clave para disminuir el impacto de sus consecuencias. El uso de clips hemostáticos es uno de los método preferidos por los endoscopistas para el manejo del sangrado inmediato pospolipectomía, no obstante su utilidad en la prevención del sangrado tardío es incierto. En los últimos años, tanto metaanálisis como estudios de costo efectividad concluyen que el uso de hemoclips no reduce la incidencia de sangrado tardío pospolipectomía por lo que su uso debería reservarse sólo a pacientes de alto riesgo.
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Instrumentos Cirúrgicos , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Colonoscopia/efeitos adversos , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodosRESUMO
ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is recognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.
RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.
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Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. There are a lot of studies done on colonic polypectomy around the world, and mostly diagnosis with dysplasia change, so we consider to chose to study this topic.@*Aim@#In this study, we aimed to compare the between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of removing colon polyps. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2022 and 2023, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colon polyps less than 5mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result@#The average age of the 81 cases included in the study was 57.9 years, and the male-female ratio was 1:1.2.149 cases (75.6%) of slightly elevated type 0-IIa according to the Paris classification, according to the morphological structure revealed by endoscopy, while 79 cases (75.6%) were tubular adenoma according to histological analysis. (38.9%), low grade dysplasia 52 (25.6%) and high grade dysplasia 3 (1.5%) cases are noteworthy. Average polyp was 5-9 mm. Most of polyps removed was left side of colon especially in sigmoid colon. Bleeding rate was higher in hot snare method 11.5%. (1/149, 0.7%, 5/52, 9.6%; P = 0.6). There was no recurrent rate and no perforation in our study. @*Conclusions@#In our study, average size of 5-9 mm were removed and slightly elevated (0-IIa), sessile (0-Is) type of polyps were commonly found in the sigmoid colon. There is a higher risk of bleeding due to mucosal damage in hot snare polypectomy. A combination of hot and cold methods is equally effective for resection of colon pollyps up to 1 cm in size.
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Objective:To compare the efficacy and safety of endoscopic cold snare polypectomy(CSP)and hot snare polypectomy(HSP)on 5 to 10 mm colonic polyps in children.Methods:One hundred and eighteen children, who underwent colonoscopy at Children′s Hospital Affiliated to Jiangnan University from June 2018 to June 2022 and found polyps with a diameter of 5-10 mm, were selected as the study subjects.They were divided into two groups by random number table method, with CSP(CSP group) and HSP(HSP group) for polypectomy respectively.The time required to remove a single polyp, intraoperative bleeding rate, postoperative bleeding rate, abdominal discomfort rate, hospitalization time, and hospitalization costs were compared between two groups.Results:Among 118 cases, there were 58 cases in CSP group, including 36 males and 22 females, with an average age of (6.17±3.34) years.There were 60 cases in HSP group, including 34 males and 26 females, with an average age of (5.68±3.18) years.There were no significant differences in sex and age between two groups( P>0.05). Compared with HSP group, the time required to remove a single polyp in CSP group was shorter[(6.68±0.34)min vs.(7.60±0.53)min], the rate of delayed postoperative bleeding was lower (0 vs.10.0%), the hospitalization time was shorter[(5.50±1.87) d vs.(6.38±1.38) d], and the hospitalization expenses were lower[(7 646.99±3 575.10)yuan vs.(10 006.47±3 657.42)yuan]. The differences were statistically significant (all P<0.05). Conclusion:The application of CSP to remove 5-10 mm colon polyps in children could shorten surgical treatment time and reduce the occurrence of complications.At the same time, it could reduce the hospitalization time and cost, and the overall effect is positive and safe, which is worthy of popularization and application by pediatricians in clinical practice.
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Objective:To explore the effect of cold-strap endoscopic mucosal resection (CS-EMR) in patients with colorectal polyps.Methods:A prospective randomized clinical trial was conducted to 320 selected patients with colorectal polyps diagnosed by Shenzhen Luohu District People′s Hospital from May 2019 to June 2021. The patients were randomly divided into CS-EMR group and HS-EMR group with 160 cases each, using a random number table generated by Excel 2007. The main parameters for statistical analysis contain the process indicators of the two groups of surgical methods, the complete polypectomy rate of patients after surgery, the degree of postoperative pain and the recovery of gastrointestinal function, and the differences in surgical complications.Results:The polypectomy time of CS-EMR group was shorter than that of HS-EMR group: (4.11 ± 1.20) min vs. (4.42 ± 0.98) min, with a statistically significant difference ( P<0.05). The score of visual analogue pain scale (VAS) in CS-EMR group was lower than that in HS-EMR group at 4 and 12 hours after operation: (3.11 ± 0.78) scores vs. (3.48 ± 0.80) scores, (3.38 ± 0.80) scores vs. (3.61 ± 0.92) scores, with a statistically significant difference ( P<0.05). The first anal exhaust time and first defecation time in CS-EMR group were lower than those in HS-EMR group: (27.83 ± 5.01) h vs. (29.66 ± 4.84) h, (43.73 ± 7.80) h vs. (47.28 ± 8.14) h, with a statistically significant difference ( P<0.05). The complications in CS-EMR group were significantly lower than those in HS-EMR group: 5.63% (9/160) vs. 12.50% (20/160), with a statistically significant difference ( P<0.05). Conclusions:The effect of CS-EMR in the treatment of colorectal polyps is not different from that of HS-EMR, but the former has the advantages of short resection time, rapid recovery of gastrointestinal function after operation, light pain and less complications.
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Objective To explore the curative effect of day care unit on the efficacy,safety and satisfaction of elderly patients who underwent a cold snare polypectomy for the treatment colorectal polyps.Methods Clinical data from 454 elderly patients with 824 colorectal polyps(Diameter 4～10 mm)who received a polypectomy from Mar 2020 to Mar 2021 were collected.These patients were classified into three groups.The cold snare polypectomy group and hot snare polypectomy group in day care unit,and the cold snare polypectomy group in general wards.The clinical characteristics,adverse events,recurrence,hospitalization time,and expenses,were compared among three groups.Additionally,the patients'hospitalization satisfaction was investigated and analyzed.Results There were no significant differences in clinical characteristics,histopathology,and rates of postoperative bleeding,perforation,and recurrence among the 3 groups(P＞0.05),but the probability of immediate bleeding was higher in the cold snare polypectomy group.Moreover,coagulation syndrome was unique to the hot snare polypectomy group.The hot snare polypectomy group used the highest amount of endoclips,while the cold snare polypectomy group in the general wards used the least.Furthermore,the hospitalization time and expenses in the day care unit group were significantly lower than in the general wards group.However,the patients'satisfaction survey showed that the day care unit group scored lower than the general wards group(P＜0.05).Conclusions It is safe,cost-effective and effective for elderly patients with colorectal polyps using cold snare polypectomy technique under the day care unit mode,but the lack of communication with the patient's condition in a short period of time rather leads to a decrease in hospital satisfaction.
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Cataract surgery is constantly evolving with new techniques, machines, and procedures entering the lexicon. With the modernization, the cost of surgery is increasing with respect to the surgeon, patient, and the society. Early rehabilitation with modern minimal access techniques reduces the societal cost of intervention. Manual small-incision surgery is simple, safer, and cheaper when contrasted with the cost and steep learning curve of machine-driven surgeries. A nucleus of a normal size is 6 mm, which can be bisected; 3 mm longitudinal fragments can be removed through 3.5 to 4.5 mm incision, and a large nucleus of 9.0 mm can trisected and removed through 3.5 to 4.5 mm. The limbal tunnel incision is 3.5 mm, which is close to 2.8 mm phacoincision, so it gives all the advantages of modern phacosurgery. The search of an ideal technique for manual phaco-fragmentation leads us to this specially designed snare (designed by the first author AS) which can tackle any grade nucleus. The nucleus can be bisected or trisected with ease. The technique has been around for 2 decades. There is a small learning curve. The complications are few and can be minimized with practice and simulation. It is a safe, valid, repeatable, and generalizable surgical procedure.
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Resumen El implante percutáneo de un electrodo de estimulación ventricular izquierdo a través del seno coronario para resincronización cardiaca siempre ha implicado un reto y más aún en pacientes con anatomía venosa coronaria compleja. Este caso demuestra cómo una técnica de doble canulación del seno coronario con uso de catéter multi-snare permite la colocación exitosa de un electrodo de estimulación ventricular izquierdo mediante acceso retrógrado a una vena posterolateral estenótica.
Abstract The percutaneous implantation of a left ventricular pacing electrode through the coronary sinus for cardiac resynchronization has always been a challenge, especially in patients with a complex coronary venous anatomy. This case shows how double cannulation of the coronary sinus using a multisnare catheter allows a left ventricular pacing electrode to be placed through retrograde access to a stenotic posterolateral vein, with a good clinical outcome.
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Introduction@#Colorectal cancer remains one of the critical healthcare challenges nowadays. Most patients’ disease, especially colorectal polyps develop via the adenoma carcinoma sequence; using colonoscopy with polypectomy reduces both mortality and incidence by removing precancerous adenomas, which are called polyps. In recent years, colorectal cancer tends to increase among Asian population. There are only limited studies that have been conducted in Mongolia regarding colorectal polypectomy and its complications. Both cold polypectomy and hot polypectomy are accepted methods. In this study, we aimed to compare the complications (bleeding, perforation) between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) of adenomas and hyperplastic polyps. After the procedure, repeated endoscopy was performed to compare the incomplete resection rate (IRR) and complete resection rate (CRR) of mucosal residual and presence of recurrency. This method helped us to investigate which of the two methods is most prevalent for polypectomy.@*Materials and Method@#The research was carried out using a targeted sampling method from the cases where colonoscopy was performed between 2020 and 2022, based on the Center for Imaging Diagnostics and Pathology of Third General Hospital of Mongolia with a colonoscopy with a high-performance Olympus EVIS EXERA III brand NBI from Japan. In this study, we selected only hyperplastic polyps and adenomas <10 mm in size. Polyps less than 5 mm in size should be removed using the cold snare method according to the recommendation, and polyps between 5-10 mm should be removed using the hot snare method. After polypectomy, we assessed deep mucosal lesions using the Sydney classification.@*Result @#According to the results of the study, in terms of age, the percentage of people having a polyp removed was relatively low among 15-39 year olds compared to the other age groups, while it was higher in those aged >65 years. In terms of body mass index, 75% of the total number of people who had a tumor removed were overweight, indicating that overweight or obese people are at higher risk of developing a colorectal polyps. In terms of gender, 63% of people who had a polyp removed were male, indicating a male predominance in polyp prevalence. The percentage of tumor questionnaires in the total study population was 0% or absent. Early detection of adenomas and hyperplastic polyps, which are precursors of tumor, is the main way to prevent the development of cancer. A slightly raised polyp was present in 53 or 79.1% of the polyps, while a broad-based polyp occurred in 13 or 19% of the polyps, indicating the predominance of the slightly raised polyp in the population. In terms of location, polyps occurred more often in the descending colon and the sigmoid colon, and complications (perforation, bleeding) related to the anatomical structure and location are more likely to occur in these parts of the colon. However, the likelihood of relapse is very low. The procedure time was 17.6 minutes on average, and in 14 cases, hemostatic clamps were placed to prevent the risk of bleeding, and in 5 cases, epinephrine was injected for hemostasis. Early detection of colorectal diseases (endoscopy), changes in the lifestyle of clients, and regular preventive examinations are the main factors to reduce the risk of cancer development, and early start of treatment as well as complete removal of adenoma, an antecedent to cancer, will have a significant impact on cancer prevention and mortality reduction.@*Conclusions@#</br>1. Left sided polyps were commonly diagnosed among study participants. </br>2. Correlation between the probability of recurrence and the anatomical location of the polyps was very low. </br>3. Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4–10mm colorectal polyps. Moreover, there was no significant difference between CSP and HSP in terms of overall complications.
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@#Endovascular aneurysm repair (EVAR) has gained acceptance as a viable alternative to open surgical treatment for abdominal aortic aneurysm (AAA). We report the use of snare guiding wire in bifurcated EVAR case with severely tortuous femoral access. A 63-year-old man referred to the hospital from another facility with complaints of pulsating mass in right iliac and umbilical region for the last 2 years. He was then admitted to the cardiac catheterization lab for EVAR under general anaesthetic. Endovascular aneurysm repair (EVAR), also known as an endoprosthesis, is a stent-graft device-guided therapy for a AAA. This procedure is a safer choice for individuals who are elderly or have pulmonary, cardiac, or renal problems. Tortuous iliac arteries might obstruct device delivery during EVAR. The Snare Guiding Wire approach might be an alternate method for EVAR to treat AAA if conventional cannulation is difficult or impossible in individuals with highly tortuous iliac access.
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Objective:To investigate the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for the removal of colorectal polyps of 10-15 mm.Methods:A total of 173 polyps of 154 patients with at least one polyp of 10-15 mm were resected under colonoscopy from December 2019 to December 2020. Based on Paris classification, the polyps were divided into Ⅰsp, Ⅰs and Ⅱa. According to random number table, the polyps were randomly divided into CSP group ( n=85) and HSP group ( n=88). The polyp size, location, morphology, histological classification, complete resection rate, incidence of complications, resection time and the number of prophylactic clips were compared between the two groups. Results:There were no significant differences in age, sex, indication of colonoscopy or the success rate of intubation at the end of ileum between the two groups. The polyps of the two groups were comparable in size, position, morphology and histological classification. There were no significant differences in the complete resection rate of polyps, rates of intraoperative bleeding and postoperative bleeding or perforation between the CSP group and the HSP group. The operation time in CSP group was significantly shorter than that in HSP group (63.5 ±23.6 s VS 184.3 ±62.4 s, P<0.05). The number of prophylactic clips used in CSP group was significantly less than that in HSP group (0.8±0.5 VS 1.4±0.7, P<0.05). Conclusion:CSP shows similar complete resection rate and complication incidence, and requires shorter operation time and fewer prophylactic clips, compared with HSP, in the resection of colorectal sessile polyps of 10-15 mm.
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Objective:To explore the curative effect and safety of cold snare polypectomy for colorectal adenoma of less than 15 mm.Methods:Data of 464 colorectal adenoma from 315 patients who were treated with cold snare polypectomy (CSP) and cold endoscopic mucosal resection (cold EMR) in the Third People′s Hospital of Jingdezhen from January 2018 to December 2019 were collected. Patients were divided into group A(3-5 mm), B (6-9 mm), and C (10-15 mm) according to the size of adenoma. Enbloc resection rate, immediate bleeding during polypectomy, delayed postpolypectomy bleeding, cold snare defect protrusions(CSDPs)and postoperative recurrence were analyzed.Results:The overall enbloc resection rate was 99.4%(461/464), and 100.0%(248/248), 98.8%(170/172), 97.7%(43/44) respectively in group A, B, and C without significant difference( P =0.126, 95% CI: 0.097-0.157). The overall incidence of immediate bleeding during polypectomy was 1.1%(5/464), and 0.4%(1/248), 1.7%(3/172), 2.3%(1/44) respectively in group A, B, and C without significant difference( P = 0.267, 95% CI: 0.227-0.308), showing an upward trend in the immediate postpolypectomy bleeding incidence with the increase of diameter of the polyps. No delayed postpolypectomy bleeding occurred. The overall incidence of CSDPs was 20.5%(95/464), 16.4%(63/384) and 40.0%(32/80) in the group of CSP and cold EMR respectively with significant difference( P<0.001, 95% CI: 0-0.006), showing an upward trend in the incidence of CSDPs with the increase of the diameter. A total of 286 adenomas in 195 patients were followed up. The median follow-up time was 9.7 months. Three patients relapsed. Conclusion:CSP is safe and effective for colorectal adenoma ≤15 mm with low incidence of immediate bleeding during polypectomy and recurrence, and no delayed postprocedural bleeding.
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Endoscopic full-thickness resection (EFTR) allows completely resecting deep submucosal tumors (SMTs) in the gastrointestinal wall, which has a broad application prospect in clinic. However, its application and promotion are limited by complex surgical procedures and high surgical risk. Various auxiliary traction techniques are expected to reduce the operation difficulty and risk of EFTR and improve its operative success rate. To provide a reference for clinicians, we summarize various auxiliary traction techniques in EFTR in this article. The clip-with-line method is simple to operate and widely used, whereas its traction is limited and there is a risk of clip falling off. The snare traction method and the clip-snare traction method has advantage of large traction force, but its thrust is affected by the hardness of snare. The traction point of the grasping forceps traction method is flexible and easy to adjust. Nevertheless, it requires the use of a dual-channel upper endoscope, which is difficult to operate. The transparent cap traction method and the full-thickness resection device traction method takes a short time and is easy to promote, whereas the resectable lesion is limited, and the size of the lesion may affect the success rate. In contrast, the suture loop needle-T-tag tissue anchors assisted method has a large resection range, but the operation is complicated and the feasibility has not been verified. The robot-assisted method has flexible operation and excellent visualization, whereas it is expensive and difficult to operate. There is no report of the application of magnetic anchor technology in EFTR, but it may have good application prospects in the auxiliary traction of EFTR.
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Humanos , Ressecção Endoscópica de Mucosa , Gastroscopia , TraçãoRESUMO
Objective To investigate the clinical application of self-made snare in laparoscopic appendectomy. Methods The clinical datas of 197 cases who were acute appendicitis under laparoscopic appendectomy in the first people's hospital of Fuyang in Hangzhou from June 2015 to June 2017 were collected, then they were divided into self-made snare group (85) and Hem-o-lok group (112). Variations of operation time, operation bleeding, first postoperative anal exhaust time and length of stay above two groups were analyzed. Variations of incision infection, abdominal abscess and intestinal obstructionabove two groups were analyzed. Results Two groups of patients were compared with operation time [self-made snare group(43. 71±5. 54)min: Hem-o-lok group(42. 29±5. 34)min], operation bleeding[self-made snare group(l 1. 60±2. 44)mL: Hem-o-lok group(l 1. 00±2. 56)mL],first postoperative anal exhaust time [self-made snare group (10. 01±2. 27)h: Hem-o-lok group(9. 60±2. 32)h] and length of stay[self-made snare group(5. 19±0. 95)d: Hem-o-lok group (4. 99±0. 85)d], the differences were not statistically significant(P＞0. 05). Two groups of patients were compared with incision infection[self-made snare group 2 cases(2. 35％): Hem-o-lok group 3 cases(2. 68％)], abdominal abscess [self-made snare group 1 case(1. 18％): Hem-o-lok group 2 cases (1. 79％)] and intestinal obstructionabove [self-made snare group 3 cases(3. 53％): Hem-o-lok group 5 cases(4. 46％)], the differences were not statistically significant(P＞0. 05). Conclusion Self-made snare in laparoscopic appendectomy is safe and feasible.
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Objective To investigate the expression and significance of syntaxin 8 (STX8) in non-small cell lung cancer (NSCLC),and analyze the relationship between STX8 expression and clinicopathological features of NSCLC.Methods Seventy samples of NSCLC and 70 samples of pericancerous tissues were collected for immunohistochemistry staining,and another 10 samples of NSCLC and pericancerous tissues were used for RNA and protein extraction,qRT-PCR was performed to detect the expression of STX8 mRNA,and Western blot assay was adopted to detect the expression of STX8 protein.The relationship between STX8 expression and clinicopathological features of NSCLC was analyzed.Results Results of qRT-PCR showed that the expression of STX8 mRNA was significantly higher in NSCLC tissues than that in the pericancerous tissues (3.962 5±0.487 3 vs.0.538 2±0.097 5,t=21.797,P＜0.01).Immunohistochemistry results showed that the high expression rate of STX8 was significantly higher in NSCLC tissues than that in the pericancerous tissues [71.43％ (50/70) vs.38.57％ (27/70),x2=15.267,P＜0.01].Western blot results showed that the expression of STX8 protein was significantly higher in NSCLC tissues than that in the pericancerous tissues (2.496 1±0.362 5 vs.0.340 2±0.119 1,t=17.876,P＜0.01).The high expression rate of STX8 was significantly different in different histological types of NSCLC (P ＜0.05).The high expression rate of STX8 was higher in squamous cell carcinoma and adenocarcinoma than that in adenosquamous carcinoma,and the high expression rate of STX8 was not observed in large cell carcinoma.There were no significant differences in expressions of STX8 in NSCLC patients with different gender,ages,tumor diameters,TNM stages and with or without lymph node metastasis (P＞0.05).Conclusion A high expression of STX8 in NSCLC tissues may be correlated with the occurrence and development of NSCLC.
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Objective To investigate the clinical efficacy and safety of high-frequency electric snare for the treatment of main airway neoplasm through bronchoscopy. Methods The clinical datas of 18 patients from July 2013 to April 2016, who had main airway neoplasm and were treated with high-frequency electric snare through bronchoscopy, were retrospectively analyzed. Meanwhile, the interventional bronchoscopic techniques partly included argon plasma coagulation and cryoablation. After operarion, the relief of symptoms and complications were observed. Results After operarion, the clinical symptoms, shortness of breath, dyspnea index score and the degree of airway stenosis were improved significantly. No serious complications such as massive hemoptysis occurred in all patients. Conclusion High-frequency electric snare is an effective and safe approach for the treatment of main airway neoplasm.
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Objective To evaluate the therapeutic effectiveness and safety of endoscopic submucosal dissection (ESD) with improved snare for colorectal polyps and submucosal tumors.Methods The clinical data such as clinical pathological characteristics, en bloc resection rate, curative resection rate, complications and follow-up results of 20 patients with colorectal polyps or submucosal tumors, who were treated by ESD, were retrospectively analyzed.Results 20 patients (total 24 lesions) with colorectal polyps or submucosal tumors were performed ESD operation successfully, in which 16 cases (total 20 lesions) were treated by ESD with improved snare (the trial group), 4 cases were treated by ESD with HOOK knife (the control group).The surgical success rate was 100.0% (24/24), the en blot resection rate was 100.0% (24/24). The mean polyps diameter in the trial group was (2.4 ± 0.9) cm (1.2~4.0 cm), while that in the control group was (2.2 ± 0.6) cm (1.5~3.0 cm). The mean procedure time in the trial group was (83.3 ± 23.9) min (45.0~120.0 min), while the control group was (66.2 ± 15.4) min (45.0~80.0 min), compared with the control group, the trial group need more times to complete the operation. The postoperative pathology as follows: 15 cases were adenoma (including 3 cases of adenoma with partial gland high-grade intraepithelial neoplasia), 1 case was hyperplastic polyp, 1 case was high-grade intraepithelial neoplasia, 2 cases were neuroendocrine tumor (total 4 lesions) 1 case was stromal tumor. Except for 1 case of stromal tumor from the muscularis propria was taken full thickness resection, no patient appeared complications such as hemorrhage, perforation, infection. No patient need intraoperative and postoperative surgical treatment.Conclusion Improved snare can be used to endoscopic submucosal dissection for large colorectal polyps and submucosal tumors safely and effectively, expanded the use and indications of snare in endoscopic resection, but need more times to completed the operation.
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Objective To evaluate the safety and efficiency of domestic snare applied during retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions.Methods A total of 27 patients who underwent retrograde PCI for CTO and used domestic snare during the procedure were enrolled in our study from March 2012 to November 2016.Clinical data, angiographic characteristics and PCI details were collected.Clinical data, characteristics of CTO lesion, effect of the domestic snare and snaring time were retrospectively analyzed.Special complications related to the domestic snare and major adverse cardiovascular events (MACE) were also documented.Results Domestic snare was used in all the procedures, which included facillitating the micro-catheter to pass through the CTO lesions in 6 patients and assisting the RG3/rotational guide-wire externalization in all the 27 patients.Mean snaring time was 3.5±5.4 minutes.Stents were successfully implanted in 26 patients except in 1 patient who failed to receive stent implantation for severe coronary calcification.No complications including coronary dissection, fracture of guide-wire and unreleased snare happened during the procedures and no MACE occurred during hospitalization.Conclusions Domestic snare facilitates retrograde micro-catheter crossing CTO lesions and retrograde guide-wire entering the guiding catheter and externalization.It is a simple, safe and efficient method.
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Objective To explore the role of a comprehensive-teaching method based on a diagnosis-and-treatment simulator for bronchoscopic procedure in the training of high-frequency electrocautery using snare. Methods A prospective self-control study including 20 trainees from the Bronchoscopic Center of Changhai Hospital was designed to evaluate the training outcome of bronchoscopic high-frequency electrocautery snare technique. During the training course, theoretical knowledge teaching was followed by simulator-based practice under the guidance of respiratory endoscopic exports from Changhai Hospital. We recorded and analyzed the procedure accuracy and fluency, operation time, and target tissue excision rate of each trainee before and after the training project The appraisal of the training effect for each trainee in this study was conducted by questionnaire survey. Results All the 20 trainees successfully completed thewhole training project Compared with the data before the training, the procedure accuracy of excising the target tissue by snare after the training was significantly increased from 5. 73 ± 1.37 to 8.50 ± 0.81 (P<0.01); the fluency of operating snare was significantly improved from 5.20 ± 1.61 to 8.27 ± 1.00 (P<0. 01); the total operation time-consuming was significantly shortened from (214.9 ± 112. 6) s to (88.1 ± 18.2) s (P=0.01); and the target tissue excision rate was increased significantly from (60 0 ± 16.3)% to (76.0 ± 12.6)% (P=0. 05). The questionnaire survey showed that all the trainees benefited from the comprehensive simulator-based teaching method. The advantages of this teaching method included repeatability, high simulation degree, safety, operational stability and 1529 improved training efficiency. Conclusion The simulator-based comprehensive teaching method has a distinct teaching outcome in bronchoscopic electrocautery snare technique raining, and is worth promoting in bronchoscopic raining.
RESUMO
Objective To discuss the efficacy and safety of sterile repositionable hemostasis clipping device in combination with high frequency electric snare in polypectomy of colorectal polyps with wide and long peduncle. Methods From January 2014 to December 2015, 21 cases of colorectal polyps with wide and long peduncle (diameter greater than 2 cm) in endoscopic treatment under electronic colonoscopy. We used 1 ~ 2 hemostatic clips to clip colorectal polyps roots, then used electric resection with high frequency electric snare electric coagulation. Postoperative bleeding, perforation were observed follow-up. Results 24 polyps in 21 cases were removed one-time successfully. Stump errhysis in 1 case, hot biopsy forceps is given to deal with local wound followed by Olympus Clip HX-610-135L EZ titanium clip. There was no complication such as bleeding and perforation in 3 to 6 months after the operation. In the colonoscopy examination, recurrence of polyps were not found in the original polyp resection site. Conclusion Sterile repositionable hemostasis clipping device in combination with high frequency electric snare in polypectomy of colorectal polyps with wide and long peduncle is safe and effective, without bleeding or perforation.