RESUMO
Objective To evaluate the adenoma detection rate( ADR)of fecal occult blood test (FOBT)-positive population in colorectal cancer screening programme and to analyse potential influence of“resection and discard”strategy on ADR. Methods Data of patients who paticipated in the Shanghai color-ectal cancer screening programme with FOBT-positive and received colonoscopy in the Digestive Endoscopic Center of Changhai Hospital from July 2013 to July 2014 were retrospectively analysed. ADR was calculated and compared by different genders. Multivariate logistic regression model was used to analyse the risk factors of polyp resection without retrieval. Results A total of 222 FOBT-positive patients were involved with 36. 5% male proportion. The total ADR was 19. 8%,higher in male(28. 4%)than in female(14. 9%)(P=0. 015). The independent risk factors of polyp resection without retrieval were diminutive polyp( OR =15. 256,95% CI:4. 159-55. 957),located in rectum( OR = 3. 663,95% CI:1. 427-9. 398) and polyp number >2(OR= 3. 988,95%CI:1. 562-10. 187).Conclusion ADR of FOBT-positive population is approx-imately 20%in our center. Low male proportion and“resection and discard”strategy may lead to lower ADR. ADR should be calculated by different genders and advanced endoscopic technology should be employed rou-tinely to predict the pathological diagonosis of the lesions.
RESUMO
Objective To evaluate the feasibility of slightly acidic electrolyzed oxidizing water for the disinfection of gastrointestinal endoscopes.Methods Electrolyzed oxidizion water generator was utilized to produce the water,which was applied for the disinfection of gastrointestinal endoscopes.The disinfectant efficiency and effect were evaluated.Results A total of 215 samples were taken for bacterial culture after the disinfection.The mean sterilization efficiency of slightly acidic electrolyzed oxidized water and 2％ glutaraldehyde by machine were 99.92％ and 99.85％,respectively,while the mean sterilization efficiency were 99.85％ and 99.84％ by manual disinfection.There were no statistical significance between the two groups.The effective rates of both groups were 100％.No deformation or aging was observed in the endoscopes.The disinfectant caused no damage to the cleansing and disinfection.Conclusion It is feasible to apply slightly acidic electrolyzed oxidizing water to the disinfection of endoscopes.
RESUMO
ObjectiveTo probe the indication,treatment algorithm,anesthesia method,safety and efficacy ofextracorporealshockwavelithotripsy(ESWL)incombinationwithendoscopicretrograde cholangiopancreatography (ERCP) for pancreatic duct stones.MethodsThe patients with chronic pancreatitis and large pancreatic duct stones ( ＞ 5 mm diameter) and receiving ESWL and ERCP between March and July 2011 in Changhai Hospital were prospective studied.The third generation of extracorporeal shockwave lithotripsy was applied in ESWL,and the localization of stone was determined by X-ray.No more than 5000 shocks were given per session,and ESWL was performed continuously till the calculi were fragmented,and then was cleared by ERCP.ResultsA total of 100 patients underwent ESWL during the 5 months,among whom 84 patients received ERCP treatment and 41 cases failed to deep cannulation (41/84,48.8％ ).Multiple stones were seen in 83 patients.Ninety five patients had radio-opaque stones,two patients had radiolucent calculi,while three patients had both radio-opaque and radiolucent stones.Seventy five percent,14％ and 11％ stones were located in pancreatic head,pancreatic head and body,pancreatic body and tail,respectively.A total of 175 ESWL procedures were performed,43 patients needed 2 or more sessions for successful fragmentation.Anesthesia method was mainly intravenous sedation,accounting for 96％ (168/175).ERCP was successful in 96 patients after ESWL,only 4 patients failed after ESWL. Forty one cases which failed ERCP procedures before ESWL underwent ERCP,and 37 patients (90.2％) achieved successful cannulation.Successful fragmentation ratewas 100％.Complete clearance was achieved in 78 patients,and complication rate of post-ERCP pancreatitis,fever was 1.71％ (n =3 ),0.57％ (n =1 ),and the overall complication rate was 2.28％.Conclusions ESWL is an effective,safe and necessary modality for fragmentation of large PD stones in the management of minimal invasive treatment of chronic pancreatitis.
RESUMO
Objective To evaluate the safety and efficacy of therapeutic ERCP for patients above 90 years of age.Methods The data of 37 patients of above 90 years who underwent 42 ERCP procedures from January 2001 to December 2009 were studied retrospectively and compared with those of 152 matched patients ( 168 procedures) below 65 years old at a 1∶4 ratio for success rate and complications.Results The rate of complete success,partial success,and failure in observation group was 73.81％ (31/42),19.05％(8/42) and 2.38％ (1/42),respectively,which were similar (P ＞0.05) with those in control group,with complete success rate at 85.12％ ( 143/168),partial success rate at 12.50％ (21/168) and failure rate at 2.38％ (4/168).The rate of terminated operation in observation group (4.76％,2/42) was significantly higher than that of the control group (0.00％,0,P =0.039).The overall rate of complication in observation group was 7.14％ ( 3/42 ),slightly higher than that of the control group ( 6.55％,11/168,P ＞0.05 ).There was no significant difference between the two groups regarding the rates and severity of such complications as pancreatitis,hemorrhage and infection ( P ＞ 0.05 ).No perforation or death was observed.Conclusion Therapeutic ERCP for patients of 90 years or older is safe and effective.Adverse events related to chronic concomitant diseases need early detection and proper management.
RESUMO
ObjectiveTo investigate the value of double-balloon endoscopy for the diagnosis of small bowel Crohn disease(CD).MethodsData of 141 patients with suspected CD undergoing double-balloon endoscopy were reviewed.Diagnosis was made based on pathological,endoscopic findings and clinic follow-up results.Detection rates and diagnosis rates of small bowel CD were compared by double-balloon enteroscopy,CT enterography and capsule endoscopy.ResultsThe detection and diagnosis rates of small bowel CD by double-balloon endoscopy were 90.8％ ( 128/141 ) and 98.4％ ( 126/128),respectively.These two variables by CT enterography were 76.0％ (19/25) and 89.5％ (17/19),and those by capsule endoscopy were 60.0％ (15/25) and 93.3％ (14/15).ConclusionDouble balloon enteroscopy has high application value for the diagnosis of small bowel CD.For those contraindicated with endoscopy,CT enterography can be considered as a preferred auxiliary diagnostic modality.
RESUMO
Objective To explore the efficacy and safety of endoscopic balloon dilatation of small bowel stricture in Crohn′s disease with single balloon enteroscopy (SBE).Methods Seven Crohn′s disease patients (four males and three females with a mean age of 37 years) were underwent 10 times dilatation.Before performance,Crohn′s disease with varying degrees of intestinal obstruction was confirmed by image and pathological examinations.There were 8 severe strictures,6 strictures in jejunum.The dilatation was performed step by step with controlled radial expansiondilator (CRE) balloon.After dilatation,the scope could reach the further small bowel was taken as a standard.Results The overall suecess rate was 8 of 10.The average diameter of intestinal stricture was expanded from (4.1 ± 2.5) mm before therapy to (10.2 ±1.5) mm (P＜0.01),and the average distance of the further small bowel that the scope reached was 62 cm.Two patients underwent twice and three times of dilatation.After the performance,all patients′ symptoms of abdominal pain and obstruction relieved obviously and there were no severe complication of bleeding or perforation.After the performance,the average follow-up time was 14 months,two patients were treated by surgery and the other two underwent dilatation treatment again because of the recurrence of symptoms.The median symptom-free time was 15 months and 70％ of patients were without symptom recurrence in one year.Conclusion Endoscopic balloon dilatation of small bowel stricture with SBE is a new technology of endoscopic treatment,which is safe and effective in the treatment of Crohn's diseasecomplicated with intestinal obstruction.
RESUMO
ObjectiveTo evaluate the disinfective effect of a new peracetic acid solution for digestive endoscope.MethodsForty endoscopes were divided into experimental group and control group,10 gastroscopes and 10 enteroscopes in each group,the experimental group was disinfected with the new peracetic acid solution for 10 min,the control group was disinfected with 2％ glutaral for 10 min,the disinfection effect was compared.Subsequently,80 other endoscopes were divided into 4 groups,10 gastroscopes and 10 enteroscopes in each group,each group was disinfected for 2 min,3 min,4 min and 5 min,the disinfection efficiency was evaluated.ResultsThe disinfection rates of gastroscopes and enteroscopes in the control were 100％ (10/10)and 90％ (9/10)respectively.Bacteria were found in both endoscopes.In the experimental group,disinfection rates of both gastroscopes and enteroscopes were 100％ (10/10),and no bacterium was found,which was superior to the control.disinfection rates of gastroscopes of 3 min,4 min and 5 min were all 100％ (10/10),which were higher than that of 2 min group (30％) (P ＜0.05).Bacteria were found in 3 min group.Disinfection rates of 4 min and 5 min group were 100％ ( 10/10),which were higher than that of 3 min group (80％)(P ＜0.05).Bacteria were found in 4 min group,and 2 min group was not disinfected.ConclusionThe new peracetic acid solution is effective for clinic digestive endoscope disinfection,and is superior to 2％ glutaral.
RESUMO
Objective To evaluate the feasibility and efficacy of betadine solution irrigation of gastrointestinal tract for infection prevention during the procedure of natural orifice transluminal endoscopic surgery(NOTES).Methods Twelve female porcine were divided into control group(n =4)to receive lavage with 500 ml normal saline and experimental group(n =8)to undergo lavage with 500 ml normal saline followed by 200 ml betadine solution.Fluid from gastrointestinal tract(5 ml)were collected before and after lavage,and after NOTES for culture.Endoscopy was performed 24 hours after NOTES to observe possible existence of inflammation,ulcer or bleeding.The animals were sacrificed 3 weeks after NOTES to explore intra-peritoneal adhesions,abscesses and other infections.Results One swine died of diaphragmatic injury and the other 11 animals successfully survived for 3 weeks.In trans-gastric approach,the average bacterial load of the fluid was 17.5 x 103 CFU/ml before lavage.In control group,the average bacterial load of the fluid was 2.5 × 103 CFU/ml after lavage and 5.5 × 103 CFU/ml after NOTES,while those in experimental group were 0 CFU/ml and 7.5 CFU/ml,respectively.In trans-colonic approach,the average bacterial load of the fluid before lavage was 76.2 × 103 CFU/ml.In control group,the average bacterial load of the fluid was 19.5 × 103 CFU/ml after lavage and 21 × 103 CFU/ml after NOTES,while those in experimental group were 2.25 × 103 CFU/ml and 1 × 103 CFU/ml,respectively.No inflammation,ulcer or bleeding were observed by endoscopy at 24 hours after NOTES.More adhesion and abscess were found in the control group than in the experimental group.In experimental group with trans-colonic approach,only one case of adhesion was observed.Conclusion It is effective and feasible of using betadine solution irrigation of gastrointestinal tract in infection prevention during the procedure of NOTES.However,further clinical studies assessing the effectiveness and safety are still necessary.
RESUMO
Objective To evaluate the efficacy and tolerability of EUS-guided intra-tumoral injection of E1B gene-deleted adenovirus (H101) combined with intravenous gemcitabine for unresectable pancreatic carcinomas. Methods Nineteen patients with advanced adenocarcinoma of the pancreas who were not resectable and never to anti-cancer treatment were enrolled in this study. Each patient underwent two sessions of EUS-guided H101 intra-tumoral injection in combination with gemcitabine (i. v. , 1000 mg/m2, d3, 10, 17). The tumor size before and after H101 intra-tumoral injection were recorded for efficacy assessment. The changes of pain score and KPS, adverse effects and complication rates, survival were estimated. Results The tumor size decreased in twelve patients by5.3% ~ 69.7% , but the difference was not statistically significant (P =0.275). All of nineteen patients completed two cycles of combination treatment. Among them, 3 (15. 8% ) achieved partial response, 10 (52.6% ) had stable disease, and none had complete response. The mean pain score after injection was significantly lower than that before injection (3.1 ±1.7 vs. 3.9±1.6, P = 0.004). KPS after injection was significantly increased more than that before injection [ (68.4 ± 12.1)% vs. (61.1 ±9.9)%, P =0.003)]. There was no complication associated with the procedure. Major adverse effects associated with H101 injection were fever and diarrhea. The survival time was 2.5 to 10 months. Nine patients were still alive. Conclusions EUS-guided E1B gene-deleted adenovirus intra-tumral injection in unresectable pancreatic carcinomas is feasible and well tolerated in combination with intravenous gemcitabine, which can improve the quality of life and decrease the pain score.
RESUMO
Objective To explore a new approach of sequential cannulation in bile duct and pancreatic duct in the pig model for ERCP training.Methods A group of 5 trainees received 5 to 10 sessions of training of bile duct cannulation first, the results were evaluated by ERCP experts.When the trainees passed the assessment, they received next phase of training of pancreatic duct cannulation.A 3 scores system was used to evaluate the level of operation before and after the training conducted by experts.Results All participants successfully completed the sequential cannulation training.Compared with the operation level before training, the insertion time of ERCP after training was shortened (5.2±1.5 min vs.2.5±0.7 min, P<0.05), and the operating skills were also improved significantly (1.3±0.5 vs.2.7±0.5, P<0.05).The training project was accepted very well by all participants.Conclusion The sequential cannulation in bile duct and pancreatic duct in pig model is of good cost-effectiveness and can get better training results under the premise of increasing the operating frequency and operating difficulties.
RESUMO
Objective To evaluate the safety and feasibility of natural orifice transluminal endoscopic surgery(NOTES)with current available techniques and endoscopic accessories.Methods Transgastric and transvaginal endoscopic abdominal cavity exploration were performed in 6 female pigs.A needle-knife and a ERCP scalpel were used to make an anterior gastric wall incision,and a dilating balloon to expand the passage,through which a therapeutic gastroscope was sent into the abdominal cavity to seek the target organ.Partial liver resection was performed in 2 cases.For incision closure,a clip was applied to the incision orifice or it was just given putting-aside therapy.One week later,the abdominal cavity was examined via vagina.Another week later,it was observed via other incision of the stomach.Four weeks after the operation,the pigs were sacrificed.Adhesion,injury to the organs and closure of the incision were evaluated.Results Transgastric procedures were performed 12 times and transvaginal procedures 6 times.Mean operation time via stomach was 33.4±10.9 min.and that via vagina WaS 10.1±2.5 min.All animals recovered and gained weight after the operation.The incision healed up with no obvious complications.Re-exploration showed adhesion of various degrees,no effusion,or injury to the organs were observed.Ketamine plus propofol achieved satisfactory anesthetic effect with no complications.One of the two animals which underwent liver partial resection died of disphragmatic muscle perforation.Hemarrhage occurred twice,both in the procedures via satisfied.One case developed abdominal abscess.Conclusion It Was feasible and safe to perform NOTES via transgastric and transvaginal approach to the abdominal cavity and liver resection.But development of NOTES specific instruments is essential to the procedure.
RESUMO
Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery(NOTES)in human being with current available devices.Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoscopy in a 50-year-old man,who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure.After routine anesthesia and abdominal skin sterilization,a pneumoperitoneum was induced with a Veress needle placed in the umbilical area,followed by the introduction of a 5-mm trocar.Gastral cavity Was sterilized with antibiotics and povidone iodine.Under laparoscopie optical control,we made a styliform incision in the anterior wall of gastric corpus with a needle knife,and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope.We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy.The specimen was taken out by retrieval basket through the stomach.The gastric incision Was closed with metal clips.Results The biopsy by means of NOTES was successfully performed without intra-or postoperative complications.The diagnosis was confirmed as lymphoma pathologically.The patient received chemotherapy and was discharged on the sixth postoperative day.There was no short or long-term complication.Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being.
RESUMO
Objective To investigate the changes of indications, degree of difficulty in procedure, complication and its severity in endoscopic retrograde cholangiopancreatography (ERCP) in Changhai hospital from 2001 to 2007. Methods The clinical data, including demographic data, indications, degree of difficulty in procedure, success rate, complication rate and severity of complication, of 2374 patients who underwent ERCP in 2001 and 2007 (966 in 2001 and 1408 in 2007), were retrospectively reviewed. Results Indications of ERCP changed at an interval of 5 years. Operations due to bile duct stone decreased (59.0% vs. 49.3%, P=0.000), while operations due to pancreas disease, especially chronic pancreatitis (6.6% vs. 18.5%, P=0.000) and recurrent pancreatitis (0.2% vs.1.6%, P=0.001), increased. Patients with biliary duct problems after liver transplantation appeared in 2007. The procedures of ERCP performed in 2007 were more difficult (P=0.000), with an increased percentage of Degree 5 procedure (7.3% vs. 33.3%, P=0.000). The number of diagnostic ERCP significantly decreased (Degree 1 + Degree 3, 30.5% +2.8% vs. 5.9% +3.1%, P=0.000). There was no significant difference in the success rate between the two years (P=0.084). The complication rate of ERCP in 2007 was significantly higher than that in 2001 (3.73% vs. 7.88%, P=0.000), but the severity of complication showed no significant difference (P=0.820). Conclusion Cases of diagnostic ERCP decreased in 2007. Indications of ERCP have changed, with a decrease in bile duct diseases and an increase in pancreatic diseases. The procedures are more complicated, but it does not lead to lower success rate. The increase in complication rate is possibly due to increase of therapeutic ERCP.
RESUMO
Objective To explore the efficacy and safety of choledochoscopy combined with laser lithotripsy for refractory residual biliary calculi after operation. Methods Clinical data of 22 patients, who underwent choledochoseopy together with laser lithotripsy for refractory intra- and extra-hepatic calculi after operation from February 2007 to February 2009, were retrospectively studied. Results The success rate of stone removal was 95.5% (21/22) , with one session success rate of 86. 4% (19/22), and two sessions of 9. 1% (2/22). Stone removal could not be performed in one patient due to multiple intra-hepatic calculi, difficult calculi location at bile ducts of grade Ⅱ, and wide biliary angle with no access. No biliary duct hem-orrhage, perforation, or infection occurred. Conclusion Choledochoscopy combined with laser lithotripsy is an effective and safe procedure for refractory residual biliary calculi after operation.
RESUMO
Objective To evaluate the efficacy and salty of endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) in the treatment of pain due to pancreatic cancer and celiac metastatic carcinoma.Methods Thirty-three patients with celiac carcinoma were selected for EUS-CPN. Among whom 15 pateints were received chemotherapy before procedure . Using endoscopic ultrasounography,transgastric injection of the celiac plexus with bupivacaine and 98% dehydrated absolute alcohol was accomplished.The abdominal pain was evaluated by the numeric pain intensity scale before and at 24,48,72 hours and one week after the precedure.The successful rate of precedure,the complication and the relief of the pain were observed. Results All procedures were performed successfully . No serious complications such as pancreatitis by trauma,pancreatic fistula,bleeding and celiac infection was found.Compared with baseline,pain was significantly relieved at 12,24,72 hours and 1 week after EUS-CPN (100%,98%,90% and 88%,respectively).The pain remission at 24,48,72 hours and one week in patients who received chemotherapy before procedure were 100%,100%,980% and 98%,respectively,while in those who had not treated chemically were 100%,98%,95% and 90%,respectively.The complete%relief of pain in chemotherapy group was significantly higher than that in nonchemotherapy group (75 % vs 56 %,P%0.05).Conclusions EUS CPN is a safe and effective method for relieving pain with low complications.It can raise the quality life of the patients and chemical therapy may be helpful in pain control.
RESUMO
Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pan-creatography (ERCP) in treatment of pain of chronic pancreatitis (CP). Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed.The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of ther-apy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients ( 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years).The mean follow-up period was 41.9 months (12～131 months). Twenty-eight patients (13. 1% ) under-went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% (P >0. 05 ) respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14.9% (71/476) in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6%, mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub-sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.
