ObjectiveTo evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy (EST). MethodsThe clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed, study group （n=102) were treated with spotwelding electrocoagulation with needleknife and 110 000 noradrenaline washing, control group (n=85) were treated with 110 000 noradrenaline washing alone. The bleeding and complications after EST were observed. ResultsThe differences of gender, age, primary diseases, cormorbidities, nutritional status, and immune function were not significant between two groups (Pgt;0.05). The bleeding after EST happened 4 cases (4.70%) in the control group and none in the study group. The bleeding rate of the study group was significantly lower than that of the control group (Plt;0.05). The bleeding cases in the control group were controlled successfully by spotwelding electrocoagulation with needleknife under endoscopy. Cholangitis occurred in 5 cases altogether, 1 case in each group deteriorated promptly and died of multiple organ failure syndrome, another 3 cases, 2 in the study group, 1 in the control group, were cured by PTCD and antibiotics. Biliary tract hemorrhage occurred one case in each group, which one died in the study group. Pancreatitis occurred 1 case in the study group and 2 cases in the control group, all of which were salvaged by conservative therapy. The incidences of complications were not significantly different between two groups (Pgt;0.05). ConclusionsThe spotwelding electrocoagulation with needleknife can significantly reduce the bleeding rate after EST. It is an effective, safe, and easy technique, especially to rural areas.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
Endoscopic retrograde cholangiopancreatography (ERCP) is currently the first-line minimally invasive diagnosis and treatment of biliary and pancreatic diseases. With the increasing popularity of ERCP, ERCP-related adverse events which include post-ERCP pancreatitis, cholecystitis, cholangitis, bleeding, perforation, etc., have received more and more attention. In response to the controversy and problems in the management of these adverse events, the European Society of Gastrointestinal Endoscopy published the guidelines for ERCP-related adverse events in December 2019. The paper interprets the key points in the guideline to provide references for clinical practice.
Objective To analyze the clinical features， common etiologies， prevention measurements of recurrent acute pancreatitis （AP）. Methods The clinical characteristics and imaging examination data of 43 patients with recurrent AP were analyzed retrospectively， which was compared with the results of 258 patients with primary AP. The recurrence etiologies were analyzed. Results There were no significant differences on the fever， jaundice， abdominal pain relief time， pancreatic local complications， and ratio of severe AP between two groups （P＞0.05）. Comparion of etiologies between recurrent AP and primary AP， cholecystitis and diet factor （alcoholic） had priority in patients with primary AP （P=0.038， P=0.006， respectively）， but the hyperlipidemic， duodenal nipple disease， and small stone in the common bile duct were the major etiologies in patients with recurrent AP （P=0.007， P=0.008， respectively）. No relapse was found within the follow up for 3 months to 2 years （the average time was 14.2 months）. Conclusion Find out the exact etiology and performe correct therapy are the key to the treatment and prevention of recurrent AP.
Objective To evaluate the therapeutic effects of endoscopic treatment on biliary tract complications after liver transplantation. Methods The clinical data of 55 patients with biliary tract complications after liver transplantation undergoing endoscopic treatment from January 2006 to June 2009 were analyzed retrospectively. Results Ninety-eight times of endoscopic treatment were performed in 55 patients. There were 11 cases of biliary fistula, 4 cases of bile duct stricture with biliary fistula, 21 cases of bile duct stricture, 12 cases of bile duct stricture with biliary sludge or stones, 3 cases of biliary sludge or stones, 2 cases of angular distortion of the bile duct and papilla duodeni stenosis in 2 cases. Different procedures including biliary tract dilation, endoscopic nasobiliary drainage, endoscopic sphincterotomy, stone extraction technique and biliary stent placement were performed in different biliary tract complications. The endoscopic treatments were successful in 46 cases (83.6%). The procedure related complications were found in 13 times (13.3%). Conclusion Endoscopy may serve as the primary modality for treating biliary tract complications after liver transplantation with safety and effectiveness.
Objective To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach. Methods The treatment procedures of 8 patients with synchronous double cancers of the esophagus andstomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-ronous double cancers of the esophagus and stomach was explored. Results Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation. Conclusions Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis
Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.
Objective To investigate the feasibility and operation effect of endoscopic sentinel lymph node biopsy （SLNB） in breast cancer. Methods The data of 410 breast cancer patients who underwent SLNB （including 107 patients with endoscopy and 303 with open operation） were analyzed in our hospital from January 2009 to March 2012. SLNB was performed by using methylene blue staining or the combination of methylene blue and 99Tcm-sulfur colloid tracing. Results The successful rate of SLN detection with methylene blue and 99Tcm-sulfur colloid tracing was 94.56% （139/147） in open operation group and 94.25% （82/87） in endoscopy group. The successful rate of SLN detection with methylene blue was 88.46% （138/156）in open operation group and 85.00% （17/20） in endoscopy group. The mean of detected SLN number with combined method or methylene blue was 1.90/1.98 in open operation group and 1.91/1.82 in endoscopy group respectively. SLN-positive rate was 22.30% （31/139） and 25.36% （35/138） in open operation group， and 19.51% （16/82） and 23.53% （4/17） in endoscopy group， respectively. The rate of subcutaneous effusion in endoscopy group was higher than that in open operation group （P=0.001）, but other postoperative complications presented no significant difference. Conclusions Endoscopic SLNB can obtain the similar safety and the clinical efficacy with traditional SLNB， but superior cosmetic effect. So it is worthy of clinical application in breast cancer.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.