Objective To evaluate the safety and efficacy of metal clips combined with endoscopic histoacryl injection for gastric varices with spontaneous portosystemic shunts. Methods The clinical data and complications of 32 patients who were treated with metal clips combined with endoscopic histoacryl injection at Beijing Ditan Hospital of Capital Medical University from May 2016 to October 2018 were collected and analyzed. Results Hemostasis was achieved in all patients, and the median volume of histoacryl was 3.8 mL. Varices were eradicated or disappeared in 9 cases, and the degree of varices were lessened in 23 cases. No rebleeding was found at 72 h, 7 d, 14 d and 6 weeks after operation in any patient. No ectopic embolism occurred. Conclusion Metal clips combined with endoscopic histoacryl injection is effective and safe to treat gastric varices with spontaneous portosystemic shunts. Key words: Endoscopy; Esophageal and gastric varices; Spontaneous protosystemic shunt; Histoacryl; Metal clip
{"title":"Metal clips combined with endoscopic histoacryl injection in the treatment of gastric varices with spontaneous portosystemic shunts (with video)","authors":"Jia-Li Ma, Xu Chen, Shan Hong, Caihong Deng, Yu Jiang, Julong Hu","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.007","url":null,"abstract":"Objective \u0000To evaluate the safety and efficacy of metal clips combined with endoscopic histoacryl injection for gastric varices with spontaneous portosystemic shunts. \u0000 \u0000 \u0000Methods \u0000The clinical data and complications of 32 patients who were treated with metal clips combined with endoscopic histoacryl injection at Beijing Ditan Hospital of Capital Medical University from May 2016 to October 2018 were collected and analyzed. \u0000 \u0000 \u0000Results \u0000Hemostasis was achieved in all patients, and the median volume of histoacryl was 3.8 mL. Varices were eradicated or disappeared in 9 cases, and the degree of varices were lessened in 23 cases. No rebleeding was found at 72 h, 7 d, 14 d and 6 weeks after operation in any patient. No ectopic embolism occurred. \u0000 \u0000 \u0000Conclusion \u0000Metal clips combined with endoscopic histoacryl injection is effective and safe to treat gastric varices with spontaneous portosystemic shunts. \u0000 \u0000 \u0000Key words: \u0000Endoscopy; Esophageal and gastric varices; Spontaneous protosystemic shunt; Histoacryl; Metal clip","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"111-114"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48814995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.02.004
R. Liang, Bao-yu Zhao, B. Hou, Rong Wang
Objective To evaluate the long-term efficacy of endoscopic submucosal dissection (ESD) and surgical resection on the treatment of early esophagogastric junction (EGJ) adenocarcinoma. Methods A retrospective analysis was performed on the data of 166 consecutive cases with early EGJ adenocarcinoma in Digestive Endoscopy Center and Department of General Surgery of Shanxi Provincial People′s Hospital from January 2004 to June 2018. Their preoperative assessment conformed to the absolute and expanded criteria of ESD, and postoperative pathological assessment accorded with the absolute and expanded criteria of curative resection. Patients were divided into the ESD group (n=77) and the surgical resection group (n=89), and the recent results (curative resection rate and complications) and long-term results (cumulative survival rate) were compared between the two groups. Results In the ESD group, 65 (84.4%) patients met the absolute criteria of ESD treatment and 12 (15.6%) patients met the expanded criteria. In the surgical resection group, 60 (67.4%) patients met the absolute criteria of ESD and 29 (32.6%) patients met the expanded criteria. The difference in the composition of ESD criteria was statistically significant between the two groups (P=0.011). Other baseline indicators showed no significant difference between the two groups (P > 0.05). In the ESD group, the overall resection rate was 98.7% (76/77), the complete resection rate was 94.8% (73/77), and the curative resection rate was 93.5% (72/77). In the surgical resection group, the curative resection rate was 100.0% (89/89). The difference in the curative resection rate between the two groups was not statistically significant (P=0.05). In the ESD group, there were 3 (3.9%) cases of intraoperative bleeding, 1 (1.3%) case of early postoperative bleeding, and 2 (2.6%) cases of intraoperative perforation. In the surgical resection group, there was 1 (1.1%) case of intraoperative bleeding, 4 (4.5%) cases of postoperative bleeding, and 2 (2.2%) cases of postoperative anastomotic leakage. There was no death or local recurrence occurred in the both groups within 1 month after treatment. The median follow-up time was 89.3 months (ranged 72.5-105.7 months) in the ESD group and 82.3 months (ranged 69.6-101.0 months) in the surgical treatment group, respectively. There was no tumor-related death or recurrence occurred in the two groups during follow-up. The 5-year survival rate in the ESD group and the surgical resection group was 94.8% (73/77) and 96.6% (86/89), respectively. The difference in the cumulative survival rate was not significant between the two groups (P=0.648). Subgroup analysis showed that there was no significant difference in the cumulative survival rate between patients receiving ESD and those receiving surgical resection who met the absolute criteria of ESD (P=0.449) and met ESD expanded criteria (P=0.505). Conclusion For EGJ adenocarcinoma conforming to the ESD treatm
{"title":"Comparison of long-term outcomes between endoscopic submucosal dissection and surgery on treatment of early esophagogastric junction adenocarcinoma","authors":"R. Liang, Bao-yu Zhao, B. Hou, Rong Wang","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.004","url":null,"abstract":"Objective \u0000To evaluate the long-term efficacy of endoscopic submucosal dissection (ESD) and surgical resection on the treatment of early esophagogastric junction (EGJ) adenocarcinoma. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on the data of 166 consecutive cases with early EGJ adenocarcinoma in Digestive Endoscopy Center and Department of General Surgery of Shanxi Provincial People′s Hospital from January 2004 to June 2018. Their preoperative assessment conformed to the absolute and expanded criteria of ESD, and postoperative pathological assessment accorded with the absolute and expanded criteria of curative resection. Patients were divided into the ESD group (n=77) and the surgical resection group (n=89), and the recent results (curative resection rate and complications) and long-term results (cumulative survival rate) were compared between the two groups. \u0000 \u0000 \u0000Results \u0000In the ESD group, 65 (84.4%) patients met the absolute criteria of ESD treatment and 12 (15.6%) patients met the expanded criteria. In the surgical resection group, 60 (67.4%) patients met the absolute criteria of ESD and 29 (32.6%) patients met the expanded criteria. The difference in the composition of ESD criteria was statistically significant between the two groups (P=0.011). Other baseline indicators showed no significant difference between the two groups (P > 0.05). In the ESD group, the overall resection rate was 98.7% (76/77), the complete resection rate was 94.8% (73/77), and the curative resection rate was 93.5% (72/77). In the surgical resection group, the curative resection rate was 100.0% (89/89). The difference in the curative resection rate between the two groups was not statistically significant (P=0.05). In the ESD group, there were 3 (3.9%) cases of intraoperative bleeding, 1 (1.3%) case of early postoperative bleeding, and 2 (2.6%) cases of intraoperative perforation. In the surgical resection group, there was 1 (1.1%) case of intraoperative bleeding, 4 (4.5%) cases of postoperative bleeding, and 2 (2.2%) cases of postoperative anastomotic leakage. There was no death or local recurrence occurred in the both groups within 1 month after treatment. The median follow-up time was 89.3 months (ranged 72.5-105.7 months) in the ESD group and 82.3 months (ranged 69.6-101.0 months) in the surgical treatment group, respectively. There was no tumor-related death or recurrence occurred in the two groups during follow-up. The 5-year survival rate in the ESD group and the surgical resection group was 94.8% (73/77) and 96.6% (86/89), respectively. The difference in the cumulative survival rate was not significant between the two groups (P=0.648). Subgroup analysis showed that there was no significant difference in the cumulative survival rate between patients receiving ESD and those receiving surgical resection who met the absolute criteria of ESD (P=0.449) and met ESD expanded criteria (P=0.505). \u0000 \u0000 \u0000Conclusion \u0000For EGJ adenocarcinoma conforming to the ESD treatm","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"94-99"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47243372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.02.005
Yang Yu, D. Shi, Deqing Zhang, Wei-chang Chen, Xiao-yan Liu, Rui Li
Objective To evaluate the efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection (ESD). Methods Patients who received ESD in the First Affiliated Hospital of Soochow University and Yulin No.2 Hospital from June 2017 to August 2018 were enrolled with informed consents, and randomly divided into the study group and the control group. Hemostatic powder was applied on post-ESD ulcer after routine hemostasis method in the study group, and the control group was given routine hemostasis method only. The time and dosage of hemostatic powder spraying and its adverse events were observed in the study group. The operation time, rate of delayed bleeding (within 30 days after operation) and early delayed bleeding (within 48 hours after operation), and postoperative hospital stay were compared between the two groups. Results A total of 196 patients were enrolled including 97 in the study group and 99 in the control group. The baseline data were comparable between the two groups (all P>0.05). In the study group, the time to spray powder was 68.78±19.75 s, dosage was 2.51±0.93 g. Powder delivery catheter was blocked in one case (1.03%, 1/97). No adverse event was reported during 30 days of follow-up. The operation time was not statistically different in the study group and the control group (61.92±11.71 min VS 59.76±11.01 min, t=1.330, P=0.185). The delayed bleeding rate of the study group was significantly lower than that of the control group [1.03% (1/97) VS 8.08% (8/99), P=0.035]. There was no case of early delayed bleeding occurred in the study group, while 6 cases (6.06%, 6/99) in the control group (P=0.029). The postoperative hospital stay was not statistically different between the study group and the control group (4.57±0.85 d VS 4.86±1.37 d, t=1.778, P=0.077). Conclusion Although capacity of hemostatic system remains to be improved, hemostatic powder is an effective, safe and simple method to reduce delayed bleeding rate after ESD, especially on early delayed bleeding. Key words: Randomized controlled trial; Endoscopic submucosal dissection; Delayed bleeding; Hemostatic powder
目的评价止血粉预防内镜下黏膜下剥离术后延迟出血的疗效。方法将2017年6月至2018年8月在东吴大学附属第一医院和榆林市第二医院接受ESD治疗的患者纳入知情同意书中，随机分为研究组和对照组。研究组采用常规止血法对ESD后溃疡涂止血粉，对照组仅采用常规止血方法。观察研究组止血粉喷洒时间、剂量及不良反应。比较两组的手术时间、术后30天内延迟出血率、术后48小时内早期延迟出血率及术后住院时间。结果共有196例患者入选，其中研究组97例，对照组99例。两组的基线数据具有可比性（均P>0.05）。研究组喷洒粉末的时间为68.78±19.75s，剂量为2.51±0.93g。1例（1.03%，1/97）粉末输送导管堵塞。随访30天内未报告不良事件。研究组和对照组的手术时间无统计学差异（61.92±11.71分钟VS 59.76±11.01分钟，t=1.330，P=0.015）。研究组的延迟出血率显著低于对照组[1.03%（1/97）VS 8.08%（8/99），P=0.035]，对照组6例（6.06%，6/99）（P=0.029）。研究组与对照组术后住院时间无统计学差异（4.57±0.85 d VS 4.86±1.37 d，t=1.778，P=0.077），尤其是早期延迟出血。关键词：随机对照试验；内镜黏膜下剥离术；延迟出血；止血粉
{"title":"Efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection: a randomized controlled trial","authors":"Yang Yu, D. Shi, Deqing Zhang, Wei-chang Chen, Xiao-yan Liu, Rui Li","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.005","url":null,"abstract":"Objective \u0000To evaluate the efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection (ESD). \u0000 \u0000 \u0000Methods \u0000Patients who received ESD in the First Affiliated Hospital of Soochow University and Yulin No.2 Hospital from June 2017 to August 2018 were enrolled with informed consents, and randomly divided into the study group and the control group. Hemostatic powder was applied on post-ESD ulcer after routine hemostasis method in the study group, and the control group was given routine hemostasis method only. The time and dosage of hemostatic powder spraying and its adverse events were observed in the study group. The operation time, rate of delayed bleeding (within 30 days after operation) and early delayed bleeding (within 48 hours after operation), and postoperative hospital stay were compared between the two groups. \u0000 \u0000 \u0000Results \u0000A total of 196 patients were enrolled including 97 in the study group and 99 in the control group. The baseline data were comparable between the two groups (all P>0.05). In the study group, the time to spray powder was 68.78±19.75 s, dosage was 2.51±0.93 g. Powder delivery catheter was blocked in one case (1.03%, 1/97). No adverse event was reported during 30 days of follow-up. The operation time was not statistically different in the study group and the control group (61.92±11.71 min VS 59.76±11.01 min, t=1.330, P=0.185). The delayed bleeding rate of the study group was significantly lower than that of the control group [1.03% (1/97) VS 8.08% (8/99), P=0.035]. There was no case of early delayed bleeding occurred in the study group, while 6 cases (6.06%, 6/99) in the control group (P=0.029). The postoperative hospital stay was not statistically different between the study group and the control group (4.57±0.85 d VS 4.86±1.37 d, t=1.778, P=0.077). \u0000 \u0000 \u0000Conclusion \u0000Although capacity of hemostatic system remains to be improved, hemostatic powder is an effective, safe and simple method to reduce delayed bleeding rate after ESD, especially on early delayed bleeding. \u0000 \u0000 \u0000Key words: \u0000Randomized controlled trial; Endoscopic submucosal dissection; Delayed bleeding; Hemostatic powder","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"100-104"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44872393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.02.006
Zhengyan Su, Chao Sun, X. Jiang, Ya Wang, You Deng, Bangmao Wang
Objective To compare the risk assessment capability of model for end-stage liver disease (MELD), glasgow-blatchford score (GBS), and the AIMS65 scoring system for liver cirrhosis patients with esophageal and gastric variceal bleeding (EGVB). Methods A retrospective analysis was made on data of 182 cirrhosis patients with EGVB admitted to the Department of Gastroenterology, General Hospital of Tianjin Medical University from January 1, 2015 to March 1, 2018. According to the MELD, GBS and AIMS65 scoring system, the corresponding scores of each patient were calculated to evaluate the ability of the three scoring systems to correctly classify EGVB as a " high-risk patient" . The receiver operating characteristic curve was drawn to compare the predictive value of three scoring systems for different clinical outcomes (blood transfusion, rebleeding, and death). The area under curve (AUC)>0.7 was believed to have higher accuracy. Results The clinical outcomes of 182 patients included blood transfusion in 113 (62.1%) cases, rebleeding in 31 (17.0%) cases, and death of 11 (6.0%) cases. The MELD score was 7-25, GBS was 3-16, and AIMS65 score was 0-3. There were 4 (2.2%) patients with MELD score < 9, 139 (76.4%) patients with AIMS65 score 0-1, including 68 patients with AIMS65 score of 0 and 71 patients with AIMS65 score of 1. The AUC of MELD, GBS and AIMS65 for predicting blood transfusion was 0.514 (95%CI: 0.439-0.589), 0.681 (95%CI: 0.608-0.748), and 0.669 (95%CI: 0.596-0.737), respectively. When predicting rebleeding, the AUC of MELD, GBS and AIMS65 was 0.525 (95%CI: 0.449-0.599), 0.528 (95%CI: 0.453-0.602) and 0.580 (95%CI: 0.505-0.652), respectively. When predicting in-hospital mortality, the AUC of MELD, GBS and AIMS65 was 0.642 (95%CI: 0.567-0.711), 0.581 (95%CI: 0.505-0.653) and 0.786 (95%CI: 0.719-0.843), respectively. AIMS65 was superior to MELD (P=0.083 6) and GBS (P=0.047 0). Conclusion GBS can correctly classify cirrhosis patients with EGVB as " high-risk group" , and is better than AIMS65 and MELD scoring system. MELD, GBS and AIMS65 all have poor accuracy in predicting blood transfusion and rebleeding, AIMS65 has a higher predictive value for death. Key words: Prognosis; Liver cirrhosis; Esophageal and gastric variceal bleeding; Scoring system
{"title":"Risk assessment of cirrhosis patients with esophageal and gastric variceal bleeding by three scoring systems","authors":"Zhengyan Su, Chao Sun, X. Jiang, Ya Wang, You Deng, Bangmao Wang","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.006","url":null,"abstract":"Objective \u0000To compare the risk assessment capability of model for end-stage liver disease (MELD), glasgow-blatchford score (GBS), and the AIMS65 scoring system for liver cirrhosis patients with esophageal and gastric variceal bleeding (EGVB). \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was made on data of 182 cirrhosis patients with EGVB admitted to the Department of Gastroenterology, General Hospital of Tianjin Medical University from January 1, 2015 to March 1, 2018. According to the MELD, GBS and AIMS65 scoring system, the corresponding scores of each patient were calculated to evaluate the ability of the three scoring systems to correctly classify EGVB as a \" high-risk patient\" . The receiver operating characteristic curve was drawn to compare the predictive value of three scoring systems for different clinical outcomes (blood transfusion, rebleeding, and death). The area under curve (AUC)>0.7 was believed to have higher accuracy. \u0000 \u0000 \u0000Results \u0000The clinical outcomes of 182 patients included blood transfusion in 113 (62.1%) cases, rebleeding in 31 (17.0%) cases, and death of 11 (6.0%) cases. The MELD score was 7-25, GBS was 3-16, and AIMS65 score was 0-3. There were 4 (2.2%) patients with MELD score < 9, 139 (76.4%) patients with AIMS65 score 0-1, including 68 patients with AIMS65 score of 0 and 71 patients with AIMS65 score of 1. The AUC of MELD, GBS and AIMS65 for predicting blood transfusion was 0.514 (95%CI: 0.439-0.589), 0.681 (95%CI: 0.608-0.748), and 0.669 (95%CI: 0.596-0.737), respectively. When predicting rebleeding, the AUC of MELD, GBS and AIMS65 was 0.525 (95%CI: 0.449-0.599), 0.528 (95%CI: 0.453-0.602) and 0.580 (95%CI: 0.505-0.652), respectively. When predicting in-hospital mortality, the AUC of MELD, GBS and AIMS65 was 0.642 (95%CI: 0.567-0.711), 0.581 (95%CI: 0.505-0.653) and 0.786 (95%CI: 0.719-0.843), respectively. AIMS65 was superior to MELD (P=0.083 6) and GBS (P=0.047 0). \u0000 \u0000 \u0000Conclusion \u0000GBS can correctly classify cirrhosis patients with EGVB as \" high-risk group\" , and is better than AIMS65 and MELD scoring system. MELD, GBS and AIMS65 all have poor accuracy in predicting blood transfusion and rebleeding, AIMS65 has a higher predictive value for death. \u0000 \u0000 \u0000Key words: \u0000Prognosis; Liver cirrhosis; Esophageal and gastric variceal bleeding; Scoring system","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"105-110"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42192796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.02.008
Si-Kai Liu, F. Meng
Objective To evaluate the effects of peroral endoscopic myotomy (POEM) on esophageal motility in patients with achalasia(AC) after POEM. Methods Demographics, clinical and manometric data, and outcomes were collected from the medical records of patients who received POEM as the primary therapy for AC in Beijing Friendship Hospital from January 2012 to June 2016. The rate of treatment success and change in esophageal dynamics before and after treatment were compared in different types of AC. Results At 6 months′ follow-up of POEM, the symptom remission rate of AC patients with type Ⅰ, type Ⅱ, and type Ⅲ was 100.0% (13/13), 95.5% (42/44) and 90.1% (10/11), respectively. Within 6 months after POEM, lower esophageal sphincter resting pressure [10.5 (6.9, 15.8) mmHg VS 24.6 (18.3, 35.1) mmHg, 1 mmHg=0.133 kPa], 4 s integrated relaxation pressure [6.0 (3.7, 8.8) mmHg VS 21.8 (15.3, 28.0) mmHg], upper esophageal sphincter (UES)resting pressure [43.4 (33.7, 57.3) mmHg VS 45.3 (33.2, 71.1) mmHg] and UES residual pressure [1.5 (0.0, 4.6) mmHg VS 3.9 (1.1, 6.9) mmHg] were significantly improved compared with those of pre-operation (all P<0.05). At 6 months after POEM, esophageal dilatation diameter (3.0±0.7 cm VS 3.9±1.1 cm) and Eckardt scores [1 (0, 2) VS 6 (5, 8)] were also significantly improved compared with those of pre-operation (all P<0.001). After POEM, the esophageal body peristalsis did not recover in type Ⅰ AC patients. Four patients (9.1%, 4/44) of type Ⅱ AC recovered weak peristalsis or premature contraction, and 10 patients (90.9%, 10/11) of type Ⅲ AC recovered with more normal peristaltic wave, and the rate of pre-systolic contraction or weak peristalsis increased. Conclusion POEM can improve the esophagogastric junction outflow tract obstruction and change the esophageal body motility.After POEM, part patients have recovery of esophageal body motility, which is most obvious in type Ⅲ AC, followed by type Ⅱ, and type Ⅰ AC patients have no significant change. Key words: Esophageal achalasia; Peroral endoscopic myotomy; Esophageal motility
目的评价经口内镜肌切开术（POEM）对贲门失弛缓症（AC）患者术后食管动力的影响。方法从2012年1月至2016年6月在北京友谊医院接受POEM作为AC初级治疗的患者的病历中收集人口学、临床和测压数据以及结果。比较不同类型AC的治疗成功率和治疗前后食管动力学的变化。结果POEM随访6个月，Ⅰ型、Ⅱ型和Ⅲ型AC患者的症状缓解率分别为100.0%（13/13）、95.5%（42/44）和90.1%（10/11）。POEM后6个月内，食管下括约肌静息压[10.5（6.9，15.8）mmHg VS 24.6（18.3，35.1）mmHg，1mmHg=0.133kPa]，4 s综合舒张压[6.0（3.7，8.8）mmHg VS 21.8（15.3，28.0）mmHg]，上食管括约肌（UES）静息压[43.4（33.7,57.3）mmHg VS 45.3（33.2,71.1）mmHg]和UES残余压[1.5（0.0,4.6）mmHg VS3.9（1.1,6.9）mmH]与术前相比均有显著改善（均P<0.05），食管扩张直径（3.0±0.7cm VS 3.9±1.1cm）和Eckardt评分[1（0，2）VS 6（5，8）]均较术前有显著改善（均P＜0.001）。4例（9.1%，4/44）Ⅱ型AC患者恢复了弱蠕动或早期收缩，10例（90.9%，10/11）Ⅲ型AC患者以更正常的蠕动波恢复，收缩前收缩或弱蠕动率增加。结论POEM可改善食管胃交界处流出道梗阻，改变食管体运动。POEM后，部分患者食管体动力恢复，以Ⅲ型AC最为明显，其次为Ⅱ型，Ⅰ型AC患者无明显变化。关键词：食管贲门失弛缓症；经口内镜肌切开术；食管运动
{"title":"Effects of peroral endoscopic myotomy on esophageal motility in patients with achalasia","authors":"Si-Kai Liu, F. Meng","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.008","url":null,"abstract":"Objective \u0000To evaluate the effects of peroral endoscopic myotomy (POEM) on esophageal motility in patients with achalasia(AC) after POEM. \u0000 \u0000 \u0000Methods \u0000Demographics, clinical and manometric data, and outcomes were collected from the medical records of patients who received POEM as the primary therapy for AC in Beijing Friendship Hospital from January 2012 to June 2016. The rate of treatment success and change in esophageal dynamics before and after treatment were compared in different types of AC. \u0000 \u0000 \u0000Results \u0000At 6 months′ follow-up of POEM, the symptom remission rate of AC patients with type Ⅰ, type Ⅱ, and type Ⅲ was 100.0% (13/13), 95.5% (42/44) and 90.1% (10/11), respectively. Within 6 months after POEM, lower esophageal sphincter resting pressure [10.5 (6.9, 15.8) mmHg VS 24.6 (18.3, 35.1) mmHg, 1 mmHg=0.133 kPa], 4 s integrated relaxation pressure [6.0 (3.7, 8.8) mmHg VS 21.8 (15.3, 28.0) mmHg], upper esophageal sphincter (UES)resting pressure [43.4 (33.7, 57.3) mmHg VS 45.3 (33.2, 71.1) mmHg] and UES residual pressure [1.5 (0.0, 4.6) mmHg VS 3.9 (1.1, 6.9) mmHg] were significantly improved compared with those of pre-operation (all P<0.05). At 6 months after POEM, esophageal dilatation diameter (3.0±0.7 cm VS 3.9±1.1 cm) and Eckardt scores [1 (0, 2) VS 6 (5, 8)] were also significantly improved compared with those of pre-operation (all P<0.001). After POEM, the esophageal body peristalsis did not recover in type Ⅰ AC patients. Four patients (9.1%, 4/44) of type Ⅱ AC recovered weak peristalsis or premature contraction, and 10 patients (90.9%, 10/11) of type Ⅲ AC recovered with more normal peristaltic wave, and the rate of pre-systolic contraction or weak peristalsis increased. \u0000 \u0000 \u0000Conclusion \u0000POEM can improve the esophagogastric junction outflow tract obstruction and change the esophageal body motility.After POEM, part patients have recovery of esophageal body motility, which is most obvious in type Ⅲ AC, followed by type Ⅱ, and type Ⅰ AC patients have no significant change. \u0000 \u0000 \u0000Key words: \u0000Esophageal achalasia; Peroral endoscopic myotomy; Esophageal motility","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"115-120"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44673653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To construct a real-time monitoring system based on computer vision for monitoring withdrawal speed of colonoscopy and to validate its feasibility and performance. Methods A total of 35 938 images and 63 videos of colonoscopy were collected in endoscopic database of Renmin Hospital of Wuhan University from May to October 2018. The images were divided into two datasets, one dataset included in vitro, in vivo and unqualified colonoscopy images, and another dataset included ileocecal and non-cecal area images. And then 3 594 and 2 000 images were selected respectively from the two datasets for testing the deep learning model, and the remaining images were used to train the model. Three colonoscopy videos were selected to evaluate the feasibility of real-time monitoring system, and 60 colonoscopy videos were used to evaluate its performance. Results The accuracy rate of the deep learning model for classification for in vitro, in vivo, and unqualified colonoscopy images was 90.79% (897/988), 99.92% (1 300/1 301), and 99.08% (1 293/1 305), respectively, and the overall accuracy rate was 97.11% (3 490/3 594). The accuracy rate of identifying ileocecal and non-cecal area was 96.70% (967/1 000) and 94.90% (949/1 000), respectively, and the overall accuracy rate was 95.80% (1 916/2 000). In terms of feasibility evaluation, 3 colonoscopy videos data showed a linear relationship between the retraction speed and the image processing interval, which indicated that the real-time monitoring system automatically monitored the retraction speed during the colonoscopy withdrawal process. In terms of performance evaluation, the real-time monitoring system correctly predicted entry time and withdrawal time of all 60 examinations, and the results showed that the withdrawal speed and withdrawal time was significantly negative-related (R=-0.661, P<0.001). The 95% confidence interval of withdrawal speed for the colonoscopy with withdrawal time of less than 5 min, 5-6 min, and more than 6 min was 43.90-49.74, 40.19-45.43, and 34.89-39.11 respectively. Therefore, 39.11 was set as the safe withdrawal speed and 45.43 as the alarm withdrawal speed. Conclusion The real-time monitoring system we constructed can be used to monitor real-time withdrawal speed of colonoscopy and improve the quality of endoscopy. Key words: Quality control; Artificial intelligence; Colonoscopy; Withdrawal time; Withdrawal speed
{"title":"Application of artificial intelligence in real-time monitoring of withdrawal speed of colonoscopy","authors":"Xiaoyun Zhu, Lianlian Wu, Suqin Li, Xia Li, Jun Zhang, Shan Hu, Yiyun Chen, Honggang Yu","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.010","url":null,"abstract":"Objective \u0000To construct a real-time monitoring system based on computer vision for monitoring withdrawal speed of colonoscopy and to validate its feasibility and performance. \u0000 \u0000 \u0000Methods \u0000A total of 35 938 images and 63 videos of colonoscopy were collected in endoscopic database of Renmin Hospital of Wuhan University from May to October 2018. The images were divided into two datasets, one dataset included in vitro, in vivo and unqualified colonoscopy images, and another dataset included ileocecal and non-cecal area images. And then 3 594 and 2 000 images were selected respectively from the two datasets for testing the deep learning model, and the remaining images were used to train the model. Three colonoscopy videos were selected to evaluate the feasibility of real-time monitoring system, and 60 colonoscopy videos were used to evaluate its performance. \u0000 \u0000 \u0000Results \u0000The accuracy rate of the deep learning model for classification for in vitro, in vivo, and unqualified colonoscopy images was 90.79% (897/988), 99.92% (1 300/1 301), and 99.08% (1 293/1 305), respectively, and the overall accuracy rate was 97.11% (3 490/3 594). The accuracy rate of identifying ileocecal and non-cecal area was 96.70% (967/1 000) and 94.90% (949/1 000), respectively, and the overall accuracy rate was 95.80% (1 916/2 000). In terms of feasibility evaluation, 3 colonoscopy videos data showed a linear relationship between the retraction speed and the image processing interval, which indicated that the real-time monitoring system automatically monitored the retraction speed during the colonoscopy withdrawal process. In terms of performance evaluation, the real-time monitoring system correctly predicted entry time and withdrawal time of all 60 examinations, and the results showed that the withdrawal speed and withdrawal time was significantly negative-related (R=-0.661, P<0.001). The 95% confidence interval of withdrawal speed for the colonoscopy with withdrawal time of less than 5 min, 5-6 min, and more than 6 min was 43.90-49.74, 40.19-45.43, and 34.89-39.11 respectively. Therefore, 39.11 was set as the safe withdrawal speed and 45.43 as the alarm withdrawal speed. \u0000 \u0000 \u0000Conclusion \u0000The real-time monitoring system we constructed can be used to monitor real-time withdrawal speed of colonoscopy and improve the quality of endoscopy. \u0000 \u0000 \u0000Key words: \u0000Quality control; Artificial intelligence; Colonoscopy; Withdrawal time; Withdrawal speed","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"125-130"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49239533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To evaluate the screening value of serum pepsinogen (PG) Ⅰ, pepsinogen ratio (PGR, PG Ⅰ/PG Ⅱ) and gastrin 17 (G17) levels combined with gastroscopy for early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province. Methods A total of 2 700 cases were identified as the appropriate age (40-69 years) target population through the questionnaire survey from 25 000 local residents in high incidence areas of gastric cancer in Qinghai Province. The serum PGⅠ, PGⅡ and G17 levels of the 2 700 target population were determined by ELISA, and PGR were calculated. And then 949 patients with abnormal levels of PG and G17 were screened out as a high-risk group of gastric cancer to receive gastroscopy and pathologic biopsy. According to the results of gastroscopy and biopsy, the patients were divided into non-atrophic gastritis group, atrophic gastritis group, peptic ulcer group, early-stage gastric cancer group, and advanced gastric cancer group. The optimal threshold and its sensitivity and specificity of serum PG Ⅰ, PGR and G17 levels for diagnosis of early-stage and advanced gastric cancer were determined based on the receiver operator characteristic curve (ROC). Results Totally 949 cases received gastroscopy and 649 cases received pathological biopsy, including 239 cases of non-atrophic gastritis, 500 cases of atrophic gastritis, 197 cases of peptic ulcer, 5 cases of early-stage gastric cancer, and 8 cases of advanced gastric cancer. The level of serum PG Ⅰ in the early-stage gastric cancer group (70.00±12.35 μg/L) and advanced gastric cancer group (38.39±2.77 μg/L) was significant lower than that in the non-atrophic gastritis group (103.89±37.45 μg/L, both P<0.05), and the value of early-stage gastric cancer group was obviously higher than that of advanced gastric cancer group (P<0.05). The PGR of the early-stage gastric cancer group (3.74±1.40) and the advanced gastric cancer group (2.05±0.59) was significantly lower than that in the non-atrophic gastritis group (9.18±4.10, both P<0.05), and the value of early-stage gastric cancer group was significantly higher than that of the advanced gastric cancer group (P<0.05). The level of serum G17 in the early gastric cancer group (18.03±4.52 pmol/L) and the advanced gastric cancer group (25.15±3.76 pmol/L) was significantly higher than that in the non-atrophic gastritis group (14.99±7.12 pmol/L, both P<0.05), and the level of early-stage gastric cancer group was significantly lower than that of advanced gastric cancer group (P<0.05). According to the analysis of ROC in the diagnosis of early-stage gastric cancer, the best threshold of PG Ⅰ, PGR and G17 was 71.85 μg/L, 5.04, and 15.65 pmol/L, respectively, and the corresponding sensitivity and specificity was 80.0% and 59.0%, 100.0% and 70.4%, and 80.0% and 69.3%, respectively, for PG Ⅰ, PGR and G17. The analysis of ROC in the diagnosis of advanced gastric cancer showd that the best critical value of PG Ⅰ, PGR and
{"title":"Clinical value of serological examination combined with gastroscopy for early gastric cancer screening in Qinghai high incidence areas of gastric cancer","authors":"Yingcai Ma, Yaping Wang, Zhilan Liu, Zhiyong Zhu, Xiaohong Xue, Guanghong Rong","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.003","url":null,"abstract":"Objective \u0000To evaluate the screening value of serum pepsinogen (PG) Ⅰ, pepsinogen ratio (PGR, PG Ⅰ/PG Ⅱ) and gastrin 17 (G17) levels combined with gastroscopy for early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province. \u0000 \u0000 \u0000Methods \u0000A total of 2 700 cases were identified as the appropriate age (40-69 years) target population through the questionnaire survey from 25 000 local residents in high incidence areas of gastric cancer in Qinghai Province. The serum PGⅠ, PGⅡ and G17 levels of the 2 700 target population were determined by ELISA, and PGR were calculated. And then 949 patients with abnormal levels of PG and G17 were screened out as a high-risk group of gastric cancer to receive gastroscopy and pathologic biopsy. According to the results of gastroscopy and biopsy, the patients were divided into non-atrophic gastritis group, atrophic gastritis group, peptic ulcer group, early-stage gastric cancer group, and advanced gastric cancer group. The optimal threshold and its sensitivity and specificity of serum PG Ⅰ, PGR and G17 levels for diagnosis of early-stage and advanced gastric cancer were determined based on the receiver operator characteristic curve (ROC). \u0000 \u0000 \u0000Results \u0000Totally 949 cases received gastroscopy and 649 cases received pathological biopsy, including 239 cases of non-atrophic gastritis, 500 cases of atrophic gastritis, 197 cases of peptic ulcer, 5 cases of early-stage gastric cancer, and 8 cases of advanced gastric cancer. The level of serum PG Ⅰ in the early-stage gastric cancer group (70.00±12.35 μg/L) and advanced gastric cancer group (38.39±2.77 μg/L) was significant lower than that in the non-atrophic gastritis group (103.89±37.45 μg/L, both P<0.05), and the value of early-stage gastric cancer group was obviously higher than that of advanced gastric cancer group (P<0.05). The PGR of the early-stage gastric cancer group (3.74±1.40) and the advanced gastric cancer group (2.05±0.59) was significantly lower than that in the non-atrophic gastritis group (9.18±4.10, both P<0.05), and the value of early-stage gastric cancer group was significantly higher than that of the advanced gastric cancer group (P<0.05). The level of serum G17 in the early gastric cancer group (18.03±4.52 pmol/L) and the advanced gastric cancer group (25.15±3.76 pmol/L) was significantly higher than that in the non-atrophic gastritis group (14.99±7.12 pmol/L, both P<0.05), and the level of early-stage gastric cancer group was significantly lower than that of advanced gastric cancer group (P<0.05). According to the analysis of ROC in the diagnosis of early-stage gastric cancer, the best threshold of PG Ⅰ, PGR and G17 was 71.85 μg/L, 5.04, and 15.65 pmol/L, respectively, and the corresponding sensitivity and specificity was 80.0% and 59.0%, 100.0% and 70.4%, and 80.0% and 69.3%, respectively, for PG Ⅰ, PGR and G17. The analysis of ROC in the diagnosis of advanced gastric cancer showd that the best critical value of PG Ⅰ, PGR and ","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"88-93"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49010794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.02.002
Rong-Xi Li, Huihong Zhai, J. Xing, Peng Li
Objective To investigate the clinical, endoscopic and pathological characteristics of early Barrett esophageal adenocarcinoma (BEA) and to evaluate the treatment efficacy of endoscopic submucosal dissection (ESD). Methods Data of 13 patients who were diagnosed as early BEA and treated by ESD in Beijing Friendship Hospital from November 2015 to June 2018 were retrospectively analyzed, including clinical data, endoscopic manifestations and pathological information. Results Out of 13 patients, 10 were male. One had underlying long-segment Barrett esophagus (LSBE), 6 had short-segment Barrett esophagus (SSBE), and 6 had super short-segment Barrett esophagus (less than 1 cm). Two arose from circumferential Barrett esophageal (BE) and 11 from tongue-like BE. Ten lesions were located on the right anterior side wall (12-2 o′clock) of the esophagogastric junction (EGJ), and 12 lesions were superficial type (0-Ⅱ). ESD was successfully conducted in all the patients without any complication. The en bloc and curative resection rate was 100% (13/13) and 92% (12/13), respectively. Pathology examination found 9 well-differentiated adenocarcinoma and 10 intramucosal cancer. No recurrence was detected in 11 patients during follow-up of 3.3-29.3 months. Conclusion Early BEA tends to occur in elderly male, and mostly originated from non-LSBE and tongue-like BE. Most lesions are superficial type and located on the right anterior side wall of EGJ. In pathology, most lesions are well-differentiated adenocarcinoma and limited to the mucosa. ESD is a safe and efficient treatment for BEA. Key words: Barrett esophagus; Adenocarcinoma; Clinical feature; Endoscopic feature; Pathologic feature; Endoscopic submucosal dissection
{"title":"Clinical, endoscopic and pathological features of early Barrett esophageal adenocarcinoma and its treatment efficacy by endoscopic submucosal dissection","authors":"Rong-Xi Li, Huihong Zhai, J. Xing, Peng Li","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.002","url":null,"abstract":"Objective \u0000To investigate the clinical, endoscopic and pathological characteristics of early Barrett esophageal adenocarcinoma (BEA) and to evaluate the treatment efficacy of endoscopic submucosal dissection (ESD). \u0000 \u0000 \u0000Methods \u0000Data of 13 patients who were diagnosed as early BEA and treated by ESD in Beijing Friendship Hospital from November 2015 to June 2018 were retrospectively analyzed, including clinical data, endoscopic manifestations and pathological information. \u0000 \u0000 \u0000Results \u0000Out of 13 patients, 10 were male. One had underlying long-segment Barrett esophagus (LSBE), 6 had short-segment Barrett esophagus (SSBE), and 6 had super short-segment Barrett esophagus (less than 1 cm). Two arose from circumferential Barrett esophageal (BE) and 11 from tongue-like BE. Ten lesions were located on the right anterior side wall (12-2 o′clock) of the esophagogastric junction (EGJ), and 12 lesions were superficial type (0-Ⅱ). ESD was successfully conducted in all the patients without any complication. The en bloc and curative resection rate was 100% (13/13) and 92% (12/13), respectively. Pathology examination found 9 well-differentiated adenocarcinoma and 10 intramucosal cancer. No recurrence was detected in 11 patients during follow-up of 3.3-29.3 months. \u0000 \u0000 \u0000Conclusion \u0000Early BEA tends to occur in elderly male, and mostly originated from non-LSBE and tongue-like BE. Most lesions are superficial type and located on the right anterior side wall of EGJ. In pathology, most lesions are well-differentiated adenocarcinoma and limited to the mucosa. ESD is a safe and efficient treatment for BEA. \u0000 \u0000 \u0000Key words: \u0000Barrett esophagus; Adenocarcinoma; Clinical feature; Endoscopic feature; Pathologic feature; Endoscopic submucosal dissection","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47346695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.02.009
Wen-bin Ran, Jielin Li, J. Gan, Yanglin Pan, Xuegang Guo
Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for patients with liver cirrhosis combined with biliopancreatic diseases. Methods Data of 99 patients with liver cirrhosis combined with biliopancreatic diseases who received ERCP at Xijing Digestive Hospital from November 2008 to December 2017 for the first time were retrospectively studied. Success rate of ERCP and incidence of complications were analyzed. Results The 99 cases of liver cirrhosis were mainly caused by hepatitis B virus infection (40.4%, 40/99) and unknown reasons (30.3%, 30/99), and the mean model for end-stage liver disease score was 15.4±5.3. The common bile duct stones and bile duct stricture were the most common biliopancreatic diseases, accounting for 49.5% (49/99) and 33.3% (33/99), respectively. The success rate of ERCP was 100.0%(99/99). The total postoperative complication incidence was 14.1% (14/99), among which liver cirrhosis-related complications was 3.0% (3/99); ERCP-related complications was 11.1% (11/99), including 9.1% (9/99) biliary tract infection, and 2.0% (2/99) delayed bleeding. No post-ERCP pancreatitis, perforation or death occurred. Conclusion ERCP is safe and effective for liver cirrhosis combined with biliopancreatic diseases. Key words: Liver cirrhosis; Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Postoperative complications; Biliary stricture
{"title":"Therapeutic value of endoscopic retrograde cholangiopancreatography for liver cirrhosis combined with biliopancreatic diseases","authors":"Wen-bin Ran, Jielin Li, J. Gan, Yanglin Pan, Xuegang Guo","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.02.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.02.009","url":null,"abstract":"Objective \u0000To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for patients with liver cirrhosis combined with biliopancreatic diseases. \u0000 \u0000 \u0000Methods \u0000Data of 99 patients with liver cirrhosis combined with biliopancreatic diseases who received ERCP at Xijing Digestive Hospital from November 2008 to December 2017 for the first time were retrospectively studied. Success rate of ERCP and incidence of complications were analyzed. \u0000 \u0000 \u0000Results \u0000The 99 cases of liver cirrhosis were mainly caused by hepatitis B virus infection (40.4%, 40/99) and unknown reasons (30.3%, 30/99), and the mean model for end-stage liver disease score was 15.4±5.3. The common bile duct stones and bile duct stricture were the most common biliopancreatic diseases, accounting for 49.5% (49/99) and 33.3% (33/99), respectively. The success rate of ERCP was 100.0%(99/99). The total postoperative complication incidence was 14.1% (14/99), among which liver cirrhosis-related complications was 3.0% (3/99); ERCP-related complications was 11.1% (11/99), including 9.1% (9/99) biliary tract infection, and 2.0% (2/99) delayed bleeding. No post-ERCP pancreatitis, perforation or death occurred. \u0000 \u0000 \u0000Conclusion \u0000ERCP is safe and effective for liver cirrhosis combined with biliopancreatic diseases. \u0000 \u0000 \u0000Key words: \u0000Liver cirrhosis; Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Postoperative complications; Biliary stricture","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"121-124"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69818999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.01.005
Min Chen, Yu-ling Yao, Xiaoqi Zhang, Lei Wang, Ying Lyu, X. Zou, T. Ling
Objective To investigate the prerequisites for endoscopists, who were chosen to receive endoscopic submucosal dissection (ESD) training. Methods A total of 41 trainees, who attended ESD training in the endoscopic center of Nanjing Drum Tower Hospital from January 2017 to June 2018 were enrolled in the study. The general information of the subjects were collected, including name, age, gender, the number of gastroscopy and colonoscopy independently performed before training, the independent usage of narrow band image (NBI), magnifying endoscopy (ME), endoscopic mucosal resection (EMR), ESD, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) before training. And then every trainee independently finished four in vitro experiments of pig esophagus ESD. The specimen area and operating time were recorded, and the operating speed was calculated. Linear regression analysis was used to analyze the affecting factors of operating speed of ESD. Results Among the 41 trainees, 26 were male and 15 were female, with age of 36.07±4.44 years. The specimen area, operating time and operating speed of pig esophagus ESD was 4.67±1.61 cm2, 24.54±5.97 min, and 0.19±0.05 cm2/min, respectively. Univariate linear regression analysis showed that the number of gastroscopy (n>5 000, P=0.001 8) and colonoscopy (n>3 000, P=0.000 1), the detect number of early cancer in upper digestive tract (n>30, P=0.000 3) and lower digestive tract (n>10, P=0.019 7), and the usage of ME (P=0.047 8), EMR (P=0.019 6) and ESD (P=0.000 3) before training were statistically correlated with the operating speed of ESD. Carrying out NBI (P=0.532 9), ERCP (P=0.500 7) and EUS (P=0.766 8) before training were not statistically correlated with the operating speed of ESD. The operating speed of ESD was negatively correlated with the perforation rate of ESD (P<0.000 1). According to multivariable linear regression model, the usage of EMR (P=0.029) and ESD (P=0.034) were statistically correlated with the operating speed of ESD. Conclusion ESD trainees, who have the number of gastroscopy more than 5 000, the number of colonoscopy more than 3 000, the detect number of early cancer more than 30 in upper digestive tract and 10 in lower digestive tract, and the usage of ME, EMR and ESD before training, can get a better training effect. The study provides a theoretical basis for selecting appropriate ESD trainees. Key words: Animal models; In vitro; Endoscopic submucosal dissection; Operating training; Dissection time
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