Endoscopic dilation of esophageal stricture without fluoroscopy is safe and effective

AIM: Endoscopic dilation of esophageal strictures is acommonly performed procedure in the management ofdysphagia. The procedure is usually done withfluoroscopic guidance. The aim of this study was toassess the use of Tracer guide wire in conjunction withSavary-Gilliard dilators in the dilation of tightesophageal strictures without fluoroscopy.METHODS: Fifty-five patients with significant dysphagiafrom strictures due to a variety of causes were dilatedendoscopically. The procedure consisted of two parts.First, a guidewire was passed using endoscopic guidance,and then, dilation was performed without fiuoroscopy.Amodified Tracer wire was employed and was particularlyeffective in negotiating very tight esophageal strictures,in which the lumen is less than 6 mm. In general, the'Rule of Three' and '2-3 sessions in 10 days, maximumdilation up to 42 French' rules were followed. 40:1dilations in a total of 55 patients(malignant strictures 30,benign 25) in 177 sessions were carried out.RESULTS: The guide wire placement and Savary-Gilliarddilation were successfully performed without fluoroscopy,and improvement of dysphagia was achieved in allpatients. Esophageal plastic stent (out diameter 40French) was placed in five patients with malignantstricture-three of them with tracheo-esophageal fistula.CONCLUSION: Dilation using Tracer guide wire withoutfluoroscopy is safe and effective in treatment of evenvery tight esophageal strictures.

Effects of Helicobacterpyloriinfection on gastric emptying rate in patients with non-ulcer dyspepsia

AIM:The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia(NUD)remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori(Hpylori) infection and whether it was affected by eradication of the infection. METHODS:Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls(n=17).Hpylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients(n=23)received 10-day triple eradication therapy.Hpyloristatus was re-assessed by biopsy urease test four weeks later,and if eradication was confirmed,gastric emptying rate was re-evaluated. RESULTS:Thirty-three NUD patients and 17 controls were evaluated.NUD patients had significantly delayed gastric emptying compared with controls.The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM)was 0.173 and 0.224 mg/L.kg respectively (P=0.02),the mean area under plasma paracetamol concentration-time curve divided by body mass(AUC/BM) was 18.42 and 24.39 mg.min/L.kg respectively(P=0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients.The mean Cmax/BM was 0.172 and 0.177 mg/L·kg respectively (P=0.58),the mean AUC/BM was 18.43 and 18.38 mg·min/ L·kg respectively(P=0.91).Among 14 NUD patients who were initially H pylori-positive,confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L.kg before and after Hp eradication,respectively(P=0.64),the mean AUC/BM was 17.41 and 18.02 mg.min/L.kg before and after eradication,respectively(P=0.93). CONCLUSION:Although gastric emptying is delayed in NUD patients compared with controls,gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.

Abscess in the inguinal hernial sac after peritonitis surgery: A case report

In this paper, we report an extremely rare case of an abscess that developed in the inguinal hernial sac after surgery for peritonitis. A 60-year-old man underwent laparoscopic low anterior resection for rectal cancer. One day after this operation, peritoneal drainage and ileostomy were performed for rectal anastomotic leakage. Five days after the second operation, computed tomography revealed an abscess in the left inguinal hernial sac. Subsequently, hernioplasty and resection of the inflamed sac were performed.

Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps:two or more clips may be safe

Background:The resection of small colorectal polyps(≤10mm)is routine for endoscopists.However,the management of one of its main complications,namely delayed(within 14 days)postpolypectomy bleeding(DPPB),has not been clearly demonstrated.We aimed to assess the role of coloscopy in the management of DPPB from small colorectal polyps and identify the associated factors for initial hemostatic success.Methods:We conducted a retrospective study of 69 patients who developed DPPB after the removal of colorectal polyps of≤10mmand underwent hemostatic colonoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between April 2013 and June 2021.Demographics,clinical variables,and colonoscopic features were collected independently.We applied univariate and multivariate analyses to assess factors associated with initial hemostatic success.Results:General colonoscopy without oral bowel preparation was successfully performed in all the patients,with a median duration of 23.9(12.5–37.9)minutes.Among 69 patients,62(89.9%)achieved hemostasis after initial hemostatic colonoscopy and 7(10.1%)rebled 2.761.1 days after initial colonoscopic hemostasis and had rebleeding successfully controlled by one additional colonoscopy.No colonoscopy-related adverse events occurred.Multivariate analysis showed that management with at least two clips was the only independent prognostic factor for initial hemostatic success(odds ratio,0.17;95%confidence interval,0.03–0.91;P=0.04).All the patients who had at least two clips placed at the initial hemostatic colonoscopy required no further hemostatic intervention.Conclusions:Colonoscopy is a safe,effective,and not too time-consuming approach for the management of patients with DPPB of small colorectal polyps and management with the placement of at least two hemoclips may be beneficial.

Clinical application of laparoscopic spleen-preserving operation in traumatic spleen rupture

Objective： To evaluate the effect of laparoscopic spleen-preserving operation for traumatic spleen rupture. Methods ： From 1997 to 2003. 15 cases of traumatic spleen rupture were treated with laparoscopic spleen-preserving operation in our hospital. Nine cases had operation history in the middle and lower abdomen. ZT binding, electrocoagulation, fibrin and gelfoam tamping and suture repairing were used in patients with spleen rupture of grade I and grade Ⅱ. Combined hemostasis was used for spleen rupture of grade Ⅲ. Results： All patients did not need laparotomy during operation and no postoperative bleeding occurred. They were all cured and followed up for 3-12 months.Determination of immunoglobulinis after operation showed normal, and spleen ultrasonic examination, CT and body state evaluations were all satisfactory. Conclusions： Laparoscopy in the management of spleen trauma can be used in confirmed diagnosis and in determining the degree of spleen injury. For patients with stable vital signs laparoscopic spleen-preserving operation can be used. The laparoscopic spleen-preserving operation is safe in the treatment of traumatic spleen rupture.