AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also asses...AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also assessed.METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUSGBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. TheSEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient(8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d(78-1492).CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.展开更多
BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been identified.Additionally, the appropriate interval for endoscop...BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been identified.Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established.AIM To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval.METHODS Three hundred and sixty patients(1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses.RESULTS Local recurrence was observed in 31 of 360(8.6%) patients [31 of 1412(2.2%)lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection torecurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces(3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05).CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulati...Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.展开更多
BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinic...BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.展开更多
To the Editor:Endoscopic retrograde cholangiopancreatography(ERCP)causes adverse events;post-ERCP pancreatitis(PEP)is one of the frequent adverse events.Recently,the efficacy of rectal administration of non-steroidal ...To the Editor:Endoscopic retrograde cholangiopancreatography(ERCP)causes adverse events;post-ERCP pancreatitis(PEP)is one of the frequent adverse events.Recently,the efficacy of rectal administration of non-steroidal anti-inflammatory drugs(NSAIDs)before or after ERCP for PEP prevention has been reported[1].展开更多
BACKGROUND Preparation for colon capsule endoscopy(CCE)requires a large liquid laxative volume for capsule excretion,which compromises the procedure's tolerability.AIM To assess the safety and utility of castor oi...BACKGROUND Preparation for colon capsule endoscopy(CCE)requires a large liquid laxative volume for capsule excretion,which compromises the procedure's tolerability.AIM To assess the safety and utility of castor oil-boosted bowel preparation.METHODS This prospective cohort study including 20 patients(age range,16-80 years;six men and 14 women)suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019.All patients underwent CCE because of the following inclusion criteria:previous incomplete colonoscopy in other facility(n=20),history of abdominal surgery(n=7),or organ abnormalities such as multiple diverticulum(n=4)and adhesion after surgery(n=6).The exclusion criteria were as follows:Dysphagia,history of allergic reactions to the drugs used in this study(magnesium citrate,polyethylene glycol,metoclopramide,and castor oil),possibility of pregnancy,possibility of bowel obstruction or stenosis based on symptoms,or scheduled magnetic resonance imaging within 2 wk after CCE.The primary outcome was the capsule excretion rate within the battery life,as evaluated by the total large bowel observation rate,large bowel transit time,and bowel creasing level using a fivegrade scale in different colorectal segments.The secondary outcomes were complications,colorectal lesion detection rates,and patients’tolerability.RESULTS The castor oil-based regimen was implemented in 17 patients.Three patients cancelled CCE because they could tolerate castor oil,but not liquid laxatives.The capsule excretion rate within the battery life was 88%(15/17).The mean large bowel transit time was 236 min.Approximately 70%of patients had satisfactory colon cleansing levels.CCE detected colon polyps(14/17,82%)and colonic diverticulum(4/12,33%).The sensitivity,specificity,and diagnostic accuracy rates for detecting colorectal polyps(size≥6 mm)were 76.9%,75.0%,and 76.4%,respectively.The sensitivity,specificity,and diagnostic accuracy rates for detection of diverticulum were 100%each.Twelve patients(71%)rated CCE as more than“good”,confirming the new regimen’s tolerability.No serious adverse events occurred during this study.CONCLUSION The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.展开更多
基金Supported by the Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy No.22590764 and No.25461035
文摘AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also assessed.METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUSGBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. TheSEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient(8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d(78-1492).CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.
文摘BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been identified.Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established.AIM To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval.METHODS Three hundred and sixty patients(1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses.RESULTS Local recurrence was observed in 31 of 360(8.6%) patients [31 of 1412(2.2%)lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection torecurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces(3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05).CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.
文摘Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
文摘BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.
文摘To the Editor:Endoscopic retrograde cholangiopancreatography(ERCP)causes adverse events;post-ERCP pancreatitis(PEP)is one of the frequent adverse events.Recently,the efficacy of rectal administration of non-steroidal anti-inflammatory drugs(NSAIDs)before or after ERCP for PEP prevention has been reported[1].
文摘BACKGROUND Preparation for colon capsule endoscopy(CCE)requires a large liquid laxative volume for capsule excretion,which compromises the procedure's tolerability.AIM To assess the safety and utility of castor oil-boosted bowel preparation.METHODS This prospective cohort study including 20 patients(age range,16-80 years;six men and 14 women)suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019.All patients underwent CCE because of the following inclusion criteria:previous incomplete colonoscopy in other facility(n=20),history of abdominal surgery(n=7),or organ abnormalities such as multiple diverticulum(n=4)and adhesion after surgery(n=6).The exclusion criteria were as follows:Dysphagia,history of allergic reactions to the drugs used in this study(magnesium citrate,polyethylene glycol,metoclopramide,and castor oil),possibility of pregnancy,possibility of bowel obstruction or stenosis based on symptoms,or scheduled magnetic resonance imaging within 2 wk after CCE.The primary outcome was the capsule excretion rate within the battery life,as evaluated by the total large bowel observation rate,large bowel transit time,and bowel creasing level using a fivegrade scale in different colorectal segments.The secondary outcomes were complications,colorectal lesion detection rates,and patients’tolerability.RESULTS The castor oil-based regimen was implemented in 17 patients.Three patients cancelled CCE because they could tolerate castor oil,but not liquid laxatives.The capsule excretion rate within the battery life was 88%(15/17).The mean large bowel transit time was 236 min.Approximately 70%of patients had satisfactory colon cleansing levels.CCE detected colon polyps(14/17,82%)and colonic diverticulum(4/12,33%).The sensitivity,specificity,and diagnostic accuracy rates for detecting colorectal polyps(size≥6 mm)were 76.9%,75.0%,and 76.4%,respectively.The sensitivity,specificity,and diagnostic accuracy rates for detection of diverticulum were 100%each.Twelve patients(71%)rated CCE as more than“good”,confirming the new regimen’s tolerability.No serious adverse events occurred during this study.CONCLUSION The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.
