Background and Study Aims: It is difficult to achieve complete endoscopic resection of rectal carcinoid tumors without any procedure-related complications. In this study, we evaluated the efficacy and safety of endosc...Background and Study Aims: It is difficult to achieve complete endoscopic resection of rectal carcinoid tumors without any procedure-related complications. In this study, we evaluated the efficacy and safety of endoscopic submucosal resection with double ligation (ESMR-DL) for the treatment of small rectal carcinoid tumors. Patients and Methods: Eleven rectal carcinoid tumors (in 11 patients) were resected by ESMR-DL between November 2001 and April 2004, using a conventional single-channel endoscope with an attached band-ligator device. The lesion was aspirated into the ligator device and an elastic band was placed around the base; a detachable snare was then used to ligate the stalk below the elastic band; and snare resection was performed above the elastic band. The resected specimens were examined with respect to size, histological atypia, depth of invasion, and the histological appearance of the resection margins. Results: All the lesions were excised completely without any complications. There was no tumor invasion beyond the submucosal layer and there was no evidence of atypia in any of the specimens. Tumor diameter varied from 2.0 mm to 10.0 mm (average 6.2 mm). None of the 11 specimens showed histopathological evidence of tumor involvement at the resection margins. There were no immediate or late complications (bleeding or perforation) after ESMR-DL. There was no local recurrence and there were no distant metastases in any patients during the mean follow-up period of 18 months. Conclusion: Endoscopic submucosal resection with double ligation is a useful and safe method for the treatment of small rectal carcinoid tumors.展开更多
Background:Electrohydraulic lithotripsy is a highly effective method for fragm enting biliary stones,butdirectvisual control is required.The efficacy and the safety of electrohydraulic lithotripsy without cholangiosco...Background:Electrohydraulic lithotripsy is a highly effective method for fragm enting biliary stones,butdirectvisual control is required.The efficacy and the safety of electrohydraulic lithotripsy without cholangioscopy by using a balloon catheter were evaluated in patients with bile-duct stones thatcould notbe extracted by using standard techniques. Methods: Nineteen patients with extrahepatic bile-duct stones that could not be extracted by using conventionalendoscopic methods,e.g.,mechanical lithotripsy,were selected to undergo electrohydraulic lithotripsy without peroral cholangioscopy. An electrohydraulic lithotripsy probe with a 3.0F radio-opaque tip was inserted through a balloon catheter.Electrohydraulic lithotripsy was performed under fluoroscopy until the fragm ented stone could be captured in a large basket for mechanical lithotripsy.Endoscopic removal of the fragments was attempted during the electrohydraulic lithotripsy session. Results:Stones were successfully fragm ented in 17of 19 patients.In 16patients (84.2% ),the bile duct was cleared ofallstones.A mean of 1.8endoscopic sessions was required for com plete removal.Additional mechanical lithotripsy wasperformed in 9(56.2%)of the 16patients. Minorcom plications were noted in 4patients (2hem obilia, 1pancreatitis,1cholangitis).There was no 30day mortality.Conclusions:For a selected group of patients with bile-duct stones not extractable by using standard techniques, fluoroscopically controlled electrohydraulic lithotripsy with a balloon catheter seems to be an effective method offragmentation.展开更多
文摘Background and Study Aims: It is difficult to achieve complete endoscopic resection of rectal carcinoid tumors without any procedure-related complications. In this study, we evaluated the efficacy and safety of endoscopic submucosal resection with double ligation (ESMR-DL) for the treatment of small rectal carcinoid tumors. Patients and Methods: Eleven rectal carcinoid tumors (in 11 patients) were resected by ESMR-DL between November 2001 and April 2004, using a conventional single-channel endoscope with an attached band-ligator device. The lesion was aspirated into the ligator device and an elastic band was placed around the base; a detachable snare was then used to ligate the stalk below the elastic band; and snare resection was performed above the elastic band. The resected specimens were examined with respect to size, histological atypia, depth of invasion, and the histological appearance of the resection margins. Results: All the lesions were excised completely without any complications. There was no tumor invasion beyond the submucosal layer and there was no evidence of atypia in any of the specimens. Tumor diameter varied from 2.0 mm to 10.0 mm (average 6.2 mm). None of the 11 specimens showed histopathological evidence of tumor involvement at the resection margins. There were no immediate or late complications (bleeding or perforation) after ESMR-DL. There was no local recurrence and there were no distant metastases in any patients during the mean follow-up period of 18 months. Conclusion: Endoscopic submucosal resection with double ligation is a useful and safe method for the treatment of small rectal carcinoid tumors.
文摘Background:Electrohydraulic lithotripsy is a highly effective method for fragm enting biliary stones,butdirectvisual control is required.The efficacy and the safety of electrohydraulic lithotripsy without cholangioscopy by using a balloon catheter were evaluated in patients with bile-duct stones thatcould notbe extracted by using standard techniques. Methods: Nineteen patients with extrahepatic bile-duct stones that could not be extracted by using conventionalendoscopic methods,e.g.,mechanical lithotripsy,were selected to undergo electrohydraulic lithotripsy without peroral cholangioscopy. An electrohydraulic lithotripsy probe with a 3.0F radio-opaque tip was inserted through a balloon catheter.Electrohydraulic lithotripsy was performed under fluoroscopy until the fragm ented stone could be captured in a large basket for mechanical lithotripsy.Endoscopic removal of the fragments was attempted during the electrohydraulic lithotripsy session. Results:Stones were successfully fragm ented in 17of 19 patients.In 16patients (84.2% ),the bile duct was cleared ofallstones.A mean of 1.8endoscopic sessions was required for com plete removal.Additional mechanical lithotripsy wasperformed in 9(56.2%)of the 16patients. Minorcom plications were noted in 4patients (2hem obilia, 1pancreatitis,1cholangitis).There was no 30day mortality.Conclusions:For a selected group of patients with bile-duct stones not extractable by using standard techniques, fluoroscopically controlled electrohydraulic lithotripsy with a balloon catheter seems to be an effective method offragmentation.
