AIM:Achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES)has abnormally high resting pressure and incomplete relaxation with swallowing.Pneumatic dilatation ...AIM:Achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES)has abnormally high resting pressure and incomplete relaxation with swallowing.Pneumatic dilatation remains the first choice of treatment.The aims of this study were to determine the long term clinical outcome of treating achatasia initially with pneumatic dilatation and usefulness of pneumatic dilatation technique under endoscopic observation without fluoroscopy. METHODS:A total of 65 dilatations were performed in 43 patients with achalasia[23 males and 20 females,the mean age was 43 years(range,19-73)].All patients underwent an initial dilatation by inflating a 30 mm balloon to 15 psi under endoscopic control.The need for subsequent dilatation was based on symptom assessment.A 3.5 cm balloon was used for repeat procedures. RESULTS:The 30 mm balloon achieved a satisfactory result in 24 patients(54%)and the 35 mm ballon in 78% of the remainder(14/18).Esophageal perforation as a short-term complication was observed in one patient(2.3%).The only late complication encountered was gastroesophageal reflux in 2(4%)patients with a good response to dilatation.The mean follow-up period was 2.4 years(6 mo-5 years).Of the patients studied,38(88%)were relieved of their symptoms after only one or two sessions.Five patients were referred for surgery(one for esophageal perforation and four for persistent or recurrent symptoms).Among the patients whose follow up information was available,the percentage of patients in remission was 79%(19/24)at 1 year and 54%(7/13)at 5 years. CONCLUSION:Performing balloon dilatation under endoscopic observation as an outpatient procedure is simple,safe and efficacious for treating patients with achalasia and referral of surgical myotomy should be considered for patients who do not respond to medical therapy or individuals that do not desire pneumatic dilatations.展开更多
Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because i...Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography （CT） are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.展开更多
Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior ureth...Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior urethral stricture Methods： From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy （DVIU）. Patient de- mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results： The operation time was much shorter for the HPBD procedure than for the DVIU （（13.19±2.68） min vs. （18.44±3.29） min, P〈0.01）. For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection （UTI） were less frequently encountered than those in DVIU （urethral bleeding： 2/31 vs. 8/25, P=0.017; UTI： 1/31 vs. 6/25 P=0.037）. The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups （P=-0.21, hazard ratio （HR）=0.65, 95% confidence interval （CI）： 0.34 to 1.26）. However, there was a significantly higher stricture-free survival in the HPBD group at 12 months （P=-0.02, HR=0.35, 95% CI： 0.14 to 0.87）, which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions： HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.展开更多
文摘AIM:Achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES)has abnormally high resting pressure and incomplete relaxation with swallowing.Pneumatic dilatation remains the first choice of treatment.The aims of this study were to determine the long term clinical outcome of treating achatasia initially with pneumatic dilatation and usefulness of pneumatic dilatation technique under endoscopic observation without fluoroscopy. METHODS:A total of 65 dilatations were performed in 43 patients with achalasia[23 males and 20 females,the mean age was 43 years(range,19-73)].All patients underwent an initial dilatation by inflating a 30 mm balloon to 15 psi under endoscopic control.The need for subsequent dilatation was based on symptom assessment.A 3.5 cm balloon was used for repeat procedures. RESULTS:The 30 mm balloon achieved a satisfactory result in 24 patients(54%)and the 35 mm ballon in 78% of the remainder(14/18).Esophageal perforation as a short-term complication was observed in one patient(2.3%).The only late complication encountered was gastroesophageal reflux in 2(4%)patients with a good response to dilatation.The mean follow-up period was 2.4 years(6 mo-5 years).Of the patients studied,38(88%)were relieved of their symptoms after only one or two sessions.Five patients were referred for surgery(one for esophageal perforation and four for persistent or recurrent symptoms).Among the patients whose follow up information was available,the percentage of patients in remission was 79%(19/24)at 1 year and 54%(7/13)at 5 years. CONCLUSION:Performing balloon dilatation under endoscopic observation as an outpatient procedure is simple,safe and efficacious for treating patients with achalasia and referral of surgical myotomy should be considered for patients who do not respond to medical therapy or individuals that do not desire pneumatic dilatations.
文摘Intestinal lymphangiectasia （IL） is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography （CT） are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.
基金Project supported by the Medical Health Program of Zhejiang Province(No.2014ZDA011)the Zhejiang Provincial Natural Science Foundation of China(No.2015KYB222)
文摘Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior urethral stricture Methods： From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy （DVIU）. Patient de- mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results： The operation time was much shorter for the HPBD procedure than for the DVIU （（13.19±2.68） min vs. （18.44±3.29） min, P〈0.01）. For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection （UTI） were less frequently encountered than those in DVIU （urethral bleeding： 2/31 vs. 8/25, P=0.017; UTI： 1/31 vs. 6/25 P=0.037）. The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups （P=-0.21, hazard ratio （HR）=0.65, 95% confidence interval （CI）： 0.34 to 1.26）. However, there was a significantly higher stricture-free survival in the HPBD group at 12 months （P=-0.02, HR=0.35, 95% CI： 0.14 to 0.87）, which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions： HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.
