Background &Aims: Effective colonoscopic screening for polyps, whether by optical or virtual means, requires adequate visualization of the entire colonic surface. The purpose of this study was to assess prospectiv...Background &Aims: Effective colonoscopic screening for polyps, whether by optical or virtual means, requires adequate visualization of the entire colonic surface. The purpose of this study was to assess prospectively the degree of surface coverage at 3-dimensional (3D) endoluminal computed tomography colonography (CTC) after retrograde fly-through, combined retrograde-antegrade fly-through, and review of remaining missed regions. Methods: The study group consisted of 223 asymptomatic adults (mean age, 57.8 ±7.2 y; 111 men, 112 women) undergoing primary CTC screening. CTC studies were interpreted by experienced readers using a primary 3D approach. The CTC software system that was used continually tracks the percentage of endoluminal surface visualized. The degree of coverage was assessed prospectively after retrograde and combined retrograde-antegrade navigation. The added effect of reviewing missed regions was also assessed pro- spectively. Results: The mean surface coverage after only retrograde 3D endoluminal fly-through from rectum to cecum was 76.6%±4.8%(range, 63%-92%); coverage was 80%or less in 181 (81.2%) patients. Antegrade navigation back to the rectum increased the overall coverage to 94.1%±2.3%(range, 84%-99%; P < .0001). A review of missed regions 300 mm2 or larger increased coverage to 97.9%±1.1%(range, 93%-99%; P < .0001) and added 21.4 ±11.4 seconds to the interpretation time (range, 3-67 s). Conclusions: Combined bidirectional retrograde and antegrade 3D navigation, supplemented by rapid review of missed regions, effectively covers the entire evaluable surface at CTC. Unidirectional retrograde 3D fly-through typically excludes 20%or more of the endoluminal surface, which may provide insight into potential limitations at optical colonoscopy.展开更多
AIM: To investigate the relationship between the staging by endoscopic ultrasonography (EUS) and the expression of carcinoma metastasis associated gene in the patients with gastric carcinoma. METHODS: Sixty-three pati...AIM: To investigate the relationship between the staging by endoscopic ultrasonography (EUS) and the expression of carcinoma metastasis associated gene in the patients with gastric carcinoma. METHODS: Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS. The preoperative staging of gastric cancer was measured by EUS and compared with pathologic staging and MMP-9 expression. Peripheral serum level of MMP-9 was measured with enzyme-linked immunosorbent assay (ELISA), while the expression of MMP-9 protein was tested with immunohistochemistry and hybridization in situ in the gastric carcinoma tissues. RESULTS: The total accuracy of EUS in estimating invasive depth of gastric cancer was 80.95%, while that in estimating lymphatic metastasis was 73.02%. Serum MMP-9 levels were consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue, a result closely correlated with invasive degree, staging with EUS and lymphatic metastasis in gastric cancer (P < 0.05). The total accuracy of estimating invasive depth in gastric cancer was 95.22% using both EUS and MMP-9. CONCLUSION: The MMP-9 level of preoperative serum presents the reference value for preoperative staging by EUS in the patients with gastric cancer. When serum MMP-9 level in gastric cancer is significantly high, physicians should pay closer attention to the metastasis which reaches the serosa or beyond. Combining EUS and MMP-9 improves the accuracy in deciding the invasion and metastasis in the patients with gastric carcinoma.展开更多
AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were ...AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were undergoing PEG were enrolled in our study.After eliminating 13 patients who fitted our exclusion criteria,60 patients were randomly assigned to either CO2 (30 patients) or air insufflation (30 patients) groups.PEG was performed by pull-through technique after threepoint fixation of the gastric wall to the abdominal wall using a gastropexy device.Arterial blood gas analysis was performed immediately before and after the procedure.Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension.Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum.The outcomes of PEG for 7 d postprocedure were also investigated.RESULTS:Among 30 patients each for the air and the CO2 groups,PEG could not be conducted in 2 patients of the CO2 group,thus they were excluded.Analyses of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two groups.The elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg,respectively (P = 0.408).The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P < 0.001) at 10 min and 24 h after PEG,whereas there was no significant difference in large bowel distension between the two groups.Pneumoperitoneum was observed only in the air group but not in the CO2 group (P = 0.003).There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.CONCLUSION:There was no adverse event associated with CO2 insufflation.CO2 insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.展开更多
文摘Background &Aims: Effective colonoscopic screening for polyps, whether by optical or virtual means, requires adequate visualization of the entire colonic surface. The purpose of this study was to assess prospectively the degree of surface coverage at 3-dimensional (3D) endoluminal computed tomography colonography (CTC) after retrograde fly-through, combined retrograde-antegrade fly-through, and review of remaining missed regions. Methods: The study group consisted of 223 asymptomatic adults (mean age, 57.8 ±7.2 y; 111 men, 112 women) undergoing primary CTC screening. CTC studies were interpreted by experienced readers using a primary 3D approach. The CTC software system that was used continually tracks the percentage of endoluminal surface visualized. The degree of coverage was assessed prospectively after retrograde and combined retrograde-antegrade navigation. The added effect of reviewing missed regions was also assessed pro- spectively. Results: The mean surface coverage after only retrograde 3D endoluminal fly-through from rectum to cecum was 76.6%±4.8%(range, 63%-92%); coverage was 80%or less in 181 (81.2%) patients. Antegrade navigation back to the rectum increased the overall coverage to 94.1%±2.3%(range, 84%-99%; P < .0001). A review of missed regions 300 mm2 or larger increased coverage to 97.9%±1.1%(range, 93%-99%; P < .0001) and added 21.4 ±11.4 seconds to the interpretation time (range, 3-67 s). Conclusions: Combined bidirectional retrograde and antegrade 3D navigation, supplemented by rapid review of missed regions, effectively covers the entire evaluable surface at CTC. Unidirectional retrograde 3D fly-through typically excludes 20%or more of the endoluminal surface, which may provide insight into potential limitations at optical colonoscopy.
文摘AIM: To investigate the relationship between the staging by endoscopic ultrasonography (EUS) and the expression of carcinoma metastasis associated gene in the patients with gastric carcinoma. METHODS: Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS. The preoperative staging of gastric cancer was measured by EUS and compared with pathologic staging and MMP-9 expression. Peripheral serum level of MMP-9 was measured with enzyme-linked immunosorbent assay (ELISA), while the expression of MMP-9 protein was tested with immunohistochemistry and hybridization in situ in the gastric carcinoma tissues. RESULTS: The total accuracy of EUS in estimating invasive depth of gastric cancer was 80.95%, while that in estimating lymphatic metastasis was 73.02%. Serum MMP-9 levels were consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue, a result closely correlated with invasive degree, staging with EUS and lymphatic metastasis in gastric cancer (P < 0.05). The total accuracy of estimating invasive depth in gastric cancer was 95.22% using both EUS and MMP-9. CONCLUSION: The MMP-9 level of preoperative serum presents the reference value for preoperative staging by EUS in the patients with gastric cancer. When serum MMP-9 level in gastric cancer is significantly high, physicians should pay closer attention to the metastasis which reaches the serosa or beyond. Combining EUS and MMP-9 improves the accuracy in deciding the invasion and metastasis in the patients with gastric carcinoma.
文摘AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were undergoing PEG were enrolled in our study.After eliminating 13 patients who fitted our exclusion criteria,60 patients were randomly assigned to either CO2 (30 patients) or air insufflation (30 patients) groups.PEG was performed by pull-through technique after threepoint fixation of the gastric wall to the abdominal wall using a gastropexy device.Arterial blood gas analysis was performed immediately before and after the procedure.Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension.Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum.The outcomes of PEG for 7 d postprocedure were also investigated.RESULTS:Among 30 patients each for the air and the CO2 groups,PEG could not be conducted in 2 patients of the CO2 group,thus they were excluded.Analyses of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two groups.The elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg,respectively (P = 0.408).The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P < 0.001) at 10 min and 24 h after PEG,whereas there was no significant difference in large bowel distension between the two groups.Pneumoperitoneum was observed only in the air group but not in the CO2 group (P = 0.003).There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.CONCLUSION:There was no adverse event associated with CO2 insufflation.CO2 insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.
