Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatment...Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sclerotherapy (EIS), and endoscopic variceal ligation (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow- up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients’ quality of life. Recently, we have performed EVL at 2-mo (bimonthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment.展开更多
Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as cu...Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.展开更多
Prevention of late complications after large endoscopic resection is inefficient with current methods.Endoscopic shielding,as a simple and safe technique,has been proposed to improve the incidence of these events.Diff...Prevention of late complications after large endoscopic resection is inefficient with current methods.Endoscopic shielding,as a simple and safe technique,has been proposed to improve the incidence of these events.Different methods,sheets or hydrogels,have showed proven efficacy in the prevention of late bleeding and perforation,as well as the improvement of tissue repair,in experimental models and in clinical practice.展开更多
Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occ...Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018.Results:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours.Abdominal pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms.Endoscopic treatment often fails and surgery is effective when performed early.展开更多
文摘Bleeding from esophageal varices (EVs) is a catastrophic complication of chronic liver disease. Many years ago, surgical procedures such as esophageal transection or distal splenorenal shunting were the only treatments for EVs. In the 1970s, interventional radiology procedures such as transportal obliteration, left gastric artery embolization, and partial splenic artery embolization were introduced, improving the survival of patients with bleeding EVs. In the 1980s, endoscopic treatment, endoscopic injection sclerotherapy (EIS), and endoscopic variceal ligation (EVL), further contributed to improved survival. We combined IVR with endoscopic treatment or EIS with EVL. Most patients with EVs treated endoscopically required follow- up treatment for recurrent varices. Proper management of recurrent EVs can significantly improve patients’ quality of life. Recently, we have performed EVL at 2-mo (bimonthly) intervals for the management of EVs. Longer intervals between treatment sessions resulted in a higher rate of total eradication and lower rates of recurrence and additional treatment.
基金Supported by The fund of National Natural Science Foundation Financial of China,No. 81072913
文摘Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.
文摘Prevention of late complications after large endoscopic resection is inefficient with current methods.Endoscopic shielding,as a simple and safe technique,has been proposed to improve the incidence of these events.Different methods,sheets or hydrogels,have showed proven efficacy in the prevention of late bleeding and perforation,as well as the improvement of tissue repair,in experimental models and in clinical practice.
基金No source of funding has been declared by the authors.The guidelines of the PRISMA 2009 statement were adopted.
文摘Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018.Results:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours.Abdominal pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms.Endoscopic treatment often fails and surgery is effective when performed early.
