胃镜辅助下放置空肠营养管的方法

目的:探讨内镜下放置空肠营养管的方法。方法:给148例病人放置空肠营养管,116例病人在胃镜下用异物钳钳夹胃腔内空肠营养管,推送胃镜将其送至Treitz韧带以下。32例经鼻超细胃镜放置导丝后,再经导丝放入空肠营养管。结果:两种空肠营养管放置成功率均为100%,其中鼻肠管126例,三腔鼻肠管22例。两组均无严重并发症,1例病人置管后出现血淀粉酶升高。结论:两种空肠营养管放置的方法成功率均高,不良反应小,操作简单安全。

主动插进内镜操作方法的临床应用研究

目的缩短镜端通过咽部的时间，减轻镜端通过咽部时对咽部的刺激；提高镜端通过咽部进入食管的成功率．方法接受插镜的患者，术前常规准备后，取仰卧位，轻抬下颌，使口轴线与咽轴线的夹角在100％±10％度范围内，然后头颈尽力向左旋转60°～90°，喉头被拉向左前上方，腹肌放松，保持平静呼吸．术者以单人插镜手法将镜端从口垫中插至喉咽部可看到松弛的食管上口与镜端在一条线上，继续主动插进内镜即可顺利准确插入食管，进镜深度距门齿25cm～30cm时，喉患者换成左侧卧位完成内镜检查或治疗．结果我们用主动插进内镜的方法对内镜检查1806例次，男845次，女961例次，9岁～86岁，其中12岁以下10例，伴有吞咽障碍6例，一次插镜成功1801例次，有5例因头颈旋转不到位第一次未插入，其中2例重新调整头位后第二次插镜成功，3例因颈椎旋转受限（＜50°）换成常规插镜法完成内镜检查，插镜成功率99．83％，有5例术后吐痰中带少量血丝，未见其他并发症．结论主动插进内镜的操作方法，改变了受检者喉咽腔的形态及咽部肌肉的弛张状态，使喉咽腔由前后扁平漏斗状，被扭拉成近似例圆锥状，进镜准确无误，提高了插镜成功率；环咽肌松驰，镜端通过咽部阻力明显减小，减轻了插镜时患者的不良反应。

小儿腹型过敏性紫癜胃镜早期诊断及甲泼尼龙琥珀酸钠治疗疗效观察

过敏性紫癜（HSP）是一种主要累及毛细血管的变态反应性疾病，是儿童时期血管炎综合征最常见的类型。17岁以下儿童中平均发病率为13～20／10万，临床常见皮肤、胃肠道、关节、肾脏等脏器受累。18％～52％HSP患儿发生消化道出血，严重危及生命，以腹痛、恶心、呕吐及便血或大便潜血阳性为表现的腹型过敏性紫癜，因临床缺少特异性，

胃镜下活体组织检查与外科手术病理诊断胃癌的价值对比分析

目的将胃镜下活体组织检查方法和外科手术病理检查方法对胃癌疾病进行诊断,比较两种方法的诊断价值。方法选取该次研究病例的周期为2019年6月—2020年6月期间,共随机选取了100例胃癌患者作为研究对象,100例患者的一般资料等均相同,利用回顾性分析,分别通过两种方法进行检查,将采用胃镜下活体组织检查方法进行检查的患者收纳入活体检查组(n=50),将采用外科手术病理方法进行检查的患者收纳入病理检查组(n=50),比较两组患者的检查组织的类型情况,包括:腺癌、印戎细胞癌、其他肿瘤,比较两种检查方式的病型分型状况,包括:浸润型、溃疡型、局限溃疡型、肿块型,比较两种方法对于分化不良型以及分化型的检查结果。结果活体检查组结果表明:腺癌率为68.0%(34/50)、印戎细胞癌率为76.0%(38/50)、其他肿瘤为2.0%(1/50),病理检查组结果表明:腺癌率为20.0%(10/50)、印戎细胞癌率为18.0%(9/50)、其他肿瘤为10.0%(5/50),两组比较,除其他肿瘤率外,差异有统计学意义(χ^(2)=23.377、33.762,P<0.05);活体检查组结果表明:浸润型率为2.0%(1/50)、溃疡型率为26.0%(13/50)、局限溃疡型率为10.0%(5/50)、肿块型率为30.0%(15/50),病理检查结果表明:浸润型率为14.0%(7/50)、溃疡型率为28.0%(14/50)、局限溃疡型率为22.2%(11/50)、肿块型率为30.0%(15/50),除浸润型外差异无统计学意义(P>0.05),浸润型差异有统计学意义(χ^(2)=3.396,P<0.05)。活体检查组结果对于分化不良型的检出概率高于病理检查,对于分化型的检出概率低于病理检查,差异有统计学意义(χ^(2)=17.704,P<0.05)。结论胃癌疾病通过胃镜下活体组织检查方法进行检查,可以得到优良的检查结果,如果需要对胃癌疾病全面评估,可以将外科手术病理诊断方法与胃镜下活体组织检查方法进行联合诊断,诊断价值高。

意识指数用于无痛胃镜中麻醉用药的指导意义

【目的】探讨意识指数（IOC）应用于无痛胃镜检查对麻醉用药的指导意义。【方法】选取本院拟进行无痛胃镜检查的80例患者采用随机数字表法分为IOC组和常规组各40例，两组均给予芬太尼1μg／kg、丙泊酚2mg／kg后，IOC组根据10C监测值（45-60）给予丙泊酚维持量调节，常规组术中根据一般监测指标和患者体征进行丙泊酚用量调节，比较两组患者麻醉诱导前（T1）、麻醉诱导后（T2）、胃镜插入即刻（T3）、苏醒时（T4）时间点的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）的波动及麻醉情况。【结果】IOC组和常规组的丙泊酚诱导用量、手术时间比较差异无显著性（P〉0．05），IOC组患者的追加丙泊酚次数、丙泊酚总用量、苏醒时间均显著的低于常规组（P〈0．05）；T1、T2、T4时刻IOC组和常规组患者的HR、MAP及SpO2监测值相比较差异均无显著性（P〉0．05）；在T3时刻IOC组患者的HR、MAP值显著高于常规组（P〈0．05）；IOC组患者发生体动反应、恶心呕吐、心动过缓的发生率显著的低于常规组（P〈0．05）；两组呼吸抑制、头晕的发生率相比较差异无显著性（P〉0．05）。【结论】IOC应用于无痛胃镜检查有利于更加准确的对患者应用麻醉药物用量，可以有效的达到麻醉效果并且减少不良反应的发生。

肠-胃胆汁返流放射性核素显像与胃镜检查的比较

本文对24例经胃镜检查有肠一胃胆汁返流者,再用ce 9meeTe—EHIDA放射性核素肝胆显像,进一步观察有无胆汁返流存在。结果:17例未做胃部手术经胃镜检查为胆汁返流阳性者,放射性核素检查仅1例阳性,7例行胃大部切除术后胃镜检查为胆汁返流阳性者,经核素显像复核4例阳性。结果显示:胃镜检查肠-胃胆汁、返流的假阳性率高达79.2%(19/24)。

食管上段胃粘膜异位症30例临床分析

目的:探讨食管上段胃粘膜异位症的临床及病理特点和诊治方法。方法:分析30例食管上段胃粘膜异位症患者的临床、病理以及幽门螺杆菌(HP)感染情况,其中6例采用抑酸、抗幽门螺杆菌治疗,24例采用内镜下行氩离子凝固术(APC)根治性治疗。结果:主要临床表现为吞咽困难、胸骨后痛、咽喉部症状,内镜下表现为呈玫瑰-橙红色天鹅绒样斑块,酷似胃粘膜,与周围的灰白色正常食管粘膜的界限清晰。病理检查显示病变由含有主细胞和壁细胞为主的胃上皮组织组成。氩离子凝固术(APC)根治性治疗治愈率91.67%。结论:食管上段胃粘膜异位症是一种先天性胚胎残余病变,临床表现为胃粘膜酸分泌而产生的症状,诊断主要依据内镜下特征性表现的酷似胃粘膜的玫瑰-橙红色天鹅绒样斑块,病理活检显示病变由含有主细胞和壁细胞为主的胃上皮组织组成。治疗采用内镜下行氩离子凝固术(APC)根治性治疗疗效较好。

Public Screening for Early Carcinoma of Gastric Cardia: Rule of Carcinogenetic Development Observed by Endoscopy

Objective： To study the rule of development of early cancer of gastric cardia in vivo in public screening. Methods： A prospective cohort study on gastric cardiac cancer was performed in the high incidence area of cancer of esophagus and stomach in china. 106 subjects had been examined regularly by endoscopy to observe the change of mucosa in high incident area of gastric cardiac carcinoma developing at the root of gastric cardiac ridge by taking biopsy specimen. All specimens were diagnosed through normal pathological process to study the prognosis of pro-cancer lesions of gastric cardia. Results： The results of 106 subjects who had been observed for 4 years were： （1） Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. （2） Of 61 persons with chronic gastritis, 11 were observed to have gland atrophy, 4 mild atypical hyperplasia, and 2 highly atypical hyperplasia. （3） Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. （4） Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. （5） One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. （6） Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early cancer stage, and 3 turned to atypical hyperplasia. Conclusion： The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, gland atrophy, and atypical hyperplasia. （2） The early cancer and pre-cancer lesions of gastric cardia is reversible, though possessing malignant possibility.

Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy

The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.

How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers. METHODS: Only EUS studies confirmed by surgery were selected. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 × 2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specifi city, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fi xed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESULTS: Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n = 1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 hada pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to have true anatomic stage of T4 disease.

Results of gastroscope bacterial decontamination by enzymatic detergent compared to chlorhexidine

AIM： To compare the efficacy of enzymatic detergent with chlorhexidine for gastroscope bacterial decontamination. METHODS： A prospective randomized controlled study was undertaken to evaluate the ability of these 2 agents to achieve high level disinfection in a gastroscope. A total of 260 samples were collected from 5 different gastroscopes. Manual cleaning was done for 10 min with these 2 agents separately （n = 130 each）. Then all specimens underwent 2% glutaraldehyde soaking for 20 min. After 70% alcohol was rinsed, sterile normal saline was flushed into each gastroscope channel and 40 mL of sample was collected. The sample was sent for aerobic bacterial culture after membrane was filtered. A colony count greater than 200 cfu/mL was considered significant. RESULTS： The positive culture rate was 4.6% in the enzymatic detergent arm and 3.1% in the chlorhexidine arm. Pseudomonas species were the main organism detected from both groups （60%）. Multiple organisms were found from 4 specimens （enzymatic detergent arm = 1, chlorhexidine arm = 3）. CONCLUSION： The contamination rate of both types of cleaning solution is equivalent.

Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer

AIM： To evaluate the value of endoscopic ultrasono- graphy （EUS） in the preoperative TNM staging of gastric cancer. METHODS ： Forty-one patients with gastric cancer （12 early stage and 29 advanced stage） proved by esophagogastroduodenoscopy and biopsies preoperatively evaluated with EUS according to TNM （1997） classification of International Union Contrele Cancer （UICC）. Pentax EG-3630U/Hitachi EUB-525 echo endoscope with real-time ultrasound imaging linear scanning transducers （7.5 and 5.0 MHz） and Doppler information was used in the current study. EUS staging procedures for tumor depth of invasion （T stage） were performed according to the widely accepted five-layer structure of the gastric wall. All patients underwent surgery. Diagnostic accuracy of EUS for TNM staging of gastric cancer was determined by comparing preoperative EUS with subsequent postoperative histopathologic findings. RESULTS： The overall diagnostic accuracy of EUS in preoperative determination of cancer depth of invasion was 68.3% （41/28） and 83.3% （12/10）, 60% （20/12）, 100% （5/5）, 25% （4/1） for T1, T2, T3, and T4, respectively. The rates for overstaging and understaging were 24.4% （41110）, and 7.3% （4113）, respectively. EUS tended to overstage T criteria, and main reasons for overstaging were thickening of the gastric wall due to perifocal inflammatory change, and absence of serosal layer in certain areas of the stomach. The diagnostic accuracy of metastatic lymph node involvement or N staging of EUS was 100% （17/17） for NO and 41.7% （24/10） for N＋, respectively, and 66% （41127） overall.Misdiagnosing of the metastatic lymph nodes was related to the difficulty of distinguishing inflammatory lymph nodes from malignant lymph nodes, which imitate similar echo features. Predominant location and distribution of tumors in the stomach were in the antrum （20 patients）, and the lesser curvature （17 patients）, respectively. Three cases were found as surgically unresectable （T4 N＋）, and included as being correctly diagnosed by EUS. CONCLUSION： EUS is a useful diagnostic method for preoperative staging of gastric cancer for T and N criteria. However, EUS evaluation of malignant lymph nodes is still unsatisfactory.

An autopsy case of a primary aortoenteric fistula: A pitfall of the endoscopic diagnosis

A primary aortoenteric fistula (PAEF), defined as a communication between the native aorta and the gastrointestinal tract, is a rare cause of gastrointes-tinal bleeding. The preoperative diagnosis of PAEF is extremely difficult. Consequently, PAEF may cause sudden and unexpected death. We present an autopsy case of a 68-year-old man who died of massive gastro-intestinal bleeding due to a PAEF. Autopsy revealed a pinhole rupture located on the third part of the duode-nal mucosa and fistulized into the adjacent abdominal aortic aneurysm (AAA). Our case indicates that the aortoenteric fistula can result in fatal gastrointestinal bleeding. Consequently, a PAEF should be included in the differential diagnosis of gastrointestinal bleeding.

Effect of music on patients undergoing outpatient colonoscopy

AIM: To evaluate the effect of relaxing music during colonoscopy under low-dose conscious sedation, on patient satisfaction, scope insertion time and procedure duration, medication doses, and the perceived adequacy of sedation and scope insertion difficulty on the part of the endoscopist. METHODS: One hundred and sixty-seven consecutive adult outpatients presenting for routine colonoscopy under low-dose conscious sedation were randomized to undergo their procedures either with music played during the procedure or no music played. RESULTS: There were no statistical differences between the two groups in terms of meperidine dose, midazolam dose, time to reach the cecum, total procedure time, endoscopist assessment of scope insertion difficulty, endoscopist assessment of adequacy of sedation, or the pain experience of the patients during their procedure. The music group did report significantly better overall procedure satisfaction as compared to the non music group on two of our three different scales. CONCLUSION: While music does not result in shortened procedure times, lower doses of sedative medications or perceived patient pain, the patients who have music playing during their procedures report modestly greater satisfaction with their procedures.

Endoscopic resection of superficial gastrointestinal tumors

Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

Cerebral metastasis from hepatoid adenocarcinoma of the stomach

We first report a rare case of metastasis from gastric hepatoid adenocarcinoma (HAC) to cerebral parenchyma, in a 50-year-old Chinese patient. He complained of a one-month history of a paroxysm of headache in the left temple and pars parietalis accompanied with binocular caligation caligo, insensible feeling of limbs and transient anepia. Magnetic resonance (MR) imaging revealed a spherical occupying lesion in the left posterior-temple lobe which was clinically diagnosed as a metastatic tumor. Three years ago, the patient accepted total gastrectomy as he was pathologically diagnosed at gastroscopy having an adenocarcinoma. Eight months after gastrectomy, the occupying lesion in liver was detected by ultrasound and CT, and he accepted transcatheter arterial embolization. Before operation of the brain metastasis, no obvious abnormality was found in liver by ultrasound. Histopathological characteristics of the brain tumor were identical to those of stomach tumor. The growth pattern of both tumors showed solid cell nests. The tumor cells were polygonal, and had abundant eosinophilic cytoplasm and round nuclei with obvious nucleoli. Sinusoid-like blood spaces were located between nodular tumor cells. Immunohistochemistry-stained tumor cells were positive for AFP and negative for Hep-Par-1. According to these histopathological findings, both tumors were diagnosed as HAC and metastatic HAC. The patient remained alive 16 mo after tumorectomy of the cerebral metastasis. The differential diagnosis of brain metastasis from metastatic tumors should use a panel of antibodies to avoid confusing with the brain metastasis of hepatocellular carcinoma (HCC). This paper describes this rare case of metastasis from gastric hepatoid adenocarcinoma to cerebral parenchyma, and provides a review of the literature concerning its histopathological and immunohistochemical characteristics.

Expression of COX-2, PCNA, Ki-67 and p53 in gastrointestinal stromal tumors and its relationship with histopathological parameters

AIM: To investigate the expression of Cyclooxygenase-2 (COX-2), proliferating cell nuclear antigen (PCNA), Ki-67 and p53 in gastrointestinal stromal tumors (GISTs) and its relationship with histopathological parameters. METHODS: Twenty-five GISTs were examined by light microscopy and immunohistochemistry. c-kit, CD34, SMA, S-100 protein, COX-2, PCNA, Ki-67 and p53 were detected immunohistochemically and the relationship was evaluated among histopathologic parameters such as mitotic index (MI), tumor grade, tumor size, COX-2, PCNA, Ki-67 and p53. RESULTS: COX-2 protein expression was found in 19 of 25 (76%) of the tumors, and expression was noted in the cytoplasm of the tumor cells. p53 was significantly related to MI and tumor grade but no relationship was found between COX-2, proliferation markers and MI, tumor grade and tumor size. CONCLUSION: COX-2 is expressed in most GISTs and it may play an important role in the proliferation and progression of these tumors or a useful marker to identify GIST. Although immunohistochemical assessment of p53 can be used for distinguishing the risk groups of GISTs, tumor size and mitotic rate should be considered at the same time.

Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms

Endoscopic submucosal dissection (ESD) is a new endoluminal therapeutic technique involving the use of cutting devices to permit a larger resection of the tissue over the muscularis propria. The major advantages of the technique in comparison with polypectomy and endoscopic mucosal resection are controllable resection size and shape and en bloc resection of a large lesion or a lesion with ulcerative findings. This technique is applied for the endoscopic treatment of epithelial neoplasms in the gastrointestinal tract from the pharynx to the rectum. Furthermore, some carcinoids and submucosal tumors in the gastrointestinal tract are treated by ESD. To determine the indication, two aspects should be considered. The first is a little likelihood of lymph node metastasis and the second is the technical resectability. In this review, practical guidelines of ESD for the gastrointestinal neoplasms are discussed based on the evidence found in the literature.