自扩张金属支架治疗恶性食道狭窄及食道气管瘘

本文综述了自扩张支架的构造、食道内置入技术、术后护理、并发症、适应症及其优缺点。

基于迁移学习的食道癌影像识别研究

针对食道癌影像在深度学习中因为数据集小、数据不平衡而识别效果不佳等问题,提出一种基于AlexNet神经网络模型的迁移学习识别方法。首先对下载好的食道癌数据集进行相应的数据增强和预处理作为目标样本备用,接着挑选大量标签完整有关联的ImageNet图像对AlexNet网络进行训练,将训练好的AlexNet网络有效的特征提取层进行冻结,对未冻结的替换层进行符合目标样本分类任务的参数调整和结构优化,然后将目标样本放入完成迁移学习的AlexNet网络中进行训练。最后将目标样本直接放入传统的AlexNet、GooLeNet、ResNet神经网络中直接训练,并与进行迁移学习以后的AlexNet模型进行结果比较。结果表明基于迁移学习的AlexNet模型识别率明显高于传统的AlexNet神经网络模型,验证了迁移学习的可行性。

Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis

AIM： To report 13 patients with benign esophagea stenosis treated with the biodegradable stent. METHODS： We developed a Ultraflex-type stent by knitting poly-/-lactic acid rnonofilaments. RESULTS： Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the preventive placement of biodegradable stents for postendoscopic mucosal dissection （ESD） stenosis. The preventive placement was performed within 2 to 3 d after ESD. In 10 of the 13 cases, spontaneous migration of the stents occurred between 10 to 21 d after placement. In these cases, the migrated stents were excreted with the feces, and no obstructive complications were experienced. In 3 cases, the stents remained at the proper location on d 21 after placement. No symptoms of re-stenosis were observed within the follow-up period of 7 mo to 2 years. Further treatment with balloon dilatation or replacement of the biodegradable stent was not required. CONCLUSION： Biodegradable stents were useful for the treatment of benign esophageal stenosis, particularly for the prevention of post-ESD stenosis.

Esophageal ulceration complicating doxycycline therapy

AIM;TO report present state of iatrogenic drug-induced esophageal injury(DIEI)induced by medications in a private clinic. METHODS:Iatrogenic drug-induced esophageal injury (DIEI)induced by medications has been more frequently reported.In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population(median age 29 years). RESULTS:The most frequent presenting symptoms were odynophagia,retrosternal burning pain and dysphagia(94 %, 75 % and 56 %,respectively).The diagnosis was according to medical history and confirmed by endoscopy in all patients. Beside withdrawal of doxycycline,when feasible,all patients were treated with a proton-pump inhibitor(PPI)and a prokinetic.Thirty patients who reported to the clinic after treatment were improved within 1-7(median 1.7)days. CONCLUSION:Esophageal ulceration has to be suspected in younger patients with odynophagia,retrosternal burning pain and/or dysphagia during the treatment with doxycycline.

A new approach to endoscopic treatment of tumors of the esophagogastric junction with individually designed self-expanding metal stents

The incidence of adenocarcinoma of the esophago-gastric junction is constantly increasing. Curative treatment is no longer possible at the time of diagnosis in more than 50% of patients with esophageal carcinoma,and palliative treatment focusing on eliminating dysphagia is required. Endoscopic therapy with stent implantation is an established method of achieving this. It can be carried out quickly,with a low rate of early complications,and leads to fast symptomatic improvement,assessed using the dysphagia score. The relatively high rate of late complications such as stent migration,hemorrhage,and gastroesophageal mucosal prolapse has led to recent debate on the role of metal stents in palliative therapy. We present here a new type of stent design for transcardial application,which is intended to prevent bleeding due to mechanical mucosal lesions caused by the distal end of the stent extending into the stomach. The further intention of this case report is to force the discussion on individually designed nitinol stents in special anatomic conditions.

Acute esophageal necrosis and liver pathology,a rare combination

Acute esophageal necrosis (AEN) or 'black esophagus' is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe a case of 'black esophagus', first of its kind, in the setting of liver cirrhosis and hepatic encephalopathy.

Heterogeneity of endoscopy negative heartburn:Epidemiology and natural history

It has now become clear that only about 40% or less of patients with heartburn and/or regurgitation have esophagitis, and that the majority of them lack visible distal esophageal mucosa breaks. These subjects are referred to as non-erosive gastroesophageal reflux disease (NERD) patients. It has been estimated that in the Western world at least one tenth of the general population has at least weekly heartburn. This proportion seems to be lower in Asia, while prevalence is rapidly increasing. Although it would be extremely useful to have prospective information regarding the fate of such patients, the natural history of NERD is largely unknown, and very few studies in the literature have addressed this issue. These studies are for the greater part old, not well conducted, and suffer from methodological drawbacks including ill-defined entry criteria. However, a review of these studies indicates that a consistent minority of NERD patients may develop erosive disease at an approximate rate of about 10% per year.

The Relationship between a Cohort Endoscopic Screening of 15,000 Subjects and the Death of Patients with Esophageal and Gastric Cancers in High-Risk Areas

OBJECTIVE Ci-xian County is located in the north of Chinaand is a high-risk area for esophageal cancer(EC).In 2004,theincidence rate of EC in the county was 127/100,000 and 93/100,000in the male and female population,respectively,and that ofgastric cancer(GC)was 72/100,000 and 36/100,000.Since 2001 acohort screening,supported by a special national fund,utilizingendoscopic examination with iodine staining for the targetpopulation at the age ranging from 40 to 69 years was carried out,so as to reduce the incidence and mortality rates in the high-riskareas of EC.METHODS In October 2001,4 townships in the Ci-xian County,Hebei,China were selected,with 22,016 cases in the interventiongroup(IVG)and 33,410 in the control group(CG).The totalpopulation coverage reached 55,000.There were 3257 males and3339 females in the IVG with the age ranging from 40 to 69 years,and 4299 males and 4430 females in the CG with the same rangeof the age.Endoscopic screening with iodine staining was used inthe IVG,with a screening rate of 53.2%.During the screening byendoscopic examination,97 cases were found to have esophagealsquamous epithelium,carcinoma-in-situ at the cardiac glandularepithelium or intra-mucosal carcinoma.Additionally,102cases were identified to have severe atypical hyperplasia in theesophagus and gastric cardia.The natural incidence rate of cancerand the mortality were observed in the CG.The ICD-0 version wasused in the tumor incidence and death registration coding.Duringa period from June to September 2008,based on the information ofthe tumor registration database of the incidence and mortality inthe Ci-xian County,the cohort groups were studied and followed.RESULTS There were 133 patients with untreatable EC and48 with GC in the IVG,while there were 259 and 37 patients inthe CG who died of esophageal and gastric cancer,respectively.The relative risk(RR)of death was 0.76 in the male patients withEC,95%CI(0.59-0.98),P=0.038,and in the female patients theRR was 0.51,95%CI(0.35-0.75),P=0.000.The RR of death in theGC patients was 2.45,(1.40-4.29)in the male,P=0.01,and 0.99,(0.47-1.99),in the female cases,P=0.906.CONCLUSION Six years after a cohort screening of a largepopulation by endoscopic examination with iodine staining inareas at high risk for EC,the death risk in the male and femalepatients with EC has decreased compared with that in the controlgroup.The difference between the 2 groups was statisticallysignificant.However,no protective method used to decrease thedeath risk in GC patients has been found during this period ofendoscopic screening.

彩色多普勒超声对预防性EVL后疗效的研究

目的:探讨肝硬化Child-Pugh A级患者预防性经内镜食道曲张静脉套扎(EVL)对门静脉血流量和肝功能的影响及其相关性。方法:对16例Child-Pugh A级患者食道曲张静脉行预防性EVL,套扎前后采用彩色多普勒超声对门静脉血流参数定量测定,并结合肝功能指标的变化进行分析。结果:门静脉血流量由套扎前的994.86±175.03mL/min升高至套扎后三个月的1070.45±217.61mL/min和六个月的1074.93±224.09mL/min,患者血清白蛋白浓度、总胆固醇浓度以及血浆凝血酶原时间均较套扎前显著改善;门静脉血流量的增加同上述肝功能指标的改善,呈显著直线相关。结论:彩色多普勒超声可以准确评价EVL术前后门静脉血流参数的变化,预防性EVL可以通过增加门静脉血流改善Child-Pugh A级患者的肝功能。