AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to M...AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP attempts.In all cases,the ERCP procedures were started using a duodenoscope.If intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success rate.RESULTS:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent DBE-ERCP.The DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully treated.One patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by biopsy.There were no complications related to the DBE.The overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.展开更多
AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challen...AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.展开更多
AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was develope...AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraductal ultrasonography could be performed in 8 sessions.As for complications,hyperamylasemia(defined as a rise in serum amylase levels to more than 3 times the upper limit of normal) occurred in 1 patient(7 sessions) with a B-Ⅱ gastrectomy and 4 patients(19 sessions) with an R-Y gastrectomy.After ERCP in patients with an R-Y gastrectomy,2 patients(19 sessions) had pancreatitis,1 patient(21 sessions) had gastrointestinal perforation,and 1 patient(19 sessions) had papillary bleeding.Pancreatitis and bleeding were both mild.Gastrointestinal perforation improved after conservative treatment.CONCLUSION:Short-type SBE is effective for ERCP in patients with a reconstructed intestine and allows most conventional ERCP devices to be used.展开更多
Objective:Reconstruction of the digestive tract for adenocarcinoma of esophagogastric junction(AEG)is in dispute.This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His ...Objective:Reconstruction of the digestive tract for adenocarcinoma of esophagogastric junction(AEG)is in dispute.This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His angle and fundus(Cheng’s GIRAFFE anastomosis)in laparoscopic/open proximal gastrectomy for Siewert typeⅡAEG,which was performed at Zhejiang Cancer Hospital and the First Affiliated Hospital of Zhejiang Chinese Medical University.Here,we discuss the preliminary results of gastric emptying and anti-reflux.Methods:From a retrospective database,74 patients with advanced Siewert typeⅡAEG underwent curative proximal gastrectomy with GIRAFFE anastomosis,and their gastric emptying and anti-reflux outcomes were evaluated by the Reflux Disease Questionnaire(RDQ)score,nuclide gastric emptying,24-h impedance-pH monitoring and gastroscopy.Results:Seventy-four patients successfully completed proximal partial gastrectomy with Cheng’s GIRAFFE esophagogastric anastomosis.RDQ score six months after the operation was 2.2±2.5.Results of nuclide gastric emptying examinations showed that the gastric half-emptying time was 67.0±21.5 min,the 1-h residual rate was(52.2±7.7)%,the 2-h residual rate was(36.4±5.1)%,and the 3-h residual rate was(28.8±3.6)%;24-h impedance-p H monitoring revealed that the mean De Meester score was 5.8±2.9.Reflux esophagitis was observed by gastroscopy in 7 patients six months after surgery.Conclusions:Cheng’s GIRAFFE anastomosis is safe and feasible for Siewert typeⅡAEG.展开更多
AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery. METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy f...AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery. METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy for gastric cancer were retrospectively divided into 2 time-period cohorts; those treated with Billroth Ⅱ (BⅡ) reconstruction in the first 6 years and those with Roux-en-Y (RY) reconstruction in the last 5 years. In the latter group, the patients were further divided into 2 subgroups; with and without nasogastric decompression.RESULTS: Postoperatively, there were no significant differences in the number of anastomotic leaks between the 3 groups. In the tubeless RY group, time to semiliquid diet was significantly shorter than in the other 2 groups (4.4 d ± 1.4 d vs 7.2 d ± 1.3 d and 5.9 d ± 1.2 d, P = 0.005). The length of postoperative stay was significantly increased in patients with BⅡ reconstruction compared with patients with RY reconstruction with/without NG decompression (15.4 d ± 4.3 d in BⅡ group vs 12.6 d ± 3.1 d in decompressed RY and 11.4 d ± 3.4 d in the tubeless RY group, P = 0.035). The postoperative pneumonia rate was lowest in the tubeless group and highest in the BⅡ group (1.4% vs 4.6%, P = 0.01). Severe sore throat was noted in 59 (20.7%) members of the BⅡ group, 18 (17.4%) members of the decompressed RY group and 6 (4.2%) members of the tubeless RY group. Fewer patients in the tubeless group complained of severe sore throat (P = 0.001). CONCLUSION: This study provides support for abandoning routine NG decompression in patients undergoing subtotal gastrectomy with Roux-en-Y gastrojejunostomy.展开更多
文摘AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP attempts.In all cases,the ERCP procedures were started using a duodenoscope.If intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success rate.RESULTS:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent DBE-ERCP.The DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully treated.One patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by biopsy.There were no complications related to the DBE.The overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.
文摘AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.
基金Supported by A Prototype Single Balloon Enteroscope from Olympus Medical Systems,Tokyo,Japan
文摘AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraductal ultrasonography could be performed in 8 sessions.As for complications,hyperamylasemia(defined as a rise in serum amylase levels to more than 3 times the upper limit of normal) occurred in 1 patient(7 sessions) with a B-Ⅱ gastrectomy and 4 patients(19 sessions) with an R-Y gastrectomy.After ERCP in patients with an R-Y gastrectomy,2 patients(19 sessions) had pancreatitis,1 patient(21 sessions) had gastrointestinal perforation,and 1 patient(19 sessions) had papillary bleeding.Pancreatitis and bleeding were both mild.Gastrointestinal perforation improved after conservative treatment.CONCLUSION:Short-type SBE is effective for ERCP in patients with a reconstructed intestine and allows most conventional ERCP devices to be used.
基金Diagnosis and Therapy Center of Upper Gastrointestinal Tumor(No.JBZX202006)Key Laboratory of Prevention,Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province(No.2022E10021)Medical Health Plan of Zhejiang Province(No.2020KY488 and No.2022KY684)。
文摘Objective:Reconstruction of the digestive tract for adenocarcinoma of esophagogastric junction(AEG)is in dispute.This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His angle and fundus(Cheng’s GIRAFFE anastomosis)in laparoscopic/open proximal gastrectomy for Siewert typeⅡAEG,which was performed at Zhejiang Cancer Hospital and the First Affiliated Hospital of Zhejiang Chinese Medical University.Here,we discuss the preliminary results of gastric emptying and anti-reflux.Methods:From a retrospective database,74 patients with advanced Siewert typeⅡAEG underwent curative proximal gastrectomy with GIRAFFE anastomosis,and their gastric emptying and anti-reflux outcomes were evaluated by the Reflux Disease Questionnaire(RDQ)score,nuclide gastric emptying,24-h impedance-pH monitoring and gastroscopy.Results:Seventy-four patients successfully completed proximal partial gastrectomy with Cheng’s GIRAFFE esophagogastric anastomosis.RDQ score six months after the operation was 2.2±2.5.Results of nuclide gastric emptying examinations showed that the gastric half-emptying time was 67.0±21.5 min,the 1-h residual rate was(52.2±7.7)%,the 2-h residual rate was(36.4±5.1)%,and the 3-h residual rate was(28.8±3.6)%;24-h impedance-p H monitoring revealed that the mean De Meester score was 5.8±2.9.Reflux esophagitis was observed by gastroscopy in 7 patients six months after surgery.Conclusions:Cheng’s GIRAFFE anastomosis is safe and feasible for Siewert typeⅡAEG.
文摘AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery. METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy for gastric cancer were retrospectively divided into 2 time-period cohorts; those treated with Billroth Ⅱ (BⅡ) reconstruction in the first 6 years and those with Roux-en-Y (RY) reconstruction in the last 5 years. In the latter group, the patients were further divided into 2 subgroups; with and without nasogastric decompression.RESULTS: Postoperatively, there were no significant differences in the number of anastomotic leaks between the 3 groups. In the tubeless RY group, time to semiliquid diet was significantly shorter than in the other 2 groups (4.4 d ± 1.4 d vs 7.2 d ± 1.3 d and 5.9 d ± 1.2 d, P = 0.005). The length of postoperative stay was significantly increased in patients with BⅡ reconstruction compared with patients with RY reconstruction with/without NG decompression (15.4 d ± 4.3 d in BⅡ group vs 12.6 d ± 3.1 d in decompressed RY and 11.4 d ± 3.4 d in the tubeless RY group, P = 0.035). The postoperative pneumonia rate was lowest in the tubeless group and highest in the BⅡ group (1.4% vs 4.6%, P = 0.01). Severe sore throat was noted in 59 (20.7%) members of the BⅡ group, 18 (17.4%) members of the decompressed RY group and 6 (4.2%) members of the tubeless RY group. Fewer patients in the tubeless group complained of severe sore throat (P = 0.001). CONCLUSION: This study provides support for abandoning routine NG decompression in patients undergoing subtotal gastrectomy with Roux-en-Y gastrojejunostomy.
