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
AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus wer...AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus were prospectively collected.All patients underwent curative gastrectomy(36 subtotal gastrectomy with gastroduodenostomy,16subtotal gastrectomy with gastrojejunostomy,12 total gastrectomy)and their physical and laboratory data were evaluated before and 3,6 and 12 mo after surgery.RESULTS:Fasting blood glucose(FBS),HbA1c,insulin,C-peptide,and homeostasis model assessment-estimated insulin resistance were significantly improved 3mo after surgery,regardless of operation type,and the significant improvement in all measured values,except HbA1c,was sustained up to 12 mo postoperatively.Approximately 3.1%of patients stopped diabetes medication and had HbA1c<6.0%and FBS<126 mg/dL.54.7%of patients decreased their medication,and had reduced FBS or HbA1c.In multivariate analysis,good diabetic control was not associated with operation type,but was associated with diabetes duration.CONCLUSION:Diabetes improved in more than 50%of patients during the first year after gastric cancer surgery.The degree of diabetes control was related to diabetes duration.展开更多
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Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology,2011-0011301a faculty research grant of Yonsei University College of Medicine for 2011,6-2011-0084
文摘AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus were prospectively collected.All patients underwent curative gastrectomy(36 subtotal gastrectomy with gastroduodenostomy,16subtotal gastrectomy with gastrojejunostomy,12 total gastrectomy)and their physical and laboratory data were evaluated before and 3,6 and 12 mo after surgery.RESULTS:Fasting blood glucose(FBS),HbA1c,insulin,C-peptide,and homeostasis model assessment-estimated insulin resistance were significantly improved 3mo after surgery,regardless of operation type,and the significant improvement in all measured values,except HbA1c,was sustained up to 12 mo postoperatively.Approximately 3.1%of patients stopped diabetes medication and had HbA1c<6.0%and FBS<126 mg/dL.54.7%of patients decreased their medication,and had reduced FBS or HbA1c.In multivariate analysis,good diabetic control was not associated with operation type,but was associated with diabetes duration.CONCLUSION:Diabetes improved in more than 50%of patients during the first year after gastric cancer surgery.The degree of diabetes control was related to diabetes duration.
