BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studi...BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy （VCE） in the diagnosis of MD is unknown, and the endoscopic patterns are not defned. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.CASE SUMMARYWe present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding （OGIB）. TheyGarcía-Compeán D et al . Merckel’s diverticulum diagnosis by VCEhad a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglo-bin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retain-ed in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.CONCLUSIONVCE is useful for the diagnosis of MD. However, endo-scopic characteristics must be recognized in order to establish preoperative diagnosis.展开更多
AIM:To study the current application situation of gastrointestinal(GI) endoscopy in China's Mainland.METHODS:From 12 August,2011 to 15 February,2012,draft questionnaires were sent by e-mail to 289 hospital-based G...AIM:To study the current application situation of gastrointestinal(GI) endoscopy in China's Mainland.METHODS:From 12 August,2011 to 15 February,2012,draft questionnaires were sent by e-mail to 289 hospital-based GI endoscopy units,including units with three levels(provincial,prefecture and county level) in China's Mainland.All the surveyed GI endoscopy units were state-owned and hospital-based.Proportions were compared using χ 2 tests.Comparisons between groups were performed using the Mann-Whitney U test.A probability of P < 0.05 was considered to represent a statistically significant difference.RESULTS:Based on satisfactory replies,169/279(60.6%) of units were enrolled in the survey,which covered 28 provinces(90.3%,28/31) in China's Mainland.Compared with published survey data,the number of GI endoscopes per unit has increased by nearly three times(from 2.9 to 9.3) in the past decade.About 33 of 169(19.5%) endoscopy units possessed an X-ray machine,which was mainly owned by provincial endoscopy units(43.2%,19/44).Video capsule endoscopes,which were almost unavailable ten years ago,were owned by 20.7%(35/169) of GI endoscopy units.Endoscopic submucosal dissection could be performed by 36.4%(19/44) of the provincial units,which was significantly higher than the prefecture level(9.9%,P < 0.01) and county level(0.0%,P < 0.01) units,respectively.CONCLUSION:Rapid development in GI endoscopy has been made in China's Mainland,and major diagnostic endoscopes and therapeutic endoscopy procedures are predominantly used in large endoscopy units.展开更多
目的:研制一种野战便携式内窥镜视频系统。方法:将主控制器TMS320DM368、图像传感器MT9P301、LED照明单元、LED显示器、光学接口和Wi-Fi模块一体化设计,集成在一个微型手持主机上。系统通过手持主机按键或无线脚踏开关2种方式进行采集图...目的:研制一种野战便携式内窥镜视频系统。方法:将主控制器TMS320DM368、图像传感器MT9P301、LED照明单元、LED显示器、光学接口和Wi-Fi模块一体化设计,集成在一个微型手持主机上。系统通过手持主机按键或无线脚踏开关2种方式进行采集图像;采用1 800 m Ah锂电池供电,通过市电或太阳能进行充电。结果:经过临床测试,研制的便携式内窥镜视频系统可以与相应的医用内窥镜配接,适合于内窥镜检查及手术的实时观察、记录和回放,可通过Wi-Fi实现远程医疗。结论:便携式内窥镜视频系统体积小、性能稳定、操作方便、自我续航能力强,非常适合野战医疗。展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy is altered following upper gastrointestinal(UGI) tract surgery, ERCP is technically challenging because the biliary tree becomes difficult to access by per-oral endoscopy.Advanced endoscopic therapies like balloon-enteroscopy or rendevous-ERCP may be considered but are not always feasible. Biliary sepsis and comorbidities may also make these patients poor candidates for surgical management of their biliary obstruction.CASE SUMMARY We present two 70-year-old caucasian patients admitted as emergencies with obstructive cholangitis. Both patients had BEAS associated with calculi that were predominantly extrahepatic in Patient 1 and intrahepatic in Patient 2. Both patients were unsuitable for conventional ERCP due to surgically-altered UGl anatomy. Emergency biliary drainage was by percutaneous transhepatic cholangiography(PTC) in both cases and after 6-weeks' maturation, PTC tracts were dilated to perform percutaneous transhepatic cholangioscopy and lithotripsy(PTCSL) for duct clearance. BEAS were firstly dilated fluoroscopically,and then biliary stones were flushed into the small bowel or basket-retrieved under visualization provided by the percutaneously-inserted video cholangioscope. Lithotripsy was used to fragment impacted calculi, also under visualization by video cholangioscopy. Satisfactory duct clearance was achieved in Patient 1 after one PTCSL procedure, but Patient 2 required a further procedure to clear persisting intrahepatic calculi. Ultimately both patients had successful stone clearance confirmed by check cholangiograms.CONCLUSION PTCSL offers a pragmatic, feasible and safe method for biliary tract clearance when neither ERCP nor surgical exploration is suitable.展开更多
文摘BACKGROUND Meckel’s diverticulum （MD） occurs predominantly in chil-dren and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is diffcult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy （VCE） in the diagnosis of MD is unknown, and the endoscopic patterns are not defned. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.CASE SUMMARYWe present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding （OGIB）. TheyGarcía-Compeán D et al . Merckel’s diverticulum diagnosis by VCEhad a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglo-bin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retain-ed in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.CONCLUSIONVCE is useful for the diagnosis of MD. However, endo-scopic characteristics must be recognized in order to establish preoperative diagnosis.
文摘AIM:To study the current application situation of gastrointestinal(GI) endoscopy in China's Mainland.METHODS:From 12 August,2011 to 15 February,2012,draft questionnaires were sent by e-mail to 289 hospital-based GI endoscopy units,including units with three levels(provincial,prefecture and county level) in China's Mainland.All the surveyed GI endoscopy units were state-owned and hospital-based.Proportions were compared using χ 2 tests.Comparisons between groups were performed using the Mann-Whitney U test.A probability of P < 0.05 was considered to represent a statistically significant difference.RESULTS:Based on satisfactory replies,169/279(60.6%) of units were enrolled in the survey,which covered 28 provinces(90.3%,28/31) in China's Mainland.Compared with published survey data,the number of GI endoscopes per unit has increased by nearly three times(from 2.9 to 9.3) in the past decade.About 33 of 169(19.5%) endoscopy units possessed an X-ray machine,which was mainly owned by provincial endoscopy units(43.2%,19/44).Video capsule endoscopes,which were almost unavailable ten years ago,were owned by 20.7%(35/169) of GI endoscopy units.Endoscopic submucosal dissection could be performed by 36.4%(19/44) of the provincial units,which was significantly higher than the prefecture level(9.9%,P < 0.01) and county level(0.0%,P < 0.01) units,respectively.CONCLUSION:Rapid development in GI endoscopy has been made in China's Mainland,and major diagnostic endoscopes and therapeutic endoscopy procedures are predominantly used in large endoscopy units.
文摘目的:研制一种野战便携式内窥镜视频系统。方法:将主控制器TMS320DM368、图像传感器MT9P301、LED照明单元、LED显示器、光学接口和Wi-Fi模块一体化设计,集成在一个微型手持主机上。系统通过手持主机按键或无线脚踏开关2种方式进行采集图像;采用1 800 m Ah锂电池供电,通过市电或太阳能进行充电。结果:经过临床测试,研制的便携式内窥镜视频系统可以与相应的医用内窥镜配接,适合于内窥镜检查及手术的实时观察、记录和回放,可通过Wi-Fi实现远程医疗。结论:便携式内窥镜视频系统体积小、性能稳定、操作方便、自我续航能力强,非常适合野战医疗。
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy is altered following upper gastrointestinal(UGI) tract surgery, ERCP is technically challenging because the biliary tree becomes difficult to access by per-oral endoscopy.Advanced endoscopic therapies like balloon-enteroscopy or rendevous-ERCP may be considered but are not always feasible. Biliary sepsis and comorbidities may also make these patients poor candidates for surgical management of their biliary obstruction.CASE SUMMARY We present two 70-year-old caucasian patients admitted as emergencies with obstructive cholangitis. Both patients had BEAS associated with calculi that were predominantly extrahepatic in Patient 1 and intrahepatic in Patient 2. Both patients were unsuitable for conventional ERCP due to surgically-altered UGl anatomy. Emergency biliary drainage was by percutaneous transhepatic cholangiography(PTC) in both cases and after 6-weeks' maturation, PTC tracts were dilated to perform percutaneous transhepatic cholangioscopy and lithotripsy(PTCSL) for duct clearance. BEAS were firstly dilated fluoroscopically,and then biliary stones were flushed into the small bowel or basket-retrieved under visualization provided by the percutaneously-inserted video cholangioscope. Lithotripsy was used to fragment impacted calculi, also under visualization by video cholangioscopy. Satisfactory duct clearance was achieved in Patient 1 after one PTCSL procedure, but Patient 2 required a further procedure to clear persisting intrahepatic calculi. Ultimately both patients had successful stone clearance confirmed by check cholangiograms.CONCLUSION PTCSL offers a pragmatic, feasible and safe method for biliary tract clearance when neither ERCP nor surgical exploration is suitable.
