Gastric varices(GV)represent a common and severe complication in patients with portal hypertension,commonly seen in patients with cirrhosis and severe pancreatic disease.Endoscopic ultrasonography is a safe and effica...Gastric varices(GV)represent a common and severe complication in patients with portal hypertension,commonly seen in patients with cirrhosis and severe pancreatic disease.Endoscopic ultrasonography is a safe and efficacious approach that can perform real-time ultrasonic scanning and intervention for the gastrointestinal submucosa,portal vein and its tributaries,and collateral circulations during direct endoscopic observation.Recently,various studies have been published about endoscopic ultrasound(EUS)-guided management of GV,mainly including diagnosis,treatment,and prognostic analysis.This article reviews published articles and guidelines to present the development process and current management of EUS-guided GV procedures.展开更多
AIM: To investigate the prevalence of colorectal cancer in geriatrie patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestin...AIM: To investigate the prevalence of colorectal cancer in geriatrie patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatrie patiente with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatrie patients is demonstrated.展开更多
BACKGROUND Goblet cell carcinoid(GCC)of the appendix is a rare tumor characterized by neuroendocrine and adenocarcinoma features.Accurate preoperative diagnosis is very difficult,with most patients complaining mainly ...BACKGROUND Goblet cell carcinoid(GCC)of the appendix is a rare tumor characterized by neuroendocrine and adenocarcinoma features.Accurate preoperative diagnosis is very difficult,with most patients complaining mainly of abdominal pain.Computed tomography shows swelling of the appendix,so diagnosis is usually made incidentally after appendectomy based on a preoperative diagnosis of appendicitis.Even if a patient undergoes preoperative colonoscopy,accurate endoscopic diagnosis is very difficult because GCC shows a submucosal growth pattern with invasion of the appendiceal wall.CASE SUMMARY Between 2017 and 2022,6 patients with GCC were treated in our hospital.The presenting complaint for 5 of these 6 patients was abdominal pain.All 5 patients underwent appendectomy,including 4 for a preoperative diagnosis of appendicitis and the other for diagnosis and treatment of an appendiceal tumor.The sixth patient presented with vomiting and underwent ileocecal resection for GCC diagnosed from preoperative biopsy.Although 2 patients with GCC underwent colonoscopy,no neoplastic changes were identified.Two of the six patients showed lymph node metastasis on pathological examination.As of the last followup(median:15 mo),all cases remained alive without recurrence.CONCLUSION As preoperative diagnosis of GCC is difficult,this possibility must be considered during surgical treatments for presumptive appendicitis.展开更多
AIM:To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography(ERC)in patients with Roux-en-Y hepaticojejunoanastomosis(HJA).METHODS:The study took place from January 20...AIM:To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography(ERC)in patients with Roux-en-Y hepaticojejunoanastomosis(HJA).METHODS:The study took place from January 2009to December 2011 and we retrospectively assessed 15patients with Roux-en-Y HJA who had signs of biliary obstruction.In total,23 ERC procedures were performed in these patients and a single balloon videoen-teroscope(Olympus SIF Q 180)was used in all of the cases.A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope.Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of≤5.4 kPa.The technical limitations or rather the parameters of the single balloon enteroscope(working length-200 cm,diameter of the working channel-2.8 mm,absence of Albarran bridge)showed the need for special endoscopic instrumentation.RESULTS:Cannulation success was reached in diagnostic ERC in 12 of 15 patients.ERC findings were normal in 1 of 12 patients.ERC in the remaining 11 patients showed some pathological changes.One of these(cystic bile duct dilation)was subsequently resolved surgically.Endoscopic treatment was initialized in the remaining 10 patients(5 with HJA stenosis,2 with choledocholithiasis,and 3 with both).This treatment was successful in 9 of 10 patients.The endoscopic therapeutic procedures included:balloon dilatation of HJA stenosis-11 times(7 patients);choledocholitiasis extraction-five times(5 patients);biliary plastic stent placement-six times(4 patients);and removal of biliary stents placed by us-six times(4 patients).The mean time of performing a single ERC was 72 min.The longest procedure took 110 min and the shortest took34 min.This shows that it is necessary to allow for more time in individual procedures.Furthermore,these procedures require the presence of an anesthesiologist.We did not observe any complications in these 15 patients.CONCLUSION:This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy.However,it is effective,safe,and widens the possibilities of resolving biliary pathology.展开更多
BACKGROUND Esophageal bronchogenic cyst(EBC) is a rare congenital disease that is difficult to diagnose preoperatively, and treatment remains controversial.CASE SUMMARY We report a 53-year-old Chinese woman hospitaliz...BACKGROUND Esophageal bronchogenic cyst(EBC) is a rare congenital disease that is difficult to diagnose preoperatively, and treatment remains controversial.CASE SUMMARY We report a 53-year-old Chinese woman hospitalized in our hospital following the discovery of a submucosal protruding mass of the esophagus by upper endoscopy. A preliminary diagnosis of EBC was made by endoscopic ultrasonography(EUS), and treatment was accomplished by endoscopic submucosal tunnel dissection(ESTD). The pathological results verified the diagnosis. No scar changes or cystic lesion within the original lesion were found under EUS after a 3-mo follow-up.CONCLUSION EUS is valuable for the preliminary diagnosis of EBC and surveillance. ESTD is a safe and effective treatment for EBC. Further evaluation of complications and long-term follow-ups are required.展开更多
AIM:To evaluate the clinical usefulness of singleballoon endoscopy(SBE) in patients in whom a colonoscope was technically difficult to insert previously.METHODS:The study group comprised 15 patients(8 men and 7 women)...AIM:To evaluate the clinical usefulness of singleballoon endoscopy(SBE) in patients in whom a colonoscope was technically difficult to insert previously.METHODS:The study group comprised 15 patients(8 men and 7 women) who underwent SBE for colonoscopy(30 sessions).The number of SBE sessions was 1 in 7 patients,2 in 5 patients,3 in 1 patient,4 in 1 patient,and 6 in 1 patient.In all patients,total colonoscopy was previously unsuccessful.The reasons for difficulty in scope passage were an elongated colon in 6 patients,severe intestinal adhesions after open surgery in 4,an elongated colon and severe intestinal adhesions in 2,a left inguinal hernia in 2,and multiple diverticulosis of the sigmoid colon in 1.Three endoscopists were responsible for SBE.The technique for inserting SBE in the colon was basically similar to that in the small intestine.The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications.We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.RESULTS:Total colonoscopy was successfully accomplished in all sessions.The mean insertion time to the cecum was 22.9 ± 8.9 min(range 9 to 40).Abnormalities were found during 21 sessions of SBE.The most common abnormality was colorectal polyps(20 sessions),followed by radiation colitis(3 sessions) and diverticular disease of the colon(3 sessions).Colorectal polyps were resected endoscopically in 15 sessions.A total of 42 polyps were resected endoscopically,using snare polypectomy in 32 lesions,hot biopsy in 7 lesions,and endoscopic mucosal resection in 3 lesions.Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE.Histopathologically,these lesions included 2 intramucosal cancers,42 tubular adenomas,and 2 tubulovillous adenomas.The mean examination time was 48.2 ± 20.0 min(range 25 to 90).Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.CONCLUSION:SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.展开更多
BACKGROUND Solitary hamartomatous polyps(SHPs)are rare lesions.Endoscopic full-thickness resection(EFTR)is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and ...BACKGROUND Solitary hamartomatous polyps(SHPs)are rare lesions.Endoscopic full-thickness resection(EFTR)is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and high safety.CASE SUMMARY A 47-year-old man was admitted to our hospital after experiencing hypogastric pain and constipation for over fifteen days.Computed tomography and endoscopy revealed a giant pedunculated polyp(approximately 18 cm long)in the descending and sigmoid colon.This is the largest SHP reported to date.Having considered the condition of the patient and mass growth,the polyp was removed using EFTR.CONCLUSION On the basis of clinical and pathological evaluations,the mass was considered an SHP.展开更多
The occurrence and development of esophageal cancer(EC)is a multi-stage process involving from inflammation to invasive cancer.However,this process is very complex,and so far there are few relevant studies to reveal t...The occurrence and development of esophageal cancer(EC)is a multi-stage process involving from inflammation to invasive cancer.However,this process is very complex,and so far there are few relevant studies to reveal this process.Early diagnosis and treatment of EC is the focus of the early diagnosis and treatment of malignant tumors project in China.How to screen EC in a lower cost and more efficient way deserves to be explored.Here,we reviewed the recent advances in the mechanisms of the occurrence and development,and early diagnosis and treatment of EC.展开更多
Objective To analyze the efficacy and safety of daratumumab plus dexamethasone in the treatment of renal injury patients with light chain amyloidosis,and to provide clinical reference.Methods It was a single center re...Objective To analyze the efficacy and safety of daratumumab plus dexamethasone in the treatment of renal injury patients with light chain amyloidosis,and to provide clinical reference.Methods It was a single center retrospective observational study.The clinical data before and after daratumumab treatment of renal injury patients with light chain amyloidosis treated with daratumumab plus dexamethasone from December 2021 to August 2022 were retrospectively collected.展开更多
文摘Gastric varices(GV)represent a common and severe complication in patients with portal hypertension,commonly seen in patients with cirrhosis and severe pancreatic disease.Endoscopic ultrasonography is a safe and efficacious approach that can perform real-time ultrasonic scanning and intervention for the gastrointestinal submucosa,portal vein and its tributaries,and collateral circulations during direct endoscopic observation.Recently,various studies have been published about endoscopic ultrasound(EUS)-guided management of GV,mainly including diagnosis,treatment,and prognostic analysis.This article reviews published articles and guidelines to present the development process and current management of EUS-guided GV procedures.
文摘AIM: To investigate the prevalence of colorectal cancer in geriatrie patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatrie patiente with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatrie patients is demonstrated.
文摘BACKGROUND Goblet cell carcinoid(GCC)of the appendix is a rare tumor characterized by neuroendocrine and adenocarcinoma features.Accurate preoperative diagnosis is very difficult,with most patients complaining mainly of abdominal pain.Computed tomography shows swelling of the appendix,so diagnosis is usually made incidentally after appendectomy based on a preoperative diagnosis of appendicitis.Even if a patient undergoes preoperative colonoscopy,accurate endoscopic diagnosis is very difficult because GCC shows a submucosal growth pattern with invasion of the appendiceal wall.CASE SUMMARY Between 2017 and 2022,6 patients with GCC were treated in our hospital.The presenting complaint for 5 of these 6 patients was abdominal pain.All 5 patients underwent appendectomy,including 4 for a preoperative diagnosis of appendicitis and the other for diagnosis and treatment of an appendiceal tumor.The sixth patient presented with vomiting and underwent ileocecal resection for GCC diagnosed from preoperative biopsy.Although 2 patients with GCC underwent colonoscopy,no neoplastic changes were identified.Two of the six patients showed lymph node metastasis on pathological examination.As of the last followup(median:15 mo),all cases remained alive without recurrence.CONCLUSION As preoperative diagnosis of GCC is difficult,this possibility must be considered during surgical treatments for presumptive appendicitis.
文摘AIM:To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography(ERC)in patients with Roux-en-Y hepaticojejunoanastomosis(HJA).METHODS:The study took place from January 2009to December 2011 and we retrospectively assessed 15patients with Roux-en-Y HJA who had signs of biliary obstruction.In total,23 ERC procedures were performed in these patients and a single balloon videoen-teroscope(Olympus SIF Q 180)was used in all of the cases.A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope.Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of≤5.4 kPa.The technical limitations or rather the parameters of the single balloon enteroscope(working length-200 cm,diameter of the working channel-2.8 mm,absence of Albarran bridge)showed the need for special endoscopic instrumentation.RESULTS:Cannulation success was reached in diagnostic ERC in 12 of 15 patients.ERC findings were normal in 1 of 12 patients.ERC in the remaining 11 patients showed some pathological changes.One of these(cystic bile duct dilation)was subsequently resolved surgically.Endoscopic treatment was initialized in the remaining 10 patients(5 with HJA stenosis,2 with choledocholithiasis,and 3 with both).This treatment was successful in 9 of 10 patients.The endoscopic therapeutic procedures included:balloon dilatation of HJA stenosis-11 times(7 patients);choledocholitiasis extraction-five times(5 patients);biliary plastic stent placement-six times(4 patients);and removal of biliary stents placed by us-six times(4 patients).The mean time of performing a single ERC was 72 min.The longest procedure took 110 min and the shortest took34 min.This shows that it is necessary to allow for more time in individual procedures.Furthermore,these procedures require the presence of an anesthesiologist.We did not observe any complications in these 15 patients.CONCLUSION:This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy.However,it is effective,safe,and widens the possibilities of resolving biliary pathology.
基金Supported by Zhejiang Medical Innovation Discipline Plan,No.2015-JX1-006-001
文摘BACKGROUND Esophageal bronchogenic cyst(EBC) is a rare congenital disease that is difficult to diagnose preoperatively, and treatment remains controversial.CASE SUMMARY We report a 53-year-old Chinese woman hospitalized in our hospital following the discovery of a submucosal protruding mass of the esophagus by upper endoscopy. A preliminary diagnosis of EBC was made by endoscopic ultrasonography(EUS), and treatment was accomplished by endoscopic submucosal tunnel dissection(ESTD). The pathological results verified the diagnosis. No scar changes or cystic lesion within the original lesion were found under EUS after a 3-mo follow-up.CONCLUSION EUS is valuable for the preliminary diagnosis of EBC and surveillance. ESTD is a safe and effective treatment for EBC. Further evaluation of complications and long-term follow-ups are required.
文摘AIM:To evaluate the clinical usefulness of singleballoon endoscopy(SBE) in patients in whom a colonoscope was technically difficult to insert previously.METHODS:The study group comprised 15 patients(8 men and 7 women) who underwent SBE for colonoscopy(30 sessions).The number of SBE sessions was 1 in 7 patients,2 in 5 patients,3 in 1 patient,4 in 1 patient,and 6 in 1 patient.In all patients,total colonoscopy was previously unsuccessful.The reasons for difficulty in scope passage were an elongated colon in 6 patients,severe intestinal adhesions after open surgery in 4,an elongated colon and severe intestinal adhesions in 2,a left inguinal hernia in 2,and multiple diverticulosis of the sigmoid colon in 1.Three endoscopists were responsible for SBE.The technique for inserting SBE in the colon was basically similar to that in the small intestine.The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications.We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.RESULTS:Total colonoscopy was successfully accomplished in all sessions.The mean insertion time to the cecum was 22.9 ± 8.9 min(range 9 to 40).Abnormalities were found during 21 sessions of SBE.The most common abnormality was colorectal polyps(20 sessions),followed by radiation colitis(3 sessions) and diverticular disease of the colon(3 sessions).Colorectal polyps were resected endoscopically in 15 sessions.A total of 42 polyps were resected endoscopically,using snare polypectomy in 32 lesions,hot biopsy in 7 lesions,and endoscopic mucosal resection in 3 lesions.Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE.Histopathologically,these lesions included 2 intramucosal cancers,42 tubular adenomas,and 2 tubulovillous adenomas.The mean examination time was 48.2 ± 20.0 min(range 25 to 90).Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.CONCLUSION:SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.
基金Supported by the Natural Science Foundation of Zhejiang Province,China,No.LY21H290004.
文摘BACKGROUND Solitary hamartomatous polyps(SHPs)are rare lesions.Endoscopic full-thickness resection(EFTR)is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and high safety.CASE SUMMARY A 47-year-old man was admitted to our hospital after experiencing hypogastric pain and constipation for over fifteen days.Computed tomography and endoscopy revealed a giant pedunculated polyp(approximately 18 cm long)in the descending and sigmoid colon.This is the largest SHP reported to date.Having considered the condition of the patient and mass growth,the polyp was removed using EFTR.CONCLUSION On the basis of clinical and pathological evaluations,the mass was considered an SHP.
文摘The occurrence and development of esophageal cancer(EC)is a multi-stage process involving from inflammation to invasive cancer.However,this process is very complex,and so far there are few relevant studies to reveal this process.Early diagnosis and treatment of EC is the focus of the early diagnosis and treatment of malignant tumors project in China.How to screen EC in a lower cost and more efficient way deserves to be explored.Here,we reviewed the recent advances in the mechanisms of the occurrence and development,and early diagnosis and treatment of EC.
文摘Objective To analyze the efficacy and safety of daratumumab plus dexamethasone in the treatment of renal injury patients with light chain amyloidosis,and to provide clinical reference.Methods It was a single center retrospective observational study.The clinical data before and after daratumumab treatment of renal injury patients with light chain amyloidosis treated with daratumumab plus dexamethasone from December 2021 to August 2022 were retrospectively collected.