BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniqu...BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniques have been developed and attempted for this disease.Endoscopic radial incision and cutting(RIC)techniques are reportedly very effective in benign anastomotic stricture.This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital.The patient complained of postprandial fullness in the epigastric region.Previous physical examinations or blood tests indicated no abnormalities.Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum.Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb;a very small hole was observed in the distal part of the second portion,and scope passage was not possible.Gastrografin upper gastrointestinal series was performed,revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim,a typical"windsock"sign.Endoscopic RIC was performed on the duodenal web.The patient recovered uneventfully.Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis.The patient reported complete resolution of symptoms at the 18-month follow-up.CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.展开更多
BACKGROUND Anastomotic stenosis(AS)after colorectal surgery was treated with balloon dilation,endoscopic procedure or surgery.The endoscopic procedures including dilation,electrocautery incision,or radial incision and...BACKGROUND Anastomotic stenosis(AS)after colorectal surgery was treated with balloon dilation,endoscopic procedure or surgery.The endoscopic procedures including dilation,electrocautery incision,or radial incision and cutting(RIC)were preferred because of lower complication rates than surgery and are less invasive.Endoscopic RIC has a greater success rate than dilation methods.Most reports showed that repeated RICs were needed to maintain patency of the anastomosis.We report that single session RIC was applied only to treatment-naive patients with AS.CASE SUMMARY Two female patients presented with AS.One patient had advanced rectal cancer and the other had a refractory stenosis following surgery for endometriosis at sigmoid colon.The endoscopic RIC procedure was performed as follows.A single small incision was carefully made to increase the view of the proximal colon and the incision was expanded until the surgical stapling line.Finally,we made a further circumferential excision with endoscopic knife along the inner border of the surgical staple line.At the end of the procedure,the standard colonoscope was able to pass freely through the widened opening.All patients showed improved AS after a single session of RIC without immediate or delayed procedure-related complications.Follow-up colonoscopy at 7 and 8 mo after endoscopic RIC revealed intact anastomotic sites in both patients.No treatment-related adverse events or recurrence of the stenosis was demonstrated during follow-up periods of 20 and 23 mo.CONCLUSION The endoscopic RIC may play a role as one of treatment options for treatmentnaive AS with short stenotic lengths.展开更多
Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineat...Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)post-procedure stricture is a relatively common long-term complication following ESD treatment.A range of approaches has been implemented for the treatment of post-proce...BACKGROUND Endoscopic submucosal dissection(ESD)post-procedure stricture is a relatively common long-term complication following ESD treatment.A range of approaches has been implemented for the treatment of post-procedural stricture using endoscopic techniques such as endoscopic dilation,self-expandable metallic stent insertion,local steroid injection in the esophagus,oral steroid administration,radial incision and cutting(RIC).The actual efficacy of these different therapeutic options is highly variable,and uniform international standards for the prevention or treatment of stricture.CASE SUMMARY In this report,we describe the case of a 51-year-old male diagnosed with early esophageal cancer.To protect against esophageal stricture,the patient was administered oral steroids and underwent self-expandable metallic stent insertion for 45 d.Despite these interventions,stricture was detected at the lower edge of the stent following its removal.The patient remained refractory to multiple rounds of endoscopic bougie dilation treatment,and thus suffered from complex refractory benign esophageal stricture.As such,RIC combined with bougie dilation and steroid injection was employed to treat this patient more effectively,ultimately achieving satisfactory therapeutic efficacy.CONCLUSION Combination of RIC,dilation,and steroid injection can be safely and effectively implemented to treat cases of post-ESD refractory esophageal stricture.展开更多
Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstr...Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstructing the enteral nutrition pathway in patients with gastrointestinal strictures.Endoscopic stricturotomy is a safe and effective way to open the nutritional pathway,especially for those with anatomic stricture length<1 cm,and can be used either as the primary choice of treatment for patients with gastrointestinal stricture or as rescue therapy for refractory cases.Endoscopic stricturotomy can be executed with radial incision and cutting or circular incision and cutting.After the stricturotomy,other endoscopic treatments,such as endoscopic balloon dilation,stent implantation,and intra-lesional injection of steroids,can be used to prevent the development of re-stricture.This article reviews the clinical experiences with endoscopic stricturotomy for opening strictures along the enteral nutrition pathway in patients with gastrointestinal strictures.展开更多
Background:To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.Methods:Partial thickne...Background:To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.Methods:Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth,quality,and consistency.Optical coherence tomography was used to determine the accuracy and precision of incision depth.Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss.Quality was evaluated by ease of opening and examination of interfaces.Results:In two micro radial incision groups,intended incision depths of 50%and 80%resulted in mean achieved depths of 50.01%and 77.69%,respectively.In three arcuate incision groups,intended incision depths of 80%,600μm or 100μm residual uncut bed thickness resulted in mean achieved depths of 80.16%,603.03μm and residual bed of 115μm,respectively.No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85-116μm.The incisions were easy to open,and interfaces were smooth.Conclusions:A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions.Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.展开更多
文摘BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniques have been developed and attempted for this disease.Endoscopic radial incision and cutting(RIC)techniques are reportedly very effective in benign anastomotic stricture.This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital.The patient complained of postprandial fullness in the epigastric region.Previous physical examinations or blood tests indicated no abnormalities.Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum.Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb;a very small hole was observed in the distal part of the second portion,and scope passage was not possible.Gastrografin upper gastrointestinal series was performed,revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim,a typical"windsock"sign.Endoscopic RIC was performed on the duodenal web.The patient recovered uneventfully.Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis.The patient reported complete resolution of symptoms at the 18-month follow-up.CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.
文摘BACKGROUND Anastomotic stenosis(AS)after colorectal surgery was treated with balloon dilation,endoscopic procedure or surgery.The endoscopic procedures including dilation,electrocautery incision,or radial incision and cutting(RIC)were preferred because of lower complication rates than surgery and are less invasive.Endoscopic RIC has a greater success rate than dilation methods.Most reports showed that repeated RICs were needed to maintain patency of the anastomosis.We report that single session RIC was applied only to treatment-naive patients with AS.CASE SUMMARY Two female patients presented with AS.One patient had advanced rectal cancer and the other had a refractory stenosis following surgery for endometriosis at sigmoid colon.The endoscopic RIC procedure was performed as follows.A single small incision was carefully made to increase the view of the proximal colon and the incision was expanded until the surgical stapling line.Finally,we made a further circumferential excision with endoscopic knife along the inner border of the surgical staple line.At the end of the procedure,the standard colonoscope was able to pass freely through the widened opening.All patients showed improved AS after a single session of RIC without immediate or delayed procedure-related complications.Follow-up colonoscopy at 7 and 8 mo after endoscopic RIC revealed intact anastomotic sites in both patients.No treatment-related adverse events or recurrence of the stenosis was demonstrated during follow-up periods of 20 and 23 mo.CONCLUSION The endoscopic RIC may play a role as one of treatment options for treatmentnaive AS with short stenotic lengths.
文摘Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.
基金Supported by The Sichuan Medical Association Digestive Endoscopy Special Committee Special Topic,China,No.2021XHNJ05。
文摘BACKGROUND Endoscopic submucosal dissection(ESD)post-procedure stricture is a relatively common long-term complication following ESD treatment.A range of approaches has been implemented for the treatment of post-procedural stricture using endoscopic techniques such as endoscopic dilation,self-expandable metallic stent insertion,local steroid injection in the esophagus,oral steroid administration,radial incision and cutting(RIC).The actual efficacy of these different therapeutic options is highly variable,and uniform international standards for the prevention or treatment of stricture.CASE SUMMARY In this report,we describe the case of a 51-year-old male diagnosed with early esophageal cancer.To protect against esophageal stricture,the patient was administered oral steroids and underwent self-expandable metallic stent insertion for 45 d.Despite these interventions,stricture was detected at the lower edge of the stent following its removal.The patient remained refractory to multiple rounds of endoscopic bougie dilation treatment,and thus suffered from complex refractory benign esophageal stricture.As such,RIC combined with bougie dilation and steroid injection was employed to treat this patient more effectively,ultimately achieving satisfactory therapeutic efficacy.CONCLUSION Combination of RIC,dilation,and steroid injection can be safely and effectively implemented to treat cases of post-ESD refractory esophageal stricture.
文摘Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstructing the enteral nutrition pathway in patients with gastrointestinal strictures.Endoscopic stricturotomy is a safe and effective way to open the nutritional pathway,especially for those with anatomic stricture length<1 cm,and can be used either as the primary choice of treatment for patients with gastrointestinal stricture or as rescue therapy for refractory cases.Endoscopic stricturotomy can be executed with radial incision and cutting or circular incision and cutting.After the stricturotomy,other endoscopic treatments,such as endoscopic balloon dilation,stent implantation,and intra-lesional injection of steroids,can be used to prevent the development of re-stricture.This article reviews the clinical experiences with endoscopic stricturotomy for opening strictures along the enteral nutrition pathway in patients with gastrointestinal strictures.
文摘Background:To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.Methods:Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth,quality,and consistency.Optical coherence tomography was used to determine the accuracy and precision of incision depth.Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss.Quality was evaluated by ease of opening and examination of interfaces.Results:In two micro radial incision groups,intended incision depths of 50%and 80%resulted in mean achieved depths of 50.01%and 77.69%,respectively.In three arcuate incision groups,intended incision depths of 80%,600μm or 100μm residual uncut bed thickness resulted in mean achieved depths of 80.16%,603.03μm and residual bed of 115μm,respectively.No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85-116μm.The incisions were easy to open,and interfaces were smooth.Conclusions:A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions.Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.
