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Objective:To evaluate the influence on the results and safety of double-balloon enteroscopy (DBE) at different combination time.Methods:Patients who received combined DBE procedures in Nanjing Drum Tower Hospital from April 2019 to August 2020 were divided into the one-day combination group and the non-one-day combination group. The complete enteroscopy rate, time of anterograde approach, time of retrograde approach, total time of combined approach, adverse events, hospital stay and cost were compared.Results:Among 119 patients who received DBE, 23 patients were excluded due to small intestinal stenosis. The complete enteroscopy rate was 92.9% (39/42) in the one-day group and 74.1% (40/54) in the non-one-day group, showing significant difference ( χ2=4.390, P=0.036). There were significant differences in the time of retrograde approach (35.59±23.29 min VS 55.10±19.04 min, t=-4.080, P<0.001), total time of combined approach (89.10±27.82 min VS 114.20±24.55 min, t=-4.254, P<0.001), hospital stay (9.24±3.76 d VS 11.76±4.41 d, t=-2.599, P=0.011) between the two groups. There were no significant differences in the time of anterograde approach, hospital cost or adverse events between the two groups. Conclusion:Combined DBE on one day yields a higher complete enteroscopy rate, less examination time and less hospital stay, which is worth of clinical application.
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To review the clinical data of 13 patients with benign stenosis in deep small intestine treated by balloon-assisted enteroscopy from September 2017 to December 2019, and to evaluate the stenosis characteristics, endoscopic treatment effects and its safety in different lesions. The results showed that there were 6 cases of Crohn disease (CD), 4 cases of cryptogenic multifocal ulcerative stenosing enteritis (CMUSE) and 3 cases of small bowel stenosis with unknown etiology. A total of 38 stenoses were found after 17 enteroscopic treatments, including 35 web-like stenoses and 3 columnar stenoses. Thirteen stenoses were found in 6 patients with CD, including 4 single stenosis, 1 case of 3 stenoses and 1 case of 6 stenoses. Twenty-one stenoses were found in 4 patients with CMUSE and they were all web-like stenosis. A total of 18 times of balloon dilatation and 10 times of IT knife incision were performed. The technical success rate was 88.2% (15/17), and the clinical effective rate was 76.9% (10/13). The follow-up time was 3-28 months, and one patient underwent surgical treatment. There was 1 case of delayed hemorrhage and 3 cases of delayed perforation after operation. They were all improved by medical treatment. These results indicated that treatment of benign stenosis in deep small intestine by enteroscopy is technically feasible and can improve the symptoms of patients in a short time.
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Objective:To evaluate the application value of small IT knife pre-cut in assistance to duodenal papillary cannulation compared with conventional guidewire cannulation.Methods:A retrospective analysis was performed on the data of 90 patients with choledocholithiasis including 52 patients with small IT knife pre-cut assisted intubation (small IT knife group) and 38 patients with conventional guidewire intubation (conventional group) in endoscopic retrograde cholangiopancreatography (ERCP) from May 2016 to July 2019 in the digestive endoscopy center of Nanjing Drum Tower Hospital. The basic data, curative effect and complications of the two groups were collected and compared.Results:There was statistically significant difference in gender composition between the small IT knife group and the conventional group ( χ2=5.679, P=0.017), but no significant difference in other baseline data between the two groups (all P>0.05). The median intubation time of the small IT knife group was significantly shorter than that of the conventional group (141.5 s VS 270.0 s, Z=1 268.0, P=0.022). There were no significant differences in the success rate of intubation [98.1% (51/52) VS 94.7% (36/38), χ2=0.760, P=0.571], the incidence of intraoperative bleeding [15.4% (8/52) VS 7.9% (3/38), χ2=1.148, P=0.345], postoperative pancreatitis [5.8% (3/52) VS 7.9% (3/38), χ2=0.159, P=0.694], and postoperative cholangitis [1.9% (1/52) VS 5.3% (2/38), χ2=0.760, P=0.571] between the two groups. No perforation occurred in the two groups. After stratifying according to the operator′s proficiency, the median intubation time was significantly different between the small IT knife expert group and the conventional expert group (116.0 s VS 258.0 s, Z=276.0, P=0.038), while there was no significant difference in the intubation time among other groups (all P>0.05). Conclusion:The small IT knife is safe and effective to pre-cut and assist intubation in ERCP, and it may shorten the intubation time.
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Objective To investigate the clinical application of enteroscopies in China, and to further provide evidence for popularization and promotion of enteroscopies. Methods The survey was designed between January 1st , 2017 and July 31th , 2017 with pre-survey in Guangdong Province between May 1st , 2017 and July 31st , 2017. It was conducted in Chinese mainland between August 30th , 2017 and December 30th , 2017. Data were collected through the online survey and reality survey at 385 hospitals. A total of 373 hospitals gave feedbacks and 7 hospitals were unqualified for further analysis after data checking, so 366 hospitals were included for final analysis, with a responding rate of 95. 1％. Information on practice status of hospitals with enteroscopies and enteroscopists were collected. The chi-squared test was used for comparison of data between eastern and central and western regions. Results The hospitals owning enteroscopies accounted for 47. 0％ ( 172/366 ) , 154/172 ( 89. 5％) were tertiary referral hospitals, 112/172 ( 65. 1％) established enteroscopy units, and 84/172 ( 48. 8％) owned X-ray exclusive for enteroscopy. The proportion of enteroscopists with senior title was 40. 3％ (50/124), female enteroscopists accounted for 42. 7％ ( 53/124 ) . Most enteroscopists aged 31-40 ( 50. 8％) and 41-50 years ( 27. 4％) . 43. 0％ ( 74/172) hospitals employed only 1-2 enteroscopists. The diagnostic cases per year were less than 50 cases in 51. 2％ hospitals ( 88/172) . The therapeutic cases per year were less than 10 cases in 51. 7％hospitals ( 89/172 ) . Nineteen of 124 ( 15. 3％) of enteroscopists didn' t receive standard training. The number of hospitals performing enteroscopies in eastern regions was higher than that in central and western regions [111(51. 6％) VS 61(40. 4％), P=0. 034]. The training background of enteroscopists in eastern regions was better than that in central and western regions. Untrained endoscopists accounted for 10. 5％ in eastern regions, while those accounted for 22. 9％ in central and western regions with significant difference ( P=0. 031 ) . Conclusion Low number of patients treated and shortage of enteroscopists are obvious in Chinese mainland, especially in central and western regions. Standard training of enteroscopists is impending.
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Objective To assess the clinical effects of simethicone emulsion combined with polyethylene glycol on bowel preparation for colonoscopy. Methods Two hundred out-patients, who underwent colonoscopy,were randomly divided into the study group and the control group. The study group was given simethicone in addition with polyethylene glycol, and the control group was given polyethylene glycol only. The differences on bowel preparation scores, air bubble reduction rate, colon lens sharpness, ileocecal region arrival time, colon polyp detection rate, the number of colon poly detection, and adverse event rate between the two groups were compared. Results The air bubble reduction rate, colon lens sharpness score and ileocecal region arrival time of the study group was 1(0-3)score,1.0(0-2)score,and 9(5-21)min,respectively,which was 2(1-3)score,1.5(0-2)score and 12(6-22)min, respectively in the control group. Differences between the two groups were statistically significant(Z=-9.490,P=0.000;Z=-6.768,P=0.000;Z=-5.521,P=0.000). For the bowel preparation score, colonoscopy polyp detection rate,the detection rate of colon polyp of diameter less than 5 mm, and number of colonoscopy polyp detection,there was no statistical difference between the two groups(P>0.05). No adverse events were observed in the both two groups. Conclusion The bowel preparation using simethicone combined with polyethylene glycol could effectively decrease the number of air bubble, enhance colon lens sharpness and shorten operation time,which contributes significant improvement for colonoscopy quality.
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Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers ( SMEGC) and gastric high grade intraepithelial neoplasia ( GHGIN) . Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66. 19±7. 46 years, 90. 62％(29/32) were male, 17 cases (53. 3％) had family history of gastric cancer, 25 (78. 13％) had smoking history, and 22 ( 68. 75％) were alcohol users. There were 30 cases ( 93. 75％) and 31 cases ( 96. 88％) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0. 4167, P=0. 018). The endoscopic classification of major and minor lesions had no statistical significant consistency ( P=0. 314 ) , but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation ( P<0. 05 ) . The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach ( r=0. 463,P=0. 003) . Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation( r=0. 417,P=0. 009) . Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis.
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Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection ( ESD ) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD. The pathological features of all resection margins in the specimen and the follow?up outcome of the patients with positive resection margin were evaluated. Univariate and multi?variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions,there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion( submucosal layer invasion, P=0?048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension (≥3/4,P=0?014) and the depth of invasion( exceeding muscularis mucosa, P=0?007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.
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Objective To study the risk factors for pathological upgrading after diagnosis of esophageal low?grade intra?epithelial neoplasia with ESD preoperative biopsy. Methods The endoscopic and pathological data of 85 lesions with ESD preoperative biopsy were analyzed, and grouped based on pathological upgrading after ESD. The risk factors for pathological upgrading after ESD was studied through single and multiple factor analysis. Results Pathological upgrading occurred in 45(52?94%) lesions after ESD, among whom 38 lesions developed up to high?grade intra?epithelial neoplasia and 7 lesions developed to esophageal early cancer. NBI?ME was performed on 37 patients and the accuracy of detecting the pathological invasion was 83?8%(31/37).Multi?factor analysis showed that reddish surface(OR=9?478, 95%CI:2?775?32?368, P = 0?000 3 ) and nodular lesion ( OR = 15?628, 95%CI:1?475?165?617, P =0?022 5) were independent factors for pathological upgrading after ESD. Conclusion Pathological upgrading of low?grade intra?epithelial neoplasia was common, especially esophageal mucosa with red surface and nodular lesion.Biopsy combined with NBI?ME is of significant importance to improve diagnostic accuracy.
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Objective To investigate the influence of duodenal diverticula on cannulation time and complication in patients undergoing ERCP.Methods Data of 3 265 patients undergoing ERCP in Drum Tower Hospital affiliated to Nanjing Medical University between January 1,2008 and December 31,2014 were enrolled.The patients' information and endoscopic pictures/videos were collected.The duodenal diverticula,cannulation time,postoperative complications were analyzed.Results There were 2 599 (79.6％) cases of non-diverticula,445(13.6％) cases of one-diverticula,122(3.7％) patients with two or more diverticula,and 99 (3.0％) intradiverticular papilla.Patients with duodenal diverticula accounted for 20.4％ (666/3 265) of all patients who received ERCP procedure.The mean cannulation time was 6.62 minutes in all cases,6.30 minutes in non-diverticula group,7.63 minutes in one-diverticula group,8.07 minutes in two-or-more group,8.58 minutes in intradiverticular papilla group,respectively.There were significant differences in cannulation time and complication rate between the groups.Conclusion Duodenal diverticula may be one of the factors that affect the cannulation time.It may enhance the cannulation complications and prolong the cannulation time,especially in those with intradiverticular papilla.
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Objective To study the diagnostic value of double-balloon endoscopy (DBE) and capsule endoscopy (CE) for small intestinal bleeding. Methods Overall detection rates of small intestinal bleeding with DBE, CE and the whole alimentary tract barium meal were compared. Positive rates of bleeding detection with DBE and CE were compared within the same patients. Influence of CE on one-procedure rate of DBE was analyzed. Results In 105 cases of small intestine bleeding, DBE detected 24 cases of Crohn's disease, 15 adenocarcinoma, 12 chronic nonspecific inflammation, 10 small intestinal ulcer of unknown reason, 8 entero-mesenchymoma, 8 polypus, 6 vascular deformation hemorrhage, 5 ancylostomiasis, 5 Mechel's diverticula ( including multiple diverticula), 3 lymphoma and 9 of no evident abnormalities. The positive detection rate of DBE is 91.4% (96/105). Disease detection rates of CE and whole alimentary tract barium meal were 75.0% (30/40) and 33.3% (25/75), respectively. The one-procedure rate of DBE is 90% (36/40) based on CE results, but it was only 69. 2% (45/65) according to clinic features and the whole alimentary tract barium meal. Conclusion The main causes of small intestinal bleeding are benign ulcers (including Crohn's disease) and tumor, as well as chronic inflammation. Polyps, vascular deformation, parasitosis, Mechel's diverticulum and lymphoma are the secondary causes.DBE is superior to CE in diagnosis of small intestine bleeding, but CE can increase the one-procedure rate of DBE.
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Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after stents implacement. The levels of amylase (plasma and urine) and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82.4% (28/34) and 88.2% (15/17), respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duct stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.