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Objective:To compare the safety and efficacy of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for the treatment of biliary obstruction at different locations.Methods:From January 2016 to June 2021 data of 82 patients with obstructive jaundice treated with EUS-HGS in Nanjing Drum Tower Hospital were reviewed in this retrospective cohort study. According to the location of biliary obstruction,patients were divided into hilar biliary obstruction group ( n=30) and distal biliary obstruction group ( n=52). Univariate and multivariate logistic regression analyses were conducted adjusting covariates to compare the technical success rate, the clinical success rate, the adverse reaction incidence, hospital stay and cost of the two groups. Results:The technical success rates were 93.3% (28/30) and 94.2% (49/52) in the hilar biliary obstruction group and the distal biliary obstruction group with no significant difference between the two groups ( P=0.870, OR=1.17, 95% CI: 0.18-7.41). The clinical success rates were 83.3% (25/30) and 88.5% (46/52) in the hilar biliary obstruction group and the distal biliary obstruction group with no significant difference between the two groups ( P=0.514, OR=1.53, 95% CI: 0.43-5.53). The incidence of adverse events in hilar biliary obstruction group was 10.0% (3/30), including cholangitis 3.3% (1/30), biliary fistula 6.7% (2/30), biliary peritonitis 6.7% (2/30). The incidence of adverse events in patients with distal biliary obstruction was 17.3% (9/52), including cholangitis 9.6% (5/52), biliary fistula 7.7% (4/52) and biliary peritonitis 5.8% (3/52). There was no significant difference in the incidence of adverse events between the two groups ( P>0.05). Conclusion:There is no significant difference in safety or efficacy of EUS-HGS for hilar biliary obstruction and distal biliary obstruction.
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To analyze the endoscopic ultrasonography (EUS) and histopathological features of esophageal epithelial malignant tumors misdiagnosed as esophageal submucosal tumors (SMT), data of patients diagnosed as having esophageal SMT preoperatively but confirmed as esophageal epithelial malignant tumor by pathology after operation in Nanjing Drum Tower Hospital from January 2012 to December 2020 were retrospectively analyzed, and the clinical data including age, gender, size and location of the lesion, origin and echo of the lesion under EUS, endoscopic treatment and postoperative pathology were recorded. Among the 11 patients, there were 9 males and 2 females, aged (65.5±6.2) years. The length diameter of 9 lesions was ≤2 cm, and 8 lesions were located in the middle thoracic esophagus. Among the 11 patients, 10 underwent EUS before operation. The lesions originated from submucosa in 6 cases, muscularis propria in 2 cases and muscularis mucosa in 2 cases. The echo of the lesions was hypoechoic in 9 cases and isoechoic in only 1 case. Of the 11 patients, 3 underwent endoscopic mucosal resection, 6 underwent endoscopic submucosal dissection, and 2 underwent submucosal tunneling endoscopic resection. The histopathological types included 3 cases of moderately to poorly differentiated squamous cell carcinoma, 3 cases of basaloid squamous cell carcinoma, 2 cases of adenoid cystic carcinoma (including 1 case of adenoid cystic carcinoma colliding with squamous cell carcinoma), 2 cases of adenocarcinoma, and 1 case of esophageal sarcomatoid carcinoma with basaloid squamous cell carcinoma. Endoscopic manifestations of submucosal eminence in esophageal epithelial malignant tumors are extremely rare. EUS is helpful for differential diagnosis, and diagnostic treatment can make a definite diagnosis.
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Objective:To investigate the safety and long-term outcomes of fully covered self-expanding metal stent (FCSEMS) placement in patients with benign refractory pancreatic stenosis.Methods:Data of 18 patients with benign refractory pancreatic stenosis who underwent endoscopic treatment with FCSEMS in Nanjing Drum Tower Hospital between March 2013 and July 2020 were collected. The technical success, clinical success, adverse events and long-term outcomes were analyzed.Results:FCSEMS placement was successful in all 18 patients, with technical success rate of 100.0% (18/18). After stenting, the visual analogue scale (VAS) significantly decreased [2.00 (1.75, 3.00) VS 6.00 (5.00, 7.00), Z=-3.572, P<0.001]. The VAS decreased by more than 50% in 15 cases, and the clinical success rate was 83.3% (15/18). Stent-related adverse events included intolerable pain in 3 patients, stented-induced de novo stricture in 2 patients, and distal migration of stent in 2 patients. The stents were successfully removed in all patients after 137.5 (59.0, 417.0) days. There was significant reduction in terms of decreased upstream ductal dilatation after stent removal [9.1 (6.7, 14.1) mm VS 11.0 (7.6, 16.2) mm, Z=10.508, P<0.001]. After stent removal, 10 of the 14 patients maintained the response to pancreatic stenting and 4 recurred during the follow-up of 37-1 246 days. Conclusion:FCSEMS placement appears to be safe and effective in the treatment of benign refractory pancreatic stenosis and can provide persistent improvement in the stricture.
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Objective:To investigate the efficacy and safety of a new China-made direct visualization system of peroral cholangiopancreatography in the diagnosis and treatment of biliopancreatic diseases.Methods:Clinical data of 37 patients who underwent endoscopic examination through the direct visualization system of peroral cholangiopancreatography at Digestive Endoscopy Center of Nanjing Drum Tower Hospital from April 2020 to June 2021 were retrospectively analyzed. Technical success rate and complications were analyzed.Results:The examination was completed in 37 patients through the system. The technical success rate was 100.0%. The nature of biliary stricture was confirmed in 24 cases, presenece or absence of bleeding or residual stones in the bile duct was confirmed in 6 cases, neoplasm or residual stones in the pancreatic duct was determined in 2 cases, biliary stricture was passed assisted with visualized guidewire in 2 cases, and lithotripsy was performed assisted with biliary laser in 3 cases. Nine patients were pathologically diagnosed as having malignant biliary stricture, and 8 of them were confirmed malignant by the system. Drainage was performed in 34 cases after the examination. There were 3 cases of cholangitis, 4 cases of bacteremia and 2 cases of postoperative pancreatitis after the operation, which were relieved in a short time after conservative treatment. Bleeding occurred in 1 case which was improved after two times of endoscopic hemostasis.Conclusion:The new direct visualization system of peroral cholangiopancreatography is safe and effective in the diagnosis and treatment of biliopancreatic diseases.
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Objective:To investigate the safety and efficacy of endoscopic treatment for sporadic non-ampullary descending duodenal adenoma, and to analyze high-risk endoscopic features of malignant adenoma.Methods:Data of 54 patients diagnosed as having non-ampullary descending duodenal adenoma in Nanjing Drum Tower Hospital from November 2012 to September 2019 were retrospectively studied. The patients were divided into two groups, the high-grade intraepithelial neoplasia/adenocarcinoma (HGIN/AC) group and the low-grade intraepithelial neoplasia (LGIN) group according to pathological grade. Clinical features including gender, age, size and color of lesions, therapeutic methods, complications and postoperative follow-up results were analyzed.Results:A total of 54 patients were divided into the HGIN/AC group ( n=12) and the LGIN group ( n=42). There were significant differences in size or color of lesions between the two groups (both P<0.05). All 54 patients received endoscopic treatment. Biopsy, endoscopic mucosal resection and endoscopic submucosal dissection were performed on 8, 32 and 14 cases, respectively. A small perforation was found and clipped during operation without any complications. There were 2 cases of delayed hemorrhage, and the bleeding stopped under endoscopic treatment. The mean follow-up time was 2-58 months with no recurrence. Conclusion:Endoscopic treatment is safe and effective for non-ampullary descending duodenal adenoma. Lesions of size larger than 10 mm and those with a red surface have higher malignant tendency.
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Objective:To evaluate the short-type single balloon enteroscope (SBE) to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis.Methods:Data of 10 patients with Roux-en-Y anastomosis who received short-type SBE assisting ERCP (14 times of ERCP, the short-type SBE group) from May 2019 to September 2019 and 55 patients who received conventional SBE assisting ERCP (87 times of ERCP, the conventional SBE group) from March 2016 to April 2019 were collected in Nanjing Drum Tower Hospital. Success rates and mean time of reaching the blind loop, diagnosis and treatment success rates, procedure time and complication incidence in the two groups were compared.Results:The mean time to reach the blind loop was significantly shorter in short-type SBE group than that in the conventional SBE group (17.1 min VS 23.4 min, P = 0.04). There were no significant differences in success rates of reaching the blind loop[100.0%(14/14) VS 95.4%(83/87)], the success rates of diagnosis and treatment[both 100.0% (14/14) VS 100.0% (83/83)], the mean procedure time (62.6 min VS 64.3 min) or complication incidence [21.4%(3/14) VS 16.1% (14/83) ] between the two groups (all P>0.05). Conclusion:ERCP assisted by either type of SBE is safe and effective in patients with Roux-en-Y anastomosis. However, short-type SBE is faster to reach the blind loop because of its unique design and easier manipulation.
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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 explore the effect of drug combined with CO2 laser minimally invasive surgery in the treatment of patients with vascularized vocal cord inflammation, and the influence on the voice function of patients.Methods:From April 2018 to July 2019, 74 patients with vascularized vocal cord inflammation admitted in the Affiliated Hospital of Yangzhou University were divided into two groups according to the random number table method, with 37 cases in each group.The patients in the control group were treated with oral medicine.The patients in the observation group were treated with medicine combined with CO 2 laser minimally invasive surgery.The voice quality, improvement of voice disorders, recurrence and patients' satisfaction were observed. Results:After treatment for 12 months, the total hoarseness(G), roughness(R) and breath(B) scores in the observation group were (1.60±0.13)points, (1.71±0.21)points and (1.42±0.12)points, respectively, which were significantly lower than those in the control group [(1.88±0.16)points, (1.98±0.10)points and (1.78±0.13)points] ( t=8.262, 7.061, 12.377, all P<0.05). After treatment, the functional, physiological and emotional scores of voice disorders index(VHI) and total score in the observation group were (10.10±1.03)points, (13.26±2.10)points, (7.30±1.10)points, (31.26±4.74)points, respectively, which were significantly lower than those in the control group [(11.63±2.16)points, (15.42±2.16)points, (8.86±1.05)points, (35.86±5.33)points] ( t=3.889, 4.361, 6.240, 19.103, all P<0.05). The recurrence rates at the first and third month after treatment in the observation group were 2.70%(1/37) and 8.11%(2/37), respectively, which were significantly lower than those in the control group [16.22%(6/37) and 27.03%(10/37)] (χ 2=3.945, 4.573, all P<0.05). The satisfaction rate of patients in the observation group was 94.59%(35/37), which was significantly higher than 78.38%(29/37) in the control group(χ 2=4.163, P<0.05). Conclusion:On the basis of conventional drug treatment, CO 2 laser microinvasive surgery can effectively improve the treatment effect, improve the voice function of patients, and significantly reduce the recurrence rate, the overall effect and prognosis are better.
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Objective To investigate the value of endoscopic ultrasound ( EUS)-guided drainage via upper gastrointestinal tract for peripancreatic fluid collection. Methods The clinical data of 103 patients with peripancreatic fluid collection undergoing EUS-guided drainage via upper gastrointestinal tract from May 2006 to July 2017 in Nanjing Drum Tower Hospital were retrospectively analyzed, the treatment and postoperative complications were summarized. Results Among the 103 patients, 101 ( 98. 1％) were punctured successfully, and patients were punctured mostly through the gastric wall (97. 1％, 100/103). There were 29 cases of metal stent placement, and 66 plastic stent placement. Ten patients underwent ERCP with pancreatic stent placement. After operation, 8 patients underwent percutaneous drainage, and 1 surgical drainage. Complications occurred in 14 ( 13. 6％) cases, including stent displacement in 5 cases, and postoperative infection in 9 cases. There was no perforation, bleeding, pancreatic fistula, other serious complications or death. Conclusion EUS-guided drainage is safe and reliable for peripancreatic fluid collection.
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Objective@#To explore the reliability, validity and best cut-off value of Chinese version Addenbrooke's cognitive examination-Ⅲ(ACE-Ⅲ) in presbycusis patients with mild cognitive impairment(MCI).@*Methods@#A total of 43 presbycusis patients with mild cognitive impairment, 61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE), Montreal cognitive assessment(MoCA) and ACE-Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE-Ⅲ were analyzed with the SPSS 21.0, and the cut-off point was confirmed with the receiver operating characteristic(ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed.@*Results@#Chinese version of ACE-Ⅲ had betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach's alpha, split-half reliability and intraclass correlation coefficient were 0.870(P<0.05), 0.874(P<0.05) and 0.880(P<0.05), respectively.The patients in MCI group got a lower score in the sub-scale of attention/orientation, memory, verbal fluency, language and visual space of ACE-Ⅲ compared with those in NCI group and healthy control group, and the differences were statistically significant (F=48.042, 46.594, 35.442, 19.374, 256.19, 140.319, all P<0.001). The criteria validity calculated between the Chinese version of ACE-Ⅲ and MMSE was 0.802 (P<0.001). Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals(P<0.05). The Chinese version of ACE-Ⅲ showed significantly correlation with the total scores of MoCA(r=0.802, P<0, 001). When the cut-off value for diagnosis was 86.5, the largest area under the ROC curve for the Chinese version of ACE-Ⅲ was 0.98(95% CI: 0.897-0.996). The relative sensitivity and specificity were 100.0% and 95.0%, respectively.@*Conclusion@#The Chinese version of ACE-Ⅲ had better internal consistency, reliability and validity, and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.
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Objective To explore the reliability , validity and best cut －off value of Chinese version Addenbrooke＇s cognitive examination －Ⅲ(ACE－Ⅲ) in presbycusis patients with mild cognitive impairment (MCI). Methods A total of 43 presbycusis patients with mild cognitive impairment ,61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE),Montreal cognitive assessment ( MoCA) and ACE －Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE －Ⅲwere analyzed with the SPSS 21.0,and the cut－off point was confirmed with the receiver operating characteristic ( ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed.Results Chinese version of ACE －Ⅲhad betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach＇s alpha,split－half reliability and intraclass correlation coefficient were 0.870(P＜0.05), 0.874(P＜0.05) and 0.880(P＜0.05),respectively.The patients in MCI group got a lower score in the sub －scale of attention／orientation,memory,verbal fluency,language and visual space of ACE －Ⅲ compared with those in NCI group and healthy control group ,and the differences were statistically significant ( F ＝48.042,46.594,35.442, 19.374,256.19,140.319,all P＜0.001).The criteria validity calculated between the Chinese version of ACE －Ⅲand MMSE was 0.802 (P＜0.001).Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals (P＜0.05).The Chinese version of ACE －Ⅲ showed significantly correlation with the total scores of MoCA ( r＝0.802,P＜0,001).When the cut －off value for diagnosis was 86.5,the largest area under the ROC curve for the Chinese version of ACE－Ⅲwas 0.98(95%CI:0.897－0.996).The relative sensitivity and specificity were 100.0%and 95.0%,respectively.Conclusion The Chinese version of ACE －Ⅲ had better internal consistency ,reliability and validity,and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.
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Objective To assess the application value of lumen-apposing,fully covered,self-expandable metal stent (LAMS) in the treatment of peripancreatic fluid collection (PFC).Methods From July 2015 to July 2017,at Drum Tower Hospital Affiliated to Medical School of Nanjing University,the patients with PFC who received LAMS under endoscopic ultrasound were enrolled.The inclusion criteria was the first treatment,age ≥ 18 years old,PFC diameter ＞ 6 cm and clinical manifestations of compression,or increased diameter of PFC after continuous observation,or signs of infection,course ＞four weeks,and the distance between the cyst wall and the digestive gastrointestinal wall less than 1 cm;exclude other pancreatic cystic lesions,such as serous cystic neoplasm,mucinous cystic neoplasm and solid pseudopapillary neoplasm.The clinical data of enrolled patients were retrospectively analyzed,and the efficacy and postoperative complication were summarized.Results A total of 27 patients with PFC were enrolled.All patients were successfully punctured and placed with LAMS.The percentage of complete drainage rate of PFC was 96.3％ (26/27).The median LAMS maintenance time was 26 days,with a range of four to 135 days.Seventeen patients received debridement treatment through LAMS,and the number of debridement treatment was (2.5± 1.3) times.Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were placed with pancreatic stent,five patients received percutaneous drainage,and one patient underwent surgical drainage.Among 27 patients with PFC,eight patients (29.6％) coexisted with complications,including stent displacement in two cases,postoperative infection in three cases,perforation in two cases and bleeding in one case.They all improved after conservative treatment and none of them died.Conclusion LAMS is effective and relatively safe in the treatment of PFC,and may change the clinical treatment strategy of PFC.
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Objective To assess the application value of pancreatic stent placement for endoscopic resection of duodenal major papilla adenoma.Methods A total of 67 cases of duodenal major papilla adenoma that were confirmed by biopsy and underwent endoscopic papillectomy from August 2007 to July 2016 in endoscopy center of Drum Tower Hospital of Nanjing were analyzed retrospectively.There were 50 patients treated with pancreatic stent placement and 17 patients without as the control group.The general information, efficacy and complications of two groups were collected at the same time.Results There were no significant differences in gender(P=0.070), age(P=0.151) or tumor size(P=0.136) between pancreatic stent placement group and the control group.There were no statistical differences in en bloc resection rates or complete resection rates between the two groups.And there were no significant differences in short-term complications of bleeding(P=0.428), pancreatitis(P=0.982), cholangitis(P=1.000), perforation(P=1.000)or long-term complications of distal common pancreatic duct stricture between the two groups.Conclusion Pancreatic stent should not be routinely placed in endoscopic papillectomy, and should be considered for specific cases.
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Objective To evaluate the long-term efficacy and safety of endoscopic mucosal resection (EMR) for lesions at gastroesophageal junction (GEJ). Methods A total of 51 lesions located at GEJ from 51 patients, with an average size of 10. 9±4. 0 mm (3-28 mm), were treated with EMR between November 2005 and March 2009, among which 39 were diagnosed as low grade dysplasia and 12 as high grade dysplasia pathologically after EMR. The histopathologic results were compared between biopsies and EMR samples. All patients were followed up endoscopically. Results Complete resection was achieved in 44 ( 86. 3% ). The histopathologic diagnosis of 25 cases (49. 9% ) was inconsistent between biopsy and EMR samples, with 24 exhibited higher grade dysplasia after EMR. Main complication during EMR was bleeding in 17 patients ( 33. 3% ), all of which were successfully managed. No perforation or postoperative stenesis occurred. Endoscopic follow-up was carried out in 8 patients for more than 3 years, in 17 for 2-3 years, in 12 for 1-2 years and in 14 for less than 1 year. No death occurred during follow-up. Conclusion EMR can be adquately adopted as an effective treatment for pre-cuncerous lesions at GEJ, which is important in blocking malignant progression of dysplastic lesions.