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Objective:The study aimed to analyze the clinical and endoscopic characteristics of adult celiac disease (CD) to provide a scientific basis for more effective CD diagnosis and treatment.Methods:In this cross-sectional study, the clinical and endoscopic data of 96 adult CD patients treated in the Department of Gastroenterology of the People′s Hospital of Xinjiang Uygur Autonomous Region from March 2016 to December 2021 were retrospectively collected and analyzed.Results:A total of 96 CD patients were diagnosed, including 33 men and 63 women. The average age was 47±14 years (range, 18-81 years). The disease occurred mainly in the age group of 31-60 years. The median course of the disease was 2.0 (0.2-40.0) years. There were 41 (42.7%) classical and 55 (57.3%) non-classical CD patients. All patients with classical CD showed chronic diarrhea, often accompanied by abdominal pain (46.3%, 19/41), abdominal distension (17.1%, 7/41), anemia (65.9%, 27/41), and chronic fatigue (48.8%, 20/41). The main manifestations of non-classical CD were chronic abdominal pain (58.2%, 32/55), abdominal distension (32.7%, 18/55), anemia (40.0%, 22/55), and osteopenia/osteoporosis (38.2%, 21/55). Compared with non-classical CD, anemia developed more frequently in classical CD, and the difference was statistically significant ( P = 0.012). The incidence of complications in CD patients was 36.5% (35/96), and the main complications were thyroid disease (19.8%, 19/96), connective tissue disease (6.2%, 6/96), and kidney disease (6.2%, 6/96). There was no significant difference between classical and non-classical CD ( P>0.05). The frequency of endoscopic manifestations in CD patients was 84.4% (81/96). Duodenal bulb endoscopy showed nodular changes (72.9%, 70/96), grooved changes (10.4%, 10/96), and focal villous atrophy (9.4%, 9/96). The main manifestations of descending endoscopy were the decrease, flattening, or disappearance of duodenal folds (43.8%, 42/96), scallop-like changes (38.5%, 37/96), and nodular changes (34.4%, 33/96). Conclusions:Adult CD patients are mostly female. CD occurred mainly in the age group of 31-60 years. The clinical manifestations were mainly those of non-classical CD. Some patients often had other autoimmune diseases. Patients with characteristic endoscopic manifestations should be warned about the possibility of developing CD. Clinicians should strengthen the understanding of CD and reduce the related rates of missed diagnosis.
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Objective:To analyze and summarize the clinical characteristics, endoscopic manifestations, pathology and treatment of gastric adenocarcinoma of the fundic gland(GA-FD)to promote clinicians' understanding of this disease.Methods:The clinical data of 3 patients with GA-FD admitted to Beijing Hospital from May 2020 to January 2022 were retrospectively analyzed.Among them, 2 presented with abdominal distension or abdominal pain.The other case was diagnosed during follow-up endoscopy after gastrectomy for gastric cancer.A diagnosis of GA-FD was made based on the results of white light imaging, magnifying endoscopy, pathology and immunohistochemistry.In addition, we reviewed the literature about GA-FD between January 1990 and April 2021 from both national and international reports of 195 cases.We analyzed and summarized the endoscopic and pathological characteristics of the disease and insights on its diagnosis and treatment.Results:Of all 198 cases, patients had a male/female ratio of 1.6/1.0 and an average age of 65.3 years(range: 39-87 years).79.82%(91/114)of the patients were negative for Helicobacter pylori.Gastroscopy showed that the average diameter was 8.97 mm, and 89.9%(178/198)of the patients had lesions infiltrating into the submucosa.91.98%(149/162)of the patients had gastric chief cells as the predominant cell type, 98.86%(130/140)had no lymphovascular invasion, and 97.6%(162/166)had no recurrence or metastasis.Conclusions:GA-FD is a rare gastric cancer, with low-grade atypia and highly differentiated tissues.The mechanisms of GA-FD are not clear and the disease is more commonly seen in the elderly.There is no obvious correlation between Helicobacter pylori infections and GA-FD.Gastric chief cells make up the predominant cell type.The results of endoscopy, pathology and immunohistochemistry can help confirm the diagnosis.The prognosis of most cases is good.
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Objective:To analyze the difference and clinical significance of reflux related parameters between patients with reflux asthma (RA) and typical gastroesophageal reflux disease (TGERD).Methods:From June 2017 to June 2020, at PLA Rocket Force Characteristic Medical Center, the clinical data of 120 patients with gastroesophageal reflux disease (GERD) who underwent gastroscopy, high-resolution esophageal manometry (HREM) and 24 h pH-impedance monitoring contemporaneously were retrospectively analyzed. The GERD patients were divided into RA group and TGERD group according to the symptom correlated indexes, 60 cases in each group. The reflux related indexes of two groups were compared, which included reflux esophagitis (RE) score, esophageal hiatal hernia, Hill grade score of gastroesophageal flap valve, upper esophageal sphincter (UES) pressure, DeMeester score, and reflux episodes. Mann-Whitney U test and chi-square test were used for statistical analysis. Results:There were no significant differences in RE score and Hill grade score between TGERD group and RA group (0.0, 0.0 to 1.0 vs. 0.0, 0.0 to 1.8; 3.0, 2.0 to 3.0 vs. 3.0, 2.0 to 3.0) (both P>0.05). The detection rate of UES pressure less than 34 mmHg (1 mmHg=0.133 kPa) of RA group was higher than that of TGERD group (41.7%, 25/60 vs. 23.3%, 14/60), and the difference was statistically significant ( χ2=4.596, P=0.032). The UES pressure of RA group was lower than that of TGERD group (51.7 mmHg, 23.6 mmHg to 70.1 mmHg vs. 62.0 mmHg, 37.4 mmHg to 77.4 mmHg), and the difference was statistically significant ( Z=-2.105, P=0.035). There were no significant differences in other parameters of HREM between TGERD group and RA group (all P>0.05). The detection rates of DeMeester score more than 14.7, acid exposure time more than 4.5% and total reflux episodes more than 73 episodes of RA group were all higher than those of TGERD group (41.7%, 25/60 vs. 23.3%, 14/60; 40.0%, 24/60 vs. 21.7%, 13/60; 38.3%, 23/60 vs. 20.0%, 12/60, respectively), and the differences were all statistically significant ( χ2=5.546, 4.728 and 4.881, all P<0.05). The total reflux episodes and weak acid gas reflux episodes of RA group were both higher than those of TGERD group (60 episodes, 43 episodes to 98 episodes vs. 52 episodes, 34 episodes to 69 episodes; 12 episodes, 6 episodes to 21 episodes vs. 9 episodes, 3 episodes to 14 episodes), and the differences were statistically significant ( Z=-2.323 and -2.053, both P<0.05). There were no significant differences in other parameters of 24 h pH-impedance monitoring between TGERD group and RA group (all P>0.05). Conclusion:Low UES pressure, abnormal esophageal acid exposure and increased reflux episodes, especially weak acid gas reflux episodes, may be more likely to induce RA.
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Objective:To further understand the clinical characteristics of scirrhous gastric cancer (SGC)and clear it definitions. Analyzed the clinicopathologic features and prognosis of patients with SGC and Non SGC(NSGC).Methods:The study included 342 gastric cancer patients who had undergone gastrectomy in the Second Hospital University of South China between May 2011 and May 2018. The SGC was diagnosed by endoscopic, CT, tumor stroma ratio and appearance of surgical specimen clinicopathological characteristics were summarized and compared between SGC patients and NSGC using pearson′s χ2 test or student′s t test. Survival curves were estimated with the Kaplan-Meier method. Patients were matched 1∶1 using propensity score matching, and their overall survival rates were compared. Results:A total of 342 patients with gastrectomy were collected, 49 (14.3%) were diagnosed as SGC. Patients with SGC were younger, later pathological stage lymph node metastases tend to occur than those(NSGC). SGC had a higher total gastric resection rate, easier prone to nerve/vascular invasion and omental metastasis ( P<0.01). The median survival of SGC patients and overall survival at 1, 3, and 5 years after surgery were shorter than NSGC patients, which were independent risk factors affecting the prognosis of patients. Conclusions:SGC can be well defined by endoscopy, CT, TSR and tumor appearance. It is a peculiar solid tumor with poor differentiated, advanced stage and poor prognosis. Future research should focus on how to diagnose SGC earlier and intervene in time.
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Objective To verify the feasibility and safety of stomach tumor marker localization based on magnetic tracer technique in dogs.Methods Six male Beagle dogs were examined by gastroscopy.Then tracer magnets were sent to the "tumor" locations assumed in advance and fixed near the "tumors" by endoscopic soft tissue clamp.Laparoscopic gastric tumor localization was performed under general anesthesia 24 hours later.The tracer magnet was placed near the tumor on the surface of the stomach through the operating hole after the conventional establishment of laparoscope puncture parallel mirror to explore the tracer magnet.After the two magnets were attracted,the location of the tracer magnet seen under the laparoscope was the location of the gastric tumor,so as to complete the labeling and positioning of the lesion.Results All the 6 Beagle dogs were successfully implanted with tracer magnets under gastroscopy.Twenty-four hours after the gastroscopy,the pursuit magnet was successfully implanted during laparoscopic surgery.The two magnets automatically attracted each other and formed a sandwich structure of "tracer magnet-gastric wall-pursuit magnet ",which completed the location and identification of gastric tumor under the laparoscopy.Conclusion Gastroscopy combined with laparoscopy based on magnetic tracer technique is simple,accurate,safe and feasible.
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Objective To evaluate the efficacy and safety of X-ray guided endoscopic gastrojejunostomy using stent in treatment of malignant gastric outlet obstruction ( GOO ) . Methods Six hospitalized patients with malignant GOO underwent X-ray guided endoscopic gastrojejunostomy using stent in the department of gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University between March 2017 and June 2017. The technical success rate, clinical success rate, procedure time, adverse events and follow-up were recorded and analyzed in this retrospective study. Results The stent was successfully placed in the 6 patients with 100％ ( 6/6) technical success rate. The mean procedure time was 91. 7±51. 8 min. After the procedure, all patients were fed liquid or semi-liquid diet, and the GOO score system was increased from 0-1 before operation to 2-3 after operation. The clinical success rate was 100％(6/6). Peritonitis was observed in 2 patients during operation, and resolved by abdominal drainage. Gastrointestinal bleeding occurred in 1 patient after operation, which was resolved with conservative treatment. During a mean follow-up period of 78. 6 days (range 32-100 days), there was no recurrence of obstruction symptoms except that 1 patient died because of tumor progress 60 days after procedure. Conclusion The X-ray guided endoscopic gastrojejunostomy using stent is feasible and safe to treat malignant GOO with a reliable short-term efficacy.
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Objective To evaluate the disinfect effects of glutaraldehyde, ortho-phthalaldehyde ( OPA ) and peracetic acid on gastroscopy disinfection. Methods Relevant literature from PubMed, Cochrane Library, web of science, Embase, CNKI, CBM, VIP were retrieved to collect the randomized controlled trials on disinfection by glutaraldehyde, OPA and peracetic acid on gastroscope. Literature was selected according to the inclusion and exclusion criteria. The RevMan 5. 3. 4. 0 statistic software was used to extract data and a meta-analysis was performed. Results A total of 18 RCT were included. There were significant differences in the disinfect effects between the OPA group and the glutaraldehyde group ( OR=2. 02, 95％CI:1. 88-1. 27, P<0. 00001), and between the peracetic acid group and the glutaraldehyde group ( OR = 2. 79, 95％CI:1. 52-5. 11, P = 0. 0009 ) . There were no significant differences in the disinfection effect between the OPA group and peracetic acid group ( OR=1. 30,95％CI:0. 62-2. 73, P=0. 49) . Conclusion The disinfect effects of OPA and peracetic acid are similar, which are superior to glutaraldehyde. Compared with OPA and glutaraldehyde, peracetic acid is a better choice considering its good disinfect effect and low cost.
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Use of a BioEnterics intragastric balloon is a noninvasive,repeatable,low-cost,and safe method that can help in weight reduction. Injection of substances such as saline or air into a part of the stomach leads to a reduction in food intake and delays gastric emptying.This article aims to introduce the clinical application of different types of balloons and summarize the progress in treating obesity.
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Objective To evaluate the clinical control role of magnifying endoscopy with narrow-band imaging plus forceps biopsy for gastric low-grade intraepithelial neoplasia detected by normalendoscopic biopsy. Methods This retrospective study enrolled 142 patients between January 2012 to December 2017, who were diagnosed as gastric LGIN by forceps biopsy in the first endoscopy examination and followed up by endoscopic surveillance. All the cases received endoscopic submucosal dissection or operation. One hundred and forty-two patients were divided into three groups according to different methods used to reexamine, including conventional white-light imaging (C-WLI) plus biopsy group, magnifying endoscopy with narrow-band imaging (ME-NBI) group and magnifying endoscopy with narrow-band imaging (ME-NBI) plus biopsy group. The consistent rate between the endoscopic-reexamined diagnosis and the pathologic diagnosis after ESD or operation in the three groups were compared. According to the pathologic diagnosis after ESD or operation, they were divided into two groups:the non-cancer group and the cancer group, the clinic and endoscopic characteristics between the non-cancer group and the cancer group were analyzed. Results The accuracy, sensitivity, specificity, NPV and PPV were significantly higher in ME-NBI group than those in C-WLI plus biopsy group and ME-NBI plus biopsy group:94.59％vs. 86.76％and 81.08％, 85.71％vs. 62.50％and 75.00％, 100.00％vs. 100.00％and 84.78％, 100.00％vs. 100.00％and 75.00％, 92.00％vs. 83.02％and 86.27％. As for the clinic and endoscopic characteristics, there was no statistically significant difference between the non-cancer group and the cancer group with age of patients, gender of patients, location of lesions, gastric mucosal atrophy, intestinal metaplasia and H.pylori infections (P>0.05). There was statistically significant difference with the size>1 cm, redness, nodularity and depression between the two groups (P<0.05). Conclusions Using the method of ME-NBI plus biopsy, actual high-grade intraepithelial neoplasia or early carcinoma can be differentiated from low-grade intraepithelial neoplasia so that treatment can be performed without delay.For the lesions of the size>1 cm, redness, nodularity and depression, they need to be reexamized as quickly as possible by the method of ME-NBI plus biopsy.
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Objective To explore the clinical efficacy and safety of Hydromorphone combined with Propofol therapy in painless gastroscopy combined with colonoscopy examination in elder patients.Methods Sixty-one patients aged 65-80 years underwent a painless gastroscopy combined with colonoscopy examination in the Affiliated Tumor Hospital of Zhengzhou University from June 2015 to January 2016.The patients were randomly divided into the Hydromorphone combined with Propofol group (Group H,n=31) and the Fentanyl combined with propofol group (Group F,n=30).Results The levels (H vs F group) of VAS at 5,15,30 min after anesthetic recovery were lower in H group thanin F group[(2.4±0.5) vs (3.4±0.6),(2.0±0.5) vs (3.2±0.6),(1.6±0.4) vs (2.6±0.7) respectively,(all P＜0.05)],and those of ramsay sedation scores at 5,15,30,45,and 60 min after anesthetic recovery were lower in H group than in F group[(2.6 ± 0.4) vs (3.3 ± 0.5),(2.3±0.5) vs (2.9±0.4),(2.1±0.3) vs (2.6±0.3),(1.9±0.3) vs (2.2±0.3),(1.8±0.3) vs (2.0±0.3) (all P＜0.05)] respectively.Additionally,the incidence rates (H vs F group) of nausea and vomit (3.2％ vs.26.7％),respiratory depression (0.0％ vs.33.3％) and restlessness (6.5％ vs.30.0％) within 60 min after anesthetic recovery were lower in the group H than in the group F (all P＜ 0.05).However,there were no statistical differences in the indexes of postoperative gastrointestinal function between two groups (all P＞0.05).Conclusions The clinical efficiency of hydromorphone combined with propofol used in painless gastroscopy combined colonoscopy examination is favourable and safe without increasing postoperative adverse reactions in elder patients.Hydromorphone combined with propofol is superior to fentanyl combined with propofol as a general intravenous anesthesia.
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Objective To study the clinical application of laparoscope combined with gastroscope surgery in patients with gastric stromal tumor. Methods The clinical data of 50 patients with gastric stromal tumor were retrospectively analyzed. Among them 20 cases were treated with traditional laparotomy (laparotomy group), and 30 cases were treated with laparoscope combined with gastroscope surgery (combination group). The intraoperative bleeding, operation time, postoperative recovery time, postoperative hospitalization time and complications were compared between 2 groups. Results One case in combination group received open surgery (3.33%, 1/30), mainly because of obesity, and tumor rupture occurred in 1 case during operation. All specimens of the 2 groups had no tumor residue. There were no statistical differences in tumor diameter and operation time between 2 groups (P>0.05); the intraoperative bleeding, postoperative recovery time and postoperative hospitalization time in combination group were significantly lower than those in laparotomy group:(26.33 ± 14.21) ml vs. (42.57 ± 15.67) ml, (37.96 ± 8.80) h vs. (60.14 ± 13.41) h and (6.42 ± 2.80) d vs. (12.04 ± 4.69) d, and there were statistical differences (P<0.05). The 2 groups had no death, stomach bleeding, anastomotic stenosis and anastomotic leakage. The laparotomy group had postoperative incision fat liquefaction in 3 cases and incision infection in 2 cases, and the combination group had pulmonary infection in 1 case. All were cured after symptomatic treatment. Conclusions Laparoscope combined with gastroscope surgery in the treatment of gastric stromal tumors has a short operation time, less blood loss, faster postoperative gastrointestinal function recovery, shorter hospitalization time, and no major complications. It is a more ideal and minimally invasive surgery.
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Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted.Biopsy or surgical pathological findings served as the golden standard.The main outcome measure was the diagnostic accuracy of alarm features.Results Among 921 gastrointestinal outpatients,39 patients (4.2％) with malignancy were detected,including 13 (33.3％) with esophageal cancer,24 (61.5％) with gastric cancer and 2(5.1％) with duodenal ampulla cancer.36 patients (92.3％) were found with advanced cancer.In 137patients who had alarm features,21 (15.3％) were found to have malignancy and all were advanced.The sensitivity,specificity,positive predictive value and negative predictive value of alarm features were 53.8％(21/39),86.8％ (766/882),15.3％ (21/137) and 97.7％ (766/784),respectively.Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy.Noninvasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.
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Objective To evaluate the clinical application of enteral nutrition by nasojejunal tube insertion and by percutaneous endoscopic gastrostomy (PEG) in elderly patients.Methods A total of 65 elderly patients with dysphagia recruited at our department from January 2010 to November 2014 were divided into the nasojejunal tube feeding group (35 cases) and the PEG feeding group (30 cases).Differences between these two groups in nutritional indexes,immunological indexes,complications and mortality were analyzed retrospectively.Results Serum total protein,albumin and prealbumin and upper arm circumferences all increased after treatment with nasojejunal tube feeding or percutaneous endoscopic gastrostomy (P＞0.05).There was overall improvement in nutritional status,as assessed by Nutritional Risk Screening 2002 (NRS2002).Specifically,the before/one month-after-treatment ratio of scores was 3.72±0.91/1.90±0.61 (t=7.24,P＜0.01) for the nasojejunal tube feeding group and 3.52±1.23/2.02±0.53 (t=4.17,P＜0.01) for the PEG feeding group.Compared with NRS2002 scores at one month post-operation,further improvement was achieved at 3 months postoperation both for the nasojejunal tube feeding group (1.89±0.65,t=5.21,P＜0.01) and for the PEG feeding group (1.91±0.62,t=4.40,P＜0.01).There was no difference in the indexes of nutrition,immune status or mortality between the two groups (P＞0.05).Although improvement in CD3+,CD4+,CD8+,CD4+/CD8+,IgA,IgG,and IgM was seen in both groups after operation,the differences did not reach statistical significance (P＞0.05).The incidence of aspiration pneumonia was notably lower (P＜0.05) while the incidence of diarrhea was much higher (P＜0.05) in the nasojejunal tube feeding group than in the PEG feeding group at one month and three months.The two groups had similar causes of death and mortality rates.Conclusion Both nasojejunal tube and PEG feeding can improve the nutritional status of elderly patients with dysphagia.However,the choice for the route of nutrition should be individualized.
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Objective To evaluate the effect of percutaneous endoscopic gastrostomy ( PEG) on the nutritional status and complication rate in patients with enteral nutrition support.Methods Sixty five patients receiving PEG from January 2008 to December 2014 were enrolled in the study.The nutritional status was examined and the incidence of complications was documented before and after PEG.Results The serum albumin, body mass index (BMI) and arm muscle circumference were (29.2 ±3.2)g/L, (18.0 ± 1.0)kg/m2, (21.1 ±1.9)cm and (32.9 ±3.0)g/L, (18.8 ±1.6)kg/m2, (23.0 ±3.0)cm before and 1 month after PEG, respectively (t=-6.798, -3.202 and -3.957, all P<0.05).Compared to those before PEG, the serum albumin, BMI and arm muscle circumference at 3 and 6 months after PEG were increased to ( 35.4 ±4.9 ) g/L, ( 19.7 ±1.4 ) kg/m2 , ( 24.9 ±2.2 ) cm ( t =-7.845, -7.202,-10.432, all P<0.05) and (37.9 ±3.7)g/L, (20.7 ±1.6)kg/m2, (26.9 ±3.7)cm (t=-14.046,-10.686, -9.827, all P<0.05), respectively.Compared to those with nasal feeding, the incidence of aspiration pneumonia was decreased from 62% ( 40/65 ) to 18% ( 10/57 ) and the incidence of reflux esophagitis was decreased from 51% (33/65) to 19% (11/57) 6 months after PEG, respectively (χ2 =24.3 and 13.5, all P<0.01).Conclusion PEG can improve nutritional status and reduce the incidence of aspiration pneumonia and reflux esophagitis for patients with enteral nutrition support.
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Objective To evaluate the association of gastric hyperplastic polyps with colorectal neo-plasia.Methods Data of consecutive patients who underwent esophagogastroduodenoscopy (EGD)and colonoscopy between January 2011 and December 2013 were reviewed retrospectively.They were compared with patients without gastric polyps who also underwent EGD in the same period.The relationship between gastric polyps and colorectal neoplasia was analyzed.Results The incidence of colorectal neoplasia in gas-tric hyperplastic polyps group was higher than that of the control group [24.0% (46 /192)VS 10.4%(40 /384),P =0.000].An increased incidence of colorectal adenomas in gastric hyperplastic polyps group was found,but there was no difference in the incidence of colorectal cancer in gastric hyperplastic polyps group and control group[2.1%(4 /192)VS 2.3%(9 /384),P =1.000].Stratification analysis suggested that the incidence of colorectal neoplasia in gastric hyperplastic polyps group who aged over 50 was signifi-cantly higher than that in the control group[28.5%(43 /151)VS 10.6%(29 /274),P =0.017],regard-less of different genders and the number of gastric hyperplastic polyps.Conclusion The incidence of color-ectal neoplasia in gastric hyperplastic polyps has significantly increased,especially in those aged over 50 years,regardless of different genders and the number of gastric hyperplastic polyps.Such patients should undergo colonoscopy to detect colorectal neoplasia.
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Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholan-gioscopy (PDCS)using an ultra-slim upper endoscopy assisted by a snare.Methods Between November 2014 and January 2015,8 patients underwent PDCS with assistance of an ultra-slim endoscopy.After endo-scopic papillary balloon dilation,the duodenoscopy was withdrew,an ultra-slim endoscopy was inserted di-rectly into the biliary tract assisted by a snare,and biopsy or laser lithotripsy was performed.The snare was closed tightly in the bent portion of the scope,and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation,in order to advance the scope into common bile duct.Results PDCS succeeded in all eight cases,one common hepatic duct adenoma was diagnosed by biopsy,and con-firmed by surgery;one benign biliary stricture was diagnosed by PDCS;laser lithotripsy was successfully per-formed in 4 patients with large CBD stones;bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones.No perforation,bleeding or post-operative pancreatitis was found.Con-clusion PDCS using an ultra-slim gastroscopy assisted by a snare is a safe,simple and practical procedure in the diagnosis and treatment of biliary tract diseases.
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Objective To investigate the feasibility,safety and efficacy of laparoscopic and endoscopic cooperative surgery (LECS) for elderly patients with gastric gastrointestinal stromal tumor (GIST).Methods 54 cases with GIST aged 65 years and over in Department of Gastrointestinal Surgery in Beijing Hospital from Dec.2008 to Dec.2012 were selected.31 cases underwent LECS and 23 cases underwent open surgery.Clinical data including operation time,intraoperative blood loss,complications,tumor size,length of incision,postoperative gastrointestinal function recovery time,postoperative in hospitalization and follow up data were retrospectively analyzed in patients.Results There were 17 males and 14 females in the LECS group,and the mean age was (72.8±5.9)years.29 patients underwent laparoscopic-assisted partial gastrectomy,and 2 cases underwent laparoscopicassisted endoscopic dissection in LECS group.All operations were successful with no conversion to open surgery and death.There were 13 males and 10 females in the open surgery group,and the mean age was(73.3±6.1)years.The mean operation time was longer in LECS group than in open surgery group [(120.6±32.8) min vs.(86.3±33.5) min].The mean intraoperative blood loss,mean tumor size,mean length of incision,mean time of gastrointestinal function recovery,mean postoperative hospitalization were less or smaller in LECS group than in open surgery group [(40±23.4) ml vs.(130±65.6) ml,(2.3±1.2)cm vs.(3.6 ±1.8)cm,(3.6±1.1) cm vs.(14.4±3.5) cm,(47.7± 10.4)h vs.(61.4±11.9)h,(5.1±2.3)d vs.(7.2±2.5)d,respectively,t=3.192,1.831,5.212,2.014,3.519,P=0.002,0.012,0.000,0.015,0.001].According postoperative tumor risk assessment,13 cases were at very low risk,15 cases at low risk and 3 cases at middle risk in LECS group; 4 cases were at very low risk,14 cases at low risk and 5 cases at middle risk in open surgery group.The risk degree was lower in LECS group than in open surgery group (x2 =5.63,P=0.017).During a follow-up of 5 53 months,death without GIST was found in 5 patients in LECS group and 4 cases in open surgery group.Hepatic metastasis was found in 1 case in open surgery group.Conclusions LECS is a safe and feasibility alternative approach for elderly patients with gastric GISTs.It has more minimal invasion,fast recovery and satisfaction with short term outcomes as compared with conventional open surgery.
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Objective To investigate the diagnostic and therapeutic value of peroral cholangioscopy for residual stones after retrograde chalangiopancreatography (ERCP).Methods The soft-tipped guidewire (0.021in) was linked to 3-0 silk thread on the front of extraction balloon catheter outside as a guide device.After retrograde chalangiopancreato-graphy (ERCP) for common bile duct stones,extraction balloon with the guide device was sent to intrahepatic bile duct by duodenoscopy,and residual stones were observed and removed with a stone basket directly under ultrathin upper endoscope if the residual stones were small ; if the stones were large,they were crushed with electrohydraulic lithotripsy before being removed.Results The ultrathin upper endoscope were successfully inserted into hilar bile duct in 42 cases of 46 patients,and failed in 4 cases,and the success rate of insertion was 91.3％.The mean time was 11.3 min from the mouth into hilar bile duct.Stones were found larger than 4 mm in diameter in 6 of 42 patients,and stone residual rate was 14.3％.The biggest stone was 10 mm× 12 mm in diameter.Stones were found in in 2 of 27 patients after ERCP,and the stone residual rate was 7.4％.Stones were found in 4 of 15 patients after ERCP basket lithotripsy,and the stone residual rate was 26.7％.Stones were removed directly in 5 in 6 cases with extraction basket,they were crushed in 1 case by electrohydraulic lithotripsy and then removed with basket.No serious complications were observed.Conclusion The application of peroral cholangioscopy using an ultrathin upper endoscope is feasible.The method is a useful endoscopic procedure for extraction of residual stones,which helps to avoid repeated treatment.