Effectiveness of S-curve leakage testing method on flexible endoscope / 中华消化内镜杂志

To investigate the effects of the S-curve leakage testing method on the detection of flexible endoscope and occurrence of medium to high-level faults of flexible endoscope. A convenience sampling method was used to study the information of endoscopic leak detection at the digestive endoscopic centre of the First Affiliated Hospital of Air Force Medical University. From July 2016 to December 2017, 58 endoscopes which received conventional leakage testing were set as the control group (29 116 tests). From January 2018 to June 2019, 56 endoscopes which received S-curve leakage testing were set as the observation group (28 112 tests). The results showed that the detection proportion of angular abnormalities in the observation group was higher than that in the control group [65.6% (59/90) VS 40.4% (36/89), χ2=11.330, P<0.001]. However, the detection proportion of medium to high-grade faults such as damaged charge coupled device (CCD) components and broken insertion section in the observation group was lower than that in the control group [0.04% (10/28 112) VS 0.08% (23/29 116), χ2=4.680, P=0.030]. Moreover, the overall maintenance cost was lower in the observation group than that in the control group (313.7 thousand yuan VS 942.6 thousand yuan). It is indicated that the S-curve leakage testing method can detect low-level endoscopic faults early such as angular abnormalities, and reduce the occurrence of medium to high-level endoscopic faults, which contributes to cost reduction and efficiency increase.

Retrospective analysis of endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy / 中华消化内镜杂志

Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) after pancreaticoduodenectomy and endoscopic selection strategies.Methods:Clinical data of 34 patients treated with ERCP after pancreaticoduodenectomy at the Endoscopic Center of the First Affiliated Hospital of Air Force Medical University from January 2013 to December 2021 were retrospectively analyzed. The success rates of endoscopic insertion, diagnosis, treatment and ERCP, and the incidence of adverse events were analyzed.Results:Fifty ERCP treatments were performed in 34 patients. The success rates of endoscopic insertion, diagnosis, treatment, and ERCP after pancreaticoduodenectomy were 92.0% (46/50), 93.5% (43/46), 88.4% (38/43) and 76.0% (38/50), respectively. The success rates of ERCP assisted with colonoscope and balloon-assisted enterosocpe were 76.0% (19/25) and 75.0% (18/24), respectively. There were 3 adverse events, including 1 case of anastomotic mucosa tear during surgery, 1 case of cardiopulmonary arrest and 1 case of postoperative cholangitis.Conclusion:ERCP is effective and safe after pancreaticoduodenectomy in general. ERCP assisted with colonoscope and balloon-assisted colonoscope shows similar success rate after pancreaticoduodenectomy.

Clinical analysis of endoscopic retrograde cholangiopancreatography biliary stent implantation in treatment of malignant biliary stricture / 肿瘤研究与临床

Objective:To explore the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) biliary stent implantation in patients with unresectable malignant biliary stricture (MBS) and the influencing factors of overall survival.Methods:The clinical data of 346 patients who underwent ERCP biliary stent implantation due to MBS from May 2013 to October 2016 in Xijing Digestive Disease Hospital of Air Force Military Medical University, Shanxi Bethune Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University were retrospectively analyzed, and the efficacy, complications and risk factors affecting overall survival were also analyzed.Results:After ERCP biliary stent implantation, the levels of total bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase and alanine aminotransferase were lower than those before surgery (all P < 0.01). The incidence of infection after operation was 14.7% (51/346), and the incidence of biliary infection was 13.0% (45/346). The incidence of post-ERCP pancreatitis (PEP) was 4.6% (16/346). The median survival time after ERCP was 131.0 d (70.3 d, 246.5 d). Multivariate Cox regression analysis showed that the independent risk factors affecting the overall survival patients included the hilar bile duct stenosis ( HR = 1.85, 95% CI 1.44-2.38, P < 0.01), preoperative bilirubin level exceeding the upper limit of normal level by 5 times ( HR = 1.75, 95% CI 1.30-2.36, P < 0.01), carbohydrate antigen 199 level exceeding the upper limit of normal level by 10 times ( HR = 1.27, 95% CI 1.00-1.61, P = 0.050), vascular and organ metastasis ( HR = 1.32, 95% CI 1.04-1.69, P = 0.023), and the poor jaundice decreasing level ( HR = 1.37, 95% CI 1.02-1.85, P = 0.037) . Conclusions:The ERCP biliary stent implantation is a safe and effective therapy for MBS. ERCP biliary stent implantation MBS patients with hilar bile duct stenosis, preoperative bilirubin levels more than 5 times of the upper limit of normal level, carbohydrate antigen 199 levels more than 10 times of the upper limit of normal level, vascular and organ metastasis, and poor jaundice decreasing level may have poor overall survival.

Therapeutic value of endoscopic retrograde cholangiopancreatography for liver cirrhosis combined with biliopancreatic diseases / 中华消化内镜杂志

Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for patients with liver cirrhosis combined with biliopancreatic diseases.Methods:Data of 99 patients with liver cirrhosis combined with biliopancreatic diseases who received ERCP at Xijing Digestive Hospital from November 2008 to December 2017 for the first time were retrospectively studied. Success rate of ERCP and incidence of complications were analyzed.Results:The 99 cases of liver cirrhosis were mainly caused by hepatitis B virus infection (40.4%, 40/99) and unknown reasons (30.3%, 30/99), and the mean model for end-stage liver disease score was 15.4±5.3. The common bile duct stones and bile duct stricture were the most common biliopancreatic diseases, accounting for 49.5% (49/99) and 33.3% (33/99), respectively. The success rate of ERCP was 100.0%(99/99). The total postoperative complication incidence was 14.1% (14/99), among which liver cirrhosis-related complications was 3.0% (3/99); ERCP-related complications was 11.1% (11/99), including 9.1% (9/99) biliary tract infection, and 2.0% (2/99) delayed bleeding. No post-ERCP pancreatitis, perforation or death occurred.Conclusion:ERCP is safe and effective for liver cirrhosis combined with biliopancreatic diseases.

Comparison of efficacy and safety between percutaneous drainage and endoscopic drainage in 153 cases of pancreatic pseudocysts / 中华消化杂志

Objective To investigate the clinical outcome of pancreatic pseudocyst(PPC)treated with non-surgical methods,and to compare the efficacy and safety between percutaneous drainage and endoscopic drainage in the management of PPC.Methods From February 2010 to July 2017,clinical data of patients with PPC,who received percutaneous drainage or endoscopic drainage,were retrospectively analyzed.The symptom relief rate,short-term and long-term radiologic remission rate,complication rate, recurrence rate and length of hospital stay were compared between patients treated by ultrasound guided percutaneous drainage(percutaneous group),by endoscopic ultrasonography-guided drainage(EUS group)and by endoscopic retrograde pancreatography guided transpapillary drainage(ERP group).Two independent samples t test,one-way analysis of variance,non-parametric test and Fisher′s exact test were performed for statistical analysis.Results A total of 153 patients were treated and the operation was successfully conducted in 148 patients(96.7%),of whom 39 were in percutaneous group,73 in EUS group and 36 in ERP group.The median follow-up time was 26 weeks(two weeks to 358 weeks).The symptom relief rate,long-term radiographic remission rate,complication rate,recurrence rate and retreatment rate of percutaneous group,EUS group and ERP group were 87.2%(34/39),79.5%(58/73),80.6%(29/36);81.5%(22/27),88.6%(39/44),66.7%(16/24);17.9%(7/39),28.8%(21/73),16.7%(6/36);15.0%(3/20),13.8%(8/58),10.0%(2/20);and 10.3%(4/39),8.2%(6/73),2.8%(1/36),respectively.There was no statistically significant difference among three groups (all P> 0.05).The short-term radiographic remission rate of ERP group was significantly lower than those of percutaneous group and EUS group(46.7%,14/30 vs 77.1%,27/35 and 87.7%,64/73),and the differences were statistically significant(χ2 =6.442 and 19.450,both P<0.01).The median hospital stay of percutaneous group was longer than those of EUS group and ERP group(14.0 days vs 9.0 days and 8.0 days),and the differences were statistically significant(Z= -3.687 and -2.630,both P<0.01).Conclusions The efficacies of percutaneous drainage and EUS-guided drainage are both better than ERP,and they are effective and safe methods especially for the patients with complication of pseudocysts and necrosis debris in pseudocysts.However,the hospitalization time of percutaneous drainage is longer. In addition,percutaneous drainage can be an alternative method after failed endoscopic drainage.

The diagnostic value of automated quantitative DNA cytometry for pancreatic malignancy / 中华消化内镜杂志

Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.

Advances in endoscopic retrograde cholangiopancreatography / 临床肝胆病杂志

Endoscopic retrograde cholangiopancreatography(ERCP)is a well-established advanced endoscopic technique for the diagnosis and treatment of pancreatobiliary diseases. New advances have been made in the treatment concept and techniques of ERCP in recent years. This article elaborates on the recent advances in ERCP,including the application of pancreatic duct stent,non-steroidal anti-inflammatory drugs,and aggressive hydration to prevent postoperative pancreatitis,covered metal stent for the treatment of benign bile duct stenosis,in-traluminal radiofrequency ablation for malignant bile duct stenosis,extracorporeal shockwave lithotripsy and covered metal stent for the treat-ment of chronic pancreatitis,peroral choledochoscopy for qualitative diagnosis of bile duct stenosis and huge refractory stones,definition of difficult intubation,timing of pre-cut technique,and ERCP after gastrointestinal reconstruction.

COMTH score for the survival of patients with malignant biliary stricture: a retrospective study / 中华消化内镜杂志

Objective@#To investigate the history, risk factors for prognosis of malignant biliary stricture (MBS) patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival (OS).@*Methods@#MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort.@*Results@#Between January 2009 and December 2013, 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort, tumors were mainly originated from bile duct (33.6%), pancreas (23.5%) or ampulla (20.4%). 76.3% (116/152) patients died during the observation period. The median OS for the training population was 5.0 months (3.9-6.2 months). CA19-9≥1 000 U/mL, non-ampulla tumor, metastasis, pre-ERCP total bilirubin≥7 mg/dL and hilar stricture were identified as independent predictive factors of poor OS (all P<0.05). Based on these factors, the COMTH predictive model was developed. The median OS of patients with COMTH>8 in the training and validation cohorts were both 3.0 months, which were significantly shorter than those with COMTH≤8 (10.0 and 6.9 months in the training and validation cohorts respectively, both P<0.001).@*Conclusion@#The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH>8 is even more dismal.

Effects of cannulation time on post-endoscopic retrograde cholangiopancreatography pancreatitis / 中华消化内镜杂志

Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.

Risk factors influencing cannulation success rate of hands-on training of endoscopic retrograde cholangiopancreatography / 中华消化内镜杂志

Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve thelevel of ERCP training.Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed.Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees.Results There were 1 165 and 28 patients undergoing common biliary duct (CBD) cannulation and pancreatic duct(PD) cannulation respectively.The success rate of CBD cannulation by trainees was 58.5％(681/1 165)and the overall success rate was 97.9％(1 140/1 165).PD cannulation success rate by trainees was 39.3％ (11/28) and the overall success rate was 89.3％ (25/28).The overall complication incidence was 8.0％ (96/1 193)and the incidence of post-ERCP pancreatitis was 4.4％(53/1 193).Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture(OR =0.44,95％CI:0.28-0.67,P＜0.01),benign or undetermined biliary stricture(OR =0.32,95％ CI:0.17-0.60,P＜ 0.01),suspected sphincter of Oddi dysfunction(SOD) (OR =0.28,95％ CI:0.16-0.47,P＜ 0.01),coexisting hypertension (OR =0.65,95 ％ CI:0.44-0.96,P＜0.05),RDW ≥ 48 fL (OR =0.69,95％ CI:0.51-0.92,P＜ 0.05),PLT＜ 100 × 109/L (OR=1.68,95％CI:1.05-2.71,P＜0.05).Conclusion Biliary stricture,suspected sphincter of Oddi dysfunction,coexisting hypertension,abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training.

Whole-process management of perioperative period is crucial for ERCP / 天津医药

Endoscopic retrograde cholangiopancreatography (ERCP) is the most challenging technique of gastrointestinal endoscopy. Patients are most likely to benefit from this mini invasive treatment, meanwhile they bear high risk of complications, which might be life-threatening. Standard operation, standardized training, quality control and whole-process management of perioperative period are critical factors for ERCP training, and should be popularized in medical centers, where ERCP are performed. This paper has illustrated the whole-process management of perioperative period for ERCP, including preoperative preparation, decision-making during operation, postoperative management, as well as prevention and treatment of complications. By performing whole-process management of ERCP, patient can benefit more from ERCP operation, and which will serve more patients.

Accuracy of endoscopic ultrasonography for evaluating minimal submucosal invasion of early gastro-intestinal tumor / 中华消化内镜杂志

Objective To explore the diagnostic value of endoscopic ultrasonography(EUS)for the minimal submucosal invasion of early gastrointestinal tumor. Methods A total of 242 patients with early gastrointestinal tumor,who underwent endoscopic submucosal dissection,were retrospectively analyzed. The accuracy of EUS diagnosis was calculated based on postoperative histopathological findings as the golden standard,and influencing factors were also analyzed. Results Overall diagnostic accuracy of EUS for sub-mucosal invasion of early gastrointestinal tumors was 72. 3%(175/ 242),with an overstaging rate of 21. 5%(52/ 242)and an understaging rate of 6. 2%(15/ 242).Tumor size(P = 0. 018)and location(P = 0. 005) had significant effects on the diagnostic accuracy of the minimal submucosal invasion of early gastrointestinal tumor by EUS. The overstaging rate in the lesion length of diameter>3 cm was higher than those of 3 cm or less[27. 0%(33/ 122)VS 15. 8%(19/ 120),P = 0. 807],the overstaging rates of early colonrectal and gastric cancer were also significantly higher than the understaging rate[ Colonrectum:12. 2%(9/ 74)VS 2. 7%(2/ 74),P= 0. 028;Stomach:26. 9%(28/ 104)VS 2. 9%(3/ 104),P = 0. 000]. Conclusion Endoscopic ultrasonography is of diagnostic value for the invasion depth of early cancer in gastrointestinal tract. However,precaution should be taken in large lesions and the tendency of overstaging in gastrointestinal tract.

A national survey of ERCP training in China / 中华消化内镜杂志

Objective To investigate the current popularity of ERCP training in China.Methods A questionnaire-based survey was performed on a professional survey website.A total of 48 questions were designed,including personal information,training information,current status of ERCP performance and sug-gestions to ERCP training.The questionnaire was completed anonymously by physicians who fulfilled full-time ERCP training in any Chinese endoscopy center for at least 1 year before.Results A total of 464 phy-sicians,from all the regions of mainland China,among which 362 people completed all the questions.More than two thirds trainees thought that they had got fruitful training and 27.4% trainees had their ERCP vol-umes greatly increased and 64.3% trainees increased practice.According to related index,the physicians who were competent in routine ERCP performance were 84.5%,with outstanding operators of 12.2%.Con-clusion China has made great progress in the training program of ERCP technique in recent decades,but problems still remain such as various admission standard,insufficient training duration,incomprehensive program,as well as lack of evaluation and follow-up system.

Placement of biliary self-expandable metal stents after metal stenting in duodenum / 中华消化内镜杂志

Objective To explore the success rate and failure risk factors of biliary stenting on the patients with type Ⅰor Ⅱ duodenal malignant stricture treated by self-expandable metallic stent (SEMS). Methods A total of 36 patients with unresectable duodenal stricture after endoscopic SEMS placement be-tween February 2010 and February 2014 at Xijing Digestive Disease Hospital were enrolled.These patients underwent ERCP biliary metal stenting subsequently due to the malignant biliary stenosis.The clinical and imaging features of these patients were retrospectively analyzed.Results ERCP biliary stenting was suc-cessfully completed in 66.7% of patients with previous duodenal SEMS treatment.The success rates of pa-tients with type Ⅰ and Ⅱ duodenal stricture were 88.0% and 18.2% respectively(P <0.001).The suc-cess rates of patients with different lengths of duodenal stenosis were 88.9% for <3.5 cm and 44.4% for ≥3.5 cm (P =0.005).Compared with 80 or 90 mm duodenal stent,patients with 60 mm stent had a higher completion rate for ERCP biliary stent (88.0% VS 18.2%,P <0.001).Multivariate logistic regression a-nalysis revealed that length of duodenal stenosis ≥3.5 cm and 80 or 90 mm duodenal stent were independent factors for failure of ERCP in patients with previous SEMS placement.Conclusion For unresectable DMS patients with SEMS placement,subsequently ERCP biliary metal stenting is safe and effective.The length of duodenal malignant stenosis and longer duodenal stent are high-risk factors for the failure of ERCP biliary stenting.

Safety and tolerability of ERCP for elderly patients in diagnose and therapy / 局解手术学杂志

Objective To analyze the safety and tolerability of endoscopic retrograde cholangiopancreatography ( ERCP) for elderly pa-tients in diagnose and therapy. Methods From Jan. 2010 to Dec. 2013, 1 560 patients were collected in our hospital for diagnosis and treatment, 1 116 cases were 60~69 years old, and the other 444 cases were over 70 years old. Retrospective data including clinical and bio-chemical characteristics, ERCP diagnosis and complications were analyzed. Results Using Logistic regression, the potential factors of com-plex multivariable were analyzed, and there was no statistical difference between the two groups (P=0. 039). The successful intubation, in-tubation difficulties and failed intubation in the examination and the treatment were of significantly difference between the two groups (P0. 05), but the ERCP diagnosis, postoperative complications and complications of acute pancreatitis were of certain difference (P<0. 05). Patients over 70 years old were of better tolerance, but their bile duct stones was about two times than that in patients of 60~69 years old (P=0. 004). Conclusion The results show that ERCP for elderly patients in diagnose and therapy is safe and well tolerated, and there were relatively less complications in patients over 70 years old.

Clinical analysis on combination therapy of ERCP and EST for elderly patients with choledocholithiasis in 256 cases / 局解手术学杂志

Objective Objective To analysis the clinical curative effect on elderly patients with choledocholithiasis by endoscopic retro-grade cholangiopancreatography ( ERCP) and endoscopic sphincterotomy ( EST) and discuss its clinical significance. Methods 256 patients with choledocholithiasis were collected for diagnosis and treatment by ERCP. The stone characteristics was mastered by ERCP and the pa-tients were treated with EST. Results Patients with choledocholithiasis were successful in 249 cases (97. 27%) for ERCP intubation and 239 cases (93. 36%) for stone remove. After EST,the stones were removed successfully at one time in 199 cases (83. 26%),2 times in 40 cases (16. 74%). 7 patients (2. 73%) with multiple diverticulum and papillary position poor by intubation failure were changed over to op-eration treatment. After ERCP,patients were performed endoscopic nasobiliary drainage (ENBD) 64. 44% (154/239). Pull out the drain-age tube of 90. 91% (140/154) of the patients after stones disappeared which was proved by angiography for 3~5 days. 14 cases (9. 09%) were performed second times to remove the stones due to the presence of residual stones. Postoperative complications occured in 15 cases (6. 02%) including 9 cases of acute pancreatitis and 6 cases of infection of biliary tract, and they were cured after 1 week of corresponding treatment. Transient increase of serum amylase occurred in 39 cases, and all of them recoveried after 3 days without special treatment. Con-clusion The results showed that ERCP ( or EST) were well tolerated by elderly patients with choledocholithiasis,and they were of obvious curative effect and quick recovery,which is worthy of promotion and application.

Clinical features and endoscopic management of non-iatrogenic hemobilia / 中华消化内镜杂志

Objective To investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) management in the diagnosis and treatment and illustrate clinical features of non-iatrogenic hemobi lia.Methods A total of 35 patients diagnosed as hemobilia via endoscope from August 2009 to September 2012 were reviewed retrospectively.Patients with iatrogenic causes of hemobilia were excluded in this study.Results The clinical features of hemobilia mainly included jaundice (77.1％),abdominal pain (62.9％),hematemesis (5.7％),melena (2.9％) and hematochezia (2.9％).Quincke triad was found in 4 patients with hemobilia.Hemobilia were caused by hepatobiliary malignancies in 29 patients and benign biliary tract diseases in the other six.Biliary obstruction caused by hemobilia was successfully ameliorated by ERCP in 34 patients.Postoperative pancreatitis ocurred in 1 patient.Conclusion The common noniatrogenic causes of hemobilia were hepatobiliary and pancreatic malignancies.ERCP is recommended as the initial management to confirm the hemobilia and solve biliary obstruction.

Transvaginal appendectomy by endoscopy in canine models / 中华消化内镜杂志

Objective To evaluate the technical feasibility and safety of transvaginal appendectomy by endoscopy in canine models.Methods Six female dogs weighing between 12-15 kg underwent transvaginal appendectomy by endoscopy.A small incision at posterior fornix of the vagina was made endoscopically by a needle knife and then dilated by a balloon dilator.After the endoscope entered the peritoneal cavity,the appendicular artery was clipped and the appendix was dissociated,and then the free appendix was ligated by an endoloop near root and removed by snare cutting.The appendix was then removed through the vaginal port.Finally,the vaginal incision was closed by clipping and endolooping.Two weeks after the procedure,the animals were sacrificed for anatomic investigation.Results Endoscopic transvaginal appendectomy was successfully performed in all animals with a mean operating time of (94.2±41.8) min.Complicated bleeding occurred in 1 dog and rectal burn in another during the operation.All the experimental animals survived the post operative period for 2 weeks without any complications.Post mortem examination revealed that the wound and vaginal incision healed well.Conclusion Transvaginal appendectomy by endoscopy is safe and feasible in a canine model,while further study and progression of appropriate accessories are needed for future clinical use.

Adjustable loop-based purse-string technique in NOTES gastrotomy closure / 中华消化内镜杂志

Objective To assess the feasibility and safety of adjustable loop-based purse-string technique in gastrotomy closure of natural orifice translumenal endoscopic surgery (NOTES).Methods Ten healthy female dogs were used in this study.Transgastric NOTES peritoneal exploration was performed in 5 groups (2 dogs in each) via various sites of the stomach ( greater curvature of the antrum; greater and lesser curvature of the body; anterior and posterior wall of the body).The gastric incision was then closed by using loop-based purse-string technique.Healing of the incision and intra-peritoneal infection were checked by endoscopy,necropsy,bacterial culture and histological examination 2 weeks later.Results The performance of NOTES peritoneal exploration and closure with purse-string technique was successful in ten dogs without significant complications.The mean operation time of closure was 7.3 ± 1.8 min.Minor bleeding occurred in 2 dogs (20％) during the incision of greater curvature of the antrum and body,which was controlled by electrocoagulation.Culture of the ascitic fluid and necropsy revealed no sign of abdominal infection or other complications except for adhesion in 1 dog ( 10％ ).The intact incision was confirmed by endoscopic,postmortem and histological examination,which suggested complete healing of the incision.Conclusion It is easy and safe to use loop-based purse-string technique for closure of multi-regional NOTES gastrotomy.This technology may be used for the repair of gastric ulcer perforation theoretically.

Clinical efficacy and safety of therapeutic ERCP for patients over 80 years / 中华消化内镜杂志

Objective To investigate the efficacy and complications of therapeutic ERCP for patients over 80 years. Methods Data of 80 patients aging over 80 years, who tnderwent therapeutic ERCP from August 2007 to August 2009 were retrospectively studied. The etiology, complications and therapeutic effects were evaluated. Results A total of 51 patients (63. 8% ) were accompanied by cardiovascular diseases, and 43 patients were diagnosed as having malignant bile duct stricture (53. 8% ). The overail therapeutic efficacy was 96. 3%. The incidence of post-operative complications was 12. 5% (10/80). Occurrence of complications in patients with malignant tumors ( 18. 6% ) was significantly higher than that in patients with bile duct stones (5.6% ,P ＜0. 05). Incidence of complications in those with cardiopulmonary diseases was similar with that in patients without (11.8% vs. 13.8%,P＞0.05). Conclusion Age more than 80should not be considered as contraindication of ERCP. Therapeutic ERCP is effective in senior patients. Patients with advanced ages shows a relatively high incidence of complication after ERCP, which may not be related to other accompanying diseases.