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In September 2023， the European Society for Medical Oncology published Pancreatic cancer： ESMO Clinical Practice Guideline for diagnosis， treatment and follow-up in Annals of Oncology. The guideline provides recommendations on the epidemiology， diagnosis， and treatment of pancreatic cancer （PC）. The guideline highlights the high-risk populations of PC and recommended screening methods， clarifies the diagnostic process of PC and various radiological and molecular biology tests， and mentions the appropriate treatment methods for different types of PC. This article makes an excerpt of this guideline and introduces related recommendations for the clinical treatment of PC， in order to provide a reference for clinical practice.
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Objective:To evaluate the value of endoclip-assisted and submucosal injection-assisted cannulation techniques for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP).Methods:Data of 12 458 patients treated with ERCP for the first time in the First Affilated Hospital of Naval Medical University from June 2015 to September 2020 were retrospectively analyzed. Twenty eight (0.22%) were identified as difficult cannulation where metal clip- or submucosal injection-assisted cannulation was used. The selective cannulation success rate, intubation time and complication incidence of the two techniques in difficult cannulation patients were analyzed.Results:Difficult cannulation was performed in 18 males (64.3%) and 10 females (35.7%) with an age of 69.6±14.1 years assisted by metal clips or submucosal injection. Five cases (17.9%) were type Ⅱ, 5 cases (17.9%) type Ⅲ, and 18 cases (64.3%) type Ⅴ according to papilla classification. Sixteen patients (57.1%) received metal clip-assisted cannulation, and 12 cases (42.9%) submucosal injection-assisted cannulation. Twenty-five (89.3%) patients successfully underwent selective cannulation with the cannulation time of 9.9±4.3 min. One case (3.6%) of mild post-ERCP pancreatitis and 3 cases (10.7%) of post-ERCP hyperamylasemia occurred. No postoperative bleeding or perforation occurred. All patients were cured and discharged after conservative treatment.Conclusion:When selective cannulation is difficult due to poor papilla exposure or deflection, endoclip- or submucosal injection-assisted cannulation can effectively improve the successful selective cannulation rate during ERCP with low complication incidence, which is worth of clinical promotion.
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Objective:To investigate the effect of air sterilization station on air quality control of digestive endoscopy center through a national multi-center dynamic monitoring research.Methods:This study was conducted jointly with 15 digestive endoscopy centers in different regions of China. Each center selected 2 endoscopy rooms using level 4 and level 3 digestive endoscopy techniques, one with an air sterilization station (the experimental group) and the other without the device (the control group). The concentrations of PM 5 and PM 0.5 in the rooms before and after the use of air sterilization station were detected and compared. Results:The air quality of all research units failed to reach the standard air cleanliness level 8 without using air sterilization station. After using the air sterilization station, the PM 5 concentration and PM 0.5 concentration of the experimental group in each center under dynamic conditions were lower than those of the control group, and the difference was significant ( P<0.05). The PM 5 concentration and PM 0.5 concentration in the experimental group at each center showed a decreasing trend with start-up time, with significant difference at different start-up times ( P<0.05). The PM 5 concentration could reach the air cleanliness level 8 standard 15.7 minutes after the air sterilization station started, and the PM 0.5 concentration could reach the air cleanliness level 8 standard 25.0 minutes after the air sterilization station started. Conclusion:In the dynamic environment of the digestive endoscopy center, the air sterilization station can significantly improve the air quality in the endoscopy rooms, which is worth promoting in endoscopy rooms of medical institutions of all levels.
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Objective:To evaluate the services, quality and safety of digestive endoscopy in China in 2020.Methods:Data of digestive endoscopy in 2020 collected by the national medical quality information network were included. After data quality evaluation, the basic information of digestive endoscopy centers in different types of hospitals, the diagnosis and treatment of digestive endoscopy, the process and outcome indicators of digestive endoscopy were analyzed and compared.Results:A total of 3 714 hospitals were included in this survey. The digestive endoscopy operations completed by each hospital was 3 562.5 (1 299.75, 8 426.75), the digestive endoscopists was 4 (2, 7), and the endoscopic operations completed per capita per year was 900 (500, 1 452). The detection rate of early gastrointestinal cancer was 17.46% (110 069/630 265). The success rates of cecal intubation under colonoscopy and selective intubation of endoscopic retrograde cholangiopancreatography were 95.43% (6 976 521/7 310 970) and 94.21% (121 666/129 149) respectively. The complete resection rate of endoscopic submucosal dissection was 92.68% (93 536/100 924). The incidence of serious complications related to digestive endoscopic operations [0.05‰ (1 316/26 499 108)] and mortality [0.003‰ (80/26 499 108)] remained at a low level.Conclusion:The quality and safety of digestive endoscopy in China in 2020 is improved, but there are still some problems, such as the shortage of digestive endoscopists, the poor ability of endoscopists in the diagnosis of early gastrointestinal cancer.
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Objective:To investigate the current status of endoscopy department of county hospitals in China, and to improve the construction quality of the endoscopy department of county hospitals.Methods:County hospitals from 20 provinces, autonomous regions and municipalities in 2019 were investigated in this study through an online survey. Questions were about the department scale, basic information of the endoscopy center, clinical diagnosis and treatment ability, teaching and academic ability.Results:A total of 114 county hospitals were included. The department of gastroenterology in county hospitals owned 38.9 beds, 8.6 doctors and 6.4 nurses on average in 2019. The mean host and endoscope were 3.1 and 11.0 respectively in each center. The mean outpatient, discharge and endoscopy procedure were 22 thousand , 2.3 thousand and 7.8 thousand respectively. The referral rate of 53 (46.5%) hospitals to higher-level hospitals was less than 3%. In terms of teaching and academy, 5 (4.4%) in 114 hospitals had endoscopist training bases of Chinese Medical Association. Fifty-two (45.6%) county hospitals hosted academic conferences at the city level and above, 21 (18.4%) published SCI papers and 67 (58.8%) published papers in key Chinese journals.Conclusion:Endoscopy centers of most county hospitals are well constructed with comprehensive facilities, qualified medical ability, management, and a research team, which meets the recommendation level of service.
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Objective:To analyze characteristics and trend of publications in digestive endoscopy quality control from 2010 to 2021.Methods:The literature on digestive endoscopy quality control from 2010 to 2021 were searched through the Web of Science core collection with the method of bibliometrics. The year of publication, journal name, country, main researchers, institutions and citations were analyzed by Web of Science. Then, the downloaded data were imported into VOSviewer for co-occurrence network analysis of the country, keywords and citations.Results:A total of 3 283 English papers on digestive endoscopy quality control were included. The number of papers from China and other countries showed an upward trend, and citations as well from 2010 to 2021. The publications were mainly from the United States (1 209, 36.8%), the United Kingdom (325, 9.9%), and China (324, 9.9%). The journal with the largest number of publications in this category was Gastrointest Endosc (241, 7.3%). The U.S. Department of Veterans Affairs had 175 publications, ranking the first among all institutions. Research topics were focused on colonoscopy, adenoma detection rate, and artificial intelligence. Conclusion:The research in digestive endoscopy quality control is booming, and the research activity is gradually increasing. Chinese academic influence in this field still needs to be further improved.
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To investigate the current status of digestive endoscopy diagnosis and treatment in Shanghai, and to provide decision-making support for the revision of the diagnostic and treatment standards and quality control criteria of digestive endoscopy in Shanghai. A total of 145 hospitals providing digestive endoscopy service were investigated through an online survey. The main survey contents were the situation of digestive endoscopists, the development of diagnosis and treatment technology, and the quality and safety situation. There were 1 212 digestive endoscopists in Shanghai, accounting for 1.59% of China which ranked first in all registered practioners in 2019. The annual diagnostic and treatment procedures of digestive endoscopy was 1 902.6 thousand, and endoscopists' working pressure was relatively high. In terms of quality control indicator of a single disease, detection rates of early gastrointestinal cancers and adenomas remained at a high level. The number of digestive endoscopists, endoscopic procedures and quality control indicators of a single disease in Shanghai was in a leading position in China in 2019.
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Objective To investigate the dynamic changes in achalasia patients by using high resolution manometry (HRM).Methods Twenty-four achalasia patients were enrolled for HRM examination and typing.The esophageal pressure of patients with different subtypes was analyzed.Chi-square test was used for count data analysis.Two independent samples t-test was used for measurement data.Results Among twenty-four achalasia patients,five patients were type Ⅰ and maledominated,18 patients were type Ⅱ and female was more than male,and only one male patient was type Ⅲ.The frequency of weight loss in type Ⅰ was higher than that of type Ⅱ (x2 =6.97,P=0.008).The frequency of chest pain and food reflux in type Ⅰ was higher than that of type Ⅱ (both P＞0.05).The average distance from the nares to the upper edge of the lower esophageal sphincter (LES) with the electrode successfully inserted into the stomach was (44.9±3.3) cm and to the lower edge of the LES was (48.0±3.2) cm.The average LES length was (3.1 ±0.7) cm,average intraabdominal LES length was (2.1 ±0.5) cm.The average LES resting pressure was (34.6 ± 13.8) mm Hg (1 mm Hg =0.133 kPa) and the integrated relaxation pressure (IRP) was (31.1 ± 12.0) mm Hg.Conclusion Esophageal manometry is the golden standard for achalasia diagnosis,and HRM may be a simple,direct viewing and accurate method for accessing esophageal motor function.
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Objective To explore the expression and significance of hedgehog signal molecules (Ptch,Smo and Gli1 ) in chronic pancreatitis tissues in rats.MethodsSixty SD rats were randomly divided into CP group (n =50) and control group (n =10).DBTC solvent (8 mg · ml-1 · kg-1 ) was injected into the rat via tall vein in CP group.In control group,rats were treated only with the solvent at a dose of 1ml/kg body weight.All rats were sacrificed 6 weeks later to observe the pancreatic pathologic changes.Collagen accumulation in pancreatic sections was determined by staining for Sirius red.Expressions of Ptch,Smo,Gli1 mRNA and protein in pancreatic tissues were assessed by RT-PCR and immunohistochemistry.ResultsThe rate of chronic pancreatitis development in rats in CP group within six weeks was 73.9％.Collagen content was markedly higher in CP group than that in control group [ ( 38.52 ± 6.49 ) ％ ~s (7.37 ± 2.28 ) ％,P ＜ 0.05 ].No Path,Smo,Gli1 protein expression was observed in normal pancreatic tissues in control group.The positive rate of Ptch,Smo,Gli 1 expression was 73.5％,64.7％ and 52.9％ in CP group,and the difference between the two groups was statistically significant (P ＜ 0.05).The expressions of Ptch,Smo,Gli1 mRNA were 2.38 ±0.42,3.85 ± 1.03,4.63 ± 1.49 in CP group,which were significantly higher than those in control group (0.23 ±0.16,0.14 ±0.05,0.57 ±0.12,P ＜0.05).ConclusionsThe Ptch,Smo,Gli1 was highly expressed in pancreatic tissues in CP rats,suggests hedgehog messenger pathway may play an important role in the chronic inflammation and fibrosis of chronic pancreatitis.
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Objective To evaluate the safety and efficacy of therapeutic ERCP for patients above 90 years of age.Methods The data of 37 patients of above 90 years who underwent 42 ERCP procedures from January 2001 to December 2009 were studied retrospectively and compared with those of 152 matched patients ( 168 procedures) below 65 years old at a 1∶4 ratio for success rate and complications.Results The rate of complete success,partial success,and failure in observation group was 73.81％ (31/42),19.05％(8/42) and 2.38％ (1/42),respectively,which were similar (P ＞0.05) with those in control group,with complete success rate at 85.12％ ( 143/168),partial success rate at 12.50％ (21/168) and failure rate at 2.38％ (4/168).The rate of terminated operation in observation group (4.76％,2/42) was significantly higher than that of the control group (0.00％,0,P =0.039).The overall rate of complication in observation group was 7.14％ ( 3/42 ),slightly higher than that of the control group ( 6.55％,11/168,P ＞0.05 ).There was no significant difference between the two groups regarding the rates and severity of such complications as pancreatitis,hemorrhage and infection ( P ＞ 0.05 ).No perforation or death was observed.Conclusion Therapeutic ERCP for patients of 90 years or older is safe and effective.Adverse events related to chronic concomitant diseases need early detection and proper management.
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Objective To explore the expression and significance of hedgehog signal molecules (Ptch, Smo and Gli1 ) in pancreatic cancer. Methods Two hundred SD rats were randomly divided into DMBA group ( group A, n = 90), cyclopamine intervening group ( group B, n = 90) and control group ( group C, n = 20).For group A and B, DMBA was directly implanted into the parenchyma of the pancreas to establish the model of pancreatic cancer. The rats in group B were treated with 6.25 ml/kg cyclopamine and DMSO solution intraperitoneally daily. All rats were sacrificed four months later to observe the pancreatic tissue pathologic changes, and immunohistochemistry SP was used to detect the expression of Ptch, Smo, Gli1 protein in pancreatic cancer and normal pancreatic tissue. Results The prevalence rate of pancreatic cancer in group A was 57.5％ (46/80), the maximum size of the tumor was 0.5 ～ ＞2 cm; the prevalence rate of pancreatic cancer in group B was 17.1％ ( 14/82), the maximum size of the tumor was 0.5 ～ 2.0 cm, and the difference between the two group was statistically significant (P ＜0.05). The positive expression rate of Ptch, Smo and Gli1 protein was 82.6％, 73.9％ and 65.2％ in DMBA group, and was 50.0％, 42.9％ and 28.6％ in cyclopamine group, and the difference between the two group was statistically significant ( P ＜ 0.05 ). Ptch,Smo and Gli1 protein was expressed in normal pancreatic tissue. Conclusions Direct implantation of DMBA in the parenchyma of rat pancreas can induce pancreatic cancer with a high incidence in a short time.Hedgehog signal protein expression is significantly increased, cyclopamine can inhibit the occurrence and progression of pancreatic cancer by inhibiting Hedgehog messenger expression.
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Objective To establish the orthotopic human pancreatic cancer model in mice and study the method to detect the tumor growth. Methods Human pancreatic cancer cell lines SW1990 in logarithmic phase was made into cell suspension and in situ injected into the envelope of pancreatic tail of BALB/c nude mice. High-frequency endoscopy ultrasound was used to observe the growth of tumor mass and its imaging characteristics were studied. Results 20 nude mice were successfully implanted, and 1 died 25 h after implantation. 14 days after implantation, the tumor of pancreatic cancer on EUS was (8.09 ± 2.61) mm3, the tumor appeared as homogeneous hypoechoic mass with clear boundary, and envelope as well as sound halo was present, and the shape was regular; there was low speed circular vasculature signal in around 30% of tumor.The tumor size increased to (12.40 ± 3.51)mm3, and the shape of 70% tumor was irregular, and some appeared as lobulated, and the tumor appeared as heterogeneous hypoechoic mass, no necrosis or liquefaction was found 28 days after implantation. There was low speed circular vasculature signal in around 70% tumors.Conclusions The orthotopic pancreatic cancer model in nude mouse can be established by in situ injection and this method is relatively ideal because it is simple and effective. The high frequency probe of endoscopic ultrasonograph is a reliable method for monitoring implanted pancreatic cancer.
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ObjectiveTo evaluate the accuracy of contrast-enhanced harmonic EUS (CEH-EUS) by using a second-generation contrast medium in differential diagnosis of pancreatic occupying lesions.MethodsPatients with suspected pancreatic neoplasms or chronic pancreatitis were enrolled and underwent CEH-EUS by using ultrasonic contrast medium Sonovue.Cytological and/or histological diagnoses were made by EUS-FNA and the final follow-up results.Characteristics of enhancement of the target areas,such as enhancement sequence,time features,pattern grade and venous elution degree were investigated.ResultsA total of 23 patients were enrolled,in which 13 were diagnosed with FNA as having pancreatic cancer,7 with chronic pancreatitis,2 with intraductal papillary mucinous neoplasms and 1 with microcystic serous cystadenoma.The accuracy of CEH-EUS was 95.65％,which was significantly higher than that of conventional EUS (78.2％).Enhancement of pancreatic cancer by CEH-EUS was later than or simultaneous with the nearby tissues,with heterogeneous low enhancement or fulfillment defect areas,and early subsidence without obvious peak.Enhancement of benign pancreatic diseases was simultaneous with the surrounding tissues,with homogenous fulfillment and simultaneous subsidence.ConclusionCEH-EUS is safe,convenient and accurate in diagnosis of pancreatic occupying lesions and can be used as an additional diagnostic method to EUSFNA.
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Objective To evaluate the sensitivity and specificity of endoscopic uhrasonography (EUS) and endoscopic retrograde cholangiopancreatography(ERCP)in diagnosis of chronic pancrea (CP).Methods Data of histologically confirmed CP cases,from May 1994 to May 2004 in 22 Chinese hospitals,were retrospectively analyzed.The receiver operating characteristic(ROC)was used to compare the sensitivity and specificity of EUS and ERCP.Results The data of 1994 CP cases were retrieved,including 1298 males and 696 females.aging from 5 to 85(48.9±15.0).The diagnosis of CP was confirmed histologitally in 239 patients(11.98%),and pancreatic exocrine function test(BT-PABA)were employed in 261 patients(13.09%),X-ray in 419(20.86%),B ultrasonography in 1424(71.41%),CT in 889 (44.58%),magnetic resonance imaging(MRI)and magnetic resonance cholangiopancreatography(MRCP) in 245(12.29%),ERCP in 628(31.49%),and EUS in 258(12.94%).The sensitivity and specificity of each method were as follows:88% and 93% for EUS.87% and 93% for ERCP,66% and 85% for MRI and MRCP,61% and 85% for CT,69% and 82% for B ultrasonography,32%and 80%for X ray,83% and 80% for BT-PABA.Conclusion Of all the diagnostic methods,EUS and ERCP are the most sensitive and specific to diagnose of CP,while EUS is of the highest.
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Objective To evaluate the efficacy and salty of endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) in the treatment of pain due to pancreatic cancer and celiac metastatic carcinoma.Methods Thirty-three patients with celiac carcinoma were selected for EUS-CPN. Among whom 15 pateints were received chemotherapy before procedure . Using endoscopic ultrasounography,transgastric injection of the celiac plexus with bupivacaine and 98% dehydrated absolute alcohol was accomplished.The abdominal pain was evaluated by the numeric pain intensity scale before and at 24,48,72 hours and one week after the precedure.The successful rate of precedure,the complication and the relief of the pain were observed. Results All procedures were performed successfully . No serious complications such as pancreatitis by trauma,pancreatic fistula,bleeding and celiac infection was found.Compared with baseline,pain was significantly relieved at 12,24,72 hours and 1 week after EUS-CPN (100%,98%,90% and 88%,respectively).The pain remission at 24,48,72 hours and one week in patients who received chemotherapy before procedure were 100%,100%,980% and 98%,respectively,while in those who had not treated chemically were 100%,98%,95% and 90%,respectively.The complete%relief of pain in chemotherapy group was significantly higher than that in nonchemotherapy group (75 % vs 56 %,P%0.05).Conclusions EUS CPN is a safe and effective method for relieving pain with low complications.It can raise the quality life of the patients and chemical therapy may be helpful in pain control.
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Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pan-creatography (ERCP) in treatment of pain of chronic pancreatitis (CP). Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed.The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of ther-apy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients ( 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years).The mean follow-up period was 41.9 months (12～131 months). Twenty-eight patients (13. 1% ) under-went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% (P >0. 05 ) respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14.9% (71/476) in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6%, mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub-sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.
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This study was conducted to assess the diagnostic value of serum CA19 9 in patients with pancreatic cancer. Seven hundred and seventy eight patients with the diagnosis of pancreatic cancer were involved in the study, and every patient had serum CA19 9 determined. The descriptive statistics and correlation analysis were used to evaluate the serum CA19 9 as an index in patients with pancreatic cancer. Results showed that 80 33% patients had the serum CA19 9 value higher than 37U/ml. Further more, a positive correlation was found between the serum CA19 9 and the TNM status of pancreatic cancer( r =0 513, P
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Our aim was to assess the curative effect of endoscopic stenting in patients with pancreatic fistula. One patient suffered from pancreatic fistula was treated by pancreatic stenting drainage. The patient′s condition was significantly improved after endoscopic treatment, and no complications such as abdominal pain, bleeding, perforation, and elevation of serum amylase level were found. The fistula was cured in one week. Followed up for 5 months, no relapse of pancreatic fistula was found, and body weight of the patient increased 4kg. The results of B ultrasonography and abdominal X ray examination were also normal. So pancreatic stenting drainage is an effective and safe therapy for pancreatic fistula and should be the first choice.
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To assess the therapeutic value of endoscopic treatment in pancreas divisum(PD), 5 cases of PD from January 1993 to December 2001 were involved and analyzed retrospectively. Dilatation of minor papilla by passage of a balloon was used in one patient, and tapered catheter passed over guide wire was used in three patients, whereas endoscopic minor papilla sphincterotomy was used in one patient. Pancreatic stents were put into the accessory pancreatic duct in three patients after endoscopic minor papilla dilatation or sphincterotomy. The diameter of the stents was 7F and the length was 3 5cm, 5cm and 6cm. Severe pancreatitis, hemorrage or perforation was not found after endoscopic treatment, except in two patients the serum amylase level elevated within 24h and returned normal after 48h. After endoscopic treatment the remission rate of abdominal pain was up to 100%. By follow up for 5～36 months (average 18 months), no relapse of abdominal pain and complications were found except one patient who had stent occlusion and replaced by a new stent. So endoscopic treatment is a safe and effective therapeutic technique for symptomatic PD and should be used as the first choice.
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The aim of this study was to evaluate the diagnostic value of MRCP and ERCP in patients with chronic pancreatitis. A total of 262 patients were diagnosed as charonic pancreatitis by clinical feature, screenage and pathology from January 1993 to December 2001 in Changhai Hospital. Among them 120 patients who had been subjected to MRCP and ERCP were analyzed retrospectively. There were 106 patients discovered constriction, dilatation and calculuses of pancreatic, bile ducts, and diagnosed chronic pancreatitis by MRCP, the sensitivity was 88 3%. Also there were 108 patients discovered cholangiopancreatic disorder and diagnosed chronic pancreatitis by ERCP, the sensitivity was 90%. No statistical difference was found between interpretations based upon MRCP and ERCP( P =0 678). Results from both MRCP and ERCP discovered 96 patients with chronic pancreatitis; the agreement rate in diagnosis was 81 4%. Furthermore, 118 patients were diagnosed chronic pancreaitis by MRCP or ERCP, and the sensitivity was up to 98 3%. In addition, all examined patients were succeeded and no severe complications were found in regard to examination itself. So MRCP is as sensitive as ERCP when detecting chronic pancreatitis. Furthermore, it is feasible to presume that all chronic pancreatitis cases could be diagnosed by MRCP combined with ERCP.