OBJECTIVE: To evaluate the effects of intravenous anesthesia in painless esophagoscopy for extraction of foreign bodies in the esophagus. METHOD: Forty-two patients underwent painless esophagoscopy, and extracted the foreign bodies in the esophagus. RESULT: Thirty-two cases had their foreign bodies extracted smoothly and no serious complication occurred,the other 10 cases were mucosal injuries of esophagus with no obvious foreign body. CONCLUSION Intravenous sedation with propofol in extraction of foreign bodies in the esophagus can relieve the suffering and adverse reactions, and it is safe, quick, comfortable and effective for extraction of foreign bodies in the esophagus and is worthy to be applied in the clinic.
Anesthesia, Intravenous ; methods ; Anesthetics, Intravenous ; Esophagoscopy ; methods ; Esophagus ; injuries ; Female ; Foreign Bodies ; therapy ; Humans ; Male ; Propofol

A sharp, impacted fish bone in the esophagus is an indication for urgent endoscopy. Endoscopic removal of such an object is a challenging task. An endoscopic protector hood is then used to remove the object. However, an endoscopic hood protector is not always available. In a patient with a large hiatal hernia, the protector hood may not return to the original shape when it passes through the gastroesophageal junction and therefore may not properly protect the esophageal mucosa from the sharp foreign body. In our case, it was impossible to deploy the endoscopic hood protector through the gastroesophageal junction despite multiple attempts. We propose an alternative solution for such cases. We safely removed a large sharp-edged flat fish bone that was folded and compressed using a detachable snare after releasing and pushing the fish bone into the stomach using an endoscope equipped with a transparent cap used for dilating the esophageal wall. This method of using an endoscopic cap and detachable snare is a safe, useful alternative for endoscopically removing a large sharp-edged flat foreign body from the upper gastrointestinal tract. This alternative technique has not been reported in the English medical literature.
Aged, 80 and over ; Esophagoscopy/*instrumentation/methods ; *Esophagus ; Foreign Bodies/radiography/*surgery ; Humans ; Male

China ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; methods ; trends ; Esophagoscopy ; methods ; Humans ; Lymph Node Excision ; methods ; Survival Rate

Worldwide, peroral endoscopic myotomy (POEM) has achieved remarkable initial outcomes in the treatment of achalasia. In China, POEM has developed very quickly since the first case was performed in our center in August 2010. With experience, we have successfully performed POEM for special cases (such as pediatric patients, patients with sigmoid-type esophagus, and patients with recurrent symptoms after previous surgery) and have altered our technique to achieve long-term symptom remission and simplify the POEM procedure. These changes include posterior wall incision, full-thickness myotomy, a "push-and-pull" technique for myotomy, and water-jet assisted POEM. In this article, our experiences in POEM are summarized, including changes in technique, applications of the procedure, and the management of possible complications.
Adult ; Child ; China ; Esophageal Achalasia/*surgery ; Esophagoscopy/*methods ; Esophagus/surgery ; Humans ; Natural Orifice Endoscopic Surgery/contraindications/*methods

Worldwide, peroral endoscopic myotomy (POEM) has achieved remarkable initial outcomes in the treatment of achalasia. In China, POEM has developed very quickly since the first case was performed in our center in August 2010. With experience, we have successfully performed POEM for special cases (such as pediatric patients, patients with sigmoid-type esophagus, and patients with recurrent symptoms after previous surgery) and have altered our technique to achieve long-term symptom remission and simplify the POEM procedure. These changes include posterior wall incision, full-thickness myotomy, a "push-and-pull" technique for myotomy, and water-jet assisted POEM. In this article, our experiences in POEM are summarized, including changes in technique, applications of the procedure, and the management of possible complications.
Adult ; Child ; China ; Esophageal Achalasia/*surgery ; Esophagoscopy/*methods ; Esophagus/surgery ; Humans ; Natural Orifice Endoscopic Surgery/contraindications/*methods

Tumors originating from the muscularis propria layer of esophagus are usually removed by thoracoscopic resection. With the introduction of new endoscopic therapeutic techniques, some of these tumors could be treated by endoscopic submucosal dissection (ESD). However, the above endoscopic methods are associated with a high risk of perforation and it is hard to close the perforation through the endoscopy. Recently we successfully resected a tumor originating from the muscularis propria layer of the esophagus by submucosal tunneling endoscopic resection (STER), which was based on peroral endoscopic myotomy (POEM) and ESD. Compared with ESD, STER is a safe, economic and less invasive treatment. Even when perforation happens, it is easier to close the tunnel with the endoscopic clips which can help stopping the leak of air and digestive fluids. In this case, we found STER wss an effective and safe endoscopic procedure to remove tumors originating from the muscularis propria layer in the esophagus.
Adult ; Dissection ; methods ; Esophageal Neoplasms ; pathology ; surgery ; Esophagoscopy ; methods ; Esophagus ; pathology ; surgery ; Humans ; Leiomyoma ; pathology ; surgery ; Male

OBJECTIVEThe aim of this study is to evaluate the relationship between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis.

METHODSA balloon cytological screening was conducted in 4000 participants in high-risk area of esophageal cancer in 1997-1998, 1050 out of these 4000 participants were confirmed as abnormal by cytology. Among them, 867 were given endoscopy examination during which mucosal stain with 1.2% iodine solution was used. The stain images were graded as four categories: Grade 1, dark yellow, protruding inlay-like with clear borders and showing pink after discoloration; Grade 2, between grade 1 and grade 3; Grade 3, light yellow, flat lesion with clear but not sharp borders and Grade 4, dark-brown color. According to the above criteria, the lesions were recorded and graded after the examination. The biopsies were taken from the unstained lesions and underwent pathologic evaluation. A comparison between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis was evaluated. The correlation coefficient was estimated using Spearman's Rank Correlation.

RESULTS94.4% (68/72) of the superficial carcinoma and severe dysplasia, 61.8% (73/118) of moderate dysplasia and 27.7% (35/126) of mild dysplasia were distributed in the grade 1 and grade 2 of iodine stain images of which the patterns conforming to the principle and rule of formation of the image by iodine stain.

CONCLUSIONThere is close relationship between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis. The magnitude of exposure of the malignant tissue is the pathologic basis of formation of various images by iodine stain. Iodine stain greatly helps of early detection of esophageal cancer.

Biopsy ; Early Diagnosis ; Esophageal Neoplasms ; pathology ; Esophagoscopy ; methods ; Female ; Humans ; Iodine ; Male ; Precancerous Conditions ; pathology ; Staining and Labeling ; methods

Esophageal leiomyoma derived from the muscularis mucosae (MM) is a rare condition, and the optimal modality for diagnosis and treatment is controversial. Endoscopic ultrasonography can provide an accurate image of esophageal layer structure, providing information on lesion suitability for potential endoscopic therapy. We attempted to investigate the diagnostic value of a transendoscopic balloon-tipped miniature ultrasonic endoprobe for small esophageal leiomyomas derived from MM. We resected 7 small esophageal leiomyomas derived from MM by endoscopic mucosal resection (EMR), all of which were diagnosed by a balloon-tipped endoprobe. The endosonographic and pathologic features of 7 cases of small esophageal leiomyomas derived from MM were compared. The balloon-tipped endoprobe clearly showed all 7 small esophageal leiomyomas derived from MM, even those under 5 mm in size (smallest lesion, 3.0 mm). The endosonographic characteristics of small esophageal leiomyomas derived from MM were a hypoechoic mass with smooth, regular, and a well-defined outer margin and homogenous inner echogram arising from the second hypoechoic layer. Complete resections were possible in all 7 cases by EMR without any complications. Tumor size was 3.0 - 13.5 mm (mean 7.8 mm) in maximum diameter. In all cases, endosonographic findings by endoprobe were exactly concordant with pathologic finding in determining the tumors depth in the esophageal wall, tissue origin and characteristics, growth pattern, and size. We detail the balloon-tipped endoprobe is a simple, convenient, and very useful in making accurate diagnosis of small esophageal leiomyomas derived from the MM and the appropriate applications of EMR.
Adult ; *Endosonography ; Esophageal Neoplasms/pathology/*ultrasonography ; Esophagoscopy/*methods ; Female ; Humans ; Leiomyoma/pathology/*ultrasonography ; Male ; Middle Aged ; Mucous Membrane/pathology

Biopsy ; methods ; Esophageal Neoplasms ; pathology ; surgery ; Esophagoscopy ; Esophagus ; pathology ; Humans ; Mucous Membrane ; pathology ; Precancerous Conditions ; pathology ; surgery

OBJECTIVETo investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia.

METHODSFrom September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed.

RESULTSAfter POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients.

CONCLUSIONPOEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Adolescent ; Adult ; Aged ; Esophageal Achalasia ; physiopathology ; surgery ; Esophagoscopy ; methods ; Esophagus ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult