Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery

Blood Vessels ; Humans ; Stromal Cells

Over the past 10 years, endoscopic diagnosis and treatment of gastrointestinal disesses has become one of the most commonly performed invasive procedures in China. Recently, China is considered the international leader in some new endoscopic technologies. In this paper, we discuss anesthesia support for new endoscopic technologies, including endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM), in terms of selection such as operative procedure, complications, preoperative evaluation, anesthesia management, and intraoperative monitoring.
Anesthesia ; Endoscopy ; Gastrointestinal Diseases ; surgery ; Humans

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Occlusion ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged ; Stents

OBJECTIVETo investigate cachexia in hospitalized patients with digestive system cancer and evaluate its impact on clinical outcomes.

METHODSBy analyzing the clinical data of 5118 hospitalized patients with digestive system cancer in Zhongshan Hospital of Fudan University from January 2012 to December 2013, cachexia was investigated and clinical outcomes between cachexia patients and non-cachexia patients was compared.

RESULTSThe total cachexia rate of hospitalized patients with digestive system cancer was 15.7%(803/5118). The highest rate of cachexia was 34.0%(89/262) in patients with pancreatic cancer followed by gastric cancer 22.4%(261/1164), colon cancer 21.7%(146/672), and rectal cancer 20.1%(117/581). In cachexia group and non-cachexia group, the overall completion rate of radical resection was 67.1%(539/803) and 74.5%(3214/4315) respectively(P<0.05). Compared to the non-cachexia group, the cachexia group was associated with longer postoperative hospital stay [(11.5±6.2) d vs. (9.4±4.9) d, P<0.05], slower postoperative recovery of bowel function [(3.4±0.9) d vs. (3.2±0.8) d, P<0.05], longer postoperative time to intake of semifluid [(4.4±1.5) d vs. (3.9±1.1) d, P<0.05], and more postoperative complications within 28 days after radical surgery [8.9%(48/539) vs. 5.8%(186/3214), P<0.05]. After radical surgery, the ICU admission rate of the cachexia group [24.3%(131/539)] was higher than that of the non-cachexia group [20.1%(646/3214)] with significant difference(P<0.05). Compared to non-cachexia group, the reoperation rate [3.2%(17/539) vs. 1.5%(48/3214), P<0.05], ventilator support rate [8.0%(43/539)vs. 5.7%(184/3214), P<0.05] and mortality [2.4%(13/539) vs. 1.1%(35/3214), P<0.05] in the cachexia group were all significantly higher(all P<0.05).

CONCLUSIONSCachexia is commen in patients with digestive system cancer. Cachexia has significant adverse effects on clinical outcomes in hospitalized patients with digestive system cancer.

Cachexia ; etiology ; Colonic Neoplasms ; complications ; Defecation ; Humans ; Postoperative Complications ; Rectal Neoplasms ; complications ; Reoperation ; Stomach Neoplasms ; complications

OBJECTIVETo investigate the feasibility of video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma.

METHODSClinical data of 83 patients with esophageal leiomyoma from December 2002 to August 2012 treated by video-assisted thoracoscopic surgery were retrospectively analyzed.

RESULTSVideo-assisted thoracoscopic leiomyoma enucleations were performed in 82 patients. One patient was converted to thoracotomy to repair the esophageal mucosa and two patients required intraoperative mucosal repair by video-assisted thoracoscopic surgery for esophageal mucosa rupture. The mean operative time was 83.0 min (range, 40-300 min), and the mean blood loss was 52.4 ml (range, 20-150 ml). The mean length of postoperative hospital stay was 5.8 d (range, 3-50 d). The mean tumor diameter was 3.3 cm (range, 0.8-12.0 cm). One case with postoperative esophageal fistula was cured by conservative treatment. Eighty patients were followed up for 2-117 months, and all the patients were free of dysphagia without recurrence or other related complications.

CONCLUSIONSThoracoscopic enucleation of esophageal leiomyoma can be performed effectively and safely. Thoracoscopic techniques for the removal of larger esophageal leiomyoma may be recommended as the treatment of choice in centers experienced with minimally invasive surgery.

Adult ; Aged ; Esophageal Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Leiomyoma ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Treatment Outcome ; Young Adult

BACKGROUNDMore patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation.

METHODSA retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients.

RESULTSAll patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results.

CONCLUSIONSImmunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.

Adolescent ; Adult ; Female ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Liver Transplantation ; Male ; Middle Aged ; Organ Transplantation ; Surgery, Plastic ; adverse effects ; methods ; Young Adult

Objectives: Intracranial atherosclerosis, especially the middle cerebral artery (MCA), is the commonestvascular lesion for ischemic stroke the Chinese population. We explored the association of geneticpolymorphism and environmental factors in MCA atherosclerosis in the Chinese population. Methods:One hundred fifty-six ischemic stroke patients with MCA stenosis and 181 well-matched ischemicstroke patients without MCA stenosis were examined by polymerase chain reaction (PCR). ThePCR products were analyzed for lipoprotein lipase (LPL) S447X and paraoxonase1 (PON1) Q192Rpolymorphisms by restriction enzyme digestion. Medical history documentation and investigationof biochemical markers were performed for each subject. Results: Univariate analysis showed thatthe levels of systolic blood pressure (SBP) were higher in the MCA stenosis group. There were nosignificant differences in the genotype and allele frequencies of the LPL S447X and PON1 Q192Rpolymorphism observed between the two groups. But, in the patients above 60 years of age with andwithout MCA stenosis, LPL X carriers have higher level of SBP than the LPL SS genotype carriers.Multivariate logistic regression found that SBP was the significant, independent predictor of thepresence of MCA stenosis patients above 60 years of age (P < 0.001, OR=1.206, 95% confidenceintervals: 1.014-1.032).Conclusions: SBP appears to contribute to the pathogenesis of MCA stenosis among Chinese. Thegene polymorphism of LPL S447X may be associated with atherosclerotic MCA stenosis in Chinesepopulation.

OBJECTIVETo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of gastrointestinal cysts.

METHODSClinicopathological data of 40 patients with gastrointestinal cyst undergoing ESD in our center during January 2008 and February 2012 were analyzed retrospectively. Complications, en bloc resection rate, and local recurrence were assessed.

RESULTSEight lesions located in the esophagus, 11 in the stomach, 5 in the duodenum, and 16 in the colorectum. Thirty-seven lesions were successfully resected with ESD in an en bloc fashion (92.5%). During the operation, one perforation was encountered in the ascending colon and was clipped; one massive hemorrhage occurred in the esophagus and was treated with balloon compression. Postoperative pathological examination revealed cyst samples were intact without lesions in lateral and basal resection margins. Local recurrence was not found in 36 patients during a median postoperative follow-up of 9.7 months (range, 6-12 months).

CONCLUSIONESD is a safe and effective procedure for the treatment of gastrointestinal cysts.

Adult ; Aged ; Cysts ; surgery ; Digestive System Neoplasms ; surgery ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Mucous Membrane ; surgery ; Retrospective Studies

OBJECTIVETo evaluate the clinical value of submucosal tunneling endoscopic resection (STER) for rectal submucosal tumors (SMT) originating from muscularis propria.

METHODSClinicopathological data of 8 cases with rectal SMT originating from muscularis propria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively.

RESULTSEn bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm (average 1.8 cm). The mean procedure time was 51 min (range, 40-70 min). One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 1 case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found.

CONCLUSIONSTER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.

Adult ; Aged ; Aged, 80 and over ; Endoscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Leiomyoma ; surgery ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome