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Combination of endoscopic submucosal dissection and endoscopic band ligation in treatment of upper gastrointestinal submucosal tumors

Fubing YU ; Xikun HE ; Bing ZHANG ; Zan ZUO ; Tianle MA

Chinese Journal of Digestive Endoscopy.2009;26(9):455-459. doi:10.3760/cma.j.issn.1007-5232.2009.09.004

is able to provide pathologic data and achieve the efficacy equivalent to surgery.

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Endoscopic features and earcinoembryonic antigen expressions of colorectal serrated adenomas

Qihong YANG ; Mingen LI ; Wenru ZHANG ; Shaojuan HANG ; Hongli WANG ; Yuhua CHEN ; Guanying XIAO

Chinese Journal of Digestive Endoscopy.2009;26(8):423-426. doi:10.3760/cma.j.issn.1007-5232.2009.08.012

Objective To explore the endoscopic features and careinoembryonic antigen (CEA) ex-pressions of colorectal serrated adenomas (SA). Methods From June 2005 to July 2008, 27 patients with colorectal polyps and 26 cases of advanced colorectal cancer (ACC) were enrolled in the study. The pit pat-tern of the suspected lesions were observed with 0. 4% indigo carmine sodium stain and classified according to Kudo classification. The polyps were removed by biopsy, high-frequency electrical excision or endoscopic mucosa resection and the samples of ACC were collected with biopsy forceps. All specimens underwent rou-tine pathological examination and CEA expression was detected by immunohistochemistry. Results There were 47 SAs and 27 other types of polyps in polyp group. Most SAs located in left-side colon and were char-acterized by the bulge semipedunculation. The diameters of 45 serrated adenomas ranged from 3 to 8ram, and the maximal diameter of other 2 were more than 10ram. The most common type of pit pattern in SA was mixed type Ⅱ and ⅢL, with type Ⅱ predominant in a certain percentage. Expression of CEA in SA glands was significantly higher than that in proliferative polyps (P < 0. O1). Candnsion SA is an unique type of colorectal adenoma, which is capable of expressing CEA, and displays malignant potential and deserves great attention.

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Combination of magnifying endoscopy and narrow band imaging in diagnosis of early gastric cancer

Lin XU ; Jiyong LIU

Chinese Journal of Digestive Endoscopy.2009;26(8):415-418. doi:10.3760/cma.j.issn.1007-5232.2009.08.008

Objective To evaluate the use of magnifying endoscopy combined with narrow band im-aging (NBI) system in diagnosis of early gastric cancer. Methods From March 2008 to December in 2008, a total of 56 patients with suspected gastric mucosal lesions were enrolled in the study. The lesions were ob-served with magnifying endoscopy combined with NBI and indigo-earmine-chromoendoscopy, and the results were compared with pathologic diagnosis from targeted biopsies. Results Out of 56 patients, 16 were diag-nosed as early gastric cancer pathologically. The accordance rate with the pathological diagnosis, sensibility, specificity, false positive rate and false negative rate of the magnifying endoscopy combined with NBI system were 94.6% (53/56), 93. 8% (15/16), 95.0% (38/40), 5.0% (2/40) and 6. 3% (1/16), respec-tively; while those of chromoendoscopy were 91.1% (51/56), 87. 5% (14/16), 92. 5% (37/40), 7. 5% (3/40) and 12. 5% (2/16), respectively (P >0.05). There was no difference between NBI and chro-moendoscopy in regarding of observing pit pattern, however, NBI was superior in displaying intrapapillary capillary loop. Conclusion Combination of magnifying endoscopy and NBI provides clear images of gas-tric mucosa and intrapapillary capillary, which is useful in diagnosis of early gastric cancer and can improve accuracy of biopsy. When combined with chromoendoscopy, it can further improve the yield of diagnosis.

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Interventional treatment of bile duct injury after laparoscopic cholecystectomy

Yunpeng HUA ; Shaoqiang LI ; Jiaming LAI ; Baogang PENG ; Lijian LIANG

Chinese Journal of Digestive Endoscopy.2009;26(8):406-409. doi:10.3760/cma.j.issn.1007-5232.2009.08.005

Objective To investigate the value of interventional therapy in bile duct injury (BDI) due to laparoscopie cholecystectomy (LC). Methods Data of 24 BDI patients, who received interventional treatment after LC from June 1997 to May 2007, were retrospectively analyzed. Results According to Liu Yunyi criteria of BDI classification, there were 5 cases of type Ⅰ , 11 cases type Ⅱ , 2 type Ⅲ and 6 type Ⅳ. BDI was found during LC in 2 patients and the operation was switched to open cholecysteetomy, but bile duct infection was experienced 10 months and 2 years after the operation, respectively. BDI was diagnosed postoperatively in 22 patients, in which 13 eases occurred 3-12 days after LC, 7 cases 20-60 days after LC, and 2 cases 2 years after LC. Complete remission was achieved by interventional therapy in 5 patients, the other 19 patients received curative operation after control of cholangitis and jaundice. Among 13 patients who were diagnosed BDI 3-12 days after LC, 6 underwent emergency operation and failed. Of the 7 other patients who received interventional therapy, 3 were cured and the others underwent curative operation after cholangi-tis and jaundice were controlled. Conclusion Application of interventional therapy in BDI after LC can a-chieve successful bile duct support and drainage, and can obtain complete image of bile duct system, which is effective not only in control of cholangitis and jaundice for the safety of the following surgery, but also in cure of BDI.

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Endoscopic management of Chronic Panereatitis: a prospective study

Zhou YE ; Zhaan LIAO ; Wei WANG ; Rui GAO ; Xiaowei LAI ; Xintao WANG ; Lianghao HU ; Fei JIANG ; Zhaoshen LI

Chinese Journal of Digestive Endoscopy.2009;26(8):402-405. doi:10.3760/cma.j.issn.1007-5232.2009.08.004

Objective To investigate the long-term effect of endoscopic management of chronic pan-creatitis(CP) prospectively. Methods Based on the M-ANNHEIM diagnostic criteria of CP, the patients with CP were treated with endoscopic procedures, including papillotomy or pancreatic sphincterotomy, calcu-Ins removal, stonosis dilation and stent insertion. Pre-and post-operative incidence of acute pancreatitis (AP), abdominal pain, weight, endocrine and exocrine functions and change of pancreatic duct diameter were analyzed. Results From January 1,2006 to December 31,2007, a total of 107 patients with CP, in-cluding 74 males and 33 females, with a mean age of 41.2 years at admission, were recruited. All patients except 2 lost ones were followed up at a mean duration of 15 months (3-27 months). During the follow-up, 4 patients received surgery. Abdominal pain was completely resolved in 70 patients and partly resolved in 19 patients, with a total remission rate at 88. 1%. Insufficient endocrine funetion presented as diabetes was de-tooted in 10 patients before the treatment and no improvement was observed during the follow-up. Steatorrhea was presented in 10 patients and was resolved in 7 after the treatments. Weight gain at an average of 4 kg was achieved in 56. 4% (57/101) of the patients. No significant change in diameter of pancreatic duct was observed before and after the endoscopic procedure, which was not correlated with patient outcome. Conclusion Endoscopic managements can relieve abdominal pain and increase body weight in patients with CP.

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Expression of Cdx2 and LI-cadherin in intestinal metaplasla of gastric mucosa and gastric adenocarcinoma of the intestinal type

Xin CHEN ; Bangmao WANG

Chinese Journal of Digestive Endoscopy.2009;26(7):360-363. doi:10.3760/cma.j.issn.1007-5232.2009.07.008

Objective To explore the expression of caudal type homeobox transcription factor 2 (Cdx2) and liver intestinal cadherin (LI-CD) in intestinal metaplasia ( IM ) of gastric mucosa and gastric adenocarcinoma of the intestinal type (GAIT). Methods By using immunohistochemical method, the ex-pressions of Cdx2 and LI-CD were detected in biopsy sample including 30 cases of GAIT, 30 IM and 30 nor-mal controls. Results The positive rate of Cdx2 expression was 0, 93.3% and 46.7% in normal stomach mucosa, IM and GAIT, respectively. The positive rates of Cdx2 expression in IM and GAIT were significant-ly higher than that in normal stomach mucosa ( P < 0. 005 ), and the expression of Cdx2 in IM was signifi-cantly higher than that in GAIT (P<0. 005). Similarly, LI-CD was also negative in normal stomach muco-sa, and positive rates were 96. 7% and 73. 3% in IM and GAIT group, which were significantly higher than that in normal stomach mucasa (P < 0. 005 ), and LI-CD expression was also significantly higher in IM than in GAIT (P < 0. 05 ). In addition, the staining intensity of Cdx2 and LI-CD expressions in IM exhibited sig-nificant correlation (r=0. 827, P<0.01), but those in GAIT did not (r =0.438, P=0. 117). Conclu-sion Ectopic expression of Cdx2 and LI-CD can be found in IM and GAIT tissues, which could be an early marker in the disease progression. There is correlation between Cdx2 and LI-CD expression in IM tissue of human, and presumably, Cdx2 regulates LI-CD in IM development.

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Laparoendoscopic examination in ascites of unknown origin

Yang SONG ; Dingguo ZHANG ; Huiming ZHU

Chinese Journal of Digestive Endoscopy.2009;26(7):357-359. doi:10.3760/cma.j.issn.1007-5232.2009.07.007

Objective To investigate the diagnostic value of laparoendoscopic exploration and peri-toneum biopsy in patients with ascites of unknown origin and to study the feasibility of replacing hard laparo-endoscope with ultrathin gastroendoscope. Methods A total of 35 patients with ascites of unknown origin underwent laparoendoscopic exploration and biopsies were taken at suspected sites on peritoneum. Results Definite diagnosis was made in 33 patients after laparoendoscopy (94. 3% ), among which there were 10 tuberculosis peritonitis (28. 6% ), 7 metastatic peritoneal carcinoma (20%), 5 liver cancer, 3 liv-er cirrhosis, 3 primary peritoneal carcinoma, 2 ovary cancer, 1 hepatovascular sarcoma, 1 spleen lymphoma and 1 acidophilic enteritis. No procedure related complications were observed. Conclusion Laparoendosco-py is safe and effective in target peritoneal biopsy, and is of great importance in diagnosis of ascites of un-known origin.

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Simultaneous endoscopic bilateral placement of biliary metal stent: a pilot study of 9 cases

Bing HU ; Rui LU ; Funing XU ; Yuqian LI ; Shuzhi WANG ; Zhimei SHI ; Hui HUANG ; Shuping WANG ; Yamin PAN ; Yubao ZHOU

Chinese Journal of Digestive Endoscopy.2009;26(7):339-343. doi:10.3760/cma.j.issn.1007-5232.2009.07.002

Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.

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Managements and prevention of complications after endoscopic retrograde cholangiopancreatography

Fenghai YU ; Wei ZHANG ; Yuanyuan SUN ; Yimei JI ; Bing HU ; Shuzhi WANG ; Rui LU

Chinese Journal of Digestive Endoscopy.2009;26(5):256-259. doi:10.3760/cma.j.issn.1007-5232.2009.05.011

Objective To investigate the incidence, diagnosis and treatment of complications after endoscopic retrograde cholangiopancreatography (ERCP), and to explore the ways of prevention. Methods Clinical data of 930 subjects, in which 510 were older than 60, with cholangiopancreatic diseases who underwent ERCP in the past 2 years were retrospectively analyzed. Results Success rate of ERCP was 96.34% (896/930),and the postoperative complication incidence was 7.85% (73/930). Of all the complications, there were 42 cases of acute pancreatitis, among which 1 was accompanied with biliary tract infection, 4 cases of duodenum perforation, 6 delayed hemorrhage, 2 cardiac dilacerations bleeding, and 19 biliary tract infection (5 combined with infectious shock). All subjects with complications were cured except for 2 deaths. Conclusion ERCP is a safe and effective method for elderly patients. However, due to decreased organ functions and other underlying diseases, complications after ERCP in elderly patients are usually difficult to manage. The key factors in prevention of complications after ERCP includes in obedience to indications, improvement in procedure skills, treatment of accompanied diseases before and after ERCP, and active management of complications.

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Biliary tract prosthesis combined with pancreatic duct stents in patients with periampullary carcinoma

Shutang HAN ; Wei SHI ; Xiaoqin ZHANG ; Yiyang ZHANG ; Qide ZHANG ; Jun XIAO ; Yuhong ZHOU ; Yumei HU ; Sufeng JIANG

Chinese Journal of Digestive Endoscopy.2009;26(5):253-255. doi:10.3760/cma.j.issn.1007-5232.2009.05.010

Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after stents implacement. The levels of amylase (plasma and urine) and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82.4% (28/34) and 88.2% (15/17), respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duct stents is safe and effective in relieving malignant obstruction in periampullary carcinoma.

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