Objective: To analyze the risk factors for complications of endoscopic full-thickness resection (EFTR) of upper gastrointestinal submucosal tumors (SMTs). Methods: This was a retrospective observational study. The indications for EFTR included: (1) SMTs originating from the muscularis propria layer and growing out of the cavity or infiltrating the deep part of the muscularis propria layer; (2) SMTs diameter <5 cm; and (3) tumor identified as closely adherent to the serous layer during endoscopic submucosal dissection or endoscopic mucosal resection. This study included patients with SMTs originating from the muscularis propria layer in upper digestive tract, diagnosed preoperatively by endoscopic ultrasonography or computed tomography, who were successfully treated with EFTR. Those with incomplete clinical data were excluded. The clinical data of 154 patients with upper gastrointestinal SMTs who underwent EFTR at the Department of Gastroenterology, First Affiliated Hospital of Soochow University from January 2016 to January 2022 were retrospectively analyzed. Post-EFTR complications (such as delayed perforation, delayed bleeding, and postoperative infection, including electrocoagulation syndrome) were monitored and the risk factors for them were analyzed. Results: Among the 154 study patients, 33 (21.4%) developed complications, including delayed bleeding in three (1.9%), delayed perforation in two (1.3%), and postoperative infection in 28 (18.2%). One patient with bleeding was classified as having a major complication (hospitalized for more than 10 days because of complication). According to univariate analysis, complication was associated with tumor diameter >15 mm, operation time >90 minutes, defect closure method(purse string suture), and diameter of resected specimen ≥20 mm (all P<0.05). Multivariate logistic regression analysis showed that operation time >90 minutes (OR=6.252, 95%CI: 2.530-15.446, P<0.001) and tumor diameter >15 mm (OR=4.843, 95%CI: 1.985-11.817, P=0.001) were independent risk factors for complications after EFTR in patients with upper gastrointestinal SMTs. The independent risk factors for postoperative infection in these patients were operation time>90 minutes (OR=4.993, 95%CI:1.964-12.694, P=0.001) and purse string suture (OR=7.142, 95%CI: 1.953-26.123, P=0.003). Conclusion: Patients with upper gastrointestinal SMTs undergoing EFTR with tumor diameter >15 mm or operation time >90 minutes have a significantly increased risk of postoperative complications. Postoperative monitoring is important for these patients with SMTs.
Humans ; Stomach Neoplasms/surgery* ; Endoscopic Mucosal Resection/methods* ; Gastroscopy/methods* ; Retrospective Studies ; Endosonography/adverse effects* ; Postoperative Complications/etiology* ; Treatment Outcome ; Gastric Mucosa/surgery*

BACKGROUND: Virtual bronchoscopic navigation (VBN) assisted endobronchial ultrasonography with guide sheath (EBUS-GS) has reduced the difficulty and even avoiding radiation exposure during performing transbronchus lung biopsy (TBLB). To evaluate the feasibility and safety of virtual bronchoscopic navigation assisted endobronchial ultrasonography with guide sheath for peripheral pulmonary lesions. METHODS: We performed a retrospective analysis of the patients with PPLs who received VBN assisted EBUS-GS-TBLB in Peking University Cancer Hospital from January 2016 to December 2017. Their clinicopathologic data and complications were assessed. RESULTS: A total of 121 patients were enrolled in the study. The patients included 65 men and 56 women, with a mean age of (58.8±10.3) years. A total of 121 PPLs were examined, and 108 lesions of which could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 73.5%. The diagnostic yield of malignancy was 82.5%. The combination of transbronchial lung biopsy, brush smear and bronchoalveolar lavage fluid provided the greatest diagnostic yield (χ²=6.084, P=0.014). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesions (χ²=20.372, P=0.000) and PPLs located in the central two-thirds of the lung (χ²=10.810, P=0.001). 1 patient (0.8%) suffered from intraoperative bleeding which could be managed under endoscopy. CONCLUSIONS VBN assisted EBUS-GS-TBLB for PPLs was an effective and safe procedure.
Bronchoscopy ; adverse effects ; methods ; Endosonography ; adverse effects ; methods ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Safety

No abstract available.
Adult ; Choledochostomy/*adverse effects/instrumentation/methods ; Duodenum/*injuries ; Endosonography/*adverse effects/instrumentation/methods ; Female ; Humans ; Jaundice, Obstructive/diagnostic imaging/etiology/surgery ; Self Expandable Metallic Stents/adverse effects

No abstract available.
Biliary Tract Diseases/*surgery ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Endosonography/*adverse effects ; Female ; Humans ; Obstetric Surgical Procedures/*adverse effects ; Pancreatic Diseases/*surgery ; Pregnancy ; Pregnancy Complications/*surgery

BACKGROUND/AIMS: Intraductal ultrasonography (IDUS) has been performed as an adjunct to endoscopic retrograde cholangiography (ERC) during radiocontrast cholangiography (RC). Radiation exposure during RC poses a health risk to both patients and examiners. We evaluated the feasibility of IDUS without RC in various extrahepatic biliary diseases. METHODS: IDUS was performed with the insertion of an IDUS probe from the papilla of Vater to the confluent portion of the common hepatic duct without fluoroscopy. The technical success rate and procedure-related complications were evaluated retrospectively. RESULTS: Wire-guided IDUS without RC was performed in 105 patients. The mean age was 66.5 years, and 50 (47.6%) were male. The IDUS diagnoses included choledocholithiasis (73, 69.5%), benign biliary stricture (11, 10.5%), choledocholithiasis with biliary pancreatitis (9, 8.6%), bile duct cancer (5, 4.8%), pancreatic cancer (1, 0.9%), and others (6, 5.7%). After IDUS, 66 (62.8%) underwent stone removal, 19 (18.1%) underwent biliary drainage, and 7 (6.6%) underwent brush cytology and biopsy. No significant complications such as perforation or severe pancreatitis occurred. CONCLUSIONS: IDUS without RC was a feasible and safe approach in patients with various extrahepatic biliary diseases. We anticipate a potentially important role of IDUS in various ERC procedures because it lacks the hazards of RC.
Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Extrahepatic/pathology/*ultrasonography ; Biliary Tract Diseases/*ultrasonography ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects/*methods ; Contrast Media ; Drainage/methods ; Endosonography/*methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis/ultrasonography ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional/*methods

BACKGROUND/AIMS: Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. METHODS: We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. RESULTS: A total of 10 ER-CPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. CONCLUSIONS: ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy.
Adult ; Biliary Tract Diseases/*surgery ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects/methods ; Endosonography/*adverse effects/methods ; Female ; Fetus ; Humans ; Obstetric Surgical Procedures/*adverse effects/methods ; Pancreatic Diseases/*surgery ; Pregnancy ; Pregnancy Complications/*surgery ; Pregnancy Outcome ; Retrospective Studies ; Young Adult

PURPOSE: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is usually safe. However, some patients are hospitalized owing to complications from TRUS biopsy. We identified the risk factors for complications and effective preventive measures for treating complications after TRUS biopsy. MATERIALS AND METHODS: Medical records and radiological images of 1,083 patients who underwent TRUS biopsy of the prostate over 10 years in Gyeongsang National University Hospital were examined retrospectively to investigate the correlation between complications after TRUS biopsy and preventive antibiotics, prebiopsy enema, number of biopsy cores, and pathological findings. RESULTS: Complications occurred in 69 patients (6.4%). The complication rates of the 1,008 patients who received antibiotics and the 75 patients who did not were 6.3% and 8.0%, respectively (p=0.469). Complication rates of the pre-biopsy enema group (n=658) and the group without prebiopsy enema (n=425) were 4.7% and 8.9%, respectively (p=0.007). Complication rates of the 6-core biopsy group (n=41) and the 12-core biopsy group (n=955) were 7.3% and 6.3%, respectively (p=0.891). Complication rates of the prostate cancer group (n=306) and the no prostate cancer group (n=713) were 6.2% and 6.6%, respectively (p=0.740). CONCLUSIONS: A prebiopsy enema was associated with a reduced risk of complications after TRUS biopsy. Preventive antibiotics, number of biopsy cores, and pathological findings did not significantly influence the complication rate.
Aged ; *Endosonography ; Enema/*methods ; Humans ; Image-Guided Biopsy/*adverse effects/methods ; Incidence ; Male ; Prostatic Neoplasms/*pathology ; Prostatitis/epidemiology/etiology/*prevention & control ; Rectum ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Syncope, Vasovagal/epidemiology/etiology/*prevention & control ; Urinary Retention/epidemiology/etiology/*prevention & control

An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8degrees C), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.
Aged, 80 and over ; Allopurinol/adverse effects ; Biliary Tract/pathology ; Biliary Tract Diseases/diagnosis ; Bilirubin/blood ; Creatine/blood ; Drug Hypersensitivity Syndrome/*diagnosis/etiology ; Endosonography ; Eosinophils/cytology ; Humans ; Magnetic Resonance Angiography ; Male ; Tomography, X-Ray Computed

INTRODUCTIONPeriprostatic nerve block (PPNB) is a common local anaesthetic technique in transrectal ultrasound-guided (TRUS) prostate biopsy, but concerns remain over the increased theoretical risks of urinary tract infection (UTI) and sepsis from the additional transrectal needle punctures. This study reviewed our biopsy data to assess this risk.

MATERIALS AND METHODSRetrospective data collected from 177 men who underwent TRUS biopsy between July 2007 and December 2009 in a single institution were analysed. PPNB was administered using 1% xylocaine at the prostatic base and apex and repeated on the contralateral side under ultrasound guidance. Complications, including UTI sepsis, bleeding per rectum and acute retention of urine (ARU) were noted. Every patient was tracked for the first 2 weeks for complications until his clinic review. Demographic profi le, biopsy parameters and histological fi ndings were reviewed. Univariate and multivariate analysis of possible risk factors for development of sepsis after TRUS biopsy were performed. Statistical analysis was performed using SPSS 17.0.

RESULTSNinety (51%) men received PPNB and 87 (49%) did not. The groups were matched in age (PPNB: mean 62.7 ± 5.8 years; without PPNB: mean 64.4 ± 5.7 years) and prebiopsy prostate specific antigen (PSA) levels (PPNB: mean 8.2 ± 3.9 ng/mL; without PPNB: mean 8.3 ± 3.7 ng/mL). The PPNB group had a larger prostate volume, with more cores taken (P <0.05). On univariate and multivariate analysis controlling for age, PSA, prostate volume, number of cores taken and histological prostatitis, PPNB was not a significant risk factor for sepsis. Sepsis rates were 5.6% in the PPNB group and 5.7% in the other group (P = 0.956). Overall prostate cancer detection rate was 33.3%.

CONCLUSIONThe risk of sepsis was not increased in patients who received PPNB, even though this group had larger gland volumes and more biopsy cores taken.

Aged ; Biopsy, Needle ; adverse effects ; methods ; Endosonography ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Nerve Block ; adverse effects ; methods ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; Retrospective Studies ; Risk Factors ; Sepsis ; blood ; epidemiology ; etiology ; Singapore ; epidemiology

OBJECTIVETo investigate the diagnosis and treatment of pancreatic islet cell tumors.

METHODSFifty-one patients with islet cell tumors treated in our department from January 1991 to April 2011 were included in this study. The data of clinical features, diagnosis and treatment were retrospectively analyzed.

RESULTSAmong the 51 cases, 38 cases showed typical Whipple's triad, and the other 13 cases were non-functional islet cell tumors. In these 13 cases, 5 patients had no specific clinical symptoms, and 8 patients had abdominal distending pain. The positive rates of imaging were: B-ultrasound 43.1%, multi-slice spiral CT 69.8%; MRI 62.5%, endoscopic ultrasonography (EUS) 64.7% (11/17), and intraoperative ultrasound (IOUS) 96.3%, the differences among them were statistically significant (P<0.05). All patients underwent surgical treatment. Postoperative pancreatic leakage happened in 6 cases. Finally all the patients recovered after effective external drainage, anti-infection treatment and nutritional support.

CONCLUSIONSIntraoperative ultrasonography (IOUS) has a higher accuracy in the diagnosis of pancreatic islet cell tumors, compared with preoperative B-ultrasonography, CT, MRI, and endoscopic ultrasound (EUS). The most effective treatment of this disease is surgery.

Adenoma, Islet Cell ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Anastomotic Leak ; etiology ; Endosonography ; Female ; Humans ; Insulinoma ; diagnosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; Pancreatectomy ; adverse effects ; Pancreatic Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Retrospective Studies