Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） for digestive tract mucosal lesions, and risk factor of complications. Methods The data of 154 con secutive patients who underwent ESD for superficial digestive tract mueosal lesions were analyzed prospective ly for therapeutic effect and rate of complications. Risk factors for bleeding was analyzed. Results The en bloc resection rate in 145 completed ESD procedures was 100. 0%. Histologically, complete resection rate was 99. 3%. ESD was not completed in 9 patients due to bleeding （n =5） and perforation （n =4）. Acute massive bleeding occurred in 6 patients （6/154,3.9%）, mild bleeding in 5 （3.2%）, delayed bleeding in 1 （0. 6% ） ,perforation in 4 （2. 6% ） and postESD stenosis in 1 （0. 6% ）. All complications were cured. The postESD uleer healing was achieved in 100% at 8 weeks after treatment. During followup of 10. 6 months （ranged from 8 to 18 months）, no residual or local recurrence was found. Statistic analysis showed in dependent risk factors for bleeding in ESD were lesion location （cardiac fundus） , and lesion size. Conclu sion ESD is an effective and safe procedure in treatment of digestive tract mucosal lesions. The complica tions of ESD are preventable and curable. Strictly controlling operation indications, individualized treatment and the proficient operation skills of physicians are the keys to success.
Key words:
Endoscopes ; Endoscopic submucosal dissection; Efficiency ; Hemorrhage ; Riskfactors
OBJECTIVE To improve the understanding and treatment of otogenic deep neck abscess.METHODS To analyse the treatments of 2 cases retrospectively and do the literature review.RESULTS2 cases had long history of otitis media,showed abnormal signal connection on MRI image between neck lesion and middle ear.They were cured by mastoidectomy and drainage from neck abscess to mastoid cavity.CONCLUSION The otogenic deep neck abscess is different from other one in the etiology,pathogenesis,pathogenic bacteria,treatment and so on.The neck MRI examination has obvious advantages in the nature of the lesion,the resolution of the soft tissue and the correlation of lesions between the neck and the mastoid,and can be used as the predominant treatment.Incision and drainage of the neck abscess is unnecessary if operated on time.Before the neck abscess is cured thoroughly,keeping drainage of the mastoid tip is very important for prevention of recurrence.Postoperative change dressing should also be strengthened.
To discuss the causes of successlessness of therapic ERCP and to investigate how to prevent its complications. Methods: ERCP data of 453 cases were reviewed, of which 328 cases received EST.The causes of successlessness of ERCP were analysed,and the color, size, shape,and configuration of stones and the size of CBD were compared, the improvement of the technique were discussed.Results: 453 cases received ERCP,of which 445(98.2%) were successful. 328 patients received EST,of which 319 (97.2%) were successful. Of these patients, 17(5.3%) had complications.The causes of successlessness of ERCP related to the diameter and classification of the stone,and to the operation technique.Conclusion:The indications of ERCP for beating cholopancreatic diseases can be wide, the efficacy is better, and the procedure is safe. In order to significantly reduce the rate of sucesslessness and complications, the indication of ERCP and EST should be evaluated, and endoscopic technique should be improved.
To investigate the value of a transendoscopic miniature ultrasonic probe (USP) in the diagnosis of esophageal diseases.Endoscopic ultrasonography was performed by means of USP in 53 patients with esophageal diseases, including 16 with esophageal leiomyoma, 14 with esophageal carcinoma, seven with achalasia, seven with reflux esophagitis, six with esophageal polyps and three with esophageal varices.USP clearly showed all 16 esophageal leiomyomas, whereas, conventional EUS could not show five small leiomyomas less than 1.0 x 1.0 cm in size. The appearance of esophageal leiomyoma was that of a hypoechoic mass with a homogeneous inner echogram arising from the fourth hypoechoic layer. All 14 patients with esophageal carcinoma underwent full endosonographic T and N staging with USP. In two cases passage of the malignant stenosis proved to be impossible using conventional EUS. The accuracy of USP on T staging and N staging was 80% and 30%, respectively. In the seven achalasia patients USP demonstrated a seven-layer structure of the esophageal wall, with thickening of the third and fifth layers. In the seven patients with reflux esophagitis no difference was found for the ultrasonic image between that with and that without Barrett's epithelium. All of the esophageal polyps were showed by USP as hypoechoic homogeneous lesion with indistinct margins. After endoscopic sclerotherapy the ultrasonographic feature of esophageal varices changed from submucosal multiple anechoic areas to high echoic areas.With refinement, the transendoscopic miniature ultrasonic probe will play an increasing role in the diagnosis of esophageal disease.
BACKGROUND : Endoscopic submucosal dissection (ESD) has been widely used to treat superficial esophageal neoplasms (SENs). Intraoperative bleeding is one of the main concerns that makes ESD in the esophagus more difficult and time consuming with higher complication rates. We introduced a novel laser endoknife system that enabled better intraoperative hemostasis, and preliminarily investigated its feasibility in ESD for patients with SENs.17 consecutive patients with SENs were prospectively enrolled. The laser endoknife system was used in marking and submucosal dissection. Data on therapeutic outcomes were collected and analyzed.The median diameter of the lesions was 2.5 cm and of the resected specimens was 3.0 cm. The median procedure time was 48 minutes. Histologic evaluation revealed 15 high grade intraepithelial neoplasias and two squamous cell carcinomas. No intraoperative bleeding occurred during laser cutting and no significant complications occurred postoperatively. Curative R0 resection was achieved in all patients.Our new laser endoknife system was feasible in the submucosal dissection of SENs and showed great prospects for future application.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)