This study retrospectively reviewed 48 cases of gastric submucosal tumors (SMTs) treated by endolumenal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center.From November 2009 to October 2012, 48 cases underwent endolumenal EFR for resection of muscularis propria-originating gastric SMTs. Characteristics of the 48 patients, clinical efficacy, safety of EFR, and post-EFR pathological diagnoses were evaluated retrospectively.EFR was successfully performed in 48 cases with 52 lesions. The median operation time was 59.72 minutes (range, 30-270 minutes; standard deviation, 39.72 minutes). The mean tumor size was 1.59 cm (range, 0.50-4.80 cm; standard deviation, 1.01 cm). During the EFR process, dual-channel gastroscopy was applied in 20 cases of SMTs, and paracentesis during the EFR process was applied in 9 cases. EFR for larger SMTs and gastric corpus-originating SMTs had longer operative times. Pathological diagnosis included 43 gastrointestinal stromal tumors, 4 leiomyomas, and 1 schwannoma. A larger tumor size was associated with higher risk of malignancy. No severe postoperative complications were observed. No tumor recurrences were confirmed in follow-up gastroscopy.The endolumenal EFR technique proved to be feasible and minimally invasive, even for the resection of large gastric tumors originating from the muscularis propria. However, more data on EFR must be obtained and analyzed.
AIM To investigate efficacy and safety of Pepcid Complete(compound famotidine) on heartburn,acid related functional disorders.METHODS 229 patients with heartburn,acid related FD in different trial centers were enrolled and double-blindly,randomly prescribed either Pepcid Complete or Famotidine.Intention-to-treat(ITT),Per-Protocol and Safety Population(PP) are employed for analysis of efficacy and safety respectively.RESULTS 218,229,229 patients were enrolled PP,ITT and Safety Population respectively.No significant difference in efficacy and safety were found between Pepcid Complete and Famotidine on heartburn,acid reflux,abdominal discomfort or pain.The mean time of control heartburn and acid reflux of Pepcid Complete is shorter than that of Famotidine.There was more significant improvement in heartburn and acid reflux scores during the first treatment period in Pepcid Complete group.CONCLUSIONS Both Pepcid Complete and Famotidine are effective and safe in treatment of heartburn and acid related FD.Patients in Pepcid Complete group got sooner and longer remission than those in Famotidine group.
Endoscopic procedures, such as balloon/bougie dilation and stent implantation, have gained increasing potential as the treatment of corrosive esophageal stricture. The purpose of the present retrospective case series study was to assess clinical outcomes of endoscopic therapy of esophageal strictures after caustic injury.Between January 2003 and December 2009, 13 admitted patients that developed esophageal stricture after caustic agent ingestion underwent endoscopic therapy at the First Affiliated Hospital of Nanjing Medical University. Data such as age, gender, caustic agents, site of burn, type of treatment, effectiveness and outcome of endoscopic therapy were recorded.The average follow up was 39 months with a range of 29-70 months. Successful endoscopic therapy was achieved in 12 of 13 patients (92%). Duration of stricture resolution was between 4 and 48 months (mean, 15 months). Among them, seven patients required dilations only, whereas the other five patients received both dilations and stent implantation. There were no severe complications in these patients.These data suggest that endoscopic therapy is feasible, less invasive and effective for the management of caustic esophageal stricture. After repeat dilation and stenting, patients can achieve stricture resolution in approximately 15 months and avoid surgery.
Objective To explore the pathologic and morphologic changes of local esophageal mueosa after placement of metal stents covered with three different kinds of membranes. Methods Sixteen healthy adult rabbits were randomly divided into 4 groups to receive silicone rubber-covered esophageal stents （group A, n =4）, silicone rubber-covered stents with fringe （group B, n=4, control group）, polytetraflu- oroethylene-covered stents with fringe （ group C, n = 4 ） and polyurethane-covered stents with fringe （ group D, n =4）, respectively, under X-ray guidance. One rabbit from each group was sacrificed at 2,4,6 and 8 weeks after stent placement and the esophageal tissue adjacent to the stent was collected and analyzed by gross observation, light microscopy, electron microscopy, and immunohistochemical examination. Results The thickness of esophageal wall increased with the duration of stent placement in each group. Tissue prolif- eration occurred at both ends of the stents, with local granulation, fibrosis and stenosis. The esophageal wall of animal in group C was thinner than that in group B （ P 〈 0. 05 ）. Compared with that in group B, esoph geal mucosal inflammation in group A was more severe, while that in group C was milder, and that in group D was similar. In group A, PCNA was slightly expressed at 2 and 6 weeks, and markedly expressed at 4 weeks after stent placement, while in groups B, C and D, PCNA was markedly expressed at 4 and 6 weeks, and slightly expressed at 8 weeks after stent placement. Conclusion Esophageal re-stenosis after stent placement is characterized by granulation and fibrosis at both ends of the stent, with inflammation at distal end more severe than that at proximal end. Different stent membrane stimulates different levels of inflammation in esophageal mucosa, which is the mildest by polytetrafluoroethylene membrane and occurred at the latest time.
Key words:
Esophagus ; Stent ; Animal experimentation; Esophageal stenosis
Objective
To investigate the intermediate and long-term efficacy of endoscopic submucosal dissection (ESD) for early esophageal cancer(EEC).
Methods
A total of 56 patients with EEC underwent ESD at Jiangsu Province People's Hospital between April 2010 and June 2015.Among the 56 cases, there were 39 cases of intramucosal cancer, 17 cases of submucosal cancer. Intravascular cancer embolus was found in 2 patients.The en bloc and complete resection rates, the residual, local tumor recurrence and new occurrence rates of EEC after ESD were evaluated. The average follow-up time was 24.4 months, ranging from 1 to 62 months.
Results
The en bloc and complete resection rates were 92.9%(52) and 87.5%(49), respectively. Four patients were treated by additional esophagectomy. The cases of residual lesions, local tumor recurrence, new occurrence and second primary extra-esophageal cancer (gastric cancer) was 1(1.8%), 2(3.6%), 2(3.6%) and 2(3.6%), respectively. No additional surgical operations were performed in the 7 patients or no recurrence was found, and there was no death during the follow-up period.
Conclusion
ESD has the advantage of high complete resection rate, low residual and local tumor recurrence rate in treatment of EEC, and the intermediate and long-term outcomes are satisfactory.
Key words:
Follow-up studies; Endoscopic submucosal dissection; Esophageal neoplasms
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