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直肠神经内分泌肿瘤内镜下诊疗的临床研究 预览
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作者 朱建华 郝凤媛 李楠 《中华保健医学杂志》 2019年第1期42-44,共3页
目的探讨超声内镜(endoscopic ultrasonography,EUS)对直肠神经内分泌肿瘤的临床诊断价值,以及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠神经内分泌肿瘤的临床疗效及安全性。方法回顾性分析18例直肠神经内分泌... 目的探讨超声内镜(endoscopic ultrasonography,EUS)对直肠神经内分泌肿瘤的临床诊断价值,以及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠神经内分泌肿瘤的临床疗效及安全性。方法回顾性分析18例直肠神经内分泌肿瘤患者,经常规电子结肠镜检查初步诊断;超声内镜(EUS)下诊断,指导ESD拟切除范围及深度;对直肠神经内分泌肿瘤行ESD治疗,内镜下标识预切除范围,黏膜下注射、黏膜切开、病变剥离及创面处理;术后常规病理及免疫组织化学检验。结果18例直肠神经内分泌肿瘤直径0.5~1.2 cm,直径平均(0.6±0.2)cm。ESD均一次性完整剥离,无穿孔,术中出血5例,予以Dualknife刀头电凝止血。病灶创面基底部与病灶切缘取病理无类癌组织残存;免疫组织化学检验Secretagogin100.0%(18/18)、Syn94.4%(17/18)、CgA83.3%(15/18)、神经特异性烯醇化酶(NSE)44.4%(8/18)、CEA 0.0%(0/18)、p53 0.0%(0/18)提示诊断直肠神经内分泌肿瘤且预后良好。结论肿瘤直径<1.2 cm的直肠神经内分泌肿瘤患者行ESD治疗安全有效。 展开更多
关键词 直肠神经内分泌肿瘤 超声内镜(endoscopic ultrasonography EUS) 内镜黏膜下剥离术(endoscopic SUBMUCOSAL dissection ESD) 免疫组织化学
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Endoscopic resection techniques for colorectal neoplasia:Current developments 预览
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作者 Franz Ludwig Dumoulin Ralf Hildenbrand 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第3期300-307,共8页
Endoscopic polypectomy and endoscopic mucosal resection(EMR)are the established treatment standards for colorectal polyps.Current research aims at the reduction of both complication and recurrence rates as well as on ... Endoscopic polypectomy and endoscopic mucosal resection(EMR)are the established treatment standards for colorectal polyps.Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times.Cold snare resection is the emerging standard for the treatment of smaller(<5mm)polyps and is possibly also suitable for the removal of noncancerous polyps up to 9 mm.The method avoids thermal damage,has reduced procedure times and probably also a lower risk for delayed bleeding.On the other end of the treatment spectrum,endoscopic submucosal dissection(ESD)offers en bloc resection of larger flat or sessile lesions.The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer.Due to its minimal recurrence rate,it may also be an alternative to fractionated EMR of larger flat or sessile lesions.However,ESD is technically demanding and burdened by longer procedure times and higher costs.It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer.The latest addition to endoscopic resection techniques is endoscopic fullthickness resection with specifically developed devices for flexible endoscopy.This method is very useful for the treatment of smaller difficult-to-resect lesions,e.g.,recurrence with scar formation after previous endoscopic resections. 展开更多
关键词 COLORECTAL NEOPLASIA COLORECTAL cancer screening Cold SNARE RESECTION ENDOSCOPIC POLYPECTOMY ENDOSCOPIC mucosal RESECTION ENDOSCOPIC submucosal dissection ENDOSCOPIC full-thickness RESECTION Adenoma recurrence rate
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Comprehensive review on EUS-guided biliary drainage 预览
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作者 Raffaele Salerno Sophia Elizabeth Campbell Davies +1 位作者 Nicolo Mezzina Sandro Ardizzone 《世界胃肠内镜杂志:英文版(电子版)》 2019年第5期354-364,共11页
Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary... Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However, endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree, two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendezvous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However, the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore, trained endoscopists, in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup. 展开更多
关键词 ENDOSCOPIC ultrasonography-guided BILIARY drainage EUS Percutaneous transhepatic BILIARY drainage ENDOSCOPIC ultrasonography-guided hepatogastric anastomosis ENDOSCOPIC ultrasonography-guided ANTEGRADE stent placement ENDOSCOPIC ultrasonography-guided CHOLEDOCHODUODENOSTOMY ENDOSCOPIC ultrasonography-guided transgallbladder ENDOSCOPIC ultrasonography-guided rendezvous
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Gastric per-oral endoscopic myotomy: Current status and future directions 预览
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作者 Alexander Podboy Joo Ha Hwang +5 位作者 Linda A Nguyen Patricia Garcia Thomas A Zikos Afrin Kamal George Triadafilopoulos John O Clarke 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第21期2581-2590,共10页
Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by t... Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field. 展开更多
关键词 Gastroparesis GASTRIC per-oral ENDOSCOPIC MYOTOMY Per-oral ENDOSCOPIC PYLOROMYOTOMY MYOTOMY ENDOSCOPIC MYOTOMY Peroral ENDOSCOPIC MYOTOMY GASTRIC emptying
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Consensus on the digestive endoscopic tunnel technique 预览
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作者 Ning-Li Chai Hui-Kai Li +45 位作者 En-Qiang Linghu Zhao-Shen Li Shu-Tian Zhang Yu Bao Wei-Gang Chen Philip WY Chiu Tong Dang Wei Gong Shu-Tang Han Jian-Yu Hao Shui-Xiang He Bing Hu1 Bing Hu2 Xiao-Jun Huang Yong-Hui Huang Zhen-Dong Jin Mouen A Khashab James Lau Peng Li Rui Li De-Liang Liu Hai-Feng Liu Jun Liu Xiao-Gang Liu Zhi-Guo Liu Ying-Cai Ma Gui-Yong Peng Long Rong Wei-Hong Sha Pateek Sharma Jian-Qiu Sheng Shui-Sheng Shi Dong Wan Seo Si-Yu Sun Gui-Qi Wang Wen Wang Qi Wu Hong Xu Mei-Dong Xu Ai-Ming Yang Fang Yao Hong-Gang Yu Ping-Hong Zhou Bin Zhang Xiao-Feng Zhang Ya-Qi Zhai 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第7期744-776,共33页
With the digestive endoscopic tunnel technique(DETT),many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and musculari... With the digestive endoscopic tunnel technique(DETT),many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP).Through the tunnel,endoscopic diagnosis or treatment is performed for lesions in the mucosa,in the MP,and even outside the gastrointestinal(GI)tract.At present,the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer,e.g.,endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2)treatment of lesions from the MP layer,per-oral endoscopic myotomy,submucosal tunnelling endoscopic resection,etc.;and(3)diagnosis and treatment of lesions outside the GI tract,such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity.With the increasing number of DETTs performed worldwide,endoscopic tunnel therapeutics,which is based on DETT,has been gradually developed and optimized.However,there is not yet an expert consensus on DETT to regulate its indications,contraindications,surgical procedure,and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT.In this consensus,we describe the definition,mechanism,and significance of DETT,prevention of infection and concepts of DETTassociated complications,methods to establish a submucosal tunnel,and application of DETT for lesions in the mucosa,in the MP and outside the GI tract(indications and contraindications,procedures,pre-and postoperative treatments,effectiveness,complications and treatments,and a comparison between DETT and other operations). 展开更多
关键词 DIGESTIVE ENDOSCOPIC TUNNEL technique ENDOSCOPIC SUBMUCOSAL TUNNEL dissection Per-oral ENDOSCOPIC MYOTOMY SUBMUCOSAL TUNNELLING ENDOSCOPIC resection Gastrointestinal tract
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Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy 预览
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作者 Chonlada Krutsri Mitsuhiro Kida +3 位作者 Hiroshi Yamauchi Tomohisa Iwai Hiroshi Imaizumi Wasaburo Koizumi 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第26期3313-3333,共21页
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types o... Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed. 展开更多
关键词 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Surgically ALTERED ANATOMY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY in Billroth II ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY post-Whipple ENDOSCOPIC ultrasonography-guided ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
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Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience? 预览
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作者 Andrea Anderloni Edoardo Troncone +4 位作者 Alessandro Fugazza Annalisa Cappello Giovanna Del Vecchio Blanco Giovanni Monteleone Alessandro Repici 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第29期3857-3869,共13页
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic inter... In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients. 展开更多
关键词 Interventional ENDOSCOPIC ULTRASONOGRAPHY ENDOSCOPIC ultrasonography-guided BILIARY drainage ENDOSCOPIC ultrasonography-guided choledocho-duodenostomy BILIARY METAL STENT Lumen-apposing METAL STENT
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Endoscopic ultrasound-guided biliary drainage: A change in paradigm? 预览
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作者 En-Ling Leung Ki Bertrand Napoleon 《世界胃肠内镜杂志:英文版(电子版)》 2019年第5期345-353,共9页
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative means of biliary drainage for malignant biliary obstruction (MBO). Compared to percutaneous transhepatic biliary drainage, EU... Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative means of biliary drainage for malignant biliary obstruction (MBO). Compared to percutaneous transhepatic biliary drainage, EUS-BD offers effective internal drainage in a single session in the event of failed endoscopic retrograde cholangiopancreatography and has fewer adverse events (AE). In choosing which technique to use for EUS-BD, a combination of factors appears to be important in decision-making;technical expertise, the risk of AE, and anatomy. With the advent of novel all-in-one EUS-BD specific devices enabling simpler and safer techniques, as well as the growing experience and training of endosonographers, EUS-BD may potentially become a first-line technique in biliary drainage for MBO. 展开更多
关键词 ENDOSCOPIC ULTRASOUND-GUIDED biliary drainage ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY ENDOSCOPIC ULTRASOUND-GUIDED hepaticogastrostomy Lumenapposing METAL STENTS Electrocautery-enhanced lumen-apposing METAL STENTS
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Endoscopic foregut surgery and interventions:The future is now.The state-of-the-art and my personal journey 预览
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作者 Kenneth J Chang H.H.Chao 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第1期1-41,共41页
In this paper,I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgicall... In this paper,I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically.Within each topic,the content will progress as follows:“lessons learned”,“technical considerations”and“future opportunities”.Lessons learned will provide a brief background and update on the most current literature.Technical considerations will include my personal experience,including tips and tricks that I have learned over the years.Finally,future opportunities will address current unmet needs and potential new areas of development.The foregut is defined as“the upper part of the embryonic alimentary canal from which the pharynx,esophagus,lung,stomach,liver,pancreas,and part of the duodenum develop”.Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease(GERD),achalasia,esophageal diverticula,Barrett’s esophagus(BE)and esophageal cancer,stomach cancer,gastric-outlet obstruction,and obesity.Over the past decade,remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper.Regarding GERD,there are now several technologies available to effectively treat it and potentially eliminate symptoms,and the need for long-term treatment with proton pump inhibitors.For the first time,fundoplication can be performed without the need for open or laparoscopic surgery.Long-term data going out 5-10 years are now emerging showing extended durability.In respect to achalasia,per-oral endoscopic myotomy(POEM)which was developed in Japan,has become an alternative to the traditional Heller’s myotomy.Recent meta-analysis show that POEM may have better results than Heller,but the issue of post-POEM GERD still needs to be addressed.There is now a resurgence of endoscopic treatment of Zenker’s diverticula with improved technique(Z-POEM)an 展开更多
关键词 Endoscopy FOREGUT diseases GASTROESOPHAGEAL reflux disease ENDOSCOPIC sleeve GASTROPLASTY ENDOSCOPIC submucosal dissection Per-oral ENDOSCOPIC MYOTOMY Endo-hepatology
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Resection of early esophageal neoplasms:The pendulum swings from surgical to endoscopic management 预览
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作者 Vedha Sanghi Hina Amin +1 位作者 Madhusudhan R Sanaka Prashanthi N Thota 《世界胃肠内镜杂志:英文版(电子版)》 2019年第10期491-503,共13页
Esophageal cancer is a highly lethal disease and is the sixth leading cause of cancer related mortality in the world.The standard treatment is esophagectomy which is associated with significant morbidity and mortality... Esophageal cancer is a highly lethal disease and is the sixth leading cause of cancer related mortality in the world.The standard treatment is esophagectomy which is associated with significant morbidity and mortality.This led to development of minimally invasive,organ sparing endoscopic therapies which have comparable outcomes to esophagectomy in early cancer.These include endoscopic mucosal resection and endoscopic submucosal dissection.In early squamous cell cancer,endoscopic submucosal dissection is preferred as it is associated with cause specific 5-year survival rates of 100%for M1 and M2 tumors and 85%for M3 and SM1 tumors and low recurrence rates.In early adenocarcinoma,endoscopic resection of visible abnormalities is followed by ablation of the remaining flat Barrett’s mucosa to prevent recurrences.Radiofrequency ablation is the most widely used ablation modality with others being cryotherapy and argon plasma coagulation.Focal endoscopic mucosal resection followed by radiofrequency ablation leads to eradication of neoplasia in 93.4%of patients and eradication of intestinal metaplasia in 73.1%of patients.Innovative techniques such as submucosal tunneling with endoscopic resection are developed for management of submucosal tumors of the esophagus.This review includes a discussion of various endoscopic techniques and their clinical outcomes in early squamous cell cancer,adenocarcinoma and submucosal tumors.An overview of comparison between esophagectomy and endoscopic therapy are also presented. 展开更多
关键词 Esophageal cancer SUBMUCOSAL tumors SUBMUCOSAL tunneling Barrett’s esophagus DYSPLASIA Adenocarcinoma ENDOSCOPIC therapy Radiofrequency ablation ENDOSCOPIC MUCOSAL RESECTION
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Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis 预览
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作者 Fares Ayoub Donevan R Westerveld +3 位作者 Justin J Forde Christopher E Forsmark Peter V Draganov Dennis Yang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第18期2251-2263,共13页
BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection t... BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes. AIM To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm. METHODS We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I2 were used to test for heterogeneity. Pooling was conducted using a random-effects model. RESULTS Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%)(pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I^2 = 0%, P = 0.67). CONLUSION Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy. 展开更多
关键词 META-ANALYSIS CLIPPING ENDOSCOPIC RESECTION ENDOSCOPIC mucosal RESECTION
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Genetic testing vs microforceps biopsy in pancreatic cysts:Systematic review and meta-analysis 预览
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作者 Sandra Faias Luisa Pereira +2 位作者 Angelo Luis Paula Chaves Marilia Cravo 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第26期3450-3467,共18页
BACKGROUND Carcinoembryonic antigen(CEA)and cytology in pancreatic cystic fluid are suboptimal for evaluation of pancreatic cystic neoplasms.Genetic testing and microforceps biopsy are promising tools for pre-operativ... BACKGROUND Carcinoembryonic antigen(CEA)and cytology in pancreatic cystic fluid are suboptimal for evaluation of pancreatic cystic neoplasms.Genetic testing and microforceps biopsy are promising tools for pre-operative diagnostic improvement but comparative performance of both methods is unknown.AIM To compare the accuracy of genetic testing and microforceps biopsy in pancreatic cysts referred for surgery.METHODS We performed a literature search in Medline,Scopus,and Web of Science for studies evaluating genetic testing of cystic fluid and microforceps biopsy of pancreatic cysts,with endoscopic ultrasound with fine-needle aspiration(EUSFNA)prior to surgery and surgical pathology as reference standard for diagnosis.We evaluated the diagnostic accuracy for:1-benign cysts;2-mucinous low-risk cysts;3-high-risk cysts,and the diagnostic yield and rate of correctly identified cysts with microforceps biopsy and molecular analysis.We also assessed publication bias,heterogeneity,and study quality.RESULTS Eight studies,including 1206 patients,of which 203(17%)referred for surgery who met the inclusion criteria were analyzed in the systematic review,and seven studies were included in the meta-analysis.Genetic testing and microforceps biopsies were identical for diagnosis of benign cysts.Molecular analysis was superior for diagnosis of both low and high-risk mucinous cysts,with sensitivities of 0.89(95%CI:0.79-0.95)and 0.57(95%CI:0.42-0.71),specificities of 0.88(95%CI:0.75-0.95)and 0.88(95%CI:0.80-0.93)and AUC of 0.9555 and 0.92,respectively.The diagnostic yield was higher in microforceps biopsies than in genetic analysis(0.73 vs 0.54,respectively)but the rates of correctly identified cysts were identical(0.73 with 95%CI:0.62-0.82 vs 0.71 with 95%CI:0.49-0.86,respectively).CONCLUSION Genetic testing and microforceps biopsies are useful second tests,with identical results in benign pancreatic cysts.Genetic analysis performs better for low-and high-risk cysts but has lower diagnostic yield. 展开更多
关键词 Pancreatic CYSTS ENDOSCOPIC ULTRASOUND ENDOSCOPIC ULTRASOUND with fineneedle ASPIRATION Genetic testing Microforceps BIOPSY Molecular analysis KRAS Carcinoembryonic antigen CYTOLOGY
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Potential role of new technological innovations in nonvariceal hemorrhage 预览
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作者 David Friedel 《世界胃肠内镜杂志:英文版(电子版)》 2019年第8期443-447,共5页
The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,en... The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope clips.Peptic hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis success.However,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant lesions.Novel innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable hemostasis.Gastric antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as well.We will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox. 展开更多
关键词 NON-VARICEAL upper gastrointestinal HEMORRHAGE ENDOSCOPIC HEMOSTASIS Gastric antral vascular ectasias Over-the-scope CLIPS ENDOSCOPIC SUTURING
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Endoloop ligation after endoscopic mucosal resection using a transparent cap: A novel method to treat small rectal carcinoid tumors 预览
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作者 Ding-Guo Zhang Su Luo +4 位作者 Feng Xiong Zheng-Lei Xu Ying-Xue Li Jun Yao Li-Sheng Wang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第10期1259-1265,共7页
BACKGROUND Local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue.AIM To evaluate the efficacy and ... BACKGROUND Local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue.AIM To evaluate the efficacy and safety of resection of small rectal carcinoid tumors by endoloop ligation after cap-endoscopic mucosal resection(LC-EMR) using a transparent cap.METHODS Thirty-four patients with rectal carcinoid tumors of less than 10 mm in diameter were treated by LC-EMR(n = 22) or endoscopic submucosal dissection(ESD)(n =12) between January 2016 and December 2017. Demographic data, complete resection rates, pathologically complete resection rates, operation duration, and postoperative complications were collected. All cases were followed for 6 to 30 mo.RESULTS A total of 22 LC-EMR cases and 12 ESD cases were enrolled. The average age was48.18 ± 12.31 and 46.17 ± 12.57 years old, and the tumor size was 7.23 ± 1.63 mm and 7.50 ± 1.38 mm, respectively, for the LC-EMR and ESD groups. Resection time in the ESD group was longer than that in the LC-EMR group(15.67 ± 2.15 min vs 5.91 ± 0.87 min;P < 0.001). All lesions were completely resected at one time. No perforation or delayed bleeding was observed in either group.Pathologically complete resection(P-CR) rate was 86.36%(19/22) and 91.67%(11/12) in the LC-EMR and ESD groups(P = 0.646), respectively. Two of the three cases with a positive margin in the LC-EMR group received transanal endoscopic microsurgery(TEM) and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period.CONCLUSION LC-EMR appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors. 展开更多
关键词 RECTAL CARCINOID ENDOSCOPIC SUBMUCOSAL dissection ENDOSCOPIC mucosal resection LIGATION
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Appropriate number of biliary biopsies and endoscopic retrograde cholangiopancreatography sessions for diagnosing biliary tract cancer 预览
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作者 Tadayuki Takagi Mitsuru Sugimoto +11 位作者 Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira 《世界胃肠内镜杂志:英文版(电子版)》 2019年第3期231-238,共8页
BACKGROUND Biliary ductal cancer(BDC) is a lethal disease;however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [numbe... BACKGROUND Biliary ductal cancer(BDC) is a lethal disease;however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [number of biliary biopsies, number of endoscopic retrograde cholangiopancreatography(ERCP) sessions, etc.] are unknown.AIM To clarify what constitutes an adequate method for biliary biopsy.METHODS In total, 95 patients who underwent endoscopic biliary biopsy without choledochoscopy and who were pathologically diagnosed with BDC were enrolled in this study. The patients were divided into two groups. Seventy-six patients who were diagnosed by biliary biopsy were defined as the positive group(P group), and nineteen patients who were not diagnosed by biliary biopsy were defined as the negative group(N group). The patient characteristics and ERCP-related procedures were compared between the P and N groups.RESULTS The numbers of ERCP sessions and biliary biopsies were significantly different between the two groups (ERCP sessions(one/two), P group 72/4 vs N group15/4, P value = 0.048;number of biliary biopsies, P group 2(1-6) vs N group 2(1-7), P value = 0.039)In a multivariate analysis, fewer than 2 ERCP sessions was an independent factor influencing the positivity of the biliary biopsies.CONCLUSION This study clarified that ERCP and biliary ductal biopsy should only be performed once. If biliary cancer is not pathologically diagnosed after the first ERCP session, other methods(Endoscopic ultrasonography-guided fine needle aspiration or choledochoscopy-guided biliary ductal biopsy) should be employed. 展开更多
关键词 BILIARY DUCTAL cancer BILIARY biopsy ENDOSCOPIC retrograde cholangiopancreatography ENDOSCOPIC ultrasonography-guided fine needle aspiration CHOLEDOCHOSCOPY
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Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis 预览
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作者 Fernanda P Logiudice Wanderlei M Bernardo +9 位作者 Facundo Galetti Vitor M Sagae Carolina O Matsubayashi Antonio C Madruga Neto Vitor O Brunaldi Diogo T H de Moura Tomazo Franzini Spencer Cheng Sergio E Matuguma Eduardo G H de Moura 《世界胃肠内镜杂志:英文版(电子版)》 2019年第4期281-291,共11页
BACKGROUND For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic... BACKGROUND For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic ultrasound (EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure. Recently, however, there have been robust randomized clinical trials (RCTs) comparing EUS-guided drainage and ERCP as primary approaches to MBO. AIM To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO. METHODS This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96% and 91.81%, respectively, with a risk difference (RD) of 0.00%(95%CI:-0.07, 0.07;P = 0.97;I2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of ?0.01%(95%CI:-0.12, 0.10;P = 0.90;I2 = 0%). The mean difference (MD) for the duration of the procedure was -0.12%(95%CI:-8.20, 7.97;P = 0.98;I2 = 84%). In the EUS and ERCP groups, there were 14 and 25 adverse events, respectively, with an RD of -0.06%(95%CI:-0.23, 0.12;P = 0.54;I2 = 77%). The MD for stent patency was 9.32%(95%CI:-4.53, 23.18;P = 0.19;I2 = 44%). The stent dysfunction rate was significantly lower in the EUS group (MD =-0. 展开更多
关键词 Common bile duct neoplasms ENDOSCOPIC retrograde CHOLANGIOPANCREATOGRAPHY ENDOSONOGRAPHY Ultrasonography Interventional/methods ENDOSCOPIC ultrasound Systematic review META-ANALYSIS
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Risk factors for the development of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones 预览
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作者 Hirokazu Saito Tatsuyuki Kakuma Ikuo Matsushit 《世界胃肠内镜杂志:英文版(电子版)》 2019年第10期515-522,共8页
BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However... BACKGROUND Previous studies have revealed that patients with asymptomatic common bile duct(CBD)stones are at a high risk of developing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).However,no studies to date have addressed the risk factors for PEP in patients with asymptomatic CBD stones.AIM To examine the risk factors for PEP in patients with asymptomatic CBD stones.METHODS Using medical records of three institutions in Japan for 6 years,we identified a total of 1135 patients with choledocholithiasis including 967 symptomatic patients and 168 asymptomatic patients with native papilla who underwent therapeutic ERCP.We performed univariate and multivariate analyses to examine the risk factors for PEP in the 168 patients with asymptomatic CBD stones.RESULTS The overall incidence rate of PEP in all the patients with during study period was 4.7%(53/1135).Of the 168 patients with asymptomatic CBD stones,24(14.3%)developed PEP.In univariate analysis,precut sphincterotomy(P=0.009)and biliary balloon sphincter dilation(P=0.043)were significant risk factors for PEP.In multivariate analysis,precut sphincterotomy(P=0.002,95%CI:2.2-27.8,odds ratio=7.7),biliary balloon sphincter dilation(P=0.015,95%CI:1.4-17.3,odds ratio=4.9),and trainee endoscopists(P=0.048,95%CI:1.01-8.1,odds ratio=2.9)were significant risk factors for PEP.CONCLUSION ERCP for asymptomatic CBD stones should be performed by experienced endoscopists.When performing precut sphincterotomy or biliary balloon sphincter dilation in patients with asymptomatic CBD stones,the placement of a prophylactic pancreatic stent is strongly recommended to prevent PEP. 展开更多
关键词 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Post-endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS Risk factor ASYMPTOMATIC common bile duct stone
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Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length 预览
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作者 Mitsuru Sugimoto Tadayuki Takagi +11 位作者 Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira 《世界荟萃分析杂志》 2019年第6期259-268,共10页
Although endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreaticobiliary diseases, post-ERCP pancreatitis (PEP) is the most frequent adverse event ... Although endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreaticobiliary diseases, post-ERCP pancreatitis (PEP) is the most frequent adverse event that can sometimes be fatal. However, prophylactic pancreatic stent (PS) insertion has been performed to prevent PEP in high-risk patients. In some randomized controlled trials (RCTs) and meta-analyses, the efficacy of prophylactic PS insertion has been shown to prevent PEP. In addition, several types of stents have been used to decrease PEP. In this review, we introduce the details of these RCTs and meta-analyses and reveal the specifications for stent placement, for example, the stent diameter and length and the pancreatic region into which the stent should be inserted. 展开更多
关键词 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Post-endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS PROPHYLACTIC pancreatic stent
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Endoscopic submucosal dissection as excisional biopsy for anorectal malignant melanoma: A case report 预览
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作者 Shigeo Manabe Yoshio Boku +3 位作者 Michiyo Takeda Fumitaka Usui Ikuhiro Hirata Shuji Takahashi 《世界临床病例杂志》 2019年第13期1652-1659,共8页
BACKGROUND Anorectal malignant melanoma (AMM) is a rare disorder with an extremely poor prognosis. Although there is currently no consensus on the treatment methods for AMM, surgical procedures have been the most comm... BACKGROUND Anorectal malignant melanoma (AMM) is a rare disorder with an extremely poor prognosis. Although there is currently no consensus on the treatment methods for AMM, surgical procedures have been the most common treatment methods used until now. We recently encountered a case of AMM that we diagnosed using endoscopic submucosal dissection (ESD). To our knowledge, this is the first case of ESD for AMM, suggesting that ESD can potentially be a diagnostic and treatment method for AMM. CASE SUMMARY A 77-year-old woman visited our hospital with a chief complaint of anal bleeding and a palpable rectal mass. Colonoscopy revealed a 20-mm protruded lesion in the lower rectum. After obtaining biopsy specimens from the lesion, although a malignant rectal tumor was suspected, a definitive diagnosis was not made. Endoscopic ultrasonography revealed tumor invasion into the submucosal layer but not the muscular layer. Therefore, we performed an excisional biopsy using ESD. Immunohistochemical examination of the ESD-resected specimen revealed tumor cells positive for Human Melanin Black-45, Melan-A, and S-100. Moreover, the tumor cells lacked melanin pigment;thus, a diagnosis of amelanotic AMM was made. Although the AMM had massively invaded the submucosal layer and both lymphatic and venous invasion were present, we closely monitored the patient without any additional therapy on the basis of her request. Six months after ESD, local recurrence was detected, and the patient consented to wide local excision. CONCLUSION It is suggested that ESD is a potential diagnostic and treatment method for AMM. 展开更多
关键词 ENDOSCOPIC SUBMUCOSAL DISSECTION ANORECTAL malignant MELANOMA ENDOSCOPIC MUCOSAL resection Case report
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Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide 预览
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作者 Parit Mekaroonkamol Rushikesh Shah Qiang Cai 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第8期909-922,共14页
Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is... Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is becoming more recognized in clinical practice,its safety and efficacy need to be carefully evaluated.Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research.This review aims to systemically summarize the existing data on clinical outcomes of POP.Symptomatologic responses to the procedure,its adverse effects,procedural techniques,and predictive factors of clinical success are also discussed. 展开更多
关键词 Gastroparesis PER ORAL ENDOSCOPIC PYLOROMYOTOMY Gastric per-oral ENDOSCOPIC myotomy PYLOROMYOTOMY OUTCOMES
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