Bing Hu

Second Military Medical University, Shanghai, Shanghai, Shanghai Shi, China

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Publications (33)93.92 Total impact

  • Jun Wu, Dao-Jian Gao, Bing Hu
    Gastrointestinal Endoscopy 05/2014; 79(5):AB362-AB363. DOI:10.1016/j.gie.2014.02.421 · 4.90 Impact Factor
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    ABSTRACT: Endoscopic placement of covered self-expandable metal stent (SEMS) has gained popularity in the management of benign biliary strictures (BBS). The existing SEMS has been designed primarily to palliate malignant biliary obstruction and has a high frequency of stent migration, difficulty in retrieval and stricture recurrence after stent removal. This study aimed to design a novel retrievable SEMS dedicated to the treatment of extrahepatic BBS and evaluate its clinical efficacy and safety. A short fully covered SEMS (FCSEMS) with a retrieval lasso was designed for the specific treatment of BBS. A total of 45 patients with segmental extrahepatic BBS were included in this study. The stent was placed entirely inside the bile duct with only the retrieval lasso extending from the papilla. The stents were recommended to be in situ for 6 to 12 months before removal. The FCSEMS was successfully placed in all 45 patients. In all, 33 patients had their FCSEMS successfully removed after a mean period of 8.6 ± 3.7 (range 2-15.5) months. Stent migration occurred in 9.1% of the patients. During a mean follow-up of 18.9 months after stent removal, recurrent stricture was found in 2 (6.1%) patients and was successfully treated with a second FCSEMS. Overall, the strictures resolved in 30/33 (90.9%) patients. Intraductal placement of a short FCSEMS is suitable for the treatment of segmental extrahepatic BBS. This new removable design offered prolonged stenting and drainage for BBS for up to one year with minimal complications.
    Journal of Digestive Diseases 03/2014; 15(3):146-53. DOI:10.1111/1751-2980.12117 · 1.85 Impact Factor
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    ABSTRACT: Background and study aims: There are limited data on the role of antireflux biliary stents. This single-center randomized trial compared the endoscopic use of partly covered antireflux metal stents (pcARMS) with that of standard uncovered self-expandable metal stents (ucSEMS) for the palliation of nonhilar malignant biliary obstruction. Patients and methods: Between August 2007 and February 2012, patients with nonhilar malignant biliary obstruction were randomly assigned to treatment with either pcARMS or ucSEMS. Subsequent follow-up was conducted in clinic or by phone. The primary outcome was onset of cholangitis within 12 months of stenting. Secondary outcomes included other morbidities, stent dysfunctions, and survival. Results: Altogether 112 patients were included, 56 in each group. The stents were successfully deployed in all patients. Satisfactory jaundice control was achieved in 49 cases in the pcARMS group, compared with 47 in the ucSEMS group (P = 0.135). Fewer patients experienced cholangitis in the pcARMS group than in the ucSEMS group (10 vs. 21 patients; P = 0.035), and the frequency of episodes was less (P = 0.022). Respectively, 17 and 29 stent dysfunctions before death were observed in the pcARMS and ucSEMS groups (P = 0.051) and the median stent patency was 13.0 (standard deviation [SD] 3.4) and 10.0 (1.2) months, respectively (P = 0.044). At final follow-up, in January 2013, 50 /52 and 52 /55 patients had died and no difference in median survival was seen between the two groups (8.0 vs. 9.0 months, P = 0.56). Conclusions: Stenting with pcARMS compared with standard ucSEMS reduces risk of ascending cholangitis and has longer stent patency, but does not increase patient survival. Chictr.org. number, ChiCTR-TRC-11001800.
    Endoscopy 02/2014; 46(2):120-6. DOI:10.1055/s-0034-1364872 · 5.20 Impact Factor
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    ABSTRACT: Endoscopic management of benign biliary stricture (BBS) remains challenging. There is no reported method for the amelioration of biliary fibroplasia endoscopically. We report our initial experience of radiofrequency ablation (RFA) for the management of BBS. Nine patients with BBS (postoperation stricture four, liver transplant three, and chronic inflammation two), seven of whom had previously unsuccessful endoscopic or percutaneous interventions, were enrolled. Intraductal bipolar RFA was delivered at power of 10 W for 90 s per stricture segment, followed by balloon dilatation with/without stent placement. All patients had immediate stricture improvements after RFA. No severe adverse event occurred except for one patient with mild post-endoscopic retrograde cholangiopancreatography pancreatitis. During median (SD) follow-up duration of 12.6 (3.9) months, BBS resolution without the need for further stenting was achieved in four patients whereas two patients had stent(s) in situ waiting scheduled removal. However, one patient had stricture relapse after initial resolution, one underwent surgery, and another patient died of other cause. Endobiliary RFA appears to be safe and effective for the treatment of BBS, especially for refractory cases. Further studies are warranted.
    Digestive Endoscopy 01/2014; 26(4). DOI:10.1111/den.12225 · 1.61 Impact Factor
  • Xiao-Ming Yang, Bing Hu
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    ABSTRACT: To perform a meta-analysis of large-balloon dilation (LBD) plus endoscopic sphincterotomy (EST) vs EST alone for removal of bile duct stones. Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index, and important meeting abstracts were searched and evaluated by two reviewers independently. The main outcome measures included: complete stone removal, stone removal in the first session, use of mechanical lithotripsy, procedure time, and procedure-related complications. A fixed-effects model weighted by the Mantel-Haenszel method was used for pooling the odds ratio (OR) when heterogeneity was not significant among the studies. When a Q test or I(2) statistic indicated substantial heterogeneity, a random-effects model weighted by the DerSimonian-Laird method was used. Six randomized controlled trials involving 835 patients were analyzed. There was no significant heterogeneity for most results; we analyzed these using a fixed-effects model. Meta-analysis showed EST plus LBD caused fewer overall complications than EST alone (OR = 0.53, 95%CI: 0.33-0.85, P = 0.008); subcategory analysis indicated a significantly lower risk of perforation in the EST plus LBD group (Peto OR = 0.14, 95%CI: 0.20-0.98, P = 0.05). Use of mechanical lithotripsy in the EST plus LBD group decreased significantly (OR = 0.26, 95%CI: 0.08-0.82, P = 0.02), especially in patients with a stone size larger than 15 mm (OR = 0.15, 95%CI: 0.03-0.68, P = 0.01). There were no significant differences between the two groups regarding complete stone removal, stone removal in the first session, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, infection of biliary tract, and procedure time. EST plus LBD is an effective approach for the removal of large bile duct stones, causing fewer complications than EST alone.
    World Journal of Gastroenterology 12/2013; 19(48):9453-9460. DOI:10.3748/wjg.v19.i48.9453 · 2.43 Impact Factor
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    ABSTRACT: Esophagectomy is the conventional treatment for Barrett's esophagus with high-grade dysplasia and intramucosal cancer. Endotherapy is an alternative treatment. To compare the efficacy and safety of these 2 treatments. PubMed, Web of Science, EMBASE, Cochrane Library and momentous meeting abstracts were searched. Studies comparing endotherapy with esophagectomy were included in the meta-analysis. Pooling was conducted in a random-effects model. Tertiary-care facility. Seven studies involving 870 patients were included. Endotherapy and esophagectomy. Neoplasia remission rate, neoplasia recurrence rate, overall survival rate, neoplasia-related death, and major adverse events. Meta-analysis showed that there was no significant difference between endotherapy and esophagectomy in the neoplasia remission rate (relative risk [RR] 0.96; 95% CI, 0.91-1.01); overall survival rate at 1 year (RR 0.99; 95% CI, 0.94-1.03), 3 years (RR 1.03; 95% CI, 0.96-1.10), and 5 years (RR 1.00; 95% CI, 0.93-1.06); and neoplasia-related mortality (risk difference [RD] 0; 95% CI, -0.02 to 0.01). Endotherapy was associated with a higher neoplasia recurrence rate (RR 9.50; 95% CI, 3.26-27.75) and fewer major adverse events (RR 0.38; 95% CI, 0.20-0.73). Relatively small number of retrospective studies available, different types of endoscopic treatments were used. Endotherapy and esophagectomy show similar efficacy except in the neoplasia recurrence rate, which is higher after endotherapy. Prospective, randomized, controlled trials are needed to confirm these results.
    Gastrointestinal endoscopy 09/2013; 79(2). DOI:10.1016/j.gie.2013.08.005 · 4.90 Impact Factor
  • Gastrointestinal Endoscopy 05/2013; 77(5):AB320. DOI:10.1016/j.gie.2013.03.1080 · 4.90 Impact Factor
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    ABSTRACT: Intramural duodenal hematoma (IDH) is a rare complication following endoscopic retrograde cholangiopancreatography (ERCP). Blunt damage caused by the endoscope or an accessory has been suggested as the main reason for IDH. Surgical treatment of isolated duodenal hematoma after blunt trauma is traditionally reserved for rare cases of perforation or persistent symptoms despite conservative management. Typical clinical symptoms of IDH include abdominal pain and vomiting. Diagnosis of IDH can be confirmed by imaging techniques, such as magnetic resonance imaging or computed tomography and upper gastrointestinal endoscopy. Duodenal hematoma is mainly treated by drainage, which includes open surgery drainage and percutaneous transhepatic cholangial drainage, both causing great trauma. Here we present a case of massive IDH following ERCP, which was successfully managed by minimally invasive management: intranasal hematoma aspiration combined with needle knife opening under a duodenoscope.
    World Journal of Gastroenterology 04/2013; 19(13):2118-2121. DOI:10.3748/wjg.v19.i13.2118 · 2.43 Impact Factor
  • Academic Journal of Second Military Medical University 03/2013; 33(3):257-260. DOI:10.3724/SP.J.1008.2013.00257
  • Ya-Min Pan, Bing Hu
    Academic Journal of Second Military Medical University 03/2013; 33(3):235-239. DOI:10.3724/SP.J.1008.2013.00235
  • Academic Journal of Second Military Medical University 03/2013; 33(3):240-246. DOI:10.3724/SP.J.1008.2013.00240
  • Academic Journal of Second Military Medical University 03/2013; 33(3):247-251. DOI:10.3724/SP.J.1008.2013.00247
  • Academic Journal of Second Military Medical University 03/2013; 33(3):252-256. DOI:10.3724/SP.J.1008.2013.00252
  • Academic Journal of Second Military Medical University 03/2013; 33(3):261-265. DOI:10.3724/SP.J.1008.2013.00261
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    ABSTRACT: BACKGROUND: Endoscopic management of biliary or pancreatic strictures by stent insertion is well established. However, some high-grade strictures are refractory to dilation and stent placement with conventional methods. OBJECTIVE: To evaluate the safety and efficacy of the wire-guided electrotomy technique in dilating stiff biliary and/or pancreatic stenoses when ordinary methods failed. DESIGN: Retrospective analysis of a prospective database. SETTING: Tertiary referral university hospital. PATIENTS: This study involved 279 patients with biliary or pancreatic strictures who underwent ERCP for stenting. INTERVENTION: After conventional dilation failed, wire-guided needle-knife electrocautery was attempted to facilitate insertion of the dilating devices and eventually endoprosthesis. MAIN OUTCOME MEASUREMENTS: The successful treatment and drainage of biliary or pancreatic strictures. RESULTS: With wire-guided needle-knife cauterization, the success rate of stricture dilatation increased from 95.7% (267 of 279 patients) to 98.9% (276 of 279 patients). Dilation of stenoses was successful in 9 of 10 patients (90%) by using electrocautery with the wire-guided needle-knife technique. Postprocedure adverse events included self-limited bleeding, mild acute pancreatitis, hyperamylasemia, cholangitis, and biliary perforation. No procedure-related death occurred. LIMITATIONS: Retrospective, single-center study and small sample size. CONCLUSIONS: Wire-guided needle-knife electroincision appears to be effective for traversing refractory biliary or pancreatic strictures and can be considered as an alternative approach to conventional methods. However, the safety of such a technique needs to be further evaluated.
    Gastrointestinal endoscopy 01/2013; 77(5). DOI:10.1016/j.gie.2012.11.023 · 4.90 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the efficacy and safety of endoscopic papillary large-balloon dilation (EPLBD) combined with limited endoscopic sphincterotomy (EST) for the removal of large biliary duct stone. METHODS: Data of patients who underwent attempted removal of large bile duct stones (≥ 10 mm) by limited EST followed by EPLBD (≥ 12 mm in diameter) from April 2006 to October 2011 in our institute were collected. Clinical characteristics, endoscopic methods and outcomes were collected and analyzed. RESULTS: A total of 169 patients with a mean age of 69.3 years (range 19-97 years) underwent 171 procedures. Median stone size and balloon diameter was 15 mm and 13 mm, respectively. Complete stone removal in single session was achieved in 163 procedures (95.3%) with mechanical lithotripsy (ML) used in 66 (38.6%). Patients with larger stone size required more frequent use of lithotripsy with comparable success rate (P < 0.01). There were no significant differences between patients with and without periampullary diverticula in stone clearance (97.3% vs. 93.8%), ML requirement (36.5% vs. 40.6%) and complications (2.7% vs. 6.2%) (all P > 0.05). Seven patients had 8 procedure-related complications (4.7%) including moderate or mild bleeding (n = 4), minor perforation (n = 1), mild pancreatitis (n = 2) and cholangitis (n = 1). CONCLUSION: EPLBD after limited EST is an effective and safe approach for the removal of large biliary duct stones, especially for those refractory cases.
    Journal of Digestive Diseases 11/2012; DOI:10.1111/1751-2980.12013 · 1.85 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: Limited endoscopic sphincterotomy with large balloon dilation (ESBD) is an alternative to ES for removing bile duct stones, but it is not clear which procedure is most effective. We compared the 2 techniques in removal of bile duct stones. METHODS: Between September 2005 and 2011, 156 consecutive patients with suspected of having, or known to have, common bile duct stones were randomly assigned to groups that underwent ES or ESBD. Patients in the ESBD group received limited sphincterotomy (up to half of the sphincter), followed by balloon dilation to the size of the common bile duct or 15 mm. The ES group received complete sphincterotomy alone. Stones were then removed with standard techniques. The primary outcome was percentage of stones cleared; secondary outcomes included procedure time, method of stone extraction, number of procedures required for stone clearance, morbidities and mortality within 30 days, and direct costs. RESULTS: There was no significant difference between groups in percentages of stones cleared (ES vs ESBD: 88.5% vs 89.0%). More patients in the ES group (46.2%) than the ESBD group (28.8%) required mechanical lithotripsy (P=.028), particularly for stones ≥ 15 mm (90.9% vs 58.1%; P=.002). Morbidities developed in 10.3% in the ES group and 6.8% in the ESBD group (P=.46). The cost of the hospitalization was also significantly lower in the ESBD group (P=.034) CONCLUSIONS: ESBD and ES clear bile stones with equal efficacy. However, ESBD reduces the need for mechanical lithotripsy and is less expensive.
    Gastroenterology 10/2012; 144(2). DOI:10.1053/j.gastro.2012.10.027 · 12.82 Impact Factor
  • Jun Wu, Bing Hu
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    ABSTRACT: Aim:  Colonoscopy with air insufflation is known to result in abdominal pain and discomfort. Recently, some trials reported that water infusion in lieu of air insufflation could decrease patient discomfort. We aimed to determine the effectiveness of water infusion during colonoscopy through a meta-analysis. Method:  Original articles and abstracts published up to October 2011 were searched in Medline, EMBASE, Cochrane Library Database and momentous Meeting Abstracts. Clinical appraisal and data extraction were conducted by two reviewers independently. Statistical analysis was performed by meta-analysis using fixed effects model or random effects model. Results:  Seven studies containing 872 patients were included. Meta-analysis showed that water infusion group had less patients requiring abdominal compression or position change (RR 0.73, 95%CI [0.59,0.91]), a lower mean pain score (RR -1.10, 95%CI[-1.26,-0.95]), lower maximum pain score (RR -2.34, 95%CI[-2.92,-1.76]) and fewer patients requiring on-demand sedation (RR 0.45, 95%CI[0.31,0.66]) than air insufflation group during colonoscopy. There were no significant difference in caecal intubation rate, caecal intubation time, total procedure time and adenoma detection rate. Conclusion:  Water infusion significantly decreases patient discomfort and abdominal pain during colonoscopy without affecting operation time and intubation success rate. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology ofGreat Britain and Ireland.
    Colorectal Disease 08/2012; 15(4). DOI:10.1111/j.1463-1318.2012.03194.x · 2.02 Impact Factor
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    ABSTRACT: A 61-year-old woman was diagnosed with common bile duct stones and acute biliary pancreatitis. She had previously undergone cholecystectomy 5 years ago. A planed endoscopic retrograde cholangio-pancreatography (ERCP) was arranged under general anesthesia. The patient was posed at prone position without bronchial intubation. Endoscopic access was achieved smoothly and cholangiography revealed mild dilation of the extrahepatic bile duct with mild graduate taper at ampullary region. Some filling defects were found inside lower CBD. A moderate sphincterotomy was made unremarkably, and some tiny stones were retrieved using a Dormia basket. A retrieval balloon was advanced into bile duct to make occlusion cholangiogram. At this moment, the endoscope lost its location into part one of duodenum. When the scope reaches back to descending duodenum, active bleeding was found coming out from orifice of papilla, accompanied with decreased oxygen saturation and arrhythmia. X-ray examination demonstrated gas within hepatic vein and inferior cava vein, although no free gas was observed in the renal region or subphrenic area. The endoscope was removed immediately and patient was changed to supine position. Vigorous cardiopulmonary resuscitation was begun immediately, unfortunately the patient did not response to all the efforts. The causes of death were thought to be systemic air embolism with cardiopulmonary failure.
    Journal of Medical Colleges of PLA 08/2012; 27(4):239–243. DOI:10.1016/S1000-1948(12)60024-0
  • Bing Hu, Dao-Jian Gao, Jun Wu
    Gastrointestinal Endoscopy 04/2012; 75(4):AB375-AB376. DOI:10.1016/j.gie.2012.03.990 · 4.90 Impact Factor