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ABSTRACT: Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce.
To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients.
Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center.
All patients underwent endoscopic procedure after admission.
Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed.
A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988).
Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.
Gastrointestinal Endoscopy 11/2006; 64(4):485-92. · 4.88 Impact Factor
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ABSTRACT: Patients with gastroesophageal reflux disease (GERD) usually suffer from acid reflux and duodenogastroesophageal reflux (DGER) simultaneously. The question of whether DGER has an important effect on the development of GERD remains controversial. The aim of the present study was to investigate the role of DGER in the pathogenesis of GERD and its value for the diagnosis of nonerosive reflux disease (NERD).
GERD was initially diagnosed using the reflux disease questionnaire. For further diagnosis, results of the upper gastrointestinal endoscopy (excluding a diagnosis of Barrett's esophagus) were considered in conjunction with simultaneous 24 h esophageal pH and bilirubin monitoring.
According to endoscopic findings, 95 patients (43 men, 50+/-10 years of age) were divided into two groups: the reflux esophagitis (RE) group (n=51) and the NERD group (n=44). Three DGER parameters, the percentage of time with absorbance greater than 0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 min, were evaluated in the study. For the RE group, the values of the DGER parameters (19.05%+/-23.44%, 30.56+/-34.04 and 5.90+/-6.37, respectively) were significantly higher than those of the NERD group (7.26%+/-11.08%, 15.68+/-20.92 and 2.59+/-3.57, respectively, P<0.05 for all) but no significant difference was found in acid reflux. Of NERD patients, 18.5% were diagnosed with simple DGER. The positive diagnosis rate of NERD could be significantly elevated from 65.9% to 84.1% (P<0.05), if bilirubin monitoring was employed in diagnosis.
DGER may occur independently but plays an important role in the development of RE and GERD symptoms. Simultaneous 24 h esophageal pH and bilirubin monitoring is superior to simple pH monitoring in helping identify patients at risk for NERD.
Canadian journal of gastroenterology = Journal canadien de gastroenterologie 03/2006; 20(2):91-4. · 1.21 Impact Factor
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ABSTRACT: Biliary complications are a serious problem in patients after liver transplantation and often require reoperation. This study was conducted to summarize the endoscopic diagnosis and management of biliary complications after orthotopic liver transplantation (OLT).
From December 2000 to November 2003, twelve endoscopic retrograde cholangiopancreatographies (ERCPs) were performed in 7 patients after OLT at Digestive Endoscopic Center of Changhai Hospital in Shanghai, China. The therapeutic maneuvers included endoscopic sphincterotomy (EST), biliary stent placement, balloon and basket extraction, irrigation, and nasobiliary tube placement. A retrospective study was made to determine the types of biliary tract complications after OLT. The success of ERCP and therapeutic maneuvers was also evaluated.
Biliary tract complications including biliary stricture, biliary leak, biliary sludge, and stump leak of the cyst duct were treated respectively by endoscopic sphincterotomy with sludge extraction, stricture dilation or endoscopic retrograde biliary drainage. Two of the 3 patients with proximal common bile duct stricture were successfully treated with ERCP and stent placement. Four patients with anastomotic stricture and/without bile leak were treated successfully by dilation and stent placement or endoscopic nosobiliary drainage. No severe ERCP-related complications occurred.
ERCP is an effective and accurate approach for the diagnosis of biliary tract complications after OLT, and placement of a stent is a safe initial treatment for biliary complications after liver transplantation.
Hepatobiliary & pancreatic diseases international: HBPD INT 03/2006; 5(1):39-42. · 1.08 Impact Factor
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ABSTRACT: To investigate the expression of mesothelin in specimen of pancreas fine-needle aspiration and to evaluate the potential contribution of immunohistochemical labeling of mesothelin to the interpretation of pancreas fine-needle aspiration (FNA).
Specimens from 27 patients were selected for immunolabeling. Immunohistochemical EnVision method was used to detect the expression of mesothelin in specimen of pancreas fine-needle aspiration. The labeling in each patient was scored as positive or negative. These results were compared with the cytologic diagnosis and the follow-up data.
Nineteen of the 27 patients were ultimately shown to have an adenocarcinoma, and 8 had no evidence of malignancy on follow-up. Initial cytologic diagnosis of malignancy correlated with carcinoma on follow-up in 10 of 10 cases, and initial benign cytologic diagnosis correlated with benign follow-up in 4 of 6 cases. Seven of the 11 patients with suspicious cytology were found to have carcinomas on follow-up. Mesothelin labeling was seen in 14 of the 19 patients ultimately shown to have carcinomas and was absent in 7 of the 8 benign lesions (sensitivity, 73.7%; specificity, 87.5%). Five of the 7 cytologically suspicious cases with malignant follow-up labeled for mesothelin. Positive mesothelin labeling was observed in one of the 4 suspicious cases who finally proved to be benign during follow-up.
Immunohistochemical labeling for mesothelin may be a highly specific tool for the detection of pancreatic adenocarcinoma in FNA specimens and is useful in categorizing cytologically suspicious lesions.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 11/2005; 27(5):615-8.
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ABSTRACT: To study the mechanism of visceral hypersensitivity in patients with non-erosive gastroesophageal reflux disease (NERD) and to get further objective evidence in the abnormal alteration of the afferents involved in mediating esophageal sensation by cerebral evoked potentials (CEP).
We recruited 21 NERD patients and 10 normal healthy volunteers for the study. Mechanical distention stimulation was performed using a balloon-affixed polyvinyl multilumen catheter. First, maximally tolerated pain threshold of all subjects were recorded, then esophageal mechanical stimulation at an intensity of 75% maximum tolerated intensity and a frequency of 0.2 Hz was inflated in a total of 64 times by means of a computer-controlled barostat. The alternation of esophageal CEP was recorded before and after acid perfusion with a multi-channel international 10-20 system of electroencephalograph.
Esophageal mucosal distention may evoke recognizable and reproducible multi-peak CEP. CEP morphology of the NERD patients was characterized by randomly distributed patterns and the peak latencies for N1, P1, and N2 were significantly shorter for mechanical stimulation as compared with the control group (respectively, P = 0.016, 0.003, 0.031), and the amplitude of the P1-N2 components was significantly increased in NERD patients (P = 0.03).
Characterization and alternation of CEP morphology and peak latencies and P1-N2 amplitudes elicited by esophageal distention in NERD patients provides evidence for defective hypersensitivity of afferent neural pathways and cortical processing.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 10/2005; 44(9):684-6.
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ABSTRACT: Visceral hypersensitivity is highly prevalent in most functional bowel disorders, such as irritable bowel syndrome (IBS), and activation of intestinal mast cells (MC) may play a role because they have been found in close proximity to gastrointestinal mucosal sensory nerve terminals containing neuropeptides and a bi-directional pathway connecting the central nervous system, gut, and MC has been demonstrated. The current study appraised the status of rectal visceral perception, as well as the changes in the MC and substance P (SP) in the intestinal mucosa of patients with IBS.
The study group comprised 42 patients with IBS and 19 healthy subjects who underwent anorectal manometry and rectal perception thresholds to balloon distension. The MC and the SP-ergic terminals in the mucosa were stained for respective histochemical and immunohistochemical investigations. The results were presented both qualitatively and quantitatively by color image analyzer, based on analysis of the intensity and area of stained fibrils. The structural relationship between the MC and nerve terminals was studied by electron microscopy, using an in situ embedding technique.
The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. The sensation threshold, defecation threshold and pain threshold in diarrhea-predominant IBS and the pain thresholds in constipation-predominant IBS were much lower than in the controls. Rectal compliance decreased in IBS. The number of MC in the terminal ileum, the ileocecal junction and the ascending colon was significantly elevated in IBS (P < 0.01), and the MC showed great variation. A significantly increased concentration of SP was found in the colon of the IBS patients compared with the controls. There was a positive correlation between the profiles of mucosal MC and the SP-ergic terminals, and MC were closely adjacent to SP-ergic terminals in the lamina propria.
As altered rectal perception is present in almost all patients with IBS, it might be a reliable biological characteristic of the disease. Alterations in the MC and SP of the intestinal mucosa may be important factors in visceral hypersensitivity.
Chinese Journal of Digestive Diseases 02/2004; 5(3):103-9.
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Zhao Shen LI,
Wen Zhu DONG,
Duo Wu ZOU,
Xiao Ping ZOU,
Guo Ming XU,
Ai Yong ZHU,
Ning YIN,
Yan Fang GONG, Zhen Xing SUN,
Can XU,
Xiao Hua MAN
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ABSTRACT: OBJECTIVE: The failure of dysmotility to explain the symptoms of pain in irritable bowel syndrome (IBS) led to studies on visceral hypersensitivity. Mucosal mast cells (MC) may be one factor influencing the response of visceral afferents to mechanical and chemical stimuli because they are found in close proximity to gastrointestinal mucosal sensory nerve terminals containing neuropeptides and a bi-directional pathway linking the central nervous system, gut and MC has been demonstrated.METHODS: The present study investigated the extent of MC and the neuropeptides, substance P (SP) and vasoactive intestinal peptide (VIP), in the intestinal mucosa of patients with IBS, as well as the location of the MC. The MC and neuropeptidergic terminals were stained histochemically and immunohistochemically, respectively, neuropeptide concentrations were measured by radioimmunoassay (RIA), and the results were investigated qualitatively and quantitatively by color image analyzer. The structural relation between the MC and neuropeptide terminals was studied by ultramicroscopy using in situ embedding technique.RESULTS: In IBS, the number of MC in the terminal ileum, the ileocecal junction, and the ascending colon was significantly increased (P < 0.01), and the MC had great variations in their extent and size. Significantly increased concentrations of VIP and SP were found in the colon of IBS patients compared with controls. A correlation between mucosal MC and the SP(VIP)-ergic terminals was found, and the MC were close to these terminals in the lamina propria, which demonstrated SP (VIP)-ergic terminals.CONCLUSIONS: Mast cells and the neuropeptides of intestinal mucosa may play a central role in gut hypersensitivity, resulting in both the motor response and visceral perceptions that occur with IBS.
Chinese Journal of Digestive Diseases 10/2003; 4(3):111 - 117.
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ABSTRACT: To assess the diagnostic value of endoscopic pancreatic duct brushing in detecting mutation of the K-ras gene at codon 12 in cytologic specimens from patients with pancreatic cancer.
Thirty-five patients treated at Changhai Hospital, Shanghai between 1999 and 2001 were enrolled. Their cells obtained by pancreatic duct brushing during endoscopic retrograde cholangiopancreatography (ERCP) were suspended with phosphate buffer solution (PBS). DNA of the cells was extracted and mutation of the K-ras gene at codon 12 detected by means of PCR-SSCP.
The K-ras gene mutation rate of pancreatic cancer was 70%, which was higher than that of chronic pancreatitis (14%, P<0.05). K-ras gene mutation was not found in patients with pancreatic cystocarcinoma and duodenum carcinoma. As to the location of pancreatic cancer, no significant difference was observed between the head, the body and tail. The sensitivity, specificity, accuracy of pancreatic duct brushing in detecting pancreatic cancer was 70%, 94%, and 83%, respectively.
K-ras analysis of pancreatic brushing samples is helpful in the diagnosis of patients with early pancreatic cancer.
Hepatobiliary & pancreatic diseases international: HBPD INT 05/2003; 2(2):313-7. · 1.08 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate the value of the p53 protein for diagnosing cancer in pancreatic cells obtained by using endoscopic pancreatic duct brushing.METHODS: Immunohistochemical methods were used to assay the amount of p53 protein in cytological specimens. The results were compared with those obtained by hematoxylin and eosin (H&E) staining.RESULTS: Detection of the p53 protein by staining cytological specimens with H&E diagnosed pancreatic cancer with 53% sensitivity, 100% specificity and 70% accuracy. Using immunohistochemical methods, pancreatic cancer was diagnosed with 59% sensitivity, 100% specificity and 74% accuracy. The methods in combination produced a test with 71% sensitivity, 100% specificity and 81% accuracy.CONCLUSIONS: Hematoxylin and eosin staining combined with p53 protein detection in cells obtained by using endoscopic pancreatic duct brushing is a useful tool in the diagnosis of pancreatic cancer, and in the differentiation of benign and malignant panÂcreatic disease.
Chinese Journal of Digestive Diseases 09/2002; 3(3):107 - 110.
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ABSTRACT: OBJECTIVE: To investigate the risk factors for postoperative pancreatitis following endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting.METHODS: Four hundred and twelve patients referred to the endoscopy unit were divided into seven groups: (i) double ducts (pancreatic duct and biliary duct) contrast media filling group (ERCP group); (ii) biliary duct contrast media filling group (ERC group); (iii) pancreatic duct contrast media filling group (ERP group); (iv) ERCP plus biliary stenting group (ERCP + stent group); (v) ERC plus stenting group (ERC + stent group); (vi) ERCP plus EST and stone extraction (SE) group (ERCP + EST + SE group); and (vii) ERC plus EST and SE group (ERC + EST + SE group). Differences in postoperative serum amylase at 4 and 24 h, as well as clinical symptoms, were compared among the different groups.RESULTS: The incidence of postoperative hyperamylasemia at 4 and 24 h was 17.7 and 4.4%, respectively. The overall incidence of postoperative acute pancreatitis was 3.9% and the ERP group had the highest incidence of postoperative acute pancreatitis among the seven groups.CONCLUSIONS: Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis and therapeutic ERCP, such as EST, stenting and SE, does not increase the incidence of postoperative pancreatitis.
Chinese Journal of Digestive Diseases 01/2002; 3(1):35 - 38.
