Yun-Shi Zhong

Fudan University, Shanghai, Shanghai Shi, China

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Publications (84)123.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The sigmoid-shaped esophagus is considered to be the advanced stage of achalasia, in which the esophageal lumen is significantly dilated, swerved, and rotated. In consideration of the efficacy of peroral endoscopic myotomy (POEM) for early achalasia, it may also offer another option for the treatment of advanced achalasia with sigmoid-shaped esophagus. Our purpose was to evaluate the feasibility and long-term efficacy of POEM for patients with sigmoid-type achalasia. 32 consecutive patients with sigmoid-type achalasia (S1 type in 29 patients and S2 type in 3 patients) were prospectively included. Primary outcome was symptom relief during follow-up, defined as an Eckardt score ≤3. Secondary outcomes were procedure-related adverse events, the resting lower esophageal sphincter (LES) pressure, clinical reflux complications, and procedure-related parameters. All cases received POEM successfully. The mean operation time was 63.7 min (range 22-130 min). No serious complications related to POEM were encountered. During a mean follow-up period of 30.0 months (range 24-44 months), treatment success was achieved e in 96.8 % of cases (mean score pre- vs. post-treatment 7.8 vs. 1.4; P < 0.001). Mean LES pressure also decreased from a mean of 37.9 to 12.9 mmHg after POEM (P < 0.001). One patient experienced only partial symptom relief and additional balloon dilations were carried out to relief the symptoms twice. The overall clinical reflux complication rate of POEM for sigmoid-type achalasia was 25.8 %. The 2-year outcomes of POEM for advanced achalasia with sigmoid-shaped esophagus were excellent, resulting in long-term symptom relief in over 96 % cases and without serious complications. The morphological changes of esophagus may make subsequent endoscopic tunneling more challenging and time-consuming, but do not prevent successful POEM.
    Surgical Endoscopy 12/2014; · 3.31 Impact Factor
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    ABSTRACT: The main cause of death in colorectal carcinoma (CRC) patients is tumor metastasis; however, the underlying molecular mechanisms are largely unknown. In the present study, a novel metastasis-related gene, fibrinogen-like protein 2 (FGL2), was characterized for its role in CRC metastasis and underlying molecular mechanisms. The clinical significance of FGL2 was investigated using tissue microarray analysis of samples from 82 patients with CRC. The molecular effects of FGL2 in CRC cells were determined using RNA interference and ectopic expression of FGL2. The overexpression of FGL2 was examined by immunohistochemistry in 82 CRC patients, and it was determined to be an independent predictor of overall survival (P < 0.05). The depletion of FGL2 expression inhibited tumor progression and epithelial-to-mesenchymal transition (EMT) in vitro and in vivo, while ectopic overexpression of FGL2 enhanced cell invasion and induced EMT in vitro. Our results suggest that FGL2 plays an important oncogenic role in CRC aggressiveness by inducing EMT, and FGL2 could be employed as a novel prognostic marker and effective therapeutic target for CRC.
    Medical Oncology 09/2014; 31(9):181. · 2.06 Impact Factor
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    ABSTRACT: Peroral endoscopic myotomy (POEM) has been developed to provide a less-invasive myotomy for achalasia in adults but seldom has been used in pediatric patients.
    Gastrointestinal Endoscopy 08/2014; · 4.90 Impact Factor
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    ABSTRACT: Primary malignant melanoma originating in the colon is an extremely rare disease. Herein, we report a case of primary melanoma of the ascending colon. The patient was a 57-year-old male who was admitted to our hospital for persistent abdominal pain and episodes of bloody stool, nausea and vomiting. A computed tomography scan revealed lower intestinal intussusception and enlarged lymph nodes in the abdominal cavity and retroperitoneum. During laparoscopic operation, multiple enlarged lymph nodes were found. Several segments of the proximal small intestine were incarcerated into the distal small intestine, forming an internal hernia and obstruction. The necrotic terminal ileum was invaginated into the ascending cecum. Subsequently, adhesive internal hernia reduction and palliative right hemicolectomy were performed. Pathologic examination of the excised specimen revealed a polypoid mass in the ascending colon. Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition. Immunohistochemical staining revealed that the tumor cells were positive for S-100, HMB-45 and vimentin, confirming the diagnosis of melanoma. The patient history and a thorough postoperative investigation excluded the preexistence or coexistence of a primary lesion elsewhere in the skin, anus or oculus or at other sites. Thus, we consider our case to represent an aggressive primary colon melanoma presenting as ileocecal intussusception and intestinal obstruction.
    World journal of gastroenterology : WJG. 07/2014; 20(28):9626-30.
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    ABSTRACT: Esophageal granular cell tumor (GCT) is a rare benign tumor with malignant potential. With wide application of endoscopic techniques, the esophageal GCT discovery rate and treatment strategy has changed. This study was to preliminarily evaluate outcomes of esophageal GCT endoscopic diagnosis and treatment.
    World Journal of Surgical Oncology 07/2014; 12(1):221. · 1.20 Impact Factor
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    ABSTRACT: Background and study aims: Endoscopic submucosal dissection (ESD) is accepted as an established treatment modality for superficial esophageal carcinoma (SEC). The aim of this study was to identify risk factors for postoperative stricture after ESD for SEC. Patients and methods: This was a retrospective study at a single institution. A total of 362 patients with SEC treated by ESD at Zhongshan Hospital, Shanghai, were enrolled between January 2007 and February 2012. Demographic and clinical parameters, including patient-, lesion-, and procedure-related factors, were analyzed for postoperative stricture risk factors. Results: The postoperative stricture rate was 11.6 % (42/362). The mean and median time from ESD to stricture was 58.5 ± 12.3 days (range 21 - 90 days) and 28 days, respectively. Mild, median, and severe stricture were observed in 16.7 % (7/42), 38.1 % (16 /42), and 45.2 % (19/42) of patients, respectively. Multivariate analysis revealed that circumferential extension of > 3/4 (odds ratio [OR] 44.2, 95 % confidence interval [CI] 4.4 - 443.6) and the depth of invasion above m2 (OR 14.2, 95 %CI 2.7 - 74.2) were independent risk factors for stricture. The degree of stricture was also related to lesion circumferential extension (relational coefficient φ = 0.47; P < 0.05) and histological depth (relational coefficient φ = 0.647; P < 0.05). Conclusions: Circumferential extension and histological depth were reliable risk factors for postoperative stricture.
    Endoscopy 05/2014; · 5.20 Impact Factor
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    ABSTRACT: The molecular mechanisms underlying colorectal cancer (CRC) tumorigenesis remain incompletely understood, partially contributing to the mortality of CRC. Advances in identification of novel mechanisms are therefore in an urgent need to fill the gap of our knowledge in CRC development. Here, we performed both in vitro and in vivo experiments along with in silico analysis to identify a new regulatory circuit that stimulated CRC tumorigenesis. In this report, we, for the first time, analyzed the correlation of FIH-1 level with clinicopathological features of CRC. The finding that FIH-1 was not only significantly decreased in tumor tissue as compared with the adjacent normal tissue but also was significantly correlated with tumor T stage status, indicated the role of FIH-1 as a tumor suppressor in CRC development. Moreover, we found the expression of miR-31, a short non-coding RNA which played a critical role in CRC development, was negatively correlated with FIH-1 expression in CRC samples and cell lines. Together with the result from luciferase report assay, it was demonstrated that miR-31 could directly regulate FIH-1 expression in CRC. This miR-31/FIH-1 nexus was further shown to control cell proliferation, migration and invasion in vitro and to control tumor growth in vivo. Additionally, correlation of the miR-31 expression with clinicopathologic features in CRC samples was examined in support of the driving role of newly identified miR-31/FIH-1 nexus in CRC tumorigenesis. These findings highlight the critical role of miR-31/FIH-1 nexus in CRC and reveal the contribution of miR-31 to CRC development by targeting FIH-1.
    Cancer biology & therapy 02/2014; 15(5). · 3.29 Impact Factor
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    ABSTRACT: The esophagogastric junction (EGJ) is a difficult location for endoscopic resection due to its narrow lumen and sharp angle. Potential increased risks of perforation and mediastinal infection exist, especially for submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. We previously demonstrated the safety and efficacy of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal SMTs, but the feasibility of STER for the removal of SMTs at the EGJ requires systematic investigation. The aim of the investigation was to evaluate the clinical impact of STER on the removal of SMTs at the EGJ. A prospective study was carried out which included a consecutive cohort of 57 patients who underwent STER for 57 SMTs of the EGJ originating from the MP layer between July 2010 and August 2012 in a single academic medical center. Adverse events, en bloc resection rate, and local recurrence were evaluated. The average maximum diameter of the lesions was 21.5 mm (range 6-35 mm). The en bloc resection rate was 100 % (57/57). No delayed hemorrhage or severe adverse events occurred in any of the 57 patients following STER. No local recurrence and distant metastasis occurred during 24 months' follow-up. Less subcutaneous emphysema and pneumomediastinum absorption time (p = 0.005) occurred with CO2 versus air insufflations. Our study showed that STER was safe and effective, provided accurate histopathologic evaluation, and was curative for SMTs of the deep MP layers at the EGJ. CO2 gas insufflation is recommended.
    Surgical Endoscopy 02/2014; · 3.31 Impact Factor
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    ABSTRACT: To compare the clinical value of narrow band imaging(NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection(ESD). Clinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection(ESD) were analyzed retrospectively. Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation. Clinicopathological features, esophageal spasm ratio, operation time, en bloc resection rate, complications, local recurrence, and distant metastases were compared between the two groups. There were 37 patients in NBI group while 50 patients in iodine staining group. Location and size of the lesions between two groups were not significantly different. The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group[10.8%(4/37) vs. 32.0%(16/50), P<0.05]. The average operation time in NBI group was significantly shorter than that in iodine staining group[(42.2±19.5) min vs. (53.3±30.9) min, P<0.05). All the tumors were resected in an en bloc fashion and the R0 resection rate was 100%. Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods. Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group, who were treated by endoscopic dilation and retrievable stents. During mean 13.2 months(range 4 to 20 months) follow-up periods, local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group. These patients received ESD or other surgery. Compared with iodine staining, using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2013; 16(12):1138-41.
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    ABSTRACT: To investigate the efficacy and safety of membrane-covered self-expanding metal stent in the treatment of high-positioned esophageal diseases, including esophageal stenosis, esophagotracheal fistula and anastomotic stricture. Clinical data of 84 patients who underwent stenting in our center from May 2005 to July 2013 were retrospectively analyzed. Of 84 patients, 31 were diagnosed as esophageal malignant stenosis, 2 compression stenosis, 10 radiation stenosis, 4 recurrent malignant stenosis, 27 anastomotic stricture, 1 esophageal stenosis after endoscopic submucosal dissection(ESD), 7 esophageal-tracheal fistula, 1 esophageal-mediastinal fistula, and 1 remnant stomach fistula. Distance from stenosis or fistula to central incisor was 15-20 cm in 48 cases, and more than 20 cm in 36 cases. All the patients were treated by 16 mm membrane-covered self-expanding metal stents. Main clinical manifestations and complications were evaluated. A total of 100 stents were placed in 84 patients,with a success rate of 100%. There were no complications such as perforation and bleeding during operation. Dysphagia and cough were improved quickly with a success rate of 100%. After the placement of stents, the incidence of complication was 6.0%(5/84), of which 2 cases were severe retrosternal pain, 1 was tracheal collapse, and 2 were stent displacement. Seventy-six patients(90.5%) received complete follow-up of 1 to 36 months (mean 15 months). Re-stenosis occurred in 4 cases, new esophageal-tracheal fistula in 2 cases. Among these 6 cases, 5 cases underwent successfully stent placement once again, and another one case received Savary bougie and Argon-ion coagulation with good efficacy. Endoscopic membrane-covered self-expanding metal stent placement is effective and safe for the relieve of dysphagia symptoms and the sealing of esophagotracheal fistula.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2013; 16(12):1146-50.
  • Li-Qing Yao, Qiang Shi, Yun-Shi Zhong
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    ABSTRACT: In recent years, the endoscopic treatment, which is based on the endoscopic mucosal resection and endoscopic submucosal dissection, has developed rapidly. Complication of the endoscopic therapy has been increasingly emphasized. When paying attention to the endoscopic technique innovation, we should also concern the standardization of endoscopic therapy and the prevention and treatment of its complications. Continuous improvement in the safety, practicality and efficacy of endoscopic therapy may translate into benefits for the patients.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2013; 16(12):1131-4.
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    ABSTRACT: To investigate the prevention and treatment of complications during and after endoscopic mucosal band ligation(EMBL) for precancerous lesions and early cancer in the esophagus. Clinical data of 47 patients with esophageal precancerous lesions and early cancer undergoing EMBL in our center from June 2011 to August 2013 were reviewed retrospectively. Complications and associated treatment during operation, after operation and during follow-up were analyzed. Complications during operation included 7 cases of bleeding(14.9%) and 1 case of perforation(2.1%), who received hot biopsy forceps and argon plasma coagulation to stop bleeding successfully, and titanium clamp to suture wound surface. No cutaneous emphysema and pneumothorax occurred. Complications after operation included 1 case of delayed bleeding(2.1%) who received blood stopping under gastroscope, 2 cases of mediastinal and subcutaneous emphysema(4.3%), 6 cases of pleural effusion(12.8%), and 5 cases of minor inflammation or segmental atelectasis of pulmonary(10.6%), who all received successful conservative treatment. Seven cases of esophageal stricture occurred during follow-up, who were improved by balloon dilatation and metal-film stent placement. No deaths associated with EMBL occurred. All the complications were cured through conservative treatment. No additional surgery associated with the complications was needed. Post-operative pathology revealed 1 case was chronic inflammatory hyperplasia, 11 were low-grade intraepithelial tumor, 15 were high-grade intraepithelial tumor, 8 were carcinoma in situ, 12 were squamous cancer (8 with invasion into mucous muscular layer, 4 into submucous layer). Only 1 case of submucous cancer needed transthorax esophageal cancer radical operation because of dangerous margin. No relapse case was found during followed-up. EMBL can treat the esophageal precancerous lesions and early esophageal cancer effectively and its complications can be managed with conservative therapy usually.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2013; 16(12):1151-4.
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    ABSTRACT: To evaluate the clinical value of submucosal tunneling endoscopic resection(STER) for rectal submucosal tumors(SMT) originating from muscularis propria. Clinicopathological data of 8 cases with rectal SMT originating from muscularis propria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively. En bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm (average 1.8 cm). The mean procedure time was 51 min(range, 40-70 min). One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 1 case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found. STER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.
    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2013; 16(12):1155-8.
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    ABSTRACT: Peroral endoscopic myotomy (POEM) has recently been introduced as a promising alternative to laparoscopic Heller myotomy for idiopathic achalasia. Several proposed technical modifications are yet to be tested in randomized trials. The objective of our study was to evaluate efficacy and safety of water-jet (WJ) assisted POEM versus the conventional (C) technique. The clinical trial registration number is NCT01742494. A prospective randomized trial was carried out in Zhongshan Hospital, Fudan University (Shanghai, China), in 100 consenting achalasia patients between August 2011 and April 2012. Patients eligible for POEM were randomized to use of either the HybridKnife (WJ group) or the conventional technique using injection and triangle tip knife interchangeably (C group). A total of 100 patients with comparable characteristics between groups were included. Procedure time was significantly shorter for the WJ group (22.9 ± 6.7 vs. 35.9 ± 11.7 min; p < 0.0001), mostly due to less replacement of accessories (2.0 ± 2.4 vs. 19.2 ± 7.6; p < 0.0001). Injection volume was larger in the WJ group (45.3 ± 10.2 vs. 35.2 ± 9.5 ml; p < 0.0001) and was associated with fewer minor bleeding episodes (3.6 ± 1.8 vs. 6.8 ± 5.2; p < 0.0001). No severe complications occurred; one case of cutaneous emphysema occurred in the WJ group, and four cases occurred in the C group (p = 0.17), three cases of pneumonia were encountered in the C group and none in the WJ group (p = 0.24). Treatment success (Eckardt score ≤3) was achieved in 96.5 % of patients, with no significant differences between groups. The use of the HybridKnife leads to a significant decrease in POEM procedure time and facilitates reinjection, possibly contributing to a lower rate of minor intra-procedural bleeding.
    Surgical Endoscopy 11/2013; · 3.31 Impact Factor
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    ABSTRACT: The technique of endoscopic submucosal dissection (ESD), which was developed for en bloc resection of large lesions in the stomach, has been widely accepted for the treatment of the entire gastrointestinal tract. Many minimally invasive endoscopic therapies based on ESD have been developed recently. Endoscopic submucosal excavation, submucosal tunneling endoscopic resection and laparoscopic-endoscopic cooperative surgery have been used to remove submucosal tumors, especially tumors which originate from the muscularis propria of the digestive tract. Peroral endoscopic myotomy has recently been described as a scarless and less invasive surgical myotomy option for the treatment of achalasia. Patients benefit from minimally invasive endoscopic therapy. This article, in the highlight topic series, provides detailed information on the indications and treatments for esophageal diseases.
    World Journal of Gastroenterology 11/2013; 19(41):6962-6968. · 2.43 Impact Factor
  • Le-Chi Ye, Yun-Shi Zhong, Qi Lin, Jianmin Xu
    Journal of Clinical Oncology 10/2013; · 17.88 Impact Factor
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    ABSTRACT: To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO). From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics. The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable. The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.
    World Journal of Gastroenterology 09/2013; 19(33):5513-9. · 2.43 Impact Factor
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    ABSTRACT: Background/aims:To study the features of gastric heterotopic pancreas and to evaluate the feasibility, efficacy, and safety of endoscopic resection for treatment of this condition. Materials and Methods:Between August 2007 and December 2010, 60 gastric heterotopic pancreas patients were treated using endoscopic mucosal resection/endoscopic submucosal dissection. The definitive histological diagnosis of heterotopic pancreas was made after the endoscopic treatment. Tumor size, site, layer, complete resection rate, complications, and local recurrence rate were evaluated. Results: The mean tumor diameter was 1.4±0.1 (0.4-3.5) cm in the 60 gastric heterotopic pancreass patients during this period. Fourteen cases (23.3%, 14/60) underwent endoscopic mucosal resection, and the en bloc resection rate was 64.3% (9/14). In 3 cases (21.4%, 3/14), arterial bleeding was controlled with hot biopsy forceps or a metal clip during endoscopic mucosal resection. Forty six cases (76.7%, 46/60) underwent endoscopic submucosal dissection procedure, and the en bloc resection rate was 97.8% (45/46). In 6/45 cases (13.3%), arterial bleeding occurred. Pneumoperitoneum developed in 3 cases (6.5%, 3/46) during the operation. The curative resection rate was 98.3% (59/60). There were no recurrences in any cases. Conclusion: Endoscopic mucosal resection/endoscopic submucosal dissection is a minimally-invasive technique that allows resection of whole lesions and provides precise histological information, which is particularly suitable for gastric heterotopic pancreas.
    The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 08/2013; 24(4):322-329. · 0.47 Impact Factor
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    ABSTRACT: Increasing colonoscopy use increases the incidence of iatrogenic colon perforation. Operative management of iatrogenic colonoscopic perforation is diverse. This study retrospectively reviewed our experiences in treating diagnostic colonoscopy-associated bowel perforation by laparoscopic direct suturing. A total of 89,014 patients underwent diagnostic colonoscopy at our institution during the past 6 years. We identified 17 iatrogenic perforations (0.019 %) that were all managed by laparoscopic direct suturing. Perforation patients included 11 men and 6 women (mean age 60 ± 18 years). Sixteen patients (94 %) had severe comorbidities or previous abdominal surgery. Perforations were noticed by the endoscopist during the procedure in 13 cases (76 %) while the remaining 4 cases (24 %) were diagnosed within 24 h after colonoscopy. The estimated mean longitudinal perforation length was 4.4 ± 2.1 cm. Mean operation time was 2.3 ± 0.6 h, without significant blood loss or other severe complication. The mean time to bowel function return was 3.4 ± 1.2 days, the mean time to initial oral intake was 3.9 ± 2.0 days and the mean hospitalization duration was 6.8 ± 4.2 days. Diagnostic colonoscopic perforation occurred in less than 2/10,000 patients when colonoscopy was performed by experienced operators in our endoscopy center. Most of the perforation patients had severe comorbidities, to which the surgeon should pay close attention during colonoscopy. Laparoscopic primary suture of colon perforations caused by diagnostic colonoscopy is a safe and feasible repair method. Further efforts will definitively assess the feasibility of routinely using laparoscopic direct suture to repair colon perforations.
    International Journal of Colorectal Disease 07/2013; · 2.24 Impact Factor
  • Gastrointestinal endoscopy 05/2013; · 4.90 Impact Factor