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ABSTRACT: Procedure for prolapse and hemorrhoids( PPH) is one of the important techniques developed for the treatment of hemorrhoids with severe degree in the last decade. Its principle is based on the "anal cushion" theory.Compared with traditional hemorrhoidectomy , PPH has advantages of shorter operation time , minor degree of postoperative pain , shorter hospital stay and quicker recovery.However, the occurrence of relapse and re-prolapse of hemorrhoids is high. Besides, the short-term efficacy of PPH for the constipation outlet obstruction caused by anterior rectocele is also favorable.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 12/2012; 15(12):1211-3.
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ABSTRACT: To investigate PIK3CA, PTEN status in the primary lesion of colorectal cancer (CRC): relationship with occurrences of liver metastasis and its prognosis.
Patients with CRC who had the primary tumor resected between 2003 and 2008 were selected and enrolled into three groups according to the occurrence of liver metastasis. The mutations of PIK3CA exon 9 and 20, PTEN exon 5, 7, 8 in primary cancer cells in formalin-fixed, paraffin-embedded specimens were detected by Pyrosequencing, then a statistical analysis was deduced to find out the relationship between PIK3CA, PTEN status and occurrences of liver metastasis as well as the prognosis.
Of all the 300 CRC cases, the mutation rates of PIK3CA and PTEN was 18.2% (51/300) and 16.3% (49/300). The multivariate Logistic analysis revealed that exon 5 mutation of PTEN was one of the independent risk factors of occurrence of metachronous liver metastasis in CRC patients (HR = 1.634, 95%CI: 1.796 - 3.355, P = 0.041). Patients with PTEN mutation had a poorer overall survival in group with synchronous liver metastasis (median survival time 62.0 months vs 71.0 months, χ(2) = 12.942, P = 0.048) while CRC patients who had the liver metastasis resected in group of synchronous and metachronous liver metastasis had a poorer disease free survival rates with PIK3CA mutation (median survival time 16.0 months vs 25.0 months, χ(2) = 9.679, P = 0.037).
The exon 5 mutation of PTEN of CRC is potentially correlated with the occurrence of synchronous liver metastasis. CRC patients who had the liver metatasis resected but with PIK3CA mutation could have a poorer prognosis.
Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2012; 50(11):1007-10.
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ABSTRACT: OBJECTIVE: To analyze the relationship of K-ras mutation with the development of liver metastasis in colorectal cancer patients and the survival outcomes. METHODS: From 2003 to 2008, 300 patients who underwent colorectal cancer surgery in the Department of General Surgery of Zhongshan Hospital, Fudan University were assigned to different groups, according to the diagnosis and follow-up results. The mutation of exon 2 of K-ras was detected in primary paraffin-embedded lesions by PCR and Pyrosequencing. The association of gene mutation with the development of liver metastasis and its prognosis was studied. RESULTS: Among 300 cases, the mutations of exon 2 were present in 120 cases(40%). The G13D mutation was more common in metachronous metastasis group than that in synchronous group(17.0% vs. 8.0%, P=0.041). Multivariable regression analysis showed that G13D mutation was an independent risk factor(HR=1.108, 95%CI:1.032-5.062, P=0.048) for metachronous metastasis. Patients with mutated K-ras had a poorer overall survival compared to those without mutated K-ras for patients without liver metastasis(median overall, 65 vs. 72 months, P=0.039), and for patients who received metastasis resection(median disease-free survival 18 vs. 24 months, P=0.048). Multivariable analysis showed that K-ras mutation was an independent risk factors of overall survival(HR=1.561, 95%CI:1.022-6.422, P=0.045) in patients without liver metastasis. Conculsion Detection of K-ras mutation may predict the development of liver metastasis and prognosis.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 11/2012; 15(11):1156-1161.
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Quan-Lin Li,
Yi-Qun Zhang,
Wei-Feng Chen,
Mei-Dong Xu, Yun-Shi Zhong,
Li-Li Ma,
Wen-Zheng Qin,
Jian-Wei Hu,
Ming-Yan Cai,
Li-Qing Yao,
Ping-Hong Zhou
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ABSTRACT: To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for foregut neuroendocrine tumors (NETs).
From April 2008 to December 2010, patients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography (EUS). ESD was attempted under general anesthesia. After making several marking dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submucosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological characteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or distant metastasis.
Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows: esophagus (n = 1), cardia (n = 1), stomach (n = 23), and duodenal bulb (n = 4). All lesions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preoperative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 lesions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type III because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm (range: 2-30 mm), and the procedure time was 20.3 min (range: 10-45 min). According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma (NEC). Complete resection was achieved in 28 lesions (28/29, 96.6%), and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The remaining patient with NEC underwent additional surgery because the resected specimens revealed angiolymphatic and muscularis invasion, as well as incomplete resection. Delayed bleeding occurred in 1 case 3 d after ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo (range: 12-48 mo), local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died during the study period.
ESD appears to be a safe, feasible, and effective procedure for providing accurate histopathological evaluations and curative treatment for eligible foregut NETs.
World Journal of Gastroenterology 10/2012; 18(40):5799-806. · 2.47 Impact Factor
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ABSTRACT: Abstract The calcifying fibrous tumor (CFT) is classified as a benign fibrous lesion, and it is a rare pathologic entity. Local excision is the preferred therapeutic approach in treating CFTs. We present the first reported case in the literature of a CFT found in the colon, and this is the first time the way we did the laparoscopic-endoscopic cooperative surgery has been introduced.
Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2012; · 1.40 Impact Factor
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ABSTRACT: Abstract Objectives: Brunner's adenoma is a rare benign tumor of the duodenum. The traditional management option was close follow-up and surgical tumor resection. With the development of endoscopy devices and techniques, endoscopic resection is considered an alternative treatment option. However, whether small lesions require treatment has been controversial. We planned to study the feasibility, efficacy, and safety of endoscopic resection for the treatment of Brunner's adenomas. Subjects and Methods: In total, 30 Brunner's adenomas from 29 patients were treated with endoscopic resection between August 2007 and June 2011 in our hospital. Endoscopic ultrasonography (EUS) was performed preoperatively to evaluate tumor origin and size. Tumor characteristics, complications, en bloc resection rate, and local recurrence rates were evaluated. Results: Of the 29 patients, 13 (44.8%) were men. The median age was 55 years (range, 29-72 years). The mean maximal dimension of the lesions was 1.7±0.1 cm (range, 0.6-7 cm). Overall, 9 lesions were treated with snare resection, 12 lesions were treated with conventional endoscopic mucosal resection (EMR), and 9 lesions were treated with endoscopic submucosal dissection (ESD). Only 1 case of delayed bleeding occurred on Day 2 after EMR. The en bloc resection rate was 100% (30/30). One lesion resected by EMR exhibited indeterminate tumor margins. The overall curative resection rate was 96.7% (29/30). During the follow-up period (median time, 13 months; range, 2-39 months), 1 patient, whose tumor exhibited indeterminate margins, showed recurrence 1 year after EMR; ESD was recommended. No recurrence was observed during the subsequent follow-up period. Conclusions: Our study provides evidence of the efficacy of endoscopic resection for the localized treatment of duodenal Brunner's gland adenomas with relatively few complications and a low mortality rate.
Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2012; · 1.40 Impact Factor
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Yun-Shi Zhong,
Quan-Lin Li,
Ping-Hong Zhou,
Mei-Dong Xu,
Yi-Qun Zhang,
Wei-Feng Chen,
Li-Li Ma,
Wen-Zheng Qin,
Jian-Wei Hu,
Ming-Yan Cai,
Li-Qing Yao
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ABSTRACT: To investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors(SMTs) of the esophagogastric junction(EGJ) originating from the muscularis propria.
A total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated.
There were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma(n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor(n=1), and intermuscular lipoma(n=1). No local recurrence and distant metastasis were noted during the follow-up(range, 3-48 months).
Endoscopic resection technique is safe and effective, and should be selected for each patient individually.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 09/2012; 15(9):901-5.
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Mei-Dong Xu,
Xiao-Yun Wang,
Quan-Lin Li,
Ping-Hong Zhou,
Yi-Qun Zhang, Yun-Shi Zhong,
Wei-Feng Chen,
Li-Li Ma,
Wen-Zheng Qin,
Jian-Wei Hu,
Li-Qing Yao
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ABSTRACT: PURPOSE: This study aims to investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assessed the outcome of endoscopic submucosal dissection (ESD) based upon subdifferentiation status. METHODS: A total of 137 LSTs were present in 135 patients; 96 were granular and 41 exhibited a nongranular pattern. Granular LSTs, subdivided into homogeneous and nodular mixed, and nongranular LSTs, subdivided into flat-elevated and pseudodepressed, were retrospectively evaluated with respect to clinicopathological features and results of ESD (en bloc R0 curative resection, procedure time, complication, and recurrence rate) according to specific subtype. RESULTS: The distribution of high-grade intraepithelial neoplasia and submucosal carcinomas was more prominent among granular nodular mixed tumors than among granular homogeneous tumors (P = 0.007), whereas there was no significant difference between nongranular pseudodepressed tumors and flat-elevated tumors. The frequency of en bloc R0 curative resection did not differ significantly among specific subtypes. For nodular mixed and pseudodepressed lesions, the median tumor size was significantly larger (P < 0.001 for each) and mean procedure time was also longer (P < 0.05 for each) than for the other two subtypes. All complications, which included three perforations, five episodes of postoperative bleeding, and one recurrence, occurred in granular nodular mixed and nongranular pseudodepressed tumors. CONCLUSION: The risk of cancer varies with the subtypes of LSTs. ESD is an effective treatment for LSTs, however ESD is more technically demanding and carries more complications in pseudodepressed and granular mixed subtypes.
International Journal of Colorectal Disease 07/2012; · 2.38 Impact Factor
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Wei-feng Chen,
Quan-lin Li,
Ping-hong Zhou,
Mei-dong Xu,
Yi-qun Zhang, Yun-shi Zhong,
Li-li Ma,
Wen-zheng Qin,
Jian-wei Hu,
Ming-yan Cai,
Li-qing Yao
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ABSTRACT: To prospectively evaluate the clinical value of different magnifying chromoendoscopic(MCE) methods in screening gastric precancerous lesions and early cancers.
Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigocarmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.
Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigocarmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopic methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigocarmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).
NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2012; 15(7):662-7.
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ABSTRACT: To investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia.
From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed.
After POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients.
POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2012; 15(7):668-70.
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ABSTRACT: To evaluate the clinical value of submucoal tunneling endoscopic resection(STER) for gastric submucosal tumor(SMT) originating from the muscularis propria (MP) layer.
Clinicopathological data of 23 cases with gastric SMT originating from the MP layer treated with STER from September 2010 to December 2011 were analyzed retrospectively.
There were 13 males and 10 females. The age ranged from 28 to 73(mean, 52.4) years old. Of the 23 SMTs, 11 were located in the cardia adjacent to the gastric body, 4 in the cardia adjacent to the fundus, 5 in the lesser curvature of gastric body and 3 in the gastric antrum of greater curvature. All the SMTs originating from the MP 1ayer, 14 were located in the superficial MP layer and 9 in the deep MP layer(including 5 gastric SMTs close to serosa). En bloc STER was performed successfully in all the patients. The mean lesion size was 2.1 cm(range 1.5-3.2 cm). The mean procedure time was 54.8 min(range 30-125 min). Pathological examination showed that the lesions were leiomyomas(n=10), stromal tumors(n=8), glomus tumor(n=2), Sehwannoma(n=2), and calcifying fibrous tumor(n=1). Both lateral and vertical margins were negative in all the cases. Three patients developed pneumothorax and subcutaneous emphysema and 5 pneumoperitoneum. One patient developed effusion under the left half of the diaphragm and secondary infection. All of them recovered uneventfully after conservative treatments. No delayed bleeding or GI tract leakage was noticed. None of the 23 cases encountered submucosal hematoma or infection. No tumor residual or recurrence was found during the follow up(range, 3-18 months).
STER is a safe, effective for appropriate lesions in the MP layer of the stomach. En bloc resection and accurate histopathological evaluations can be achieved.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2012; 15(7):671-4.
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ABSTRACT: To assess the clinical value of endoscopic submucosal dissection(ESD) for duodenal leisions.
A total of 78 patients with duodenal leisions were treated with ESD from November 2006 to August 2010. The clinical data were retrospectively analyzed.
There were 46 male and 14 female patients. The mean age was(54±9) years. The lesion location included the duodenal bulb(n=39, 50%), the junction of bulb and descending part(n=19, 24.4%), and the descending part(n=20, 25.8%). The mean diameter of the lesions was(2.1±1.7) cm. Fifty-one(65.4%) lesions originated from the mucosa, including inflammatory/ hyperplastic polyps(n=22, 28.2%), villous/tubular adenoma(n=26, 33.3%), and hamartomas polyps(n=3, 3.8%). Twenty-five(32.1%) lesions originated from the submucosa, including Brunner's glands adenoma(n=15, 19.2%), ectopic pancreas(n=3, 3.8%), carcinoid tumor(n=3, 3.8%), lipoma(n=2, 2.6%), myxoinoma(n=1, 1.3%), and angio-lymphangioma(n=1, 1.3%). There were two lesions originated from the muscularis propria(n=2, 2.5%), and both were ectopic pancreas. All cases received ESD successfully. The mean operative time was(37±41) min and the mean blood loss was(23±15) ml. The perioperative complication rate was 35.9%(28/78), including intraoperative perforation(n=6), delayed perforation(n=3), intraoperative hemorrhage(n=10), delayed bleeding(n=7), and transient elevation of serum amylase(n=2). Postoperative pathological examination showed vascular invasion with tumor cells in one patient, who received extended resection later. The remaining 77 patients showed no recurrence during the followed up(rang, 3-23 months) using endoscopy.
ESD is an effective, safe, minimally invasive method for the management of duodenal lesions.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2012; 15(7):675-8.
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ABSTRACT: To investigate the feasibility and safety of endoscopic full-thickness resection(EFTR) in the treatment of colorectal submucosal tumor(SMT).
From September 2009 to March 2012, 4 cases with colorectal SMT received EFTR at the Endoscopic Center in the Zhongshan Hospital of Fudan University. The operative time, complications, and follow-up data were analyzed.
There were 3 females and 1 male. The age ranged from 33 to 78 years. The tumor location included the upper rectum(n=2), the ascending colon(n=1), and the descending colon(n=1). The mean operative time was 48.0(24-80) min. The mean diameter was 1.45(0.8-2.0) cm. Postoperative pathological examination revealed schwannoma, pneumatosiscystoidesintestinalis, endometriosis, and mild hyperplasia of smooth muscle in the muscularis mucosa. There was no bleeding or perforation intraoperatively and postoperatively. Two patients developed abdominal pain and fever, one of whom had regional peritonitis and was managed by fasting and intravenous antibiotics. No surgical intervention was required. Postoperative follow up ranged from 1 to 30 months and no residual cancer or recurrence was found.
EFTR is a safe and effective method for colorecal SMT.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 07/2012; 15(7):679-81.
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Gastrointestinal endoscopy 07/2012; 76(1):226. · 6.71 Impact Factor
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De-xiang Zhu,
Ye Wei,
Li Ren,
Xiang-ou Pan,
Li Liang,
Sheng-yong Zhai,
Jian-Min Xu, Yun-shi Zhong,
Zhang-gang Xue,
Ling Jin,
Wei-xin Niu,
Xin-yu Qin,
Zhao-han Wu,
Zhao-guang Wu
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ABSTRACT: To compare the enhanced recovery program after surgery (ERAS) with conventional perioperative management in patients undergoing radical resection for colorectal cancer.
The ERAS protocol included a combination of evidence-based and consensus methodology. A total of 597 consecutive patients undergoing elective colorectal resection were randomized to either the ERAS(n=299) or the control group(n=298). Outcomes related to nutrition and metabolism index, stress index, and recovery index were measured and recorded.
Demographics and operative parameters were similar between the two groups(P>0.05). The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group. On postoperative day (POD) 1, the HOMA-IR in the ERAS group was significantly lower than that in the control group(P<0.01). The cortisol level in the control group was elevated on both POD 1(P<0.01) and POD 5(P<0.01) compared to the preoperative level. However, the cortisol level was not increased until POD 5(P<0.01) in the ERAS group. The levels of TNF-α, IL-1β, IL-6, and IFN-γ were reduced in the ERAS group, indicating less postoperative stress responses compared with the control group. In addition, ERAS group was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay [(5.7±1.6) d vs. (6.6±2.4) d, P<0.01] and expense[(15 998±2655) RMB vs. (17 763±3059) RMB, P<0.01] were reduced in the ERAS group. Twenty-eight patients(9.4%) in the control group and 29(9.7%) in the ERAS group developed complications, while the difference was not statistically significant(P>0.05).
ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 06/2012; 15(6):555-60.
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ABSTRACT: Given the high morbidity and mortality rates for surgery and the diminishment of quality of life caused by operative resection of the gastric cardia, a minor invasive treatment without loss of curability is desirable for submucosal tumors (SMTs) of the esophagogastric junction (EGJ). Endoscopic submucosal dissection (ESD) has been used successfully for the removal of esophageal or gastric SMTs; however, the EGJ has been regarded as a difficult location for ESD because of its narrow lumen and sharp angle.
To evaluate the clinical impact of ESD for SMTs of the EGJ arising from the muscularis propria layer.
Single-center, prospective study.
Academic medical center.
143 patients with 143 SMTs of the EGJ originating from the muscularis propria layer.
ESD.
Complications, en bloc resection rate, local recurrence, and distant metastases.
The average maximum diameter of the lesions was 17.6 mm (range 5 - 50 mm). The en bloc resection rate was 94.4% (135/143). All en bloc resection lesions showed both lateral and deep tumor-free margins, including 20 GI stromal tumors. Perforations occurred in 6 patients (4.2%, 6/143), and metal clips were used to occlude the defect. Four pneumoperitoneum and 2 pneumothorax caused by perforations were resolved with nonsurgical treatment. Local recurrence and distant metastasis have not occurred during a 2-year follow-up.
Single-center, short follow-up.
ESD appears to be a safe, feasible, and effective procedure for providing accurate histopathologic evaluations, as well as curative treatments for SMTs of the EGJ originating from the muscularis propria layer.
Gastrointestinal endoscopy 03/2012; 75(6):1153-8. · 6.71 Impact Factor
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ABSTRACT: In recent years, with the development of digestive endoscopy, endoscopic submucosal dissection(ESD) and its derived techniques including endoscopic submucosal excavation(ESE), submucosal tunnelling endoscopic resection(STER) and laparoscopic endoscopic combined surgery(LECS), can cure most of the gastric gastrointestinal stromal tumor(GIST). This article reviews the indication, method and evaluation of endoscopic resection for gastric GIST.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 03/2012; 15(3):217-20.
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ABSTRACT: To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumor(GIST) in the esophagogastric junction(EGJ).
Twenty patients with pathologically confirmed GIST in the EGJ were screened from all the patients undergoing ESD between November 2007 and June 2011. The clinicopathological and postoperative follow up data were analyzed.
There were 11 males and 9 females with the age ranging from 29 to 67 years(mean, 54.1 years). The maximum diameter of the lesions ranged from 8 to 20 mm(mean,14.8 mm). Fifteen patients underwent endoscopic submucosal excavation, 4 patients underwent endoscopic full-thickness resection, and 1 patient underwent submucosal tunneling endoscopic resection. The operative time ranged from 15 to 90 min(mean, 47.8 minutes). The estimated blood loss was 5 to 200 ml. The en bloc resection rate was 100%. Perforations occurred in 4 patients, pneumoperitonium in 3 patients, cardia mucosal tear in 1 patient. All the complications were successfully managed with endoscopic intervention and conservational therapy. The post-operative follow up ranged from 3 to 36 months(mean, 13.2 months). No local recurrence or distant metastasis occurred.
ESD is a safe and effective procedure for GIST in the EGJ.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 03/2012; 15(3):236-9.
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ABSTRACT: To study the value of the metal clips and endoloop snare for gastric wall defect after endoscopic full-thick resection(EFR).
All the patients who underwent complete closure of gastric wall defect after endoscopic full-thick resection with metal clips and endoloop snare in the Endoscopy Center of Zhongshan hospital from March 2011 to October 2011 were retrospectively studied. The feasibility, safety, and efficacy were evaluated.
Forteen patients were included in this study. The median age was 49(32-63) years. Lesions located in the gastric body in 5 cases, the gastric fundus in 8 cases, and the gastric antrum and body junction in 1 case. The were diameter was 0.6-3.0 cm. Complete closure rate was 100% using this technique. The median repair time was 12(8-20) min. No patients were converted to surgery or laparoscopic surgery. Four patients complained of abdomen pain with elevated body temperature, and ultrasonography showed minor peritoneal fluid in 2 cases, which were drained. These four cases were asked to maintain semi-reclining position and were put on fasting, continuous gastrointestinal decompression, and received antibiotics. They were discharged after 1-3 days. All the patients were followed up with a median time of 3(1-8) months. Nylon and clips residual were removed endoscopically and the wound healing was satisfactory.
Metal clips and endoloop snare is safe and effective for the closure of gastric wall defect after EFR.
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 03/2012; 15(3):280-4.
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ABSTRACT: This paper presented a case of esophageal achalasia treated by peroral endoscopic myotomy with HybridKnife and discuss the feasibility and the possible advantages of using it.
Case reports in gastrointestinal medicine. 01/2012; 2012:325479.
