AIM:To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl for treatment of gastric variceal bleeding and prophylaxis.METHODS:Between January 1994 and March 2010 at SoonChunHyang Uni...AIM:To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl for treatment of gastric variceal bleeding and prophylaxis.METHODS:Between January 1994 and March 2010 at SoonChunHyang University Hospital,a total of 127 patients with gastric varices received Histoacryl injections endoscopically.One hundred patients underwent endoscopic Histoacryl injections because of variceal bleeding,the other 27 patients received such injections as a prophylactic procedure.RESULTS:According to Sarin classification,56 patients were GOV1,61 patients were GOV2 and 10 patients were IGV.Most of the varices were large(F2 or F3,111 patients).The average volume of Histoacryl per each session was 1.7±1.3 cc and mean number of sessions was 1.3±0.6.(1 session-98 patients,2 sessions-25 patients,≥3 sessions-4 patients).Twenty-seven patients with high risk of bleeding(large or fundal or RCS+or Child C) received Histoacryl injection as a primary prophylactic procedure.In these patients,hepatitis B virus was the major etiology of cirrhosis,25 patients showed GOV1 or 2(92.6%)and F2 or F3 accounted for 88.9%(n=24).The rate of initial hemostasis was 98.4%and recurrent bleeding within one year occurred in 18.1%of patients.Successful hemostasis during episodes of rebleeding was achieved in 73.9%of cases.Median survival was 50 mo (95%CI 30.5-69.5).Major complications occurred in 4 patients(3.1%).The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions.None of the 27 subjects who were treated prophylactically experienced treatment-related complications.Cumulative survival rates of the 127 patients at 6 mo,1,3,and 5 years were 92.1%,84.2%,64.2%,and 45.3%,respectively.The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.CONCLUSION:Histoacryl injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which carry high risk of bleeding.展开更多
AIM： To compare small sphincterotomy combined with endoscopic papillary large balloon dilation （SES ＋ ELBD） and endoscopic sphincterotomy （EST） for large bile duct stones. METHODS： We compared prospectively SES...AIM： To compare small sphincterotomy combined with endoscopic papillary large balloon dilation （SES ＋ ELBD） and endoscopic sphincterotomy （EST） for large bile duct stones. METHODS： We compared prospectively SES ＋ ELBD （group A, n = 27） with conventional EST （group B, n = 28） for the treatment of large bile duct stones （≥ 15 mm）. When the stone could not be removed with a normal basket, mechanical lithotripsy was performed. We compared the rates of complete stone removal with one session and application of mechanical lithotripsy. RESULTS： No significant differences were observed in the mean largest stone size （A： 20.8 mm, B： 21.3 mm）, bile duct diameter （A： 21.4 turn, B： 20.5 ram）, number of stones （A： 2.2, B： 2.3）, or procedure time （A： 18 min, B： 19 rain） between the two groups. The rates of complete stone removal with one session was 85% in group A and 86% in group B （P = 0.473）. Mechanical lithotripsy was required for stone removal in nine of 27 patients （33%） in group A and nine of 28 patients （32%, P = 0.527） in group B.CONCLUSION： SES ＋ ELBD did not show significant benefits compared to conventional EST, especially for the removal of large （≥ 15 mm） bile duct stones.展开更多
AIM:To evaluate the effect of photodynamic therapy (PDT) on metal stent patency in patients with unresectable hilar cholangiocarcinoma (CC). METHODS:This was a retrospective analysis of patients with hilar CC referred...AIM:To evaluate the effect of photodynamic therapy (PDT) on metal stent patency in patients with unresectable hilar cholangiocarcinoma (CC). METHODS:This was a retrospective analysis of patients with hilar CC referred to our institution from December, 1999 to January, 2011. Out of 232 patients, thirty-three patients with unresectable hilar CC were treated. Eighteen patients in the PDT group were treated with uncovered metal stents after one session of PDT. Fifteen patients in the control group were treated with metal stents alone. Porfimer sodium (2 mg/kg) was administered intravenously to PDT patients. Fortyeight hours later, PDT was administered using a diffusing fiber that was advanced across the tumor by either endoscopic retrograde cholangiopancreatography or percutaneous cholangiography. After performance of PDT, uncovered metal stents were inserted to ensure adequate decompression and bile drainage. Patient survival rates and cumulative stent patency were calculated using Kaplan-Meier analysis with the log-rank test. RESULTS:The PDT and control patients were comparable with respect to age, gender, health status, pretreatment bilirubin, and hilar CC stage. When compared to control, the PDT group was associated with significantly prolonged stent patency (median 244 ± 66 and 177 ± 45 d, respectively, P = 0.002) and longer patient survival (median 356 ± 213 and 230 ± 73 d, respectively, P = 0.006). Early complication rates were similar between the groups (PDT group 17%, control group 13%) and all patients were treated conservatively. Stent malfunctions occurred in 14 PDT patients (78%) and 12 control patients (80%). Of these 26 patients, twenty-two were treated endoscopically and four were treated with external drainage. CONCLUSION:Metal stenting after one session of PDT may be safe with acceptable complication rates. The PDT group was associated with a significantly longer stent patency than the control group in patients with unresectable hilar CC.展开更多
AIM： To assess the ability of endoscopic ultrasonography （EUS） to differentiate neoplastic from non- neoplastic polypoid lesions of the gallbladder （PLGs）.METHODS： The uses of EUS and transabdominal ultrasonogra...AIM： To assess the ability of endoscopic ultrasonography （EUS） to differentiate neoplastic from non- neoplastic polypoid lesions of the gallbladder （PLGs）.METHODS： The uses of EUS and transabdominal ultrasonography （US） were retrospectively analyzed in 94 surgical cases of gallbladder polyps less than 20 mm in diameter.RESULTS： The prevalence of neoplastic lesions with a diameter of 5-20 mm was 27.2% （10/58）; 22-15 mm, 25.4% （4/26）, and 16-20 mm, 50% （5/20）. The overall diagnostic accuracies of EUS and US for small PLGs were 80.9% and 63.9% （P 〈 0.05）, respectively. EUS correctly distinguished 12 （63.2%） of 19 neoplastic PLGs but was less accurate for polyps less than 1.0 cm （4/10, 40%） than for polyps greater than 1.0 cm （8/9, 88.9%） （P = 0.02）.CONCLUSION： Although EUS was more accurate than US, its accuracy for differentiating neoplastic from non-neoplastic PLGs less than 1.0 cm was low. Thus, EUS alone is not sufficient for determining a treatment strategy for PLGs of less than 1.0 cm.展开更多
Photodynamic therapy (PDT) is an established endoscopic technique for ablating Barrett's esophagus with high-grade dysplasia or early-stage intraepithelial neoplasia. The most common clinically significant adverse...Photodynamic therapy (PDT) is an established endoscopic technique for ablating Barrett's esophagus with high-grade dysplasia or early-stage intraepithelial neoplasia. The most common clinically significant adverse effect of PDT is esophageal stricture formation. The strictures are usually superficial and might be dilated effectively with standard endoscopic accessories, such as endoscope balloon or Savary dilators. However, multiple dilations might be required to achieve stricture resolution in some cases. We report the case of stricture that recurred after dilation with a bougie, which was completely relieved by a self-expandable metal stent.展开更多
文摘AIM:To evaluate the long-term efficacy and safety of endoscopic obliteration with Histoacryl for treatment of gastric variceal bleeding and prophylaxis.METHODS:Between January 1994 and March 2010 at SoonChunHyang University Hospital,a total of 127 patients with gastric varices received Histoacryl injections endoscopically.One hundred patients underwent endoscopic Histoacryl injections because of variceal bleeding,the other 27 patients received such injections as a prophylactic procedure.RESULTS:According to Sarin classification,56 patients were GOV1,61 patients were GOV2 and 10 patients were IGV.Most of the varices were large(F2 or F3,111 patients).The average volume of Histoacryl per each session was 1.7±1.3 cc and mean number of sessions was 1.3±0.6.(1 session-98 patients,2 sessions-25 patients,≥3 sessions-4 patients).Twenty-seven patients with high risk of bleeding(large or fundal or RCS+or Child C) received Histoacryl injection as a primary prophylactic procedure.In these patients,hepatitis B virus was the major etiology of cirrhosis,25 patients showed GOV1 or 2(92.6%)and F2 or F3 accounted for 88.9%(n=24).The rate of initial hemostasis was 98.4%and recurrent bleeding within one year occurred in 18.1%of patients.Successful hemostasis during episodes of rebleeding was achieved in 73.9%of cases.Median survival was 50 mo (95%CI 30.5-69.5).Major complications occurred in 4 patients(3.1%).The rebleeding rate in patients with hepatocellular carcinoma or GOV2 was higher than in those with other conditions.None of the 27 subjects who were treated prophylactically experienced treatment-related complications.Cumulative survival rates of the 127 patients at 6 mo,1,3,and 5 years were 92.1%,84.2%,64.2%,and 45.3%,respectively.The 6 mo cumulative survival rate of the 27 patients treated prophylactically was 75%.CONCLUSION:Histoacryl injection therapy is an effective treatment for gastric varices and also an effective prophylactic treatment of gastric varices which carry high risk of bleeding.
文摘AIM： To compare small sphincterotomy combined with endoscopic papillary large balloon dilation （SES ＋ ELBD） and endoscopic sphincterotomy （EST） for large bile duct stones. METHODS： We compared prospectively SES ＋ ELBD （group A, n = 27） with conventional EST （group B, n = 28） for the treatment of large bile duct stones （≥ 15 mm）. When the stone could not be removed with a normal basket, mechanical lithotripsy was performed. We compared the rates of complete stone removal with one session and application of mechanical lithotripsy. RESULTS： No significant differences were observed in the mean largest stone size （A： 20.8 mm, B： 21.3 mm）, bile duct diameter （A： 21.4 turn, B： 20.5 ram）, number of stones （A： 2.2, B： 2.3）, or procedure time （A： 18 min, B： 19 rain） between the two groups. The rates of complete stone removal with one session was 85% in group A and 86% in group B （P = 0.473）. Mechanical lithotripsy was required for stone removal in nine of 27 patients （33%） in group A and nine of 28 patients （32%, P = 0.527） in group B.CONCLUSION： SES ＋ ELBD did not show significant benefits compared to conventional EST, especially for the removal of large （≥ 15 mm） bile duct stones.
文摘AIM:To evaluate the effect of photodynamic therapy (PDT) on metal stent patency in patients with unresectable hilar cholangiocarcinoma (CC). METHODS:This was a retrospective analysis of patients with hilar CC referred to our institution from December, 1999 to January, 2011. Out of 232 patients, thirty-three patients with unresectable hilar CC were treated. Eighteen patients in the PDT group were treated with uncovered metal stents after one session of PDT. Fifteen patients in the control group were treated with metal stents alone. Porfimer sodium (2 mg/kg) was administered intravenously to PDT patients. Fortyeight hours later, PDT was administered using a diffusing fiber that was advanced across the tumor by either endoscopic retrograde cholangiopancreatography or percutaneous cholangiography. After performance of PDT, uncovered metal stents were inserted to ensure adequate decompression and bile drainage. Patient survival rates and cumulative stent patency were calculated using Kaplan-Meier analysis with the log-rank test. RESULTS:The PDT and control patients were comparable with respect to age, gender, health status, pretreatment bilirubin, and hilar CC stage. When compared to control, the PDT group was associated with significantly prolonged stent patency (median 244 ± 66 and 177 ± 45 d, respectively, P = 0.002) and longer patient survival (median 356 ± 213 and 230 ± 73 d, respectively, P = 0.006). Early complication rates were similar between the groups (PDT group 17%, control group 13%) and all patients were treated conservatively. Stent malfunctions occurred in 14 PDT patients (78%) and 12 control patients (80%). Of these 26 patients, twenty-two were treated endoscopically and four were treated with external drainage. CONCLUSION:Metal stenting after one session of PDT may be safe with acceptable complication rates. The PDT group was associated with a significantly longer stent patency than the control group in patients with unresectable hilar CC.
文摘AIM： To assess the ability of endoscopic ultrasonography （EUS） to differentiate neoplastic from non- neoplastic polypoid lesions of the gallbladder （PLGs）.METHODS： The uses of EUS and transabdominal ultrasonography （US） were retrospectively analyzed in 94 surgical cases of gallbladder polyps less than 20 mm in diameter.RESULTS： The prevalence of neoplastic lesions with a diameter of 5-20 mm was 27.2% （10/58）; 22-15 mm, 25.4% （4/26）, and 16-20 mm, 50% （5/20）. The overall diagnostic accuracies of EUS and US for small PLGs were 80.9% and 63.9% （P 〈 0.05）, respectively. EUS correctly distinguished 12 （63.2%） of 19 neoplastic PLGs but was less accurate for polyps less than 1.0 cm （4/10, 40%） than for polyps greater than 1.0 cm （8/9, 88.9%） （P = 0.02）.CONCLUSION： Although EUS was more accurate than US, its accuracy for differentiating neoplastic from non-neoplastic PLGs less than 1.0 cm was low. Thus, EUS alone is not sufficient for determining a treatment strategy for PLGs of less than 1.0 cm.
文摘Photodynamic therapy (PDT) is an established endoscopic technique for ablating Barrett's esophagus with high-grade dysplasia or early-stage intraepithelial neoplasia. The most common clinically significant adverse effect of PDT is esophageal stricture formation. The strictures are usually superficial and might be dilated effectively with standard endoscopic accessories, such as endoscope balloon or Savary dilators. However, multiple dilations might be required to achieve stricture resolution in some cases. We report the case of stricture that recurred after dilation with a bougie, which was completely relieved by a self-expandable metal stent.
