AIM:To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring.METHODS:Fifty patients with extra-esophageal symptoms of gastroesophageal reflux ...AIM:To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring.METHODS:Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011.All of the data were collected prospectively and analyzed retrospectively.Thirty-six patients(72%,group A) underwent pH monitoring shortly after esophagogastroduodenoscopy(EGD) with conscious sedation,and 14 patients(28%,group B) underwent pH monitoring without conscious sedation.The 24-h pH data from two time periods were analyzed:the first 4 h(Period Ⅰ) and the remaining time of the study(Period Ⅱ).RESULTS:The mean age of the patients was 49.6 ± 12.5 years;20 patients(40%) were men.The baseline data,including age,sex,body mass index,reflux esophagitis,the Reflux Symptom Index,and the Reflux Findings Score,were comparable between the two groups.The percentage of total time with a pH < 4 and the frequency of acid reflux during Period Ⅰ were not significantly different between the two groups,as measured using both pharyngeal(0.03% ± 0.10% vs 0.07% ± 0.16%,P = 0.32;and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h,P = 0.33,respectively) and esophageal probes(0.96% ± 1.89% vs 0.42% ± 0.81%,P = 0.59;and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h,P = 0.49,respectively).The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and Ⅱ in group A patients,as measured using both pharyngeal(0.03% ± 0.10% vs 0.23% ± 0.85%,P = 0.21;and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h,P = 0.22,respectively) and esophageal probes(0.96% ± 1.89% vs 1.11% ± 2.57%,P = 0.55;and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h,P = 0.55,respectively).CONCLUSION:EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.展开更多
BACKGROUND The treatment of hepatocellular carcinoma(HCC)≥10 cm remains a challenge.AIM To consolidate the role of surgical resection for HCC larger than 10 cm.METHODS Eligible HCC patients were identified from the C...BACKGROUND The treatment of hepatocellular carcinoma(HCC)≥10 cm remains a challenge.AIM To consolidate the role of surgical resection for HCC larger than 10 cm.METHODS Eligible HCC patients were identified from the Chang Gung Research Database,the largest multi-institution database,which collected medical records of all patients from Chang Gung Memorial Foundation.The surgical outcome of HCC≥10 cm(L-HCC)was compared to that of HCC<10 cm(S-HCC)(model 1).The survival of L-HCC after either liver resection or transarterial chemoembolization(TACE)was also analyzed(model 2).The long-term risks of all-cause mortality and recurrence were assessed to consolidate the role of surgery for L-HCC.RESULTS From January 2004 to July 2015,a total of 32403 HCC patients were identified from the Chang Gung Research Database.Among 3985 patients who received liver resection,3559(89.3%)had S-HCC,and 426 had L-HCC.The L-HCC patients had a worse disease-free survival(0.27 for L-HCC vs 0.40 for S-HCC)and overall survival(0.18 for L-HCC vs 0.45 for S-HCC)than the S-HCC after liver resection(both P<0.001).However,the surgical and long-term outcome of resected L-HCC had improved dramatically in the recent decades.After adjusting for covariates,surgery could provide a better outcome for L-HCC than TACE(adjusted hazard ratio of all-cause mortality:0.46,95%confidence interval:0.38-0.56 for surgery).Subgroup analysis stratified by different stages showed similar trend of survival benefit among L-HCC patients receiving surgery.CONCLUSION Our study demonstrated an improving surgical outcome for HCC larger than 10 cm.Under selected conditions,surgery is better than TACE in terms of disease control and survival and should be performed.Due to inferior survival,a subclassification within T1 stage should be considered.Future studies are mandatory to confirm our findings.展开更多
基金Supported by A Grant from Chang Gung Memorial Hospital,CMRPG300011
文摘AIM:To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring.METHODS:Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011.All of the data were collected prospectively and analyzed retrospectively.Thirty-six patients(72%,group A) underwent pH monitoring shortly after esophagogastroduodenoscopy(EGD) with conscious sedation,and 14 patients(28%,group B) underwent pH monitoring without conscious sedation.The 24-h pH data from two time periods were analyzed:the first 4 h(Period Ⅰ) and the remaining time of the study(Period Ⅱ).RESULTS:The mean age of the patients was 49.6 ± 12.5 years;20 patients(40%) were men.The baseline data,including age,sex,body mass index,reflux esophagitis,the Reflux Symptom Index,and the Reflux Findings Score,were comparable between the two groups.The percentage of total time with a pH < 4 and the frequency of acid reflux during Period Ⅰ were not significantly different between the two groups,as measured using both pharyngeal(0.03% ± 0.10% vs 0.07% ± 0.16%,P = 0.32;and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h,P = 0.33,respectively) and esophageal probes(0.96% ± 1.89% vs 0.42% ± 0.81%,P = 0.59;and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h,P = 0.49,respectively).The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and Ⅱ in group A patients,as measured using both pharyngeal(0.03% ± 0.10% vs 0.23% ± 0.85%,P = 0.21;and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h,P = 0.22,respectively) and esophageal probes(0.96% ± 1.89% vs 1.11% ± 2.57%,P = 0.55;and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h,P = 0.55,respectively).CONCLUSION:EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.
文摘BACKGROUND The treatment of hepatocellular carcinoma(HCC)≥10 cm remains a challenge.AIM To consolidate the role of surgical resection for HCC larger than 10 cm.METHODS Eligible HCC patients were identified from the Chang Gung Research Database,the largest multi-institution database,which collected medical records of all patients from Chang Gung Memorial Foundation.The surgical outcome of HCC≥10 cm(L-HCC)was compared to that of HCC<10 cm(S-HCC)(model 1).The survival of L-HCC after either liver resection or transarterial chemoembolization(TACE)was also analyzed(model 2).The long-term risks of all-cause mortality and recurrence were assessed to consolidate the role of surgery for L-HCC.RESULTS From January 2004 to July 2015,a total of 32403 HCC patients were identified from the Chang Gung Research Database.Among 3985 patients who received liver resection,3559(89.3%)had S-HCC,and 426 had L-HCC.The L-HCC patients had a worse disease-free survival(0.27 for L-HCC vs 0.40 for S-HCC)and overall survival(0.18 for L-HCC vs 0.45 for S-HCC)than the S-HCC after liver resection(both P<0.001).However,the surgical and long-term outcome of resected L-HCC had improved dramatically in the recent decades.After adjusting for covariates,surgery could provide a better outcome for L-HCC than TACE(adjusted hazard ratio of all-cause mortality:0.46,95%confidence interval:0.38-0.56 for surgery).Subgroup analysis stratified by different stages showed similar trend of survival benefit among L-HCC patients receiving surgery.CONCLUSION Our study demonstrated an improving surgical outcome for HCC larger than 10 cm.Under selected conditions,surgery is better than TACE in terms of disease control and survival and should be performed.Due to inferior survival,a subclassification within T1 stage should be considered.Future studies are mandatory to confirm our findings.
