Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding ri...Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.展开更多
AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 201517 patients(8 female,9 male,average age 69.8 years)wi...AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 201517 patients(8 female,9 male,average age 69.8 years)with a symptomatic Zenker diverticulum(mean size 3.5 cm)were treated by inserting a new 5 mm fully rotatable surgical stapler(MicroCutter30 Xchange,Cardica Inc.)next to an ultrathin flexible endoscope through an overtube.The Patients were under conscious sedation with the head reclined in left position,the stapler placed centrally and pushed forward to the bottom of the diverticulum.The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients(64.7%)the stapler successfully divided the septum completely.Mean procedure time was 21 min,medium size of the septum was 2.8 cm(range 1.5 cm to 4 cm).In four patients the septum was shorter than 3 cm,in seven longer than 3 cm.To divide the septum,averagely 1.3 stapler cartridges were used.Two minor bleedings occurred.Major adverse events like perforation or secondary haemorrhage did not occur.After an average time of two days patients were discharged from the hospital.In 6 patients(35.3%)the stapler failed due to a thick septum or insufficient reclination of the head.Follow up endoscopy was performed after an average of two months in 9 patients;4 patients(44.4%)were free of symptoms,5 patients(55.6%)stated an improvement.A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new,safe and efficient treatment modality.A simultaneously tissue opening and occlusion prevents major complications.展开更多
BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique.There have been several recent studies of full-thickness resection device(FTRD)use in th...BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique.There have been several recent studies of full-thickness resection device(FTRD)use in the colon,but data regarding its use and efficacy in the duodenum are still limited.CASE SUMMARY A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior.The biopsies revealed a low-grade adenoma.The adenoma was removed using the gastroduodenal FTRD,and the pathology results revealed clear margins.Except for minor bleeding that was treated by argon plasma coagulation,no further complications occurred.CONCLUSION Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions.Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.展开更多
文摘Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
文摘AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 201517 patients(8 female,9 male,average age 69.8 years)with a symptomatic Zenker diverticulum(mean size 3.5 cm)were treated by inserting a new 5 mm fully rotatable surgical stapler(MicroCutter30 Xchange,Cardica Inc.)next to an ultrathin flexible endoscope through an overtube.The Patients were under conscious sedation with the head reclined in left position,the stapler placed centrally and pushed forward to the bottom of the diverticulum.The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients(64.7%)the stapler successfully divided the septum completely.Mean procedure time was 21 min,medium size of the septum was 2.8 cm(range 1.5 cm to 4 cm).In four patients the septum was shorter than 3 cm,in seven longer than 3 cm.To divide the septum,averagely 1.3 stapler cartridges were used.Two minor bleedings occurred.Major adverse events like perforation or secondary haemorrhage did not occur.After an average time of two days patients were discharged from the hospital.In 6 patients(35.3%)the stapler failed due to a thick septum or insufficient reclination of the head.Follow up endoscopy was performed after an average of two months in 9 patients;4 patients(44.4%)were free of symptoms,5 patients(55.6%)stated an improvement.A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new,safe and efficient treatment modality.A simultaneously tissue opening and occlusion prevents major complications.
文摘BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique.There have been several recent studies of full-thickness resection device(FTRD)use in the colon,but data regarding its use and efficacy in the duodenum are still limited.CASE SUMMARY A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior.The biopsies revealed a low-grade adenoma.The adenoma was removed using the gastroduodenal FTRD,and the pathology results revealed clear margins.Except for minor bleeding that was treated by argon plasma coagulation,no further complications occurred.CONCLUSION Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions.Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.
