AIM: To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagosco-py and to compare its accuracy with standard endoscopy.METHODS: We prospectively included subjects who were...AIM: To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagosco-py and to compare its accuracy with standard endoscopy.METHODS: We prospectively included subjects who were referred for upper endoscopy. All subjects un-derwent transnasal endoscopy with E.G. Scan^(TM). The disposable probe has a 3.6 mm gauge and at its distal end there is a 6 mm optical capsule, with a viewing angle of 125°. Patients underwent conventional endos-copy after the completion of E.G. Scan^(TM). We describe the findings detected by the E.G. Scan^(TM) and calculate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa index for esophageal diagnosis.RESULTS: A total of 96 patients(54 women), mean age of 50.12 years(14 to 79), were evaluated. In all cases we were able to perform esophagoscopy with E.G.Scan^(TM). The average realization time was 5 min. A total of 58 alterations were detected in the esophagus, 49 gastric abnormalities and 13 duodenal abnormalities. We found that for esophageal varices, E.G. Scan^(TM) has sensitivity, specificity and diagnostic accuracy of 95%, 97% and 97%, respectively. Kappa coefficients were 0.32 for hiatal hernia, 0.409 for erosive gastroesopha-geal reflux disease, 0.617 for Barrett's esophagus, and 0.909 for esophageal varices.CONCLUSION: Esophagoscopy with E.G. Scan? is a well-tolerated, fast and safe procedure. It has an ap-propriate diagnostic accuracy for esophageal varices when compared with conventional endoscopy.展开更多
Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and conve...Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.展开更多
AIM: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS: Between January 2006 and March 2...AIM: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS: Between January 2006 and March 2010, a total of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori (H. pylori)-related chronic gastritis. RESULTS: Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P < 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylori-related non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P < 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage of early cancers was significantly higher with standard transoral EGD. CONCLUSION: These results strongly suggest that the diagnostic performance of transnasal endoscopy is suboptimal for cancer screening, particularly in subjects with H. pylori-related non-atrophic gastritis.展开更多
Endoscopic biliary drainage has been established to provide effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope (TNE) is minimally invasive even...Endoscopic biliary drainage has been established to provide effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope (TNE) is minimally invasive even for critically ill patients and can be performed without conscious sedation. Transnasal endoscopic biliary drainage (TNE-BD) is performed using a frontviewing TNE with approximately 5 mm outer diameter and 2 mm working channel diameter. Finally, 5F nasobiliary tube or plastic stent are placed. Technical success rates are approximately 100% and 70% for postendoscopic sphincterotomy or placement of self-expandable metallic stent, and intact papilla, respectively. There are no serious complications. In conclusion, although further cases should be accumulated, TNEBD and in particular, one-step naso-biliary drainage using TNE may be a useful and novel technique for the treatment of acute cholangitis.展开更多
AIM:To describe the role of endoscopic transnasal canaliculorhinostomy(ETC)in refractory common canalicular obstruction(CCO)associated with an absent or unidentifiable lacrimal sac.METHODS:The records of patients with...AIM:To describe the role of endoscopic transnasal canaliculorhinostomy(ETC)in refractory common canalicular obstruction(CCO)associated with an absent or unidentifiable lacrimal sac.METHODS:The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed.RESULTS:Fifty-six patients(56 eyes)with refractory CCO were recruited into the study.Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration.The anatomic and functional success rates were both 85.4%(41/48)at a mean follow-up of 18.6 mo.Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation.Postoperative complications included mild nasal bleeding in 5 cases,dried nasal feeling in 8 cases,and olfactory dysfunction in 4 cases.CONCLUSION:Although being surgically challenging,ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy(CDCR)with Jones tube.And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.展开更多
Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy i...Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy in esophageal cancer 2 years ago was admitted to our hospital with primary pharyngeal cancer. The type of upper endoscope used was EG-580NW (FUJI Film, Tokyo, Japan). The endoscope is a trans-nasal endoscope that can provide high quality endoscopic images. The pharyngeal cancer located at right lateral wall which was previously detected could be observed easily. We asked the patient to blow hard and puff his cheeks with his mouth closed. When inspecting the hypopharynx and the orifice of the esophagus, we told the patient that we would start the trumpet maneuver. Results: After the trumpet maneuver, the pharyngeal mucosa was stretched out. Another primary lesion was observed at the posterior wall of the hypopharynx near the pharyngoesophageal junction. This technique provided a much better view of the lesion than had been possible with trans-oral endoscopy,allowing us to remove the biopsy specimen without sedation. Conclusion: In conclusion, the trumpet maneuver using trans-nasal endoscopy is a useful technique for precise inspection before treatments for patients who have already detected the lesions.展开更多
Background: Several large series have established endoscopic transnasal sellar surgery as the procedure of choice for removal of tumors in the sellar area. Although this procedure provides a less invasive approach to ...Background: Several large series have established endoscopic transnasal sellar surgery as the procedure of choice for removal of tumors in the sellar area. Although this procedure provides a less invasive approach to the sella, it entails complications such as nasal bleeding, impaired olfactory function, atrophic rhinitis, synechiae, etc. No studies have yet reported potential morbidities such as empty nose syndrome (ENS), although patients have a relatively empty nasal cavity after surgery. Therefore, we sought to verify the percentage of patients who truly met the diagnostic criteria for ENS after endoscopic transnasal sellar surgery, determine the variation between pre- and postoperative scores in each Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) item, and further evaluate the symptoms that may affect the patients the most after surgery. Methods: Between March 2015 and January 2019, eventually 11 patients who underwent extended endoscopic transnasal sellar surgery in Shin Kong Wu Ho-Su Memorial Hospital, a tertiary referral medical center in Taipei, Taiwan, were enrolled. The patients completed the recently validated ENS6Q after surgery. Results: One patient met the objective diagnostic criteria for ENS (score ≥ 11 in ENS6Q). Significant differences were observed in the pre- and postoperative total ENS6Q scores. The pre- and postoperative scores of “nose feeling too open” and nasal crusting showed statistically significant differences. Further, compared with the other items, the postoperative score of nasal crusting increased most obviously, and it may be the most apparent operation-related symptom. Conclusion: This study is the first to report the possibility of developing ENS after endoscopic transnasal sellar surgery. Although the transnasal endoscopic approach is a safe and minimally invasive procedure for the treatment of sellar lesions, possible complications such as ENS should be considered.展开更多
AIM: To investigate dysfunctions in esophageal peristalsis and sensation in patients with Barrett’s esophagus following acid infusion using endoscopy-based testing.
Cavernous hemangioma is the most primary benign orbital tumor in adults,and majority of cases could be easily settled by surgical treatment.However,cavernous hemangioma lodged deep in the orbital apex remained a chall...Cavernous hemangioma is the most primary benign orbital tumor in adults,and majority of cases could be easily settled by surgical treatment.However,cavernous hemangioma lodged deep in the orbital apex remained a challenge because the surgery may pose a high risk of injury to the optic nerve and significant visual loss.This presentation would report a case of cavernous hemangioma located in orbital apex who presented superonasal and inferotemporal peripheral vision defect.The patient received fully transnasal endoscopic surgery,and a 2 cm×1.5 cm tumor was successfully removed from the left orbital apex.The treatment results were satisfactory,with no after-effects and adverse reactions during follow-up.This case highlighted that transnasal endoscopic surgery is a promising technique for cavernous hemangiomas that are located deep in orbital apex.This approach provides direct pathway to tumor with limiting morbidity,maximal surgical field and ample illumination.The procedure represents a safe and less invasive management.展开更多
Objective: to observe the effect of comprehensive nursing plan in the nursing of patients undergoing fiberoptic bronchoscopy guided transnasal tracheal intubation. Methods: 88 patients who were treated by fiberoptic b...Objective: to observe the effect of comprehensive nursing plan in the nursing of patients undergoing fiberoptic bronchoscopy guided transnasal tracheal intubation. Methods: 88 patients who were treated by fiberoptic bronchoscopy guided by endotracheal intubation were randomly and evenly divided into control group (n=44) and analysis group (n=44), and the control group needed to receive routine nursing, while the analysis group needed to receive comprehensive nursing and intervention, and the nursing effect of the two groups was analyzed. Results: the overall effect of the patients in the analysis group was significantly better than that of the control group, and there was statistical difference after the data analysis (P < 0.05). Conclusion: the comprehensive nursing cooperation is effective and the feasibility of the scheme is high for the selection of nursing plan for patients with transnasal tracheal intubation.展开更多
Background The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical ...Background The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope. Methods Totally 49 patients, involving 46 （93.9%） being American Society of Anesthesiologists Physical Status （ASA-PS） grade III （n=3） and grade IV （n=-43）, in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed. Results The tube was placed at or beyond the Treitz＇s ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 （93.9%） cases by transnasal method and 3 （6.1%） cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was （6.2±5.6） minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was （12.3±2.1） minutes. In the period of nasoenteral tube placement, the average systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and average pulse oxygen saturation （SpO2） did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose. Conclusion The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.展开更多
Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this re...Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.展开更多
Objective： To observe the effect of Xiaoyao Nose Drops （逍遥滴鼻液 , XYND） in stopping episode of migraine. Methods： Adopted was the randomized double-blinded placebo-controled method, with the 126 patients equall...Objective： To observe the effect of Xiaoyao Nose Drops （逍遥滴鼻液 , XYND） in stopping episode of migraine. Methods： Adopted was the randomized double-blinded placebo-controled method, with the 126 patients equally assigned to two groups, the treated group treated with XYND and the control group with placebo, and the therapeutic course was 30 days for all. The clinical total effective rate and effect in al- leviating headache were observed. And hemorrheological parameters as well as the blood flow of the anterior cerebral artery （ACA）, median cerebral artery （MCA） and posterior cerebral artery （PCA） were measured before and after treatment. Results： The clinical total effective rate and headache alleviating rate in the treated group were 93.33% and 96.67% respectively, while those in the control group were 18.33% and 20.00 % respectively, and comparison between the two groups showed significant difference （all P〈0.01）. The blood viscosity （high, middle and low shear）, plasma viscosity and fibrinogen got lowered significantly in the treated group after treatment, showing significant difference in comparison either with those before treatment or with those in the control group after treatment （P〈0.05 or P〈0.01）. The velocity of blood flow in all cerebral arteries lowered significantly, also showing significant difference in comparison either with those before treatment or with those in the control group after treatment （ P 〈 0.05 or P 〈 0.01 ）. Conclusion： XYND is effective in stopping the headache of patients with migraine, and worth applying in clinical practice.展开更多
Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this st...Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this study is to discuss our early results in endoscopic skull base surgery and the development of the learning curve. Patients and Methods: We analyzed our experience regarding 25 patients presented to us in Neurosurgery Department, Assiut University Hospital, Assiut University, Assiut, Egypt in a period of 3 years (2015, 2016, 2017) and operated by endoscopic transnasal approach. All patients signed an informed consent. Results: With the highest percentage was pituitary adenoma 56%, pituitary apoplexy 12%, craniopharyngioma 12%, CSF rhinorrhea 12%, Planum sphenoidal meningioma 4% and suprasellar granuloma 4%. 88% of patients were operated without complications, 8% mortality rate postoperative, 12% complication rate and 76% complete improvement postoperative. Conclusion: Endoscopic skull base surgery is a safe approach to the skull base that needs a good experience, practice and good anatomical knowledge. Teamwork between a Neurosurgeon and ENT surgeon is a must for patient safety.展开更多
NFMAs are benign tumors that do not produce any biologically active hormones and exceed 10 mm (0.39 in) in size. Although NFMAs are benign in origin, mass effects may lead to serious clinical symptoms such as visual i...NFMAs are benign tumors that do not produce any biologically active hormones and exceed 10 mm (0.39 in) in size. Although NFMAs are benign in origin, mass effects may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The authors describe a 51-year-old woman who had a NFMA (35 × 24 × 25 mm). The vision was reduced to 7/10 in the both eyes. A transnasal transsphenoidal surgery was performed and the tumor was successfully resected. Postoperatively, the patient had visual (9/10) and headache improvement. This case highlights a rare presentation of non-functioning pituitary macroadenoma.展开更多
Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors desc...Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors describe a 37-year-old man who had a pituitary adenoma associated with obstructive hydrocephalus that was managed by endoscopic transnasal transsphenoidal surgery. Postoperative CT and MRI scans showed resolution of the obstructive hydrocephalus and the foramen of Monro was open. Postoperatively, the patient had visual and headache improvement. Subsequently, the patient is a candidate for cranial surgery or medical therapy to complete the treatment. The present case highlights the fact that pituitary adenomas with obstructive hydrocephalus should be distinguished from other tumors especially colloid cysts.展开更多
Endoscopic resection with transnasal craniectomy(ERTC)and skull-base reconstruction(SBR)are effective techniques for sinonasal/skull-base malignancies treatment.Endoscopic endonasal SBR techniques are mainly based on ...Endoscopic resection with transnasal craniectomy(ERTC)and skull-base reconstruction(SBR)are effective techniques for sinonasal/skull-base malignancies treatment.Endoscopic endonasal SBR techniques are mainly based on homologuefree grafts with excellent outcomes,but alternative techniques can be used such as regional vascularized pedicled flaps or local pedicled flap-like Hadad–Bassagasteguy nasoseptal flap and the septal flip flap(SFF).The purpose of this article is to describe an inferiorly based septal flap aimed to promote mucosal healing and improve patients’quality of life.We reported a clinical case of 51-year-old female affected by olfactory neuroblastoma,Hyams-Ⅱ,Kadish-INSICA-B treated with unilateral ERTC and SBR with fascia lata,SFF,and modified reverse septal flap(mRSF).The mRSF harvesting is described in detail,to obtain a lower hinged flap with random vascularization,which can be rotated to cover the exposed bone of the nasal cavity floor.Endoscopic evaluations immediately showed rapid healing with a minimal amount of nasal crusting,despite the adjuvant treatment and the short time since the surgery.This surgical technique is a simple and viable way to boost nasal healing after endoscopic endonasal surgery and for nasal floor resurfacing after septal removal following a unilateral ERTC.展开更多
Background: Neurological disorders represent a profound healthcare problem accounting for 6.3％ of the global disease burden.Alzheimer's disease alone is expected to impact over 115 million people worldwide by 205...Background: Neurological disorders represent a profound healthcare problem accounting for 6.3％ of the global disease burden.Alzheimer's disease alone is expected to impact over 115 million people worldwide by 2050 with a cost of over $1 trillion per year to the U.S.economy.Despite considerable advances in our understanding of the pathogenesis and natural history of neurological disorders, the development of disease modifying therapies have failed to keep pace.This lack of effective treatments is directly attributable to the presence of the blood-brain and blood-cerebrospinal fluid barriers (BBB and BCSFB) which prevent up to 98％ of all potential neuropharmaceutical agents from reaching the central nervous system (CNS).These obstacles have thereby severely limited research and development into novel therapeutic strategies for neurological disease.Current experimental methods to bypass the BBB, including pharmacologic modification and direct transcranial catheter implantation, are expensive, are associated with significant complications, and cannot be feasibly scaled up to meet the chronic needs of a large, aging patient population.Transmucosal drug delivery: An innovative method of direct CNS drug delivery using heterotopic mucosal grafts was described.This method is based on established endoscopic skull base nasoseptal flap reconstruction techniques.The model has successfully demonstrated CNS delivery of chromophore-tagged molecules 1000 times larger than those typically permitted by the BBB.Conclusions: This innovative technique represents the first described method of permanently bypassing the blood-brain barrier using purely autologous tissues.This has the potential to dramatically improve the current treatment of neurological disease by providing a safe and chronic transnasaldelivery pathway for high molecular weight neuropharmaceuticals.展开更多
Objective: To report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique. Methods: A retrospective review of all patients who underwent flexible endosco...Objective: To report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique. Methods: A retrospective review of all patients who underwent flexible endoscopic injection laryngoplasty between June 2010 and August 2016 was carried out. Only those patients who had pre- and post-injection voice outcome measures recorded were included. Voice outcome measures recorded included perceptual voice evaluation using GRBAS, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT) and closed quotient (CQ) before and after treat-ment. Results: Forty-six patients were identified, of which 32 had pre- and post-injection voice outcome measures recorded. There were 19 males and 13 females. The mean age was 56.97 years (range 20—86 years) and the most common indication was unilateral vocal fold paralysis. Thirteen patients had a transnasal flexible endoscopic injection), while 19 patients were in-jected transorally. Following injection laryngoplasty, there was significant improvement in the mean grade of dysphonia (2.81 vs. 1.22, P < 0.01, roughness (2.44 vs. 1.34, P < 0.01), breathiness (2.72 vs. 1.13, P < 0.01), asthenia (2.78 vs. 1.06, P < 0.01), and strain (2.44 vs. 1.19, P < 0.01), MPT (3.85 s vs. 9.85 s, P < 0.01) and mean CQ (0.19 vs. 0.46, P < 0.01). There was also a decrease in the mean VHI-10 score (33.31 vs. 7.94, P < 0.01). Conclusion: s: Patients achieved significant improvement in both subjective and objective voice measures after flexible endoscopic injection laryngoplasty via the nasal or transoral route. Voice outcomes were comparable to those reported for other approaches. This tech-nique provides an alternative approach for the management of patients with vocal fold paral-ysis or glottal insufficiency.展开更多
文摘AIM: To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagosco-py and to compare its accuracy with standard endoscopy.METHODS: We prospectively included subjects who were referred for upper endoscopy. All subjects un-derwent transnasal endoscopy with E.G. Scan^(TM). The disposable probe has a 3.6 mm gauge and at its distal end there is a 6 mm optical capsule, with a viewing angle of 125°. Patients underwent conventional endos-copy after the completion of E.G. Scan^(TM). We describe the findings detected by the E.G. Scan^(TM) and calculate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa index for esophageal diagnosis.RESULTS: A total of 96 patients(54 women), mean age of 50.12 years(14 to 79), were evaluated. In all cases we were able to perform esophagoscopy with E.G.Scan^(TM). The average realization time was 5 min. A total of 58 alterations were detected in the esophagus, 49 gastric abnormalities and 13 duodenal abnormalities. We found that for esophageal varices, E.G. Scan^(TM) has sensitivity, specificity and diagnostic accuracy of 95%, 97% and 97%, respectively. Kappa coefficients were 0.32 for hiatal hernia, 0.409 for erosive gastroesopha-geal reflux disease, 0.617 for Barrett's esophagus, and 0.909 for esophageal varices.CONCLUSION: Esophagoscopy with E.G. Scan? is a well-tolerated, fast and safe procedure. It has an ap-propriate diagnostic accuracy for esophageal varices when compared with conventional endoscopy.
文摘Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.
基金Supported by (in part) A Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan
文摘AIM: To compare the diagnostic performances of transnasal and standard transoral esophagogastroduodenoscopy (EGD) in gastric cancer screening of asymptomatic healthy subjects. METHODS: Between January 2006 and March 2010, a total of 3324 subjects underwent examination of the upper gastrointestinal tract by EGD for cancer screening, with 1382 subjects (41.6%) screened by transnasal EGD and the remaining 1942 subjects (58.4%) by standard transoral EGD. Clinical profiles of the screened subjects, detection rates of gastric neoplasia and histopathology of the detected neoplasias were compared between groups according to the stage of Helicobacter pylori (H. pylori)-related chronic gastritis. RESULTS: Clinical profiles of subjects did not differ significantly between the two EGD groups, except that there were significantly more men in the transnasal EGD group. During the study period, 55 cases of gastric mucosal neoplasias were detected. Of these, 23 cases were detected by transnasal EGD and 32 cases by standard transoral EGD. The detection rate for gastric mucosal neoplasia in the transnasal EGD group was thus 1.66%, compared to 1.65% in the standard transoral EGD group, with no significant difference between the two groups. Detection rates using the two endoscopies were likewise comparable, regardless of H. pylori infection. However, detection rates when screening subjects without extensive chronic atrophic gastritis (CAG) were significantly higher with standard transoral EGD (0.70%) than with transnasal EGD (0.12%, P < 0.05). In particular, standard transoral EGD was far better for detecting neoplasia in subjects with H. pylori-related non-atrophic gastritis, with a detection rate of 3.11% compared to 0.53% using transnasal EGD (P < 0.05). In the screening of subjects with extensive CAG, no significant differences in detection of neoplasia were evident between the two endoscopies, although the mean size of detected cancers was significantly smaller and the percentage of early cancers was significantly higher with standard transoral EGD. CONCLUSION: These results strongly suggest that the diagnostic performance of transnasal endoscopy is suboptimal for cancer screening, particularly in subjects with H. pylori-related non-atrophic gastritis.
文摘Endoscopic biliary drainage has been established to provide effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope (TNE) is minimally invasive even for critically ill patients and can be performed without conscious sedation. Transnasal endoscopic biliary drainage (TNE-BD) is performed using a frontviewing TNE with approximately 5 mm outer diameter and 2 mm working channel diameter. Finally, 5F nasobiliary tube or plastic stent are placed. Technical success rates are approximately 100% and 70% for postendoscopic sphincterotomy or placement of self-expandable metallic stent, and intact papilla, respectively. There are no serious complications. In conclusion, although further cases should be accumulated, TNEBD and in particular, one-step naso-biliary drainage using TNE may be a useful and novel technique for the treatment of acute cholangitis.
基金Supported by the Natural Key Research and Development Program of China(No.2016YFC1101200)the National Natural Science Foundation of China(No.81770926)。
文摘AIM:To describe the role of endoscopic transnasal canaliculorhinostomy(ETC)in refractory common canalicular obstruction(CCO)associated with an absent or unidentifiable lacrimal sac.METHODS:The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed.RESULTS:Fifty-six patients(56 eyes)with refractory CCO were recruited into the study.Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration.The anatomic and functional success rates were both 85.4%(41/48)at a mean follow-up of 18.6 mo.Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation.Postoperative complications included mild nasal bleeding in 5 cases,dried nasal feeling in 8 cases,and olfactory dysfunction in 4 cases.CONCLUSION:Although being surgically challenging,ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy(CDCR)with Jones tube.And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.
文摘Aims: In order to observe the pharyngoesophageal junction, the trumpet maneuver with trans-nasal endoscopy was used. Its efficacy is reported here. Material and Methods: A 71-year-old man who underwent esophagectomy in esophageal cancer 2 years ago was admitted to our hospital with primary pharyngeal cancer. The type of upper endoscope used was EG-580NW (FUJI Film, Tokyo, Japan). The endoscope is a trans-nasal endoscope that can provide high quality endoscopic images. The pharyngeal cancer located at right lateral wall which was previously detected could be observed easily. We asked the patient to blow hard and puff his cheeks with his mouth closed. When inspecting the hypopharynx and the orifice of the esophagus, we told the patient that we would start the trumpet maneuver. Results: After the trumpet maneuver, the pharyngeal mucosa was stretched out. Another primary lesion was observed at the posterior wall of the hypopharynx near the pharyngoesophageal junction. This technique provided a much better view of the lesion than had been possible with trans-oral endoscopy,allowing us to remove the biopsy specimen without sedation. Conclusion: In conclusion, the trumpet maneuver using trans-nasal endoscopy is a useful technique for precise inspection before treatments for patients who have already detected the lesions.
文摘Background: Several large series have established endoscopic transnasal sellar surgery as the procedure of choice for removal of tumors in the sellar area. Although this procedure provides a less invasive approach to the sella, it entails complications such as nasal bleeding, impaired olfactory function, atrophic rhinitis, synechiae, etc. No studies have yet reported potential morbidities such as empty nose syndrome (ENS), although patients have a relatively empty nasal cavity after surgery. Therefore, we sought to verify the percentage of patients who truly met the diagnostic criteria for ENS after endoscopic transnasal sellar surgery, determine the variation between pre- and postoperative scores in each Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) item, and further evaluate the symptoms that may affect the patients the most after surgery. Methods: Between March 2015 and January 2019, eventually 11 patients who underwent extended endoscopic transnasal sellar surgery in Shin Kong Wu Ho-Su Memorial Hospital, a tertiary referral medical center in Taipei, Taiwan, were enrolled. The patients completed the recently validated ENS6Q after surgery. Results: One patient met the objective diagnostic criteria for ENS (score ≥ 11 in ENS6Q). Significant differences were observed in the pre- and postoperative total ENS6Q scores. The pre- and postoperative scores of “nose feeling too open” and nasal crusting showed statistically significant differences. Further, compared with the other items, the postoperative score of nasal crusting increased most obviously, and it may be the most apparent operation-related symptom. Conclusion: This study is the first to report the possibility of developing ENS after endoscopic transnasal sellar surgery. Although the transnasal endoscopic approach is a safe and minimally invasive procedure for the treatment of sellar lesions, possible complications such as ENS should be considered.
文摘AIM: To investigate dysfunctions in esophageal peristalsis and sensation in patients with Barrett’s esophagus following acid infusion using endoscopy-based testing.
基金This work was supported by the National Natural Science Foundation of China(81960184)Ningxia Key Research and Development Program(Special Talents)(2018beb04023)Ningxia Key Research and Development Program(General Subject)(2018YBZD1445).
文摘Cavernous hemangioma is the most primary benign orbital tumor in adults,and majority of cases could be easily settled by surgical treatment.However,cavernous hemangioma lodged deep in the orbital apex remained a challenge because the surgery may pose a high risk of injury to the optic nerve and significant visual loss.This presentation would report a case of cavernous hemangioma located in orbital apex who presented superonasal and inferotemporal peripheral vision defect.The patient received fully transnasal endoscopic surgery,and a 2 cm×1.5 cm tumor was successfully removed from the left orbital apex.The treatment results were satisfactory,with no after-effects and adverse reactions during follow-up.This case highlighted that transnasal endoscopic surgery is a promising technique for cavernous hemangiomas that are located deep in orbital apex.This approach provides direct pathway to tumor with limiting morbidity,maximal surgical field and ample illumination.The procedure represents a safe and less invasive management.
文摘Objective: to observe the effect of comprehensive nursing plan in the nursing of patients undergoing fiberoptic bronchoscopy guided transnasal tracheal intubation. Methods: 88 patients who were treated by fiberoptic bronchoscopy guided by endotracheal intubation were randomly and evenly divided into control group (n=44) and analysis group (n=44), and the control group needed to receive routine nursing, while the analysis group needed to receive comprehensive nursing and intervention, and the nursing effect of the two groups was analyzed. Results: the overall effect of the patients in the analysis group was significantly better than that of the control group, and there was statistical difference after the data analysis (P < 0.05). Conclusion: the comprehensive nursing cooperation is effective and the feasibility of the scheme is high for the selection of nursing plan for patients with transnasal tracheal intubation.
文摘Background The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope. Methods Totally 49 patients, involving 46 （93.9%） being American Society of Anesthesiologists Physical Status （ASA-PS） grade III （n=3） and grade IV （n=-43）, in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed. Results The tube was placed at or beyond the Treitz＇s ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 （93.9%） cases by transnasal method and 3 （6.1%） cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was （6.2±5.6） minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was （12.3±2.1） minutes. In the period of nasoenteral tube placement, the average systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and average pulse oxygen saturation （SpO2） did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose. Conclusion The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.
基金supported by the Natural Key Research and Development Program of China(2016YFC1101200).
文摘Background:To describe the surgical technique and assess the clinical efficacy and safety of modified endoscopic transnasal orbital apex decompression in the treatment of dysthyroid optic neuropathy.Methods:In this retrospective research,forty-two subjects(74 orbits)who underwent modified endoscopic transnasal orbital apex decompression for the treatment of dysthyroid optic neuropathy were enrolled.Preoperative and postoperative best-corrected visual acuity(BCVA),visual field mean deviation(MD),Hertel exophthalmometry,and new onset diplopia were assessed before and after the intervention.The Wilcoxon test was used for differential analysis.Linear mixed-models’analyses were conducted to assess the potential predictors for BCVA change.Results:Postoperatively,the mean BCVA improved from 0.70±0.62 logMAR to 0.22±0.33 logMAR.BCVA significantly improved in 69 eyes(93%),remained stable in 4 eyes(5%)and deteriorated in 1 eye(1%).MD of visual fields improved from−13.73±9.22 dB to−7.23±7.04 dB.Proptosis decreased from 19.57±3.38mm to 16.35±3.01mm.Preoperative BCVA,MD of visual fields and medical rectus diameter were independent factors associated with improvements in BCVA(P<0.05)by linear mixed-models’analyses.Eighteen patients(42.9%)developed new diplopia postoperatively.Conclusion:Modified endoscopic transnasal orbital apex decompression effectively restores vision in dysthyroid optic neuropathy.
文摘Objective： To observe the effect of Xiaoyao Nose Drops （逍遥滴鼻液 , XYND） in stopping episode of migraine. Methods： Adopted was the randomized double-blinded placebo-controled method, with the 126 patients equally assigned to two groups, the treated group treated with XYND and the control group with placebo, and the therapeutic course was 30 days for all. The clinical total effective rate and effect in al- leviating headache were observed. And hemorrheological parameters as well as the blood flow of the anterior cerebral artery （ACA）, median cerebral artery （MCA） and posterior cerebral artery （PCA） were measured before and after treatment. Results： The clinical total effective rate and headache alleviating rate in the treated group were 93.33% and 96.67% respectively, while those in the control group were 18.33% and 20.00 % respectively, and comparison between the two groups showed significant difference （all P〈0.01）. The blood viscosity （high, middle and low shear）, plasma viscosity and fibrinogen got lowered significantly in the treated group after treatment, showing significant difference in comparison either with those before treatment or with those in the control group after treatment （P〈0.05 or P〈0.01）. The velocity of blood flow in all cerebral arteries lowered significantly, also showing significant difference in comparison either with those before treatment or with those in the control group after treatment （ P 〈 0.05 or P 〈 0.01 ）. Conclusion： XYND is effective in stopping the headache of patients with migraine, and worth applying in clinical practice.
文摘Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this study is to discuss our early results in endoscopic skull base surgery and the development of the learning curve. Patients and Methods: We analyzed our experience regarding 25 patients presented to us in Neurosurgery Department, Assiut University Hospital, Assiut University, Assiut, Egypt in a period of 3 years (2015, 2016, 2017) and operated by endoscopic transnasal approach. All patients signed an informed consent. Results: With the highest percentage was pituitary adenoma 56%, pituitary apoplexy 12%, craniopharyngioma 12%, CSF rhinorrhea 12%, Planum sphenoidal meningioma 4% and suprasellar granuloma 4%. 88% of patients were operated without complications, 8% mortality rate postoperative, 12% complication rate and 76% complete improvement postoperative. Conclusion: Endoscopic skull base surgery is a safe approach to the skull base that needs a good experience, practice and good anatomical knowledge. Teamwork between a Neurosurgeon and ENT surgeon is a must for patient safety.
文摘NFMAs are benign tumors that do not produce any biologically active hormones and exceed 10 mm (0.39 in) in size. Although NFMAs are benign in origin, mass effects may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The authors describe a 51-year-old woman who had a NFMA (35 × 24 × 25 mm). The vision was reduced to 7/10 in the both eyes. A transnasal transsphenoidal surgery was performed and the tumor was successfully resected. Postoperatively, the patient had visual (9/10) and headache improvement. This case highlights a rare presentation of non-functioning pituitary macroadenoma.
文摘Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors describe a 37-year-old man who had a pituitary adenoma associated with obstructive hydrocephalus that was managed by endoscopic transnasal transsphenoidal surgery. Postoperative CT and MRI scans showed resolution of the obstructive hydrocephalus and the foramen of Monro was open. Postoperatively, the patient had visual and headache improvement. Subsequently, the patient is a candidate for cranial surgery or medical therapy to complete the treatment. The present case highlights the fact that pituitary adenomas with obstructive hydrocephalus should be distinguished from other tumors especially colloid cysts.
文摘Endoscopic resection with transnasal craniectomy(ERTC)and skull-base reconstruction(SBR)are effective techniques for sinonasal/skull-base malignancies treatment.Endoscopic endonasal SBR techniques are mainly based on homologuefree grafts with excellent outcomes,but alternative techniques can be used such as regional vascularized pedicled flaps or local pedicled flap-like Hadad–Bassagasteguy nasoseptal flap and the septal flip flap(SFF).The purpose of this article is to describe an inferiorly based septal flap aimed to promote mucosal healing and improve patients’quality of life.We reported a clinical case of 51-year-old female affected by olfactory neuroblastoma,Hyams-Ⅱ,Kadish-INSICA-B treated with unilateral ERTC and SBR with fascia lata,SFF,and modified reverse septal flap(mRSF).The mRSF harvesting is described in detail,to obtain a lower hinged flap with random vascularization,which can be rotated to cover the exposed bone of the nasal cavity floor.Endoscopic evaluations immediately showed rapid healing with a minimal amount of nasal crusting,despite the adjuvant treatment and the short time since the surgery.This surgical technique is a simple and viable way to boost nasal healing after endoscopic endonasal surgery and for nasal floor resurfacing after septal removal following a unilateral ERTC.
文摘Background: Neurological disorders represent a profound healthcare problem accounting for 6.3％ of the global disease burden.Alzheimer's disease alone is expected to impact over 115 million people worldwide by 2050 with a cost of over $1 trillion per year to the U.S.economy.Despite considerable advances in our understanding of the pathogenesis and natural history of neurological disorders, the development of disease modifying therapies have failed to keep pace.This lack of effective treatments is directly attributable to the presence of the blood-brain and blood-cerebrospinal fluid barriers (BBB and BCSFB) which prevent up to 98％ of all potential neuropharmaceutical agents from reaching the central nervous system (CNS).These obstacles have thereby severely limited research and development into novel therapeutic strategies for neurological disease.Current experimental methods to bypass the BBB, including pharmacologic modification and direct transcranial catheter implantation, are expensive, are associated with significant complications, and cannot be feasibly scaled up to meet the chronic needs of a large, aging patient population.Transmucosal drug delivery: An innovative method of direct CNS drug delivery using heterotopic mucosal grafts was described.This method is based on established endoscopic skull base nasoseptal flap reconstruction techniques.The model has successfully demonstrated CNS delivery of chromophore-tagged molecules 1000 times larger than those typically permitted by the BBB.Conclusions: This innovative technique represents the first described method of permanently bypassing the blood-brain barrier using purely autologous tissues.This has the potential to dramatically improve the current treatment of neurological disease by providing a safe and chronic transnasaldelivery pathway for high molecular weight neuropharmaceuticals.
文摘Objective: To report voice outcome measures after injection laryngoplasty using the transnasal or transoral flexible endoscopic technique. Methods: A retrospective review of all patients who underwent flexible endoscopic injection laryngoplasty between June 2010 and August 2016 was carried out. Only those patients who had pre- and post-injection voice outcome measures recorded were included. Voice outcome measures recorded included perceptual voice evaluation using GRBAS, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT) and closed quotient (CQ) before and after treat-ment. Results: Forty-six patients were identified, of which 32 had pre- and post-injection voice outcome measures recorded. There were 19 males and 13 females. The mean age was 56.97 years (range 20—86 years) and the most common indication was unilateral vocal fold paralysis. Thirteen patients had a transnasal flexible endoscopic injection), while 19 patients were in-jected transorally. Following injection laryngoplasty, there was significant improvement in the mean grade of dysphonia (2.81 vs. 1.22, P < 0.01, roughness (2.44 vs. 1.34, P < 0.01), breathiness (2.72 vs. 1.13, P < 0.01), asthenia (2.78 vs. 1.06, P < 0.01), and strain (2.44 vs. 1.19, P < 0.01), MPT (3.85 s vs. 9.85 s, P < 0.01) and mean CQ (0.19 vs. 0.46, P < 0.01). There was also a decrease in the mean VHI-10 score (33.31 vs. 7.94, P < 0.01). Conclusion: s: Patients achieved significant improvement in both subjective and objective voice measures after flexible endoscopic injection laryngoplasty via the nasal or transoral route. Voice outcomes were comparable to those reported for other approaches. This tech-nique provides an alternative approach for the management of patients with vocal fold paral-ysis or glottal insufficiency.
