Endoscopic polypectomy(EP)is the preferred method for the treatment of rectal polyps because of its micro-trauma and rapid recovery.However,the incidence of postoperative abdominal distension can reach 15–30%.This co...Endoscopic polypectomy(EP)is the preferred method for the treatment of rectal polyps because of its micro-trauma and rapid recovery.However,the incidence of postoperative abdominal distension can reach 15–30%.This common complication seriously affects the quality of life of patients after surgery,prolongs the length of hospital stay,and may even be complicated by perforation and other problems.This article systematically reviews the latest research progress on the mechanism,related influencing factors and targeted nursing interventions of abdominal distension after EP,so as to explore effective interventions for postoperative comprehensive nursing,which has core value for improving the postoperative experience and prognosis of EP patients.展开更多
BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical...BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.AIM To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques,namely,high-frequency electroresection(HFE),cold snare polypectomy(CSP),and endoscopic mucosal resection(EMR),for the treatment of colonic polyps.METHODS This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023.Patients were grouped by technique:HFE(n=107),CSP(n=106),and EMR(n=108).Standardized preoperative,intraoperative,and postoperative protocols were applied.Outcome measures included resection status(en bloc,R0,R1,and Rx),adverse events(immediate/delayed bleeding,perforation,and post-polypectomy coagulation syndrome),postoperative pain(visual analog scale at 1,3,and 5 hours),and 12-month recurrence rate.RESULTS Baseline demographics and polyp characteristics,except for polyp diameter,were comparable among groups.CSP achieved the highest en bloc resection rate,whereas HFE had a higher R0 resection rate.Polyp diameter was largest in the EMR group.Procedure duration was shortest with HFE.Adverse reactions were more frequent with HFE,particularly post-polypectomy bleeding and delayed perforation,whereas CSP demonstrated a superior safety profile and the lowest incidence of complications.Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR.Recurrence rates were significantly higher in the EMR group vs CSP group,with HFE showing intermediate recurrence.CONCLUSION CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps,whereas HFE confers a high R0 resection rate but increased risk of adverse events.EMR remains essential for large polyps despite elevated recurrence.Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.展开更多
Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superf icial esop...Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superf icial esophageal carcinosarcoma. Here, we report a 61-year-old male who was diagnosed as esophageal carcinosarcoma and underwent endoscopic polypectomy with well tolerance and favorable prognosis. We also present a brief review of the literature.展开更多
Type I gastric cardnoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She h...Type I gastric cardnoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She had no gastrointestinal symptoms. Endoscopic examination ot the upper gastrointestinal tract revealed atrophic gastritis and a polypoid lesion in the corpus of 3-4 mm in size. Endoscopic polypectomy was performed. Histopathological examination of the specimen revealed positive chromogranin A and synaptophysin stainings compatible with the diagnosis of a carcinoid tumor. Serum gastrin level was increased, urinary 5-hydroxyindoleacetic acid was within the normal range. There was no other symptom, sign, or laboratory finding of a carcinoid syndrome in the patient. No metastasis was found with indium-ill octreotide scan, computed tomographies of abdomen and thorax. Type I gastric carcinoid tumors are only rarely solitary and patients with tumors 〈 1 cm in size may benefit from endoscopic polypectomy.展开更多
The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a ...The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp （IMGP）. Lobulated-type IMGP in the ascending colon is rare.展开更多
Endoscopic polypectomy using high frequency voltage is contraindicated in patients with cardiac pacemakers. Recently, highly advanced pacemakers have enabled us to perform endoscopic polypectomy on these patients by t...Endoscopic polypectomy using high frequency voltage is contraindicated in patients with cardiac pacemakers. Recently, highly advanced pacemakers have enabled us to perform endoscopic polypectomy on these patients by taking appropriate cautions. We successfully removed 10 colonic polyps and one gastric polyp in patients with pacemakers by endoscopic polypectomy. No complication and dysfunction of the pacemaker occurred before, during or after the polypectomy.展开更多
Objective: To investigate the effect of oral glucose combined with short-term intravenous nutrition on the prevention of hypoglycemia after endoscopic colorectal polypectomy and to provide guidance for better manageme...Objective: To investigate the effect of oral glucose combined with short-term intravenous nutrition on the prevention of hypoglycemia after endoscopic colorectal polypectomy and to provide guidance for better management of such patients. Methods: 860 patients who underwent endoscopic colorectal polypectomy for colorectal polyps in the Department of Gastroenterology of the First Affiliated Hospital of Yangtze University from January 2020 to December 2021 were selected for the study. The patients were divided into experimental and control groups according to the random number table method, with 430 patients in each group. In the control group, 3 L of polyethylene glycol electrolyte dispersion was used for preoperative intestinal preparation and postoperative fasting was performed routinely for 24 h. Short-term intravenous nutrition support was provided by rehydration, and finger blood glucose was monitored at 1, 4, and 8 h after intravenous infusion or when there were symptoms such as panic and cold sweat;in the experimental group, oral glucose intervention was implemented on the basis of the control group. The incidence of postoperative hypoglycemia, quality of bowel preparation, and tolerance of patients during bowel preparation were compared between the 2 groups. Results: The incidence of postoperative blood glucose Conclusion: Based on the present study population, oral glucose combined with short-term intravenous nutrition can effectively prevent the incidence of hypoglycemia in patients after endoscopic colorectal polypectomy;however, this was limited to a single-center study and the number of cases was small.展开更多
BACKGROUND The incidence of gastric polyps(GPs)has ranged from 0.30%to 6.8%in various studies.Most GPs include hyperplastic polyps(HPs),fundic gland polyps(FGPs),and adenomatous polyps(APs).Although APs have a high ma...BACKGROUND The incidence of gastric polyps(GPs)has ranged from 0.30%to 6.8%in various studies.Most GPs include hyperplastic polyps(HPs),fundic gland polyps(FGPs),and adenomatous polyps(APs).Although APs have a high malignant potential,HPs have a low risk of potential harm,whereas sporadic FGPs have no malignant potential.It is not enough to determine the type and displacement of a polyp by biopsy alone;therefore,some polyps may require an extensive biopsy or complete resection.AIM To evaluate the detection rate and pathological features of polyps in patients undergoing upper gastrointestinal endoscopy.METHODS This retrospective study included patients with GPs or polyphenic lesions with polyps or malignant histology found in polyps or by gastroscopy at the Department of Gastroenterology at the Shaanxi Provincial Hospital of Traditional Chinese Medicine from 2019 to 2023.RESULTS In a series of 10000 patients who underwent upper gastrointestinal endoscopy,384(3.84%)had GPs.There were 98 males(25.5%)and 286 females(74.5%).The mean age of patients was 62.8±10.4(36-75)years.The frequencies of HPs,APs,and FGPs were 88.5%,5.2%,and 2.1%,respectively.The polyp size of 274 patients(71.3%)was≤1 cm.Polyps were found in 262 cases(68.2%).The most common sites for polyps were the lumen and body of the intestine.Endoscopic polypectomy was performed in 128 patients.Bleeding events were observed and endoscopic treatment was required after endoscopic polypectomy.CONCLUSION The incidence of GPs was low.HPs were the most common types of GPs.Of note,as GPs have the potential to develop into adenocarcinoma or precancerous lesions,we suggest that appropriate GP resection technology(e.g.,biopsy forceps or mesenchymal resection)be applied.展开更多
A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duode...A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duodenum causing intermittent gastric outlet obstruction. While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp.展开更多
Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical diffi...Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.展开更多
A primary clear cell adenocarcinoma of the colon is a rare oncologic entity. We herein report a case of such a tumor of the sigmoid colon in a 71-year-old woman who was successfully treated by an endoscopic polypectom...A primary clear cell adenocarcinoma of the colon is a rare oncologic entity. We herein report a case of such a tumor of the sigmoid colon in a 71-year-old woman who was successfully treated by an endoscopic polypectomy in our hospital. We also reviewed the published reports regarding cases of primary clear cell tumors in the colon.展开更多
A case of pedunculated Brunner＇s gland hamartoma （BGH） of the duodenum causing upper gastrointestinal （GI） hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation...A case of pedunculated Brunner＇s gland hamartoma （BGH） of the duodenum causing upper gastrointestinal （GI） hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath. Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding, about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several Iobules of mature Brunner＇s gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.展开更多
A case of inflammatory myoglandular polyp (IMGP) causing hematochezia is reported. The patient was a 33-year-old man who visited our hospital for further evaluation of hematochezia. Colonoscopy revealed a red, hard, s...A case of inflammatory myoglandular polyp (IMGP) causing hematochezia is reported. The patient was a 33-year-old man who visited our hospital for further evaluation of hematochezia. Colonoscopy revealed a red, hard, spherical peduncular polyp with erosion and mucous exudation, about 20 mm in diameter, in the descending colon. Excluding the polyp, there was no lesion in the colorectum. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic changes. This polyp was diagnosed as an IMGP. The symptom of hematochezia was resolved after endoscopic resection. Our case shows that treatment is necessary for IMGP if intestinal bleeding occurs and endoscopists should be aware of the endoscopic characteristics of IMGP.展开更多
Background:Flat and depressed lesions are becoming increasingly recognized in the esophagus,stomach,and colon.Various techniques have been described for endoscopic mucosal resection(EMR)of these lesions.Aims:To evalua...Background:Flat and depressed lesions are becoming increasingly recognized in the esophagus,stomach,and colon.Various techniques have been described for endoscopic mucosal resection(EMR)of these lesions.Aims:To evaluate the efficacy of lift-grasp-cut EMR using a prototype dual-channel forward-viewing endoscope with an instrument elevator in one accessory channel(dual-channel elevator scope)as compared to standard dual-channel endoscopes.Methods:EMR was performed using a lift-grasp-cut technique on normal flat rectosigmoid or gastric mucosa in live porcine models after submucosal injection of 4mL of saline using a dual-channel elevator scope or a standard dual-channel endoscope.With the dual-channel elevator scope,the elevator was used to attain further lifting of the mucosa.The primary endpoint was size of the EMR specimen and the secondary endpoint was number of complications.Results:Twelve experiments were performed(six gastric and six colonic).Mean specimen diameter was 2.27 cm with the dual-channel elevator scope and 1.34 cm with the dual-channel endoscope(P=0.018).Two colonic perforations occurred with the dual-channel endoscope,vs no complications with the dual-channel elevator scope.Conclusions:The increased lift of the mucosal epithelium,through use of the dual-channel elevator scope,allows for larger EMR when using a lift-grasp-cut technique.Noting the thin nature of the porcine colonic wall,use of the elevator may also make this technique safer.展开更多
文摘Endoscopic polypectomy(EP)is the preferred method for the treatment of rectal polyps because of its micro-trauma and rapid recovery.However,the incidence of postoperative abdominal distension can reach 15–30%.This common complication seriously affects the quality of life of patients after surgery,prolongs the length of hospital stay,and may even be complicated by perforation and other problems.This article systematically reviews the latest research progress on the mechanism,related influencing factors and targeted nursing interventions of abdominal distension after EP,so as to explore effective interventions for postoperative comprehensive nursing,which has core value for improving the postoperative experience and prognosis of EP patients.
文摘BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.AIM To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques,namely,high-frequency electroresection(HFE),cold snare polypectomy(CSP),and endoscopic mucosal resection(EMR),for the treatment of colonic polyps.METHODS This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023.Patients were grouped by technique:HFE(n=107),CSP(n=106),and EMR(n=108).Standardized preoperative,intraoperative,and postoperative protocols were applied.Outcome measures included resection status(en bloc,R0,R1,and Rx),adverse events(immediate/delayed bleeding,perforation,and post-polypectomy coagulation syndrome),postoperative pain(visual analog scale at 1,3,and 5 hours),and 12-month recurrence rate.RESULTS Baseline demographics and polyp characteristics,except for polyp diameter,were comparable among groups.CSP achieved the highest en bloc resection rate,whereas HFE had a higher R0 resection rate.Polyp diameter was largest in the EMR group.Procedure duration was shortest with HFE.Adverse reactions were more frequent with HFE,particularly post-polypectomy bleeding and delayed perforation,whereas CSP demonstrated a superior safety profile and the lowest incidence of complications.Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR.Recurrence rates were significantly higher in the EMR group vs CSP group,with HFE showing intermediate recurrence.CONCLUSION CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps,whereas HFE confers a high R0 resection rate but increased risk of adverse events.EMR remains essential for large polyps despite elevated recurrence.Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.
文摘Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superf icial esophageal carcinosarcoma. Here, we report a 61-year-old male who was diagnosed as esophageal carcinosarcoma and underwent endoscopic polypectomy with well tolerance and favorable prognosis. We also present a brief review of the literature.
文摘Type I gastric cardnoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She had no gastrointestinal symptoms. Endoscopic examination ot the upper gastrointestinal tract revealed atrophic gastritis and a polypoid lesion in the corpus of 3-4 mm in size. Endoscopic polypectomy was performed. Histopathological examination of the specimen revealed positive chromogranin A and synaptophysin stainings compatible with the diagnosis of a carcinoid tumor. Serum gastrin level was increased, urinary 5-hydroxyindoleacetic acid was within the normal range. There was no other symptom, sign, or laboratory finding of a carcinoid syndrome in the patient. No metastasis was found with indium-ill octreotide scan, computed tomographies of abdomen and thorax. Type I gastric carcinoid tumors are only rarely solitary and patients with tumors 〈 1 cm in size may benefit from endoscopic polypectomy.
文摘The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp （IMGP）. Lobulated-type IMGP in the ascending colon is rare.
文摘Endoscopic polypectomy using high frequency voltage is contraindicated in patients with cardiac pacemakers. Recently, highly advanced pacemakers have enabled us to perform endoscopic polypectomy on these patients by taking appropriate cautions. We successfully removed 10 colonic polyps and one gastric polyp in patients with pacemakers by endoscopic polypectomy. No complication and dysfunction of the pacemaker occurred before, during or after the polypectomy.
文摘Objective: To investigate the effect of oral glucose combined with short-term intravenous nutrition on the prevention of hypoglycemia after endoscopic colorectal polypectomy and to provide guidance for better management of such patients. Methods: 860 patients who underwent endoscopic colorectal polypectomy for colorectal polyps in the Department of Gastroenterology of the First Affiliated Hospital of Yangtze University from January 2020 to December 2021 were selected for the study. The patients were divided into experimental and control groups according to the random number table method, with 430 patients in each group. In the control group, 3 L of polyethylene glycol electrolyte dispersion was used for preoperative intestinal preparation and postoperative fasting was performed routinely for 24 h. Short-term intravenous nutrition support was provided by rehydration, and finger blood glucose was monitored at 1, 4, and 8 h after intravenous infusion or when there were symptoms such as panic and cold sweat;in the experimental group, oral glucose intervention was implemented on the basis of the control group. The incidence of postoperative hypoglycemia, quality of bowel preparation, and tolerance of patients during bowel preparation were compared between the 2 groups. Results: The incidence of postoperative blood glucose Conclusion: Based on the present study population, oral glucose combined with short-term intravenous nutrition can effectively prevent the incidence of hypoglycemia in patients after endoscopic colorectal polypectomy;however, this was limited to a single-center study and the number of cases was small.
基金Supported by the Shaanxi Province Traditional Chinese Medicine Research and Innovation Talent Plan Project,No.TZKN-CXRC-16Project of Shaanxi Administration of Traditional Chinese Medicine,No.SZYKJCYC-2025-JC-010+2 种基金Shaanxi Province Outstanding TCM Talents Training Project Training Object in 2025Xi’an Science and Technology Plan Project,No.23YXYJ0162Shaanxi Province Key Research and Development Plan Project-Social Development Field,No.S2025-YF-YBSF-0391.
文摘BACKGROUND The incidence of gastric polyps(GPs)has ranged from 0.30%to 6.8%in various studies.Most GPs include hyperplastic polyps(HPs),fundic gland polyps(FGPs),and adenomatous polyps(APs).Although APs have a high malignant potential,HPs have a low risk of potential harm,whereas sporadic FGPs have no malignant potential.It is not enough to determine the type and displacement of a polyp by biopsy alone;therefore,some polyps may require an extensive biopsy or complete resection.AIM To evaluate the detection rate and pathological features of polyps in patients undergoing upper gastrointestinal endoscopy.METHODS This retrospective study included patients with GPs or polyphenic lesions with polyps or malignant histology found in polyps or by gastroscopy at the Department of Gastroenterology at the Shaanxi Provincial Hospital of Traditional Chinese Medicine from 2019 to 2023.RESULTS In a series of 10000 patients who underwent upper gastrointestinal endoscopy,384(3.84%)had GPs.There were 98 males(25.5%)and 286 females(74.5%).The mean age of patients was 62.8±10.4(36-75)years.The frequencies of HPs,APs,and FGPs were 88.5%,5.2%,and 2.1%,respectively.The polyp size of 274 patients(71.3%)was≤1 cm.Polyps were found in 262 cases(68.2%).The most common sites for polyps were the lumen and body of the intestine.Endoscopic polypectomy was performed in 128 patients.Bleeding events were observed and endoscopic treatment was required after endoscopic polypectomy.CONCLUSION The incidence of GPs was low.HPs were the most common types of GPs.Of note,as GPs have the potential to develop into adenocarcinoma or precancerous lesions,we suggest that appropriate GP resection technology(e.g.,biopsy forceps or mesenchymal resection)be applied.
文摘A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duodenum causing intermittent gastric outlet obstruction. While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp.
文摘Endoscopic submucosal dissection(ESD)is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation)have limited their use worldwide.The grasping-type scissors forceps[clutch cutter(CC)]is the first forceps-type resection device developed with reference to hemostatic forceps.The aim was to allow easy and safe ESD throughout the gastro-intestinal tract,as a biopsy technique,using one device.The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue,for safe and effective incision and hemostasis during ESD.Reported clinical studies showed that ESD using the CC(ESD-CC)is a safe(perforation rate:0%-3.6%;delayed bleeding rate:0%-4.2%),technically efficient(en-bloc resection rate:88.9%-100%),and single-device method for dissecting early-stage gastrointestinal tract tumors.The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp,pull,and coagulate and/or incise actions using an electrosurgical current.The reported self-completion rate by nonexperts was significantly better with the CC than with conventional knives(61.7%vs 24.5%,respectively;P<0.001).Furthermore,the CC is used for other endoscopic therapies,such as endoscopic polypectomy for large pedunculated polyps,endoscopic myotomy for Zenker’s diverticulum,endoscopic treatment of buried bumper syndrome,and endoscopic necrosectomy for wall-off pancreatic necrosis.The initial reports using CC for these therapies have shown favorable results.In this review,we describe the structural features of the CC,how to use the instrument,efficacies of ESD-CC,and other unique endoscopic therapies using the CC.
文摘A primary clear cell adenocarcinoma of the colon is a rare oncologic entity. We herein report a case of such a tumor of the sigmoid colon in a 71-year-old woman who was successfully treated by an endoscopic polypectomy in our hospital. We also reviewed the published reports regarding cases of primary clear cell tumors in the colon.
文摘A case of pedunculated Brunner＇s gland hamartoma （BGH） of the duodenum causing upper gastrointestinal （GI） hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath. Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding, about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several Iobules of mature Brunner＇s gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.
文摘A case of inflammatory myoglandular polyp (IMGP) causing hematochezia is reported. The patient was a 33-year-old man who visited our hospital for further evaluation of hematochezia. Colonoscopy revealed a red, hard, spherical peduncular polyp with erosion and mucous exudation, about 20 mm in diameter, in the descending colon. Excluding the polyp, there was no lesion in the colorectum. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic changes. This polyp was diagnosed as an IMGP. The symptom of hematochezia was resolved after endoscopic resection. Our case shows that treatment is necessary for IMGP if intestinal bleeding occurs and endoscopists should be aware of the endoscopic characteristics of IMGP.
基金Amitabh Chak received research support from Olympus America,supported by NIH Grant DK02800.
文摘Background:Flat and depressed lesions are becoming increasingly recognized in the esophagus,stomach,and colon.Various techniques have been described for endoscopic mucosal resection(EMR)of these lesions.Aims:To evaluate the efficacy of lift-grasp-cut EMR using a prototype dual-channel forward-viewing endoscope with an instrument elevator in one accessory channel(dual-channel elevator scope)as compared to standard dual-channel endoscopes.Methods:EMR was performed using a lift-grasp-cut technique on normal flat rectosigmoid or gastric mucosa in live porcine models after submucosal injection of 4mL of saline using a dual-channel elevator scope or a standard dual-channel endoscope.With the dual-channel elevator scope,the elevator was used to attain further lifting of the mucosa.The primary endpoint was size of the EMR specimen and the secondary endpoint was number of complications.Results:Twelve experiments were performed(six gastric and six colonic).Mean specimen diameter was 2.27 cm with the dual-channel elevator scope and 1.34 cm with the dual-channel endoscope(P=0.018).Two colonic perforations occurred with the dual-channel endoscope,vs no complications with the dual-channel elevator scope.Conclusions:The increased lift of the mucosal epithelium,through use of the dual-channel elevator scope,allows for larger EMR when using a lift-grasp-cut technique.Noting the thin nature of the porcine colonic wall,use of the elevator may also make this technique safer.
