Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, t...Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.展开更多
BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the cli...BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.展开更多
Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometr...Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.展开更多
This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study...This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.展开更多
BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisit...BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome.展开更多
BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is c...BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.展开更多
We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to perman...We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.展开更多
Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of ...Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.展开更多
Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in u...Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in urinary control and the change in demand force.Method:In this study,five sheep bladders were used to design and build a biomechanical evaluation system.The biomechanical system included the bladder,pressure gauge,pressure regulator system of the bladder,and force application system by the cuff.In this study,we increased the fluid pressure inside the bladder from 0 cmH_(2)O to 200 cmH_(2)O(1 cmH_(2)O=0.098 kPa),and at each point,the force applied by the cuff to prevent fluid leakage was measured and recorded.Results:The study revealed that a mean tensile force of 2.81(standard deviation 0.23)N for a single cuff and 1.63(standard deviation 0.16)N for double cuffs with symmetrical pressure effectively prevented bladder fluid leakage in the pressure range from 75 cmH_(2)O to 100 cmH_(2)O(p<0.001).However,there were no significant differences in results when comparing the applied tensile force required by double cuffs with asymmetric tensile force to that of the single cuff use.Furthermore,using three cuffs instead of two did not yield significantly different outcomes.Conclusion:Using double cuffs with symmetrical pressure had a greater effect compared with a single cuff with the same tensile force.Although multiple cuffs with varying tensile forces were not found to be useful in controlling urine leakage in this study,it is suggested that applying variable forces alternately and rotationally among several cuffs may reduce long-term risks such as atrophy and necrosis.Future in vivo studies are recommended to further evaluate efficiency.展开更多
We read the article by Liu et al.[1]entitled“Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low r...We read the article by Liu et al.[1]entitled“Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low rectal cancer:a propensity scorematched cohort study.”The article is very interesting and boldly depicted.However,I noticed some areas of the article that I could not find the answers to.展开更多
Correcting a gut sphincter malfunction is a difficult problem.Because each sphincter has two opposite functions,that of closure and opening,repairing one there is a risk of damaging the other.Indeed,widening a narrow ...Correcting a gut sphincter malfunction is a difficult problem.Because each sphincter has two opposite functions,that of closure and opening,repairing one there is a risk of damaging the other.Indeed,widening a narrow sphincter,such as lower esophageal sphincter(LES)and anal sphincter,may cause gastroeso-phageal reflux and fecal incontinence,respectively,whereas narrowing a wide sphincter,may cause a difficult transit.All the corrective treatments for difficult or retrograde transit concerning LES and anal sphincter with their unwanted consequences have been analyzed and discussed.To overcome the drawbacks of sphincter surgical repairs,researchers have devised devices capable of closing and opening the gut lumen,named artificial sphincters(ASs).Their function is based on various mechanisms,e.g.,hydraulic,magnetic,mechanical etc,operating through many complicated components,such as plastic cuffs,balloons,micro-pumps,micromotors,connecting tubes and wires,electromechanical clamps,rechargeable batteries,magnetic devices,elastic bands,etc.Unfortunately,these structures may facilitate the onset of infections and induce a local fibrotic reaction,which may cause device malfunctioning,whereas the compression of the gut wall to occlude the lumen may give rise to ischemia with erosions and other lesions.Some ASs are already being used in clinical practice,despite their considerable limits,while others are still at the research stage.In view of the adverse events of the ASs mentioned above,we considered applying bioengineering methods to analyze and resolve biomechanical and biological interaction problems with the aim to conceive and build efficient and safe biomimetic ASs.展开更多
Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of conti...Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.展开更多
Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity...Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.展开更多
The treatment of rectal cancer has been improved a great deal within the last 20 years. Major progress has been made in the preoperative evaluation by introducing MRI- imaging as a basis for the further management. Ne...The treatment of rectal cancer has been improved a great deal within the last 20 years. Major progress has been made in the preoperative evaluation by introducing MRI- imaging as a basis for the further management. Neoadjuvant radiochemotherapy has been shown to be effective in downstaging of advanced tumours. The surgical technique has been improved in many respects.- Total mesorectal excision has reduced local recurrences, sphincter saving techniques such as low anterior resection and intersphincteric resection reduced the need for a permanent stoma to 10%-20%. Recently the introduction of minimal invasive techniques and the application of robotic systems have reduced the surgical trauma.展开更多
The multimodality treatment methods of rectal cancer in China are presented. Extended radical excisions are used for Dukes’ B and C cases to reduce local recurrence. These include: high ligation with clearance of pro...The multimodality treatment methods of rectal cancer in China are presented. Extended radical excisions are used for Dukes’ B and C cases to reduce local recurrence. These include: high ligation with clearance of proximal lymph nodes at origin of inferior mesenteric artery, lateral pelvic lymphadenectomy, posterior or total pelvic exenterations in selected cases; but controversy exists. Radical sphincter-saving resections are advocated to improve the quality of life. Prerequisites of sphincter-saving resection are adequate resection of bowel and mesentery distal to the lesion, depending on the macroscopic type of lesion and degree of differentiation. The decisive factor in the choice of type of operation is the length of rectal stump above levator ani after resection. Bacon’s pull through resection was modified by preservation of levator ani and dentate margin, much better functional results were obtained postoperatively. Transanal full thickness local excision is advocated for small, protuberant, mobile, well differentiated lesions below the peritoneal reflection. Pre- or postoperative adjuvant radiation therapy is sometimes used for Dukes’ B and C cases. Adjuvant 5-Fu chemotherapy is usually used intraoperatively (intraluminal) or postoperatively (intravenous). The superiority of preoperative intrarectal 5-Fu emulsionover the conventional intravenous route has been demonstrated by experimental and clinical studies, which showed much higher and lasting concentration of 5-Fu in the rectal wall tissues and mesenteric lymph nodes, and a much lower concentration of 5-Fu in bone marrow after intrarectal administration. Several surgical groups employed varying techniques of sphincteric reconstruction of perineal colostomy after abdominoperineal excision, utilizing the gracilis or gluteus maximus sling, or intussusception of the colonic stump; with favorable late results in reported cases. However, controversy exists, so strict appropriate case selection is emphasized to avoid unnecessary sacrifice of the normal anus.展开更多
AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they unde...AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.展开更多
AIM To study the relationship between pre-formation of gallstone and the kinetics and ultra-structure of sphincter of Oddi.METHODS Adult female rabbits were used anddivided into 3 groups,and fed with either normalor h...AIM To study the relationship between pre-formation of gallstone and the kinetics and ultra-structure of sphincter of Oddi.METHODS Adult female rabbits were used anddivided into 3 groups,and fed with either normalor high cholesterol diet for four or eight weeks.Each group contained eight rabbits.Themanometry of sphincter of Oddi,biliarycineradiography,gallbladder volumemeasurement and ultrastructure observationunder electron microscope were performed.RESULTS In groups Ⅰ and Ⅱ,the basalpressure in low-pressure ampulla or highpressure zone of sphincter of Oddi waselevated,the amplitude of phasic contractionwas decreased and the volume of gallbladderwere increased,with a significant difference(P【0.01)from those of control.Gallstones werefound in group Ⅱ rabbits(7/8).Undercineradiography,low-pressure ampulla showeda spasmodic status without apparent peristalticcontraction.Under electron microscope,insidethe muscular cells of sphincter of Oddi,loosening of microfilament and swelling ofplasmosomes which congregated at the top wereobserved.The amount showed no obviouschange under nitric oxide synthase(NOS)stain.CONCLUSION Twisting of the microfilamentand disarrangement of kink macula densa insidethe muscular ceils suggested that the sphincterof Oddi was under spasmodic status.Theimpaired diastolic function caused andaggravated the stasis of cystic bile.Theswelling plasmosome could be one of theimportant factors in elevating the tonic pressureof sphincter of Oddi.展开更多
AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sph...AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre-and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 （43%） patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION： Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST.展开更多
基金This work was supported by a grant from the Education Department of Liaoning Province(No.05L484).
文摘Objective： To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry. Methods： twenty five patients underwent intersphincteric resection, the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. Results： The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month, but had no significant difference one year after. On the other hand, the indexes of vectorial manometry still had significant difference one year later. The indexes after intersphincteric resection could not reach the normal level. Conclusion： The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term, although the long-term results can be accepted, it still can not reach the normal level.
文摘BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.
文摘Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.
文摘This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.
文摘BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome.
基金Supported by The National Natural Science Foundation of China,No.82460107Science and Technology Talent Support Program of Shaanxi Provincial People's Hospital,No.2021 LJ-05.
文摘BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.
文摘We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.
文摘Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.
文摘Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in urinary control and the change in demand force.Method:In this study,five sheep bladders were used to design and build a biomechanical evaluation system.The biomechanical system included the bladder,pressure gauge,pressure regulator system of the bladder,and force application system by the cuff.In this study,we increased the fluid pressure inside the bladder from 0 cmH_(2)O to 200 cmH_(2)O(1 cmH_(2)O=0.098 kPa),and at each point,the force applied by the cuff to prevent fluid leakage was measured and recorded.Results:The study revealed that a mean tensile force of 2.81(standard deviation 0.23)N for a single cuff and 1.63(standard deviation 0.16)N for double cuffs with symmetrical pressure effectively prevented bladder fluid leakage in the pressure range from 75 cmH_(2)O to 100 cmH_(2)O(p<0.001).However,there were no significant differences in results when comparing the applied tensile force required by double cuffs with asymmetric tensile force to that of the single cuff use.Furthermore,using three cuffs instead of two did not yield significantly different outcomes.Conclusion:Using double cuffs with symmetrical pressure had a greater effect compared with a single cuff with the same tensile force.Although multiple cuffs with varying tensile forces were not found to be useful in controlling urine leakage in this study,it is suggested that applying variable forces alternately and rotationally among several cuffs may reduce long-term risks such as atrophy and necrosis.Future in vivo studies are recommended to further evaluate efficiency.
文摘We read the article by Liu et al.[1]entitled“Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low rectal cancer:a propensity scorematched cohort study.”The article is very interesting and boldly depicted.However,I noticed some areas of the article that I could not find the answers to.
文摘Correcting a gut sphincter malfunction is a difficult problem.Because each sphincter has two opposite functions,that of closure and opening,repairing one there is a risk of damaging the other.Indeed,widening a narrow sphincter,such as lower esophageal sphincter(LES)and anal sphincter,may cause gastroeso-phageal reflux and fecal incontinence,respectively,whereas narrowing a wide sphincter,may cause a difficult transit.All the corrective treatments for difficult or retrograde transit concerning LES and anal sphincter with their unwanted consequences have been analyzed and discussed.To overcome the drawbacks of sphincter surgical repairs,researchers have devised devices capable of closing and opening the gut lumen,named artificial sphincters(ASs).Their function is based on various mechanisms,e.g.,hydraulic,magnetic,mechanical etc,operating through many complicated components,such as plastic cuffs,balloons,micro-pumps,micromotors,connecting tubes and wires,electromechanical clamps,rechargeable batteries,magnetic devices,elastic bands,etc.Unfortunately,these structures may facilitate the onset of infections and induce a local fibrotic reaction,which may cause device malfunctioning,whereas the compression of the gut wall to occlude the lumen may give rise to ischemia with erosions and other lesions.Some ASs are already being used in clinical practice,despite their considerable limits,while others are still at the research stage.In view of the adverse events of the ASs mentioned above,we considered applying bioengineering methods to analyze and resolve biomechanical and biological interaction problems with the aim to conceive and build efficient and safe biomimetic ASs.
文摘Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.
文摘Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.
文摘The treatment of rectal cancer has been improved a great deal within the last 20 years. Major progress has been made in the preoperative evaluation by introducing MRI- imaging as a basis for the further management. Neoadjuvant radiochemotherapy has been shown to be effective in downstaging of advanced tumours. The surgical technique has been improved in many respects.- Total mesorectal excision has reduced local recurrences, sphincter saving techniques such as low anterior resection and intersphincteric resection reduced the need for a permanent stoma to 10%-20%. Recently the introduction of minimal invasive techniques and the application of robotic systems have reduced the surgical trauma.
文摘The multimodality treatment methods of rectal cancer in China are presented. Extended radical excisions are used for Dukes’ B and C cases to reduce local recurrence. These include: high ligation with clearance of proximal lymph nodes at origin of inferior mesenteric artery, lateral pelvic lymphadenectomy, posterior or total pelvic exenterations in selected cases; but controversy exists. Radical sphincter-saving resections are advocated to improve the quality of life. Prerequisites of sphincter-saving resection are adequate resection of bowel and mesentery distal to the lesion, depending on the macroscopic type of lesion and degree of differentiation. The decisive factor in the choice of type of operation is the length of rectal stump above levator ani after resection. Bacon’s pull through resection was modified by preservation of levator ani and dentate margin, much better functional results were obtained postoperatively. Transanal full thickness local excision is advocated for small, protuberant, mobile, well differentiated lesions below the peritoneal reflection. Pre- or postoperative adjuvant radiation therapy is sometimes used for Dukes’ B and C cases. Adjuvant 5-Fu chemotherapy is usually used intraoperatively (intraluminal) or postoperatively (intravenous). The superiority of preoperative intrarectal 5-Fu emulsionover the conventional intravenous route has been demonstrated by experimental and clinical studies, which showed much higher and lasting concentration of 5-Fu in the rectal wall tissues and mesenteric lymph nodes, and a much lower concentration of 5-Fu in bone marrow after intrarectal administration. Several surgical groups employed varying techniques of sphincteric reconstruction of perineal colostomy after abdominoperineal excision, utilizing the gracilis or gluteus maximus sling, or intussusception of the colonic stump; with favorable late results in reported cases. However, controversy exists, so strict appropriate case selection is emphasized to avoid unnecessary sacrifice of the normal anus.
文摘AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.
文摘AIM To study the relationship between pre-formation of gallstone and the kinetics and ultra-structure of sphincter of Oddi.METHODS Adult female rabbits were used anddivided into 3 groups,and fed with either normalor high cholesterol diet for four or eight weeks.Each group contained eight rabbits.Themanometry of sphincter of Oddi,biliarycineradiography,gallbladder volumemeasurement and ultrastructure observationunder electron microscope were performed.RESULTS In groups Ⅰ and Ⅱ,the basalpressure in low-pressure ampulla or highpressure zone of sphincter of Oddi waselevated,the amplitude of phasic contractionwas decreased and the volume of gallbladderwere increased,with a significant difference(P【0.01)from those of control.Gallstones werefound in group Ⅱ rabbits(7/8).Undercineradiography,low-pressure ampulla showeda spasmodic status without apparent peristalticcontraction.Under electron microscope,insidethe muscular cells of sphincter of Oddi,loosening of microfilament and swelling ofplasmosomes which congregated at the top wereobserved.The amount showed no obviouschange under nitric oxide synthase(NOS)stain.CONCLUSION Twisting of the microfilamentand disarrangement of kink macula densa insidethe muscular ceils suggested that the sphincterof Oddi was under spasmodic status.Theimpaired diastolic function caused andaggravated the stasis of cystic bile.Theswelling plasmosome could be one of theimportant factors in elevating the tonic pressureof sphincter of Oddi.
文摘AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre-and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 （43%） patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION： Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST.
