Zhuo Yang

A comparative study on endoscopy treatment in rectal carcinoid tumors.

Background: To investigate the advantages and disadvantages of various endoscopic resection methods for rectal carcinoid tumors. Methods: A retrospective analysis of 3 types of endoscopic resection techniques for rectal carcinoid tumors was performed. The surgical time and the complication rate were compared between 30 patients who underwent conventional endoscopic mucosal resection (EMR), cap-assisted endoscopic mucosal resection (EMR-C), or endoscopic submucosal dissection (ESD). All rectal carcinoid tumors were under 1 cm and were treated in our center between January 2002 and January 2008. Results: Ten patients underwent each surgical approach. All cases were pathologically diagnosed as rectal carcinoid tumors. One-time complete resection rates using the conventional EMR, EMR-C, and ESD were 80%, 100%, and 100%, respectively. The operation time ranged from 5 to 53 minutes for the conventional EMR group, from 4 to 7 minutes for the EMR-C group, and from 16 to 35minutes for the ESD group. The average follow-up time for the 30 patients was 18.43±9.76 months. There were no recurrent or metastatic cases. Conclusions: Endoscopic resection for rectal carcinoid tumors below 1 cm was safe. Considering the clinical efficacy, surgical time, and intraoperative complication rate, EMR-C may be the best endoscopic excision method.

Asia-Pacific consensus guidelines for endoscopic management of benign biliary strictures

Abstract Benign biliary strictures (BBSs) are commonly caused by surgical injury, chronic pancreatitis, and inflammatory cholangiopathies. Although advanced imaging tests and tissue acquisition methods have been developed for evaluation of indeterminate biliary strictures, differentiation of BBSs from biliary malignancies remains a challenge to clinicians. The majority of BBSs have good response to nonsurgical treatment and surgical intervention mainly serves as a rescue when nonsurgical approaches fail. Endoscopic management is a safe, effective, and less-invasive treatment for BBSs compared with other approaches. Endoscopic biliary stricture dilation followed by placement of multiple plastic stents has been the first-line choice with good long-term ductal patency. Recently, covered self-expanding metal stents (CSEMSs) has been increasingly used in the management of BBSs with similar effectiveness but easier deployment, fewer endoscopic sessions compared with plastic stents. Moreover, other technologies are emerging in the diagnosis and management of BBSs. To assist clinicians in managing BBSs, the Asia-Pacific ERCP Club (APEC) has developed this statement through a systematic review of the literature.

Endoscopic retrograde appendicitis therapy (ERAT) : a multicenter retrospective study in China

BackgroundEndoscopic retrograde appendicitis therapy (ERAT) is a new procedure for the treatment of acute uncomplicated appendicitis. The aim of the study was to review the clinical outcomes of ERAT and further examine its effectiveness and safety.MethodsThe study was performed on patients who underwent ERAT for acute uncomplicated appendicitis at three tertiary hospitals in China from December 2009 to May 2013. Patient demographics, technique aspects of the ERAT procedures, clinical success (resolution of symptoms and normalization of laboratory tests), time until resumption of diet, and hospital stay were analyzed, and complications and recurrence were followed up.ResultsForty-one patients were entered, among which 34 patients were definitely diagnosed as having acute uncomplicated appendicitis; in 7 patients, acute appendicitis was excluded by endoscopic retrograde appendicography. Thirty-three patients completed ERAT except one patient who failed appendiceal cannulation. Abdominal pain resolved immediately in 32 patients, and clinical success rate was 97xa0%. There was one failure case (3xa0%) that complicated perforation after 48xa0h received emergency appendectomy. The median follow-up period was 12xa0months (IQRxa0=xa09–23xa0months). During follow-up, there were no long-term complication; 2 patients (6.2xa0%) had recurrent abdominal pain and received appendectomy (one had a histologically normal appendix).ConclusionsERAT is an effective method to diagnose and treat acute uncomplicated appendicitis. Multicenter prospective clinical trials are needed to confirm its utility and place in the management of suspected acute appendicitis

Endoscopic diagnosis and treatment of esophageal cavernous lymphangioma.

The purpose of this paper is to identify the characteristic endoscopic findings in patients with esophageal cavernous lymphangioma and assess the efficacy of endoscopic techniques in the management of this disease. We retrospectively analyzed data from 6 patients who were diagnosed with esophageal cavernous lymphangioma by endoscopy and histologic evaluation. All patients underwent endoscopic resection of the tumor at our hospital between January 2010 and June 2011. Four male and 2 female patients, with a mean age of 48.2±15.2 years (range, 35 to 77 y) with esophageal cavernous lymphangioma, who underwent endoscopy followed by endoscopic resection were included in this report. The lesions varied from 0.4 to 1.2 cm in diameter, with a mean size of 0.78±0.26 cm. Endoscopy revealed dilated lymphatic channels beneath the surface epithelium of the lesion in all patients. An endoscopic ultrasound revealed that all lesions were multicystic and located in the submucosal layer. Histologic examination confirmed the initial diagnosis in all patients. Endoscopy plays an important role in the diagnosis of esophageal cavernous lymphangioma, with dilated lymphatic channels beneath the surface epithelium of the lesion being a characteristic endoscopic feature. Endoscopic ultrasonography is a useful tool to differentiate cavernous lymphangioma from other esophageal tumors. Endoscopic resection of esophageal cavernous lymphangioma was safe and effective in all of the analyzed cases.

Use of a mechanical lithotripter to aid in the removal of an impacted razor blade in the esophagus

1. Gupta V, Anupam Lal A, Sinha SK, et al. Leiomyomatosis of the esophagus: experience over a decade. J Gastrointest Surg 2009;13:206-11. 2. Lee LS, Nance M, Kaiser LR, et al. Familial massive leiomyoma with esophageal leiomyomatosis: an unusual presentation in a father and his 2 Figure 2. High-resolution manometry demonstrating isobaric esophagea incomplete relaxation to liquid swallow. Impedance demonstrates conti