Objective: This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation (ESLBD) with those of endoscopic sphincterotomy (EST) alone for large bile duct stones. Methods: We compared prospectively ESLBD group (n=63) with conventional EST group (n=69) for the treatment of large bile duct stones (≥15mm). Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones. Results: A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session (80.9 vs. 60.8%; P = 0.046), the use of mechanical lithotripsy (7.94 vs. 24.6%; P = 0.041), and less duration of admission (P =0.045). After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration. Conclusion: The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications.
Objective:Complications are important determining factors for safety of endoscopic submucosal dissection (ESD). ESD of large lesions is associated with increased procedural time. This study investigated whether double-channel gastroscope could be used to reduce procedural time in gastric antrum ESD.Methods:A retrospective cohort study of 46 patients with one gastric antrum lesion resected by ESD was conducted between January 2013 and December 2015. The diameter of a lesion was from 2cm to 4cm in 46 patients. EUS before ESD was used to evaluate the submucosal vascular structure and the location of lesion in gastric wall. Forty six lesions had ESD with either the ordinary gastroscope (OS group) (n=24) or the double-channel gastroscope (DC group) (n=22).Results:The mean procedural time was significantly lower in the DC group than in the OS group (49.1 minutes vs. 20.5 minutes, p=0.04). There were no significant differences in submucosal injection frequency, specimen size, en bloc resection rate and perforation rate between the two endoscopic groups. There was no recurrence in any case during the follow-up period.Conclusions:Our data suggest that ESD utilizing double-channel gastroscope may provide a better platform for quicker ESD with equal safety.
Objective: The aim of this study was to evaluate the detection rate accuracy of Double-balloon Enteroscopy (DBE) after Capsule Endoscopy (CE) in patients with suspected small bowel diseases. Methodology: From January 2009 to March 2012, sixty-two patients with obscure small bowel diseases who underwent CE followed by DBE were included in this study. Introduction of the endoscope by DBE was either orally or anally according to CE. Results: Sixty-two patients are reported. The overall detection rate of small bowel diseases using CE was 70.9% (44/62). Sixty-eight DBE procedures following capsule endoscopy were carried out, There was no significant difference (χ2=0.6739, P>0.05) of Positive findings between CE and CE +DBE. Furthermore, the detection rate of small bowel diseases in patients with obscure small intestinal bleeding using CE +DBE (90.9%, 30/33) was superior to that of CE (78.8%, 26/33); χ2=1.8857, P>0.05. Conclusions: Capsule Endoscopy (CE) can cover the whole GI tract and provide the selection of the route of Double-balloon enteroscopy (DBE). DBE can also serve as a good complementary approach after an initial imaging using CE. It can verify the findings of CE and provide therapeutic intervention. Using of CE followed by DBE is effective in the diagnosis and management of patients with obscure small bowel diseases.
Background/Aims:Complications are important determining factors for safety of endoscopic submucosal dissection (ESD) for gastric heterotopic pancreas (HP). This study investigated whether endoscopic color Doppler ultrasonography (ECDUS) could be used to predict the feasibility, efficacy, and safety of ESD.Patients and Methods:The study included 52 patients with heterotopic pancreas of the gastric antrum who underwent ECDUS before ESD. ECDUS was used to evaluate the submucosal vascular structure and the location of HP in gastric wall. The patients who had a vessel at least 500 μm in diameter or at least 10 vascular structures per field of view were classified into the rich group (Group R), and others were classified into the non-rich group (Group N). Procedure time, decrease in hemoglobin, frequency of clip use, complications, recurrence rate, and others were retrospectively evaluated.Results:There were 18 patients in Group R and 34 patients in Group N. Mean procedure time was significantly longer in group R (55.4 min) than in group N (35.5 min) (P = 0.014). The incidence of muscle injury and clip use were significantly higher in group R (77.8/83.3%) than in group N (20.6/23.5%) (P < 0.05). Mean decrease in hemoglobin was 2.5 g/dL in group R and 2.4 g/dL in group N, with no significant difference. There were no recurrences in any cases during the follow-up period.Conclusion:Preoperative identification of submucosal vascular structure by ECDUS can predict procedure time and the incidence of muscle injury and clip use, which is particularly suitable for predicting ESD safety in heterotopic pancreas of stomach.
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