AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcin...AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma. METHODS: In 70 patients with historically proven non neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion. RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P= 0.0004). CONCLUSION: The long-term relapse rate of non neoplastic BE following complete ablation with high-power APC is low (3% per year).展开更多
AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esop...AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal adenocarcinoma.METHODS: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively analyzed.RESULTS: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo later.CONCLUSION: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.展开更多
Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rect...Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insuff icient. There are very few controlled or prospective trials,and comparisons between therapies are limited because of different evaluation methods. Medical treatments,including formalin,topical sucralfate,5-amino salicylic acid enemas,and short chain fatty acids have been used with limited success.Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe,neodymium:yttrium-aluminium-garnet laser,potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benef it,but with frequent complications.Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its eff icacy and safety profile.Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application,with lower rate of complications.This review will focus on endoscopic ablation therapies,including such newer modalities,for chronic radiation proctitis.展开更多
针对平行平板型大气压氩气介质阻挡放电(DBD),考虑等离子体中电子能量的贡献,建立了一维多粒子流体模型。通过对模型的求解,详细分析了频率为10 k Hz、幅值为1.5k V正弦电压驱动放电的变化过程,包括放电等离子体中各特性参数,如电子数...针对平行平板型大气压氩气介质阻挡放电(DBD),考虑等离子体中电子能量的贡献,建立了一维多粒子流体模型。通过对模型的求解,详细分析了频率为10 k Hz、幅值为1.5k V正弦电压驱动放电的变化过程,包括放电等离子体中各特性参数,如电子数密度、亚稳态氩原子数密度、放电间隙电位和电子温度等的时空变化过程。结果发现:放电模式从Townsend放电转变为稳定的辉光放电,在辉光放电阶段,放电间隙存在明显的阴极位降区、阴极辉区、Faraday暗区和正柱区等特征区域,且电子能量在不同的放电阶段有着不同的能量损失渠道。与此同时,探讨了固定驱动频率为10 k Hz,不同电压幅值的情况下,放电等离子体的粒子特性参数及放电模式。结果表明:电压从1.5 k V提高到3.5 k V时,最高电子温度、电子数密度、正离子数密度和亚稳态氩原子数密度均有所提高;简单分析了2.5 k V电压,不同频率下的电流波形和各种粒子在电流脉冲峰值处的空间分布,发现50 k Hz和100 k Hz的情况下,放电间隙阳极出现了阳极辉区;第一个电流脉冲峰值时刻,放电正柱区覆盖了Faraday暗区,而第二个宽电流脉冲时刻,法拉第暗区又重新出现。展开更多
为了描述微空心阴极内等离子体放电特性,采用二维流体模型对氩气微空心阴极放电进行了数值模拟。在工作气压4 42×10~4×10 Pa,放电电流1.0~2.5 m A范围内,微空心阴极内氩气放电处于正常辉光放电区域,计算获得的微空心阴极伏安...为了描述微空心阴极内等离子体放电特性,采用二维流体模型对氩气微空心阴极放电进行了数值模拟。在工作气压4 42×10~4×10 Pa,放电电流1.0~2.5 m A范围内,微空心阴极内氩气放电处于正常辉光放电区域,计算获得的微空心阴极伏安特性及各种组分数密度与文献报道结果符合良好。数值模拟结果表明,在典型计算工况条件下,微空心阴极环形鞘层内电子温度可达20 e V;气体温度可高出室温几百K,说明微空心阴极内等离子体放电具有明显的气体加热效应。通过对体系内的化学动力学过程分析发现,在不同的区域内,Ar＋的产生机理不同。在阴极孔鞘层区内,高能电子直接电离基态原子占主导;在阴极孔中心处,电子冲击激发态电离占主导;在阴极孔外的放电区域中心轴线上,Ar＋的产生来自电子冲击激发态电离、Penning电离和电子直接冲击基态原子电离共同贡献。展开更多
BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for ...BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.展开更多
文摘AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma. METHODS: In 70 patients with historically proven non neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion. RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P= 0.0004). CONCLUSION: The long-term relapse rate of non neoplastic BE following complete ablation with high-power APC is low (3% per year).
文摘AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal adenocarcinoma.METHODS: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively analyzed.RESULTS: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo later.CONCLUSION: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.
文摘Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insuff icient. There are very few controlled or prospective trials,and comparisons between therapies are limited because of different evaluation methods. Medical treatments,including formalin,topical sucralfate,5-amino salicylic acid enemas,and short chain fatty acids have been used with limited success.Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe,neodymium:yttrium-aluminium-garnet laser,potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benef it,but with frequent complications.Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its eff icacy and safety profile.Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application,with lower rate of complications.This review will focus on endoscopic ablation therapies,including such newer modalities,for chronic radiation proctitis.
文摘针对平行平板型大气压氩气介质阻挡放电(DBD),考虑等离子体中电子能量的贡献,建立了一维多粒子流体模型。通过对模型的求解,详细分析了频率为10 k Hz、幅值为1.5k V正弦电压驱动放电的变化过程,包括放电等离子体中各特性参数,如电子数密度、亚稳态氩原子数密度、放电间隙电位和电子温度等的时空变化过程。结果发现:放电模式从Townsend放电转变为稳定的辉光放电,在辉光放电阶段,放电间隙存在明显的阴极位降区、阴极辉区、Faraday暗区和正柱区等特征区域,且电子能量在不同的放电阶段有着不同的能量损失渠道。与此同时,探讨了固定驱动频率为10 k Hz,不同电压幅值的情况下,放电等离子体的粒子特性参数及放电模式。结果表明:电压从1.5 k V提高到3.5 k V时,最高电子温度、电子数密度、正离子数密度和亚稳态氩原子数密度均有所提高;简单分析了2.5 k V电压,不同频率下的电流波形和各种粒子在电流脉冲峰值处的空间分布,发现50 k Hz和100 k Hz的情况下,放电间隙阳极出现了阳极辉区;第一个电流脉冲峰值时刻,放电正柱区覆盖了Faraday暗区,而第二个宽电流脉冲时刻,法拉第暗区又重新出现。
文摘为了描述微空心阴极内等离子体放电特性,采用二维流体模型对氩气微空心阴极放电进行了数值模拟。在工作气压4 42×10~4×10 Pa,放电电流1.0~2.5 m A范围内,微空心阴极内氩气放电处于正常辉光放电区域,计算获得的微空心阴极伏安特性及各种组分数密度与文献报道结果符合良好。数值模拟结果表明,在典型计算工况条件下,微空心阴极环形鞘层内电子温度可达20 e V;气体温度可高出室温几百K,说明微空心阴极内等离子体放电具有明显的气体加热效应。通过对体系内的化学动力学过程分析发现,在不同的区域内,Ar＋的产生机理不同。在阴极孔鞘层区内,高能电子直接电离基态原子占主导;在阴极孔中心处,电子冲击激发态电离占主导;在阴极孔外的放电区域中心轴线上,Ar＋的产生来自电子冲击激发态电离、Penning电离和电子直接冲击基态原子电离共同贡献。
文摘BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.
