AIM: To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery(NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop ...AIM: To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery(NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop matched with a pair of clips in a non-survival porcine model.METHODS: NOTES gastrojejunostomy was performed on three female domestic pigs as follows: Gastrostomy, selection and retrieval of a free-floating loop of the small bowel into the stomach pouch, hold and exposure of the loop in the gastric cavity using a submucosal inflation technique, execution of a gastro-jejunal mucosal-seromuscular layer approximation using holing followed by interrupted suture technique with endoloop/clips, and full-thickness incision of the loop with a Dual knife.RESULTS: Pure NOTES side-to-side gastrojejunostomy was successfully performed in all three animals. No leakage was identified via methylene blue evaluation following surgery.CONCLUSION: This novel technique for preforming a gastrointestinal anastomosis exclusively by NOTES is technically feasible and reproducible in an animal model but warrants further improvement.展开更多
目的 探讨新型内镜吻合夹对治疗内镜下胃壁全层切除术(EFTR)后缺损的疗效及安全性。 方法 回顾性队列研究,纳入2018年12月至2021年1月于苏州大学附属第一医院因胃黏膜下肿瘤入院而接受EFTR术的14例患者,男4例,女10例,年龄(55.9±8.2...目的 探讨新型内镜吻合夹对治疗内镜下胃壁全层切除术(EFTR)后缺损的疗效及安全性。 方法 回顾性队列研究,纳入2018年12月至2021年1月于苏州大学附属第一医院因胃黏膜下肿瘤入院而接受EFTR术的14例患者,男4例,女10例,年龄(55.9±8.2)岁(45~69岁)。其中闭合创面使用新型吻合夹6例(新型吻合夹组),使用尼龙绳联合金属夹8例(尼龙圈联合金属夹组)。所有患者术前均完善超声内镜检查,术后均行普通白光内镜检查以评估创面情况。比较两组患者的创面大小、闭合创面所需的操作时间、闭合成功率、术后胃管放置时间、术后住院时间及并发症的发生情况,术前及术后相关血清学指标等。术后对所有患者进行随访,其中术后第1个月复查普通内镜,术后第2、3、6个月及术后1年采用电话及问卷随访形式,评估新型内镜吻合夹和尼龙绳联合金属夹在EFTR术后的治疗效果。 结果 两组患者均顺利完成内镜下全层切除术,均成功闭合。两组患者的年龄、肿瘤直径、缺损直径间的差异均无统计学意义(均 P >0.05)。和尼龙圈联合金属夹组相比,新型吻合夹组操作时间缩短[(5.0±1.8)min比(35.6±10.2)min, P <0.001];手术时间缩短[(62.2±12.5)min比(92.5±0.2)min, P =0.007];术后禁食时间减少[(2.8±0.8)d比(4.9±1.1)d, P =0.002];术后住院时间也缩短[(5.2±0.8)d比(6.9±1.5)d, P =0.023];术中总出血量减少[(20.00±5.48)ml比(35.63±14.75)ml, P =0.031]。两组患者均在术后1个月接受内镜检查,均未出现术后迟发穿孔及出血;均无明显不适症状。 结论 新型内镜吻合夹对于治疗EFTR术后造成的胃壁全层缺损效果良好,具有术中操作快、出血少及术后并发症少等优点。展开更多
AIM To introduce natural orifice transgastric endoscopic surgery(NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.METHODS Six live pigs(three each i...AIM To introduce natural orifice transgastric endoscopic surgery(NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.METHODS Six live pigs(three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cmtransversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation.RESULTS Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min(range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy.CONCLUSION Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement.展开更多
BACKGROUND Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated;however,there are very few studies on the efficacy of endoscopic management of del...BACKGROUND Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated;however,there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation.Herein,we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.CASE SUMMARY A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity.Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation.An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed;however,delayed free perforation of the gastric wall was noted on computed tomography after 3 d.Following an emergency abdominal surgery for the primary repair of the gastric wall,re-perforation was noted 15 d postoperatively.The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique.The free perforated gastric wall was successfully repaired without additional surgery or intervention.The patient was discharged after 46 d without any complications.CONCLUSION Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.展开更多
基金Medical Innovation Project of Fujian Provincial Health Bureau(2012--C*B--8)
文摘AIM: To demonstrate the feasibility and reproducibility of a pure natural orifice transluminal endoscopic surgery(NOTES) gastrojejunostomy using holing followed by interrupted suture technique using a single endoloop matched with a pair of clips in a non-survival porcine model.METHODS: NOTES gastrojejunostomy was performed on three female domestic pigs as follows: Gastrostomy, selection and retrieval of a free-floating loop of the small bowel into the stomach pouch, hold and exposure of the loop in the gastric cavity using a submucosal inflation technique, execution of a gastro-jejunal mucosal-seromuscular layer approximation using holing followed by interrupted suture technique with endoloop/clips, and full-thickness incision of the loop with a Dual knife.RESULTS: Pure NOTES side-to-side gastrojejunostomy was successfully performed in all three animals. No leakage was identified via methylene blue evaluation following surgery.CONCLUSION: This novel technique for preforming a gastrointestinal anastomosis exclusively by NOTES is technically feasible and reproducible in an animal model but warrants further improvement.
文摘目的 探讨新型内镜吻合夹对治疗内镜下胃壁全层切除术(EFTR)后缺损的疗效及安全性。 方法 回顾性队列研究,纳入2018年12月至2021年1月于苏州大学附属第一医院因胃黏膜下肿瘤入院而接受EFTR术的14例患者,男4例,女10例,年龄(55.9±8.2)岁(45~69岁)。其中闭合创面使用新型吻合夹6例(新型吻合夹组),使用尼龙绳联合金属夹8例(尼龙圈联合金属夹组)。所有患者术前均完善超声内镜检查,术后均行普通白光内镜检查以评估创面情况。比较两组患者的创面大小、闭合创面所需的操作时间、闭合成功率、术后胃管放置时间、术后住院时间及并发症的发生情况,术前及术后相关血清学指标等。术后对所有患者进行随访,其中术后第1个月复查普通内镜,术后第2、3、6个月及术后1年采用电话及问卷随访形式,评估新型内镜吻合夹和尼龙绳联合金属夹在EFTR术后的治疗效果。 结果 两组患者均顺利完成内镜下全层切除术,均成功闭合。两组患者的年龄、肿瘤直径、缺损直径间的差异均无统计学意义(均 P >0.05)。和尼龙圈联合金属夹组相比,新型吻合夹组操作时间缩短[(5.0±1.8)min比(35.6±10.2)min, P <0.001];手术时间缩短[(62.2±12.5)min比(92.5±0.2)min, P =0.007];术后禁食时间减少[(2.8±0.8)d比(4.9±1.1)d, P =0.002];术后住院时间也缩短[(5.2±0.8)d比(6.9±1.5)d, P =0.023];术中总出血量减少[(20.00±5.48)ml比(35.63±14.75)ml, P =0.031]。两组患者均在术后1个月接受内镜检查,均未出现术后迟发穿孔及出血;均无明显不适症状。 结论 新型内镜吻合夹对于治疗EFTR术后造成的胃壁全层缺损效果良好,具有术中操作快、出血少及术后并发症少等优点。
基金Supported by the Natural Science Foundation Project of Fujian Provincial Department of Science and Technology,No.2014J01407the Fuzhou Technology Planning Project,No.2013-S-129-2the College Students’ Innovation and Entrepreneurship Planning Project of Fujian Medical University,No.C1503
文摘AIM To introduce natural orifice transgastric endoscopic surgery(NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy.METHODS Six live pigs(three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cmtransversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation.RESULTS Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min(range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy.CONCLUSION Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement.
基金Supported by Chonnam National University Hospital Biomedical Research Institute,No.BCRI19258.
文摘BACKGROUND Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated;however,there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation.Herein,we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.CASE SUMMARY A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity.Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation.An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed;however,delayed free perforation of the gastric wall was noted on computed tomography after 3 d.Following an emergency abdominal surgery for the primary repair of the gastric wall,re-perforation was noted 15 d postoperatively.The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique.The free perforated gastric wall was successfully repaired without additional surgery or intervention.The patient was discharged after 46 d without any complications.CONCLUSION Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.