Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis(FAP), but nonampullary sporadic duodenal adenomas(SDAs)are rare. Emerging evidence shows that duodenal adenomas, regardless of the...Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis(FAP), but nonampullary sporadic duodenal adenomas(SDAs)are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection(EMR), endoscopic submucosal dissection(ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polypfree duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAPrelated polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas.展开更多
BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To pre...BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.展开更多
目的探讨三镜(腹腔镜、胆道镜及十二指肠镜)联合下应用鼻胆管引流对胆囊结石合并胆管结石同期微创外科治疗效果。方法回顾性分析2016年12月至2017年3月收治的64例胆总管结石病人临床资料,手术分为两组,一组行腹腔镜下胆道探查术(laparos...目的探讨三镜(腹腔镜、胆道镜及十二指肠镜)联合下应用鼻胆管引流对胆囊结石合并胆管结石同期微创外科治疗效果。方法回顾性分析2016年12月至2017年3月收治的64例胆总管结石病人临床资料,手术分为两组,一组行腹腔镜下胆道探查术(laparoscopic common bile duct exploration,LCBDE)术,另一组行三镜联合,胆管一期缝合,鼻胆管引流(三镜联合)。其中LCBDE组33例,三镜联合组31例。并对病人住院费用、胆汁引流量、腹腔引流量、引流管留置时间进行对比分析。结果对照组32例行腹;32例行三镜联合下鼻胆管引流术,其中31例手术成功,1例改为LCBDE。2例出现一过性淀粉酶升高,无胰腺炎发生。对比分析三镜联合组手术较LCBDE住院费用高,差异有统计学意义(P<0.05);胆汁引流量少,差异有统计学意义(P<0.05);胆汁引流管拔除时间明显缩短,差异有统计学意义(P<0.05);腹腔引流量差异无统计学意义(P>0.05)。结论三镜联合下鼻胆管引流治疗胆管结石,达到了创伤小、痛苦小、术后恢复快、无严重并发症的目的,可作为目前治疗胆道结石的理想选择。展开更多
Due to an increasing incidence and more frequent recognition by endoscopists, gastrointestinal follicular lymphoma has been established as a variant of follicular lymphoma. However, due to its rarity, there are no est...Due to an increasing incidence and more frequent recognition by endoscopists, gastrointestinal follicular lymphoma has been established as a variant of follicular lymphoma. However, due to its rarity, there are no established guidelines on the optimal diagnostic strategy for patients with primary gastrointestinal follicular lymphoma or secondary gastrointestinal involvement of systemic follicular lymphoma. This review offers an overview and pitfalls to avoid during the initial diagnostic workup of this disease entity. Previously reported case reports, case series, and retrospective studies are reviewed and focus on the disease's endoscopic and histological features, the roles of computed tomography and positron emission tomography scanning, the clinical utility of the soluble interleukin-2 receptor, and the possible pathogenesis.展开更多
AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical pract...AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS： A 15 year-trend （1990 to 2004） in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS： Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies （7.6%）; an increase in the use of such was observed over the study period （1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004）. Celiac disease was diagnosed in 22 patients （2.2%）, this being more frequent in women than in men （3% and 1% respectively）. Fourteen out of 514 （2.7%） patients with anaemia, 12 out of 141 （8.5%） with chronic diarrhoea and 8 out of 42 （19%） with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION： Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.展开更多
文摘目的探讨经内镜金属支架置入术治疗胃出口、十二指肠和近端小肠恶性梗阻的临床价值。方法对1999年3月至2005年3月经内镜放置金属支架治疗的21例胃出口、十二指肠和近端小肠恶性梗阻患者的临床资料进行回顾性分析。结果 21例中20例放置支架成功,成功率为95．2％,其中4例采取经内镜钳道(TTS)方式释放支架,16例为经导丝直接释放支架。19例支架放置后1-3 d 梗阻症状得到缓解或消除,临床有效率为90．5％,平均生存期4．5个月。1例术后出血,予保守治疗而愈。1例术后1个月支架移位,1例术后2个月肿瘤向支架内浸润生长,导致梗阻复发,均予放置第2 根支架后缓解。结论经内镜放置金属支架治疗胃出口、十二指肠和近端小肠恶性梗阻是一种简单可行、安全有效的方法。
文摘Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis(FAP), but nonampullary sporadic duodenal adenomas(SDAs)are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection(EMR), endoscopic submucosal dissection(ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polypfree duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAPrelated polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas.
基金The study was reviewed and approved by the Research Ethics Committee of Republican Scientific and Practical Center of Pediatric Surgery Minsk,Republic of Belarus(Protocol 9 of August 24,2023).
文摘BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.
文摘目的探讨三镜(腹腔镜、胆道镜及十二指肠镜)联合下应用鼻胆管引流对胆囊结石合并胆管结石同期微创外科治疗效果。方法回顾性分析2016年12月至2017年3月收治的64例胆总管结石病人临床资料,手术分为两组,一组行腹腔镜下胆道探查术(laparoscopic common bile duct exploration,LCBDE)术,另一组行三镜联合,胆管一期缝合,鼻胆管引流(三镜联合)。其中LCBDE组33例,三镜联合组31例。并对病人住院费用、胆汁引流量、腹腔引流量、引流管留置时间进行对比分析。结果对照组32例行腹;32例行三镜联合下鼻胆管引流术,其中31例手术成功,1例改为LCBDE。2例出现一过性淀粉酶升高,无胰腺炎发生。对比分析三镜联合组手术较LCBDE住院费用高,差异有统计学意义(P<0.05);胆汁引流量少,差异有统计学意义(P<0.05);胆汁引流管拔除时间明显缩短,差异有统计学意义(P<0.05);腹腔引流量差异无统计学意义(P>0.05)。结论三镜联合下鼻胆管引流治疗胆管结石,达到了创伤小、痛苦小、术后恢复快、无严重并发症的目的,可作为目前治疗胆道结石的理想选择。
文摘Due to an increasing incidence and more frequent recognition by endoscopists, gastrointestinal follicular lymphoma has been established as a variant of follicular lymphoma. However, due to its rarity, there are no established guidelines on the optimal diagnostic strategy for patients with primary gastrointestinal follicular lymphoma or secondary gastrointestinal involvement of systemic follicular lymphoma. This review offers an overview and pitfalls to avoid during the initial diagnostic workup of this disease entity. Previously reported case reports, case series, and retrospective studies are reviewed and focus on the disease's endoscopic and histological features, the roles of computed tomography and positron emission tomography scanning, the clinical utility of the soluble interleukin-2 receptor, and the possible pathogenesis.
文摘AIM： To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice. METHODS： A 15 year-trend （1990 to 2004） in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea. RESULTS： Duodenal biopsy was performed in 1033 of 13 678 upper gastrointestinal endoscopies （7.6%）; an increase in the use of such was observed over the study period （1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004）. Celiac disease was diagnosed in 22 patients （2.2%）, this being more frequent in women than in men （3% and 1% respectively）. Fourteen out of 514 （2.7%） patients with anaemia, 12 out of 141 （8.5%） with chronic diarrhoea and 8 out of 42 （19%） with anaemia plus chronic diarrhoea had celiac disease. A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia. CONCLUSION： Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.
