穿线钳取法治疗嵌顿性食管异物

食管异物是一种常见的临床急诊，多数可经内镜取出，嵌顿性食管异物取出时常较困难，尤其是两端刺入食管壁的嵌顿性异物，取出更加棘手，少数病例最终需要手术治疗。我院1997年6月至2006年3月接诊食管异物192例，其中两端刺入食管壁的嵌顿性异物35例，采用常规方法仅取出3例，余32例采用自行设计的穿线钳取法均成功取出，疗效满意，现报告如下。[第一段]     

上消化道嵌顿性异物的内镜治疗分析

目的评价内镜治疗嵌顿性上消化道异物的有效性和安全性。方法回顾性总结62例嵌顿性食管异物患者的病史资料,统计异物的种类、数量、嵌顿部位、滞留时间,内镜治疗方法、治疗时间以及并发症发生情况,并对影响并发症发生及治疗时间的相关因素进行统计学分析。结果食管上段最易发生嵌顿(45.2%,28/62);异物滞留时间及是否穿孔与并发症发生及内镜治疗时间相关(P0.05)。结论内镜治疗嵌顿性上消化道异物是安全和有效的方法。     

胃镜联合CT仿真内镜治疗食管鸡骨嵌顿1例

患者女,70岁。因误吞鸡骨后胸骨后疼痛2d入院。有高血压及冠心病病史。钡餐检查：主动脉弓附近见一异物嵌顿。胃镜检查：距门齿20cm处可见不规则形异物嵌顿,嵌顿处黏膜轻度充血,未见出血,可见主动脉的搏动,周边有食物附着,因部位太高,位于食管的起始处,几乎位于胃镜的检查盲区,无法准确判断其形态及掌握嵌顿的情况,     

十二指肠嵌顿异物胃镜治疗八例体会

各种原因导致的上消化道异物较常见，通常可经内镜取出，但仍有些异物内镜下取出较困难。我院自1990年至2010年间共治疗8例嵌顿于十二指肠的异物，效果良好，报道如下。     

经内镜治疗食管鱼骨嵌顿一例

患者男，74岁。因吞食鱼骨后胸骨后疼痛1周入院。胃镜检查;距门齿30cm处可见一约2.5cm×0.3cm细长鱼骨两端刺入食管壁而嵌顿，鱼骨嵌顿处黏膜充血水肿明显，[第一段]     

经内镜治疗胆道蛔虫嵌顿124例

我院近8年来用纤维十二指肠镜对168例临床拟诊为胆道蛔虫症患者进行急诊检查,发现124例十二指肠乳头有蛔虫嵌顿,当即用活检钳或圈套器取出蛔虫,均获成功。临床资料本组男31、女93例,其中孕妇12例。75%反复发作,25%初次发病。一年内未服驱虫药占55.65%。     

快速切割法治疗阴茎异物嵌顿10例报告

阴茎金属异物嵌顿造成的阴茎绞窄属外科急症，临床处理较棘手。1997年3月至2004年1月，我们共收治阴茎异物嵌顿患者10例，均采用快速切割法治疗，疗效满意。现报告如下。     

内镜下取出嵌顿于食管中段鱼骨一例

患者女,60岁,因胸骨后疼痛2h前来就诊。2h前患者喝鱼汤时不慎吞入鱼骨后出现胸骨后疼痛,经多次吞咽食物后未能改善症状。入院X线钡餐见食管中段一异物嵌顿,遂转入我中心进行治疗。签署同意书后,常规术前准备,肌注地西泮10mg、盐酸山莨菪碱10mg。     

食管巨大憩室伴结石嵌顿1例

1 病例报告 女,45岁。以胸闷、胸痛、进食梗噎感15d为主诉就诊。胸部X光片显示中纵隔一个5cm×5cm×4cm大小的球形阴影,周缘光滑无毛刺。纤支镜检查总气管及两肺各段支气管口未见异常。胃镜检查见食管后壁距门齿29-34cm范围有一个憩室开口,直径约2.5cm。憩室内见一黄绿色结石团块,大约5.0cm×3.4cm×3.0cm大小,触实、质硬、充满憩室腔,嵌顿于憩室口,一端突出于食管腔,致食管腔狭窄,     

内镜下治疗十二指肠水平部异物嵌顿并穿孔一例

消化道异物合并穿孔以往多通过外科手术取出异物并修补穿孔。本文报道1例十二指肠水平部异物嵌顿并穿孔的病例,通过儿童结肠镜成功取出并用钛夹封闭穿孔。     

Endoscopic options for treatment of dysplasia in Barrett's esophagus

Recent advances in the endoscopic treatment of dysplasia in Barrett's esophagus(BE) have allowed endoscopists to provide effective and durable eradication therapies. This review summarizes the available endoscopic eradication techniques for dysplasia in patients with BE including endoscopic mucosal resection, endoscopic submucosal dissection, photodynamic therapy, argon plasma coagulation, radiofrequency ablation and cryotherapy.     

Endoscopic Management for Delayed Diagnosis of a Foreign Body Penetrating the Esophagus into the Lung

A 31-year-old male presented with chest pain started after eating chicken about 2 weeks earlier. Upper endoscopy and Computed tomography scan of the chest revealed a sharp chicken bone penetrating the esophageal wall into the right lung. The foreign body was removed endoscopically using a rat-tooth forceps, followed by prophylactic placement of a metal stent across the esophageal perforation site. Foreign body-induced perforation is one of the common etiologies of benign esophageal perforations. Although the primary treatment is surgery, endoscopic therapy may be appropriate in individualized cases like our patient.     

内镜治疗消化道异物262例

目的总结消化道异物在内镜下的处理经验．方法１９８９年～１９９６年０３月消化道异物２６２例，男１７４例，女８８例；年龄１０月龄～７９岁；部位在食管内８４例，胃内１６７例，十二指肠６例，回肠２例，大肠３例．在内镜直视下按照异物的形态和大小，选择适合的异物钳，取出异物１８８例，设法让异物通过肠道排出体外６９例．结果２６２例患者中２５７例通过上述方法治疗后取得满意疗效，取出异物１８８例、排出异物６９例．仅５例治疗失败后（取出失败３例，排出失败２例）改为手术处理．内镜治疗消化道异物成功率为９８１％．结论经内镜治疗除空回肠以外的消化道异物是一种安全、有效的方法．     

Endoscopic management of impacted esophageal foreign bodies

There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies – impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign‐body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan.     

Endoscopic management of suspected esophageal foreign body in adults

Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond‐24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond‐24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond‐24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia.     

特殊肠化生型巴雷特食管的内镜治疗效果评价

目的　评价特殊肠化生型巴雷特食管（Barrett esophagus,BE）的内镜治疗效果。方法　2017年1月—2019年12月在武汉大学人民医院确诊特殊肠化生型BE,并分别行内镜下射频消融术（endoscopic radiofrequency ablation,ERFA）、内镜黏膜切除术（endoscopic mucosal resection,EMR）治疗的56例患者纳入回顾性分析,主要观察术后出血、进食梗阻、手术时间、住院时间和残留或复发等。结果　ERFA组（n=43）与EMR组（n=13）在患者年龄、性别、BE长度、术前消化道症状及合并症方面差异均无统计学意义（P>0.05）。相对于ERFA组,EMR组术后出血发生率［23.1%（3/13）比0,P=0.010］、进食梗阻发生率［30.8%（4/13）比4.7%（2/43）,P=0.022］较高,手术时间［6.0（5.6,6.2）min比5.4（5.2,5.5）min,Z=4.95,P<0.001］及住院时间［6.0（5,7）d比3.5（3,4）d,Z=5.76,P<0.001］较长。术后疼痛及发热发生率2组比较差异无统计学意义（P>0.05）。EMR组患者随访期间均未见肠化生病灶残留或复发,ERFA组第1次治疗后随访活检发现41.9%（18/43）的患者存在肠化生残余病灶,差异有统计学意义（P=0.005）。结论　EMR治疗特殊肠化型BE更彻底;而ERFA治疗操作更简单,用时较短,术后并发症较少,在临床应用更为广泛。     

食管隆起病灶EMR术后创面出血内镜治疗33例

目的:探讨食管隆起病灶内镜下黏膜切除术(EMR)术后创面出血内镜不同止血方法,并分析疗效.方法:33例食管隆起病灶行EMR术合并创面出血,其中直接使用金属肽夹止血8例,余下25例首先采用内镜下喷洒药物止血,成功10例,继续出血的15例中7例采用黏膜注射止血,8例采用内镜下热凝止血,仍然有3例无效采用金属钛夹止血,术后6 wk复查内镜,观察创面愈合情况.结果:8例直接使用金属肽夹止血均成功,25例采用喷洒药物止血成功10例;15例止血无效,对其中7例采用注射药物止血,成功6例;8例采用热凝止血成功6例,剩余3例止血仍然无效加用钛夹止血均成功.术后6 wk内镜复查,创面愈合良好.结论:对于食管隆起病灶EMR术后创面出血,内镜止血方法多样,操作简单、安全、效果好,值得推广.     

Endoscopic submucosal dissection compared to endoscopic mucosal resection for early Barrett esophagus neoplasia

Endoscopic resection has become an invaluable diagnostic and therapeutic tool in the evaluation and management of early Barrett esophagus (BE) neoplasia. While endoscopic mucosal resection (EMR) is the current standard of care for the resection of nodular early BE neoplasia, endoscopic submucosal dissection (ESD) has been recently introduced as part of the armamentarium in the treatment of these lesions. The potential advantages of ESD compared to EMR include higher en-bloc and R0 resection rates, decreased local recurrence, and the procurement of large en-bloc specimens that may facilitate pathologic staging. On the other hand, EMR is less time-consuming and has been traditionally associated with a lower incidence of serious adverse events when compared to ESD. At present, the choice of the endoscopic resection technique hinges on operator’s preferences, patient and lesions characteristics and available local expertise. Future high-quality studies comparing clinical outcomes between ESD and EMR are needed to better define their roles in the management of early BE neoplasia.