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Nakamura J, Hikichi T, Tanaka H. Coagulation with hemostatic forceps after endoscopic injection sclerotherapy in a pediatric patient with esophageal varices. Dig Endosc 2024; 36:631-633. [PMID: 38433620 DOI: 10.1111/den.14780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
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Affiliation(s)
- Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideaki Tanaka
- Department of Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan
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Serenko АA, Hroma VH, Minukhin DV, Yevtushenko DO, Tkachenko VV, Kritsak VV, Korzh PI. TREATMENT EXPERIENCE OF CHRONIC LUNG ABSCESSES USING MINI-INVASIVE ELECTROSURGICAL TECHNIQUES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2277-2282. [PMID: 37948726 DOI: 10.36740/wlek202310122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim: To increase the efficiency of surgical treatment of patients with chronic lung abscesses by developing mini-invasive methods of surgical treatment using electrosurgical technologies. PATIENTS AND METHODS Materials and methods: Conducted study of the results of surgical treatment of 78 patients with chronic lung abscesses operated from 2011 to 2021. Patients were divided into two groups: the main group (37 patients who were treated using developed technologies) and a comparison group (41 patients, treated using traditional tactics). RESULTS Results: Transthoracic and endobronchial sanitation of the purulent cavity in the lung at the first stage of treatment contributed to the rapid elimination of inflammation and significantly accelerated the regeneration of lung tissue. Clinical effectiveness in the main group was expressed in reducing the phenomena of intoxication, decrease in Leukocyte intoxication index (LII) (early as on day 5 after surgery), on the 10th day, a significant reduction in patients bacterial excretion was noted (in the main group by 18.9%, in the comparison group - by 14.6%), the average time of reducing the abscess cavity by 1/4 of the volume 6 days less, the healing time of the cavity of the AL which is on average 13 and 16 days, respectively, less. CONCLUSION Conclusions: The developed methods of surgical interventions made it possible to significantly positively influence the level of endogenous intoxication indicators, avoid resection surgical interventions, reduce the number of postoperative complications, avoid damage to neighboring organs, reduce the time of patients with achieving a stable positive effect.
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Affiliation(s)
- Аnton A Serenko
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE
| | - Vasyl H Hroma
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Dmytro V Minukhin
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Denis O Yevtushenko
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; KHARKIV NATIONAL MEDICAL UNIVERSITY, KHARKIV, UKRAINE
| | - Volodymyr V Tkachenko
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Vasyl V Kritsak
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Pavlo I Korzh
- STATE INSTITUTION «INSTITUTE OF GENERAL AND EMERGENCY SURGERY V. T. ZAITSEV NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE; EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
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Nakachi K, Maekita T, Deguchi H, Kimura M, Iguchi M, Yoshida S, Kitano M. A case of esophageal carcinoma on esophageal varices treated by endoscopic submucosal dissection after endoscopic injection sclerotherapy. DEN OPEN 2022; 3:e202. [PMID: 36600907 PMCID: PMC9801166 DOI: 10.1002/deo2.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 01/01/2023]
Abstract
Esophageal varices (EVs) are often treated using endoscopic injection sclerotherapy. Endoscopic submucosal dissection (ESD) has been used for early esophageal epithelial neoplasia worldwide. We report a case of early esophageal squamous cell carcinoma (ESCC) that occurred over EVs, in which the EVs were treated with endoscopic injection sclerotherapy before the early ESCC was treated with endoscopic submucosal dissection. Argon plasma coagulation was finally performed to prevent the recurrence of varices. No serious complications, such as severe bleeding or perforation, were observed. Histopathological examination revealed submucosal veins occluded with an organized thrombus for which endoscopic injection sclerotherapy with an intravariceal injection of sclerosant had been performed, but no fibrosis was observed outside the blood vessels. This explains that the injected sclerosant into EVs did not cause any tissue reaction like fibrosis in the submucosa surrounding the vein, which may have made endoscopic submucosal dissection safer and easier. Varices have not recurred, and ESCC has also not recurred for 5 years. We demonstrated a successful treatment of ESCC on EVs and no submucosal fibrosis other than inside the occluded vessels and verified it histologically.
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Affiliation(s)
| | - Takao Maekita
- Department of GastroenterologyWakayama Medical UniversityWakayamaJapan
| | | | - Masatomo Kimura
- Department of PathologyHashimoto Municipal HospitalWakayamaJapan
| | - Mikitaka Iguchi
- Department of GastroenterologyWakayama Medical UniversityWakayamaJapan
| | - Satoshi Yoshida
- Gastroenterological MedicineHashimoto Municipal HospitalWakayamaJapan
| | - Masayuki Kitano
- Department of GastroenterologyWakayama Medical UniversityWakayamaJapan
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Abstract
Despite advances in the management of complications of portal hypertension, variceal bleeding continues to be associated with significant morbidity and mortality. While endoscopic variceal band ligation remains first line therapy for treating bleeding and high-risk non-bleeding esophageal varices, alternate therapies have been explored, particularly in cases of refractory bleeding. The therapies being explored include stent placement, hemostatic powder use, over-the-scope clips and others. For gastric variceal bleeding, endoscopic ultrasound-guided therapies have recently emerged as promising interventions for hemostasis. The aim of this article is to highlight these alternative therapies and their potential role in the management of gastric and esophageal variceal bleeding.
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Abe M, Furuichi Y, Takeuchi H, Yoshimasu Y, Itoi T. Prognostic and recurrence factors after endoscopic injection sclerotherapy for esophageal varices: Multivariate analysis with the propensity score matching: Multivariate analysis with propensity score matching. Dig Endosc 2022; 34:367-378. [PMID: 34411350 DOI: 10.1111/den.14112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND Peri-esophageal collateral veins have been reported to be associated with the recurrence of esophageal varices (EVs). In this study, we retrospectively analyzed whether endoscopic ultrasonography (EUS) findings obtained just before endoscopic injection sclerotherapy (EIS) are associated with the success rate of intravariceal injection, recurrence rate of EVs, and overall survival rate (OS) of patients. Furthermore, we investigated the independent predictors associated with these factors by multivariate analysis. METHODS A total of 91 patients with risky EVs treated by EIS were analyzed. The primary endpoint was to identify independent predictors associated with the success rate of intravariceal injection, recurrence rate, and OS by multivariate analysis, to confirm the usefulness of EUS examination. The secondary endpoint was to clarify differences in recurrence rate and OS between patients who underwent additional argon plasma coagulation (APC) and those who did not, by the propensity score matching method. RESULTS Luminal diameter of EVs and F factor were predictors of the success rate of intravariceal injection. APC was predictor of OS and recurrence of EVs. EUS findings were not associated with these factors. Propensity score matching (APC, 23; without APC, 23) showed that recurrence rate was significantly improved in the APC group (P = 0.050) and that OS had the tendency to be higher in the APC group (P = 0.068). CONCLUSION Endoscopic ultrasonography findings before EIS were associated with successful intravariceal injection but were not associated with recurrence rate or OS. Additional APC could improve OS and reduce the recurrence of EVs.
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Affiliation(s)
- Masakazu Abe
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiro Furuichi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
- Department of Gastroenterology, Niiza Shiki Central General Hospital, Saitama, Japan
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yuu Yoshimasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Tamari H, Oka S, Tanaka S, Hiyama Y, Ninomiya Y, Kotachi T, Boda T, Yuge R, Urabe Y, Kitadai Y, Chayama K. Clinical usefulness of combination therapy with polidocanol injection and argon plasma coagulation for gastric antral vascular ectasia. JGH OPEN 2021; 5:465-469. [PMID: 33860097 PMCID: PMC8035473 DOI: 10.1002/jgh3.12517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 01/10/2023]
Abstract
Background and Aim Gastric antral vascular ectasia (GAVE) causes gastrointestinal bleeding. The initial treatment for GAVE bleeding is endoscopic hemostasis, and currently, the most performed technique to achieve hemostasis is argon plasma coagulation (APC). However, APC is associated with a high recurrence rate. To overcome this limitation, we examined the outcomes of the combination therapy of APC and polidocanol injection (PDI) for treating GAVE. Methods We retrospectively analyzed the outcomes of 15 consecutive GAVE patients treated with PDI + APC at Hiroshima University Hospital between November 2011 and September 2019 with respect to clinical characteristics, hemostatic efficacy, complications related to treatment, and recurrence rate. Results The mean age of patients (4 men and 11 women) was 74 ± 8.4 years. Patients had comorbidities of liver cirrhosis (seven patients, 47%), chronic renal failure (seven patients, 47%), and autoimmune diseases (seven patients, 47%). Endoscopic hemostasis with PDI + APC was performed in all patients (n = 15). The mean number of PDIs attempted to stop bleeding was 1.5 ± 0.8 (1–4), and the mean number of APCs attempted was 2.1 ± 1.2 (1–5). Complications related to treatment occurred in two patients (14%): ulceration in one patient and hematoma in another patient, both of whom were treated conservatively. Two patients (13%) had recurrences during the follow‐up period (average period, 42 months). Both were cured with additional treatment of PDI only. Conclusion The combination therapy of PDI and APC is effective for GAVE with a low recurrence rate.
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Affiliation(s)
- Hirosato Tamari
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
| | - Shinji Tanaka
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Yuichi Hiyama
- Department of Center for Integrated Medical Research Hiroshima University Hospital Hiroshima Japan
| | - Yuki Ninomiya
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Takahiro Kotachi
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Tomoyuki Boda
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Ryo Yuge
- Department of Endoscopy Hiroshima University Hospital Hiroshima Japan
| | - Yuji Urabe
- Division of Regeneration and Medicine Center for Translational and Clinical Research Hiroshima University Hospital Hiroshima Japan
| | - Yasuhiko Kitadai
- Department of Health and Science Prefectural University of Hiroshima Hiroshima Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan
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Yang JK, Hyun JJ, Lee TH, Choi JH, Lee YN, Choe JW, Park JS, Kwon CI, Jeong S, Kim HJ, Moon JH, Park SH. Can prophylactic argon plasma coagulation reduce delayed post-papillectomy bleeding? A prospective multicenter trial. J Gastroenterol Hepatol 2021; 36:467-473. [PMID: 32677716 DOI: 10.1111/jgh.15186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/03/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic post-papillectomy bleeding occurs in 3% to 20% of the cases, and delayed bleeding is also problematic. However, there is no consensus on how to reduce delayed post-papillectomy bleeding. The aim of this study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) to minimize delayed bleeding and reduce the persistence of residual tumors after endoscopic papillectomy. METHODS In a prospective pilot study of patients with benign ampullary tumors, the prophylactic APC group underwent APC at the resection margin following a conventional snaring papillectomy. Then, 24 h later after the papillectomy, all patients underwent a follow-up duodenoscopy to identify post-papillectomy bleeding and were followed up until 12 months. The main outcomes were the delayed (≥24 h) post-papillectomy bleeding rate and the tumor persistence rate. RESULTS The delayed post-papillectomy bleeding rate was 30.8% (8/26) in the prophylactic APC group and 21.4% (6/28) in the non-APC group (P = 0.434). The post-procedure pancreatitis rates were 23.1% (6/26) and 35.7% (10/28), respectively (P = 0.310). The rate of tumor persistence did not differ between the two groups at 1 month (12.5% vs 7.4%, P = 0.656), 3 months (4.2% vs 3.7%, P = 1.00), 6 months (8.3% vs 3.7%, P = 0.595), and 12 months (0% vs 3.7%, P = 1.00). There were no procedure-related mortalities or serious complications. CONCLUSION Prophylactic APC may not be effective in reducing delayed post-papillectomy bleeding or remnant tumor ablation immediately after conventional papillectomy (Clinical trial registration-cris.nih.go.kr; KCT0001955).
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Affiliation(s)
- Jae Kook Yang
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Jong Jin Hyun
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Jun-Ho Choi
- Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Yun Nah Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jin-Seok Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Chang-Il Kwon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Seok Jeong
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hong Ja Kim
- Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Jong Ho Moon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Sang-Heum Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
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Song Y, Feng Y, Sun LH, Zhang BJ, Yao HJ, Qiao JG, Zhang SF, Zhang P, Liu B. Role of argon plasma coagulation in treatment of esophageal varices. World J Clin Cases 2021; 9:521-527. [PMID: 33553390 PMCID: PMC7829739 DOI: 10.12998/wjcc.v9.i3.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
With the development of endoscopic therapy, argon plasma coagulation (APC) has been widely used by endoscopists. It has many advantages, such as simple to operate, low cost, and minimal invasiveness. Because of its capability of lesion ablation and hemostasis, APC has several indications in the gastrointestinal tract. One of them is esophageal varices. The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.
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Affiliation(s)
- Ying Song
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Yuan Feng
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Li-Hui Sun
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Bo-Jiang Zhang
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Hong-Juan Yao
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Jing-Gui Qiao
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Shu-Fen Zhang
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Ping Zhang
- Department of Clinical Medical Affair, Erbe China Ltd., Shanghai 200336, China
| | - Bin Liu
- Department of Clinical Medical Affair, Erbe China Ltd., Shanghai 200336, China
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Saisho K, Tanaka T, Matono S, Mori N, Hino H, Kadoya K, Nishida R, Fujisaki M, Fujita F, Akagi Y. Argon plasma coagulation for superficial squamous cell carcinoma in the residual esophagus after esophagectomy. Esophagus 2020; 17:448-455. [PMID: 32211993 DOI: 10.1007/s10388-020-00733-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients after esophagectomy for esophageal squamous cell carcinoma (SCC) occasionally develop metachronous SCC in the residual esophagus. Although most of these second primary lesions are detected as superficial cancer at follow-up endoscopy, it is often difficult to perform endoscopic resection for these lesions near the site of anastomosis. METHODS The objective of this study was to evaluate the effectiveness of argon plasma coagulation (APC) for superficial SCC in the residual esophagus after esophagectomy. Twelve patients (involving 15 s primary lesions) received APC for superficial SCC in the residual esophagus after esophagectomy. These lesions were difficult to perform endoscopic resection and they were treated using APC. RESULTS There was no treatment-related complication. Complete remission (CR) was achieved in 13 (86.6%) of the 15 lesions: CR was achieved in 11 lesions (73.3%) after the first APC course, and in another 2 lesions (13.3%) after two or more APC courses. Of the 2 patients with persisting residual tumor, 1 patient received 12 times repeated-APC courses over 6 years, and eventually achieved local control without metastasis, the other patient received radiotherapy and cervical esophagectomy after treatment failure with APC. All patients survived except for one patient who died of old age and another patient who died of tongue cancer. CONCLUSIONS APC was a safe treatment that was easy to perform. APC was concluded to be an effective treatment for superficial SCC in the residual esophagus after esophagectomy when endoscopic resection was difficult.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
| | - Toshiaki Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoru Matono
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Haruhiro Hino
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Kazutaka Kadoya
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Ryosuke Nishida
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Masahiro Fujisaki
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka, 830-0011, Japan
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Miyamoto S, Yamamoto Y, Takagi T. New method of endoscopic injection sclerosis for esophageal varices using by modified endoscopic hood. Dig Endosc 2020; 32:e82-e83. [PMID: 32298500 DOI: 10.1111/den.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Shuichi Miyamoto
- Department of Gastroenterology, Hakodate Municipal Hospital, Hokkaido, Japan.,Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Yoshiya Yamamoto
- Department of Gastroenterology, Hakodate Municipal Hospital, Hokkaido, Japan
| | - Tomofumi Takagi
- Department of Gastroenterology, Japan Community Health Care Organization Sapporo Hokushin Hospital, Hokkaido, Japan
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Abstract
循证医学证据是评价临床治疗手段安全性和有效性的最佳证据. 食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding, EVB)是消化科常见危急重症之一, 严重威胁着肝硬化患者生命安全和身心健康, 近年来, 能够有效运用循证医学方法为食管胃底静脉曲张的治疗寻找最佳临床依据、制定循证治疗方案成为临床医生的迫切要求. 本文就EVB的内镜下治疗方面的循证医学研究进展做一综述.
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Endoscopic variceal ligation combined with argon plasma coagulation versus ligation alone for the secondary prophylaxis of variceal bleeding: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2017; 29:621-628. [PMID: 28195875 DOI: 10.1097/meg.0000000000000861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endoscopic variceal ligation (EVL) is often recommended as an effective method for the treatment of esophageal varices, despite the important tendency of variceal recurrence. Recent studies indicate that combining EVL with argon plasma coagulation (APC) may be a more effective therapy than ligation alone. To investigate these findings, we carried out a systematic review and meta-analysis to compare the safety and efficacy of EVL combined with APC versus ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage. All studies were searched through PubMed, the Cochrane Library, and Science Direct. The outcome measures were relative risk (RR) or risk difference with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference for continuous data. Heterogeneity was calculated using the χ and the I-tests. Two investigators independently identified four randomized-controlled trials included in the research. The variceal recurrence rate was significantly lower in the combined therapy group (RR=0.19, 95% CI: 0.09-0.41, P=0.000). The bleeding recurrence and mortalities in the two groups showed no significant differences (RR=0.29, 95% CI: 0.08-1.04, P=0.058; risk difference=-0.02, 95% CI: -0.08-0.04, P=0.576, respectively). Although the pyrexia incidence rate was significantly higher in the combined group (RR=3.42, 95% CI: 1.56-7.48, P=0.002), there was intertrial heterogeneity (I=52.5%, P=0.097). EVL combined with APC is superior to ligation alone for endoscopic variceal recurrence without severe adverse events in secondary prophylaxis against esophageal variceal bleeding. More high-quality studies are needed to strengthen this conclusion.
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