Endoscope Research Articles

Preliminary study on CT retrograde intubation dacryosystography (CT-RIDC) and its impact factors

To observe practicality and safety of CT-RIDC for the patients with presaccular lacrimal obstruction and study the related factors. To provide guidance for the diagnosis and treatment of the patients with presaccular lacrimal obstruction. Fifty-four patients (75 eyes) with presaccular lacrimal obstruction, including 3 cases (5 eyes) of upper and lower lacrimal punctum atresia, 15 cases (24 eyes) of superior and inferior canalicular obstruction, 18 cases (28 eyes) of common canaliculus obstruction, 18 cases (18 eyes) of old laceration of superior and inferior canalicular, were recruited. All patients underwent the examination by using 0° and 30° ear endoscope and the imaging characteristics of the inferior orifice of nasolacrimal duct were obtained. Fifty-three cases (65 eyes) with the opening inferior orifice were randomly divided into four groups (15 eyes, 17 eyes, 17 eyes, 16 eyes) according to different angle of head hypsokinesis in the supine position. The OM lines back along the sagittal plane of the head back 10°, 20°, 30°, 40° were measured. The angles of head hypsokinesis were set in accordance with the OM line measurement results.Intubation was successful when the intubation guided needle within the set of epidural anesthetic catheter aided with endoscopy was inserted into the inferior orifice of nasolacrimal duct and then the epidural anesthetic catheter was inserted into the lacrimal duct 6 mm. The angle (θ) between the long axis of the curved part of the intubation guided needle and the long axis of the guided needle was measured. The numbers of intubation success cases in each group were recorded.χ² test was used to compare intubation success rate under the different angle of head hypsokinesis.Scheffe method was used to compare intubation success rate between each group. Contrast medium was then injected into lacrimal duct through the epidural anesthetic catheter for patients with successful intubation and CT scan was carried out. 3D model of lacrimal passage was reconstructed with CT axial scanning. The intubation guided needle was successfully inserted into the inferior orifice of nasolacrimal duct in 44 eyes among 65 eyes with the opening orifice. The number of successful intubation cases were 4 eyes, 15 eyes, 13 eyes, 12 eyes and the intubation success rate was 26.67%, 88.24%, 76.74%, 75.00% according the angle of head hypsokinesis 10° group (15 eyes), 20° group (17 eyes), 30° group (17 eyes), 40° group (16 eyes). The intubation success rate of head hypsokinesis 10° group was significantly lower than that of the other groups. Multiple Comparison by Scheffe Test demonstrated that there was a remarkable difference (P < 0.05) in the intubation success rate between head hypsokinesis 10° group and the other three groups. There were no significant differences in the intubation success rate among head hypsokinesis 20° group, head hypsokinesis 30° group and head hypsokinesis 40° group. The mean of θ was 108° with a range of 93.2°-120.5° by measuring the angle θ of the successful intubation cases. According to the frequency distribution plot, most θ was in 104°-115°. The successful intubation cases (44 eyes) underwent CT scan in the same position immediately after injected contrast medium (Optiray) through the epidural anesthetic catheter. CT images of 28 eyes showed retained contrast medium in the nasolacrimal duct and lacrimal sac. The findings from CT-DCG images were basically agreed with the operation. CD-RIDC may apply to pre-operative examination for the patients with the opening orifice and presaccular lacrimal obstruction.It provideed imaging evidence for diagnosis and therapy and it was safe and practical. Many factors could affect CD-RIDC. The main verified facors were the shape of the inferior orifice of nasolacrimal duct, head position of the patient and the bending angle of the tip of intubation guided needle.

Effects of different drugs on patients undergoing endoscopic variceal ligation

Objective To study the sedative and analgesic effects of different drugs on patients under-going endoscopic variceal ligation( EVL). Methods Sixty patients undergoing selective EVL were randomly assigned to three groups:pethidine group( A),propofol-fentanyl group( B)and dexmedetomidine-fentanyl group(C). Data concerning blood pressure,heart rate,peripheral oxygen saturation,Ramsay score,endo-scopic operation and anesthesia time,surgeons' satisfaction and adverse reactions were recorded. Follow-up was done 24 hours later to confirm the patients' satisfaction and incidence of intraoperative awareness. Results The Ramsay scores of group B(5. 2 ± 0. 3)and C(3. 5 ± 0. 4)were significantly higher than group A (1. 6 ± 0. 4)(P<0. 05). There was no cough,body movement and high blood pressure during the EVL in group B or C,while the incidences of these symptoms in group A(40%,40% and 30%)were obviously higher (P<0. 05). The surgeons'satisfaction of group B(9. 2 ± 0. 3)and C(9. 6 ± 0. 4)were significantly higher than that of group A(5. 0 ± 0. 4)(P<0. 05). The patients' satisfaction scores of group B(9. 6 ± 0. 3)and C (9. 6 ± 0. 4)were also markedly higher than that of group A(5. 4 ± 0. 3)(P<0. 05). There was no difference of operation time among the three groups. The anesthesia time of group A(44 ± 6)was obviously longer than those of group B(35 ± 4)and C(36 ± 5)(P<0. 05). There was no difference in patients'or surgeons'satis-faction,or anesthesia time between group B and C. But the incidences of bradycardia( 40%),hypotension(30%)and hyoxemia(30%)in group B were obviously higher than those of group C(5%,0,0)(P<0. 05). There was no intraoperative awareness in group B or C. Conclusion Both dexmedetomidine and propofol com-bined with fentanyl are superior to pethidine for patients undergoing EVL,while dexmedetomidine provides bet-ter hemodynamics and respiratory conditions compared with propofol. Key words: Endoscope ; Pethidine ; Propofol ; Dexmedetomidine ; Esophageal varices liga-tion ;

Clinical evaluation of fully covered self-expanding metal stent for endosonograph-guided transgastric pancreatic pseudocyst drainage

Objective To evaluate technical efficacy,feasibility and safety of a fully covered self-expanding metal stent for EUS-guided transgastric pancreatic pseudocyst drainage. Methods Data of a total of 11 patients who received EUS-guided transgastric pancreatic pseudocyst drainage with a covered self-ex-panding metal stent at Changhai Hospital from September 2013 to May 2014 were retrospectively studied. The manipulative success rates,curative success rates and complication rates were evaluated. Results All 11 patients were treated by EUS-guided transgastric pancreatic pseudocyst drainage with fully covered self-ex-panding metal stents successfully,with success rate of 100%. Two patients developed infection and displace-ment occurred in 1 patient. There was no hemorrhage,perforation or death. Stents were removed in 7 pa-tients and the pseudocysts vanished. Conclusion Endosonography-guided transgastric pancreatic pseudocyst drainage using a fully covered self-expanding metal stent can be accomplished with high technical and clinical success rate and low rate of complications. Key words: Pancreatic pseudocyst ; Drainage ; Ultrasonic endoscope ; Fully covered self-ex-panding metal stent ;

Innovation Method for Sealing Bone Bleeding in Percutaneous Endoscopic Interlaminar Discectomy

Background: Adequate hemostasis to prevent postoperative epidural hematoma and its consequences such as cauda equina syndrome is important in lumbar spine surgery. However, in percutaneous endoscopic interlaminar discectomy (PEID), due to its tiny incision wound only allows for endoscopy and its sheath entered, adequate hemostasis could be difficult. Herein, we proposed an innovation way of applying bone wax to stop bone bleeding in PEID. Materials and Methods: A working channel with a beveled opening was introduced over the dilator and a rigid endoscope was inserted after the removal of the obturator. Endopunch was used to cut the ligamnetum flavum to expose underlying dura margin and nerve root. To avoid overtraction of the nerve root, we use an endoscopic high speed burr or endoscopic kerrison punch to remove partial medial facet and inferior margin of lamina to gain more room for instrument inside. Some bone bleeding causing unclear vision occurred as we proceeded. We thus use endoscopic nerve retractor to push the bone wax to the surface of the bone to seal the bleeding. Results: Intraoperative adequate hemostasis was achieved with clear endoscopic vision after the bone wax sealed the bleeding site. Conclusion: Using an endoscopic nerve retractor with bone wax to stop bone bleeding in percutaneous endoscopic interlaminar discectomy is an efficient way to provides us with immediate clear vision during the surgery.

Discussion on endoscopic staging system for juvenile nasopharyngeal angiofibroma

Objective To develop a new staging system for juvenile nasopharyngeal angiofibroma that reflects changes in surgical approaches (endonasal),route of intracranial extension,and the extent of vascular supply from the internal carotid artery.Method Retrospective review was used to study the series cases.35 patients had undergone endoscopic endonasal surgery for JNA,from 2005 to 2011.Patients were staged according to current systems and compared with a new staging system that also incorporated the route of skull base extension and tumor vascularity.Estimated blood loss,number of operations,and tumor recurrence as main outcome measures were observed.Results Skull base erosion was observed in 74％ of cases.Following embolization of external carotid artery tributaries,residual vascularity from the internal carotid artery was seen in 51％ of patients.Residual vascularity,classified as our stage Ⅳ and Ⅴ,was strongly correlated with blood loss,requirement for multiple procedures,and residual or recurrent tumor.Conclusion Tumor size and extent of sinus disease were less important in predicting complete tumor removal with endonasal surgical techniques.This staging system for JNA accounted for 2 important prognostic factors,route of cranial base extension,and vascularity,which were applicable to endoscopic or open approaches.Compared with other staging systems,this staging system provides a better prediction of immediate morbidity (including blood loss and need for multiple operations) and tumor recurrence. Key words: Angiofibroma; Nasopharyngeal; Endoscope; Staging system

Disorder of the blood aqueous barrier after endoscope-guided intraocular lens transscleral fixation surgery

Objective To observe the function of the blood-aqueous barrier(BAB) after transscleral sulcus suture intraocular lens (IOL) fixation under endoscope guidance.Methods 39 eyes of 38 cases were enrolled in this study.Endoscope-assissted transscleral IOL fixation was performed in 33 eyes,of which 21 eyes were eyeball contusion or foreign body injury,3 eyes were endogenous endophthalmitis,and 9 eyes were proliferative diabetic retinopathy.A foldable IOL was fixed in ciliary sulcus.3 eyes underwent phacoemulsification combined with IOL implantation and 3 eyes with regular IOL fixation without endoscope guidance were taken as control.The observed items included post-surgery vision and slit-lamp microscopy.The BAB function was examined using the laser flare cell meter (Kowa FC-2000) preoperatively and on postoperative day 1,7,30 by an independent examiner.The wilcoxon test was used for data analysis.Results Postoperatively,the best corrected visual acuities of all cases ranged from 0.2 ～ 1.0 (0.6 ± 0.21),were better than pre-operative hand movement/30 cm ～0.2.The UBM indicated the IOL of 1 eye dislocated slightly in regular IOL fixation group 1 week after surgery.The aqueous flare mean photon counts showed significant difference (F =216.2,214.1,P ＜ 0.05) in endoscope-assissted and regular lens fixation groups between phacoemulsification before surgery and after surgery especially on postoperative day 1,and highly significant difference between the regular lens fixation and the endoscope assissted on day 1 (F =220.3,P ＜ 0.05),but no statistically significant difference (F =205.0,P ＞ 0.05) on postoperative day 30.Conclusion Endoscope-assissted transscleral IOL fixation has little effect on BAB function.The different anatomical characteristics of ciliary sulcus,pars plana and iris root may be crucial reasons for different BAB damage. Key words: Endoscope-guided; Aphakia; Fixation, lens, intraocular; Barrier, blood-aqueous

The feasibility of slightly acidic electrolyzed oxidizing water for the disinfection of gastrointestinal endoscopes

Objective To evaluate the feasibility of slightly acidic electrolyzed oxidizing water for the disinfection of gastrointestinal endoscopes. Methods Electrolyzed oxidizion water generator was utilized to produce the water, which was applied for the disinfection of gastrointestinal endoscopes. The disinfectant efficiency and effect were evaluated. Results A total of 215 samples were taken for bacterial culture after the disinfection. The mean sterilization efficiency of slightly acidic electrolyzed oxidized water and 2% glut- araldehyde by machine were 99. 92% and 99. 85% , respectively, while the mean sterilization efficiency were 99. 85% and 99. 84% by manual disinfection. There were no statistical significance between the two groups. The effective rates of both groups were 100%. No deformation or aging was observed in the endoscopes. The disinfectant caused no damage to the cleansing and disinfection. Conclusion It is feasible to apply slightly acidic electrolyzed oxidizing water to the disinfection of endoscopes. Key words: Endoscopes; Disinfection; Glutaral; Slightly acidic electrolyzed oxidizing water

The value of target biopsy using magnifying endoscopy combined with narrow band imaging for early gastric malignancy

Objective To evaluate target biopsy using magnifying endoscopy combined with narrow band imaging（ME-NBI） in suspicious gastric lesions. Methods A total of 113 patients with suspicious early gastric lesions under white light endoscopy（WLE） were prospectively enrolled and biopsied between May 2011 and May 2013. Further endoscopy was conducted using ME-NBI and target biopsy. All patients received endoscopic resection（ER）. Outcomes of WLE biopsy and target biopsy were compared, with histology of ER specimen as golden standard. Results The overall diagnostic accuracy of WLE biopsy and target biopsy were 22. 1% （25/113） and 54.0% （61/113）, （P 〈 0.0001 ）. In diagnosing early gastric cancer （EGC） and high-grade intraepithelial neoplasia （ HGIN）, the sensitivity of target and WLE biopsy were 70. 9% and 37. 9% （P 〈0. 0001 ）, respectively. The specificity were 90. 0% in both groups. The accuracy rates were 72. 6% and 42. 5%, respectively（P 〈0. 0001 ）. The positive predictive values were 98. 6% and 97. 5% （P 〉0. 05）. The negative predictive values were 23.1% and 12. 3% （P 〉0. 05）, respectively. The overall progression rate of target biopsy was 46.9% （53/113）. Conclusion ME-NBI target biopsy is superior to traditional WLE biopsy in diagnosis of early gastric cancer. Key words: Stomach neoplasms ; Endoscopes ; Treatment outcome ; Pathology

Preoperative location of colorectal polyps in laparoscopic colectomy

Objective To investigate the efficacies of preoperative location with titanium clip and methylene blue staining in laparoscopic colectomy.Methods The clinical data of 31 patients with colorectal polyps which could not be resected under endoscope were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from August 2006 to September 2012 were retrospectively analyzed.According to the methods of preoperative location of colorectal polyps,all patients were divided into the titanium clip group (18 patients) and the methylene blue group (13 patients).Titanium clip group:enteroscopic and pathological examination were firstly performed,and then 1 or 2 titanium clips were placed at the superior and inferior part of the polyps.After enteroscopic examination,abdominal X ray examination was performed to detect the position of polyps according to the positions of the titanium clips.Methylene blue group:after colonoscopy,methylene blue of 1 mL was injected into the adjacent mucosa of the polyps,and 4 positions around the polyps were selected for the injection of methylene blue.If the 2 locating methods were failed,intraoperative enteroscopy was performed.Laparoscopic resection for intestine or mesenterium was performed according to the treatment principle of colorectal neoplasms,and the location efficacy of the 2 methods and the treatment of the 2 groups were analyzed.The measurement data and the count data were analyzed using the t test and chi-square test,respectively.Results The success rates of the titanium clip group and the methylene blue group were 15/18 and 8/13,with no significant difference between the 2 groups (x2=0.284,P ＞0.05).The polyps in 8 patients which were failed to be localized by titanium clip or methylene blue were localized by intraoperative enteroscopy,while the operation time was prolonged to (44 ± 13)minutes.No positioning errors were detected in all the 31 patients.Laparoscopic right colectomy was performed on 4 patients,laparoscopic left colectomy on 11 patients,laparoscopic sigmoid colectomy on 9 patients,laparoscopic anterior resection of rectum on 7 patients.No morbidity or mortality was detected in the 2 groups.The length of specimen,distance between the proximal margin and the superior margin of the tumor,distance between the distal margin and the inferior margin of the tumor (patients with colonic polyps),distance between the distal margin and the inferior margin of the tumor (patients with high rectal polyps),and the number of lymph node resected were (20 ± 7) cm,(11 ± 4) cm,(8.6 ± 3.1) cm,4.2 ± 1.1,8 ± 5 in the titanium clip group,and (20 ± 5) cm,(9 ± 3) cm,(9.1 ± 2.8) cm,4.6 ± 0.5,7 ± 6 in the methylene blue group,with no significant difference between the 2 groups (t =0.053,0.918,0.213,1.486,0.267,P ＞0.05).Fifteen patients had cancerization of the polyps,including 8 patients with TNM Ⅰ stage,6 with TNM Ⅱ] stage and 1 with TNM Ⅲ stage.Conclusions For patients with colorectal polyps located at the intestine above the descending colon,titanium clip locating is easy,safe and effective,and it could be the first choice for locating the colorectal polyps.Endoscopic methvlene blue staining is simple but high technique demanding.Intraoperative enteroscopy is precise for locating the polyps at the intestine below the descending colon. Key words: Polyps; Endoscopy; Laparoscopy; Location

Transnasal endoscopic management of foreign body injuries at orbital-skull base

To explore the feasibility and methods of transnasal endoscope for removing foreign bodies at orbital-skull base. Retrospective analyses were performed for 8 cases of foreign body injuries at orbital-skull base at our department from January 2009 to January 2014. The foreign bodies were metallic (n = 4) and wooden (n = 4). Six cases were only within orbit while the remainder had nasal-orbital foreign bodies. The symptoms included preoperative visual loss (n = 6), visual deterioration (n = 2) and eye movement disorder (n = 5). All underwent transnasal endoscopic removal. Foreign bodies were totally removed. During a follow-up period of 3 months to 4 years, there was no recovery of preoperative visual loss (n = 6). Two patients with reduced vision recovered to normal after 3 months. Eye movement disorder fully recovered in 4 cases and 1 case of eye movement disorder had partial recovery. Endoscopic removal of foreign body at orbital-skull base has the advantage of mini-invasiveness and non-facial surgical scar.

Resection of orbital apex lesions through transnasal endoscopic approach (a report of 18 cases)

Objective To investigate the fcasibility and efficacy of resection of orbital apex lesions through transnasal endoscopic approach.Methods From January 2009 to June 2013,18 patients with orbital apex lesions were analyzed retrospectively,of which the main symptoms were proptosis and vision loss.In this series,6 cases were orbital foreign body,4 cavernous hemangioma,3 trans-nasal-orbital mucinous cyst,2 inflammatory pseudotumor,1 cholesteatoma,1 neurofibroma,and 1 fibrodysplasia.All the patients underwent operation through ethmoid sinus with endoscopic techniques into orbit or orbital apex.Results All the foreign bodies were taken out by one operation.4 cavernous hemangiomas in orbital apex were totally removed,in two of them the postoperative visions were improved and another two unchanged.In 8 trans-nasal-orbital tumors,4 were totally removed,3 partially removed,of which the proptosis and eyeball movement were improved.All the patients were followed-up from 3 months to 4 years.1 inflammatory pseudotumor recurred and was removed again.There was no recurrence in the rest of cases,and the symptoms were disappeared.Conclusions In carefully selected cases,the lesions in orbit and orbital apex could be removed feasibly through transnasal endoscopic approach. Key words: Endoscope; Skull base surgery; Orbital apex lesion

Thoracic sympathectomy by Natural Orifice Trans Umbilical Surgery （NOTUS） for woman patients with palmar hyperhidrosis

Objective To investigate the clinical value of transumbilical endoscopic thoracic sympa- thectomy on women patients with palmar hyperhidrosis. Methods A total of 25 consecutive women patients with palmar hyperhidrosis underwent transumblical thoracic sympathectomy with ultra-thin endoscope. The operative data, including duration of operation, intra-operative and postoperative complications were recor- ded. Results The procedure was performed successfully in all 25 patients with a mean operative time of 64 min（58-113 min）. No umbilical hernia, diaphragmatic hernia, Homer＇s syndrome or hemothorax were observed. Minor pneumothorax was found in postoperative chest X-ray in 3 patients, all of which were com- pletely resolved with conservative treatment. All patients recovered to their normal life at 1 week after dis- charge. The scar was small and hidden in umbilical with no visible incisions. After a follow-up of 4 to 12 months, all patients＇ hands sweating symptoms completely disappeared, axillary sweat symptoms completely resolved in 6 patients, significantly improved in 4 and mildly improved in 1. Conclusion Trans- umbilical thoracic sympathectomy with ultrathin flexible endoscope is a safe and effective option for women patients with severe palmar hyperhidrosis, which provides excellent cosmetic outcomes. Key words: Hyperhidrosis ; Endoscopic surgery; Ultrathin gastroscope

Study on joint detection of serological markers in the diagnosis of Crohn's disease

Objective To explore the values of detecting anti-Saccharomyces cerevisiae antibody (ASCA) IgA,ASCA IgG,anti laminaribioside carbohydrate antibody (ALCA),anti-chitobioside carbohydrate antibody (ACCA) and anti mannobioside carbohydrate antibody (AMCA) and antibody against outer membrane porin C of Escherichia coli (anti-OmpC) in the diagnosis of Crohn's disease (CD).Methods From October 10th 2012 to January 24th 2013,63 patients diagnosed as CD were selected.At the same period 30 patients diagnosed as ulcerative colitis (UC) were set as disease control group and 25 individuals without abnormal findings under endoscope and imaging examination were set as healthy control group.Fasting blood of all the subjects were drawn in the morning and serum was isolated after centrifuge.The level of ASCA IgG,ALCA,AMCA,ACCA,ASCA IgA,anti OmpC and I2 was detected by indirect enzyme linked immunosorbent assay.The sensitivity,specificity,positive predictive value and negative predictive value of each antibody were calculated and its value in the diagnosis was evaluated by receiver operating characteristic (ROC) curve.Results In the differential diagnosis of CD and UC by single antibody test,the accuracy of AMCA was the highest and the area under ROC curve was 0.739.In the screening of CD with single antibody examination,the diagnosis accuracy of I2 antibody was the highest and the area under ROC curve was 0.751.In multi antibodies joint examination,the accuracy of either ASCA IgA or AMCA positive was the highest in the differential diagnosis of CD and UC,also in the screening of CD and the area under ROC curve was 0.612 and 0.633,respectively.Conclusion In clinical practice,CD screening and the differential diagnosis of CD and UC may be achieved through detecting AMCA,ASCA IgA and I2 antibody. Key words: Crohn disease; Antibodies; Enzyme-linked immunosorbent assay; Serological markers; Diagnosis

Application of neuroendoscope in microsurgical clipping to the intracranial aneurysm

Objective To explore the value of neuroendoscope in the intracranial aneurysm surgery.Methods To study 87 cases with aneurysms,treated between Janurary 2007 and September 2012,for whom the endoscope were used to assist the microsurgical treatment,of which 85 aneurysms were located in the anterior circulation and 2 were located in the basilar tip.the endoscope was used in 18 cases before clipping and in 87 cases after clipping to observe the anatomic features of necks and perforators,and to verify the optimal clipping position.Results Postoperative computed tomography angiography in 77 patients and digital subtraction angiography in 23 patients performed showed satisfactory aneurysm clipping.The clip was repositioned in ninteen aneurysm operations,and the second clip was used in1 case by endoscope.None case hadpostoperative complications directly related to endoscopy.Conclusions Endoscope is very useful during cerebral aneurysm surgery because of its ability in magnification,illumination,wide-angel and angulation.It can provide valuable information by better observation of regional anatomic features around aneurysm and improve the quality of aneurysm surgery. Key words: Neuroendoscope; Intracranial aneurysm; Aneurysm clipping

Peroral endoscopic full-thickness myotomy for severe esophageal achalasia

Objective To evaluate the efficacy and safety of peroral endoscopic full-thickness myoto- my for patients with severe esophageal achalasia. Methods A total of 64 patients with severe achalasia, whose Eckardt＇s score ≥6, esophageal diameter ≥6 cm or with S-type esophagus, were treated by peroral endoscopic full-thickness myotomy. Data of Eckardt＇s score, complications, recurrence, gastroscopy and esophageal barium radiography were collected before and during periodical follow-up. Results All the 64 patients underwent peroral endoscopic myotomy （POEM） successfully, mean operation time was 55 minutes, average length of tunnel and myotomy were 14. 1 cm and 10. 6 cm respectively, and full-thickness myotomy was performed beyond 6 cm near esophagogastric junction. Symptoms remitted in all patients. Eckardt＇s score decreased significantly [ pre-treatment VS post-treatment, （7.4 ± 1.5 ） VS （0. 6 ± 0. 8）, P 〈 0. 001 ], the diameter of esophageal lumen reduced[ pre-treatment VS post-treatment, （59.7 ± 13.0） mm VS （31.4 ±3.3） mm, P 〈 0. 001 ）, and the diameter of cardia increased [ pre-treatment VS post-treatment, （ 15.6 ± 10. 1 ）mm VS （33.4 ±8.9）mm, P 〈0. 001 ]. Complications occurred in 9. 4% （6/64） of the cases, gas-related complications was 6. 3% （4/64）. Treatment success was achieved in 98.4% cases （63/64） with a follow-up of 6-20 months （median 12. 3 months） , with no recurrence cases. Conchlsion Peroral endoscopic full-thickness myotomy is an effective and safe method for severe achalasia. Long-term efficacy and complications need further assessment. Key words: Esophageal achalasia; Endoscopes; Follow up; Endoscopic full-thickness myotomy

An animal experimental study on access to mediastinum with flexible endoscope via suprasternal fossa

Objective To evaluate the feasibility and safety of mediastinum examination with flexi- ble endoscope via suprasternal fossa. Methods A total of 20 healthy pigs were enrolled. Mediastinocosopy was performed via a tunnel to thoracix through a 1.5 cm incision on suprasternal fossa. Mediastinum was observed and complications were recorded. Results Mediastinocosopy was successfully achieved in all pigs. No severe bleeding or death occurred during the procedure. Five pigs got fever after the procedure with elevated white blood cell count. Four pigs had pneumothorax and three of them died in 1-6 days. Conclusion Mediastinocosopy with flexible endoscope through suprasternal fossa is feasible to diagnose mediastinal diseases,which can be important experimental evidence for the mini-invasive therapy of mediastimum diseases. Key words: Mediastinum; Animal experimentation; Diagnosis ; Flexible endoscope

Perioperative nursing of 20 cases with endoscope-assisted modified radical opera-tion for preserving nipple-areola and I-stage breast prosthesis reconstruction

Objective To explore perioperative major nursing in the treatment of patients with endoscope -assisted modified radi-cal operation for preserving nipple -areola andⅠ-stage breast prosthesis reconstruction.Methods A total of 20 cases of medical records were reviewed and nursing plan and methods were analyzed , nursing experiences were summarized.Results The 20 patients’reconstructed breasts were symmetrical with beautiful contour , the cases made a excellent functional recovery of the ipsilateral upper extremity.The pa-tients were followed up from five months to 29 months with an average of 15 months.There was no operative complication in these cases such as recurrence and metastasis.Conclusions The endoscope-assisted modified radical operation for preserving nipple -areola and I-stage breast prosthesis reconstruction has the advantages including less surgery trauma , rapid recovery and good cosmetic results.Given strength-ened perioperative nursing can decrease the occurrence of postoperative complications , improve the patient’s life quality and recovering. Key words: Breast cancer; Endoscope; Prosthesis replacement; Breast reconstruction; Nursing

Clinical analysis of intractable epistaxis under nasal endoscope in the treatment of elderly people

Objective To summarize the clinical experience of intractable epistaxis under nasal endoscope in the treatment of elderly people .Methods 312 cases of endoscope of intractable epistaxis patients were retrospectively analyzed.Results Nasal septum and olfactory corresponding head of middle turbinate bleeding site was mainly the upper part of the nasal cavity and the split-plot,back-end middle turbinate at the back of the nose and nasal were fol-lowed,as well as inferior turbinate and the rear end of inferior nasal meatus ,the Littell nasal septum of the front nose were bleeding less .After nasal endoscopic radio hemostatic therapy or local packing treatment with expansive sponge , 310 cases were cured,2 cases were invalid.The total efficiency was up to 99.4%.During the following 3 months,there was no recurrence .Conclusion For the elderly intractable epistaxis hemostatic therapy ,under nasal endoscope oper-ation method,radio hemostatic therapy or local packing treatment with expansive sponge is simple and effective ,which is worthy of popularization and application . Key words: Natural Orifice Endoscopic Surgery; Epistaxis

Clinical applications of dual plane breast augmentation under endoscope through transaxillary incision

Objective To introduce the technical key points and clinical efficacy of dual plane breast augmentation under endoscope through a transaxillary incision.Methods By analyzing the 89 surgical cases,we have summarized the key points of the pre-operative design,surgical skills and postoperative management.Results All patients had no uncontrolled bleeding during operation and loss of nipple and areola sensation.71 patients got 6-12 months follow-up,showing that only one case presented with unilateral capsular contraction,and the others had satisfied results.Conclusions Blunt dissection can reduce the risks of uncontrolled bleeding on the inner side of the pocket and the damage of the nerves on the lateral side of the dissecting pocket.The lower inner part,lower part and lower lateral part are the areas that could be sharply dissected by electrocautery under endoscope to achieve the dual plane Ⅰ.The drainage and bandage are necessary after the operation. Key words: Endoscope; Breast augmentation; Dual plane technique

Hospital, CDC Alarmed by “Superbug” on Reprocessed Endoscopes

Biomedical Safety & Standards 44(7):p 49-51, April 15, 2014. | DOI: 10.1097/01.BMSAS.0000445992.03218.45