Triple intramural dexamethasone injections increase the efficiency of endoscopic bougienage of esophageal re-stenosis and anastomosis

Purpose of the study. To analyze retrospectively our own experience of using intramural dexamethasone injections during endoscopic bougienage of recurrent or very tight (refractory) benign cicatricial strictures of the esophagus and esophageal anastomoses.Materials and methods. From 2013 to March 2021, this method was applied in 43 patients (26 — men, 17 — women) with peptic (11), cicatricial (8), burn (6) esophageal strictures and strictures of anastomoses (18) prone to restenosis. Dexamethasone was injected into the constricted area with a needle passed through the endoscope biopsy channel as an addition to supportive bougienage.Results. After dexamethasone injections, 41 (95.3%) of 43 patients achieved a satisfactory lumen diameter, at which the symptoms of dysphagia disappeared for a long time without relapse. In most patients, the lumen in the stricture zone stabilized at a diameter of 8–18 mm (average 13 mm). With strictures of the esophagus, it was possible to achieve a diameter of 8–14 mm (average 11 mm), and with strictures of the anastomoses — 10–18 mm (average 14 mm).Conclusion. With the tendency of stricture to restenosis, the standard algorithm for endoscopic bougienage, developed in the endoscopy department of the “Petrovsky National Research Center of Surgery”, was supplemented with intramural injections of dexamethasone. This combined endoscopic treatment made it possible to increase the diameter of the bougie and the intervals between bougienage due to the stabilization of the scar frame and to complete the endoscopic treatment with a satisfactory result in 95.3% of patients.

Comparative Study of Microbiological Monitoring Results from Three Types of Sampling Methods after Gastrointestinal Endoscope Reprocessing

Objective. Compare the effects of three sampling methods on the microbiological monitoring results after reprocessing of gastrointestinal endoscopes, providing scientific basis for improving the monitoring quality of gastrointestinal endoscope cleaning and disinfection. Method. Gastrointestinal endoscopes after reprocessing were selected randomly at the gastrointestinal endoscopy center of a tertiary hospital in Shanghai from October 2018 to February 2019. The endoscopes selected were all sampled in three different methods under continuous sampling and intermittent sampling respectively. Methods used includes, the biopsy channel group (Group A), the entire channel group (Group B), and the disc brush group (Group C). Then the colony forming units (CFU/piece) were counted in the laboratory. Results. A total of 12 endoscopes were sampled by using continuous sampling approach, in which the detection rate of bacteria in disc brush group (33.3%) and entire channel group (33.3%) was higher than biopsy channel group (8.3%). Among the 12 endoscopes sampled with intermittent approach, the detection rate of bacteria from high to low was the disc brush group (50%), the entire channel group (41.7%), and the biopsy channel group (8.3%). Conclusion. Different sampling methods will lead to the difference of microbiological culture results after reprocessing of gastrointestinal endoscope, indicating that the improved sampling method is beneficial to objectively reflect the endoscope cleaning and disinfection effect, and improve the monitoring quality of endoscope disinfection.

Analyses of the Temperature Field of a Piezoelectric Micro Actuator in the Endoscopic Biopsy Channel

Micro actuators have been used to realize the arrival of digestive tract lesions for the local targeted application of drugs in endoscopes. However, there still exists a key safety issue that casts a shadow over the practical and safe implementation of actuators in the human body, namely an overheated environment caused by actuators’ operation. Herein, with the aim of solving the temperature rising problem of a piezoelectric micro actuator operating in an endoscopic biopsy channel (OLYMPUS, Tokyo, Japan), a thermal finite element method (FEM) based on COMSOL Multiphysics software is proposed. The temperature distribution and its rising curves are obtained by the FEM method. Both the simulated and experimental maximum temperatures are larger than the safety value (e.g., 42 °C for human tissues) when the driving voltage of the actuator is 200 Vpp, which proves that the overheating problem really exists in the actuator. Furthermore, the results show that the calculated temperature rising curves correspond to the experimental results, proving the effectiveness of this FEM method. Therefore, we introduce a temperature control method through optimizing the duty ratio of the actuator. In comparison with a 100% duty ratio operation condition, it is found that a 60% duty ratio with a driving voltage of 200 Vpp can more effectively prevent the temperature rising issue in the first 3 min, as revealed by the corresponding temperatures of 44.4 and 41.4 °C, respectively. When the duty ratio is adjusted to 30% or less, the temperature rise of the actuator can be significantly reduced to only 36.6 °C, which is close to the initial temperature (36.4 °C). Meanwhile, the speed of the actuator can be well-maintained at a certain level, demonstrating its great applicability for safe operation in the human body.

Photodynamic therapy in the treatment of stomach cancer

The analysis of the results of treatment of 10 patients with gastric cancer with high surgical risk, who in the treatment complex used photodynamic therapy with photosensitizer Photolon and further irradiation with a semiconductor laser with a wavelength of λ = 0.67 μm cross-irradiation fields introduced through the biopsy channel of the endoscope. Endoscopic PDT can be used at the stage of combined treatment in combination with drug therapy and surgical interventions and is an effective means of preventing the development of esopha- geal-small intestinal anastomosis failures in the early postoperative period. Endoscopic PDT can also be used in the postoperative period as a prophylaxis of early postoperative complications in cases of detection of tumor cells in the margins of resection.

Intraductal Ultrasonography in Pancreatobiliary Diseases

ABSTRACTIntraductal ultrasonography (IDUS) utilizes probe catheter and operates at a higher frequency (12–30 MHz). It can be passed down the biopsy channel of a side‑view endoscope during endoscopic retrograde cholangiopancreatography, and it provides real‑time, high‑quality imaging of pancreatobiliary ducts and the surrounding structures. IDUS has been used in defining choledocholithiasis, evaluating biliary as well as pancreatic strictures or thickening, and local staging of tumor. We shall discuss the utility of IDUS in the current review.

Novel laryngoscopic strategies to improve evaluation of the site and extent of primary hypopharyngeal tumours

Objective:To investigate different strategies for displaying the hypopharynx and oesophageal entrance during laryngoscopy for hypopharyngeal cancer.Patients and methods:A total of 113 patients with hypopharyngeal cancer underwent laryngoscopy prior to surgery. The hypopharynx was displayed by: (1) pulling the anterior cervical skin; (2) having the patient perform the Valsalva balloon-blowing manoeuvre; and (3) injecting oxygen through the biopsy channel to expose the oesophageal entrance. The effect of these methods on visualisation of primary tumour size and extent was assessed.Results:During pronunciation of the letter ‘e', the hypopharynx was displayed in only 33 patients (29.2 per cent); with anterior cervical skin traction plus the balloon-blowing manoeuvre, the hypopharynx was displayed in 106 patients (93.8 per cent; p < 0.001). The combined strategy was superior especially when judging the extent of posterior pharyngeal wall and postcricoid invasion. Oesophageal entrance involvement was visible in 33 patients upon injecting oxygen through the laryngoscopic biopsy channel, and in 25 patients during radiological examination; laryngoscopy was superior to radiological examination in determining the extent of oesophageal entrance invasion (p = 0.003).Conclusion:Adequate laryngoscopic display of the hypopharynx could increase the accuracy of pre-treatment hypopharyngeal cancer staging.

Novel Jumbo Biopsy Forceps for Surveillance of Inflammatory Bowel Disease: A Comparative Retrospective Assessment

Background and Study Aims. Most available jumbo cup forceps require a 3.7 mm biopsy channel, necessitating the use of standard-sized colonoscope. A newer jumbo forceps (Radial Jaw 4 Jumbo Biopsy Forceps [RJ4]) fits within a 3.2 mm biopsy channel, allowing use with a pediatric colonoscope. To assure the RJ4 did not alter biopsy adequacy, we compared the size and quality of specimens to a historical jumbo cup forceps (Radial Jaw 3 Max Capacity Biopsy Forceps, [RJ3 MC]).Patients and Methods. A retrospective comparative study of biopsies taken with either forceps. Biopsies were compared for diameter, depth, crush artifact, and acceptability for diagnosis.Results. 333 specimens were taken with RJ4 and 335 specimens with the RJ3 MC. Mean sample diameter was 4.45 mm and 4.55 mm for the RJ4 and RJ3 MC (). Mean depth of biopsies with the RJ4 was greater ().Conclusions. Biopsies from the RJ4 are similar in size and quality to biopsies from the RJ3 MC. The RJ4 has the advantage of fitting in a smaller biopsy channel.

Extensive Atrophic Gastritis Increases Intraduodenal Hydrogen Gas

Objective. Gastric acid plays an important part in the prevention of bacterial colonization of the gastrointestinal tract. If these bacteria have an ability of hydrogen (H2) fermentation, intraluminal H2 gas might be detected. We attempted to measure the intraluminal H2 concentrations to determine the bacterial overgrowth in the gastrointestinal tract.Patients and methods. Studies were performed in 647 consecutive patients undergoing upper endoscopy. At the time of endoscopic examination, we intubated the stomach and the descending part of the duodenum without inflation by air, and 20 mL of intraluminal gas samples of both sites was collected through the biopsy channel. Intraluminal H2 concentrations were measured by gas chromatography.Results. Intragastric and intraduodenal H2 gas was detected in 566 (87.5%) and 524 (81.0%) patients, respectively. The mean values of intragastric and intraduodenal H2 gas were8.5±15.9and13.2±58.0 ppm, respectively. The intraduodenal H2 level was increased with the progression of atrophic gastritis, whereas the intragastric H2 level was the highest in patients without atrophic gastritis.Conclusions. The intraduodenal hydrogen levels were increased with the progression of atrophic gastritis. It is likely that the influence of hypochlorhydria on bacterial overgrowth in the proximal small intestine is more pronounced, compared to that in the stomach.

A new technique for the management of inaccessible anterior glottic lesions

We describe a new technique for removing anterior vocal fold lesions, which cannot be visualized with conventional suspension laryngoscopy. These situations are rare and the only alternative surgeons have had previously is an open laryngeal procedure. The technique we describe involves the use of a laryngeal mask airway (LMA), a flexible bronchoscope with biopsy channel, a 400 μm laser fibre and KTP/532 nm laser. This method was used to treat two patients in whom conventional suspension laryngoscopy had previously been attempted and abandoned.