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Diagnostic endoscopic ultrasonography:Assessment of safety and prevention of complications

World Journal of Gastroenterology 2012年第34期18卷 4659-4676页

作者： Christian Jenssen Maria Victoria Alvarez-Sánchez Bertrand Napoléon siegbert faiss Department of Internal Medicine Krankenhaus M rkisch-Oderland GmbHD15344 StrausbergGermany Department of Gastroenterology and Hepatology Hopital Privé Jean MermozF69008 LyonFrance Department of Gastroenterology and Hepatology Asklepios Klinik BarmbekD22291 HamburgGermany

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

关键词：内视镜的 ultrasonography 内视镜的指导 ultrasonography 的好针的活体检视复杂并发症禁止徵候风险安全穿孔流血感染尖锐胰腺炎

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New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum:A case series

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World Journal of Gastroenterology 2017年第17期23卷 3084-3091页

作者： Johanna Wilmsen Robert Baumbach Dietmar Stüker Vincens Weingart Frank Neser Stefan Karl Golder Christof Pfundstein Ellen Claudia Notzel Thomas Rosch siegbert faiss Department of Gastroenterology and Interventional Endoscopy Asklepios Hospital BarmbekSemmelweis UniversityMedical Faculty Department of Interdisciplinary Endoscopy University Medical Center Tübingen Department of Internal Medicine Garmisch-Partenkirchen Medical Center Department of Internal Medicine II Hospital Chemnitz Department of Internal Medicine III Private Practice for Internal Medicine and Gastroenterology Department of Internal Medicine and Gastroenterology Sana Hospital Lichtenberg Department of Interdisciplinary Endoscopy University Medical Center Hamburg-Eppendorf

AIM To report about the combination and advantages of a tapler-assisted diverticulotomy performed by flexible endoscopy.METHODS From November 2014 till December 2015 17 patients(8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum(mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler(Micro Cutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.RESULTS In eleven patients(64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm(range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients(35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients(44.4%) were free of symptoms, 5 patients(55.6%) stated an improvement. A relapse of symptoms did not occur. CONCLUSION Flexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.

关键词： Zenkers 憩室灵活内视镜的治疗 Stapler 技术 Overtube 外科的 stapler

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Repeat full-thickness resection device use for recurrent duodenal adenoma: A case report

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World Journal of Gastrointestinal Endoscopy 2020年第6期12卷 193-197页

作者： Maximilian Gericke Matthias Mende Uwe Schlichting Gerald Niedobitek siegbert faiss Department of Gastroenterology Sana Klinikum LichtenbergBerlin 13065Germany Department of Pathology Sana Klinikum LichtenbergBerlin 13065Germany

BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique.There have been several recent studies of full-thickness resection device(FTRD)use in the colon,but data regarding its use and efficacy in the duodenum are still limited.CASE SUMMARY A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior.The biopsies revealed a low-grade adenoma.The adenoma was removed using the gastroduodenal FTRD,and the pathology results revealed clear margins.Except for minor bleeding that was treated by argon plasma coagulation,no further complications occurred.CONCLUSION Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions.Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.

关键词： Endoscopic full-thickness resection Full-thickness resection device Duodenum Duodenal adenoma Endoscopy Case report

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