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| 1 | Non-polypoid colorectal neoplasms:Classification,therapy and follow-up显示文摘In the last years,an increasing interest has been raised on non-polypoid colorectal tumors(NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally,called laterally spreading tumors(LST).LSTs and large sessile polyps have a greater frequency of high-grade dysplasia and local invasiveness as compared to pedunculated lesions of the same size and usually represent a technical challenge for the endoscopist in terms of either diagnosis and resection.According to the Paris classification,NPTs are distinguished in slightly elevated(0-Ⅱa,less than 2.5 mm),flat(0-Ⅱb) or slightly depressed(0-Ⅱc).NPTs are usually flat or slightly elevated and tend to spread laterally while in case of depressed lesions,cell proliferation growth progresses in depth in the colonic wall,thus leading to an increased risk of submucosal invasion(SMI) even for smaller neoplasms.NPTs may be frequently missed by inexperienced endoscopists,thus a careful training and precise assessment of all suspected mucosal areas should be performed.Chromoendoscopy or,if possible,narrow-band imaging technique should be considered for the estimation of SMI risk of NPTs,and the characterization of pit pattern and vascular pattern may be useful to predict the risk of SMI and,therefore,to guide the therapeutic decision.Lesions suitable to endoscopic resection are those confined to the mucosa(or superficial layer of submucosa in selected cases) whereas deeper invasion makes endoscopic therapy infeasible.Endoscopic mucosal resection(EMR,piecemeal for LSTs > 20 mm,en bloc for smaller neoplasms) remains the first-line therapy for NPTs,whereas endoscopic submucosal dissection in high-volume centers or surgery should be considered for large LSTs for which en bloc resection is mandatory and cannot be achieved by means of EMR.After piecemeal EMR,follow-up colonoscopy should be performed at 3 mo to assess resection completeness.In case of en bloc resection,surveillance colonoscopy should be scheduled at 3 years for adenomatous lesions ≥ 1 cm,or in presence of villous features or high-grade dysplasia patients(regardless of the size),while less intensive surveillance(colonoscopy at 5-10 years) is needed in case of single(or two) NPT < 1 cm presenting tubular features or low-grade dysplasia at histology. | Antonio Facciorusso Matteo Antonino Marianna Di Maso Michele Barone Nicola Muscatiello | 2015 | World Journal of Gastroenterology2015，21，17： | 20 |
| 2 | 结直肠息肉切除术后并发出血的研究进展显示文摘出血、术后电凝综合征、穿孔和腹部不适是内镜下结直肠息肉切除术的主要并发症,其中又以出血最为常见,对医院及患者均是较大的负担。本文对结直肠息肉切除后并发出血的研究进展作一综述,旨在加深对此种并发症的认识,以便指导临床工作。 | 解曼 赵清喜 田字彬 | 2019 | 中华消化内镜杂志2019，36，8： | 16 |
| 3 | 血凝酶与肾上腺素在内镜下黏膜切除、息肉电切术中预防出血作用的随机对照研究显示文摘目的比较血凝酶与1∶10000肾上腺素用于消化内镜下黏膜切除术(endoscopic mucosal resection,EMR)、扁平息肉摘除术的预防出血作用和安全性。方法选择2007年4~11月在我院内镜中心因食管、胃、结肠局部病变行内镜下EMR者60例,随机分为血凝酶组和肾上腺素组,每组30例。于病变基底部注射血凝酶或肾上腺素液体垫至病变抬起,行EMR或分次内镜下黏膜切除术(endoscopic piecemeal mucosal resection,EPMR)。切除后观察切缘残端有无出血。操作中监测患者血压、心率,记录不良反应(心悸、头晕、疼痛、恶心等)。结果即刻出血血凝酶组1例(1/30,3%),肾上腺素组6例(6/30,20%),2组差异无显著性(χ2=2.588,P=0.108),24小时2组均无出血病例。血凝酶组和肾上腺素组液体垫注射剂量分别为(11.0±6.0)ml(5~30ml)和(11.9±7.0)ml(5~28ml),差异无显著性(t=-0.535,P=0.595)。肾上腺素组注射液体垫后平均动脉压和心率均较注射前明显升高[平均动脉压:注射前(96.9±7.9)mmHg,注射后(99.9±8.1)mmHg,t=-3.005,P=0.005;心率:注射前(79.8±7.9)次/min,注射后(84.3±8.1)次/min,t=-3.585,P=0.001],血凝酶组无显著性变化。注射后肾上腺素组5例出现一过性头晕伴心悸,2例食管病变患者出现注射部位明显疼痛,血凝酶组患者无明显不适。结论血凝酶作为内镜下黏膜切除术、扁平息肉摘除的液体垫成分,预防出血效果与肾上腺素相同而无明显不良反应。 | 李文燕 冀明 张澍田 | 2009 | 中国微创外科杂志2009，9，11： | 7 |
| 4 | 注射肾上腺素辅助镜下高频电切除结肠巨大广基息肉19例显示文摘目的探讨黏膜下注射肾上腺素生理盐水辅助镜下高频电切除结肠巨大广基息肉的适用价值。方法对2006年5月至2008年11月该院消化科收治的19例结肠巨大广基息肉患者,先采用黏膜下注射肾上腺素生理盐水,再行高频电切除治疗息肉。结果19例结肠息肉均完整切除。无1例肠穿孔,仅1例并发迟发性出血,出血量少,很快控制,出血率5.3%。结论黏膜下注射肾上腺素生理盐水辅助镜下高频电切除结肠广基息肉,具有一定的适用价值,值得推广,有进一步研究的必要。 | 马祖帅 别文华 卢秀英 彭波 | 2010 | 重庆医学2010，39，1： | 4 |
| 5 | 内镜黏膜下剥离术及黏膜切除术后出血局部用药进展显示文摘出血是内镜黏膜下剥离术(ESD)及内镜黏膜切除术(EMR)的常见并发症之一,ESD术后出血发生率为1.3%~11.9%,EMR略低。内镜下局部药物注射/喷洒是预防尤其是治疗ESD、EMR术后出血的重要手段,并与热凝止血(高频电凝、氩离子凝固术、热探头、微波等)和机械止血(止血夹、套扎等)成为内镜干预的主要方式。 | 潘骏 李兆申 | 2017 | 中华消化内镜杂志2017，34，3： | 3 |
| 6 | 内镜黏膜切除术治疗老年人结肠息肉临床观察显示文摘目的探讨内镜黏膜切除术(EMR)对于老年人结肠息肉治疗的安全性和疗效。方法回顾性分析118例行EMR治疗的老年人结肠息肉患者的临床资料。结果 118例中增生性息肉7例,腺瘤71例,炎性息肉31例,高级别上皮内瘤变6例,早期癌3例。3例为局部癌变且黏膜下浸润,转外科手术治疗;1例出现短暂的凝固综合征;其余114例,病灶切除完整,无一例出现大出血及穿孔等并发症。术后1个月左右复查内镜,创面愈合情况良好,术后1年内均未见病灶复发征象。结论 EMR治疗老年人结肠息肉安全、有效。 | 陈新宇 张虹 戴一扬 郑培奋 程玲 | 2011 | 现代实用医学2011，23，5： | 3 |
| 7 | 大肠息肉内镜下治疗术后并发症分析显示文摘目的:探讨内镜下治疗大肠息肉并发症的预防措施。方法:2005-01-2011-01住院内镜下治疗大肠息肉患者741例,分别采用单纯高频电切除术和高频电切除息肉前行预处理两种方法对大肠息肉进行治疗观察其并发症的发生情况。结果:行预处理的大肠息肉术后并发症的发生率较未处理的明显降低。结论:对于大息肉及巨大息肉,内镜下切除前应采取干预措施以预防出血、穿孔等并发症的发生,值得临床推广。 | 贺明 滑利民 代文洁 张可 周长江 | 2013 | 临床急诊杂志2013，14，6： | 2 |
| 8 | Ankaferd hemostat in the management of gastrointestinal hemorrhages显示文摘Gastrointestinal (GI) bleeding refers to any hemorrhage ascribed to the pathologies of the gastrointestinal tract,extending from the mouth to the anal canal.Despite the recent improvements in the endoscopic,hemostatic and adjuvant pharmacologic techniques,the reported mortality is still around 5%-10% for peptic ulcer bleeding and about 15%-20% for variceal hemorrhages.Although endoscopic management reduces the rates of re-bleeding,surgery,and mortality in active bleeding;early recurrence ratios still occur in around 20% of the cases even with effective initial hemostatic measures.In this quest for an alternative pro-hemostatic agent for the management of GI bleedings,Ankaferd blood stopper (ABS) offers a successful candidate,specifically for 'difficult-to-manage' situations as evidenced by data presented in several studies.ABS is a standardized mixture of the plants Thymus vulgaris,Glycyrrhiza glabra,Vitis vinifera,Alpinia officinarum,and Urtica dioica.It is effective in both bleeding individuals with normal hemostatic parameters and in patients with deficient primary and/or secondary hemostasis.ABS also modulates the cellular apoptotic responses to hemorrhagic stress,as well as hemostatic hemodynamic activity.Through its effects on the endothelium,blood cells,angiogenesis,cellular proliferation,vascular dynamics,and wound healing,ABS is now becoming an effective alternative hemostatic medicine for gastrointestinal bleedings that are resistant to conventional anti-hemorrhagic measurements.The aim of this review is to outline current literature experience suggesting the place of ABS in the management of GI bleeding,and potential future controlled trials in this complicated field. | Yavuz Beyazit Murat Kekilli Ibrahim C Haznedaroglu Ertugrul Kayacetin Metin Basaranoglu | 2011 | World Journal of Gastroenterology2011，17，35： | 1 |
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