中国北方单中心 3 年回顾性研究：上消化道枣核嵌顿的个体化内镜处理策略。
Individualized endoscopic management strategy for impacting jujube pits in the upper gastrointestinal tract: a 3-year single-center experience in northern China.
机构信息
Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China.
Department of Gastroenterology and Hepatology, The First Hospital of Harbin, Harbin, China.
出版信息
BMC Surg. 2021 Jan 6;21(1):18. doi: 10.1186/s12893-020-01008-y.
BACKGROUND
Impaction of jujube pits in the upper gastrointestinal (GI) tract is a special clinical condition in the northern Chinese population. Endoscopic removal is the preferred therapy, but there is no consensus on the management strategies. We reported our individualized endoscopic strategies on the jujube pits impacted in the upper GI tract.
METHODS
In this retrospective study, we included 191 patients (male: 57; female: 134) who presented to our hospital with ingestion of jujube pits between January 2015 and December 2017. Demographic information, times of hospital visiting, locations of jujube pits, endoscopic procedures, post-extraction endoscopic characteristics were analyzed. Management strategies including sufficient suction, repeated irrigation, jejunal nutrition and gastrointestinal decompression were given based on post-extraction endoscopic characteristics and impacted locations.
RESULTS
Peak incidence was in the second quarter of each year (85/191 cases, 44.5%). Among the 191 cases, 169 (88.5%) showed pits impaction in the esophagus, 20 (10.5%) in the prepyloric region and 2 (1.0%) in the duodenal bulb. A total of 185 patients (96.9%) had pits removed with alligator jaw forceps, and 6 (3.1%) underwent suction removal with transparent caps placed over the end of the endoscope to prevent injury on removal of these pits with two sharp painted edges. Post-extraction endoscopic manifestations included mucosal erosion (26.7%), mucosa laceration (24.6%), ulceration with a white coating (18.9%) and penetrating trauma with pus cavity formation (29.8%). All patients received individualized endoscopic and subsequent management strategies and showed good outcomes.
CONCLUSIONS
Individualized endoscopic management for impacted jujube pits in the upper GI tract based on post-extraction endoscopic characteristics and impacted locations was safe, effective, and minimally invasive.
背景
在中国北方人群中，胃食管（GI）上段的枣核嵌顿是一种特殊的临床情况。内镜下取除是首选治疗方法，但在管理策略上尚未达成共识。我们报告了我们针对胃食管上段枣核嵌顿的个体化内镜策略。
方法
在这项回顾性研究中，我们纳入了 191 例（男性 57 例，女性 134 例）于 2015 年 1 月至 2017 年 12 月期间因食用枣核就诊于我院的患者。分析了人口统计学资料、就诊次数、枣核位置、内镜操作、取除后内镜特点。根据取除后内镜特点和嵌顿位置，给予充分吸引、反复冲洗、空肠营养和胃肠减压等管理策略。
结果
高发季节在每年的第二季度（85/191 例，44.5%）。191 例患者中，169 例（88.5%）食管段有枣核嵌顿，20 例（10.5%）在幽门前区，2 例（1.0%）在十二指肠球部。185 例（96.9%）患者使用鳄嘴钳取出枣核，6 例（3.1%）患者使用透明帽吸引取出，将透明帽置于内镜末端，以防止取除这 6 例具有两个锐利划纹边缘的枣核时造成损伤。取除后内镜表现包括黏膜糜烂（26.7%）、黏膜撕裂（24.6%）、溃疡伴白色涂层（18.9%）和穿透性创伤伴脓肿腔形成（29.8%）。所有患者均接受个体化内镜和后续管理策略，均获得良好结局。
结论
根据取除后内镜特点和嵌顿位置，对胃食管上段枣核嵌顿进行个体化内镜管理是安全、有效且微创的。
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