简介：Middleearsurgeryisusuallyperformedusingasurgicalmicroscope.Initially,inotorhinolaryngologypractice,endoscopeswereusedforparanasalsinussurgeries.Itwasonlylaterthattheywereappliedintheareaofotology.Inotologicsurgeries,endoscopeswerefirstusedtovisualizethemiddleear,beforebeingusedtoassistwithvisualizationofinstrumentsduringcholesteatomasurgeries,althoughtheyarestillnotusedaloneinvariousotologicsurgeries.Asinothersurgicalfields,thereisalsoatrendtowardsminimallyinvasiveinterventioninthefieldofotorhinolaryngology.Smallerincisionsperformedundertheguidanceofendoscopesarepreferredoverconventionallargeincisions.Usingthisapproach,improvedoutcomescanbeachievedandpostoperativemorbiditiescanbereduced.Inaddition,theoutcomesofgraftsperformedusingtheendoscopicapproacharesimilartothatachievedbythemicroscopicapproach.Therefore,endoscopicearsurgeryimplementationsarebecomingincreasinglypopular.

简介：ThisworkisconductedinMansouraUniversityHospitals,Egypt,toshowtheadvantagesanddisadvantagesofendoscopicstapedotomyincomparisontomicroscopicstapedotomy.Theworkdescribedhasnotbeenpublishedpreviouslynorunderconsiderationforpublicationelsewhere.Theauthorsdeclarethatthereisnoconflictofinterest.ThisstudyisapartofamasterdegreethesissubmittedbyEslamMahmoudaspartialfulfillmentforamasterdegree.Institutionalreviewboardapproval,FacultyofMedicine-MansouraUniversity,wasobtainedforthestudy(IRB:MS/15.09.49).

简介：摘要Endoscopic ultrasound (EUS) has both diagnostic and therapeutic clinical applications. This review article focuses on recent advances in two commonly performed procedures: EUS-guided tissue acquisition and EUS-guided drainage. There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses. There is growing interest and research about artificial intelligence in EUS. Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic. The range of EUS-guided drainage procedures has expanded. EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option. EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) is now an accepted alternative to percutaneous transhepatic biliary drainage. EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates. Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction, and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible, but further prospective randomized studies are needed to establish the actual clinical impact.

简介：AbstractThe surgical approach to lesions of the ventral craniovertebral junction (CVJ) has evolved significantly in the last several years with the advent of endoscopic skull base surgery. Differing pathologies of the CVJ can result in irreducible compression of the cervicomedullary region. The endoscopic endonasal approach lends itself well to this region due to the ventral location, and while there is a steep learning curve, is a safe and effective way to perform decompression of the cervicomedullary region. Herein, we discuss the anatomy of the CVJ, preoperative evaluation and surgical considerations, our surgical approach, complications, and outcomes.

简介：OBJECTIVETodeservetheeffectsofFG(FibrinGlue)onendoscopicliposuction.Methods:FromOct.1998toAug.2000fortycaseswereundergoingfortheliposuction.Attheaidsoftumescentteachnique,endoscopyandFGwereused,ofwhich20casesoperationontheirabdominalwalls,8casesupperabdomenwallsand12casesownerabdominal.

简介：Endoscopicsubmucosaldissection(ESD)inventedinJapan,playsanimportantroleinthetreatmentofearlygastrointestinalcancer(EGC)anddysplasia.Endoscopicproceduresarenowwidelyspreadingaroundtheworld.ESDhastheadvantagethatenblocresectionaswellaspathologicalviewcanbeachievedwhencomparedwithconventionalendoscopicmucosalresection(1).Thankstothe

简介：AbstractObjective:The aim of this study was to analyze the outcomes and complications of endoscopic tympanoplasties and review the strategies for endoscopic revision surgeries.Methods:Revision endoscopic surgeries are performed on patients with unsatisfactory outcomes after endoscopic tympanoplasties. This study was approved by the Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China (approval No. 2020-0045-1).Results:Residual or recurrent tympanic membrane marginal perforation is treated by autogenous fat and cartilage grafting; graft collapse is treated using tissue from the tragus; and graft displacement is treated by endoscopic fixation of the cartilage-perichondrium complex. Lateral healing of the tympanic membrane, prosthesis fracture, prosthesis extrusion, middle ear adhesions, and recurrent perforation also required revision surgeries.Conclusion:Residual or recurrent tympanic membrane marginal perforation is the most common cause of unsatisfactory outcomes after endoscopic tympanoplasty; fat grafting is effective only for small perforations. Small cartilage grafts are an effective means of dealing with residual marginal perforation; the cartilage and perichondrium complex should be fixed securely. Patients with prosthesis implants require regular examination.

简介：AbstractEndoscopic endonasal orbital surgery is evolving. With increasing knowledge, expertise, and technology, the historical limits of the endonasal endoscopic approach to the orbit have been redefined. This review discusses the clinical presentation and etiology, and highlights the pertinent anatomy, and discusses the diagnostic workup and surgical approach to orbital tumors and post-operative care. The role of the multidisciplinary team is not to be underestimated. The introduction of a classification system to ensure standardization of technical difficulty and outcome data will assist with international collaboration and further consolidate our attainment of knowledge in this developing field.

简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AbstractEndoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.

简介：AbstractThe contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

简介：Objective:Toinvestigatethefeasibilityoftranscanalendoscopicmyringoplastyinthehandofyoungbeginnersurgeonswhohadjustcompletedtheresidencyprogramme.Methods:Inathreeyearperiod(August2012toAugust2015),44earsin42patientswereoperateduponbyabeginnersurgeonthroughthetranscanalendoscopicapproachinasubdistrictlevelhospitallocatedinthenorthwesternrangesoftheHimalayanregion.Results:Ofthe42patient,19weremaleand23female.Themeanagewas26.23years(range:15e47years).In40ears,completeperforationclosurewasachievedatsixmonths(successrate:90.9%).ThemeanairconductionPTApreoperativelywas40.84dBHLandimprovedto28.06dBHLpostoperatively(p<.001).ThemeanABgappreoperativelywas22.40dB,whichimprovedto9.1dBpostoperatively(p<.001).Conclusion:Endoscopictranscanalmyringoplastyissafeandreliableeveninyoungbeginners'hands.Surgeonscanconsiderendoscopicapproachearlyintheircareerswithoutthefearoflearningcurve.Thecostofendoscopicequipmentisaboutonetenthascomparedtoopenapproachunderaoperatingmicroscope,andanaddedadvantage.

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简介：AbstractBackground:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy-two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6-83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5-year follow-up, reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5-year survival is 91.1%.

简介：AbstractBackground and objective:Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.Methods:The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.Results:In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.Conclusion:Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

简介：AIM:ToevaluatetheefficacyandsafetyofN-butyl-2-cyanoacrylateintreatingacutebleedingofgastricvaricesinchildren.METHODS:Theretrospectivestudyincluded21childrenwith47episodesofactivegastricvaricealbleedingwhoweretreatedbyendoscopicinjectionofN-butyl-2-cyanoacrylateatAsanMedicalCenterChildren’sHospitalbetweenAugust2004andDecember2011.Toreducetheriskofembolism,eachinjectionconsistedof0.1-0.5mLof0.5mLN-butyl-2-cyanoacrylatedilutedwith0.5or0.8mLLipiodol.Theprimaryoutcomewasincidenceofhemostasisaftervaricealobliterationandthesecondaryoutcomewascomplicationoftheprocedure.RESULTS:The21patientsexperienced47episodesofactivegastricvaricealbleeding,includingrebleeding,forwhichtheyreceivedatotalof52cyanoacrylateinjections.Following42bleedingepisodes,hemostasiswasachievedafteroneinjectionandfollowingfivebleedingepisodesitwasachievedaftertwoinjections.Themeanvolumeofeachsinglealiquotofcyanoacrylateinjectedwas0.3±0.1mL(range:0.1-0.5mL).Injectionachievedhemostasisin45of47(95.7%)episodesofacutegastricvaricealbleeding.Elevenpatients(52.4%)developedrebleedingevents,withthemeandurationofhemostasisbeing11.1±11.6mo(range:1.0-39.2mo).Notreatment-relatedcomplicationssuchasdistalembolismwerenotedwiththeexceptionofabdominalpaininonepatient(4.8%).Amongfourmortalities,onepatientdiedofvaricealrebleeding.CONCLUSION:Endoscopicvaricealobliterationusingasmallvolumeofaliquotswithrepeatedcyanoacrylateinjectionwasaneffectiveandsafeoptionforthetreatmentofgastricvaricesinchildren.

简介：AIM:Toinvestigatetheaccuracyofendoscopicorbiopsydiagnosesofsuperficialnonampullaryduodenalepithelialtumors(NADETs).METHODS:Clinicopathologicaldatawerereviewedfor84superficialNADETsfrom74patientswhounderwentsurgeryorendoscopicresectionbetweenSeptember2002andAugust2014atasingleprefecturalcancercenter.SuperficialNADETsweredefinedaslesionsconfinedtothemucosaorsubmucosa.Demographicandclinicopathologicaldatawereretrievedfromcharts,endoscopicandpathologicreports.Endoscopicreportsincludedendoscopicdiagnosis,location,grosstype,diameter,color,andpresenceorabsenceofbiopsy.Endoscopicdiagnosesweremadebyanendoscopistinchargeoftheexaminationbeforebiopsyspecimenswereobtained.Endoscopicimageswereobtainedusingroutine,front-view,high-resolutionvideoendoscopy,andchromoendoscopywithindigocarminewasperformedforalllesions.Endoscopicimageswerereviewedbyatleasttwoendoscopiststoassessendoscopicfindingsindicativeofcarcinoma.Preoperativediagnosesbasedonendoscopyandbiopsyfindingswerecomparedwithhistologicaldiagnosesofresectedspecimens.Sensitivity,specificity,andaccuracywereassessedforendoscopicdiagnosisandbiopsydiagnosis.RESULTS:Themajority(81%)ofthelesionswerelocatedinthesecondportionoftheduodenum.Themedianlesiondiameterwas14.5mmaccordingtofinalhistology.Surgerywasperformedfor49lesionsfrom39patients,and35lesionsfrom35patientswereendoscopicallyresected.Finalhistologyconfirmed65carcinomas,15adenomas,and3hyperplasias.Afinaldiagnosisofduodenalcarcinomawasmadefor91%(52/57)ofthelesionsdiagnosedascarcinomabyendoscopyand93%(42/45)ofthelesionsdiagnosedascarcinomabybiopsy.Thesensitivity,specificity,andaccuracyofendoscopicdiagnoseswere80%,72%,and78%,respectively,whereasthoseofbiopsydiagnoseswere72%,80%,and74%,respectively.Preoperativediagnosesofcarcinomasweremadein88%(57/65)ofthecarcinomalesionsviaendoscopyorbiopsy.En

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简介：Objective:Tostudythetechniquesofplacementofmemoryalloyplatinggoldbiliarystentandplasticstentforpalliationofmalignantandbenignbiliaryobstruction,andtoassessitsclinicaleffectiveness.Methods:Thepatientsinplasticstentgroupincludedpaplillaofduodenuminflamationalstrictures(n=24),commonbileductinflammationalinferiorsegmentstrictures(n=4),choledocholithiasis(n=5),bileleak(n=11),bileductsurgeryinjurey(n=7)andpancreaticcarcinoma(n=1).Thepatientsinplatinggoldstentgroupincludedcommonbileductcarcinoma(n=5)andpancreaticcarcinoma(n=6).Underfluoroscopicguidancethestentwasinsertedintobiliaryobstructionsitesfromoralcavityinallcases.Complications,liverfunctionandbloodserumamylasewereinvestigatedduringthestudyperiod.Results:Successfulstentplacementwasachievedinallcases.Afteroperationof7days,ingoldbiliarystentgroups,theratesofdecreaseofbloodserumtotalbilirubin,glutamic-pyruvictransaminase,r-glutamyltranspeptidaseandalkalinephosphatasewere67.16%,58.37%,40.63%and41.54%respectively.Inplasticstentgroup,theratesofdecreaseofSTB,ALT,r-GTandAKPwere53.24%,55.03%,37.15%,34.12%respectively.Earlycomplicationincludedpost-ERCPpancreatitisandcholangititis.Occlusionofstentwasthemajorlatecomplication.Conclusion:Memoryalloyplatinggoldbiliarystentandplasticstentweresafeandefficaciousmethodsformalignantandbenignbiliaryobstruction,andcouldimprovepatient'slivingquality.Plasticstentwasanefficientcomplementfortherapyofbileleakandbileductinjury.