Preoperative ultrasound-guided dual localization with titanium clips and carbon nanoparticles for predicting the surgical approach and guiding the resection of Siewert type II esophagogastric junction adenocarcinoma

OBJECTIVE

To investigate the superiority of preoperative ultrasound-guided titanium clip and nanocarbon dual localization over traditional methods for determining the surgical approach and guiding resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG).

METHOD

This study included 66 patients with Siewert type II AEG who were treated at the PLA Joint Logistics Support Force 900th Hospital between September 1, 2021, and September 1, 2023. They were randomly divided into an experimental group (n = 33), in which resection was guided by the dual localization technique, and the routine group (n = 33), in which the localization technique was not used. Surgical approach predictions, proximal esophageal resection lengths, pathological features, and the occurrence of complications were compared between the groups.

RESULT

The use of the dual localization technique resulted in higher accuracy in predicting the surgical approach (96.8% vs. 75.9%, P = 0.02) and shorter proximal esophageal resection lengths (2.39 ± 0.28 cm vs. 2.86 ± 0.39 cm, P < 0.001) in the experimental group as compared to the routine group, while there was no significant difference in the incidence of postoperative complications (22.59% vs. 24.14%, P = 0.88).

CONCLUSION

Preoperative dual localization with titanium clips and carbon nanoparticles is significantly superior to traditional methods and can reliably delineate the actual infiltration boundaries of Siewert type II AEG, guide the surgical approach, and avoid excessive esophageal resection.

The value of endoscopic duodenal papilloplasty with titanium clip in improving post-operative complications of choledocholithiasis

OBJECTIVE

To investigate the value of endoscopic duodenal papillary sphincterotomy combined with balloon dilatation in the treatment of duodenal papilloplasty with titanium clip after choledocholithiasis in post-operative complications.

MATERIALS AND METHODS

One hundred and twenty-five patients (69 males and 56 females) with a median age of 65 (32-81) years were included. The treatment plan was randomly divided into Group A (n = 59) and Group B (n = 66) according to the random number table. Patients in Group A were treated with endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD), followed by a titanium clip for duodenal papilloplasty and then indwelling nasobiliary drainage, whereas those in Group B were treated with EST combined EPLBD to remove stones and then indwelling nasobiliary drainage.

RESULTS

In patients with choledocholithiasis or with anatomical changes that make stone extraction difficult, this prospective study attempted to perform duodenal papilloplasty with titanium clips after EST and EPLBD lithotripsy to compare and observe post-operative papillary healing, biliary reflux, and complication rates.

CONCLUSIONS

The use of endoscopic duodenal papilloplasty with a titanium clip can improve biliary reflux after lithotripsy and reduce the incidence of post-operative cholangitis complications.

Endoscopically guided titanium clip therapy and adrenaline injection for treatment of patients with peptic ulcer bleeding: Clinical efficacy and impact on serum inflammatory cytokines

AIM

To evaluate the clinical efficacy of endoscopically guided titanium clip therapy and adrenaline injection in the treatment of patients with peptic ulcer bleeding and the impact on serum inflammatory cytokines.

METHODS

One hundred and thirty-two patients with peptic ulcer bleeding treated from January 2015 to December 2016 were divided into either an observation group or a control group. The control group was given endoscopically guided titanium clip therapy, and the observation group was given endoscopically guided titanium clip therapy and adrenaline injection. Therapeutic indicators, serum inflammatory cytokines, adverse reactions, and clinical efficacy were compared between the two groups.

RESULTS

The effective rate was significantly higher in the observation group than in the control group (98.48% vs 89.39%, χ² = 4.790, P < 0.05). Time to achieve hemostasis, blood loss, amount of blood transfusion, and hospital stay were significantly lower in the observation group than in the control group (t = 6.842, 5.384, 6.772, and 9.407, respectively, P < 0.05 or 0.01). Serum levels of interleukin (IL)-6 and C-reaction protein were significantly lower and that of IL-10 was significantly higher in the observation group than in the control group (t = 7.545, 6.071, and 8.919, respectively, P < 0.05 or 0.01). The rates of perforation, infection, and rebleeding were significantly lower in the observation group than in the control group (3.03% vs 12.12%, 6.06% vs 18.18%, and 1.52% vs 10.61%; χ² = 3.895, 4.552, and 4.790, respectively; P < 0.05).

CONCLUSION

Endoscopically guided titanium clip therapy and adrenaline injection can improve the therapeutic effect in patients with peptic ulcer bleeding and reduce adverse reactions, which may be related to the alleviation of the inflammatory state.

Preoperative endoscopic titanium clip placement facilitates intraoperative localization of early-stage esophageal cancer or severe dysplasia

Background

Accurate intraoperative localization of esophageal lesions is essential for successful surgical resection. We tested whether preoperative endoscopic placement of titanium clips could facilitate intraoperative localization of early-stage esophageal cancer or severe dysplasia.

Methods

A prospective randomized clinical trial was performed between May 2012 and July 2014. All enrolled patients received preoperative endoscopy and esophageal endoscopic ultrasound, as well as pathological study on the biopsy specimen, to confirm early stage esophageal cancer or severe dysplasia. One day before the surgical operation, patients in the experimental group received the preoperative endoscopic titanium labeling of esophageal lesions. Then, during the surgical operation, palpitation of titanium clips was used to localize the lesions in these patients. In patients in the control group, palpitation of nodules or esophageal wall mucosal thickening, together with the consideration of the results from preoperative endoscopic and ultrasound studies, was applied to estimate the location of the esophageal lesions. Study outcomes included the proportions of patients having successful intraoperative pre-resection lesion localization, post-esophagectomy lesion visualization, negative upper surgical margin, change of surgical approaches, and positive postoperative pathological diagnosis.

Results

A total of 27 patients were enrolled into the study, with 14 in the experimental group and 13 in the control group. Compared to the patients in the control group, a higher proportion of patients in the experimental group had statistically significant successful intraoperative esophageal lesion localization (100 versus 15.3% in the experimental versus control group).

Conclusions

Preoperative endoscopic titanium clip placement could facilitate intraoperative localization of early-stage esophageal cancer or severe dysplasia.

Trial registration

Current study was registered in Chinese Clinical Trial Registry and World Health Organization International Clinical Trials Registry Platform, ChiCTR-INR-17010949. Registered 22 March 2017, retrospectively registered.

Radiologic advantages of potential use of polymer plastic clips in neurosurgery

BACKGROUND

Plastic clips are made of diamagnetic material and may result in fewer computed tomography (CT) and magnetic resonance artifacts than titanium clips. Considering that polymer plastic clips are increasingly being used in endoscopic surgery, our study examined the CT and magnetic resonance imaging (MRI) characteristics of plastic clips after application in the neurocranium and compared them with titanium clips.

METHODS

Craniotomy was performed on the heads of domestic pigs (Sus scrofa domestica), and, at an angle of 90°, a permanent Yasargil FT 746 T clip was placed in a frontobasal, interhemispheric position. A plastic polymer medium-large Hem-o-lok clip was placed in the same position into another animal. After this procedure, CT of the brain was performed using Siemens 16 slice, followed by an MRI scan, on Philips MRI, 1.5 Tesla. The CT and magnetic resonance scans were analyzed.

RESULTS

On axial CT sections through the site of placement of titanium clips, dotted hyperdensity with a high value of Hounsfield units (HUI) of about 2800-3000 could be clearly seen. At the site where the plastic polymer clips were placed, discrete hyperdensity was observed, measuring 130-140 HUI. MRI of the brain in which titanium clips were used revealed a hypointensive T1W signal in the interhemispheric fissure, with a hypointensive T2W signal. On the other hand, upon examination of the MRI of the brain in which plastic clips were used, the T1W signal described above did not occur, and there was also no T2W signal, and no artifacts observed.

CONCLUSIONS

The plastic clips are made of a diamagnetic, nonconductive material that results in fewer CT and MRI artifacts than titanium clips.