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        Balloon-occluded retrograde transvenous obliteration for six consecutive patients with duodenal varices

        Shiro Miyayama,Masashi Yamashiro,Rie Ikeda,Junichi Matsumoto,Nobuhiko Ogawa,Kazuo Notsumata 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.1

        Background: Bleeding from duodenal varices is a rare but life-threatening complication of portal hypertension. The treatment of duodenal varices remains difficult and a definitive treatment strategy has not been established. The aim of this study was to report the technical aspects and outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using 5% ethanolamine oleate with iopamidol (EOI) for duodenal varices. Methods: Six consecutive patients with duodenal varices treated using BRTO were eligible. Endoscopic treatment was performed first in three patients with active bleeding. After coil embolization of collateral veins, stepwise EOI infusion was performed at intervals of 10–30 minutes under balloon occlusion until the main efferent vein, varices, and the main afferent vein were filled with EOI and clots. The techniques and outcomes of BRTO were retrospectively evaluated. Results: The main efferent vein of duodenal varices was the right (n = 4) or left (n = 2) gonadal vein. In three patients with ruptured varices, BRTO was performed after achieving hemostasis by endoscopic treatment. In five patients, 1–4 (mean, 2.4 ± 1.1) collateral veins were embolized with coils before EOI infusion. Furthermore, 11–21 mL (mean, 15.3 ± 4.2 mL) of EOI was infused by 3–5 (mean, 3.5 ± 1.0) stepwise infusions via the efferent vein under balloon occlusion. The duration of EOI infusion under balloon occlusion ranged from 82 to 118 minutes (mean, 87.8 ± 13.6 minutes). The varices were thrombosed in all but one patient. In the remaining patient, the varices were thrombosed by additional BRTO under overnight balloon occlusion performed 19 days later. The only complications were a transient fever and hematuria. All duodenal varices disappeared during a followup of 4–32 months (mean, 16.2 ± 11.1 months) after BRTO. Conclusion: BRTO using EOI is an effective treatment for duodenal varices.

      • KCI등재

        Balloon-occluded retrograde transvenous obliteration for six consecutive patients with duodenal varices

        Shiro Miyayama,Masashi Yamashiro,Rie Ikeda,Junichi Matsumoto,Nobuhiko Ogawa,Kazuo Notsumata 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.1

        Background: Bleeding from duodenal varices is a rare but life-threatening complication of portal hypertension. The treatment of duodenal varices remains difficult and a definitive treatment strategy has not been established. The aim of this study was to report the technical aspects and outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using 5% ethanolamine oleate with iopamidol (EOI) for duodenal varices. Methods: Six consecutive patients with duodenal varices treated using BRTO were eligible. Endoscopic treatment was performed first in three patients with active bleeding. After coil embolization of collateral veins, stepwise EOI infusion was performed at intervals of 10–30 minutes under balloon occlusion until the main efferent vein, varices, and the main afferent vein were filled with EOI and clots. The techniques and outcomes of BRTO were retrospectively evaluated. Results: The main efferent vein of duodenal varices was the right (n = 4) or left (n = 2) gonadal vein. In three patients with ruptured varices, BRTO was performed after achieving hemostasis by endoscopic treatment. In five patients, 1–4 (mean, 2.4 ± 1.1) collateral veins were embolized with coils before EOI infusion. Furthermore, 11–21 mL (mean, 15.3 ± 4.2 mL) of EOI was infused by 3–5 (mean, 3.5 ± 1.0) stepwise infusions via the efferent vein under balloon occlusion. The duration of EOI infusion under balloon occlusion ranged from 82 to 118 minutes (mean, 87.8 ± 13.6 minutes). The varices were thrombosed in all but one patient. In the remaining patient, the varices were thrombosed by additional BRTO under overnight balloon occlusion performed 19 days later. The only complications were a transient fever and hematuria. All duodenal varices disappeared during a followup of 4–32 months (mean, 16.2 ± 11.1 months) after BRTO. Conclusion: BRTO using EOI is an effective treatment for duodenal varices.

      • KCI등재

        Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study

        ( Hiroshi Hasegawa ),( Shigeki Bamba ),( Kenichiro Takahashi ),( Masaki Murata ),( Taketo Otsuka ),( Hiroshi Matsumoto ),( Takehide Fujimoto ),( Rie Osaki ),( Hirotsugu Imaeda ),( Atsushi Nishida ),( 대한장연구학회 2019 Intestinal Research Vol.17 No.2

        Background/Aims: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an ade-noma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colo-noscopy 1 year later. Methods: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. Results: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. Conclusions: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon. (Intest Res 2019;17:265-272.)

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