Expert profile: Zhang Jianguo, director of the Department of Gastroenterology and Gastrointestinal Endoscopy Center, Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Aviation General Hospital of China Medical University, and chief physician. A well-known young endoscopist in China, a doctor inventor, and the famous inventor of Zhang's scissors. He also serves as the chairman of the China Gastrointestinal Endoscopy Collaborative Innovation Platform of the China Industry-University-Research Association, and the National Committee of the Equipment Research and Development Group of the Digestive Endoscopy Branch of the Chinese Medical Association. Good at endoscopic diagnosis and treatment of digestive diseases, including ERCP, ESD, Spyglss, STER, POEM, EFTR, NOTES, EUS, etc.
In the past 40 years, the incidence of cholangiocarcinoma has been increasing. Currently, surgery is the only possible cure. However, many patients are not suitable for surgery due to various factors, such as weak constitution, large tumor size, and poor location. patient. How can these patients fight cancer?
Biliary stent implantation is ineffective, infection and fever follow
One patient, Grandpa Deng, in his 70s, developed abdominal pain for unknown reasons, accompanied by high fever, and skin jaundice gradually aggravated. The children were very anxious when they found out, and promptly sent the old man to the hospital for examination, but it turned out that he had hilar cholangiocarcinoma.
Bile duct tumors are common but difficult, accounting for 50%-70% of all biliary tract malignant tumors. Because Grandpa Deng was old and in poor physical condition, he could not tolerate major surgery to remove the tumor, so the doctor decided to implant a bile duct for the elderly Stents, as palliative maintenance therapy. After a period of time, the old man's jaundice got better and the abdominal pain was relieved, but the high fever still existed, and the interval between fever became shorter and shorter, and the old man's constitution became weaker and weaker.
ERCP+Radiofrequency ablation saves the patient from danger
After communicating with the family, the doctor decided to use endoscopic retrograde cholangiopancreatography (ERCP) to perform endoscopic radiofrequency ablation for the patient. ERCP is to insert the fibrous duodenum into the descending part of the duodenum , find the main duodenal papilla (hereinafter referred to as the nipple), insert a plastic catheter into the opening of the nipple from the biopsy tube, and inject the contrast agent to thereby Angiographic technique for retrograde visualization of the cholangiopancreatic duct. Radiofrequency ablation is the introduction of electrodes into the lesion, and the release of radiofrequency current produces a thermal effect to achieve local high temperature, causing degeneration and necrosis of pathological cells and tissues, so as to achieve the purpose of treating the disease. The powerful combination of ERCP and radiofrequency ablation is expected to remove the stubborn diseases that plague the old family. On the day of the
operation, ERCP showed that the upper segment of the common bile duct was truncated, the upper segment of the common bile duct and the intrahepatic bile duct were obviously dilated, and the bile duct was full of tumors. Afterwards, the doctor solved the big trouble that plagued Grandpa Deng through radiofrequency treatment for dozens of minutes. Grandpa Deng lamented that the current medical technology is so good after surgery that he can now "treat it" without surgery.
Another weapon for the treatment of cholangiocarcinoma-ERCP+biliary stent placement
Clinically, some patients with cholangiocarcinoma can benefit from ERCP+biliary duct stent placement. This combination is easy to operate, less traumatic, requires no special care after operation, does not lose bile, and does not affect digestive function. If conditions permit, implantation of fully covered metal stents with radioactive particles is more effective, which can not only relieve bile duct obstruction, but also local radiotherapy to tumor tissue.
Biliary duct tumor The diagnostic tool - SPYGLASS
Aviation General Hospital Gastroenterology On the basis of ERCP technology, further breakthroughs have been made, aiming at the international frontier, introducing and successfully developing the digital direct vision system (SPYGLASS) in China earlier related technologies.The SPYGLASS direct vision system has a sensitivity of 90% and a specificity of 95.8% for the diagnosis of biliary tract malignant tumors, and has become the most powerful weapon in the diagnosis of biliary tract tumors. Neither surgery nor ERCP can achieve direct oral observation of cholangiopancreatic duct disease. The ability to directly observe the bile and pancreatic ducts and diagnose and treat cholangiopancreatic duct diseases under direct vision has always been the dream of countless physicians and surgeons, and SPYGLASS has succeeded in realizing their dreams.
The second generation SPYGLASS choledochoscope direct vision system and bile duct tumor model diagram
