ABSTRACT
Objective:To study the effectiveness of a strategy for detecting early gastric cancer using high-definition gastroscopy.Methods:A total of 849 patients over 35 years old who underwent gastroscopy in the Seventh Medical Center of PLA General Hospital from December 2018 to January 2019 were enrolled to a prospective study. During gastroscopy, biopsies were taken at any suspicious lesions in patients who had never been infected with Helicobacter pylori. In ulcer-type lesions, biopsies were taken at the edge of the ulcer. Outside the atrophic area, biopsies were taken at lesions in the cardia which were reddish under white light, or lesions in the non-cardiac area which were white or showed clear borders under white light. Inside the atrophic area, biopsies were taken at elevated lesions with clear borders or irregular depressions on the top, or flat/depressed lesions with irregular borders or being ocherous under narrow band imaging. In addition, biopsies were performed on any lesion that did not meet the above standard but was considered necessary. The high-risk patients were followed up by gastroscopy to observe the detection and missed diagnosis of neoplasm that meet the above standard, and to determine the sensitivity and positive predictive value of the strategy. Results:A total of 548 patients were biopsied (781 lesions). Among the 327 lesions that met the above standard, 16 lesions (4.9%) were diagnosed as epithelial neoplasm, of which 10 (3.1%) were high-grade neoplasm. Among the 454 lesions that did not meet the standard, only 1 (0.2%) epithelial neoplasm was diagnosed, and there was no high-grade neoplasm. The positive predictive value of this screening strategy for gastric epithelial neoplasm and high-grade neoplasm was higher than those who did not meet the standard (4.9% VS 0.2%, χ2=19.49, P<0.01; 3.1% VS 0, P<0.001). There were 146 patients (17.2%, 146/849) followed up by gastroscopy. During the follow-up, 2 high-grade intramucosal neoplasms were found. 84.2% (16/19) of epithelial tumors and 83.3% (10/12) of high-grade neoplasm were detected during the initial gastroscopy. Conclusion:This screening strategy can efficiently detect early gastric cancer under high-definition gastroscopy.
ABSTRACT
Objective@#To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST) (diameter<3.5 cm).@*Methods@#According to the Cocharane system search strategy, Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5.3.@*Results@#Of the 10 articles, 1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1 062. There were 732 cases in the endoscopic treatment group, and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD=-30.58 min, 95%CI: -39.31--21.84, P<0.05), less blood loss (MD=-12.99 mL, 95%CI: -16.40--9.57, P<0.05), shorter hospital stay (MD=-3.17 d, 95%CI: -4.76--1.59, P<0.05), and less total cost (MD=-1.63 ten thousand RMB, 95%CI: -2.42--0.84, P<0.05) than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR=2.35, 95%CI: 0.52-10.69, P=0.27) or perioperative complications(RR=1.08, 95%CI: 0.48-2.42, P=0.85).@*Conclusion@#Existing studies have shown that endoscopic treatment for GIST is effective, minimally invasive, economical with better prognosis, ensuring complete resection.
ABSTRACT
Objective To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST)(diameter<3. 5 cm). Methods According to the Cocharane system search strategy,Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5. 3. Results Of the 10 articles,1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1062. There were 732 cases in the endoscopic treatment group,and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD= -30. 58 min,95％CI:-39. 31--21. 84,P<0. 05),less blood loss (MD= -12. 99 mL, 95％CI:- 16. 40-- 9. 57,P < 0. 05),shorter hospital stay (MD = - 3. 17 d,95％CI:-4. 76--1. 59,P <0. 05),and less total cost (MD= -1. 63 ten thousand RMB,95％CI:-2. 42--0. 84,P<0. 05)than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR = 2. 35, 95％CI:0. 52-10. 69,P= 0. 27)or perioperative complications(RR= 1. 08,95％CI:0. 48-2. 42,P= 0. 85). Conclusion Existing studies have shown that endoscopic treatment for GIST is effective,minimally invasive,economical with better prognosis,ensuring complete resection.