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Objective@#To evaluate the diagnostic efficacy of Japan Narrow Band Imaging Expert Team(JNET) classification under narrow-band imaging (NBI) for colorectal laterally spreading tumors.@*Methods@#Data of 170 laterally spreading tumors (LST) detected by NBI and pigment dyeing were reviewed in the retrospective study. JNET classification under NBI was used for rediagnosis based on surface pattern and vessel pattern. Pit pattern(PP) was observed under pigment dyeing using PP classification. The results were compared with histologic results after endoscopic resection or surgery.@*Results@#The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of JNET classification and PP classification were 92.2% VS 70.3%, 82.3% VS 85.0%, 74.7% VS 72.6%, 94.9% VS 83.5%, 85.9% VS 79.7%, respectively (P=0.159). The consistency rates of JNET classification and PP classification in predicting shallow invasion depth of LST were 6.1% and 8.3% respectively and the consistency rates in predicting deep invasion were 30.8% and 4.8%, respectively.@*Conclusion@#JNET classification under NBI is effective in predicting malignant laterally spreading tumors, however, its efficacy in predicting tumor invasion depth is unsatisfied. PP classification can be used to improve the diagnostic accuracy for those with diagnostic difficulty.
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Objective To evaluate the diagnostic efficacy of Japan Narrow Band Imaging Expert Team(JNET)classification under narrow-band imaging (NBI)for colorectal laterally spreading tumors. Methods Data of 170 laterally spreading tumors (LST)detected by NBI and pigment dyeing were reviewed in the retrospective study. JNET classification under NBI was used for rediagnosis based on surface pattern and vessel pattern. Pit pattern(PP)was observed under pigment dyeing using PP classification. The results were compared with histologic results after endoscopic resection or surgery. Results The diagnostic sensitivity,specificity, positive predictive value, negative predictive value and accuracy of JNET classification and PP classification were 92. 2％ VS 70. 3％,82. 3％ VS 85. 0％,74. 7％ VS 72. 6％,94. 9％VS 83. 5％,85. 9％ VS 79. 7％,respectively (P= 0. 159). The consistency rates of JNET classification and PP classification in predicting shallow invasion depth of LST were 6. 1％ and 8. 3％ respectively and the consistency rates in predicting deep invasion were 30. 8％ and 4. 8％,respectively. Conclusion JNET classification under NBI is effective in predicting malignant laterally spreading tumors,however,its efficacy in predicting tumor invasion depth is unsatisfied. PP classification can be used to improve the diagnostic accuracy for those with diagnostic difficulty.
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Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.
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Background:DNA methylation is a vital part of epigenetic modification,and is closely related with the development and progress of multiple tumors such as colorectal cancer. However,its mechanism is not fully clarified. Screening specific methylation gene and construct the methylation expression profile of tumor has become the current research hotspot. Aims:To screen the differential methylation loci in colorectal cancer and para-cancerous normal tissue by gene methylation microarray technique,and to construct specific differential methylation gene profile of colorectal cancer. Methods:Methylation 450K bead-chip was applied to detect the methylation status in colorectal cancer and para-cancerous normal tissues of 6 cases. A total of 431 467 loci were analyzed and compared. Aberrant methylation loci were screened according to P value,and the hypermethylation loci and hypomethylation loci were differentiated by delta beta value. Moreover,the function of differential methylation gene was further analyzed by GO analysis and KEGG analysis. Results:A total of 3 649 differential methylation loci were found by comparing colorectal cancer tissue and para-cancerous normal tissue,including 1 259 hypermethylation loci,which mainly located in promoter and genosome,and 2 390 hypomethylation loci,which mainly located in intergenic region and genosome. A panel of aberrant methylation gene loci was screened out,including hypermethylation gene loci such as SLC15A3 and hypomethylation gene loci such as ACOT2,TTLL8 and UHRF1. GO analysis and KEGG analysis showed that the function of these genes might be correlated with DNA binding,transcription factor activity and signal transduction pathway. Conclusions:There are many differential methylation loci in colorectal cancer and para-cancerous normal tissues,suggesting that aberrant DNA methylation is closely related with the development and progress of colorectal cancer. DNA methylation microarray technique could be applied for preliminary screening of differential methylation loci. However,constructing the differential methylation profile in colorectal cancer as a clinical biomarker should be further validated.
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Non-coding RNA (ncRNA) is a class of RNA not coding the protein and plays a significant role in the process of growth and development of diseases.Barrett''s esophagus (BE) is considered as the precancerous lesion of esophageal adenocarcinoma.Several studies showed that ncRNA has the potential value in diagnosis, treatment and designing of targeting drugs.This article reviewed the role of ncRNA, especially microRNA, long non-coding RNA and circular RNA in the development and carcinogenic process of BE.
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Background:It is commonly recommended that patients should refrain from driving for 24 hours after sedation for endoscopy,however,this recommendation has been queried recently. Aims:To investigate the effect of sedation on early postoperative cognitive function in patients undergoing endoscopy. Methods:One hundred adult patients undergoing sedative esophagogastroduodenoscopy ( EGD ) were randomly recruited, and another 100 adult patients undergoing conventional EGD were served as controls. All patients had an education level more than 9 years. Cognitive function was assessed by number connection test-A( NCT-A),number cancellation test and digit symbol test( DST)before propofol sedation or the beginning of endoscopic procedure and was reassessed when the discharge criteria were met. If the results obtained were inferior to those before EGD,a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels. Results:All patients completed the first and second assessment,and 124 patients had taken the third assessment. When the discharge criteria were met,result of number cancellation test was inferior to that before EGD in sedation group( P =0. 000 ). Furthermore,the results were analyzed by grouping with age,number cancellation test in young patients and NCT-A in elderly patients were inferior to that before EGD,respectively(P=0. 000 and P =0. 025 ). In control group,none of the results were inferior to those before EGD. The results of the third assessment recovered or being superior to the baseline levels. Conclusions:Early postoperative cognitive dysfunction at discharge is common in patients undergoing endoscopy using propofol sedation,but the impairment will recover by a prolonged staying calm before discharge. The optimal time for discharge and resuming driving remains to be further studied.
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ObjectiveTo investigate the correlation between any two of Capsule Endoscopy ScroringIndex (Lewis score),simplified Crohn Disease Activity Index (CDAI) and C-reactive protein (CRP) in small bowel Crohn disease (CD).MethodsA total of 58 consecutive patients with known small bowel CD were enrolled. We evaluated disease activity with Lewis score and simplified CDAI. Correlations among CRP,simplified CDAI and Lewis score were calculated with Spearman's rank order correlation coefficient.The optimal CRP cut-off value was calculated using the ROC curve.ResultsThe Lewis score showed inactive,mild and moderate-severe patients were 13,21 and 24,respectively.CRP of moderate-severe group was significantly higher than that in mild and inactive groups ( P ＜ 0.05 ).The optimal CRP cut-off value that differentiated patients with moderate to severe disease from the others was 13.50 mg/L with sensitivity of 87.5％ and specificity of 82.4％.The area under the ROC curve to analyze the cut-off was 0.849.Lewis score was moderately correlated with CRP (r =0.58,P ＜ 0.01 ),and weakly correlated with the simplified CDAI (r =0.40,P ＜ 0.01 ).ConclusionSerum CRP and the simplified CDAI cannot replace Lewis score for capsule endoscopy in the assessment of disease activity in small bowel CD.However,CRP may be considered as an inflammatory marker for evaluating the moderate to severe capsule endoscopic activity.
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ObjectiveTo investigate the long-term (＞1 year) rebleeding rate after capsule endoscopy (CE)-guided intervention in patients with obscure gastrointestinal bleeding (OGIB) and to identify the risk factors of rebleeding.MethodsA total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled.Follow-up data were obtained by reviewing medical records,CE database and contacting the patients or their relatives by telephone.We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model.ResultsThe medium follow-up was 52 months (range13-112 months).Significant lesions were found in 202 patients (65.8％).The overall rebleeding rate after interventional therapy induced by CE findings was 28.0％ (86/307).CE positive patients had higher rebleeding rate than CE negative patients (37.6％ vs 9.5％,log-rank test,P=0.000),while specific therapy could prevent rebleeding,compared with nonspecific therapy (32.9％ vs 23.0％,P=0.042).95.3％ (82/86) rebleeding occurred within 24 months after CE.Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years,CE positive findings,lowest hemoglobin (Hb) level 3 months before CE ≤7 g/dl,receiving nonspecific therapy after CE,hypertension,administration of anticoagulants,antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding.Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding,which can reduce the occurrence of rebleeding and improve OGIB patients' prognosis.Those high risk OGIB patients should be followed up for at least 24 months after CE.
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Objective To explore the feasibility,efficacy and safety of endoscopic submucosal dissection (ESD) for tumors originating from gastric muscularis propria.Methods A total of 20 patients with tumors originating from gastric muscularis propria confirmed by EUS and CT scan underwent ESD.Laparoscopic intervention was applied in 3 cases when difficulties in en bloc removal or perforation occurred.Results The mean ESD procedure time was 74.8 min (40-120 min),and the mean resected tumor size was 2.6 cm (1.5-3.5 cm).No severe complication occurred.Pathological findings were 17 cases of gastrointestinal stromal tumors and 3 cases of leiomyoma.Conclusion ESD is an effective method for treating the tumors originating from gastric muscularis propria,and laparoscopic intervention is necessary for en bloc resection in some cases.
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Objective To investigate the method of locating intestinal lesions by scatter diagram which simulating the movement of capsule endoscopy in small intestine and its significance. Methods A total of 30 consecutive patients with lesions in small intestine which was diagnosed by wireless capsule endoscopy (WCE) and confirmed by following surgery were enrolled in the study as group A. The time index was defined as the ratio of the transition time from the duodenojejunal flexure to the lesion to that to the ileocaecal valve. For each case in group A, the time index was marked on a horizontal axis with the distance between duodenojejunal flexure and the lesion on a vertical axis. The best curve was obtained to simulate the intestinal movement, and 30 other patients selected by the same criteria were used as group B to testify the accuracy of the curve. Results Parabola and quadratic equation were obtained from group A to simulate the intestinal peristalsis. Calculation of errors in group B showed a minimal error of 0. 79 cm, a maximal error of 41.49 cm and a mean error of ( 19. 64± 13. 98 ) cm. Patients with errors less than 20 cm accounted for 50%(15/30), those with errors less than 30 cm were 67% (20/30), and those with errors less than 50 cm amounted to 100% (30/30). Conclusion Locating the lesion in small intestine by transition time of WCE is of high accuracy and is able to facilitating the diagnosis yield of WCE.
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Objective To investigate diagnostic value of colon capsule endoscopy (CCE) for mucosal lesions of patients with active ulcerative colitis. Methods A total of 19 consecutive patients, including 12 males and 7 females, were enrolled from July 2009 to June 2010, with a mean age at 44. 16 + 14.64.Dominant symptoms were hematochezia, diarrhea and abdominal pain, consistent with the criteria of ulcerative colitis. All cases were scored into 3 grades according to severity of mucosal lesions. Using conventionalcolonoscopic findings as golden standard, the consistence of mucosal classification of CCE was calculated with kappa- and P-value. Meanwhile, related data such as the rate of completion, colonic cleanliness and adverse reactions were also collected and analyzed. Results CCE revealed that mild, moderate and severe cases were 2, 8 and 9, respectively, while the 3 types shown by conventional colonoscopy were 3, 8 and 8,respectively. Kappa-value was 0. 826 and P-value was less than 0. 001, which indicated good consistence. In addition, the completion rate of CCE and excellent/fine rate of the colonic cleanliness were 100% (19/19)and 79% ( 15/19), respectively. There were no adverse reactions recorded. Conclusion With high diag-nostic consistency to conventional colonoscopy in classification of mucosa severity, CCE precisely reveals the mucosal lesions of ulcerative colitis and becomes a potential alternative to partially replace conventional colonoscopy, especially in surveillance.
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Objective To study the long-term effect of argon plasma coagulation (APC) combined with proton pump inhibitor (PPI) on Barrett esophagus (BE). Methods A total of 36 patients, histologically proven as having BE from 2004 to 2007, were enrolled to underwent a therapy of APC plus PPI. The patients were re-examined on endoscopy at 1, 6 and 12 months after first APC and once a year thereafter.Results A total of 48 APC sessions were given to 36 patients with a mean number at 1. 33 per patient. The effective rate of reversal of BE was 100%. The follow-up was accomplished for all patients in 14-51 months with a median of 36months. The total recurrence rate (RR) of BE reached 16. 7% (6/36). The 1-year and 2-year RRs were 2. 8% (1/36) and 11.1% (4/36), respectively. The logistic regression analysis suggested that 2-year and total RRs were related to APC sessions ( P ＜ 0. 01 ). Conclusion The therapy of APC combined with PPI for BE is safe and of long-term effects.
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Objective To discuss the differential diagnostic value of confocal laser endomicroscopy (CLE)for benign and malignant non-protruding gastric lesions.Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and target biopsy was obtained.Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery.Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured.Results CLE diagnosed 11 malignant and 26 benign lesions.However,1 of 11 cancers was confirmed as benign by histopathology,while 1 of 26 benign lesions was confirmed cancer.Lesions in 12 patients were resected,with 3 by endoscopy,and 9 by surgery,and findings of post-operative pathology were consistent with those of target biopsy.No malignancy was found during the follow-up of benign lesions,and all lesions were healed after 3.16(3.58 ± 1.20)months.The sensitivity,specificity,and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90.9％,96.2％,and 90.9％,respectively.The positive and negative predictive values were 90.9％ and 96.2％,respectively.The Kappa value of CLE and histopathology was 0.871.Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions,and may replace biopsy in real-time histological diagnosis.
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Objective To evaluate the clinical efficacy and safety of endoscopic mucosal resection (EMR) assisted with magnifying chromoendoscopy in treatment of colorectal neoplasms. Methods Patients who met criteria for EMR including appropriate flat or depressed type and sessile lesions were enrolled. The association of morphology of colorectal lesions with histopathology was observed and the accuracy of estimation of invasive depth by magnifying chromoendoscopy was evaluated. Results Ninety lesions of 81 patients were reseeted by EMR (25 being sessile and 65 being flat or depressed). The histological results revealed low-grade dysplasia (LGD) in 58 lesions, high-grade dysplasia (HGD) in 20 lesions, and adenocarcinoma in 12 lesions. The average size of lesions was (1.4±0.5) cm in HGD, (1.6±0.5) cm in cancer and (1.0±0.4) cm in LGD with no significant difference (P> 0.05). It was shown that the flat and depressed lesions were more likely to be HGD or cancer as compared to sessile lesions, but with no statistical difference [41.5 % (27/65)vs. 20.0% (5/25), P= 0.084]. Moreover, the lesion with central depression was more likely to be HGD or cancer as compared to those without depressed surface [51.0% (25/49) vs. 17.1 % (7/41), P<0.01)]. The accuracy of estimating invasive depth by magnifying chromoendoscopy was 97.8% (86/90). Complete resection was confirmed histologically in 95.8% (88/90) of all lesions. Conclusions Colorectal lesions of depressed and flat types with central depression are more likely to be malignant. Estimation of invasive depth of colorectal neoplasia by magnifying chromoendoscopy in EMR treatment makes it more effective and safer.
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Objective To evaluate the therapeutic effect of endoscopic cryotherapy for Barrett's esophagus (BE). Methods A total of 22 consecutive patients, who were diagnosed as BE from January 2008 to May 2009, underwent endoscopic cryotherapy by using pressurized gas of C02. The data including effective rate, therapy courses and procedure related complications were retrospectively analyzed.Results Except for 2 cases of withdrawal, the other 20 patients completed the treatment with a total therapy number of 42 times (mean 2. 1 times/patient) and were followed up for 6 months. Complete histologic reversal of BE mucus was achieved in all 20 patients after 1-3 times of cryotherapy, among whom complete endoscopic reversal was obtained in 9 and effective endoscopic reversal in 11. Histologic recurrence was observed in 3 cases during the follow-up, including 2 of occult intestinal metaplasia and 1 of mild intestinal metaplasia, which achieved a BE mucosal reversal rate of 85% (17/20). Procedure related complications included 1 case of esophageal ulcer and 3 cases of mild or severe esophagitis, which were all cured after acid suppression treatment. Conclusion Endoscopic cryotherapy in BE is effective and safe, with the advantages of easy manipulation, less complications and good compliances.
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Objective To evaluate the diagnosis and management of ectopic pancreas.Methods The clinical data of 62 cases of ectopic pancreas,which were diagnosed by endoscopic uhrasonography (EUS)or pathologic findings between July 2006 and December 2007 were retrospectively analyzed.The cases were divided into 4 groups according to different ways of management.Group A included 37 patients,who were diagnosed as having ectopic pancreas(＜19mm)by EUS only and were followed up via phone call every 3 months.Eight patients in group B were diagnosed by EUS as having submucosal lesions suspected as ectopic pancreas,and underwent operation because of large size or difficulty in diagnosis.Eight patients in group C received operation for other diseases and the eetopic pancreases were found in operation.Group D included 9 patients who underwent surgery due to malignant tumors.ResultsEctopic pancreas were most commonly found as a single lesion in gastric antrum(35/62,56.5%)with mean size of 9.2±5.4 mm.All patients in group A were asymptomatic,of which 10 received followed-up endoscopy and no changes in size of the lesion were found.All patients in group B,C and D were diagnosed as ectopic pancreas pathologically.Conclusion Ectopic pancrea is relatively common and asymptomatic,only part of them could be diagnosed clinically.Carcinoma arising from the ectopic pancreas is rare and lesion of small size diagnosed by EUS could be followed up endoseopieally.
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Objective To evaluate the safety and efficacy of ultra-thin transnasal esophagogastroduodenoscopy(EGD).Methods The patients(n=240)receiving diagnostic EGD were randomly assigned to 3 groups to undergo ultra-thin trails-nasal EGD(group A,n=82),ultra-thin trans-oral EGD(group B,n=79)and conventional trans-oral EGD(group C,n=79).The blood pressure,pulse rate,arterial oxygen saturation,myocardial oxygen consumption were monitored and recorded before and during the procedure,as well as the operation time.All patients completed a questionnaire after the procedure.Results No significant difference was found in drop of arterial oxygen saturation between three groups.Increases in pulse rate,blood pressure,rate-pressure product in group A were significantly lower than those in group B and C(P＜0.05).Patients in group A experienced the lowest VAS scores of discomfort and nausea during the procedure (P＜0.05).But examination time and insertion time were significantly longer in group A than those in group B and C.With the increase in number of cases,the insertion time for group A decreased gradually.Conclusion Ultra-thin trans-nasal EGD is well tolerated and has fewer hemodynamic effects.It is safe and may be the optimal route of intubation with ultra-thin scopes.
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Objective To evaluate the accuracy of preoperative three-dimensional endoscopic ultra-sonography (3D-EUS) in tumor invasion depth (T-staging) of rectal cancer. Methods From May 2007 to November 2007, 21 patients with rectal cancer diagnosed by eolonoscopy and biopsy, underwent 3D-EUS, 2D-EUS and MRI before surgery to predict T-staging. The results were assessed according to post-surgical pathological findings. Results The accuracy of 3D-EUS in T-staging was 85.71%, which was significantly higher than that of MRI (57.14%, P<0.05), and similar with that of 2D-EUS (76.19%, P>0.05). Conclusion More accurate T-staging could be achieved by 3D-EUS, which could be combined with MRI to detect lymph node metastasis, and provide more information for therapy decision in rectal cancer.
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Objective To improve the management of dyspepsia by evaluating the potential role of pretreatment gastric histology as predictive factors on the symptomatic response after Helicobacter pylori (H. pylori) eradication in patients with functional dyspepsia (FD).Methods 240 FD patients with H. pylori infection out of 920 consecutive patients receiving gastroendoscopy due to dyspepsia were investigated, including 190 patients enrolled as the therapy group and administered with anti-H. pylori triple therapy. In addition, 50 patients were enrolled as the control group, in which omeprazole was an alternative to the triple therapy. The course of therapy in both groups was 7 days. Pretreatment gastric histology was evaluated by the updated Sydney system. C~ 13 urea breath test was performed to evaluate the H. pylori eradication results one month (both therapy group and control group) and six months (therapy group) after therapy. For each patient, the baseline, month 1 and month 6 symptom scores were assessed by a questionnaire of dyspepsia, including 12 symptom items of dyspepsia with scoring of severity. The relationship between pretreatment gastric histology and good symptom responses after H. pylori eradication was then analyzed.Results Of 35.3% and 42.6% patients with successful H. pylori eradication in the therapy group had a good symptomatic response one month and six months after the triple therapy respectively, higher than those from the patients who failed H. pylori eradication (month 1:35.3% vs 12.2%, P