ABSTRACT
Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.
ABSTRACT
Objectives To observe the effect of Jianpi-Huayu decoction for preventing the patients from the recurrence of colonic adenoma after endoscopic mucosal resection. Methods A total of 60 patients with colonic adenoma who received endoscopic mucosal resection were divided randomly into the experimental group (taking Jianpi-Huayu decoction) and the controlled group (taking nothing as treatment), 30 patients in each group. Both groups were treated for 1 year. After 1 year, colonscopy was taken, and the number and size of colonic adenoma were recorded. The expression of COX-2, Ki67 in the colonic mucosa were detected the immunohistochemistry, and the negative rate of COX-2, Ki67 were also detected. Results After the treatment, the number (0.20 ± 0.48 vs. 1.67 ± 1.54, t=4.980) and size (0.23 ± 0.57 vs. 2.73 ± 2.80, t=4.788) of colonic adenoma in the experimental group were statistically lower than those in the ontrolled group (P<0.01);the expression of COX-2 (1.96 ± 1.27 vs. 3.64 ± 1.95, t=3.673) and Ki67 (2.04 ± 1.46 vs. 4.50 ± 1.73, t=5.558) in the the experimental group were statistically lower than those in the ontrolled group (P<0.01). The number of the paitents whose COX-2, Ki67 negative rates in the experimental group were 21 and 22, and the control group were 12(P=0.004) and 14 (P<0.001), which showed the significant difference between two groups. Conclusions The Jianpi-Huayu decoction could reduce recurrence of colonic adenoma after endoscopic mucosal resection, the mechanism was decreasing the expression of COX-2, Ki67 in colonic mucosa.