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Objective:To develop an online interactive cytopathological training program, and to evaluate it for improving the cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreas.Methods:A total of 5 500 cytopathological images were collected from 194 patients with pancreatic solid mass who underwent EUS-FNA in Nanjing Drum Tower Hospital from August 2018 to August 2019. The cell type in each cytopathological picture was labeled by senior cellular pathologists, which was used to build a learning and testing platform for online interactive cytopathological training. Five endoscopists without cytopathological background were invited to participate in this training. Sensitivity, specificity, positive predictive value and negative predictive value of endoscopists in differential diagnosis of cancer and non-cancer before and after training were compared to evaluate the effect of the online interactive cytopathological training program on improving the ability of endoscopists in diagnosis of cytopathology.Results:A cytopathological training platform for endoscopists to learn and take online test was successfully built. Before training, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis of cancer and non-cancer for endoscopists were 0.55 (95% CI: 0.53-0.58), 0.32 (95% CI: 0.30-0.35), 0.43 (95% CI: 0.41-0.45), 0.44 (95% CI: 0.41-0.47) and 0.43 (95% CI: 0.42-0.45), respectively. After training, the above indicators were 0.96 (95% CI: 0.95-0.97), 0.70 (95% CI: 0.68-0.73), 0.74 (95% CI: 0.72-0.76), 0.95 (95% CI: 0.94-0.96) and 0.81 (95% CI: 0.80-0.83), respectively, which were significantly improved compared with those before ( P<0.001). Conclusion:The online interactive cytopathological training program can improve the understanding and diagnostic ability of endoscopists in pancreatic cytopathology, help to implement rapid on-site evaluation in the process of EUS-FNA, and improve the diagnostic efficiency of EUS-FNA.
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Objective:To evaluate the regular endoscopic therapy for esophageal and gastric variceal bleeding (EGVB) in patients with liver cirrhosis.Methods:A total of 305 patients of EGVB with liver cirrhosis who received endoscopic hemostasis in Nanjing Drum Tower Hospital between January 2015 and January 2018 were included in the retrospective cohort study. Patients were divided into the regular endoscopic treatment group ( n=145) and the irregular endoscopic treatment group ( n=160). The primary outcome measure was rebleeding rate, and the secondary outcome measures were follow-up time, rebleeding interval and rebleeding mortality. Results:There were no significant differences between the two groups in terms of gender composition, average age, etiology composition, the cause of disease under or out of control, liver reserve function, or administration of non-selective β-blockers ( P>0.05), and the baseline data were comparable. The rebleeding rate was 11.7% (17/145) in the regular endoscopic treatment group and 41.9% (67/160) in the irregular endoscopic treatment group ( χ2=38.74, P<0.001). The follow-up time, rebleeding intervals and mortalies of rebleeding in the regular endoscopic treatment group and the irregular endoscopic treatment group were 28.14±11.11 months and 21.10±12.37 months ( t=5.21, P<0.001), 12.0 (6.0, 23.0) months and 1.0 (1.0, 6.0) months ( U=164.00, P<0.001), and 1.4% (2/145) and 10.6% (17/160) ( χ2=11.13, P=0.001), respectively. Conclusion:Compared with irregular endoscopic treatment, regular endoscopic treatment of EGVB in patients with liver cirrhosis has more clinical significance, which can significantly reduce the rebleeding rate, prolong the rebleeding interval, and reduce the mortality of rebleeding.
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Objective@#To examine the correlation between the promoter methylation of Sterol regulatory-element binding protein-2 (SREBP-2) and miR-33a expression as well as serum markers in patients with coronary artery disease (CAD).@*Methods@#The case-control study. 100 participants who underwent coronary angiography from August 2017 to April 2018 in TaiheHospital, Hubei University of Medicine, were recruited in this study.The methylation level of two fragments, including 12 CpG sites in the promoter region of SREBP-2, have been detected by pyrosequencing in 50 patients with coronary artery disease (CAD) and 50 non-CAD controls. Serum miR-33a level and a panel of 15 CAD related biomarkers were examined by qPCR and routine biochemistry methods.@*Results@#Methylation level of one CpG site (F1-4 loci) in SREBP-2 promoter region were significant higher in CAD patients than in controls(4.56%±0.70% vs 3.54%±0.72%, t=-3.864, P<0.001); methylation level of F1-4 site was negatively correlates with the serum miR-33a levels and high-density lipoprotein cholesterol (HDL-C) levels(r=-0.318, P=0.001; r=-0.225, P=0.024, respectively). Furthermore, F1-4 hypermethylation was an independent risk factor of CAD, independent of age, gender, histories of hypertension, hyperlipidemia, and diabetes(OR=2.452, 95%CI=1.398-4.299, P=0.002).@*Conclusion@#These results suggest that DNA methylation and miRNA might cooperate to regulate the lipid metabolism in CAD.
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Objective:To examine the correlation between the promoter methylation of Sterol regulatory-element binding protein-2 (SREBP-2) and miR-33a expression as well as serum markers in patients with coronary artery disease (CAD).Methods:The case-control study. 100 participants who underwent coronary angiography from August 2017 to April 2018 in TaiheHospital, Hubei University of Medicine, were recruited in this study.The methylation level of two fragments, including 12 CpG sites in the promoter region of SREBP-2, have been detected by pyrosequencing in 50 patients with coronary artery disease (CAD) and 50 non-CAD controls. Serum miR-33a level and a panel of 15 CAD related biomarkers were examined by qPCR and routine biochemistry methods.Results:Methylation level of one CpG site (F1-4 loci) in SREBP-2 promoter region were significant higher in CAD patients than in controls(4.56%±0.70% vs 3.54%±0.72%, t=-3.864, P<0.001); methylation level of F1-4 site was negatively correlates with the serum miR-33a levels and high-density lipoprotein cholesterol (HDL-C) levels( r=-0.318, P=0.001; r=-0.225, P=0.024, respectively). Furthermore, F1-4 hypermethylation was an independent risk factor of CAD, independent of age, gender, histories of hypertension, hyperlipidemia, and diabetes( OR=2.452, 95 %CI=1.398-4.299, P=0.002). Conclusion:These results suggest that DNA methylation and miRNA might cooperate to regulate the lipid metabolism in CAD.
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Objective:To evaluate the safety and efficacy of circulating tumor cells(CTCs)measurement in patients with pancreatic cancer by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA).Methods:This prospective, single-center clinical study recruited 5 patients with pancreatic cancer, who underwent EUS-FNA for portal vein blood collection to detect CTCs in portal vein blood and CTCs in peripheral blood as control. CTCs were determined using negative immunomagnetic beads combined with FISH and a folate receptor positive circulating tumor cells detection kit.Results:All 5 patients underwent EUS-FNA portal vein blood collection successfully. One sample developed blood agglutination and failed to perform CTCs test. Four others were tested, and CTCs in portal vein samples and peripheral blood samples were obtained from 3 patients. The mean CTCs in portal vein blood was 10.5±4.0 FU/3.7 mL, and the mean CTCs in peripheral blood was 11.4±4.2 FU/3.7 mL. There was no significant difference between the two groups ( P >0.05). There were no complications such as infection, abdominal bleeding or shock during operation. Conclusion:It is a safe and feasible method to collect and determine the CTCs in portal venous blood from patients with pancreatic cancer under EUS, which helps prediction and treatment of early metastasis of pancreatic cancer.
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Objective@#To study the feasibility of establishing human 3D pancreatic cancer organoids with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) specimen.@*Methods@#A total of 9 patients with suspected pancreatic masses were prospectively included in this study from June 2017 to January 2018. EUS-FNA was performed for initial diagnosis. The biopsy tissues were obtained from a COOK 22-gauge FNA needle for organoid establishment, and the growth status in vitro was observed.@*Results@#Nine specimens of pancreatic lesions obtained from EUS-FNA were enrolled. Successful establishment of organoids was achieved in 5 cases, which were all confirmed to be pancreatic cancer histopathologically. In the process of generating, the growth rate of organoids increased correspondingly. The pathological morphology of these organoids was similar to the corresponding pancreatic tissues in HE staining.@*Conclusion@#Pancreatic cancer organoids can be successfully created by means of EUS-FNA. Establishment of these organoids can potentially provide excellent models for patients with pancreatic cancer in guiding precision treatment.
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Objective To study the feasibility of establishing human 3D pancreatic cancer organoids with endoscopic ultrasound-guided fine-needle aspiration ( EUS-FNA ) specimen. Methods A total of 9 patients with suspected pancreatic masses were prospectively included in this study from June 2017 to January 2018. EUS-FNA was performed for initial diagnosis. The biopsy tissues were obtained from a COOK 22-gauge FNA needle for organoid establishment, and the growth status in vitro was observed. Results Nine specimens of pancreatic lesions obtained from EUS-FNA were enrolled. Successful establishment of organoids was achieved in 5 cases, which were all confirmed to be pancreatic cancer histopathologically. In the process of generating, the growth rate of organoids increased correspondingly. The pathological morphology of these organoids was similar to the corresponding pancreatic tissues in HE staining. Conclusion Pancreatic cancer organoids can be successfully created by means of EUS-FNA. Establishment of these organoids can potentially provide excellent models for patients with pancreatic cancer in guiding precision treatment.
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Objective To evaluate the feasibility and safety of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement in the normal porcine model.Methods Four pigs,2 male and 2 female,aged 8-12 months,weighing 20-30 kg were selected in the experiment.Under general anesthesia and EUS guidance,a 22 G fine needle connected to electrocardiograph monitor with a central vein pressure manometer was used to puncture and measure pressures in the portal vein (PV) and hepatic vein (HV) or inferior vena cava (IVC).Pressures were measured three times for each vessel and the mean pressure was recorded.The PPG was recorded as the difference between the PV pressure and HV or IVC pressure.Vital signs during and after the procedure and operation-related complications were monitored.Results EUS-PPG measurement was successful in all targeted vessels.The PV pressure,HV or IVC pressure,and PPG was 11.0±1.0 mmHg(1 mmHg=0.133 kPa),7.3±1.1 mmHg and 3.8±0.9 mmHg,respectively.No adverse event occurred.Conclusion EUS-PPG measurement has a high successful rate and reliable accuracy and safety reflecting the portal vein pressure.
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Objective To determine the diagnostic value of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for gastrointestinal lesions with inconclusive endoscopic biopsies. Methods A retrospective analysis was performed in 65 patients who were found to have gastrointestinal lesions with inconclusive endoscopic biopsies and underwent EUS-FNA in Drum Tower Hospital. Diagnostic value of EUS-FNA was determined by comparing with surgical histopathology and follow-up results. Results This study included 41 males ( 63％) and 24 females ( 37％) with median age of 60 years. The most common lesion was diffuse infiltrative lesions ( 37, 56. 9％) , followed by submucosal protrusion types ( 17, 26. 2％) . Fifty-four cases ( 83. 1％) were malignant lesions, and 11 cases ( 16. 9％) were benign. The overall sensitivity, specificity, and accuracy of EUS-FNA for gastrointestinal lesions with inconclusive biopsies were 76. 8％ ( 95％CI: 65. 7％-87. 8％) , 100. 0％ ( 95％CI: 66. 4％-100. 0％) , and 80. 0％( 95％CI: 70. 3％-89. 7％) , respectively. Sub-group analysis showed the sensitivity, specificity, and accuracy of EUS-FNA for diffuse infiltrative lesions were 70. 6％ ( 95％CI: 55. 3％-85. 9％, 100. 0％( 95％CI:29. 2％-100. 0％) , and 73. 0％ ( 95％CI: 58. 7％-87. 3％) , respectively. For submucosal protrusions, the sensitivity, specificity, and accuracy of EUS-FNA were 68. 8％ ( 95％CI: 46. 0％ -91. 5％) , 100. 0％ ( 95％CI: 2. 5％-100. 0％) , and 70. 6％ ( 95％CI: 44. 0％-89. 7％) , respectively. Conclusion EUS-FNA has moderate diagnostic value for endoscopic biopsy-inconclusive gastrointestinal lesions. It can be an alternative option when standard methods, such as endoscopic mucosal forceps biopsy, fail to provide a definitive diagnosis.
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<p><b>OBJECTIVE</b>To explore the genetic etiology for 11 sporadic patients with neurofibromatosis type 1.</p><p><b>METHODS</b>Chip targeting capture and high-throughput sequencing were employed to detect potential mutations of NF1 and NF2 genes among the 11 patients. The data was filtered through multiple mutational databases and in-house whole exome sequence database. Sanger sequencing was used for analysis of family members of the patients.</p><p><b>RESULTS</b>Eleven pathogenic variants were found among the 11 patients, which included two splicing mutations, one missense mutation, two nonsense mutations, and six frame-shifting mutations. None of the mutations was recorded by the public database or the in-house database generated from 1775 samples through whole exome sequencing. None of the unaffected parents carried the same mutation. Seven mutations were associated with neurofibromatosis type 1 previously, while the remaining four were discovered for the first time. Prenatal diagnosis of two high-risk pregnancies suggested that neither fetus has inherited the NF1 mutation from their affected parents.</p><p><b>CONCLUSION</b>Identification of causative mutations in patients with sporadic-type neurofibromatosis type 1 has provided a basis for genetic counseling. The four novel mutations have enriched the spectrum of NF1 gene mutations.</p>
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Objective To explore the effect of failure mode and effect analysis (FMEA)in the safety management of digestive endoscopic specimens. Methods From April to November 2016, the specimens by biopsy from the patients in the department of gastrointestinal endoscopy were assigned as the control group, where conventional sample management was used and those from December 2016 to July 2017 were all included in the intervention group, where FMEA was used to find the failure mode and improvement plan was worked out. The FMEA team was set up to discuss and determine the high risk factors leading to the safety management defects in the digestive endoscopy center and calculate the risk priority number (RPN). According to the potential risk factors, we optimized and implemented continuous improvement of the specimen safety management process. Results After the implementation of FMEA,the RPNs in the top 6 failure modes were less than 125,the risk coefficient value dropped from 126~175 to 0~40.The specimen error rate after the implementation of FMEA was statistically significantly lower than that before the implementation (P<0.001). Conclusion The FMEA reduces the incidence of specimen failure and improves the quality of the management of digestive endoscopy.
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Objective To investigate the clinicopathological characteristics and the expression of related molecular markers of heterotopic pancreas for better understanding and avoiding overtreatment of this disease.Methods From 24th March 2009 to 10th November 2016,92 patients with heterotopic pancreas in upper digestive tract diagnosed after endoscopic submucosal dissection(ESD),were collected. Tissues were sectioned and pathologically classified by Heinrich classification.The expressions of seven different molecular markers including cytokeratin(CK)19,insulin,trypsin,Ki-67,p53,CD133 and CD56 were detected by immunohistochemistry staining. Clinical features, pathological features and immunohistochemical results were retrospectively analyzed.Analysis of variance and Kruskal-Wallis test were used.Results According to Heinrich classification,the percentages of type Ⅰ,Ⅱ,and Ⅲ of heterotopic pancreas were 27.2%(25/92),63.0%(58/92)and 9.8%(9/92),respectively.There was no type Ⅳ patients.The heterotopic pancreas mainly located in stomach with proportion being about 91.3%(84/92)of the total heterotopic pancreas.CK19(the marker of pancreas ducts),insulin(as marker of endocrine function)and trypsin(as the marker of exocrine function)were all expressed in heterotopic pancreas.The positive rate of CD56,a pancreatic neuroendocrine marker,was 66.3%(61/92).The umbilicus like depression was the typical endoscopic appearance of heterotopic pancreas,which only found in 29 patients(31.5%).The average rate of Ki-67,cell proliferation index,was(2.08 ± 1.41)%.The expression of mutant p53 was negative in all 92 cases of heterotopic pancreas.The average staining area of CD133,a marker of pancreatic cancer stem cell,was(2.53 ± 2.43)%.The average follow-up period of 92 patients was(43.6 ± 27.5)months.No relapse and malignant change were found and all patients survived after ESD.Conclusions Heterotopic pancreas has normal pancreatic construction and function.The cell proliferation index is low in heterotopic pancreas and no mutant p53 expression is found.The expression of CD133 is also low.Heterotopic pancreas is a congenital benign disease which requires a long-term follow-up rather than overtreatment.
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Objective To investigate the clinical values of detection of plasma miRNA-544a (miR-544a) expression level in the diagnosis and treatment of lung cancer.Methods A total of 110 patients diagnosed with lung cancer in Ⅰ-Ⅱ stage from June 2017 to March 2018 in Shiyan Taihe Hospital were collected,and 35 patients with benign pulmonary nodules and 64 healthy people were also collected as the controls.Realtime quantitative polymerase chain reaction (RT-qPCR) was used to detect the level of miR-S44a in plasma of 64 healthy people,110 patients with lung cancer (50 newly diagnosed patients without anti-tumor treatment,33 patients one week after radical resection,27 patients after one week chemotherapy with the same dose) and 35 patients with benign pulmonary nodules.Of the 50 newly diagnosed patients,42 cases were non-small cell lung cancer and 8 cases were small cell lung cancer.The plasma expression level of miR-544a in each group was compared by using Mann-Whitney U test,and the efficacy of miR-544a in the diagnosis of lung cancer was evaluated by the receiver operationg characteristic (ROC) curve and the area under the curve (AUC).Results The plasma expression levels of miR-544a in the newly diagnosed untreated lung cancer group,one week after operation group,one week chemotherapy group,healthy control group and benign pulmonary nodule group were 1.40 nmol/L (0.55 nmol/L,8.76 nmol/L),33.52 nmol/L (3.64 nmol/L,250.47 nmo/L),8.87 nmol/L (0.68 nmol/L,125.43 nmol/L),0.31 nmol/L (0.17 nmol/L,1.19 nmol/L),1.04 nmol/L (0.31 nmol/L,4.62 nmol/L),respectively,and the differences between untreated lung cancer group and the other 4 groups were statistically significant (Z =-4.483,P ＜ 0.001;Z =-4.274,P ＜ 0.001;Z =-2.562,P =0.01;Z =-2.152,P =0.031).The expression levels of miR-544a in non-small cell lung cancer group and small cell lung cancer group were 1.40 nmol/L (0.66 nmol/L,8.76 nmol/L) and 1.37 nmol/L (0.26 nmol/L,36.97 nmol/L),respectively.The differences between non-small cell lung cancer group and healthy control group and benign pulmonary nodule group were statistically significant (Z =-4.463,P ＜ 0.001;Z =-2.026,P =0.043).Compared with the healthy people,the AUC of miR-544a for diagnosing the lung cancer was 0.841,the sensitivity was 87.5 ％,and the specificity was 68.0 ％.Compared with the benign pulmonary nodule,the AUC for diagnosing lung cancer was 0.638,the sensitive was 45.7 ％,and the specificity was 80.0 ％.Conclusions The plasma expression level of miR-544a has certain significances in the differential diagnosis of early stage lung cancer and benign pulmonary nodules and healthy people,and it can be used as a potential biomarker for diagnosing early stage lung cancer,especially for the non-small cell lung cancer.The plasma expression of miR-544a is increased after surgery or chemotherapy,suggesting that its expression may be related to the occurrence and development of lung cancer,and miR-544a may become a new target for cancer treatment.
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Objective To compare the pathological results between preoperative gastroscopy samples and postoperative samples of endoscopic resection from patients with gastric intraepithelial neoplasia, and further investigate the risk factors of pathological upgrading. Methods A retrospective analysis was performed on the data of 371 patients with gastric intraepithelial neoplasia confirmed by biopsy and undergoing endoscopic resection from January 2012 to December 2014 in Nanjing Drum Tower Hospital. The preoperative and postoperative pathological results were compared, and the risk factors for pathological upgrading after operation were analyzed. Results Among 371 patients, 173 and 198 cases were diagnosed as low-grade intraepithelial neoplasia ( LGIN ) and high-grade intraepithelial neoplasia ( HGIN ) , respectively, by preoperative endoscopic biopsy. By postoperative pathology of endoscopic resection, 113 ( 65. 3％) of 173 LGIN cases kept the diagnosis, while 46 ( 26. 6％) of 173 cases were upgraded to HGIN, and 10 ( 5. 8％) of 173 cases were finally upgraded to gastric cancer. The upgrade rate was 32. 4％(56/173). In the HGIN group, 107 ( 54. 0％) of 198 HGIN patients had the same diagnosis after endoscopic resection, 78 ( 39. 4％) of 198 cases were upgraded to cancer. Multivariate regression analysis showed that diameter of larger than 2 cm (P=0. 008), proximal stomach location (P=0. 011), mucosal surface redness ( P=0. 000 ) , and surface depression or ulcer ( P=0. 003 ) were independent factors of pathological upgrading for postoperative samples. Conclusion Preoperative biopsy for the diagnosis of gastric intraepithelial neoplasia has a certain misdiagnosis rate. More attentions should be paid on the lesion which is larger than 2 cm in diameter, located in the proximal stomach, or mucosa with red surface, depression or ulcer. Postoperative pathological examination can help to clarify the nature of the lesion.
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Objective To assess the clinical effects of simethicone emulsion combined with polyethylene glycol on bowel preparation for colonoscopy. Methods Two hundred out-patients, who underwent colonoscopy,were randomly divided into the study group and the control group. The study group was given simethicone in addition with polyethylene glycol, and the control group was given polyethylene glycol only. The differences on bowel preparation scores, air bubble reduction rate, colon lens sharpness, ileocecal region arrival time, colon polyp detection rate, the number of colon poly detection, and adverse event rate between the two groups were compared. Results The air bubble reduction rate, colon lens sharpness score and ileocecal region arrival time of the study group was 1(0-3)score,1.0(0-2)score,and 9(5-21)min,respectively,which was 2(1-3)score,1.5(0-2)score and 12(6-22)min, respectively in the control group. Differences between the two groups were statistically significant(Z=-9.490,P=0.000;Z=-6.768,P=0.000;Z=-5.521,P=0.000). For the bowel preparation score, colonoscopy polyp detection rate,the detection rate of colon polyp of diameter less than 5 mm, and number of colonoscopy polyp detection,there was no statistical difference between the two groups(P>0.05). No adverse events were observed in the both two groups. Conclusion The bowel preparation using simethicone combined with polyethylene glycol could effectively decrease the number of air bubble, enhance colon lens sharpness and shorten operation time,which contributes significant improvement for colonoscopy quality.
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Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers ( SMEGC) and gastric high grade intraepithelial neoplasia ( GHGIN) . Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66. 19±7. 46 years, 90. 62％(29/32) were male, 17 cases (53. 3％) had family history of gastric cancer, 25 (78. 13％) had smoking history, and 22 ( 68. 75％) were alcohol users. There were 30 cases ( 93. 75％) and 31 cases ( 96. 88％) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0. 4167, P=0. 018). The endoscopic classification of major and minor lesions had no statistical significant consistency ( P=0. 314 ) , but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation ( P<0. 05 ) . The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach ( r=0. 463,P=0. 003) . Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation( r=0. 417,P=0. 009) . Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis.
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Objective To evaluate the safety and feasibility of endoscopic ultrasonography(EUS)-guided dehydrated ethanol lavage on treatment of pancreatic cystic neoplasms(PCN). Methods The data of 15 patients with PCN treated by EUS-guided dehydrated ethanol lavage in Nanjing Drum Tower Hospital from April 2014 to December 2016 were retrospectively analyzed. All the patients underwent EUS-guided fine needle aspiration, and then the cyst cavity was lavaged with dehydrated ethanol. The curative effects and complications were evaluated after the procedure. Results Each patient had one operation and all the operations were successful. No operation-related intraoperative or postoperative complications occurred. Patients were followed up for a median time of 15 months(range from 3-30 months).Twelve patients finished a long term follow-up,including 6 cases of complete remission and 6 cases of partly remission. None of the patients underwent surgical resection. Conclusion Dehydrated ethanol lavage is safe and feasible for treatment of PCN.
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Objective To evaluate the potential malignancy, prognosis and risk factors for intraductal papillary mucinous neoplasm(IPMN), which were classified into different risk levels based on Fukuoka guideline. Methods A retrospective analysis of patients with IPMN diagnosed at Nanjing Drum Tower Hospital from 2009 to 2016 was conducted. Clinical characteristics,treatment and prognosis of IPMNs were analyzed. Results A total of 94 IPMN patients were included and divided into 3 groups according to Fukuoka guideline,46 patients in high-risk(HR)group,30 in group of worrisome features(WF), and 18 in low-risk(LR)group. For patients undergoing surgery treatment, there were 5 cases(19.2%,5/26)in HR group and 2 cases(12.5%,2/16)in WF group whose postoperative pathological findings were malignant (P=0.690). The 5-year survival rates after operations were 73.9% and 77.0% in HR and WF group, respectively(P=0.830). For patients without surgery treatment, in a 5-year follow-up, there were 6 cases (33.3%,6/18),2 cases(16.7%,2/12)and 0(0.0%,0/18)progressing into pancreatic cancers in HR, WF and LR groups,respectively(P<0.05). In addition,among the three groups,the 5-year survival rates were 49.5%,85.7% and 100.0%(P=0.025). Jaundice was significantly related to prognosis(P<0.01) and the hazard ratio was 8.883(95%CI:2.953-26.721). Conclusion Jaundice is a predictive risk factor for survival of IPMN. As for the treatment to IPMN, patients in HR group should receive surgery treatment while those in LR group can be followed up. For patients in WF group,the treatment should be customized, with evaluation of predictive risk factors,and operations can be performed when needed.
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Sphincter of Oddi dysfunction (SOD) refers to a series of clinical syndromes that occurs because of structural or functional disorders involving the biliary and/or pancreatic sphincters.It remains controversial whether endoscopic sphincter manometry (SOM) or sphincterotomy is needed in patients with type Ⅲ SOD.An important problem is that ERCP (with or without SOM) carries significant risks, especially the post-ERCP pancreatitis.The EPISOD trial has updated our knowledge on type Ⅲ SOD.The latest Rome Ⅳ consensus suggested that the classification term type Ⅲ biliary SOD should be abandoned and a new classification of biliary SOD was proposed;also, manometry and sphincterotomy were not recommended for patients with this type of SOD.The goal of this paper is to review recent literatures and elucidate the selected important questions regarding type Ⅲ SOD.
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Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection ( ESD ) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD. The pathological features of all resection margins in the specimen and the follow?up outcome of the patients with positive resection margin were evaluated. Univariate and multi?variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions,there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion( submucosal layer invasion, P=0?048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension (≥3/4,P=0?014) and the depth of invasion( exceeding muscularis mucosa, P=0?007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.