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Objective:To explore the therapeutic effect of peroral endoscopic myotomy (POEM) for primary achalasia (AC) in patients aged over 60 years.Methods:Data of 146 patients aged ≥60 years (the elderly group) and 146 patients aged 18-59 years (the adult group) who received POEM from November 2010 to September 2019 at the Digestive Endoscopy Center of PLA General Hospital were retrospectively analyzed. Baseline data, surgery data, surgery-related complications and surgery-related efficacy were compared.Results:There was no significant difference in gender, Ling classification, HRM classification or previous treatment between the two groups ( P>0.05). All 292 patients successfully underwent POEM surgery. The clinical success (Eckardt score ≤3) rates in the elderly group and the adult group were 96.33% (105/109) and 96.77% (90/93), respectively with no significant difference between the two groups ( χ2=0.030， P>0.05). There was no significant difference in the length of myotomy between the two groups (7.09±2.49 cm VS 7.12±2.24 cm， t=0.472， P>0.05). Complications occurred in 26 cases (17.81%) in the elderly group and 21 cases (14.38%) in the adult group with no significant difference between the two groups ( χ2=0.634， P>0.05). There was no significant difference in the postoperative hospital stay (12.61±9.69 days VS 11.00±4.43 days, t=1.825, P>0.05) or the incidence of gastroesophageal reflux [43.33% (13/30) VS 51.52% (17/33), χ2=0.422, P>0.05] between the elderly group and the adult group. Conclusion:The efficacy of POEM for AC patients over 60 years old is equivalent to that of adult patients, and the incidence of complications is similar. POEM is safe and effective for AC patients over 60 years old.
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BACKGROUND@#Endoscopic resection bleeding (ERB) classification was proposed by the authors' team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.@*METHODS@#We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.@*RESULTS@#Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.@*CONCLUSIONS@#Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.
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Humans , Endoscopic Mucosal Resection/adverse effects , Gastric Mucosa , Gastroscopy , Postoperative Hemorrhage , Retrospective Studies , Risk Factors , Stomach Neoplasms/surgeryABSTRACT
Objective:To evaluate the efficacy and safety of the second session of endoscopic ultrasound-guided lauromacrogol ablation (EUS-LA) for pancreatic cystic neoplasms (PCNs).Methods:A total of 74 patients with suspected of PCNs who underwent EUS-LA in the First Medical Center of Chinese PLA General Hospital from April 2015 to December 2020 were enrolled in the study. Fifteen of them underwent the second ablation. The efficiency of EUS-LA was determined based on the change of lesion volume during the imaging follow-up, categorized into complete resolution (CR), partial resolution (PR) and stable disease (SD). The safety was determined by the complication incidence.Results:Among the 15 patients undergoing the second EUS-LA, there were 9 males and 6 females with age of 51.5±17.6 years. Thirteen patients completed imaging follow-up after the second EUS-LA, CR was achieved in 8 patients, PR in 2 patients and 3 in SD. The CR rate increased from 0 after the first ablation to 8/13 after the second ablation ( P=0.002). The median cyst diameter decreased from 22.0 mm before the second ablation to 15.0 mm after the second ablation ( Z=-2.666, P=0.008) and the median cyst volume reduced from 2 419.7 mm 3 to 1 099.5 mm 3 ( Z=-2.134, P=0.033). The complication incidence of the second ablation was 2/15, similar to that of the first ablation. Conclusion:The second ablation is effective and safe without increasing the complication incidence in patients without achieving CR after the first EUS-LA.
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Objective:To evaluate the performance, efficacy and safety of a novel portable endoscopy system for upper gastrointestinal examination.Methods:A multicentered, open-label, randomized, non-inferiority controlled study was conducted in 3 clinical research centers from June 2019 to June 2020, and a total of 90 outpatients admitted to Department of Gastroenterology were randomly assigned to the trial group ( n=44) undergoing portable endoscopy and the control group ( n=46) undergoing Olympus endoscopy. The examination success rate, image quality, performance, overall operation satisfaction rate, biopsy success rate and adverse events of the two groups were compared. Results:The examination success rates of the trial group and the control group were 97.73% (43/44) and 100.00% (46/46) respectively with a difference of -2.27% (95% CI: -6.68%-2.13%), higher than the set non-inferiority margin of -10%. Rates of good and excellent image quality were 100% in both groups, and the difference of 0 was higher than the set non-inferiority margin of -10%. There was no significant difference in the rate of good and excellent performance of the operating system between the two groups [97.67% (42/43) VS 100.00% (46/46), P=0.483]. There was significant difference in the overall satisfactory rate of the operation between the two groups [86.05% (37/43) VS 100.00% (46/46), P=0.011]. A total of 9 cases underwent endoscopic biopsy, including 5 cases in the trial group and 4 cases in the control group. The biopsy channels in both groups were smooth and the biopsy were successfully completed. There was no significant difference in adverse event rate between the two groups [25.00% (11/44) VS 10.87%(5/46), χ2=3.07, P=0.080]. All adverse events disappeared in 48 hours, and no severe adverse events or device defect events occurred. Conclusion:The novel portable endoscopic system is comparable to Olympus endoscopic system in terms of the operating performance, the image quality and safety. Therefore, this system is safe and effective for upper gastrointestinal examination.
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Objective:To evaluate the long-term efficacy and safety of a novel self-help inflatable balloon to prevent esophageal stenosis after extensive endoscopic submucosal dissection (ESD).Methods:Patients with early esophageal cancer or precancerous lesions, undergoing ESD in the First Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were included in the prospective study, who had post-ESD mucosal defect greater than 5/6 of the esophageal circumference and 30-100 mm in length. The self-help inflatable balloon was used to prevent esophageal stenosis after ESD. Mucosal defect of ESD was divided into grade 1 (≥5/6 and less than the whole circumference) and grade 2 (the whole circumference). The incidence of stricture, the time from ESD to the occurrence of stricture, the total number of endoscopic balloon dilations (EBD) or radial incision and cuttings (RIC), and other adverse events were observed.Results:A total of 27 patients met the including criteria with follow-up time of 14-38 months, including 3 patients of grade 1 and 24 of grade 2. The ulcer longitudinal length was 73.7±18.4 mm. The time of wearing balloons was 92.0±20.0 days. The overall frequency of stricture was 18.5% (5/27), and the stricture incidence of patients of grade 2 resection was only 16.7% (4/27). The median time from balloon removal to stricture was 17 days. To treat the stricture, two patients received 3 EBD sessions, and three other patients received 2, 1 and 2 RIC sessions, respectively. No balloon was removed in advance, and none had a perforation or delayed bleeding.Conclusion:The self-help inflatable balloon shows high efficacy and safety in preventing esophageal stenosis in patients with mucosal defect greater than 5/6 of the esophageal circumference and less than 100 mm in length after extensive esophageal ESD.
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Objective:To investigate the risk factors for synchronous multiple early gastric cancer (SMEGC).Methods:A retrospective analysis was conducted on data of 390 patients with early gastric cancer, including 353 cases of solitary early gastric cancer (SEGC group) and 37 cases of SMEGC (SMEGC group), who underwent endoscopic submucosal dissection (ESD) in Chinese PLA General Hospital from January 2017 to June 2019. The differences in clinical characteristics (gender, age, body mass index, smoking status, drinking status, family history of gastrointestinal cancer and other cancers, etc.) and pathological characteristics (size, location, morphology, differentiation degree, invasion depth, with or without Helicobacter pylori infection, intestinal metaplasia, ulcers and atrophic gastritis of lesions, etc.) between the two groups were compared by t test, Mann-Whitney U test, Chi-square test, or Fisher′s exact test. Logistic regression (forward LR) was used to screen the independent risk factors for SMEGC. Results:There were no significant differences in the general clinical characteristics between SMEGC group and SEGC group ( P>0.05). Significant statistical differences were observed in the location of lesions ( χ2=8.375, P=0.015), the proportion of atrophic gastritis [48.6% (18/37) VS 23.8% (84/353), χ2=10.710, P=0.001] and the proportion of intestinal metaplasia [81.1% (30/37) VS 43.1% (152/353), χ2=19.452, P<0.001] between the two groups, but there were no significant differences in other pathological characteristics ( P>0.05). Multivariate logistic regression analysis showed that location of lesions in the middle 1/3 of stomach (VS upper 1/3: P=0.036, OR=3.38, 95% CI: 1.08-10.53), in the lower 1/3 of stomach (VS upper 1/3: P=0.049, OR=2.59, 95% CI: 1.00-6.69), presence of intestinal metaplasia ( P=0.001, OR=4.38, 95% CI: 1.77-10.86) and atrophic gastritis ( P=0.043, OR=2.24, 95% CI: 1.04-5.07) were independent risk factors for SMEGC. Conclusion:Patients with early gastric cancer located in the middle or lower 1/3 of stomach, with intestinal metaplasia and atrophic gastritis are prone to SMEGC and should be carefully evaluated and closely followed up after ESD.
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Objective:To explore the risk factors for esophageal stricture after endoscopic resection (ER) of large-area early esophageal cancer (≥3/4 circumferential mucosal defect).Methods:A total of 63 cases of large-area early esophageal cancer treated with ER in the Digestive Endoscopy Center of the First Medical Center of PLA General Hospital from May 2009 to April 2016 were included in the retrospective analysis. They were divided into stricture group (32 cases) and non-stricture group (31 cases) according to the occurrence of postoperative esophageal stenosis. T-test or Chi square test was conducted to compare the indicators between the two groups. Indicators of P<0.05 and potential indicators from the clinical perspective were included in multivariate logistic regression analysis. Results:Univariate analysis showed that the length of lesion, the degree of mucosal defect around the wound and the injury of muscularis propria were associated with esophageal stricture after ER ( P<0.05). The above 3 indicators were included in the multivariate logistic regression analysis, together with 3 other indicators, i. e. preventive measures for stenosis, pathological type, and en bloc resection. The results showed that more than 7/8 circumferential mucosal defect around the wound (VS 3/4-<7/8 circumferential: P=0.028, OR=0.317, 95% CI:0.114-0.884) and no preventive measures ( P=0.002, OR=0.153, 95% CI:0.046-0.512) were independent risk factors for esophageal stricture after ER of large-area early esophageal cancer. Conclusion:Circumferential mucosa defect≥7/8 is the main factor leading to esophagus stricture after large-area early esophagus carcinoma. And appropriate preventive measures can effectively reduce the incidence of postoperative stenosis after ER.
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Objective:To examine a nomogram model for individualized prediction of the risk for recurrence of early gastric cancer(EGC)in elderly patients undergoing endoscopic submucosal dissection(ESD).Methods:This was a retrospective cohort study, with a total of 3 987 elderly EGC patients who underwent ESD treatment between January 2000 and December 2016 after admission to the gastroenterology department of our hospital.Twenty-eight relapsed patients with complete clinicopathological data and follow-up data were selected as the relapse group, and 276 non-relapsed patients were selected as the control group.General data of all patients were collected and a logistic regression analysis was performed to analyze independent risk factors for the recurrence of EGC in patients after ESD.A corresponding nomogram risk prediction model was established by using the R software.Results:Among the 3 987 elderly EGC patients, 29 relapsed after an average follow-up of 2.7 years, and the recurrence rate was 0.73%(29/3 987). The differences in baseline data such as age(≥75 years old), lesion size(≥3 mm), T stage and lymph node metastasis between the recurrence group and the control group were statistically significant(11 cases or 39.3% vs.171 cases or 62.0%, 19 cases or 67.9% vs.111 cases or 40.0%, 9 cases or 32.1% vs.153 cases or 55.4%, 19 cases or 67.9% vs.102 cases or 39.0%, P<0.05). Logistic regression analysis showed that age over 75 years( OR=2.128, 95% CI: 1.373-3.624), T stage( OR=1.763, 95% CI: 1.079-2.934), lesion size≥3 mm( OR=2.604, 95% CI: 1.363-4.217), and lymph node metastasis( OR=2.871, 95% CI: 1.425-5.639)were independent risk factors for the recurrence after ESD in EGC patients( P<0.05). The nomogram model was established based on the above risk factors, and the validation results showed that the predicted value was basically the same as the actual measured value and had good predictive performance.The internal validation results showed that the consistency index was 0.817(95% CI: 0.722-0.941), suggesting that the model had a high accuracy and discrimination. Conclusions:Before ESD for elderly EGC patients is performed, factors such as age, tumor size, T stage and lymph node metastasis should be fully considered to comprehensively evaluate the recurrence rate of EGC after the procedure.This predictive model can improve the diagnostic efficacy of postoperative recurrence and has high clinical value.
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Objective:To compare the clinicopathological characteristics of main and accessory lesions in patients with synchronous multiple esophageal lesions (SMEL, i. e. early esophageal cancer and intraepithelial neoplasia) and to explore their correlation.Methods:Data of 80 patients with SMEL treated by endoscopic resection in The First Medical Center of Chinese PLA General Hospital from November 2006 to September 2019 were retrospectively analyzed, and the clinicopathological characteristics as well. The lesions were divided into main and accessory lesions, and their correlation in macroscopic type, lesion location, pathological type and invasion depth in 70 patients with double SMEL were investigated.Results:The age of 80 patients with SMEL was 61.3±8.32 years, more common in males (83.8%, 67/80). Fifty-seven patients (71.2%) had a history of smoking and drinking, respectively. There was a positive correlation between the size of main and accessory lesions in the 70 patients with double SMEL ( r=0.464, P<0.001). The macroscopic type ( P=0.115), location ( P=0.340) and depth of invasion ( P=0.555) of the main and accessory lesions were not correlated, but the pathological type had high correlation ( P<0.001). The consistency rate was 50.0% (35/70). Conclusion:Most SMEL patients are elderly males with a history of smoking and drinking. When one lesion is found, there is high possibility of multiple lesions. Physicians should be aware of the correlation between main and accessory lesions to avoid missed diagnosis.
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Objective:To determine the safety and long-term efficacy of endoscopic ultrasonography-guided lauromacrogol ablation (EUS-LA) for treatment of pancreatic cystic neoplasms (PCNs) with a larger population.Methods:From April 2015 to April 2019, 255 patients suspected of PCNs were enrolled in the First Medical Center of Chinese PLA General Hospital in the study, and 57 patients underwent EUS-LA. The effectiveness of EUS-LA was determined based on imaging volume changes. The occurrence of complications was observed and recorded.Results:Among the 57 patients who underwent EUS-LA, 38 were female and 19 were male, with the mean age of 52.0±14.6 years. The cysts were located in the head/uncinate of the pancreas in 33 patients and in the body/tail of the pancreas in 24 patients. A total of 50 patients were followed up by imaging examinations. After treated by EUS-LA, the cyst median volume sharply reduced from 11 434.1 mm 3 to 639.4 mm 3 ( Z=-5.556, P<0.01), and the median diameter decreased from 32.0 mm to 12.0 mm ( Z=-6.161, P<0.01). Postoperative imaging showed a complete resolution in 24 patients (48.0%), partial resolution in 14 patients (28.0%), and persistent cyst in 12 patients (24.0%). The total number of ablation was 69, and there were 12 patients undergoing a second ablation. The adverse events rate was 4.3% (3/69). Among the 34 patients followed up for 12 months or more, complete resolution was observed in 18 patients (52.9%), partial resolution in 9 (26.5%), and persistent cyst in 7 (20.6%). Conclusion:EUS-LA is effective and safe for the treatment of PCNs. Its effectiveness is stable after more than 12 months′ follow-up.
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Objective:To evaluate the clinical value of suspensory incision and suture technique in endoscopic full-thickness resection (EFTR) for muscularis propria tumor of gastric fundus.Methods:A retrospective analysis was performed on the data of 20 patients with muscularis propria tumor in gastric fundus and undergoing EFTR in the First Medical Center of PLA General Hospital from June 2017 to June 2019. Patients were divided into the observation group (9 cases) treated with suspensory incision and suture technique in EFTR and the control group (11 cases) treated with traditional EFTR method. The baseline data and perioperative data of the two groups were analyzed.Results:EFTR was successfully performed on all 20 patients. The tumor size of the observation group and the control group was 10.0 (7.5, 21.0) mm and 14.0 (10.0, 20.0) mm, respectively. The resection time of the two groups was 26.4±6.3 min and 35.5±11.4 min, respectively. The postoperative hospital stay was 6.4±1.0 d and 7.7±1.5 d, respectively. No postoperative delayed bleeding, perforation, or other complications occurred in the two groups.Conclusion:Using suspensory incision and suture technique is safe and effective during EFTR for muscularis propria tumor in gastric fundus, and can reduce operation time. This technique is worth applying in clinic.
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Objective:To compare the efficacy and safety of endoscopic mucosal resection (EMR), EMR with pre-cutting (EMR-P), endoscopic submucosal dissection (ESD) and ESD with snare (ESD-S) for the treatment of colorectal laterally spreading tumors (LSTs).Methods:Between January 2016 and March 2018, a total of 146 patients with 146 colorectal LSTs undergone endoscopic resection at the first medical center of PLA General Hospital. Data of demographics, treatment information, pathology and follow-up results were retrospectively analyzed.Results:Among the 146 patients, EMR, EMR-P, ESD, and ESD-S were performed in 23, 29, 50 and 44 tumors, respectively. Median tumor diameter was 2.5 cm (ranged 1.2-10.0 cm). The en bloc resection rate of EMR, EMR-P, ESD and ESD-S were 73.9% (17/23), 72.4% (21/29), 96.0% (48/50), and 65.9% (29/44), respectively, with statistical difference ( P<0.001). And the R0 resection rate were 65.2% (15/23), 69.0% (20/29), 94.0% (47/50), and 63.6% (28/44), respectively, with statistical difference ( P=0.002). The en bloc resection rate and R0 resection rate of the ESD group were significantly higher than those of the other three groups (all P<0.05). The difference was not statistically significant in terms of perforation rate [0, 0, 6.0% (3/50), and 9.1% (4/44), respectively, P=0.269] and delayed hemorrhage rate [4.3% (1/23), 0, 2.0% (1/50), and 2.3% (1/44), respectively, P=0.768] among the four groups. Follow-up endoscopy was performed in 117 cases (80.1%) with a median period of 10.0 months (ranged 3.0-26.0 months), and local recurrence was identified in 7 (6.0%) cases. Conclusion:ESD could be the optimal method for the resection of colorectal LSTs, while LSTs smaller than 20 mm can be resected by EMR. EMR-P and ESD-S as modified methods have their respective advantages for the treatment of LSTs.
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Objective To assess the diagnostic accuracy of preoperative endoscopic ultrasonography (EUS) for tumor size and invasion of non-ampullary duodenal neuroendocrine tumors (NA-DETs) and to compare the efficacy and safety of endoscopic submucosal dissection ( ESD ) and modified ESD for the treatment of NA-DETs. Methods Data of 22 patients with 22 NAD-NETs confirmed by histopathological examinations from January 2007 to January 2018 were retrospectively analyzed. ESD was performed on 13 tumors, and modified ESD was performed on 9 tumors. R0 resection rate, procedure time and incidence of procedure-related complications in the ESD group and the modified ESD group were compared. The postoperative pathological results were used as the gold standard to assess the accuracy of preoperative EUS in diagnosing tumor size and invasion of NA-DETs. Results The mean size of NA-DETs was 6. 9 ± 1. 5 mm. The accuracy in assessing the invasion depth by EUS was 95. 5％ ( 21/22 ) compared with histological results. R0 resection was achieved in 13/13 ( 100. 0％) of the ESD group and in 7/9 ( 77. 8％) of the modified ESD group (P=1. 000). The procedure time was significantly shorter in the modified ESD group than that in the ESD group ( 16. 0 ± 2. 2 min VS 29. 8 ± 4. 9 min, P<0. 001 ) . Intraoperative perforation occurred in one patient and delayed perforation occurred in one patient in the ESD group. Delayed bleeding occurred in one patient in the modified ESD group. Follow-up data were available in all cases with a mean period of 30. 0±24. 8 months. No cases of local recurrence or distant metastasis were detected in the follow-up period. Conclusion EUS can accurately assess the size and depth of NAD-NETs. Modified ESD can provide comparable clinical outcomes to ESD for NAD-NETs ≤10 mm in diameter that are confined to the submucosa.
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Objective To assess the efficacy and safety of autologous skin-grafting surgery ( ASGS) in the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection ( ESTD) for early esophageal cancer. Methods Between January 2018 and March 2018, five patients with early esophageal cancer underwent complete circular ESTD and ASGS in Chinese PLA General Hospital. The skin-graft survival situation, and occurrence of esophageal stenosis and complications were observed by endoscopy follow-up. Results Complete circular ESTD and ASGS were successfully performed in all 5 patients, and no complications including perforation, bleeding, wound infection or stent migration occurred. The mean skin-graft survival rate was 86. 0％. Four patients did not experience esophageal stenosis over the mean follow-up of 9. 5 months. One patient experienced esophageal stenosis after operation, and underwent endoscopic balloon dilatation. No stenosis occurred in 8 months of follow-up. Conclusion ASGS is a safe and effective method to prevent esophageal stenosis after complete circular ESTD.
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Objective To evaluate the efficiency and safety of full-spectrum endoscopy for detection of major duodenal papilla. Methods Patients underwent painless gastroscopy in Chinese PLA General Hospital from March 2017 to December 2017 were enrolled and randomly divided into two groups according to random number method. The group A underwent conventional gastroscopy, and the group B underwent full-spectrum endoscopy. The detection rate of major duodenal papilla was calculated and compared between the two groups. Results A total of 100 patients were recruited in the study, including 51 in the group A and 49 in the group B. The whole detection rate of major duodenal papilla of the group B was higher than that of the group A [79. 59％ (39/49) VS 41. 18％ (21/51), χ2 =15. 366, P=0. 000]. There was no statistical difference on the whole plus partial detection rate of major duodenal papilla between the two groups [100. 00％ (49/49) VS 92. 16％ (47/51), χ2=2. 221, P=0. 136]. All patients completed endoscopy examination succesfully without bleeding, peforation or death. Conclusion With the broad view-field, full-spectrum endoscopy is useful to improve the efficiency and safety in detection of major duodenal papilla.
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Objective@#To evaluate optical coherence tomography(OCT)for predicting invasion depth of early esophageal cancer(EEC) and to compare OCT and magnifying endoscopy-narrow band imaging (ME-NBI)in clinical performance.@*Methods@#Twenty-eight patients who were diagnosed with EEC and accepted OCT and ME-NBI before endoscopic submucosal dissection(ESD)were enrolled in this prospective study. On the basis of OCT and ME-NBI images, real-time prediction of EEC invasion depth was conducted. Postoperative pathological results were taken as golden standard to compare the accuracy of OCT and ME-NBI in evaluation of EEC invasion depth. The procedure time and incidence of complications during evaluation process were also analyzed.@*Results@#The overall accuracy of OCT and ME-NBI in predicting invasion depth of 28 EEC patients were 67.9% (19/28) and 75.0% (21/28) respectively, with no significant difference(P>0.05). The accuracy of OCT and ME-NBI in distinguishing lesions located in epithelium/lamina propria mucosa (EP/LPM) lesions were 78.9%(15/19) and 68.4% (13/19), with no significant difference(P>0.05). The procedure time of OCT was significantly shorter than that of ME-NBI (6.0±2.9 min VS 16.3±5.4 min, P<0.001).@*Conclusion@#The ability of OCT to predict invasion depth of EEC and distinguish lesions located in the EP/LPM is comparable with that of ME-NBI. Besides, OCT requires shorter procedure time for evaluation.
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Objective To investigate the predisposing locations of active hemorrhage in patients with esophageal variceal bleeding. Methods Data of 823 patients with acute esophageal and gastric variceal hemorrhage receiving emergency gastroscopy diagnosed from January 2003 to December 2013 were retrospectively studied. The location and site of active hemorrhage or stigmata were analyzed and its relationship with active hemorrhage was discussed. Results A total of 372(45. 2%,372/823) patients with active bleeding and stigmata were found under emergency endoscopy. Among 372 patients, 190 got accurate hemorrhage and stigmata location and site description. Bleeding or stigmata in 58(30. 5%) patients was 28-32 cm from incisor in group A, and that in 132 (69. 5%) patients was more than 35 cm in group B ( χ2＝57. 642, P＜0. 000 1). In 190 cases, the proportion of bleeding or stigmata at 3:00 point was the highest (37%,70/132), followed by those at 12:00 point(30%,58/132),6:00 point(24%,45/132),and 9:00 point (9%,17/132). The change trend of the percentage of each point in group A and group B was the same as that in all cases. The percentage of almost all points in group B was significantly higher than that in group A except that at 9:00 point ( P＜0. 000 1).Conclusion Esophageal variceal bleeding in cirrhosis is more common at 3:00 point, 6:00 point and 12:00 point of esophagus, and the high risk area is 35 cm below the incisors.
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Objective To investigate the recurrence and risk factors of gastric high-grade intraepithelial neoplasia(HGIN)and early gastric cancer(EGC)after endoscopic submucosal dissection (ESD). Methods The clinical and follow-up data on 444 patients(451 lesion)with HGIN and EGC undergoing ESD in Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016 were summarized, and the risk factors of recurrence were analyzed. Results A total of 410 patients were followed-up, and the recurrence rate was 3.2%(13 patients, 13 lesions), with mean recurrence time of 17.6±9.6 months(6-38 months). Univariate and multivariate analysis revealed that the size of the lesion>4.0 cm was the only risk factor of recurrence(P=0.012,OR=10.855,95%CI:1.673~70.442). Conclusion The rate of recurrence is increasing with the EGC extending, therefore, postoperative monitoring should be strengthened to patients with larger lesion.
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Objective To investigate the clinical efficacy and application value of submucosal tunneling endoscopic resection(STER)for upper gastrointestinal submucosal tumors(SMTs). Methods A retrospective analysis was performed on the endoscopic and clinical data of 44 cases with SMTs who received STER from January 2015 to June 2016 in Chinese PLA General Hospital. Results The rate of complete resection was 88.6%(39/44). The operating time was 60.1±30.6 min. The hospitalization time was 10.1± 3.3 days. The rate of complications was 6.8%(3/44). The diagnosis of SMTs by pathology and endoscopic ultrasonography(EUS),the size of SMTs measured by EUS and ruler after STER,and the growing direction judged by EUS and CT were consistent. Conclusion STER for SMTs has a higher complete resection rate, shorter operating time and hospitalization time, and fewer complications. EUS combined with CT is an effective method for preoperative evaluation.
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Objective To evaluate the safety and effectiveness of endoscopic ultrasonography (EUS)-guided ablation with lauromacrogol for pancreatic cystic neoplasms(PCNs). Methods A total of 38 patients with PCNs admitted to Chinese PLA General Hospital from April 2015 to March 2017 were prospectively enrolled to receive EUS-guided ablation with lauromacrogol. Adverse events, such as pancreatitis,fever,bleeding and abdominal pain, were monitored during and after the procedure. Patients were followed up with contrast-enhanced CT or MRI in 3 months,6 months,1 year and 2 year after ablation. Results Thirty-eight patients were enrolled in the study, and 8 of them underwent a second ablation;so, there were 46 treatments. There were 24 females and 14 males with mean age being 53.9±14.7 years. Mild acute pancreatitis occurred in 2 cases and moderate fever occurred in 1 case. The adverse events rate was 6.5%(3/46). Among the 29 patients with complete follow-up of 5 months(2-17 months), the medium tumor volume before operation was 7 564.40 mm3(301.38-87 082.87 mm3)while 542.84 mm3(0-18 202.58 mm3)after the operation(P=0.000). A total of 14 had complete remission(CR)and 8 had partial remission(PR)in 29 patients. The remission effective rate was 48.3%(14/29),40.0%(8/20)in the cysts of the head/uncinate and 66.7%(6/9)in the body/tail(P=0.353). The medium surface area of CR group seemed smaller than that of non-CR group(1 194.27 mm2VS 1 764.09 mm2, P=0.023). Conclusion EUS-guided ablation with lauromacrogol for PCNs is safe and effective. Cysts of smaller surface are more likely to be cured than larger ones.