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Objective:Analyze the efficacy and safety of gastric peroral endoscopic myotomy (G-POEM) in the treatment of gastroptosis.Methods:From August 1, 2016 to August 1, 2020, at Zhongda Hospital, Southeast University, the baseline data of 14 patients with gastroptosis who underwent G-POEM were retrospectively collected, including age, weight, length of hospital stay, and modified gastroparesis cardinal symptom index(mGCSI). Regular follow-ups were made, and relevant data were recorded for comparative analysis. The main observation indicators were body weight and mGCSI. Friedman rank sum test and Bonferroni correction test were used for statistical analysis.Results:The age of 14 patients with gastroptosis was 50.0 years old(24.5 years old), the operations were successfully completed in all patients without any serious surgical complications, the time of hospital stay was 10.5 d (5.0 d), and all the postoperative follow-up time was >12 months. There were statistically significant differences in mGCSI and body weight between before operation and at 1st week, 1st month, 3rd month, 6th month, and 12th month after operation (1.94(1.19), 0.78(0.47), 0.36(0.19), 0.17(0.45), 0.13(0.57) and 0.29(0.50), 43.5 kg(5.8 kg), 43.5 kg(5.8 kg), 42.5 kg(7.1 kg), 43.5 kg(6.9 kg), 45.0 kg(8.0 kg) and 45.5 kg(7.5 kg); Z=42.78 and 34.28, both P<0.001). After Bonferroni correction in the pairwise comparison, there were statistically significant differences in the mGCSI of the 14 patients between before operation and at 1st month, 3rd month, 6th month, and 12th month after operation ( Z=4.09, 5.05, 5.00 and 4.14, P=0.001, <0.001, <0.001 and =0.001). The weight of 14 patients at 12th month after operation were compared with the weight before operation, 1st week after operation, and 1st month after operation, and the differences were statistically significant (all Z=-3.64, all P=0.004). Conclusion:G-POEM has a good therapeutic effect on patients with gastroptosis and is expected to become a new treatment for gastroptosis.
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Objective:To evaluate a newly designed basket fit for digital cholangioscope in non-radiation endoscopic lithotomy for common bile duct stones.Methods:Seventy-eight patients who underwent non-radiation endoscopic removal of common bile duct stones at Zhongda Hospital Southeast University between February and October 2021 were enrolled in the randomized controlled trial, and were randomly assigned into the new basket group ( n=35) and the conventional basket group ( n=43) by drawing lots. Procedures of cholangioscope-based biliary exploration and stone removal by baskets, volume of water irrigation, time lengths of biliary exploration, stone removal and whole endoscopic procedure, and adverse events were compared. Results:Compared with the conventional basket group, the new basket group needed less biliary explorations (1.08±0.28 VS 2.30±0.51, t=-12.535, P<0.001), smaller volume of water irrigation (46.14±11.89 mL VS 78.62±10.09 mL, t=-13.052, P<0.001), and shorter time of biliary exploration and stone removal (9.69±2.97 min VS 12.67±2.51 min, t=-4.815, P<0.001) and whole endoscopic procedure (30.17±7.19 min VS 33.44±6.69 min, t=-2.076, P=0.041). The incidence of adverse events was not significantly different between the two groups [5.7% (2/35) VS 11.6% (5/43), χ2=0.826, P=0.363]. Conclusion:This newly designed basket can facilitate digital cholangioscope-guided non-radiation endoscopic removal of common bile duct stones with the advantages of shorter operation time, less exploration time of choledochoscopy and smaller volume of water irrigation.
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Objective:To investigate the efficacy of additional treatment (chemoradiotherapy or esophagectomy) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma.Methods:Clinicopathological data of 97 patients of esophageal squamous cell carcinoma with infiltration depth of M3-SM3 who underwent ESD in Zhongda Hospital from July 2014 to April 2019 were reviewed. There were 57 patients in the additional treatment group and 40 patients in the observation group. The rate of relapse-free survival (RFS) was evaluated by Kaplan-Meier method (used log-rank test).Results:In the additional treatment group, 15 underwent esophagectomy after ESD, and no tumor metastases were found, but 1 patient died of upper gastrointestinal bleeding after surgery; 42 underwent chemoradiotherapy, and all patients were alive, but 3 patients experienced distant metastases. In the observation group, 13 patients experienced local recurrence, 2 patients died of tumor recurrence and 1 patient died of cerebrovascular disorder. Kaplan-Meier analysis showed that the RFS rate of the additional treatment group was higher than that of the observation group ( P=0.001). Conclusion:ESD followed by additional chemoradiotherapy or esophagectomy has good clinical efficacy and can improve prognosis for superficial esophageal squamous cell carcinoma (M3-SM3) patients.
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To evaluate the diagnostic value of endoscopic ultrasonography (EUS) for small common bile duct stones, 60 patients diagnosed as having suspected common bile duct stones who were hospitalized in Zhongda Hospital, Southeast University from January 2018 to July 2021 were selected. All patients were examined by EUS and magnetic resonance cholangiopancreatography (MRCP) during the same hospitalization. The results of endoscopic retrograde cholangiopancreatography, laparotomy or laparoscopic common bile duct exploration were adopted as the golden standard. The diagnostic results of EUS and MRCP were compared with the golden standard, and the sensitivity, specificity, positive predictive value and negative predictive value of the two methods were calculated. Among the 60 patients, 46 cases were confirmed as having common bile duct stones, 43 cases were diagnosed accurately by EUS and 35 cases by MRCP. Fourteen patients were confirmed as having no common bile duct stones, and the diagnosis was accurate in 12 cases by EUS and 13 cases by MRCP. The sensitivity of EUS was significantly higher than that of MRCP [93.48% (43/46) VS 76.09% (35/46), χ2=4.128, P=0.042]. There were 45 cases with diameter ≤1.0 cm, of which 42 cases were diagnosed by EUS and 34 by MRCP (diagnostic accuracy 93.33% VS 75.56%, χ2=4.145, P=0.042). There were 39 cases with diameter ≤0.8 cm, of which 36 cases were diagnosed by EUS and 28 by MRCP (diagnostic accuracy 92.31% VS 71.79%, χ2=4.266, P=0.039). There were 26 cases with diameter ≤0.5 cm, of which 24 cases were diagnosed by EUS and 16 by MRCP (diagnostic accuracy 92.31% VS 61.54%, χ2=5.038, P=0.021). EUS has obvious advantages in the diagnosis of common bile duct stones, and the accuracy of EUS is not affected by the size of stone. As a consequence, EUS should be performed in patients with high clinical suspicion of common bile duct stones but negative MRCP result.
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Objective:To investigate the medium- and long-term efficacy of peroral endoscopic myotomy (POEM) for esophageal diverticulum and the risk factors for postoperative recurrence.Methods:A retrospective study was conducted on 31 cases of esophageal diverticulum who were treated by POEM in Zhongda Hospital, Southeast University from May 1st 2016 to August 1st 2019. The Eckardt score, the operative success rate, and the recurrence rate after the operation were observed and recorded. Multivariate logistic regression analysis was performed to explore the risk factors for postoperative recurrence.Results:POEM was successfully completed in all 31 patients, who were followed up for 30.6±11.1 months (20-63 months). The Eckardt score before the operation was 8.2±2.4, and was 1.4±0.7, 1.4±1.1, 1.3±1.1, and 1.3±0.9 at 1, 6, 12 and 24 months, respectively after the operation, which significantly decreased at all follow-up time points ( P<0.001). The success rates at 1, 6, 12, and 24 months after the operation were 96.8% (30/31), 90.3% (28/31), 90.3% (28/31) and 90.3% (28/31), respectively. Three patients suffered symptom relapse, with an overall recurrence rate of 9.7% (3/31). Logistic regression analysis showed that the disease duration ( P=0.038, OR=1.041, 95% CI: 1.002-1.080) and preoperative Eckardt score ( P=0.024, OR=2.299, 95% CI: 1.117-4.728) were risk factors for postoperative recurrence of POEM. Conclusion:POEM is safe and effective for esophageal diverticulum. Patients with long disease duration and high preoperative Eckardt score are associated with recurrence.
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Objective:To explore the effects of human-derived fibrin glue on prevention of postoperative complications of endoscopic submucosal dissection (ESD) in early esophageal squamous cancer and precancerous lesions.Methods:A total of 210 patients with early esophageal squamous cancer or precancerous lesions who underwent ESD at Department of Gastroenterology, Zhongda Hospital Affiliated to Southeast University from April 2017 to April 2020 were included in this retrospective study. Seventy-three cases (79 esophageal lesions) where human-derived fibrin glue was used before retrieving endoscope were included in the observation group, while 137 cases (156 esophageal lesions) where fibrin glue was not used were included in the control group. The postoperative complications and pain were compared between the two groups.Results:Clinical data including general information, longitudinal length, Paris type, pathological type, invasion depth, circumferential range, area of resection, duration of operation and local steroid used were similar between the two groups ( P>0.05). The incidences of perforation, delayed bleeding and esophageal stenosis in the observation group were 2.7% (2/73), 1.4% (1/73), and 16.4% (12/73), respectively, and were 2.9% (4/137), 1.5% (2/137), and 13.1% (18/137), respectively in the control group. There were no significant differences between the two groups ( P>0.05). The incidence of postoperative pain in the observation group was 53.4% (39/73), which was significantly lower than that in the control group of 70.8% (97/137) ( χ2=6.302, P=0.012). The incidences of mild, moderate and severe pain in observation group on the day of ESD were 9.6% (7/73), 6.8% (5/73) and 5.5% (4/73), respectively, and 27.0% (37/137, χ2=8.724, P=0.003), 17.5% (24/137, χ2=4.554, P=0.033) and 0.7% (1/137, χ2=2.805, P=0.094), respectively in the control group. The incidences of mild, moderate and severe pain in the observation group on the first day after the operation were 26.0% (19/73), 5.5% (4/73) and 6.8% (5/73), respectively, and 29.2% (40/137, χ2=0.237, P=0.626), 14.6% (20/137, χ2=3.912, P=0.048) and 4.4% (6/137, χ2=0.193, P=0.660), respectively in the control group. The corresponding incidences on the second day after the operation were 5.5% (4/73), 0 and 1.4% (1/73) in the observation group and 19.0% (26/137, χ2=7.087, P=0.008), 2.9% (4/137) and 0 in the control group, respectively. Conclusion:Human-derived fibrin glue shows no obvious preventive effect on post-ESD bleeding, perforation or stenosis in early esophageal cancer and precancerous lesions. However, it can significantly reduce the incidence of ESD-related postoperative pain, especially the incidences of mild and moderate pain.
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Objective:To evaluate the efficacy and safety of oral prednisone acetate and oral prednisone acetate combined with local injection of triamcinolone acetonide for the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions.Methods:Data of 52 patients with early esophageal cancer or precancerous lesions hospitalized from December 2014 to February 2019 in Zhongda Hospital of Southeast University were analyzed retrospectively. They were divided into the control group (group A, n=20), oral hormone group (group B, n=17) and oral medication combined with local injection group (group C, n=15). The rates of stenosis and refractory stenosis, endoscopic dilatation times after ESD, time interval of first dilation after ESD and adverse events related to the operation and administration of glucocorticoids were compared among the three groups. Results:The differences in stenosis rates [85.0% (17/20) VS 47.1% (8/17) VS 46.7% (7/15), P<0.01], rates of refractory stenosis [75.0% (15/20) VS 23.5% (4/17) VS 20.0% (3/15), P<0.01], and endoscopic dilatation times [3.50 (2.25, 6.00) VS 0.00 (0.00, 2.50) VS 0.00 (0.00, 2.00), P<0.01] were statistically significant among the three groups. In pairwise comparison, the above indicators in group B and group C were significantly lower or less than those in group A ( P<0.05), but there were no statistical differences between group B and group C ( P>0.05). The time intervals of the first dilation after ESD were significantly different among the three groups (27.7±9.4 d VS 110.1±46.0 d VS 147.4±9.4 d, P<0.01). In pairwise comparison, the first dilation intervals in group B and group C were longer than that in group A ( P<0.01), and this indicator in group C was longer than that in group B ( P<0.01). Two patients in the control group developed perforation after ESD but they were treated actively and recovered finally. No severe ESD, steroid, or perforation related adverse events occurred in any other patient of the three groups. Conclusion:Both oral prednisone and oral prednisone combined with local injection of triamcinolone acetonide after ESD can effectively and safely prevent esophageal stricture after ESD. Oral administration combined with local injection of corticosteroids can prolong the time interval of the first dilation after ESD, which is beneficial to the psychological recovery and the improvement of patients’ life quality after the operation.
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Objective To investigate the efficacy and safety of gastric peroral endoscopic myotomy ( G-POEM) for postsurgical gastroparesis. Methods A retrospective analysis was performed on data of 47 patients with gastroparesis after subtotal gastrectomy, who underwent G-POEM at Zhongda Hospital Southeast University form August 2016 to June 2018. G-POEM procedure, complications related to G-POEM, and improvement of symptoms and gastric emptying function were observed. Results All patients underwent G-POEM successfully. No serious G-POEM-related complications were observed. During a follow-up period of 9. 8±5. 8 months (range 3-18 months), the scores of gastroparesis cardinal symptoms index (GCSI) were 1. 6±0. 5, 1. 2±0. 4, 1. 1±0. 6, 1. 4±0. 3 and 1. 7±0. 3 respectively at the 1st, 3rd, 6th, 12th, and 18th months after G-POEM, and all scores were lower than that before G-POEM (3. 8±1. 1, all P<0. 01). The results showed the symptoms of gastroparesis were improved significantly. Gastric emptying imaging showed the hemi-emptying time was 23. 8±8. 8 min, 21. 2±9. 5 min, 20. 9±8. 3 min and 26. 4±7. 8 min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, significantly shorter than that before G-POEM (67. 8±12. 5 min, all P<0. 01). Three-dimensional ultrasonography results of gastric antrum volume showed that the hemi-emptying time was 26. 4 (21. 8, 40. 3) min, 22. 6 (13. 9, 32. 7) min, 24. 3 (18. 2, 36. 5) min and 26. 8 (16. 4, 38. 5) min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, which were all significantly shorter than that before G-POEM [ 72. 5 ( 48. 3, 108. 6 ) min, all P<0. 01 ] . Conclusion G-POEM has a satisfactory long-term efficacy on the treatment of gastroparesis after subtotal gastrectomy with good safety.
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Objective To evaluate the clinical value of endoscopic submucosal tunnel dissection ( ESTD) for treatment of large gastric angle superficial neoplasms. Methods A retrospective analysis was performed on data of 87 patients with superfical neoplasms in gastric angle, including 32 cases undergoing ESTD and 55 cases undergoing endoscopic submucosal dissection ( ESD) in 6 institutions between July 2014 and July 2016. The dissection time, dissection speed, en bloc resection rate, curative resection rate, adverse events, and prognosis were compared between the two groups. Results The ESTD group showed a shorter dissection time ( 87. 3 ± 32. 6 min VS 136. 7 ± 64. 5 min, P<0. 01 ) , a higher dissection speed ( 0. 18 ± 0. 07 cm2/min VS 0. 08±0. 05 cm2/min, P<0. 01), a higher en bloc resection rate[100％ (32/32) VS 87. 3％ (48/55), P=0. 035], and a higher curative resection rate[100％ (32/32) VS 85. 5％ (47/55), P=0. 024] compared with the ESD group. The intraoperative bleeding rate[59. 4％ (19/32) VS 100. 0％( 55/55) , P<0. 01] and muscular injury rate[ 0 ( 0/32) VS 14. 5％ ( 8/55) , P=0. 024] were lower in the ESTD group than those of the ESD group. There was no statistical difference on recurrence rate between the two groups[0 (0/32) VS 1. 9％ (1/54), P=0. 443]. Conclusion ESTD has a higher dissection speed and greater security on treatment of large gastric angle superficial neoplasms, and is worthy to be generalized.
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Studies have shown that microRNA plays a role of oncogene or tumor suppressor gene in the carcinogenesis and progression of tumor.However, the role of microRNA-143 (miR-143) in esophageal squamous cell carcinoma (ESCC) needs further study.Aims: To investigate the expression and clinical significance of miR-143 in ESCC.Methods: Sixty-three ESCC tissues and corresponding para-cancerous tissues, 40 esophageal intraepithelial neoplasia (IEN) tissues and corresponding normal tissues from Jan.2013 to Dec.2013 at the First Affiliated Hospital with Nanjing Medical University were enrolled.The expression of miR-143 was examined by real-time quantitative PCR, and its correlations with clinicopathological features were analyzed.Results: Compared with controls, expression of miR-143 was down-regulated in ESCC and IEN (P0.05).Expression of miR-143 was correlated with pathological staging, lymph node metastasis and TNM staging (P0.05).Conclusions: Expression of miR-143 is down-regulated in ESCC and IEN tissues, which may be closely related to the development and progression of ESCC, and has the potential to be used as a new target for diagnosis of ESCC.
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Objective To compare the efficacy and the risk of adverse effect of drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter (H.) pylori infection.Methods Literature retrieval was conducted by using major databases.Related papers published up to June 2015 were considered eligible if they were randomized control trials comparing different pharmacological formulations for H.pylori infection and used in a network Meta-analysis and a single rate Meta-analysis to evaluate the relative and absolute rates of H.pylori eradication and the risk of adverse effect.The Jadad score was used to evaluate the methodological quality.Funnel plot was constructed to evaluate the risk of publication bias.Begg's rank correlation test or Egger's regression intercept test was done for the asymmetry of funnel plot.Results Twenty randomized control trials for the treatment of 6 753 initial treated patients with H.pylori infection were included.Drug susceptibility test guided therapy was significantly superior to concomitant therapy,hybrid therapy,sequential therapy and bismuth quadruple therapy.The culture-based therapy had the highest likelihood of improving clinical efficacy,with lowest risk of adverse effect.Concomitant therapy had the highest probability of causing adverse effect despite its effectiveness.Hybrid therapy and bismuth quadruple therapy were associated with lower risk of adverse effect and higher effectiveness.Conclusion Drug susceptibility test guided therapy showed superiority to other 4 interventions for H.pylori eradication mentioned above.Hybrid therapy and bismuth quadruple therapy might be applied in the settings where the culture-based strategy is not available.
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Objective To compare the efficacy and the risk of adverse effect of drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter (H.) pylori infection.Methods Literature retrieval was conducted by using major databases.Related papers published up to June 2015 were considered eligible if they were randomized control trials comparing different pharmacological formulations for H.pylori infection and used in a network Meta-analysis and a single rate Meta-analysis to evaluate the relative and absolute rates of H.pylori eradication and the risk of adverse effect.The Jadad score was used to evaluate the methodological quality.Funnel plot was constructed to evaluate the risk of publication bias.Begg's rank correlation test or Egger's regression intercept test was done for the asymmetry of funnel plot.Results Twenty randomized control trials for the treatment of 6 753 initial treated patients with H.pylori infection were included.Drug susceptibility test guided therapy was significantly superior to concomitant therapy,hybrid therapy,sequential therapy and bismuth quadruple therapy.The culture-based therapy had the highest likelihood of improving clinical efficacy,with lowest risk of adverse effect.Concomitant therapy had the highest probability of causing adverse effect despite its effectiveness.Hybrid therapy and bismuth quadruple therapy were associated with lower risk of adverse effect and higher effectiveness.Conclusion Drug susceptibility test guided therapy showed superiority to other 4 interventions for H.pylori eradication mentioned above.Hybrid therapy and bismuth quadruple therapy might be applied in the settings where the culture-based strategy is not available.
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Objective: To evaluate the feasibility of two types of segmented biodegradable esophageal stents in treatment of refractory benign esophagus strictures. Methods: Uncovered biodegradable segmented stent and fully-covered biodegradable segmented stent were implanted into the porcine esophagus (6 for each). Data on biodegradation, complications, and tissue reactions were compared between two groups. Results: All animals kept good general conditions; no death, decreased food intake, weight loss and malnutrition were observed. No perforation, ulcer, hemorrhage, stent migration and severe complications occurred. Stents degradation commenced at week 3. Stents structure breakage and complete stents absorption occurred at week 7-8 and week 9-10 in uncovered stents. While in fully-covered stents, stents structure breakage and complete stents absorption occurred at week 8-9 and week 10-11. Hyperplasia was prominent at week 1-3 and ameliorated at week 6 after stent implantation. A longer degradation period was present in fully-covered stents than in uncovered stents, while fully-covered stents induced tissue reactions at early stage were mild. Conclusions: The application of biodegradable esophageal stents with a segmented trunk in refractory benign esophagus strictures worth further investigation. The fully-covered stent has longer degradation period, which may be more suitable for clinical use.
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Animals , Esophagus , General Surgery , Models, Animal , Stents , Reference Standards , Swine , Treatment OutcomeABSTRACT
Objective To investigate the intermediate and long-term efficacy of endoscopic submucosal dissection (ESD) for early esophageal cancer(EEC).Methods A total of 56 patients with EEC underwent ESD at Jiangsu Province People's Hospital between April 2010 and June 2015.Among the 56 cases,there were 39 cases of intramucosal cancer,17 cases of submucosal cancer.Intravascular cancer embolus was found in 2 patients.The en bloc and complete resection rates,the residual,local tumor recurrence and new occurrence rates of EEC after ESD were evaluated.The average follow-up time was 24.4 months,ranging from 1 to 62 months.Results The en bloc and complete resection rates were 92.9％(52) and 87.5％ (49),respectively.Four patients were treated by additional esophagectomy.The cases of residual lesions,local tumor recurrence,new occurrence and second primary extra-esophageal cancer (gastric cancer) was 1 (1.8％),2 (3.6％),2 (3.6％) and 2 (3.6％),respectively.No additional surgical operations were performed in the 7 patients or no recurrence was found,and there was no death during the follow-up period.Conclusion ESD has the advantage of high complete resection rate,low residual and local tumor recurrence rate in treatment of EEC,and the intermediate and long-term outcomes are satisfactory.
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<p><b>OBJECTIVE</b>To evaluate the expression of FBXW7 in esophageal squamous cell carcinoma (ESCC) and to explore the correlation of FBXW7 expression with clinicopathologic features and prognosis of ESCC.</p><p><b>METHODS</b>Ninety cases of ESCC and twenty cases of tumor-adjacent normal tissues and forty intraepithelial neoplasia tissues were detected by immunohistochemistry methods. The expression of FBXW7 in 40 surgical ESCC tissues and tumor-adjacent normal tissues was detected by Western blotting and RT-PCR. The relationship between the expression of FBXW7, clinicopathological characteristics and prognosis was analyzed.</p><p><b>RESULTS</b>The positive rate of FBXW7 protein was significantly lower in the ESCC and high-grade intraepithelial neoplasia tissues than in the tumor-adjacent normal tissues and low grade intraepithelial neoplasia tissues (40.0% and 33.3% vs. 85.0% and 77.3%, χ² = 21.923, P < 0.001). The FBXW7 protein was down-regulated in ESCC tissues (P < 0.05), whereas the FBXW7 mRNA was down-regulated in ESCC tissues compared with that in the paracancerous tissues. The expression of FBXW7 was significantly correlated with TNM stage, degree of differentiation, invasion depth and lymph node metastasis (χ² =9.643, 14.908, 16.294, 10.222, respectively, P = 0.002, 0.001, 0.000, 0.001). In the ninety patients, the 5-year survival rates of cases with positive and negative expression of FBXW7 protein was 67.6% and 39.3%, respectively (χ² =6.699, P = 0.01).</p><p><b>CONCLUSIONS</b>The results of this study demonstrate that FBXW7 expression is significantly declined in ESCC and high grade intraepithelial neoplasia tissues, and is closely correlated with poor prognosis of this disease. FBXW7 as a tumor suppressor gene may play an important role in the carcinogenesis, development and metastasis of ESCC. These results suggest that FBXW7 may become a valuable marker for the severity and prognosis in ESCC.</p>
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Humans , Biomarkers, Tumor , Metabolism , Blotting, Western , Carcinoma, Squamous Cell , Diagnosis , Metabolism , Cell Cycle Proteins , Genetics , Down-Regulation , Esophageal Neoplasms , Diagnosis , Metabolism , F-Box Proteins , Genetics , F-Box-WD Repeat-Containing Protein 7 , Immunohistochemistry , Lymphatic Metastasis , Neoplasm Staging , Prognosis , RNA, Messenger , Survival Rate , Ubiquitin-Protein Ligases , GeneticsABSTRACT
Objective To investigate the correlation between the clinical symptoms of patients with achalasia of cardia (AC) and high-resolution manometry (HRM) parameters.Methods The clinical data of 30 AC patients were retrospectively analyzed.The severe degree of symptoms was evaluated by Eckardt score questionnaires,and motility of esophagus was assessed by HRM parameters.According to Chicago classification,patients were divided into three types.Mann-Whitney U test was performed for non normal distribution quantitative data comparison.Spearman correlation was used to analyze the correlation between AC symptoms and the HRM parameters.Results The reflux symptom of type Ⅱ patients was more severe than that of type Ⅰ patients (2.50(1.00) vs 1.00(1.50),U=56.000,P＜0.05).The integrated relaxation pressure (IRP) was moderately correlated with total Eckardt score of all AC patients,the frequency of reflux and the degree of body weight loss (r=0.528,0.441 and 0.662,all P＜0.05),furthermore IRP was strongly correlated with the degree in weight loss in type Ⅰ AC patients (r =0.703,P＜ 0.05).Lower esophageal sphincter resting pressure was weakly correlated with the degree of weight loss in all AC patients (r=0.398,P＜0.05).Conclusions The degree of severity of symptoms may be different in different types of AC patients.HRM parameters,especially IRP,might play a role in the assessment of severity of AC symptoms.
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Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction.Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nanjing Medical University.Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients.The outcomes assessed included diet scores,time to diet,length of hospital stay,treatments fees and complications.Results Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome with significant higher GOOSS score compared with that before treatment (P ＜0.05),but score improves faster in stenting group.Clinical success for endoscopic stenting and surgical gastrojejunostomy was 96.6％ and 92.9％ respectively,and technical success was 100％ for both of them.Endoscopic stenting group was found to have lower early complication rate(3.4％ VS 23.8％,P ＜0.05),higher late complication rate(24.1％ VS 6.9％,P ＜0.05),less time to diet,hospital stay and treatment fees(all P value ＜ 0.05)than surgical gastrojejunostomy group.The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group.There were no significant differences in complication between two groups (27.6％ VS 11.9％,P ＞ 0.05).Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome effectively and safely,but endoscopic stenting improves GOOSS scores more rapid with less time to diet,less early complication rate and easy-dealing late complications,also it needs less hospital stay and fees.It's a better choice for patients with less survival expectation.
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Objective To investigate the effects of hypoxia-inducible factor (HIF)-1α on glycolysis of human esophageal squamous carcinoma cells and the possible mechanism.Methods TE13 and Eca109 cells were cultured under normal oxygen (20％O2) and hypoxia (1％O2) conditions.The hypoxia was duration 6 hours,12 hours,24 hours and 48 hours.HIF-1α gene was stable silented by RNA interference method and TE13/small interfering HIF cells and Eca109/siHIF cells were obtained.The cell culture condition and time was same as TE13 and Eca109 cells.The changes of HIF-1α expression were detected by Western-blot.The changes of lactic acid concentration in cell culture supernatant were determined by Spectrophotometry.The changes of glucose transporter-1 (GLUT-1) and lactic dehydrogenase A (LDHA) expression at mRNA level were examined by realtime polymerase chain reaction.The changes of GLUT-1 and LDHA expression at protein level were tested by Western blot.Using t or t' test to analyze the effects of hypoxia duration on HIF-1αexpression at protein level.One-way ANOVA was applied for the difference analysis between the groups.Results In TE13 and Eca109 cells,the HIF-1α expression significantly increased under hypoxia condition and reached the peak at 12 hour (t=6.11,8.31; both P＜0.05).The lactic acid secretion of TE13/siHIF cells and Eca109/siHIF cells was (1.24±0.33) and (1.28±0.37) mmol/L,which significantly decreased when compared with TE13 and Eca109 cells [(3.25±1.34) and (4.91±1.69) mmol/L,t=2.53,3.59,both P＜0.05].The lactic acid secretion of TE13 and Eca109 cells significantly increased after hypoxia [(6.48±1.73) and (8.02± 1.95) mmol/L,t=2.715,2.050,both P＜0.05].There was no significant lactic acid secretion in TE13/siHIF cells and Eca109/siHIF cells after hypoxia (P ＞ 0.05).The expressions of GLUT-1 and LDHA at mRNA level were significantly suppressed in TE13/siHIF cells and Eca109/siHIF cells (normal oxygen:t=6.98,3.92,7.25,3.67,all P＜0.05).The expression of GLUT-1 at protein level remarkably weaked (normal oxygen:t=4.57、16.56,hypoxia:t=6.19、6.09,all P＜0.05),while the expression of LDHA at protein level slightly decreased (P＞0.05).Conclusions The level of glycolysis can be lowered by suppression HIF-1α expression in human esophageal squamous carcinoma cells.The pathway may be involved in the suppression of GLUT-1 and LDHA expression.Except for HIF-1α,there may be other regulating factors in LDHA protein expression at same time.
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Objective To evaluate the efficacy and safety of covered metallic stents in the management of proximal esophageal strictures.Methods Retrievable covered self-expanding metallic stents were inserted individually in 43 patients with malignant strictures of the proximal esophagus.Main outcome measures included improvement of dysphagia,sealing of fistula and complications were evaluated.Results A total of 45 stents were placed in 43 patients,with a success rate of 95.6％ (43/45) at the first stent placement attempt.The dysphagia score improved significantly from 3.3 ± 0.6 to 1.8 ± 0.9 (P ＜ 0.001),with 18 having an excellent response and 25 having a good response.Improvement rate of dysphagia was 95.6％ (43/45).Fistula sealing was achieved in 7 of 9 patients (77.8％).Early complications included severe pain (n =5),mediastinal emphysema (n =1),moderate fever (n =9) and collapse of the proximal end of the stent (n =1),while late complications included migration (n =3) and tissue overgrowth (n =6).Conclusion Retrievable covered metallic stent placement is effective and safe for the palliation of obstructive dysphagia and sealing of fistulas in malignant proximal esophageal strictures.
ABSTRACT
Objective To investigate the inhibitory effect of blocking PI3K/AKT pathway by wortmannin on hypoxia-inducible factor 1α (HIF-1α) and the effect on the expression of glycolysis associated genes in human esophageal carcinoma cell lines TE1 and TE13,and to analyze the relation between PI3K/AKT-HIF-1α pathway and glycolysis in esophageal carcinoma cells. Methods Esophageal carcinoma cell lines TE1 and TE13 pretreated with wortmannin (2 μmol/L) were incubated under normoxic and hypoxic conditions.And each cell line was divided into four groups.The expression of HIF-1α and glycolysis associated genes GLUT-1,LDHA and HK-Ⅱ at protein level were measured by.Western blot.The expression of HIF-1α,GLUT-1,LDHA and HK-Ⅱ at mRNA level was determined by real-time PCR. The activities of LDH and HK-Ⅱ and lactic acid (LA)concentration in the culture supernatant were tested with spectrophotometer method.Results Under normoxic condition,HIF-1α was expressed in TE1 cells and the expression of HIF-1α was inhibited by wortmannin (2 μmol/L),the most significant inhibitory effect was at 12 hours,therefore 12 hours was selected for the subsequent hypoxia experiment.Compared with untreated cells,the expression of HIF-1α、HK-Ⅱ 、GLUT-1、LDH-A at protein level significantly decreased in TE1 and TE13 cells after pretreated with wortmannin (P ＜ 0.05),and the expression of HIF-1α、HK-Ⅱ at mRNA level significantly decreased (P＜ 0.05).Under normoxic and hypoxic conditions,the HK-Ⅱ and LDH activities in TE1 and Te13 esophageal carcinoma cells significantly decreased after treated with wortmannin compared with untreated cells (P＜0.05).Under hypoxia condition,the enzyme activity increased in untreated cells (P＜ 0.05). Under normoxic and hyp0xic conditions,the lactic acid concentration in the culture supernatant obviously decreased in cells treated with wortmannin compared with untreated cells (P＜ 0.05). Under hypoxia condition,lactic acid concentration increased in wortmannin treated cells (P ＜ 0.05). Conclusions Under normoxic and hypoxic conditions,wortmannin decrease lactic acid concentration through inhibiting the expression of HIF-1α and glycolysis associated genes, which indicate PI3K/AKT-HIF-1α pathway was closely related to glycolysis in esophageal carcinoma cells.