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Objective To evaluate the safety and efficacy of endoscopic submucosal tunnel dissection (ESTD) for esophageal submucosal tumors (SMTs). Methods A meta-analysis was performed on 18 related studies of ESTD on the treatment of esophageal SMTs retrieving from Chinese and English databases. Complete resection rate and en bloc resection rate were extracted for efficacy, and the complication rate, recurrence rate and death were used to evaluate safety. Results Complete resection rate was reported in all studies, and the pooled complete resection rate was 97. 5%(95%CI: 95. 4%-98. 6%). There were 9 studies that reported en bloc resection rate, and the pooled en bloc resection rate was 95. 9%(95%CI:90. 1%-98. 3%). Subcutaneous emphysema, mediastinal emphysema, pneumothorax, pneumoper-itoneum and perforation were reported in all 18 studies. The pooled prevalence of air leakage symptoms was 11. 3%(95%CI: 7. 0%-17. 6%) for subcutaneous emphysema and pneumomediastinum, 3. 6%( 95%CI:2. 1%-6. 2%) for pneumothorax and 3. 2%( 95%CI: 1. 9%-5. 4%) for pneumoperitoneum. Additionally, the pooled prevalence of perforation was 4. 9%(95%CI: 3. 1%-7. 8%).Intraoperative bleeding was reported in 2 studies, and the pooled incidence of bleeding was 3. 7%(95%CI: 2. 1%-6. 4%). During the follow-up of the 18 studies, no death was reported, and only 2 cases of recurrence were reported in one study. Conclusion ESTD is safe and effective for esophageal SMTs.
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Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.
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Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.
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Objective To investigate the preventive effect of endoclips and endoloops on postpolypectomy bleeding of large colorectal polyps.Methods Data of patients,who underwent polypectomy during January 2013 to March 2016,were retrospectively collected.The diameters of all polyps were more than 10 mm.Cases were divided into 4 groups.Before large pedunculated (with thick stalks) polyps were resected,endoclips were used to ligate the pedicles of polyps in Group A,and endoloops were used in Group B.After large sessile and pedunculated (without thick stalks) polyps were resected,endoclips were used to close the incision of polypectomy in Group C,but not in Group D.The immediate and delayed postpolypectomy bleeding rate and clinicopathologic features were studied.Articles about endoclip or endoloop on preventing post-polypectomy bleeding in PubMed in last five years were searched and analyzed.Results A total of 2 006 polyps were included.The immediate bleeding rate was 3.4％ (5/147) and 3.8％ (5/132) of Group A and B,respectively.The delayed bleeding rate was 6.1％ (9/147) and 7.6％ (10/132) of Group A and B,respectively.The delayed bleeding rate of Group C and D was 3.2％ (28/888) and 1.9％ (16/839),respectively.None of the bleeding cases needed a surgical operation.And no perforation occurred.Six articles were included for analysis.Most of articles revealed that endoclip and endoloop were effective tools in prevention of post-polypectomy bleeding.Conclusion Endoclips and endoloops are useful to prevent bleeding after resection of large pedunculated (with thick stalks) polyps.For large sessile and pedunculated (without thick stalks) polyps (diameter＞ 10 mm),the effect of endoclips to prevent postpolypectomy bleeding still needs further discussion.
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Objective To explore clinical pathological characteristics and treatment changed with time in patients with colorectal laterally spreading tumors (LST) from 2001 to 2015.Methods The clinical data of 549 patients with colorectal LST who received endoscopic resection or surgical operation between 2001 and 2015 were retrospectively collected.According to the time of diagnosis,patients were divided into 2001 to 2005,2006 to 2010 and 2011 to 2015 groups.The gender,age,lesion size and lesion subtypes,clinical pathologic features and their therapeutic methods were analyzed.Chi-square test was used for statistical analysis.Results The detective rates of colorectal LST in 2001 to 2005 period,2006 to 2010 period and 2011 to 2015 period were 0.38％ (50/13 319),(0.60％ (144/23 912) and 0.79％ (355/ 44 715),respectively,and the differences were statistically significant (x2 =29.34,P ＜ 0.01).During these three period,the male to female ratio was about 1:1,mean age about 59 years old,and the mean maximum diameter of the LST lesions remained about 30 mm.The percentages of granular type laterally spreading tumor (LST-G) in 2001 to 2005 period,2006 to 2010 period and 2011 to 2015 period were 82.4％(42/51),67.7％ (105/155) and 78.2％(283/262),respectively;while those of non-granular type laterally spreading tumor (LST-NG) were 17.6 ％ (9/51),32.3 ％ (50/155) and 21.8 ％ (79/362),respectively;and the differences were statistically significant (x2 =7.77,P =0.02).The proportions of LST located at the proximal colon in the three periods were 21.6 ％ (11/51),34.2 ％ (53/155) and 41.4 ％ (150/362),respectively;while the percentages of LST at distal colon were 78.4％ (40/51),65.8％ (102/ 155) and 58.6 ％ (212/362),respectively;and the differnces were statistically significant (x2 =8.61,P=0.01).The percentages of high grade neoplasia (HGN) in the three periods were 13.7 ％ (7/51),21.9 ％(34/155) and 48.6％(176/362),respectively;while the percentages of invasive carcinoma were 2.0％(1/51),5.2％ (8/155) and 8.3％ (30/362),respectively;and the differnces were statistically significantly (x2 =58.89,P＜0.01).The percentages of endoscopic mucosal resection (EMR) in the three periods were 56.9％(29/51),58.7％ (91/155) and 32.0％ (116/362),respectively;the percentages of endoscopic piecemeal mucosal resection (EPMR) were 41.2 ％ (21/51),23.9 ％ (37/155) and 14.1％ (51/362),respectively;the percentages of endoscopic submucosal dissection (ESD) were 0,12.3％ (19/155) and 46.1 ％ (167/362),respectively;the percentages of surgical operation were 0,5.2 ％ (8/155) and 7.7 ％ (28/362),respectively;and the differences were statistically significant (x2 =112.46,P＜ 0.01).Conclusions From 2001 to 2015,the clinical pathological features and therapeutic methods of colorectal LST changed along with time.The proportion of colorectal LST located at proximal colon increased,and the percentage of LST-G decreased.ESD became the primary treatment,and the proportion of pathological diagnosis of HGN and invasive carcinomas increased after operation.
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Objective To investigate whether there has any difference of gastric and small bowel transit time and completion rates between two capsule endoscopes with different size and weight. Methods Clinical data of patients who had undergone OMOM or MiroCam (smaller and lighter than OMOM) capsule endoscopy were retrospectively studied. Comparison of gastric and small bowel transit time and completion rates were made between the two kinds of capsule endoscopy. Results 1, 448 patients (628 in OMOM group and 820 in MiroCam group) were finally includ-ed. In patients with Crohn's disease or suspected Crohn's disease, gastric transit time of OMOM was significantly longer than that of MiroCam [(53.4 ± 52.6) minutes vs (41.1 ± 47.9) minutes, = 0.022]. In patients with gastroin-testinal bleeding, gastric transit time in OMOM was significantly shorter than that in MiroCam [(42.1 ± 44.8) minutes vs (62.0 ± 78.6) minutes, = 0.016). No significant difference in small bowel transit time or completion rate was found. Conclusions We conclude that the differences of gastric transit time, small bowel transit time and completion rates between the two kinds of capsule endoscopy with different size and weight are not significantly. Whereas, in patients with Crohn's disease or suspected Crohn's disease, gastric transit time of smaller and lighter capsule en-doscopy is shorter in patients with gastrointestinal bleeding, but longer of gastric transit time in smaller and lighter capsule endoscopy.
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Objective To evaluate diagnostic endoscopic submucosal dissection(D-ESD) for gastric intraepithelial neoplasia(GIN).Methods From January 2012 to May 2016,64 patients with biopsy-proven LGIN who accepted magnifying endoscopy combined with digitalchromoendoscopy(ME-DCE) and D-ESD in Gastrointestinal Endoscopy Center of Nanfang Hospital affiliated to Southern Medical University were retrospectively analyzed in this study.The consistency of ME-DCE prediction with D-ESD pathologic outcome was analyzed by using Kappa test.According to D-ESD pathologic outcome,the two groups were analyzed with independent t-test,chi-square test,or Fisher's exact probability test.Results Sixty-four patients with biopsyproven LGIN were enrolled;25 and 39 patients were predicted by ME-DCE as LGIN and HGIN/differentiated adenocarcinoma respectively;27 and 37 patients were diagnosed as LGIN and HGIN/differentiated adenocarcinoma by D-ESD respectively.ME-DCE prediction was well consistent with D-ESD pathologic outcome(k =0.676).According to pathologic outcome of D-ESD,no significant difference was observed in lesion size,biopsy amount,D-ESD sample size,complete resection rate,operation time period,complications,length of hospital stay,or in-hospital cost(P＞0.05).Conclusion ME-DCE can be proposed when the endoscopic biopsy indicates LGIN.And D-ESD should be performed for definitive diagnosis when the MEDCE indicates HGIN/differentiated adenocarcinoma.
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<p><b>OBJECTIVE</b>To establish the risk model for predicting the progression within 1 year of patients with gastric neuroendocrine neoplasms(gNEN) and to evaluate its value of prediction.</p><p><b>METHODS</b>Clinical data of 127 gENE patients with histologically comfirmed sporadic gNEN from January 1999 to February 2015 in Nanfang Hospital of Southern Medical University(n=63) and The First Affiliated Hospital of Sun Yat-sen University(n=64) were collected retrospectively. Twenty-five patients without follow-up were excluded, so a total of 102 cases were enrolled in the analysis. Tumor size enlargement, lesion number increase, recurrence after resection of primary tumor and emergence of tumor metastasis were defined as tumor progression. Patients were divided into progression group (above definitions occurred within 1 year, n=56) and non-progression group (above definitions did not occur within 1 year, n=46). Logistic regression analysis was used to identify the influencing factors of progression within 1 year and the regression equation was acquired, then the probability of progression within 1 year of gNEN patients was obtained to predict the grading: grade I(: the probability of tumor progression within 1 year was < 25.0%; grade II(: this probability was from ≥25.0% to <50.0%; grade III(: this probability was from ≥50.0% to <75.0%; grade IIII(:this probability was ≥75.0%. Spearman correlation analysis was used to study the correlation between predictive grading and the occurrence of disease progression in patients with gNEN NET within 1 years. The ROC curve of different prediction methods was drawn, then the area under the curve(AUC), sensitivity and specificity were calculated and compared.</p><p><b>RESULTS</b>Multivariate regression analysis showed that tumor size(OR=1.048, 95%CI:1.014-1.083, P=0.005), Ki-67 index(OR=2.045, 95%CI:1.261-3.316, P=0.004), and surgical resection of the primary lesion(OR=0.074, 95%CI:0.011-0.497, P=0.070) were independent influencing factors of the progression of gNET within 1 year. The regression equation was as below: P(Y)=1/[1+ e -(-0.934+0.047a+0.715b-2.597c)]. (a: tumor size, b: Ki-67 grading, c: undergoing the surgical resection of the primary lesion). Prediction grading was based on regression equation: 28 cases (29.2%) belonged to grade I(, 9 cases (9.4%) to grade II(, 24 cases (25.0%) to grade III(, and 35 cases (36.5%) to grade IIII(. The probability of progression within 1 year of patients in grade I(, II(, III( and IIII( was 10.7% (3/28),5/9, 58.3%(14/24), and 91.4%(32/35) respectively, with significant difference (χ=41.236, P=0.000). Prediction grading was positively correlated with the occurrence of tumor progression in gNEN patients within 1 year(r=0.644, P=0.000). The AUC of prediction grading to predict the progression of gNEN within 1 year was 0.857, while the sensitivity was 85.2% and the specificity was 69.0%. DeLong method was used to compare the AUC values of prediction grading, Ki-67 grading and TNM staging. Comparison result revealed that the predictive value of prediction grading was not significantly different with that of TNM staging (P=0.303), but was better than that of Ki-67 grading (P=0.006).</p><p><b>CONCLUSIONS</b>Our grading standard can objectively and accurately reflect the probability of progression within one year in gNEN patients. The later the grading, the higher the probability of progression within 1 year is for gNEN patients.</p>
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Aged , Female , Humans , Male , Middle Aged , Disease Progression , Multivariate Analysis , Neoplasm Recurrence, Local , Neoplasm Staging , Neuroendocrine Tumors , Pathology , Therapeutics , ROC Curve , Retrospective Studies , Risk , Sensitivity and Specificity , Stomach Neoplasms , Pathology , TherapeuticsABSTRACT
Objective To evaluate the efficacy and safety of high-frequency electric dissection for colorectal cysts.Methods The personal information,clinical data,operation methods and postoperative complications of patients who were diagnosed as having colorectal cysts and underwent high-frequency electric dissection in Nanfang hospital and Zhujiang Hospital of Southern Medical University between January 1st,2005 and July 1st,2015 were analysed.All patients enrolled in the study were followed up to obtain their resuits of colonoscopy.Results A total of 63 patients were enrolled into our study,9 lesions located in the ileocecus,17 in the ascending colon,19 in the transverse colon,10 in the descending colon,7 in the sigmoid colon and 1 in the rectum.The maximum diameter of the cysts was 20.2+7.5 mm (5-40 mm).All patients underwent high-frequency electric dissection to remove the cysts completely or part of the cyst wall for drainage.Hemorrhage occurred in only one patient and bleeding stopped after being clipped by Titanium clip.Forty-five patients were followed up and there were no delayed complications or recurrence during a postoperative follow-up of 24.1 + 14.3 months (6-87 months).Conclusion High-frequency electric dissection is a safe and effective procedure for the treatment of colorectal cysts.
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Objective To investigate the effect of p21-activated kinase 1 on chemotherapy sensitivity of 5-fluorouracil. Methods Cell proliferation was measured by CCK8 and apoptosis rate by flow cytometry or Hoechst staining; the expression of Bcl-xl, Bcl-2, XIAP were determined by Western Blot. Results 5-FU combined shRNA-Pak1 group (combination group) could be significantly inhibited in terms of proliferation (P <0.05). The percentage of apoptosis rate in combined group was the highest and the difference among groups indicated statistical significance (P < 0.05). The expression of Bcl-xl, Bcl-2, XIAP in combination group was significantly inhibited compared with 5-FU group or shRNA-Pak1 group. Conclusion PAK1 inhibited by RNA interference can enhance chemotherapy sensitivity of 5-Fu on growth inhibition and apoptosis induction in colon cancer significantly.
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<p><b>OBJECTIVE</b>To investigate the role of Sam68 (Src-associated substrate during mitosis 68 kD) in the occurrence and development of colorectal cancer.</p><p><b>METHODS</b>Colorectal cancer cell lines with stable Sam68 over-expressing and low Sam68 expression were established to test the effect of Sam68 in the proliferation, invasion, and migration of the cancer cells using colony formation, MTT and Transwell assays.</p><p><b>RESULTS</b>SW480 and Ls174t colorectal cell lines over-expressing Sam68 showed significantly enhanced cell proliferation, invasion and migration (P<0.05). Conversely, the low Sam68 expression in SW620 and HCT116 colorectal cell lines significantly suppressed the cell proliferation, invasion and migration (P<0.05).</p><p><b>CONCLUSION</b>The expression of Sam68 can promote the proliferation, invasion and migration of colorectal cancer cells lines in vitro.</p>
Subject(s)
Humans , Adaptor Proteins, Signal Transducing , Metabolism , Cell Cycle Proteins , Cell Line, Tumor , Cell Movement , Cell Proliferation , Colorectal Neoplasms , Metabolism , Pathology , DNA-Binding Proteins , Metabolism , RNA-Binding Proteins , MetabolismABSTRACT
Discrimination of abnormal images from the numerous wireless capsule endoscope (WCE) video sequence images is laborious and time-consuming, so that a computer-based automatic image recognition system is desired for this task. We propose an algorithm to allow feature extraction from each image channel and decision fusion using multiple BP neural networks. The algorithm was tested and the results demonstrated its high efficiency and accuracy in identification of abnormalities in the WCE images.
Subject(s)
Algorithms , Capsule Endoscopy , Methods , Image Interpretation, Computer-Assisted , Methods , Pattern Recognition, Automated , MethodsABSTRACT
Objective To investigate whether the colonoscopy skills could be retained after the endoscopy simulator training,and to find evidence for curriculum design.Methods A total of 14 trainees received virtual reality simulator colonoscopy training and took a standardized VR colonoscopy test at the end of training and at 6 months later without practice during the time period.Results Scores drastically decreased at 6 months after training when compared to those right after the training.Although there was no difference in safety or accuracy,there was significant difference in the residual air volume,intestinal loop and procedure time.Conclusion Some skills acquired by using the Endoscopy Simulator can be retained,but other skills may be lost,which requires more practice.
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ObjectiveTo analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.MethodsA total of 133 OGIB inpatients,104 in true positive group and 29 in false negativc group,were reviewed.The features of demography,diseases and capsule endoscopy were collected and then analyzed,which included 10 variables like age,sex,time of bleeding,diseases accompanied,type and location of the disease,hemoglobin concentration,transit time of CE,quality of CE pictures and type of purgative agents.All data were analyzed with t test,and all the enumeration data were analyzed with chi square test.Logistic regression was used to analyze the correlation between the factors and results of diagnosis.ResultsAge ( t =2.095,P =0.038 ),concentration of hemoglobin ( t =2.143,P=0.034),type (X2 =20.222,P ＜0.001) and location (X2 =33.732,P ＜0.001) of the diseases,image quality of the CE (X2 =9.219,P =0.002 ) and the type of purgative agents (X2 =6.999,P =0.024) were found to have statistical differences between the two groups.Chi-square and partition Chi-square test revealed the occurrence of civerticulosis and lesion location,i.e.lower ileum and ileumcecum,were of statistical difference between the two groups (X2 =22.233,P ＜ 0.001 and x2 =24.412,P ＜ 0.001 ).Univariate logistic regression showed diverticulosis ( OR =0.102,P ＜0.001 ),lower bowel diseases ( OR =0.110,P ＜0.001 ),poor quality of CE pictures ( OR =0.258,P =0.004 ) and the use of sodium phosphate agent ( OR =0.367,P =0.027) were risk factors for false negative diagnosis,while older age facilitated diagnosis ( OR =1.024,P =0.041 ).However,multivariate logistic regression showed no statistic significance in type of purgative agent ( P =0.05 ) or the concentration of hemoglobin ( P =0.394).Furthermore,elder age facilitated positive diagnosis ( OR =1.031,P =0.032),while diverticulosis ( OR =0.118,P =0.001 ),lower bowel diseases ( OR =0.145,P =0.001 ) and poor quality of CE pictures ( OR =0.245,P =0.016) were correlated with higher probability of false negative diagnosis.ConclusionAge,disease type,disease location and image quality exert great influence on CE diagnosis.Diverticulosis,lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.
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ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of laterally spreading tumors (LST).MethodsESD was applied to remove 32 colorectal LSTs larger than 2 cm.The characteristics of the tumors and clinical results including en bloc resection rate,procedure time,complication and recttrrence rates were retrospectively evaluated.Results The lesions ranged from 2.5 cm to 8.0 cm,with a mean diameter of 4.1 ± 2.1 cm.En bloc resection wasachieved in 29 patients (90.6％ ) with a mean operation time of 75.7 ±66.0 min.Immediate arerial bleeding occurred in 5 ( 15.6％ ) cases but was stopped successfully by clips or coagulations.Late bleeding occurred in 2 ( 6.2％ ) and perforations in 3 (9.4％ ),which were closed successfully by clips without surgery.Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 (59.4％ ),high-grade intraepithelial dysplasia in 6 ( 18.8％ ),and carcinomas in 7 (21.9％).The lesions were restricted in mucosal layer in 25 (78.1％ ),infiltrating into sm1 layer in 5 ( 15.6％ ) and sm2 layer in 2 (6.2％ ),and the later 2 were referred to surgery.Twenty patients were followed up for 3-12 months,and no local recurrence was found..ConclusionESD was an effective and safe therapy for colorectal LST larger than 2 cm.
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ObjectiveTo investigate the diagnostic value of transgastic peritoneoscopy for ascites of unknown aetiology.MethodsTransgastric peritoneoscopy was performed on 7 patients with ascites of unknown aetiology.Diagnosis and complications were both recorded.ResultsDiagnosis of all the 7 patients were confirmed after transgastric peritoneoscopy,among whom 6 ( 85.7％ ) were found to have tuberculosis peritonitis,and 1 ( 14.3％ ) with liver disease.All patients recovered after the operation.No intraoperative or postoperative complications occurred.ConclusionTransgastric peritoneoscopy is a valuable diagnostic method for ascites of unknown aetiology.
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ObjectiveTo evaluate the clinical value of capsule endoscopy (CE) image screening system developed by our group.MethodsBetween March 2011 and June 2011,50 patients (29 males and 21 females with a mean age of 45.7(45.7 ± 4.1 ) ) underwent CE in our department.CE images were reviewed,and processed by the screening system at the rate of 50％,60％,70％,80％ and 90％,respectively.After reviewing the remaining and the deleted frames,the endoscopists calculated the remaining rate of the lesions by recording the number of lesions of all patients and the number of remaining lesions.The procedure time and the total number of the frames of each case were also recorded.ResultsA total of 39 patients of 50 had lesions and the detection rate was 78％.91 lesions were detected in the 39 patients,most of whom had more than 2 lesions.When the prescribed deletion rate was less than or equal to 60％,the lesion remaining rate reached 100％,with a mean frames of the cases of 46 242,and the mean processing time of 15.62 min.ConclusionWith all the lesions remained,the system can delete 60％ similar frames in a very short time,which greatly reduces the diagnosis time and workload for endoscopist,and improves the efficiency of capsule endoscopy.
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ObjectiveThe procedure of peroral endoscopic myotomy (POEM) was practiced in porcine esophagus-stomach model and the efficacy and safety of POEM for patients with achalasia were evaluated.MethodsThe ex-vivo esophagus-stomach was obtained and the pylorus was closed by hemostatic forceps.The entrance of the esophagus was fixed to foamed plastics.To perform POEM,a submucosal tunnel was created,after which the circular muscle layer was dissected and the mucosal entry was finally closed with clips.After successful animal experiment,we performed POEM on 4 patients with achalasia.Results POEM was completed in 5 porcine training models,in which 2 procedures were successful without any complication,2 were complicated with perforation in muscularis propria layer and 1 with rupture in mucosal layer.POEM was successfully performed in 4 patients with achalasia,with a mean operation time of 110min.The mean length of the submucosal tunnel was 10.5cm ( ranging 8-11 cm) and the mean length of myotomy of circular muscle layer was 7 cm (ranging 5-8 cm).The resting pressure of lower esophageal sphincter (LES) decreased from 52.4 mm Hg before POEM to 19.9 mm Hg.Massive bleeding occurred at the gastroesophageal junction in the first case and perforation occurred in mucosal layer during endoscopic hemostasis.All patients were followed up for 1-4 months,and the symptom of dysphasia was relieved significantly.ConclusionThe ex-vivo esophagus-stomach model can be used as training model for procedure of POEM,enabling endoscopists with enough experience for its use in patients.POEM is an effective therapy for achalasia,while the long-term efficacy and managements for complications are still to be elucidated.
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Objective To assess the feasibility of gastroscopy training with AccuTouch(R) Endoscopy Simulator for novice endoscopists. Methods The novice endoscopists ( n = 8 ) were divided into 2 groups to receive training with the simulator ( group A, n = 4) or with traditional method ( group B, n = 4). After the training, we compared the success rate of independent performance, success rate with aids and failure rate for the first 10 cases between 2 groups. Results There were no significant differences between 2 groups in terms of age, gender, educational background and experience of practice. The group A showed higher independent success rate and success rate with aids, and lower failure rate. Conclusion The simulator, decreasing the learning fees and improving learning efficiency, is applicable to endoscopist training.
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Objective To compare the diagnostic value of magnifying chromoendoscopy with probebased confocal laser endomicroscopy (pCLE) for differentiation of neoplastic from non-neoplastic colorectal polyps. Methods A total of 16 consecutive patients, who were diagnosed as having polyps with endoscopy between December 2009 and January 2010 at Nanfang Hospital, were included in this study. The pit pattern of the polyp was first determined with magnifying chromoendoscopy in all patients. Then, confocal images of the polyps were recorded and subsequently analyzed offline. Using pathological diagnosis as golden standard,the sensitivity and specificity of the two methods were compared. Results A total of 26 polyps from 16 patients were found. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of magnifying chromoendoscopy was 94. 1%, 77.8%, 88. 8%, 87. 5% and 88.4%, respectively,while those of pCLE were 100. 0%, 88. 8%, 94. 4% ,100. 0% and 96. 1%, respectively. There was no significant difference between pCLE and magnifying chromoendoscopy. Conclusion In differentiation between neoplastic and non-neoplastic colorectal lesions, pCLE shows higher sensitivity and specificity than does magnifying chromoendoscopy, although without significant difference. pCLE can be used as a new real time method to determine the property of colorectal polyps.