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Objective:To investigate the safety and efficacy of endoscopic treatment for sporadic non-ampullary descending duodenal adenoma, and to analyze high-risk endoscopic features of malignant adenoma.Methods:Data of 54 patients diagnosed as having non-ampullary descending duodenal adenoma in Nanjing Drum Tower Hospital from November 2012 to September 2019 were retrospectively studied. The patients were divided into two groups, the high-grade intraepithelial neoplasia/adenocarcinoma (HGIN/AC) group and the low-grade intraepithelial neoplasia (LGIN) group according to pathological grade. Clinical features including gender, age, size and color of lesions, therapeutic methods, complications and postoperative follow-up results were analyzed.Results:A total of 54 patients were divided into the HGIN/AC group ( n=12) and the LGIN group ( n=42). There were significant differences in size or color of lesions between the two groups (both P<0.05). All 54 patients received endoscopic treatment. Biopsy, endoscopic mucosal resection and endoscopic submucosal dissection were performed on 8, 32 and 14 cases, respectively. A small perforation was found and clipped during operation without any complications. There were 2 cases of delayed hemorrhage, and the bleeding stopped under endoscopic treatment. The mean follow-up time was 2-58 months with no recurrence. Conclusion:Endoscopic treatment is safe and effective for non-ampullary descending duodenal adenoma. Lesions of size larger than 10 mm and those with a red surface have higher malignant tendency.
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Objective:To study the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cardia cancer (EGCC) in elderly patients.Methods:A retrospective analysis was performed on data of 499 EGCC patients who underwent ESD from January 2011 to June 2018 in Nanjing Drum Tower Hospital. The patients were divided into two groups by age, the young/middle-aged group (<65 years old) and the elderly group (≥65 years old). The baseline data, lesion features, postoperative complications, short-term efficacy and long-term efficacy of the two groups were compared.Results:The elderly group included 272 patients (283 lesions) and the young/middle-aged group included 227 patients (229 lesions). Except that there were significant differences in the age ( P<0.001) and body mass index ( P=0.002) between the elderly group and the young/middle-aged group, there were no significant differences in the baseline data or pathological features between the two groups. The rate of curative resection in the elderly group was 77.0%, lower than that in the young/middle-aged group (84.3%, P=0.045). No significant differences were found in en bloc resection rate (100.0% VS 99.6%, P=1.000), complete resection rate (94.7% VS 93.9%, P=0.705), postoperative complications incidence (6.4% VS 5.7%, P=0.747), operation time (64.02±39.24 min VS 66.16±44.62 min, P=0.566) or hospitalization time (6.76±2.06 d VS 6.47±1.74 d, P=0.092]. After the median follow-up of 47.9 months, 13.4% patients in the elderly group received additional surgery, which was slightly lower than that in the young/middle-aged group ( P=0.891). There were no significant differences in postoperative recurrence, lymph node metastasis, distant metastasis, overall mortality and disease-related mortality between the two groups. The survival analysis showed that five-year overall survival rates were 94.41% and 96.34% in the elderly group and the young/middle-aged group respectively ( P=0.156), and five-year disease-specific survival rate were 99.18% and 99.03% in the two groups respectively ( P=0.858). Conclusion:ESD is safe and effective for EGCC in elderly patients with satisfactory short-term and long-term efficacy.
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Objective@#To investigate the prerequisites for endoscopists, who were chosen to receive endoscopic submucosal dissection (ESD) training.@*Methods@#A total of 41 trainees, who attended ESD training in the endoscopic center of Nanjing Drum Tower Hospital from January 2017 to June 2018 were enrolled in the study. The general information of the subjects were collected, including name, age, gender, the number of gastroscopy and colonoscopy independently performed before training, the independent usage of narrow band image (NBI), magnifying endoscopy (ME), endoscopic mucosal resection (EMR), ESD, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) before training. And then every trainee independently finished four in vitro experiments of pig esophagus ESD. The specimen area and operating time were recorded, and the operating speed was calculated. Linear regression analysis was used to analyze the affecting factors of operating speed of ESD.@*Results@#Among the 41 trainees, 26 were male and 15 were female, with age of 36.07±4.44 years. The specimen area, operating time and operating speed of pig esophagus ESD was 4.67±1.61 cm2, 24.54±5.97 min, and 0.19±0.05 cm2/min, respectively. Univariate linear regression analysis showed that the number of gastroscopy (n>5 000, P=0.001 8) and colonoscopy (n>3 000, P=0.000 1), the detect number of early cancer in upper digestive tract (n>30, P=0.000 3) and lower digestive tract (n>10, P=0.019 7), and the usage of ME (P=0.047 8), EMR (P=0.019 6) and ESD (P=0.000 3) before training were statistically correlated with the operating speed of ESD. Carrying out NBI (P=0.532 9), ERCP (P=0.500 7) and EUS (P=0.766 8) before training were not statistically correlated with the operating speed of ESD. The operating speed of ESD was negatively correlated with the perforation rate of ESD (P<0.000 1). According to multivariable linear regression model, the usage of EMR (P=0.029) and ESD (P=0.034) were statistically correlated with the operating speed of ESD.@*Conclusion@#ESD trainees, who have the number of gastroscopy more than 5 000, the number of colonoscopy more than 3 000, the detect number of early cancer more than 30 in upper digestive tract and 10 in lower digestive tract, and the usage of ME, EMR and ESD before training, can get a better training effect. The study provides a theoretical basis for selecting appropriate ESD trainees.
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Objective:To investigate the clinicopathological characteristics and cost-effectiveness of endoscopic resection and surgical resection for gastric schwannomas arising from the muscularis propria layer.Methods:Thirty-eight consecutive cases of gastric schwannomas diagnosed by histopathology between October 2011 and July 2016 were divided into the endoscopy group(including endoscopic submucosal excavation and endoscopic full-thickness resection) and the surgery group. Complications, complete resection rate and cost-effectiveness were analyzed.Results:The age was 52±10 years (range, 41-63 years) with 11(28.9%) males and 27(71.1%) females. The most common site of gastric schwannomas was the body (71.1%) and the antrum (21.1%). All 38(100%) lesions were protruded. The maximum diameter of the lesions was 2.5±1.2 cm (range 0.6-4.5 cm). Under endoscopic ultrasonography (EUS), 60.5% lesions were heterogeneous hypoechoic, and 15 (39.5%) hypoechoic. The complete resection rate of endoscopy group was 100.0% (17/17). The median operation time of the endoscopy group was 54 minutes. Perforations occurred in 11 patients (64.7%, 11/17), and metal clips or the nylon rope combined with metallic clips were used to close the defect in the endoscopy group. Compared with the surgery group, the length of hospital stay was significantly shorter (4.6±0.6 d VS 9.6±4.4 d, P<0.001); the time to the first fluid diet was significantly shorter (1.2±0.4 d VS 2.7±0.7 d, P<0.001), and the costs were significantly lower (21 965.0±9 342.4 yuan VS 34 253.3±10 520.9 yuan, P<0.001) in the endoscopy group. S100 immunoreactivity was present in all tumors. Local recurrence and distant metastasis did not occur during the median 34 months of follow-up. Conclusions:Endoscopic resection appears to be safe and effective for diagnosis and treatment of gastric schwannomas from the muscularis propria layer. The cost-effectiveness of endoscopic resection is significantly higher than surgical resection.
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Objective:To investigate the prerequisites for endoscopists, who were chosen to receive endoscopic submucosal dissection (ESD) training.Methods:A total of 41 trainees, who attended ESD training in the endoscopic center of Nanjing Drum Tower Hospital from January 2017 to June 2018 were enrolled in the study. The general information of the subjects were collected, including name, age, gender, the number of gastroscopy and colonoscopy independently performed before training, the independent usage of narrow band image (NBI), magnifying endoscopy (ME), endoscopic mucosal resection (EMR), ESD, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) before training. And then every trainee independently finished four in vitro experiments of pig esophagus ESD. The specimen area and operating time were recorded, and the operating speed was calculated. Linear regression analysis was used to analyze the affecting factors of operating speed of ESD.Results:Among the 41 trainees, 26 were male and 15 were female, with age of 36.07±4.44 years. The specimen area, operating time and operating speed of pig esophagus ESD was 4.67±1.61 cm 2, 24.54±5.97 min, and 0.19±0.05 cm 2/min, respectively. Univariate linear regression analysis showed that the number of gastroscopy (n>5 000, P=0.001 8) and colonoscopy (n>3 000, P=0.000 1), the detect number of early cancer in upper digestive tract (n>30, P=0.000 3) and lower digestive tract (n>10, P=0.019 7), and the usage of ME ( P=0.047 8), EMR ( P=0.019 6) and ESD ( P=0.000 3) before training were statistically correlated with the operating speed of ESD. Carrying out NBI ( P=0.532 9), ERCP ( P=0.500 7) and EUS ( P=0.766 8) before training were not statistically correlated with the operating speed of ESD. The operating speed of ESD was negatively correlated with the perforation rate of ESD ( P<0.000 1). According to multivariable linear regression model, the usage of EMR ( P=0.029) and ESD ( P=0.034) were statistically correlated with the operating speed of ESD. Conclusion:ESD trainees, who have the number of gastroscopy more than 5 000, the number of colonoscopy more than 3 000, the detect number of early cancer more than 30 in upper digestive tract and 10 in lower digestive tract, and the usage of ME, EMR and ESD before training, can get a better training effect. The study provides a theoretical basis for selecting appropriate ESD trainees.
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Objective To investigate the prevalence and endoscopic detection rate of proximal serrated polyps and to screen the risk factors. Methods The data of 9010 colonoscopies performed by 22 endoscopists between September 2016 and September 2017 were reviewed. The adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSDR) were calculated, and the correlation between ADR and PSDR was estimated by Pearson correlation coefficients. Multivariate logistic regression was used to analyze PSDR among endoscopists. Results For all subjects, the mean ADR was 30. 07％ ( ranged from 20. 00％ to 40. 78％) and mean PSDR was 4. 70％ ( ranged from 1. 52％ to 9. 28％) . PSDR of males was 1. 38 times of that of females ( OR=1. 38, 95％CI:1. 13-1. 69, P<0. 01) . For 3560 cases ( 39. 51％) of 50 years and older subjects, the mean ADR was 45. 01％ ( 28. 99％-57. 78％) and mean PSDR was 6. 08％(2. 07％-10. 56％). PSDR was moderately correlated with ADR (r=0. 48, P=0. 02). PSDR of males was 1. 36 times of that of females (OR=1. 36, 95％CI: 1. 04-1. 80, P=0. 03). Endoscopist was a significant risk factor for detection of proximal serrated polyps ( P<0. 01) . Compared with endoscopist with the highest PSDR, odds ratio of other endoscopists ranged from 0. 16 (95％CI:0. 06-0. 40, P<0. 01) to 0. 83 (95％CI:0. 53-1. 32, P=0. 44) . Conclusion Proximal serrated polyps are more common in males, who are over 50 years old. The PSDR is highly variable and dependent on endoscopists. It is possible that a certain proportion of proximal serrated polyps are missed during colonoscopy.
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Objective To investigate efficacy and safety of oral prednisone acetate for prevention of esophageal stenosis after endoscopic submucosal dissection ( ESD) for patients with esophageal precancerous lesions or early esophageal carcinoma. Methods A retrospective analysis was performed on data of 56 patients who underwent circumferential or semi-circumferential ( more than three quarters but not a complete circular) ESD for esophageal precancerous lesions or early cancer in Nanjing Drum Tower Hospital from October 2014 to October 2017. The patients were divided into the study group ( n=26, prednisolone oral administration after ESD ) and the control group ( n=30, without prednisolone oral administration after ESD) . Endoscopic dilatation was performed whenever patients experienced persistent dysphagia to solids. Clinical data, stricture rate, numbers of endoscopic dilatation, and adverse events were compared between the two groups. Results There were no differences in age, gender, location and length of lesions, endoscopic findings, depths of tumor invasion, and pathological subtypes between the two groups ( all P>0. 05) . The proportion of circumferential esophageal lesions in the study group was higher than that in the control group[53. 85％ (14/26) VS 23. 33％ (7/30), χ2=5. 53, P=0. 02]. The rata of post-procedural esophageal stricture in the study group was significantly lower than that in the control group[ 30. 77％ ( 8/26) VS 60. 00％ (18/30), χ2=4. 78, P=0. 03], and the number of endoscopic dilatation was lesser in the study group than the control group (3. 85±2. 57 VS 9. 83±5. 82, t =7. 22, P =0. 00). There were no adverse events related to oral prednisone, and no treatment-related mortality. Conclusion Prednisone acetate oral administration is safe and effective to prevent esophageal stenosis after complete or semi-circular ESD for patients with esophageal precancerous lesions or early esophageal carcinoma.
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Objective To investigate the effect of visiting time on the incidence of complications, hospital expenses and stays, and to provide theoretical basis for the timely treatment of patients with esophageal foreign bodies. Methods Data of 130 patients with diagnosis of esophageal foreign bodies in the Drum Tower Hospital from June 2010 to June 2017 were retrospectively studied. The patients were divided into two groups( Group A, visiting time≤24 hours;Group B, visiting time>24 hours) according to duration from ingestion to effective treatment. Clinical features including gender, age, locations and types of foreign bodies, complications, therapeutic methods, hospitalization stays and costs were analyzed. Results The most common foreign bodies that were swallowed were fish bones in both groups [ 40. 0％ ( 20/50) ,50. 0％( 40/80) ] , followed by pig and chicken bones, dentures and jujube pips. Foreign bodies commonly blocked the upper and middle esophageal tract [ 98. 0％ ( 49/50 ) , 96. 3％ ( 77/80 ) ] , but rarely the lower esophageal tract. Compared with group A, the incidence of complications [ 61. 3％ ( 49/80) VS 36. 0％ ( 18/50) ] , hospitalization expenses ( 1. 28 ± 1. 14 thousand yuan VS 0. 77 ± 0. 92 thousand yuan ) , and stays ( 9. 06 ± 10. 08 d VS 5. 22 ± 3. 32 d ) of group B were significantly higher ( all P < 0. 05 ) . Conclusion Treatment within 24 hours results in fewer complications, less costs and shorter postoperative hospitalization stays for patients with esophaged foreign bodies.
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Objective To assess the clinical effects of simethicone emulsion combined with polyethylene glycol on bowel preparation for colonoscopy. Methods Two hundred out-patients, who underwent colonoscopy,were randomly divided into the study group and the control group. The study group was given simethicone in addition with polyethylene glycol, and the control group was given polyethylene glycol only. The differences on bowel preparation scores, air bubble reduction rate, colon lens sharpness, ileocecal region arrival time, colon polyp detection rate, the number of colon poly detection, and adverse event rate between the two groups were compared. Results The air bubble reduction rate, colon lens sharpness score and ileocecal region arrival time of the study group was 1(0-3)score,1.0(0-2)score,and 9(5-21)min,respectively,which was 2(1-3)score,1.5(0-2)score and 12(6-22)min, respectively in the control group. Differences between the two groups were statistically significant(Z=-9.490,P=0.000;Z=-6.768,P=0.000;Z=-5.521,P=0.000). For the bowel preparation score, colonoscopy polyp detection rate,the detection rate of colon polyp of diameter less than 5 mm, and number of colonoscopy polyp detection,there was no statistical difference between the two groups(P>0.05). No adverse events were observed in the both two groups. Conclusion The bowel preparation using simethicone combined with polyethylene glycol could effectively decrease the number of air bubble, enhance colon lens sharpness and shorten operation time,which contributes significant improvement for colonoscopy quality.
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Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers ( SMEGC) and gastric high grade intraepithelial neoplasia ( GHGIN) . Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66. 19±7. 46 years, 90. 62％(29/32) were male, 17 cases (53. 3％) had family history of gastric cancer, 25 (78. 13％) had smoking history, and 22 ( 68. 75％) were alcohol users. There were 30 cases ( 93. 75％) and 31 cases ( 96. 88％) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0. 4167, P=0. 018). The endoscopic classification of major and minor lesions had no statistical significant consistency ( P=0. 314 ) , but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation ( P<0. 05 ) . The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach ( r=0. 463,P=0. 003) . Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation( r=0. 417,P=0. 009) . Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis.
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Objective To evaluate the feasibility, efficacy, and safty of endoscopic submucosal dissection (ESD) in treatment of uppergastrointestinal ectopic pancreas. Methods 36 uppergastrointestinal ectopic pancreas were treated with ESD from January 1 2012 to November 30 2014. The definitive histological diagnosis of ectopic pancreas was made after the endoscopic treatment. We analyzed the operation method, dissected tissue, complication, retrospec-tively. Results 34 cases were located in stomach, the other 2 in duodenum. All cases underwent ESD, the mean op-erating time was 66 min. The mean dissected tissue diameter was 21 mm × 16 mm in the 36 cases. The curative re-section rate was 100.00 %. Bleeding rate of ESD was 2.77 %(1/36). Perferation rate of ESD was 2.77 %(1/36). 2 cases suffered from low grade fever. None need surgical intervention. Recurrence rate was 0.00%. Conclusions ESD is a minimally invasive technique that allows resection of whole lesions and provides precise histological information, which is particularly suitable for uppergastrointestinal ectopic pancreas.
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Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection ( ESD ) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD. The pathological features of all resection margins in the specimen and the follow?up outcome of the patients with positive resection margin were evaluated. Univariate and multi?variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions,there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion( submucosal layer invasion, P=0?048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension (≥3/4,P=0?014) and the depth of invasion( exceeding muscularis mucosa, P=0?007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.
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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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Objective To study the risk factors for pathological upgrading after diagnosis of esophageal low?grade intra?epithelial neoplasia with ESD preoperative biopsy. Methods The endoscopic and pathological data of 85 lesions with ESD preoperative biopsy were analyzed, and grouped based on pathological upgrading after ESD. The risk factors for pathological upgrading after ESD was studied through single and multiple factor analysis. Results Pathological upgrading occurred in 45(52?94%) lesions after ESD, among whom 38 lesions developed up to high?grade intra?epithelial neoplasia and 7 lesions developed to esophageal early cancer. NBI?ME was performed on 37 patients and the accuracy of detecting the pathological invasion was 83?8%(31/37).Multi?factor analysis showed that reddish surface(OR=9?478, 95%CI:2?775?32?368, P = 0?000 3 ) and nodular lesion ( OR = 15?628, 95%CI:1?475?165?617, P =0?022 5) were independent factors for pathological upgrading after ESD. Conclusion Pathological upgrading of low?grade intra?epithelial neoplasia was common, especially esophageal mucosa with red surface and nodular lesion.Biopsy combined with NBI?ME is of significant importance to improve diagnostic accuracy.
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Objective To evaluate the feasibility,safety and efficacy of ESD for precancerous lesions and early cancer of remnant stomach after partial gastrectomy.Methods ESD was performed in 11 cases of high grade intraepithelial neoplasia/early cancer of remnant stomach.The short-term and long-term indices including time of procedure,complication,En Bloc resection rate,R0resection rate,local recurrence rate as well as lymph node metastasis were recorded and analysed.Results ESD was completed in all patients with only one case of delayed massive bleeding which was controlled by endoscopy successfully.Average procedure time,En Bloc resection rate,R0 resection rate were 85.5 minutes,100％ and 90％,respectively.No local recurrence or lymph node metastasis was detected during post-ESD surveillance (15 ～ 51 months).Conclusion High grade intraepithelial neoplasia and early cancer of remnant stomach after partial gastrectomy might be indication for ESD because of its safety and definite effect.Additionally,careful management of the fibre tissue is the key to procedure success.
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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>
Subject(s)
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
Background:The goals for treatment of achalasia are reducing lower esophageal sphincter pressure (LESP)and alleviating esophageal obstruction and its related symptoms.Peroral endoscopic myotomy (POEM)is a promising option for treating achalasia.Aims:To assess the short-term efficacy of POEM for treating achalasia by analyzing the dynamic changes in esophageal manometry.Methods:A retrospective study was conducted in 39 achalasia patients receiving POEM in Nanjing Drum Tower Hospital from Dec.2011 to Oct.2012.Data of water-perfusion esophageal manometry and one-month follow up were collected and analyzed.Results:Thirty-eight patients accomplished the POEM procedure and esophageal manometry three days after treatment.The post-POEM LESP was significantly reduced as compared with the pre-POEMones (P <0.01),while no significant difference was seen in LES relaxation rate before and after POEM.With regard to the motility of esophageal body,absence of peristalsis and increased synchronous contraction were observed both pre-and post-operatively.One month after POEM,LESP was still significantly lower than that before treatment (P <0.05).Thirty-seven patients had their dysphagia alleviated with an efficacy rate of 94.9%.Conclusions:POEM can reduce LESP and alleviate clinical symptoms of achalasia patients but has no effect on esophageal peristalsis during the short-term follow up.Esophageal manometry is useful for evaluating the short-term outcome postoperatively.
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Objective To investigate the therapeutic efficacy and safety of endoscopic resection of giant gastric stromal tumors without explicit evidence of metastases.Methods A total of 12 giant gastric stromal tumors with no evidence of metastases diagnosed by endoscopic ultrasound (EUS) and computed tomography (CT) scan were managed by endoscopic resection.Operation time,blood loss and the incidence rate of perforation were recorded respectively.The diagnoses of tissue specimens were made by pathological examination and immunohistochemistry.In order to assess local recurrence and distant metastases,endoscopy and endoscopic ultrasound follow-up examinations were performed routinely at 2,6 and 12 months,and the whole abdominal CT scan was also performed at 12 months after operation.Results Endoscopic resections were successfully performed in 10 of 12 cases (83.3％),among which,6 underwent endoscopic submucosal excavation (ESE) without unexpected perforation and 4 endoscopic full-thickness resection (EFR)with intentional perforation.The rate of intentional perforation was 33.3％ (4/12),and all the perforations could be sealed by endoscopic methods.The blood losses were all more than 100 ml,which could be controlled by argon plasma coagulation,electrocoagulation or hemostatic clips.In the 10 encapsulated tumors,8 could be smoothly removed from esophagus,whose long diameter of the minimum cross section was less than 3.5 cm,however,2 tumors whose diameters were larger than 3.5 cm were taken out after segmentation.In the 10 tissue samples,9 were confirmed as low risk GIST,1 larger than 5 cm was pathologically confirmed as high risk GIST.During 1-year follow-up,no local recurrence or peritoneal metastasis was found.2 tumors,larger than 5.0 cm,could not be removed by endoscopic methods due to uncontrolled bleeding.The rate of uncontrolled bleeding was 16.7％ (2/12).The patients were transferred to surgery,and pathologically confirmed as having high risk GIST.Conclusion For low-risk giant gastric stromal tumors whose diameters were less than 5cm without evidence of metastases,endoscopic resection is considered as a safe and effective procedure.Tumors with long diameter of the minimum cross section less than 3.5 cm are more suitable for endoscopic resection,which can be smoothly taken out through cardia.However,for high-risk GIST larger than 5.0 cm,the rate of uncontrolled bleeding is high,so endoscopic resection should be adopted with discretion.
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Objective To evaluate the prophylactic effects of propranolol, propranolol plus endoscopic variceal ligation (EVL) and propranolol plus endoscopic sclerotherapy (EVS), and to determine the most effective combination for secondary prevention of esophageal variceal bleeding.Methods After hemostasis, a total of 78 patients with esophageal variceal bleeding were randomly assigned to receive propranolol (propranolol group), propranolol plus EVL (ligation group) or propranolol plus sclerotherapy (EVS group), with 26 in each group.All patients were followed up for 12 months, and the rates of variceal re-bleeding, mortality, portal hypertensive gastropathy (PHG), re-occurrence of esophageal varices and formation of gastric fundus varices were compared among different groups.Results During the 12-month follow-up, the rate of re-bleeding in EVL group (30.77%) was significantly lower than those of the EVS group (42.31%) or propranolol group (53.85%) (P<0.05).The occurrence of PHG and fundal varices in patients of EVL group was similar to that of propranolol group, which were both lower than that of EVS group (P<0.05), but the re-occurrence of esophageal varices in EVL group was significantly higher than that of EVS group (P<0.05).Conclusion EVL plus propranolol might be the most effective therapy for secondary prophylaxis of esophageal variceal bleeding.
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Objective To investigate the expressions of TESTIN gene and Caspase-3 protein and thier relations with the clinicopathological features and prognosis of esophageal squamous cell carcinomas(ESCC). Methods The expressions of TESTIN and Caspase-3 in 50 ESCC tissues and paracancerous tissues (＞5 cm apart form the ESCC tissue) were detected by immunohistochemistry.The expression of TESTIN in 65 matched-pairs of ESCC tissues was detected by Western blotting and RT-PCR. The association of TESTIN and Caspase-3 with clinicopathological features and prognosis of ESCC were analyzed. Results The immunohistochemistry examination showed that the positive rates of TESTIN protein [30. 0% (15/50)] and Caspase-3 protein [24.0% ( 12/50)] were significantly lower in ESCC tissues than those in paracancerous tissues [(84. 0% (42/50) and 94. 0% (47/50),respectively, P＜0.01)]. The mRNA level of TESTIN was down-regulated in ESCC tissues (P＜0.05). Whereas the protein level of TESTIN was down-regulated in 45 (69.2%) of 65 ESCC tissues in comparison with paracancerous tissues. TESTIN expression was positively correlated with the differentiation of ESCC, but not associated with gender, age, tumor size, TNM stage and lymph node metastasis. There was a positive correlation between TESTIN and Caspase-3 in protein expressions (P＜0. 05). Patients with negative expression of TESTIN had lower survival rate compared to those with positive expression (P＜0. 05). Conclusions The positive relation between low-expression of TESTIN and Caspase-3 implicates that both are involved in the development of esophageal squamous cell carcinogenesis, and TESTIN might be a novel ESCC marker with prognostic significance.