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Objective To investigate the recurrence and risk factors of gastric high-grade intraepithelial neoplasia(HGIN)and early gastric cancer(EGC)after endoscopic submucosal dissection (ESD). Methods The clinical and follow-up data on 444 patients(451 lesion)with HGIN and EGC undergoing ESD in Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016 were summarized, and the risk factors of recurrence were analyzed. Results A total of 410 patients were followed-up, and the recurrence rate was 3.2%(13 patients, 13 lesions), with mean recurrence time of 17.6±9.6 months(6-38 months). Univariate and multivariate analysis revealed that the size of the lesion>4.0 cm was the only risk factor of recurrence(P=0.012,OR=10.855,95%CI:1.673~70.442). Conclusion The rate of recurrence is increasing with the EGC extending, therefore, postoperative monitoring should be strengthened to patients with larger lesion.
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Objective:To investigate ulinastatin (UTI) combined with Xingnaojing injection in the treatment of acute cerebral hemorrhage (ACH) and its effect on the serum high sensitivity C reactive protein (hs-CRP),D-dimer (D-D) and neuron specific enolase(NSE) levels.Methods:110 cases of ACH patients admitted in our hospital from January 2015 to December 2016 were selected and divided into two groups according to the random number table method.The control group was given UTI treatment,while the observation group was given UTI combined with Xingnaojing treatment.Then the brain edema absorption effect,NIHSS score,serum hs-CRP,D-D and NSE levels before and after the treatment of the two groups were recorded and compared;the safety ofmedicidstion of the two groups was evaluated.Results:At the 14th day after treatment,the total effective rate of cerebral hematoma absorption in the observation group was 89.1％,which was significantly higher than 67.3％ of the control group (P＜0.01).At the 14th day after treatment,the NIHSS scores of both groups were significantly lower than those before the treatment (P＜0.01);compared with that of the control group of the same time period,at the 14th day after treatment,the improvement effect of NIHSS score in the observation group was more significant (P＜0.01).Compared with those before the treatment,the serum hs-CRP,D-D and NSE levels of both groups at the 14th day after treatment were significantly decreased (P＜0.01);at the 14th day after treatment,the serum indicators of the observation group improved more significantly than those of the control group (P＜0.01).The incidence rate of adverse reaction in the observation group was 3.6％ compared with 5.5％ of the control group (P＞0.05).Conclusion:Ulinastatin combined with Xingnaojing Injection could rapidly relieve or eliminate hematoma in the treatment of acute cerebral hemorrhage,control the inflammatory response,improve the blood coagulation system and fibrinolytic system,protect the nerve cells and reduce the neurological damagee.
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Objective To assess the clinical value and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for duodenal lesions.Methods The data of 12 patients with duodenal space-occupying lesions underwent EMR or ESD from January 2010 to December 2015 in Chinese PLA General Hospital were retrospectively analysed.Results All patients received operation, including 9 male and 3 female with mean age of 50.0 years(33.0-62.0 years).There were 8 lesions in duodenal bulb and 4 in descending part.The mean diameter of the lesions was 1.2 cm (0.5-3.0 cm).Three lesions were originated from mucosa, of which 2 were high-grade intraepithelial neoplasia and 1 was villous/tubular adenoma.Nine lesions were located in submucosa, including 3 cases of neuroendocrine neoplasm, 1 case of stromal tumor, 1 liomyoma case, 1 lipoma case, 1 case of Brunner glands adenoma, 1 case of ectopic pancreas, and 1 inflammatory lesion.One patient had perforation with rate of 8.3%(1/12) and was recovered after conserved treatment.The bleeding was very little during operation.No infection or stenosis happened.The mean hospitalized time was 6.0 days (1.0-12.0 days) after operation.No recurrence was found during 23.8 months(3.0-73.0 months) of follow-up.Conclusion EMR and ESD are effective and safe for treatment of duodenal space-occupying lesions.
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<p><b>BACKGROUND</b>Endoscopic submucosal dissection of the esophagogastric junction is the most difficult gastric and esophageal dissection procedure. No reports of endoscopic submucosal dissection for Siewert type II carcinoma of the esophagogastric junction have compared the outcomes of endoscopic submucosal dissection for all three Siewert types of adenocarcinoma. This study aimed to evaluate the efficacy and safety of endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction.</p><p><b>METHODS</b>From October 2008 to June 2013, 73 patients underwent endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction. The patients were prospectively evaluated regarding the executability of the technique, short-term results of the procedure, en bloc resection rate, curative resection rate, complications and additional treatment after endoscopic submucosal dissection, and follow-up outcomes.</p><p><b>RESULTS</b>Sixty-eight of the 73 patients (93.2%) underwent en bloc resection; the mean maximum specimen diameter was 33.7 mm. Fifty-seven of 61 patients (93.4%) who underwent curative resection were successfully followed-up for 1.0 to 56.0 months (average, 24.1 months). Local recurrence developed in one patient with high-grade intraepithelial neoplasm. Twelve patients underwent noncurative resection, including lateral resection margin residues in three, vertical resection margin residues in one, signet ring cell carcinoma or undifferentiated adenocarcinoma in four, lymphatic or vessel invasion in one, vertical residual margin residues combined with signet ring cell carcinoma in one, and undifferentiated adenocarcinoma with lymphatic or vessel invasion in two. In the noncurative resection group, one patient was lost to follow-up, seven underwent additional surgery, and the remaining four were periodically followed up; none had local recurrence or distant metastases. The only complication was delayed bleeding in three patients, which was successfully controlled by conservative treatment or endoscopic therapy.</p><p><b>CONCLUSIONS</b>Endoscopic submucosal dissection is safe and effective for intraepithelial neoplasia of the esophagogastric junction. R0 en bloc resection is possible and can avoid the risk of local recurrence.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma in Situ , General Surgery , Dissection , Methods , Esophageal Neoplasms , General Surgery , Esophagogastric Junction , General Surgery , Gastric Mucosa , General Surgery , Prospective StudiesABSTRACT
Objective To investigate the clinical features and prognosis of rectal neuroendocrine neoplasms (NENs) in different pathological grades.Methods The clinical data of 183 patients with rectal NENs who were admitted to the PLA General Hospital from January 2001 to April 2012 were retrospectively analyzed.All the clinical and pathological data of the patients who received endoscopy and (or) surgical resection were retrieved from the work station and the database of the endoscopic center.Based on the 2010 WHO pathology classification of digestive tumors,the pathological data were ranked according to the mitotic count.The prognosis of the patients was learned by re-examination or phone call.The follow-up ended till July 2014 or at the death of patients.Data were analyzed using the chi-square test.Results A total of 183 patients were enrolled in this study including 120 males and 63 females.The median age of the patients was 48 years (range,14-83 years).Seventy-four patients had the symptom of hemafecia,9 patients had abdominal pain and change in bowel habit,and 70 patients were diagnosed by body examination.Other symptoms included increased level of tumor markers and abdominal distension.Carcinoid syndrome was not detected in all the patients.Fourteen patients were complicated with polyp of intestine,5 with tubular adenoma,3 with colorectal adenocarcinoma and 1 with small cell lung cancer.The diameters of the tumor under 1 cm were detected in 162 patients,the diameters of the tumors ranged between 1 cm and 2 cm in 14 patients,and the diameters of the tumors above 2 cm in 7 patients.The mean distance between the tumor and the anus was (5-± 3)cm.Of the 183 patients,130 received endoscopic treatment,43 received surgical treatment and 10 received clamping because the tumor was misdiagnosed as polyps.There were 158 patients in grade1 (154 in stage Ⅰ,1 in stage Ⅱ,1 in stage Ⅲ and 2 in stage Ⅳ),21 in grade2 (13 in stage Ⅰ,3in stage Ⅱ,3 in stage Ⅲ and 2 in stage Ⅳ),4 in grade 3 (1 in stage Ⅰ,1 in stage Ⅲ and 2 in stage Ⅳ).Six patients had liver metastasis and 9 had lymph node metastasis.Fourteen patients died (4 in grade 1,6 in grade 2 and 4 in grade 3).The 5-year survival rate of patients was 92.35％ (169/183).There were significant differences in the gender,tumor diameter,tumor staging,lymph node metastasis distal metastasis and 5-year survival rate among patients with rectal NENs in different pathological grades (x2=60.949,71.587,32.135,55.486,56.512,P ＜ 0.05).Conclusions Rectal NENs lacks the specific clinical manifestation and is more likely to happen in males,and it often locates at the middle-lower rectum.Most of the rectal NENs belongs to stage Ⅰ and grade 1 and is less than 1 cm in size.The prognosis of patients with rectal NENs in different pathological grades is different.The 2010 WHO pathology classification of digestive tumors is useful to asses the prognosis of rectal NENs.Different grades of rectal NENs could be taken into account when designing the treatment plan.
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Objective To study the related prognostic factors influencing rectal neuroendocrine tumor prognosis.Methods We retrospectively reviewed tumor clinical and pathology material of 183 cases with rectal neuroendocrine in our hospital during recent 10 years and reclassified them according to the 2010 WHO pathology classification.Single factor and multivariate analysis were performed to find related prognostic factors.Results Single factor analysis showed that tumor size (＜ 1 cm,1-2 cm,＞2 cm,98.77％ vs 78.57％ vs 28.57％,x2 =71.4793,P =0.0001),pathological grading (G1,G2,G3,98.73％ vs.76.19％ vs 25.00％,x2 =56.5121,P =0.0001) and the stage (stage Ⅰ,Ⅱ,Ⅲ,Ⅳ period,99.40％ vs 50.00％ vs 60.00％ vs 16.67％,x2 =105.0383,P =0.0001) among the three variables survival difference was statistically significant.Multivariate analysis (Cox regression) indicated that the tumor stage were independent factors affecting the prognosis,regression coefficient was 1.277 (B),Wald value of 28.145,Exp (B) a value of 3.586,95％ CI:2.237-5.747.Conclusion Tumor staging is an independent risk factor of survival,without considering other factors,different tumor size and pathologic grade also have different prognosis.Clinicians in making treatment plan should fully consider the above factors before choosing the appropriate follow-up plan.
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Objective To compare the cost-effectiveness between endoscopic submucosal dissection (ESD) procedure and traditional surgery for the treatment of early gastrointestinal cancer or precancerous lesions.Methods A total of 866 early GI cancer/precancerous patients who had been admitted to Chinese PLA General hospital and Qilu hospital were included in this study.The medical records of all 866 patients were reviewed.Patients were divided into ESD group and traditional surgery group.Parameters of each patient,such as time of hospitalization,total treatment cost and incidence of complications,were documented and later compared in detail.Results A total of 607 patients were included in the ESD group and 259 in the traditional surgery group.There was no statistical difference in complete resection rate between the two groups (93.1％ vs 93.0％,P ＞ 0.05).The ESD group showed a shorter mean hospitalization time (d)(13.01 vs 18.88,P ＜ 0.05) and lower treatment cost (RMB) than the traditional surgery group (22932.17 vs 57993.88,P ＜ 0.05).The incidence of hemorrhage and perforation for each group were 3.63％ and 3.10％ respectively,which were not significantly different (1.98％ vs 3.01％,P ＞ 0.05; 2.80％ vs 1.16％,P ＞ 0.05).Conclusion ESD and surgery are both effective for early gastrointestinal cancer/precancerous lesions therapy,but ESD procedure is superior to surgery in terms of hospitalization time and expediture.
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Objective To investigate the diagnostic potential of magnifying narrow-band imaging endoscopy (NBI-ME) for different intrapapillary capillary loop (IPCL) for the diagnosis of esophageal lesion.Methods Patients with abnormal esophageal mucosa found by white light gastroscopy in digestive endoscopy center,Chinese PLA General Hospital during the period of November 2009 to November 2010 were enrolled in this study.IPCL was observed and divided into different types by NBI-ME.Histopathology of biopsy or endoscopic submucosal dissection (ESD) specimens was evaluated and used as the gold standard to evaluate the diagnostic value of NBI-ME for IPCL.Results A total of 146 lesions from 145 subjects with esophageal mucosa abnormal were collected. Among them, 88 were pathology-proven inflammation,5 were pathology-proven esophageal cancers,20 were pathology-proven low intraepithelial neoplasia (LIN) and 33 were pathology-proven high intraepithelial neoplasia (HIN) detected with NBI-ME.By a per-lesion analysis,the accuracy of inflammation and cancer were 100％ (88/88) and 7/7.For the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio of LIN and HIN were 7/10,69.8％ ( 30/43 ),69.8％ ( 37/53 ),35.0％ (7/20),90.9％ (30/33),12.5％ (70/559),2.3％ (30/1290) and 87.1％ (27/31),72.7％ ( 16/22),81.1％ ( 43/53 ),81.8％ ( 27/33 ),80.0％ ( 16/20 ),634.1％ ( 837/132 ) and 35.2％ ( 124/352 ),respectively.Conclusions NBI-ME can classify the different esophageal IPCL.Higher diagnostic accuracy of IPCL indicates the feasibility of NBI-ME for the efficacious diagnosis of esophageal inflammation and cancer.There is the higher diagnostic accuracy of HIN than LIN.
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Objective To explore the reasons for lateral and basal incomplete resection of precancerous lesions or cancer from upper digestive tract by endoscopic submucosal dissection (ESD).Methods Data of 295 patients undergoing ESD for upper gastrointestinal precancerous lesions or cancer from November 2006 to October 2011 were collected,and reasons of basal or lateral incomplete resectin confirmed by postESD pathology were analyzed.Results The total incomplete resection rate after ESD was 3.05％ ( 9/295 ).Among 95 cases of esophageal ESD,there was 1 case of lateral margin incomplete resection because of the retraction of normal tissue after dissection.Among 200 cases of gastric ESD,there were 5 cases of lateral margin incomplete resection,in which 2 cases were signet ring carcinoma with submucosal infiltration and spreading,2 were due to retraction of normal tissue after dissection,and 1 was due to inaccurate judgment on cancer demarcation.There were 3 cases of basal incomplete resectin in gastric ESD,which was caused by incorrecte invasion depth estimation before ESD.Conclusion The rate of basal or lateral incomplete resection in upper gastrointestinal ESD was low,which is related to pathological type,ESD procedure and estimation of invasion depth before ESD.
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ObjectiveTo evaluate preoperative biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection (ESD).MethodsClinical data of 195 patients diagnosed as having gastric intraepithelial neoplasia (GIEN) or early cancer by preoperative biopsy were retrospectively analyzed.The discrepancy between endoscopic biopsies and pathological diagnosis after ESD were studied.ResultsThe overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 93.8％ (183/195) and complete consistency rate was 50.8％ (99/195).For low-grade and highgrade gastric intraepithelial neoplasia ( LGIEN),the complete consistency rates were 49.4％ (42/85)and 38.0％ (30/79),respectively,which were not different ( P ＞ 0.05 ).For early cancer it was 87.1％(27/31 ),which was significantly higher than those in the LGIEN group and HGIEN group ( P ＜ 0.05 ).Post-ESD diagnosis was more severe than biopsy in 66 patients (33.8％,66/195 ),including 36 LGIEN (42.4％,36/85) and 30 HGIEN (38.0％,30/79).Final pathological diagnosis was milder than biopsy in 18 patients (9.2％,18/195),i.e.14 HGIEN (17.7％,14/79) and 4 early cancer (12.9％,4/31).Gastritis was diagnosed in 12 patients (6.2％,12/195),i.e.7 LGIEN (8.2％,7/85) and 5 HGIEN (6.3％,5/79).ConclusionPreoperative biopsy is insufficient for accurate diagnosis of gastric mucosal lesions,but facilitates resection of gastric mucosal lesions by ESD.
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Objective To determine the incidence and clinical factors associated with bleeding after endoscopic submucosal dissection (ESD) of gastric mucosal lesions.Methods Clinical,endoscopic and pathological data of 223 lesions in 215 ESD patients between January 2009 and October 2011 were collected.The following factors associated with bleeding were analyzed:( 1 ) patient-related factors:sex,age,concomitant diseases including hypertension and diabetes mellitus,history of administration of anticoagulants or antiplatelet agents; (2) lesion-related factors:size,location,ulcer or scar findings,macroscopic types and pathological types; (3) procedure-related factors:en-bloc resection,spray of porcine fibrin sealant and operation time. Results Thirteen patients (13 lesions ) developed bleeding after ESD,among whom 7(53.8％) occurred within 24 hours after the procedure,5 (38.5％) within 1 week and 1 (7.7％) on the sixteenth day after ESD.Univariate and multivariate analysis revealed that lesion size ( ≥5 cm; odds ratio 8.663 ; 95％ CI:2.081 - 36.075) was an independent risk factor for bleeding.Conclusion Lesion size is the independent risk factor for bleeding after ESD,so careful preparation and close monitoring are required during and after ESD.In the meantime efforts should be made to identify and exactly demarcate lesions to minimize the size of resected specimens and reduce the risk of bleeding after ESD.
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Objective To analyze endoscopic histological characters and establish diagnostic standards of colorectal polyps with confocal laser endomicroscopy (CLE) examination and to explore the diagnostic value of the CLE in adenomatous polyps and non-adenomatous polyps. Methods From June to December in 2009, 90 patients were recruited in this study, which included 40 pathologically confirmed colorectal polyps patients (total 48 colon and rectal polyps) and 50 patients for prospective study (total 106 colon rectal polyps). At same time 10 spots of normal mucosa was taken for comparison. Firstly the CLE images of 48 pathologically confirmed colorectal polyps (22 adenomatous polyps and 26 non-adenomatous polyps) were analyzed, and the diagnosis criteria for distinguishing adenomatous polyps and non-adenomatous polyps was established with CLE. Then according to the criteria, 106 colorectal polyps underwent prospective diagnosis with CLE. Finally, the CLE diagnosis result was compared with pathologically result to evaluate the diagnosis efficiency of CLE. Results In the 48 colorectal polyps of 40 pathologically confirmed colorectal polyps patients, there were 22 adenomatous polyps and 26 non-adenomatous polyps. The sensitivity, specificity and accuracy of CLE in adenomatous polyps diagnosis were 94. 0%, 92. 9%, and 93. 4%, respectively. The positive predictive value was 92.2% and the negative predictive value was 94.5%. The sensitivity, specificity and accuracy of CLE in non-adenomatous polyps diagnosis were 92. 9%, 94.0%, and 93. 4%respectively, the positive predictive value was 94.5% and the negative predictive value was 92.2%.The coherence of CLE and histopathology in adenomatous polyps diagnosis was pretty good (Kappa=0. 893). Conclusion The accuracy of CLE in adenomatous polyps and non-adenomatous polyps differential diagnosis was high, and the coherence with histopathology diagnosis was good, which provided experience for further detection of early rectal precancerous.
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ObjectiveTo investigate the procedure,effect and complication of endoscopic submucosal dissection (ESD) in the management of early gastrointestinal tumors and precancerous lesions.MethodsESD was performed in 28 patients with 29 lesions of early cancer and precancerous lesions in esophagus,stomach,colon and rectum.First we made marks around the lesion 3-5 mm away from the margin with a needle knife or APC,then injected solution into submucosa to elevate the lesion,and cut the mucosa and submucusa along the margin with a needle knife or IT knife.The submucosa was carefully dissected until the lesions were completely removed with IT knife.Bleeding was stopped with thermocoagulation forceps,argon plasma coagulation or clip.The samples were collected for pathological examination.All patients were followed up with endoscopy as scheduled.ResultsOf the 29 lesinas,22 were en bloc resected,6 were piecemeal resccted,and 1 was partial removed.The resection rate of antral lesion was 100% (12/12),and that of lesions between angulus and cardia was 5/7,that of esophageal lesions was 3/5 and that of colorectal ncoplasmns was 2/5.Delayed bleeding occured in 1 patient.The mean operation time for the antral lesions was 48 minutes.Twenty patients were followed up for 1 to 12 months.No residue or recurrence of the lesions was found.ConclusionThe major advantage of ESD is that the resection area can be determined by the size and shape of the lesion,and resection can be achieved en bloc even in a large neoplasm.
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Programmed cell death(PCD)of human leukemic HL-60 cell and human poorly differentiated gastric adenocarcinoma cell BGS-180 induced by efoposid(VP-16) was preliminarily observed comparatively in the same experimental condition through rate of cell death, DNA agarose gels electrophoresis and terminal deoxynucleotidyl transferase(TdT) mediated biotin-11-dUTP nickend labeling(TUNEL).It was found that apoptosis is the main pattern of HL-60 cell death induced by low does VP-16 in a short time, and it can be suppressed when protein kinase C(PKC) is activated. The main pattern of BGS-180 cell death induced by VP-16 is necrosis, and PCK activation does not affect its necrosis rate. Extracellular Ca2+ reduction do not affect BGS-180 and HL-60 cell death rate. The mechanism of VP-16 action on BGS-180 and HL-60 cell is different, apoptosis is not the main pattern of cell BGS-180 death induced by VP-16.
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Objective To retrospectively analyse the factors related to the risk of malignant change in relation with various colorectal polyps. Methods Data on a total of 820 patients (900 polyps), who had undergone polypectomy between 1997 and 2001 were collected. The relation between colorectal cancer and polyps characteristics was assessed by Logistic Regression and Chi square. Results The risk of malignant change was significantly related with the size of polyps, histology of polyps, grade of dysplasia, pathological changes of mucosa, sessile or pedunculated polyps. Conclusion High grade dysplasia, large size, adenoma, absence of a stalk, and ulcerous mucosa were confirmed as the major predictors. The likelihood of malignant degeneration of colorectal polyps seemed to be correlated with the number of the above mentioned risk factors present
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Programmed cell death(PCD)of human leukemic HL 60 cell and human poorly differentiated gastric adenocarcinoma cell BGS 180 induced by efoposid(VP 16) was preliminarily observed comparatively in the same experimental condition through rate of cell death, DNA agarose gels electrophoresis and terminal deoxynucleotidyl transferase(TdT) mediated biotin 11 dUTP nickend labeling(TUNEL).It was found that apoptosis is the main pattern of HL 60 cell death induced by low does VP 16 in a short time, and it can be suppressed when protein kinase C(PKC) is activated. The main pattern of BGS 180 cell death induced by VP 16 is necrosis, and PCK activation does not affect its necrosis rate. Extracellular Ca 2+ reduction do not affect BGS 180 and HL 60 cell death rate. The mechanism of VP 16 action on BGS 180 and HL 60 cell is different, apoptosis is not the main pattern of cell BGS 180 death induced by VP 16.