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Chinese Journal of Digestion ; (12): 680-685, 2020.
Article in Chinese | WPRIM | ID: wpr-871498


Objective:To evaluate the accuracy of white light conventional endoscopy (CE), endoscopic ultrasonography (EUS) and narrow-band imaging with magnifying endoscopy (ME-NBI) in evaluating the invasion depth of early gastric cardiac cancer, and to explore the diagnostic strategy of preoperative evaluation of invasive depth of early gastric cardiac cancer.Methods:From January 2016 to June 2019, the endoscopic images of 135 patients with early gastric cardiac cancer confirmed by pathology in Fujian Provincial Hospital were retrospectively analyzed. Intramucosal carcinoma (M) and superficial submucosal invasive carcinoma (SM1) were classified as M-SM1 cancer and compared with deep submucosal invasive cancer. The pathological diagnosis after operation was used as gold standard. The accuracy of CE, EUS, ME-NBI and the combination of them in determining the invasion depth of early gastric cardiac cancer was evaluated. Kappa test was performed for consistency test. Kappa value < 0.2 was considered as poor consistency, 0.2 to 0.4 as general consistency, more than 0.4 to 0.6 as medium consistency, more than 0.6 to 0.8 as high consistency, and 0.8 to 1.0 as close to full consistency. Results:The data of 73 patients with early gastric cardiac cancer were enrolled in this study. According to the pathological results after operation, 47 cases were M-SM1 cancer and 26 cases were deep submucosal invasive cancer. The diagnostic accuracy of CE, EUS, ME-NBI and the combination of them before operation were 79.5% (58/73), 72.6% (53/73), 65.7% (48/73) and 87.7% (64/73), respectively. The results of consistency test indicated that the consistency of CE diagnosis and pathological results after operation was medium ( Kappa=0.540, P<0.01), that of EUS and pathological results after operation was general ( Kappa=0.346, P=0.002), that of ME-NBI and pathological results after operation was poor ( Kappa=0.175, P=0.108), while that of the combination of them and pathological results after operation was high ( Kappa=0.724, P<0.01). Conclusions:Compared with single examination method, the combination of CE, EUS and ME-NBI is more accurate in evaluating the invasive depth of early gastric cardiac cancer.

Article in Chinese | WPRIM | ID: wpr-871424


Objective:To evaluate the efficacy and safety of budesonide viscous suspension (BVS) in preventing extensive esophageal stenosis after endoscopic submucosal dissection(ESD).Methods:Data of 62 cases of early esophageal neoplasms or precancerous lesions receiving ESD whose postoperative mucosal defects were more than half the circumference of the esophageal lumen at Fujian Provincial Hospital from October 2014 to December 2018 were retrospectively studied. The patients were divided into the BVS group who received BVS therapy (n=24) and the control group who received no intervention (n=38). The incidence of postoperative stenosis, the number of bougie dilation procedures and complications were compared between the two groups. Risk factors for postoperative stricture were analyzed by logistic regression.Results:The incidence of postoperative stenosis [16.7% (4/24) VS 47.3% (18/38), P=0.005], the number of bougie dilation procedures (1.50±0.58 VS 2.70±1.09, P=0.039) in the BVS group were significantly lower than those in the control group. No serious adverse events such as perforation or massive hemorrhage related to BVS were observed in the BVS group. Multivariate logistic regression analysis showed circumferential extension ≥3/4 ( OR=37.970, 95% CI: 6.338-227.482) and non-intervention with BVS( OR=20.962, 95% CI: 3.374-130.243) were the independent risk factors for esophageal stricture after ESD. Conclusion:Administration of BVS is an effective and safe method to reduce the incidence of stenosis and the number of bougie dilation procedures for extensive esophageal stenosis after ESD.

Article in Chinese | WPRIM | ID: wpr-871388


Objective:To preliminarily study the effect of Q self-traction endoscopic submucosal dissection (Q-ESD) on treatment of large early esophageal cancer (EEC).Methods:A retrospective analysis was performed on the data of 82 cases of large EEC (single lesion>1/2 cross-section diameter or longitudinal diameter length >5 cm) who underwent ESD on Fujian Provincial Hospital between January 2015 and December 2018. According to the treatment schedule, patients were divided into the conventional ESD group (n=44) and the Q-ESD group (n=38). The procedural area, time, and speed, en bloc resection rate, complete resection rate and complications of the two groups were analyzed.Results:All of the 82 lesions were resected completely under endoscope. There was no statistical difference in the procedural area [779.8 (329.9-2 552.5)mm 2 VS 875.7 (417.8-1 914.8)mm 2, U=155, P=0.636], procedural time [63 (41-177)min VS 59 (42-169)min, U=171, P=0.167] and complete resection rate [94.7% (36/38) VS 93.2% (41/44), χ2=0.086, P=0.769] between the Q-ESD group and the conventional ESD group. Compared with the conventional ESD group, the Q-ESD group had a faster dissection speed [14.9 (5.4-20.8) mm 2/min VS 9.0 (5.0-19.5) mm 2/min, U=142, P=0.035], lower muscularis propria injury rate [7.9% (3/38) VS 27.3% (12/44), χ2=5.123, P=0.023], and a lower stricture rate [5.3% (2/38) VS 20.5% (9/44), χ2=4.051, P=0.044]. No other adverse events occurred except for one case of perforation in the conventional ESD group. Conclusion:The new traction technique of Q-ESD is a safe and effective treatment for large EEC.

Article in Chinese | WPRIM | ID: wpr-734981


Objective To study the influencing factors for outcomes of gastric low-grade intraepithelial neoplasia ( LGIN) for better LGIN treatment regimen. Methods Using magnifying endoscopy combined with narrow-band imaging ( ME-NBI ) follow-up strategy, the endoscopic features of 47 cases of LGIN in Fujian Provincial Hospital, including location, size, surface situation, demarcation line, microvascular pattern and microsurface pattern, were prospectively observed, then the factors influencing the outcome were analyzed. Results Among the 47 cases of LGIN, there were 35 cases in stable condition, whose results of biopsy and ME-NBI had no changes (stable LGIN), and the mean follow-up time was 20. 7±6. 9 months. The remaining 12 patients had progressive dysplasia (progressive LGIN), including 4 cases of high-grade intraepithelial neoplasia, and 8 cases of moderate dysplasia. The mean follow-up time was 16. 3 ± 11. 8 months. There were no significant differences between the two groups in gender (P=0. 33), mean age (P=0. 13), lesion distribution (P=0. 70), and lesion morphology (P=0. 97). The lesion size was less than 20 mm in the stable group ( 71. 4%, 25/35) , and over 20 mm in the progressive group ( 66. 7%, 8/12) , and the difference was statistically significant ( P=0. 02) . The proportion of the lesion surface heterogeneity in the progressive group was significantly higher than that in the stable group[75. 0% (9/12) VS 34. 3% (12/35),P= 0. 01 ] . The proportion of positive manifestations under ME-NBI in the progressive group was also significantly higher than that in the stable group [ 83. 3% ( 10/12 ) VS 8. 6% ( 3/35 ) , P = 0. 00 ] . Conclusion The size of lesions over 20 mm, the uneven surface and positive ME-NBI are the important factors influencing the outcome of LGIN, which are of significance for the diagnosis and treatment of LGIN.

Article in Chinese | WPRIM | ID: wpr-513651


Objective To explore the effects and related mechanism of Exendin-4 on secretion of extracellular matrix in high glucose-induced glomerular mesangial cells(GMCs). Methods GMCs were incubated in medium with glucose or Exendin-4 for the four groups: normal glucose group(NG group): cells were treated in medium with 5.6 mmol/L glucose; NG with Exendin-4 treatment group(NGE group): cells were treated with 5.6 mmol/L glucose and Exendin-4; high glucose group(HG group): cells were cultured with 30 mmol/L glucose; HG with Exendin-4 treatment group(HGE group): cells were treated with 30 mmol/L glucose and Exendin-4 at concentration of 3, 5, 10, 15, 30 nmol/L separately, which were cultured for 12, 24, 48 hours. GMCs treated with Exendin-4 were determined by assessing proliferation using a CCK8 method. The levels of fibronectin(FN), collagen type Ⅳ(Col-Ⅳ)in the cell supernatant were measured using enzyme-linked immunosorbent assay(ELISA). The gene levels of Col-Ⅳ, FN, and expression of inflammatory mediators including monocyte chemotactic protein 1(MCP-1), tumor necrosis factor-α(TNF-α), intercellular cell adhesion molecule-1(ICAM-1), transforming growth factor-β1(TGF-β1)were evaluated using reverse transcription PCR(RT-PCR); The expression of nuclear transcription factor-κB(NF-κB), glucagon-like peptide-l receptor(GLP-1R), and phosphorylation levels of mitogen-activated protein kinases(MAPKs)were evaluated by Western blot. Results(1)After treatment with 10 nmol/L Exendin-4 for 24 hour, the proliferation rate of GMCs was significantly decreased compared with 3 nmol/L, 5 nmol/L Exendin-4 treatment(P0.05). (2)The gene expression of FN, Col-Ⅳ and the inflammatory mediators, MCP-1, TNF-α, ICAM-1, TGF-β1 in HG group were significantly increased compared with the NG group,(all P<0.05). After treatment with Exendin-4, the levels of FN, Col-Ⅳ and the gene expression of TNF-α, MCP-1, ICAM-1, TGF-β1 were decreased(all P<0.05). (3)Compared with NG group, the expression of NF-κB and the phosphorylation of extracellular regulated protein kinases(p-Erk1/2), Jun N-terminal kinase(p-JNK)and, p38MAPK(p-p38MAPK)in the group of HG group were increased significantly, accompanied by the decrease of GLP-1R protein level(all P<0.05). Importantly, Exendin-4 treatment significantly reduced protein expression of p-Erk1/2, p-JNK, and NF-κB(all P<0.05), and the level of GLP-1R protein increased(P<0.05). Furthermore, specific Erk1/2, JNK or NF-κB inhibitors markedly blocked Exendin-4-mediated decrease in the levels of FN, Col-Ⅳ. Conclusion Exendin-4 treatment inhibits the secretion of extracellular matrix potentially through Erk1/2, JNK/NF-κB signaling in higher glucose induced GMCs.

Article in Chinese | WPRIM | ID: wpr-442932


Objective To prospectively evaluate the risk factors of complete resection in early gastric cancer (EGC) with endoscopic submucosal dissection (ESD),and to guide the choice of treatment methods.Methods This study prospectively evaluated the endoscopic features of 66 EGCs,including the lesion size,presence or absence of ulceration,the extent of differentiation,invasion depth and entire margins of the EGC,then compared them with postoperative pathologic results and analysed these factors.Results The lesion size of the high grade intmepithelial neoplasia (H) group and the intramucosal carcinoma (M) group were mainly less than 30 mm (90.9% vs.88.5%),but 57.1% of the submucosal carcinoma (SM) were more than 30 mm.There was a significant difference between any two of three groups (P < 0.05).Fourteen EGCs who got ulceration without invasion beyond mucosal muscularis underwent ESD successfully,and the basal or dissected margin had no residual tumor cells confirmed pathologically.And no tumor cell infiltration or lymph node metastasis was discovered.Of 45 EGCs with ESD,the underestimation rate for horizontal extent determined by white light and chromoendoscopy was higher than that of magnifying endoscopy with narrow-band imaging (ME-NBI) (15.6% vs.2.2%,P <0.05).Diagnostic accuracy for the extent of differenciation by conventional endoscopy was 93.9% (31/32,P > 0.1),but it's unable to determine the extent of differentiation by ME-NBI.The accuracy of the group H was 84.8% (28/33),that of M was 57.7% (15/26),that of SM was 71.4% (5/7),and there was a significant difference between group H and group M (P < 0.05).Conclusion To achieve complete resection of EGC with ESD,the lesion more than 30 mm,presence of ulceration,undifferentiated type,deep infiltration should be considered as the risk factors,and it's also important to identify the horizontal extent of EGC to avoid unnecessary operation.