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Objective:To analyze the endoscopic characteristics of early gastric cancer and precancerous lesions after Helicobacter pylori ( H. pylori) eradication. Methods:From May 2019 to June 2022, at Shanghai Sixth People′s Hospital affiliated to Shanghai Jiaotong University School of Medicine, the medical data of patients diagnosed with differentiated early gastric cancer and precancerous lesions were collected. A total of 93 patients with early gastric cancer and precancerous lesions who had previous history of H. pylori infection and had undergone standardized eradication treatment were selected, and their endoscopic characteristics were retrospectively analyzed. Independent sample t-test, chi-square test, and Fisher′s exact test were used for statistical analysis. Results:Among 93 patients with early gastric cancer and precancerous lesions after H. pylori eradication, there were 56 males and 37 females, with an average age of (66.9±8.2) years old. The time after H. pylori eradication was 3.4 years (range 1.0 to 7.0 years). A total of 109 early gastric cancer and precancerous lesions were found, including 79 patients with single lesion and 14 patients with multiple lesions (30 lesions). There were 60 cases with 73 lesions in the early gastric cancer group and 33 cases with 36 lesions in the precancerous group. Among 93 patients, 89 cases (95.7%) were diagnosed with atrophy level above C-2 according to Kimura-Takemoto classification under endoscopy. The long diameter of 109 lesions was (1.38±0.70) cm and the short diameter was (1.04±0.53) cm. A total of 80 lesions (73.4%) were located in the lower 1/3 part of the stomach, and 53 lesions (48.6%) were located in the lesser curvature. A total of 106 lesions (97.2%) were superficial type (0-Ⅱ) under the endoscopy. The long diameter and short diameter in the early gastric cancer group after H. pylori eradication were both greater than those in the precancerous lesion group ((1.54±0.78) cm vs. (1.06±0.35) cm, (1.16±0.58) cm vs. (0.78±0.33) cm), and the differences were statistically significant ( t=3.53 and 3.73, both P<0.001). There was statistically significant difference in the morphological types between early gastric cancer group after H. pylori eradication and precancerous lesion group ( χ2=11.01, P=0.012). The main morphological type of early gastric cancer after H. pylori eradication was superficial depression type (0-Ⅱc), accounting for 45.2% (33/73), while the precancerous lesions were mainly superficial protruded and flat type, both accounting for 38.9% (14/36). Conclusions:After H. pylori eradication, the endoscopic atrophy range of early gastric cancer and precancerous lesions is mostly above C-2. And the lesions are mostly located in the middle and lower 1/3 part of the stomach, long diameter of lesions <20 mm. The main morphological type is superficial type, especially superficial depression type.
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Objective:To investigate endoscopic and clinical characteristics of intestinal Behcet′s disease (BD) in children.Methods:General information, clinical manifestations, laboratory tests, imaging examinations and endoscopic characteristics of 14 children with intestinal BD treated in the Department of Gastroenterology, Beijing Children′s Hospital Affiliated to Capital Medical University from January 2016 to March 2020 were retrospectively analyzed.Results:Fourteen children with intestinal BD were recruited, involving 5 males and 9 females with the age of 1 month to 12 years and 11 months [(6.68±3.73) years old], and a median disease course of 6 months.All of them had gastrointestinal symptoms, including 11 cases with abdominal pain, 7 cases with diarrhea and 2 cases with vomiting.Complications of children with intestinal BD included gastrointestinal bleeding, intestinal perforation and stenosis.Extragastrointestinal symptoms included recurrent oral aphthosis in all the 14 cases, fever in 11 cases, skin lesions in 9 cases, vascular manifestations in 8 cases, positive pathergy test in 6 cases, joint manifestations in 5 cases, neurological manifestations in 1 case, and malnutrition in 6 cases.Observed by the endoscopy, lesions were mainly distributed in the distal ileum [61.5%(8/13 cases)]and ileocecal part[53.8%(7/13 cases)], with the main manifestation of ulcer.There were 3 cases with single ulcer and 10 cases with multiple ulcers, including 7 cases with deep and large ulcers.Pathological examinations of endoscopic lesions showed that the main features were mucosa chronic nonspecific inflammation, mucosa chronic active inflammation with ulcer and vasculitis.Conclusions:Clinical manifestations of intestinal BD vary a lot and are non-specific.Some children with intestinal BD may develop severe complications.Endoscopic lesions of intestinal BD have certain characteristics, which contribute to the diagnosis.Gastroenterologists need to be fully aware of intestinal BD.
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Objective:To analyze the clinical and endoscopic characteristics of gastric low-grade intraepithelial neoplasia (LGIN), and to explore the risk factors related to the progression of LGIN.Methods:The clinical, endoscopic and pathological data of 411 patients with LGIN diagnosed by initial pathological biopsy in the Department of Gastroenterology, the First People′s Hospital of Yichang (the People′s Hospital of China Three Gorges University) from January 1, 2012 to December 30, 2020 were retrospectively analyzed, and were followed up every three to six months and endoscopy and pathological biopsy were performed. The clinical data of patients were collected, which included age, gender, lesion location, lesion size, lesion type, lesion color, lesion appearance, family history of gastric cancer, history of smoking and alcohol intake, history of pickled food, whether complicated with intestinal metaplasia or gastric atrophy and the degree, whether there was Helicobacter pylori infection. According to the results of last follow up, the differences in above factors between progressive and non-progressive patients, and the risk factors for the progression of LGIN were analyzed. Indenpendent sample t test, chi square test, and univariate and multivariate logistic regression were used for statistical analysis. Results:Among the 411 patients with LGIN, there were 261 males and 150 females, the ratio of male to female was 1.74 ∶1; the mean age was (57.5±10.3) years old (30 to 86 years old). The most common clinical symptoms were abdominal pain, abdominal discomfort and abdominal distension, which accounted for 30.7% (126/411), 25.8% (106/411) and 20.9% (86/411), respectively. The lesions of 245 cases (59.6%) located in gastric antrum; the maximum diameter of lesions of 344 cases (83.7%) was 0.5 to less than 2.0 cm; the lesion types of 232 cases (56.4%), 104 cases (25.3%) and 75 cases (18.2%) were prominent type, flat type and depressed type, respectively. The lesion color of 298 cases (72.5%) was red, and that of 113 cases (27.5%) was normal or white. One hundred and seventy-one cases (41.6%) had surface erosion and 61 cases (14.8%) had surface ulcer. Two hundred and seventy-two cases (66.2%) of LGIN were complicated with intestinal metaplasia, and the proportions of mild, moderate and severe intestinal metaplasia were 50.4% (137/272), 33.8% (92/272) and 15.8% (43/272), respectively; 196 cases (47.7%) of LGIN were with gastric atrophy, and the proportions of mild, moderate and severe degree of gastric atrophy were 58.2% (114/196), 29.1% (57/196) and 12.7% (25/196), respectively. Rapid urease test or 14C urea breath test were carried out in 368 cases (89.5%), the positive rate of Helicobacter pylori infection was 45.1% (166/368), and the proportion of male was higher than that of female (59.6%, 99/166 vs. 40.4%, 67/166), and the difference was statistically significant ( χ2=4.537, P<0.05). All 174 patients with LGIN were successfully followed up, and the LGIN lesion of 11.5% (20/174) patients was progressive. The results of univariate analysis indicated that there were statistically significant differences in the lesion location, lesion size, lesion type, lesion appearance, atrophy, family gastric cancer history, history of alcohol intake, and history of pickled food between the patients with progressive lesions (20 cases) and the patients with non-progressive lesions (154 cases) ( χ2=11.950, 22.370, 8.964, 8.552, 10.362, 7.139, 5.913 and 4.668, all P<0.05). The results of multivariate logistic regression analysis showed that lesions in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer, history of alcohol intake, history of pickled foods were independent risk factors of the progression of LGIN (odds ratio=4.796, 5.457, 4.431, 3.521, 1.380, 21.405, 3.294 and 1.832, 95% confidence interval 2.028 to 6.431, 3.256 to 8.943, 1.356 to 6.410, 1.305 to 5.706, 1.013 to 2.805, 5.062 to 25.391, 2.012 to 5.826, 1.072 to 3.790, all P<0.05). Conclusions:The lesions located in gastric corpus, maximum diameter of the lesion ≥2.0 cm, depressed lesions, ulcer lesions, atrophy, family gastric cancer history, history of alcohol intake, history of pickled foods are independent risk factors of the progression of LGIN. When the patients with LGIN have these characteristics, endoscopic resection should be considered.
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Objective To explore the clinical characteristics and related background diseases of type 1 gastric neuroendocrine tumor (g-NET) and to provide reference information for clinical diagnosis and treatment.Methods From Januayy 2011 to February 2019,at the First Affiliated Hospital of Sun Yat-sen University and China-Japan Friendship Hospital,the clinical features and related background diseases of type 1 g-NET patients (41 cases and 93 cases respectively)were retrospectively analyzed.The clinical symptoms,serological indicators,gastroscopic and pathological features,tumor location,metastasis and treatment,and concomitant diseases were statistically described.Results Among 134 patients with type 1 g-NET,there were 53 males (39.6％) and 81 females (60.4 ％);and the mean diagnosed age was (51 ± 11) years (21 to 76 years).Main clinical manifestations were non-specific gastrointestinal symptoms.The mean level of serum chromogranin A was (237.7 ± 176.8) μg/L.The endoscopic findings of 97.8％ (131/134) of the patients were polypoid or protuberant lesions at gastric fundus or gastric body.And 75.0％ (96/128) of the patients had multiple tumors.65.7％ (88/134) of the patients had the tumors with the maximum diameter less than 1 cm (77.2％,88/114) and the lesions mainly located in mucosa (59.8％,52/87) and submucosa (40.2％,35/87).The pathological classification of 79.3％ (96/121) of the tumors was G1 grade and 20.7％ (25/121) were G2 grade.The rate of local lymph node metastasis was 1.4％ (1/73) and no distant metastasis was found.About 70.9％ (95/134) of the patients received endoscopic treatment.Among the patients,93.6％ (103/110) of the patients had chronic atrophic gastritis confirmed by endoscopy or pathology,45.6％ (47/103) were confirmed by both endoscopy and pathology.Among the patients with chronic atrophy gastritis,serum gastrin levels of 93.2％ (96/103) patients were twice higher than the upper limit of the normal value.The positive rates of antiparietal cells antibody (PCA) and intrinsic factor (IFA) were 78.5％ (73/93) and 51.9％ (14/27),respectively.The incidence of Helicobacter pylori (H.pylori) infection was 28.1％ (16/57).The incidence of autoimmune atrophy gastritis was 80.6％ (75/93).The percentage of patients with deficiency of serum vitamin B12 and ferritin was 70.8％ (63/89) and 30.7％ (27/88),respectively.Patients with anemia accounted for 27.8％ (25/90).The patients with microcytic anemia,normocyticanemia and macrocytic anemia were 28.0％ (7/25),56.0％ (14/25) and 16.0％ (4/25),respectively.46.9％ (45/96) of the patients had increased thyroid autoantibodies and 17.9％ (17/95) patients had changes of thyroid hormone level.Conclusions Type 1 g-NET is more common in women and mainly caused by autoimmune atrophic gastritis.The level of serum PCA and IFA increase in more than half of the patients.And it is often accompanied by vitamin B12 deficiency and autoimmune thyroid disease.
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Objective To analyze the clinical and endoscopic characteristics of pneumatosis cystoides intestinalis ( PCI) in colon. Methods Data of 116 patients with colonic PCI admitted at Beijing Friendship Hospital from January 2005 to June 2018 were retrospectively collected, including age, gender, clinical manifestations, lesion size, location, and morphology. The clinical and endoscopic characteristics of colonic PCI were analyzed. Results The 116 patients included 54 males and 62 females, with age of 59. 11±13. 13 years (ranged, 17-91 years). Fifty cases (43. 10％) had a single lesion, and 66 cases (56. 90％) had multiple lesions. The detection rate of colonic PCI was 0. 40‰ ( 1/2524) to 2. 03‰(8/3945). Clinical manifestations included no symptom (24. 14％, 28/116), abdominal pain (18. 97％,22/116) , and elevated tumor markers ( 17. 24％, 20/116 ) . A total of 168 lesions were found under colonoscopy, and were single or multiple submucosal hemispherical or spherical cystic eminence of different sizes with soft surface, and some had hyperemia and erosion on the mucosal surface. The size of lesions was clearly recorded in 66 cases among the 116 patients, with 1. 61±0. 87 cm (ranged, 0. 3-5. 0 cm). The diameter of lesions was 1. 0-<2. 0 cm in 30 cases ( 45. 45％) . The single PCI was mostly located in ascending (38. 00％, 19/50) and transverse ( 28. 00％, 14/50) colon, and multiple PCIs were mostly located in ascending ( 28. 81％, 34/118 ) , sigmoid ( 22. 03％, 26/118 ) and descending ( 17. 80％, 21/118) colon. Conclusion Colonic PCI is a rare disease in clinic with non-specific clinical manifestations, and colonoscopy is an effective diagnostic method. It is apt to happen in elder patients and often found in ascending colon.
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Objective To study the clinical characteristics of non-steroidal anti-inflammatory drugs (NSAIDs)induced peptic ulcer bleeding(PUB). Methods The case-control study was used to analyze the clinical data of 142 patients with NSAIDs-induced PUB and 210 patients with non-NSAIDs-induced PUB. Results There were significant differences between the two groups regarding sex and age of patient,history of rheumatic diseases or cardio-cerebral-vascular disease,types and numbers of ulcer,abdominal pain,hemoglobin concentration,and hospital stay(P<0.05),but there was no obvious difference in terms of the size of ulcer,BUN and HP infection rate. Conclusion Proper measures should be employed to decrease the complications of NSAIDs-induced PUB.
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ObjectiveTo unify the definitions of colonoscopic characteristics of Crohn disease (CD) and intestinal tuberculosis ( ITB),and to evaluate colonoscopic and clinical features in the differential diagnosis of CD and ITB.MethodsA collaborative group composed of 10 experts from 5 hospitals voted to identify and confirm the colonoscopic characteristics.Clinical and colonoscopic characteristics were analyzed,thereafter,characteristics were scored based on different diagnostic specificity.ROC curve was used for determining the cutoff point to differentiate CD from ITB.ResultsFirstly,standard endoscopic images and descriptions were determined.Secondly,colonoscopic parameters which were significantly different between the CD and ITB patients included the follows:involvement of more than four intestinal segments,anorectal involvement,longitudinal ulcers,cobblestone appearance and transverse ulcers.Clinical findings which were significantly different between the CD and ITB patients included active pulmonary tuberculosis,PPD-test strong positive,anal fistula/perianal abscess and extra-intestinal manifestations in CD.4.4％(6/136) patients were confirmed by histological evidence of caseating granulomas.By using our scoring system,39.7％ (54/136) confirmed diagnoses and 18.4％ (25/136) suspected diagnoses were made in patients without histological evidence.ConclusionIdentification of colonoscopic characteristics and unification of the colonscopic diagnostic criteria were helpful in the differential diagnosis between CD and ITB.The differential diagnosis rate could he improved by using the scoring system.Half cases could not be confirmed even with combined pathology and the scoring system,so a more comprhensive scoring system would be warranted.
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PURPOSE: Small-sized carcinoids, less than 1 cm, are easily detected using flexible sigmoidoscopy or total colonoscopy and can be treated by local excision. Recently, there has been many advances in the technique of endoscopic resection. The aim of this study was to determine the endoscopic findings of a rectal carcinoid and to evaluate the effectiveness of endoscopic resection. METHODS: We experienced 22 rectal carcinoids in 21 patients who were treated by endoscopic resection from June 1996 to February 1999. Nineteen cases were followed for an average of 21 months. Follow-up studies consisted of chest P-A, hepatic ultrasonography, and total colonoscopy. RESULTS: The male-to-female ratio was 1.6 to 1. The most common age group was the 4th decade. The tumor was located at the lower rectum in 10 patients, at the upper rectum in 10 patients, and at the rectosigmoid junction in 2 patients. The tumor sizes ranged from 3 to 12 mm in diameter and were smaller than 10 mm in 20 cases (90.1%). Endoscopic finding revealed that the tumors were covered by a normally appearing mucosa in 12 cases, were yellow-discolored polyps in 17 cases, and were sessile-type tumors in 19 cases. The method of treatment was an endoscopic mucosal resection (EMR, 14 cases) or a snare polypectomy (8 cases). Microscopically positive margins were noticed in four cases, two cases of EMR (2/14, 14%) and two cases of snare polypectomy (2/8, 25%). All the patients were alive and clinically free of disease; however, the duration of the follow-up is short. CONCLUSIONS: Endoscopic resection for rectal carcinoid tumors smaller than 1 cm in diameter is a safe, functional, time-saving, and effective treatment. If the tumor suggests a carcinoid, EMR is advised rather than a polypectomy even though the tumor is small. Microscopically positive margins are not absolute indications for further surgery in the treatment of carcinoids smaller than 1 cm in diameter. It is much more important for an endoscopist to be confident that the endoscopic resection is done completely. It is necessary to identify the factors influencing the malignancy potential and to have a longer follow-up.
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Humans , Carcinoid Tumor , Colonoscopy , Follow-Up Studies , Mucous Membrane , Polyps , Rectum , Sigmoidoscopy , SNARE Proteins , Thorax , UltrasonographyABSTRACT
PURPOSE: Detecting and treating early colorectal cancers are most important for preventing advanced colorectal cancers which are difficult to manage. However, there is still a lack of data and guidelines in Korea about early colorectal cancers, especially when endoscopy is concerned. This study was undertaken in an effort to gather information in this area. METHODS: We experienced 107 early colorectal cancers from 1995 to 1998. We analyzed them with special reference to endoscopic characteristics and treatment. Ninty-six cases were followed for an average of 17 months. RESULTS: Ninty-four (87.9%) of the early colorectal cancers were detected during the last two years of the study. The male-to-female ratio was 2.1 to 1. The most common age group was the 7th decade. The rectum and the sigmoid colon were involved in 85% of the early cancers. Lesions smaller than 20 mm accounted for 54.2% of the early cancers and ones smaller than 10 mm 15%. There were no malignancies in flat-elevated lesions smaller than 10 mm; to the contrary, there was a 66.7% malignancy rate in depressed lesions. Malignancy developed in LSTs (Laterally spreading tumors) larger than 20 mm. Regarding configuration, protruded-type tumors accounted for 80.4% of the lesions, depressed-type tumors 5.6%, and LSTs 4.7%. The most common endoscopic characteristic of early colorectal cancer was redness. White spots, hardness, easy bleeding upon touch, and nodules were recognized in more than 20% of the tumors; depression and erosion were noticed in more than 10%. An expanded figure, convergence of mucosal folds, a whitish patch, and ulceration were useful in some cases. The submucosal cancer rate was 30.2% in protruded-type lesions and 66.7% in depressed-type ones. The overall adenoma-association rate was 93%. All lesions without an adenomatous component were submucosal cancers. The overall endoscopic resection rate was 87.9%. Among them, those who needed additional surgical resection accounted for 13.8% (13/94). Three recurrences were recognized. Those three were all early rectal cancers associated with villous tumors and were larger than 20 mm. All recurrences were treated endoscopically. There was one case of bleeding within 1 day after endoscopic resection. That was associated with a 20-mm, pedunculated lesion in the ascending colon and was treated using a detachable snare. CONCLUSIONS: It is important to recognize the endoscopic characteristics of early colorectal cancers, especially those of depressed lesions and LSTs. Those characteristics are also useful in selecting appropriate candidates for endoscopic resection.