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Objective:To study the clinical characteristics and endoscopic manifestations of patients with systemic amyloidosis involved in digestive tract.Methods:Clinical and endoscopic features, biopsy locations and positive rate of patients with systemic amyloidosis involved in digestive tract at Peking Union Medical College Hospital from December, 1991 to December, 2004 (1991 to 2004 diagnosed group, 18 cases) and from March 17th, 2009 to November 4th, 2020 (2009 to 2020 diagnosed group, 47 cases) were retrospectively analyzed and compared. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:Among 47 patients in 2009 to 2020 diagnosed group, 41 were primary amyloid light chain (AL) amyloidosis, and the age of onset was older than that of 1991 to 2004 diagnosed group ((57.15±9.10) years old vs. (50.75±10.90) years old), and the time from disease onset to diagnosis was shorter than that of 1991 to 2004 diagnosed group ((13.48±11.72) months vs. (26.38±23.02) months), and the differences were statistically significant ( t=2.08 and -2.13, P=0.048 and 0.047). There was no significant difference in time from disease onset to diagnosis between patients with gastrointestinal manifestations at disease onset and patients without gastrointestinal manifestations at disease onset (10.5 months (6.0 months, 17.3 months) vs.14.0 months (5.8 months, 25.0 months), P>0.05). Among primary AL amyloidosis patients in 2009 to 2020 diagnosed group, weight loss was the most common clinical symptom, the proportion of patients was 87.8%(36/41); secondary was gastrointestinal bleeding, among which 18 patients (43.9%) were stool occult blood test positive and 4 patients (9.8%) were with melena or bloody stool. The endoscopic features of patients with biopsy-confirmed digestive tract involvemen vary, including mucosa hemorrhage and oozing of blood in 4 cases, fragile mucosa and easy to bleed in 3 cases, and 4 cases with bulged mucosa and all the 4 cases of biopsy at bulged mucosa was positive. Gingiva and tongue were the most common biopsy locations and the positive rate of biopsy was ≥60.0%. Rectal mucosa biopsy was performed in 15 patients and 6 were Congo red staining positive. Heart or kidney biopsy was performed in 3 and 6 patients, and the number of positive cases was 2 and 4, respectively. Conclusions:Weight loss and gastrointestinal bleeding are the common gastrointestinal symptoms of primary AL amyloidosis. The common endoscopic manifestations included mucosal bleeding, fragile and bulged mucosa. Biopsy at multiple locations according to experience may help earlier diagnosis and treatment.
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To investigate the clinical and endoscopic characteristics and endoscopic treatment efficacy of cap polyposis, data of 14 patients (56 polyps) who were histologically diagnosed as having cap polyposis after endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in Beijing Friendship Hospital from June 2017 to February 2021 was retrospectively analyzed. Of the 14 patients, 8 were males and 6 were females. The age ranged from 14 to 74 years, including 7 cases of <60 years old and 7 cases of ≥60 years old. 7 patients (50.0%) had clinical manifestations. Four cases had multiple polyps and 10 cases (71.4%) had single polyps. There were 42 polyps (75.0%) located in the rectum, 13 (23.2%) in the sigmoid colon and 1 in the transverse colon. According to the classification of Yamada, 44 polyps (78.6%) were type Ⅰ, 3 polyps were type Ⅱ, 5 polyps were type Ⅲ and 4 polyps were type Ⅳ. Under endoscopy, there were 41 polyps (73.2%) with obvious white cap-like coverings on the surface and 23 polyps with obvious hyperemia and redness on the mucosa, 8 of which were both visible. Two cases were treated with ESD and 12 cases were treated with EMR, all of which were completely excised. No bleeding, perforation, infection or other complications occurred during and after operation. The clinical symptoms of 7 patients were relieved. During the follow-up period, 11 cases (78.6%) completed colonoscopy, and no polyp recurrence was found. In conclusion, there is no gender or age difference in patients of cap polyposis. It is usually single and located in the rectum and sigmoid colon with Yamada type Ⅰ. The surface of lesions is mostly covered with white cap. Patients may have no obvious clinical symptoms. Treatment of ESD and EMR is safe and effective for cap polyposis.
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Background: Esophageal basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma characterized by aggressive biological behavior and poor prognosis. Curative resection at early stage can significantly improve the outcome of patients with esophageal BSCC. Endoscopic biopsy is the main approach for the diagnosis of early esophageal cancer, however, the endoscopic features of early esophageal BSCC have not yet been systematically studied. Aims: To summarize the endoscopic features of early esophageal BSCC. Methods: The clinical, endoscopic and pathological data of 5 cases of early esophageal BSCC confirmed by pathology of endoscopic submucosal dissection from June 2016 to March 2019 at the Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed. Results: The patients were 5 males with a mean age of 61 years old. Most of the lesions were located in the middle thoracic esophagus (3/5); the long diameter was equal to or more than 3 cm (4/5), and near 50% circumference of the esophagus was involved (5/5). All of the 5 lesions were presented as endoscopic type Ⅱb. Most of the lesions showed only mucosal roughness under white light endoscopy and there were no obvious demarcation or background color changes under narrow-band imaging. Intrapapillary capillary loop (IPCL) was categorized as type B1 with low density under magnifying endoscopy in four cases. Iodine staining revealed less-stained or no staining in all the cases. Postoperative pathological results showed T1a tumor in all the cases. Conclusions: The endoscopic findings of early esophageal BSCC were occult. Most of the cases only show rough and flat lesion without other obvious specific changes. Type B1 microvessels with a low density under magnifying endoscopy might be a characteristic feature of early esophageal BSCC.
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Objective@#To analyze the clinical features and risk factors of ulcerative colitis (UC)complicated with Epstein-Barr(EB)-viremia and the effect of antiviral therapy on the remission of the symptoms.@*Methods@#From April 2014 to January 2018, data of 239 UC patients hospitalized at the Department of Gastroenterology of Second Hospital of Hebei Medical University were collected. The patients were divided into EB-viremia group (trial group, n=43) and non-EB-viremia group (control group, n=196) according to EB virus-DNA detection. The general condition, clinical characteristics and therapeutic efficacy of the two groups were compared. The risk factors and the effect of antiviral therapy on the remission of symptoms of UC complicated with EB-viremia were analyzed. Chi-square test and logistic analysis were used for statistical analysis.@*Results@#There were no significant differences in gender, age, clinical type, lesion range, the proportion of patients treated with 5-aminosalicylic acid or corticosteroids, the percentage of patients with diarrhea and bloody stool, the proportion of patients with spontaneous bleeding, platy ulcer and longitudinal ulcer under colonoscopy, the course of disease or Mayo score between the trial group and control group (all P>0.05). The proportions of patients with smoking history and severe disease, treatment with azathioprine and 6-mertocapurine (6-MP), treatrnent with infliximab, symptoms of fever or abdominal pain and deep and large ulcer under colonoscopy in the trial group were all higher than those in the control group, and the differences were all statistically significant (χ2=5.304, 6.608, 6.718, 6.939, 8.783, 4.493 and 5.425, all P<0.05). The results of multivariate logistic regression analysis showed that smoking history and treatment with azathioprine and 6-MP were risk factors of UC complicated with EB-viremia (OR=2.801 and 9.343, 95%CI 1.170 to 6.703 and 1.749 to 49.922, P=0.021 and 0.009). The improvement rates of the trial group and control group were 79.1%(34/43) and 95.4%(187/196), respectively. There was a significant difference in the improvement rate between the two groups (χ2=10.551, P=0.001). In the trial group, 12 patients (27.9%) received ganciclovir treatment, fonr patients (9.3%) had foscarnet sodium treatment, 21 patients (48.8%) were treated with the combination of these two medications and six cases (14.0%) did not received any antiviral treatment. After three weeks, the improvement cases of the above regimens were 8, 4, 16 and 6, respectively. There were no statistically significant differences in the improvement rate of patients with and without antiviral treatment, further more, no difference was found in the improvement rate of patients with different antiviral treatments (all P>0.05).@*Conclusions@#Smoking history and purine treatment are risk factors of UC complicated with EB-viremia.
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Objective To analyze the clinical features and risk factors of ulcerative colitis (UC) complicated with Epstein-Barr(EB)-viremia and the effect of antiviral therapy on the remission of the symptoms.Methods From April 2014 to January 2018,data of 239 UC patients hospitalized at the Department of Gastroenterology of Second Hospital of Hebei Medical University were collected.The patients were divided into EB-viremia group (trial group,n =43) and non-EB-viremia group (control group,n =196) according to EB virus-DNA detection.The general condition,clinical characteristics and therapeutic efficacy of the two groups were compared.The risk factors and the effect of antiviral therapy on the remission of symptoms of UC complicated with EB-viremia were analyzed.Chi-square test and logistic analysis were used for statistical analysis.Results There were no significant differences in gender,age,clinical type,lesion range,the proportion of patients treated with 5-aminosalicylic acid or corticosteroids,the percentage of patients with diarrhea and bloody stool,the proportion of patients with spontaneous bleeding,platy ulcer and longitudinal ulcer under colonoscopy,the course of disease or Mayo score between the trial group and control group (all P ＞ 0.05).The proportions of patients with smoking history and severe disease,treatment with azathioprine and 6-mertocapurine (6-MP),treatrnent with infliximab,symptoms of fever or abdominal pain and deep and large ulcer under colonoscopy in the trial group were all higher than those in the control group,and the differences were all statistically significant (x2 =5.304,6.608,6.718,6.939,8.783,4.493 and 5.425,all P ＜ 0.05).The results of multivariate logistic regression analysis showed that smoking history and treatment with azathioprine and 6-MP were risk factors of UC complicated with EB-viremia (OR =2.801 and 9.343,95％ CI 1.170 to 6.703 and 1.749 to 49.922,P =0.021 and 0.009).The improvement rates of the trial group and control group were 79.1％ (34/43) and 95.4％ (187/196),respectively.There was a significant difference in the improvement rate between the two groups (x2 =10.551,P =0.001).In the trial group,12 patients (27.9％) received ganciclovir treatment,four patients (9.3％) had foscamet sodium treatment,21 patients (48.8％) were treated with the combination of these two medications and six cases (14.0％) did not received any antiviral treatment.After three weeks,the improvement cases of the above regimens were 8,4,16 and 6,respectively.There were no statistically significant differences in the improvement rate of patients with and without antiviral treatment,further more,no difference was found in the improvement rate of patients with different antiviral treatments (all P ＞ 0.05).Conclusions Smoking history and purine treatment are risk factors of UC complicated with EB-viremia.
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Objective: To examine endoscopic features of early colorectal carcinomas smaller than 2 cm. Methods: A total of 191 pa-tients (201 early colorectal carcinomas) who were definitely diagnosed with early colorectal cancer smaller than 2 cm between Janu-ary 2014 and December 2017 in Beijing Shijitan Hospital, Capital Medical University were enrolled. The patients'clinical characteris-tics, endoscopic and pathological data were retrospectively analyzed. Results: There were more male patients than female patients (1.81:1) in the study population; distribution of lesions was higher in the left colon than in the right colon (141/201). Group 1 had a higher number of IIa lesions (20/67, P=0.037) and a lower number of Ip lesions than Group 2 (52/134, P<0.01). Conclusions: There are special characteristics in distribution and endoscopic manifestations of early colorectal carcinoma. Lesion size was less than 1 cm in 67 (191 cases of early colorectal cancer) early colorectal carcinoma cases; however, a high-risk adenoma is defined as a lesion larger than 1 cm in size. Therefore, regardless of lesion size, if fractionation, echinodermata, congestion, erosion, expansion, and depression are observed, the lesion should be assessed in detail for the sake of carcinogenesis.
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Objective To explore the clinical features, endoscopic changes, and histopathological features of abdominal type Henoch-Scho..nlein purpura (HSP) in children. Methods The clinical data of 151 children with HSP who had abdominal pain as the primary symptom from June 2011 to June 2016 were analyzed retrospectively. Results A total of 151 children with HSP, (87 males and 64 females) aged 4.8 - 11.5 years, were enrolled. All of them had abdominal pain. There were 100 cases of cutaneous purpura (66.22%), 72 cases of vomit (47.68%), 59 cases of haematemesis (39.07%), 44 cases of hematochezia (29.13%) and 8 cases of joint swelling and pain (5.29%). Peripheral blood leucocytes increased in 114 cases (75.49%), C-reactive protein increased in 48 cases (31.78%), and albumin decreased in 21 cases (13.90%). It indicated the localized thickening of the intestinal wall in 49 cases (32.45%) by B-ultrasound. Gastroscopy was performed in 96 cases and main findings were patchy hemorrhage and erythema (89 cases, 92.70%), erosion or ulcer accompanied by bleeding (68 cases, 70.83%), ecchymosis (37 cases, 38.54%) and hematoma like process (13 cases, 8.60%). The descendent duodenum was the most common and had the most serious lesions, followed by gastric antrum and duodenal bulb. Histopathology showed capillary inflammation in 37 cases, 10 of which were accompanied by Helicobacter pylori infection.Enteroscopy was performed in 55 cases and main findings were punctate hemorrhage and erythema (49 cases, 89.09%), and erosion or multiple ulcer with hemorrhage (27 cases, 49.09%). The terminal ileum was the most common and had the most serious lesions, followed by rectum. Conclusions The clinical features of abdominal type HSP in children are varied, and it often involves descendent duodenum and terminal ileum. Endoscopic examination is valuable for the diagnosis of abdominal type HSP in children.
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Objective To explore the clinical features, endoscopic changes, and histopathological features of abdominal type Henoch-Scho..nlein purpura (HSP) in children. Methods The clinical data of 151 children with HSP who had abdominal pain as the primary symptom from June 2011 to June 2016 were analyzed retrospectively. Results A total of 151 children with HSP, (87 males and 64 females) aged 4.8 - 11.5 years, were enrolled. All of them had abdominal pain. There were 100 cases of cutaneous purpura (66.22%), 72 cases of vomit (47.68%), 59 cases of haematemesis (39.07%), 44 cases of hematochezia (29.13%) and 8 cases of joint swelling and pain (5.29%). Peripheral blood leucocytes increased in 114 cases (75.49%), C-reactive protein increased in 48 cases (31.78%), and albumin decreased in 21 cases (13.90%). It indicated the localized thickening of the intestinal wall in 49 cases (32.45%) by B-ultrasound. Gastroscopy was performed in 96 cases and main findings were patchy hemorrhage and erythema (89 cases, 92.70%), erosion or ulcer accompanied by bleeding (68 cases, 70.83%), ecchymosis (37 cases, 38.54%) and hematoma like process (13 cases, 8.60%). The descendent duodenum was the most common and had the most serious lesions, followed by gastric antrum and duodenal bulb. Histopathology showed capillary inflammation in 37 cases, 10 of which were accompanied by Helicobacter pylori infection.Enteroscopy was performed in 55 cases and main findings were punctate hemorrhage and erythema (49 cases, 89.09%), and erosion or multiple ulcer with hemorrhage (27 cases, 49.09%). The terminal ileum was the most common and had the most serious lesions, followed by rectum. Conclusions The clinical features of abdominal type HSP in children are varied, and it often involves descendent duodenum and terminal ileum. Endoscopic examination is valuable for the diagnosis of abdominal type HSP in children.
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Introducción: La tasa de resangrado en hemorragia digestiva alta no variceal continúa siendo elevada. Objetivo: identificar los predictores de falla terapéutica endoscópica en adultos con hemorragia digestiva alta recurrente no variceal atendidos en el Hospital Universitario de Maracaibo entre enero, 2006 y diciembre, 2010 que ameritaron una segunda endoscopia. Materiales y Métodos: estudio retrospectivo y transversal. La muestra fue dividida en grupo A (resangró) y B (no resangró). Resultados: del total de 380 casos que recibieron terapia inicial, 271 úlceras (71,3% p<0,0001) representaron el tipo de lesión más frecuente, correspondiendo con los 24 casos que resangraron (6,31%). Las lesiones que resangraron se ubicaron en segunda porción de duodeno (20,8%), fundus gástrico (16,6%) y cara posterior de bulbo duodenal (12,5%). De éstas, 11 fueron úlceras (54,5% duodenales vs 45,4% gástricas), tipo Forrest IA, IB y IIA (p<0,03), con vaso expuesto >2mm (media 5mm, DE±3mm). Conclusión: los predictores de falla terapéutica endoscópica (úlcera ≥2cms, ubicación en cara posterior de bulbo duodenal, Forrest IA, IB y IIA, y terapia endoscópica aplicada durante el primer episodio de sangrado) contribuyen de manera independiente al aumento del riesgo del resangrado.
Introduction: Rebleedings rate in non-variceal upper gastrointestinal bleeding remains high. Aim: Identify predictors of endoscopic therapy failure in adult patients with recurrent non-variceal upper gastrointestinal bleeding treated at the Hospital Universitario de Maracaibo between January, 2006 and December, 2010 that required a second endoscopy. Methods: a retrospective and cross sectional study. The sample was divided into Group A (with rebleeding) and Group B (without rebleeding). Results: of the 380 cases who received therapy during the first endoscopy, 271 ulcers (71,3% p <0,0001) represented the most frequent type of injury, being consistent with the 24 cases that rebleed (6,31%). Rebleeding lesions were located in second portion of duodenum (20,8%), gastric fundus (16,6%) and posterior duodenal bulb (12,5%). Meanwhile, the rebleeding ulcers (n=11), were duodenal 54,5% vs gastric 45,4%, classified as Forrest IA, IB and IIA (p <0,03), with exposed vessel >2mm. Conclusions: the predictors of endoscopic therapy failure in our location are similar to those established (ulcer size ≥2cms, placed on posterior duodenal bulb, Forrest IA, IB and IIA, and endoscopic therapy applied during the first episode) and contribute independently to increased risk of rebleeding despite applying the recommended therapeutic.
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Objective To study the clinical and endoscopic features of Gastric mucosa－ associated lymphoid tissue(MALT) lymphoma. Methods Clinical and endoscopic data of thirty two patients with gastric MALT lymphoma diagnosed pathologically after opration were analyzed. Results Patients with gastric MALT lymphoma had a median age of 51.3years with male predominance and a bimodal age distribution pattern, aged 30～ 39 and 60～ 69 years respectively. The symptoms were not characteristic.The tumor originated from antrum in 12 cases,corpus in 8 and multifocal lesions were found in 12 instances. The tumor appeared infilitrative in 12, ulcerative in 16 and nodular in 6 patients endoscopically. Lymphatic metastasis was detected in infiltrative type, before the serosa was involved. Immunohistochemistry showed B－ cell lymphoma in all the 32 cases.And Helicobacter pylori(H.pylori) infection was found in 27 cases(84.4％ ).Nocorrelation was found between endoscopic types and manifestations.Metastasis to local lymph nodes was found early in infiltrative tumor.Conclusions It is suggested that H.pylori infection may play a role in the pathogenesis of gastric MALT lymphoma.