Observation on the efficacy of different stents in the treatment of patients with advanced esophageal cancer / 国际肿瘤学杂志

Objective:To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive 125I particle stent with endoscope. Methods:The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province, the First Affiliated Hospital of Xi'an Medical University, Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed. Patients were divided into common stent group ( n=66) and radioactive particle stent group ( n=34) according to different stent types. The postoperative complications, Karnofsky performance status (KPS) score, dysphagia score, restenosis rate and quality of life were compared between the two groups. Results:The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2% (43/66) and 47.1% (16/34) respectively. The incidences of pharyngeal pain and hoarseness were 12.1% (8/66) and 5.9% (2/34) . The incidences of abdominal pain were 9.1% (6/66) and 2.9% (1/34) . The incidences of errhysis were 3.0% (2/66) and 2.9% (1/34) . The incidences of vomiting and nausea were 7.6% (5/66) and 5.9% (2/34) respectively. There were no statistically significant differences between the two groups ( χ2=3.04, P=0.081; χ2=0.40, P=0.527; χ2=0.53, P=0.467; χ2<0.01, P>0.999; χ2<0.01, P>0.999) . In the two groups, KPS scores in the first, second, third and sixth month after operation were higher than those before operation (all P<0.05) . KPS scores of the radioactive particle stent group in the second, third and sixth month were significantly higher than those of the common stent group [ (89.73±7.84) points vs. (82.37±7.42) points, t=4.62, P<0.001; (93.63±8.13) points vs. (88.33±7.28) points, t=3.74, P<0.001; (92.78±6.26) points vs. (87.28±8.73) points, t=3.77, P<0.001]. The dysphagia scores of patients in the two groups in the first, second, third and sixth month were lower than those before operation (all P<0.05) . The dysphagia scores of the radioactive particle stent group in the third and sixth month after operation were significantly lower than those of the common stent group [ (0.68±0.12) points vs. (2.33±0.32) points, t=26.20, P<0.001; (0.82±0.22) points vs. (2.67±0.24) points, t=36.92, P<0.001]. In the third month after operation, the restenosis rate of the radioactive particle stent group was significantly lower than that of the common stent group [5.88% (2/34) vs. 42.4% (28/66) , χ2 =14.27, P<0.001]. The scores of QLQ-C30 and OES-18 scales in the first, second, third and sixth month after operation were lower than those before operation (all P<0.05) . The scores of QLQ-30 scale in the radioactive particle stent group in the second, third and sixth month were significantly lower than those in the common stent group [ (19.12±3.02) points vs. (21.22±2.87) points, t=3.39, P=0.001; (15.04±1.68) points vs. (20.43±2.23) points, t=12.39, P<0.001; (14.38±2.18) points vs. (19.77±3.67) points, t=9.20, P<0.001]. The scores of OES-18 scale in the radioactive particle stent group were also significantly lower than those in the common stent group [ (17.13±2.07) points vs. (20.64±2.11) points, t=7.95, P<0.001; (15.22±1.88) points vs. (19.24±1.76) points, t=10.62, P<0.001; (14.74±2.36) points vs. (18.53±3.27) points, t=6.01, P<0.001]. Conclusion:The radioactive particle stent can improve the quality of life of patients with advanced esophageal cancer with esophageal stenosis, so as to improve dysphagia and reduce the restenosis rate after operation. However, whether it is obviously superior to common stent in prolonging survival time and reducing complications needs to be further confirmed by a multicenter, prospective, large-sample randomized controlled study.

Efficacy of endoscopy for early nonampullary duodenal cancer / 中华消化内镜杂志

Objective:To evaluate the clinical efficacy of endoscopic treatment for early nonampullary duodenal cancer.Methods:Data of patients with early nonampullary duodenal cancer, who underwent endoscopic treatment from January 2015 to January 2021 at Beijing Friendship Hospital were retrospectively analyzed. Baseline data, endoscopic treatment methods, wound closure, pathology, the occurrence and outcome of complications of patients were studied.Results:A total of 47 patients who successfully went through endoscopic treatment were enrolled. Seventeen cases received endoscopic mucosal resection (EMR), 5 cases received endoscopic submucosal dissection (ESD), and 7 cases received ESD+EMR (hybrid ESD). Six cases were converted to hybrid ESD due to difficulty in ESD. Four cases received full-thickness resection with over-the-scope clip system (OTSC), and 8 cases received endoscopic piecemeal mucosal resection (EPMR). Among the 47 cases of early cancer, the en bloc resection rate was 83.0% (39/47), and the complete resection rate was 85.1% (40/47). Four patients (8.5%) had perforation which occurred at the duodenal descending part during the perioperative period, among whom, 2 patients (4.3%) recovered after endoscopic treatment, 2 others (4.3%) recovered after surgical intervention. There were no complications such as postoperative bleeding or infection during the perioperative period.Conclusion:Endoscopic treatment for early nonampullary duodenal cancer is safe and effective. A specific treatment plan can be selected according to the location, size and specific conditions of the lesion. For the operation of the descending part, it is necessary to be more vigilant to against the occurrence of perforation complications.

Endoscopic surgery strategies of delayed iatrogenic bile duct injury / 中华消化外科杂志

The treatment of iatrogenic bile duct injury is complex, especially for delayed iatrogenic bile duct injury, and the timing and treatment measures are crucial. Endoscopic surgery treatment, interventional treatment and surgery all play important roles. Endoscopic surgery treatment has become the main choice for iatrogenic bile duct injury because of its advantages of small trauma, fast recovery, short operation time and precise efficacy, etc. At the same time, endoscopic surgery treatment can create opportunities and conditions for secondary bile duct repair surgery, and can also control the occurrence of post-repair complications. With the further populari-zation and application of endoscopic technology, the development of imaging three-dimensional reconstruction technology and visualization analysis, endoscopic surgery treatment will definitely become the main treatment for delayed iatrogenic bile duct injury.

Application of detachable string-magnetically controlled capsule endoscopy in the evaluation of post-endoscopic treatment of 50 liver cirrhosis patients with esophagogastric varices during follow-up / 中华消化杂志

Objective:To explore the value of detachable string-magnetically controlled capsule endoscopy (DS-MCE) in the evaluation of post-endoscopic treatment of liver cirrhosis patients with gastroesophageal varices during follow-up, and conventional electronic esophagogastroduodenoscopy (EGD) was used as the gold standard.Methods:From July 1, 2019 to December 31, 2021, 50 follow-up patients with gastroesophageal varices due to liver cirrhosis and had a past medical history of endoscopic treatment in Ruijin Hospital, Shanghai Jiaotong University School of Medicine were selected. DS-MCE and EGD were performed in turn. The 2 endoscopic examination methods were compared and analyzed in the assessment of detecting gastroesophageal varices, grading of diameter of esophageal varices and classification of bleeding risk factors (including sensitivity, specificity, positive predictive value and negative predictive value), diagnosis of portal hypertensive gastropathy and its severity, and the patients′ satisfaction (pre-procedural perceptual and post-procedural satisfaction). Kruskal-Wallis test and Kappa test were used for statistical analysis.Results:The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices were 100.0% (43/43), 85.7%(6/7), 97.7% (43/44) and 100.0%(6/6), respectively.The accuracy of DS-MCE in evaluating the grading of esophageal varices was 86.0% (43/50), with good consistency of EGD, and the Kappa value was 0.797 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices with bleeding risk factors were 94.4% (34/36), 100.0%(14/14), 100.0% (34/34) and 87.5%(14/16), respectively. The accuracy of DS-MCE in evaluating esophageal varices with bleeding risk factors was 94.0% (47/50), with good consistency of EGD, and the Kappa value was 0.862 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of gastric varices were 85.7% (18/21), 93.1% (27/29), 90.0% (18/20) and 90.0% (27/30), respectively. The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of portal hypertensive gastropathy were all 100.0% (50/50). The consistency of DS-MCE and EGD in the severity grading of portal hypertensive gastropathy was good, the Kappa value was 0.962 ( P<0.001). The results of pre-procedural perceptual analysis showed that patients′ psychological tension before examination and expected pain before examination of DS-MCE were better than those of EGD ( H=16.04 and 23.74, both P<0.001). The results of satisfactory analysis after examination indicated that DS-MCE was better than EGD in the degree of difficulty in swallowing, pain and discomfort during examination, pain and discomfort after examination, comfort degree during examination, convenience of the procedure and willingness of receiving such examination again as gastric examination method ( H=17.28, 30.88, 44.68, 34.66, 48.05, 22.74, 13.03 and 17.19, all P<0.001). Conclusions:With EGD as the gold standard, DS-MCE can accurately evaluate gastroesophageal varices and portal hypertensive gastroenteropathy after endoscopic treatment in patients with liver cirrhosis and gastroesophageal varices, and it is a safe and comfortable method. DS-MCE can be an efficient alternative method in endoscopic follow-up of such patients.

Analysis of clinical and pathological characteristics of 266 cases of colorectal laterally spreading tumor / 中华消化杂志

Objective:To analyze the clinical and pathological characteristics of colorectal laterally spreading tumor (CLST) and provide reference for clinical diagnosis and treatment of CLST.Methods:From January 1, 2016 to June 30, 2021, the clinical data of patients with CLST who underwent endoscopic resection at the Second Affiliated Hospital of Dalian Medical University were retrospectively collected. The clinical and pathological characteristics of CLST were analyzed in terms of lesion location (right colon, left colon, rectum) and morphological type (granular-homogeneous type, granular-mixed type, flat-elevated type, and pseudo-depressed type). One-way analysis of variance, Pearson′s chi-square test and Fisher′s exact test were used for statistical analysis.Results:A total of 266 patients with CLST and 296 CLST lesions were included. The most common maximum diameters of the lesions were 10 to 29 mm, accounting for 85.1% (252/296). The main morphological type was granular type, accounting for 81.4% (241/296), and the main pathological type was adenoma, accounting for 79.7% (236/296), and the most common histological type was low-grade intraepithelial neoplasia (LGIN), accounting for 81.1% (240/296). The maximum diameter of CLST lesion of rectum was larger than that of the right colon and the left colon ((24.20±16.97), (18.38±8.24) and (18.59±7.95) mm, respectively), and the difference was statistically significant ( F=6.62, P<0.001). The detection rate of granular-homogeneous type CLST in rectum was lower than that in the right colon and the left colon (22.0%, 11/50, 53.5%, 69/129 and 58.9%, 69/117, respectively), while the detection rate of granular-mixed type CLST in rectum was higher than that in the right colon and the left colon (50.0%, 25/50; 29.4%, 38/129 and 24.8%, 29/117, respectively), and the differences were statistically significant ( χ2=20.06 and 10.67, both P<0.01). The incidence of adenoma in CLST in the right colon was lower than that in the left colon and rectum (68.2%, 88/129; 87.2%, 102/117 and 92.0%, 46/50, respectively), while the incidence of serrated adenoma in CLST in the right colon was higher than that in the left colon and rectum (30.2%, 39/129; 12.8%, 15/117 and 4.0%, 2/50, respectively), and the differences were statistically significant ( χ2=19.25 and 20.85, both P<0.001). The CLST in left colon was mostly treated by endoscopic submucosa dissection (94.9%, 111/117), while the CLST in rectum was mostly treated by endoscopic mucosal resection (20.0%, 10/50), and the difference was statistically significant ( χ2=8.77, P=0.012). The maximum diameter of the pseudo-depressed type CLST was larger than that of the granular-homogeneous type, granular-mixed type and flat-elevated type ((24.18±14.07), (15.96±5.70), (23.49±13.80) and (21.21±8.02) mm), and the difference was statistically significant ( F=13.40, P<0.001). The incidence of adenoma in flat-elevated type CLST was higher than that of the granular-homogeneous type, granular-mixed type and pseudo-depressed type (92.1%, 35/38; 71.1%, 106/149; 86.9%, 80/92 and 15/17, respectively), and the difference was statistically significant ( χ2=14.13, P=0.003). The incidence of serrated adenoma in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (28.9%, 43/149; 10.9%, 10/92; 5.3%, 2/38 and 1/17, respectively), and the difference was statistically significant ( χ2=19.98, P<0.001). The incidence of adenocarcinoma in the pseudo-depressed type CLST was higher than that of the granular-homogeneous type, granular-mixed type and flat-elevated type (1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38, respectively), and the difference was statistically significant (Fisher′s exact test, P=0.049). The incidence of LGIN in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (90.6%, 135/149; 76.1%, 70/92; 65.8%, 25/38 and 10/17, respectively), while the incidences of high-grade intraepithelial neoplasia and carcinoma in the pseudo-depressed type CLST were higher than those of the granular-homogeneous type, granular-mixed type and flat-elevated type (6/17; 9.4%, 14/149; 21.7%, 20/92; 31.6%, 12/38 and 1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38), and the differences were statistically significant( χ2=21.58 and 16.81 and Fisher′s exact test, all P<0.05). Conclusions:The clinicopathological characteristics of CLST have certain specificity. The maximum diameter and malignant potential of the rectal CLST are both larger and higher than those of the colonic CLST. Although the granular-mixed type CLST is the granular type, it shows a larger maximum diameter and a higher degree of malignancy.

Seguimento de longo prazo de pacientes com tumor neuroendócrino da papila duodenal submetidos à papilectomia endoscópica: série de casos e revisão da literatura / Long-term follow-up of patients undergoing endoscopic papillectomy for papillary neuroendocrine tumor: a case series and literature review

ABSTRACT BACKGROUND: Duodenal papilla neuroendocrine tumors (DP-NET) are rare. Surgical therapy may be recommended for their treatment. However, they have high rates of morbidity and mortality. Endoscopic papillectomy (EP) is safe and effective for complete resection of tumors at this site. OBJECTIVE: This study aimed to describe a case series of DP-NETs resected by EP and perform a literature review. METHODS: A series of patients with DP-NETs underwent EP as primary treatment between Jan/2008 and Mar/2020 at a tertiary referral center. A comprehensive search was made on the MEDLINE primary electronic database. The search strategy was designed to find all articles related to DP-NETs published in the literature. RESULTS: Six patients underwent EP for presenting DP-NETs, four of whom were women (mean age, 63 years). The mean diameter of DP-NETs was 1.6±0.3 cm. Four of six patients were followed up, one of whom suffered relapse at the resection site after 3 months and was referred to surgery (pT3n1b) and the remaining three patients experienced no endoscopic or histological recurrence during follow-up periods of 10, 7, and 4 years, respectively. Eighteen articles were found in the literature search in MEDLINE. The articles included case reports of endoscopically treated DP-NETs. CONCLUSION: EP is safe and effective for DP-NETs that are ≤20 mm, confined to the submucosal layer, well-differentiated, and without local or remote metastasis. Adequate endoscopic follow-up and definitive surgical treatment in the presence of relapse are necessary.

RESUMO CONTEXTO: Tumores neuroendócrinos da papila duodenal (TNE-PD) são raros. A cirurgia deve ser recomendada para o tratamento. No entanto, apresentam altas taxas de morbimortalidade. A papilectomia endoscópica (PE) é segura e eficaz para a ressecção completa de tumores nesta região. OBJETIVO: Descrever uma série de casos de TNEs-PD ressecados por PE e realizar uma revisão da literatura. MÉTODOS: Pacientes com TNEs-PD submetidos a PE como tratamento primário com intenção curativa entre jan/2008 e mar/2020 em um centro de referência terciário foram estudados. Uma pesquisa abrangente foi feita no MEDLINE. A estratégia de busca foi desenhada para encontrar todos os artigos relacionados a TNEs-PD publicados na literatura, que haviam sido submetidos a PE. RESULTADOS: Seis pacientes foram submetidos a PE por apresentar TNEs-PD, sendo quatro mulheres, com média de idade de 66 anos (22-96). O diâmetro médio dos TNEs-PD foi de 1,8±0,4 cm. Quatro dos seis pacientes foram acompanhados, um dos quais sofreu recidiva no local da ressecção após 3 meses e foi encaminhado para cirurgia (pT3n1b), e os três pacientes restantes não apresentaram recorrência endoscópica ou histológica durante os períodos de acompanhamento de 10, 7 e 4 anos, respectivamente. Dezoito artigos foram encontrados no MEDLINE. Os artigos incluíram relatos de casos de TNEs-PD tratados pela PE. CONCLUSÃO: A PE é segura e eficaz para TNEs-PD ≤20 mm, confinados à camada submucosa, bem diferenciados e sem metástases locais ou remotas. Acompanhamento endoscópico adequado e tratamento cirúrgico definitivo na vigência de recidiva são necessários.

Vólvulo gástrico en una paciente nonagenaria: intervención endoscópica y laparoscópica. Reporte de caso / Gastric volvulus in a nonagenarian patient: endoscopic and laparoscopic intervention. Case report

Resumen El vólvulo gástrico es una entidad rara que puede presentarse de manera aguda o crónica y se acompaña de síntomas inespecíficos. Es fundamental su rápida identificación, ya que tiene alta mortalidad y el tratamiento oportuno de esta patología determina el pronóstico del paciente. A continuación, presentamos el caso de una paciente femenina de 89 años, que consulta por cuadro clínico de dolor torácico atípico, con documentación en radiografía de tórax de vólvulo gástrico organoaxial, en quien se realiza inicialmente devolvulación endoscópica con éxito. Sin embargo, en las imágenes de control se evidencia recurrencia del vólvulo, por lo cual se realizó manejo quirúrgico con hiatoplastia y funduplicatura tipo Toupet, además de gastrostomía percutánea de fijación, procedimiento realizado sin complicaciones, con los que se logró la devolvulación completa sin recurrencia.

Abstract Gastric volvulus is a rare condition that can occur acutely or chronically and is accompanied by nonspecific symptoms. Its rapid identification is critical since it has high mortality rate and timely treatment determines the patient's prognosis. The following is the case of an 89-year-old female patient who presented with atypical chest pain, with organoaxial gastric volvulus on chest X-ray, in whom endoscopic devolvulation was initially performed successfully. However, control imaging scans revealed recurrence. Therefore, surgical management included hiatoplasty and Toupet fundoplication, as well as percutaneous fixation gastrostomy, a procedure that was completed without complications and resulted in complete devolvulation without recurrence.

Value of endoscopic retrograde cholangiopancreatography in pancreaticobiliary maljunction / 中华消化内镜杂志

Objective:To explore the clinical characteristics of pancreaticobiliary maljunction (PBM) and its disease spectrum, and to evaluate therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods:Data of 52 PBM patients who received therapeutic ERCP procedures for abdominal pain, jaundice and fever in Department of Gastroenterology of Peking University Third Hospital from June 2006 to March 2021 were collected. The clinical characteristics, typing, the change of disease spectrum and ERCP procedures were analyzed.Results:Among 52 PBM patients, female was more common. Abdominal pain and jaundice were the most common clinical manifestations, among which 20 were type Ⅰ, 25 type Ⅱ and 7 type Ⅲ. Half patients had the choledochal cyst. The mean timespan from the first onset to the final diagnosis was 12.2 years. Twenty-four cases (46.2%) had changes in PBM disease spectrum. Among 69 ERCP procedures, 5 (7.2%) failed. Difficult cannulation rate was 34.6% (18/52), and 11 patients underwent advanced cannulation techniques, while it was 15.4% (657/4 275) in the conterpart non-PBM patients in the same period, with significant difference between them ( χ2=14.455, P<0.05). Multiple therapeutic ERCP techniques including endoscopic sphincterotomy, pancreatic stent placement, removal of stones from the duct were applied with the successful rate of 92.8% (64/69). The incidence of post-ERCP pancreatitis was 15.4% (8/52). Conclusion:The chief clinical problem may be changed over time in PBM patients. Although ERCP plays an important role in PBM and its disease spectrum, there may be a higher rate of difficult cannulation and postoperative complications.

Desarrollo de la técnica de disección submucosa endoscópica en cáncer gástrico incipiente: primeros cincuenta casos de un cirujano / Development of endoscopic submucosal dissection for early gastric cancer: fifty first cases of a surgeon

Resumen Introducción: El cáncer gástrico es un problema de salud en Chile y su mal pronóstico global se explica por un diagnóstico en etapas avanzadas. El cáncer gástrico incipiente (CGI) se asocia a buen pronóstico oncológico y la disección submucosa endoscópica (DSE) como alternativa de tratamiento ha demostrado ser comparable al estándar quirúrgico. Objetivo: Describir la experiencia y resultados de un cirujano en pacientes con CGI sometidos a DSE. Materiales y Método: Estudio retrospectivo que incluyó a los pacientes sometidos a DSE por CGI entre mayo de 2015 y marzo de 2019. Se tabuló información demográfica, datos perioperatorios y del seguimiento obtenidos del registro institucional. Se utilizó estadística descriptiva. Resultados: Se realizaron 52 DSE por CGI en el período analizado. La resección en bloque se logró en un 96% de los casos. La morbilidad alcanzó el 2%, no se registró mortalidad postoperatoria. 98% de las resecciones en bloque fueron consideradas R0 y un 86% de ellas cumplieron estándares de curación. La mediana de seguimiento es de 19 meses y la sobrevida específica por cáncer gástrico y libre de recurrencia alcanza el 100%. Discusión: La DSE es una técnica con potencial curativo en pacientes con CGI, presentando mejores resultados en términos de morbimortalidad, calidad de vida y es comparable a la cirugía en el pronóstico oncológico. Los resultados presentados son concordantes con la literatura y apoyan la implementación de la técnica para el tratamiento del CGI.

Introduction: Gastric cancer is a serious health problem in Chile and its poor prognosis is explained by usual diagnosis in advanced stages. Early gastric cancer (EGC) is associated with good oncological prognosis and endoscopic submucosal dissection (ESD) as its treatment has shown to be comparable to the surgical standard. Aim: Describe the experience and results of a surgeon in patients with EGC undergoing ESD. Materials and Method: Retrospective study including patients undergoing ESD for EGC between May 2015 and March 2019. Demographic information, perioperative and follow-up data obtained from the institutional registry were tabulated. Descriptive statistics was used. Results: 52 ESD were performed per EGC in the analyzed period. En bloc resection was achieved in 96% of cases. Morbidity reached 2% and no postoperative mortality was recorded. 98% of the en bloc resections were considered R0 and 86% of them met healing standards. The median follow-up is 19 months and the specific survival due to gastric cancer and recurrence-free rates reach 100%. Discussion: ESD is a technique with curative potential in patients with EGC, presenting better results in terms of morbidity and mortality, quality of life and is comparable to surgery in the oncological prognosis. The results presented are consistent with the literature and support the implementation of the technique for the treatment of EGC.

Mitomycin C in the Endoscopic Treatment of Laryngotracheal Stenosis: Systematic Review and Proportional Meta-Analysis

Abstract Introduction Mitomycin C is a natural antibiotic that has been used to inhibit the proliferation of fibroblasts in scar tissue. Objective To evaluate the effectiveness and safety of topical Mitomycin C as an adjuvant in the endoscopic treatment of laryngotracheal stenoses. Data synthesis A systematic review of experimental or observational studies that have evaluated the treatment of laryngotracheal stenoses with the use of topical Mitomycin C was performed. Databases researched: LILACS, PubMed, Embase, Cochrane and Web of Science. Outcomes: resolution (symptom-free time ≥ one year), number of procedures required, and complications resulting from the procedure. A total of 15 studies (involving 387 patients) were selected. Mitomycin C was administered to every patient in 11 studies, and in 4 other studies, the patients were separated into 2 groups, 1 receiving mitomycin C, and the other not. The resolution of the stenosis evaluated in 12 studies in which the patients received mitomycin C was of 69% (95% confidence interval [95%CI]: 61-76%; I2 = 17.3%). A total of 52% of the patients (95%CI: 39-64%, 11 studies; I2 = 64.7%) were submitted to a single endoscopic procedure, and 48% (95%CI: 36-61%, 11 studies; I2 = 64.7%) were submitted to more than 1 procedure. Complications (mediastinal and subcutaneous emphysema, dysphonia, laceration or vocal fold paralysis and acute light obstruction) were reported in 9% of the patients (95%CI: 3-18%, 9 studies; I2 = 79.8%). Conclusions The evidence suggests that mitomycin C is an effective and safe option in the endoscopic treatment of laryngotracheal stenosis.

Brazilian gastric cancer association guidelines (part 1): an update on diagnosis, staging, endoscopic treatment and follow-up / Diretrizes da associação brasileira de câncer gástrico (parte 1): atualização sobre o diagnóstico, estadiamento, tratamento endoscópico e seguimento

The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. Aim: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. Methods: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. Results: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. Conclusion: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.

O II Consenso Brasileiro de Câncer Gástrico da Associação Brasileira de Câncer Gástrico (ABCG) foi recentemente publicado. Nesta ocasião, inúmeros especialistas que atuam no tratamento desta doença expressaram sua opinião diante declarações apresentadas. Objetivo: Apresentar as Diretrizes da ABCG (Parte 1) quanto ao diagnóstico, estadiamento, tratamento endoscópico e seguimento dos pacientes com câncer gástrico. Métodos: Para formulação destas Diretrizes os autores realizaram extensa e atual revisão referente a cada declaração presente no II Consenso, utilizando as bases Medline/PubMed, Cochrane Library e SciELO com os seguintes descritores: câncer gástrico, estadiamento, tratamento endoscópico e seguimento. Ainda, cada declaração foi classificada de acordo com o nível de evidência e grau de recomendação. Resultados: Das 24 declarações, duas (8,3%) foram classificadas com nível de evidência A, 11 (45,8%) B e 11 (45,8%) C. Quanto ao grau de recomendação, seis (25%) declarações obtiveram grau de recomendação 1, nove (37,5%) grau 2a, seis (25%) 2b e três (12,5%) 3. Conclusão: As diretrizes aqui presentes têm a finalidade de auxiliar os profissionais que atuam no combate ao câncer gástrico com informações relevantes e atuais, permitindo que sejam aplicadas na prática médica diária.

Prognostic Nomogram model for the efficacy of endoscopic treatment in gastric varices caused by liver cirrhosis / 中华消化杂志

Objective@#To predict the efficacy of endoscopic tissue adhesives in the treatment of gastric varices in patients with liver cirrhosis by Nomogram model.@*Methods@#From August 2014 to September 2017, 158 patients with liver cirrhosis caused esophagogastric variceal bleeding and received endoscopic tissue adhesives treatment at Zhongshan Hospital, Fudan University were collected. All patients were followed for 12 months. The primary outcome was rebleeding. The factors of rebleeding after endoscopic treatment of esophagogastric varices were analyzed. Nomogram prognostic model was developed and compared with Child-Pugh grading, computed tomography angiography (CTA) and hepatic venous pressure gradient (HVPG) in prognostic accuracy in rebleeding after endoscopic treatment in liver cirrhosis caused esophagogastric varices. Univariate and multivaricate Cox regression analysis, Kaplan-Meier curve and log-rank test were performed for statistical analysis.@*Results@#During the follow-up, rebleading occurred in 18 cases (11.4%), 37 cases (23.4%) and 49 cases (31.0%) at 2, 6, and 12 months after endoscopic treatment. The results of univariate Cox regression analysis showed the risk factors of rebleeding after endoscopic treatment of gastric varices included gender, alcoholic liver cirrhosis, diabetes mellitus, Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence vs. absence) HVPG (<16 mmHg vs. ≥16 mmHg, 1 mmHg = 0.133 kPa), extensive portal embolism, esophageal varices, type 2 gastric varices, injection points of tissue adhesive (≤3 points vs. > 3 points), injection volume of tissue adhesive (≤ 3 mL vs. > 3 mL) (hazard ratio (HR)=0.575, 2.018, 1.562, 3.433, 2.945, 1.859, 2.743, 0.324, 1.840, 1.477, and 1.716; 95% confidence interval (CI) 0.305 to 1.084, 0.902 to 4.514, 1.753 to 6.724, 1.663 to 5.217, 1.012 to 3.415, 0.852 to 8.830, 0.079 to 1.335, 1.012 to 3.317, 0.839 to 2.602, and 0.935 to 3.152; all P<0.2). The results of multivariate Cox regression analysis indicated that Child-Pugh grade, extraluminal vessels by CTA, and HVPG (HR = 2.095, 95% CI 1.099 to 3.995, P = 0.025) were all independent risk factors of rebleeding after endoscopic treatment of gastric varices (HR=2.665, 2.886, and 2.095; 95% CI 1.339 to 5.300, 1.580 to 5.271, and 1.099 to 3.995; all P<0.05). Kaplan-Meier curves showed that Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence or absent) and HVPG (<16 mmHg vs. ≥16 mmHg) could effectively predict cumulative non-rebleeding rate in one year after endoscopic treatment of gastric varices, and the differences were statistically significant (all P<0.05). Receiver operataring characteristic curve analysis demonstrated that the predictive value of the model combined with Child-Pugh grade, extraluminal vessels on CTA and HVPG was higher than that of Child-Pugh grade and HVPG (AUC=0.746, 0.673 and 0.585; 95% CI 0.662 to 0.829, 0.583 to 0.762, and 0.486 to 0.683; P<0.01, P=0.001 and P=0.089, respectively). Patients were divided into low, medium, and high-risk groups according to the 25th and 75th percentiles of the Nomogram score. The results showed that Nomogram model could effectively distinguish high-risk groups of rebleeding after endoscopic treatment of gastric varices, and the difference was statistically significant (P <0.01).@*Conclusions@#Extraluminal vessels on CTA, HVPG and Child-Pugh grade are independent prognostic evaluation indexes of rebleeding after endoscopic treatment of gastric varices. The predictive accuracy of Nomogram model based on these three prognostic factors may be better than Child-Pugh grade and HVPG.

Analysis on risk factors of positive vertical resection margin after endoscopic treatment of rectal neuroendocrine tumors / 中华胃肠外科杂志

Objective@#To analyze the risk factors of positive vertical resection margin of the postoperative specimens after endoscopic treatment of rectal neuroendocrine tumors (NET).@*Methods@#A case-control study was performed. Clinical data of patients with rectal NET (G1) undergoing endoscopic treatment between January 2015 and June 2018 at the Department of Gastroenterology, Beijing Tsinghua Changgung Hospital were retrospectively collected. Inclusion criteria: cases underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), whose mucosal specimens were pathologically confirmed as NET, and NET was confined to the rectum by nuclide imaging examination before endoscopic treatment. Those with incomplete clinical data or follow-up data were excluded. Resected specimen was fixed and sliced every 2 mm, and when tumor cells were found to infiltrate the vertical cutting edge, the positive vertical margin was defined. Associations of gender, age, resection method, tumor diameter, lesion morphology (nodular lesions, biopsy or post-treatment scar-like changes), mitotic figure, Ki-67 index, etc. and positive vertical margin were analyzed. Univariate analysis was performed using binary logistic analysis and multivariate analysis was performed using logistic regression model.@*Results@#A total of 133 patients with rectal NET were enrolled, including 93 males and 40 females, with an average age of (50.0±10.7) years. Sixty-four patients received EMR treatment and 3 patients (4.7%) had positive vertical margins. While 69 patients received ESD treatment and 13 (18.8%) had positive vertical margins. After endoscopic treatment, 16 cases (12.0%) were vertical positive margin, including 11 males and 5 females with an average age of (52.4±10.4) years. The lesion diameter was (9.0±4.7) mm. Univariate analysis showed that lesion diameter ≥10 mm (χ2=5.575, P=0.018) and scar-like changes (χ2=3.894, P=0.048) were significantly associated with positive vertical margin. Multivariate analysis showed that the lesion diameter ≥10 mm (OR=10.136, 95%CI: 2.114 to 48.591, P=0.004) was an independent risk factor for positive vertical margin of the specimen after endoscopic treatment of rectal NET.@*Conclusion@#The diameter of rectal NET ≥10 mm indicates a high risk for positive vertical margin after endoscopic treatment.

Standardized endoscopic evaluation and treatment of early gastric cancer / 中国实用外科杂志

Endoscopic resection is becoming the preferred primary treatment for early gastric cancer with a low incidence of lymph node metastasis. There have been published guidelines and consensus on the standardized endoscopic diagnosis and treatment in recent years. As part of the standardized endoscopic process, risk stratification regarding gastric cancer should be performed prior to gastroscopy. This is followed by a systematic gastroscopic mapping. The pre-malignant mucosal changes should be noted during screening. Chromoendoscopy and Image-Enhanced Endoscopy are recommended to assist the preoperative diagnosis for any suspicious lesion. Indication for endoscopic resection is according to the pathologic findings post biopsy. There are two main goals of a successful endoscopic resection: en bloc resection and negative margins. The final pathological diagnosis should be comprehensive and systematic. Follow-up surveillance or additional surgery should be based on the eCure system.

Recognition and consideration on the evolution trends and directions of the therapeutic strategies for early gastric cancer from the changes of different versions of Japanese Gastric Cancer Treatment Guidelines / 中国实用外科杂志

With the better diagnosis of early gastric cancer,increasing diversity and complexity of its treatment has united a multidisciplinary team led by physicians and surgeons. Japanese Gastric Cancer Treatment Guidelines are compiled and reviewed by a committee composed of physicians, surgeons and pathologists, which are based on the epidemiological trend of gastric cancer in Japan over the past two decades and clinical evidence from Japanese domestic studies and other promi-nent international clinical trials. Updated every three to six years, the guidelines now have five versions. They are one of the authoritative documents for the diagnosis and treatment for gastric cancer in the world. As far as the treatment strategies for early gastric cancer are concerned, they include the changes of endoscopic resection, the evolution of minimally invasive surgery, the widespread application of laparoscopic surgery and the promotion of the concept of functional preservation.The evolutionary trends are perfect reflections of a philosophical shift of Japanese physicians towards precision medicine:from radical resection to functional preservation, and from long-term survival only to better quality of life.

Tratamiento endoscópico de una hendidura laríngea posterior: reporte de un caso y revisión de la literatura / Endoscopic treatment of a laryngeal cleft: case report and literature review

RESUMEN Las hendiduras laríngeas posteriores son anomalías congénitas de la laringe de baja incidencia que comprometen la región interaritenoidea o la lámina cricoidea. En caso de extenderse hasta la tráquea son denominados clefts laringo-tráqueo-esofágicos. Su clínica es inespecífica y debe sospecharse en todo niño con trastorno de deglución y neumonía aspirativa a repetición. A continuación, presentamos un caso de un cleft laríngeo tipo 2 tratado endoscópicamente.

ABSTRACT The posterior laryngeal clefts are congenital anomalies of the larynx of low incidence that comprise the interaritenoid region or the cricoid lamina. In case of extending to the trachea they are called laryngo-tracheo-esophagic clefts. Its clinic is non-specific and should be suspected in any child with swallowing disorder and aspiration pneumonia. We present a case of an endoscopically treated laryngeal cleft type 2.

Progress of endoscopic interventional treatment for postoperative bronchopleural fistula in lung cancer / 临床外科杂志

Postoperative bronchopulmonary fistula(BPF) in lung cancer is an abnormal pathway formed by the bronchus communicating with the pleural cavity after pneumonectomy. Although surgical techniques and perioperative management have been improved, BPF is still a therapeutic challenges to thoracic surgeons. The treatment methods mainly include conservative treatment, surgical treatment and endoscopic interventional therapy. Among them, endoscopic interventional therapy is more and more widely used due to its minimally invasive characteristics, and has achieved a good therapeutic effect. This article reviews the endoscopic interventional treatment of BPF after pneumonectomy and hopes to provide some assistance for treatment of BPF.

Clinical application of ultra-fine nasal endoscopy in digestive tract stenosis / 实用肿瘤学杂志

Objective The aim of this study was to investigate the application and clinical value of ultra-fine nasal endos-copy in the diagnosis and treatment of digestive tract stenosis. Methods A retrospectively investigation of 160 cases of nasogastricos-copy in esophageal,gastroduodenal and colorectal stenosis lesions,the detection rate of lesions under the stenosis and endoscopic treat-ment were analyzed from January 1,2016 to December 31,2017. Results In 102 cases of diagnostic examination,the passing rates of nasogastricoscopy in esophageal,gastroduodenum and colorectal stenosis were 76. 92% ,50. 00% and 88. 00% ,respectively. In the ca-ses which the endoscope could successfully pass the stenotic lesions, the detection rates of new lesions below the stenosis were 8. 89% ,0 and 27. 78% ,respectively,in esophageal,gastroduodenum and colorectal stenosis. A total of 58 cases of digestive tract ste-nosis were treated with endoscopic gastroscopy. Among them,46 cases had stenosis and the pass rate was 79. 31% . Conclusion Ultra-fine nasal endoscopy can significantly improve the completeness and accuracy of endoscopic diagnosis in patients with digestive tract stenosis that cannot be passed by standard gastrointestinal endoscopy. It can also be used for endoscopic treatment of digestive tract stenosis.

Epidemiology and endoscopic treatment of portal hypertension associated with ectopic varices / 中国内镜杂志

Portal hypertension (PH) was defined as an increase in portal pressure caused by various etiologies. The formation of portosystemic collateral circulation was a compensatory form of PH. Gastrointestinal varices were one of the clinical manifestations of PH, and which clould be broadly divided into esophageal varices (EV), gastric varices (GV) and ectopic varices (EcV). At present, it is found that EcV has difficulty in diagnosis, large amount of bleeding, difficulty in hemostasis and poor prognosis. So far, the study of EcV is very limited. There was no guideline and expert consensus on EcV treatment. This review will focus on the epidemiological features of EcV and the research status of endoscopic treatment.

Safety, efficacy and clinical value of endoscopic treatment for duodenal lesions / 中国内镜杂志

Objective To assess the safety, efficacy and the clinical value of endoscopic treatment for duodenal lesions. Methods 59 patients with duodenal lesions were treated by endoscope from December 2012 to December 2016. The clinical data were retrospectively analyzed. Results There were 31 male and 28 female patients, aged 17 ～ 81 (58.2 ± 13.3) years. The lesion location included the duodenal bulb (n = 24, 40.68％) and the descending part (n = 21, 25.42％). The diameter of the lesions ranged from 0.2 to 5.0 (1.4 ± 0.9). Thirty-nine (66.10％) lesions originated from the mucosa, including inflammatory/hyperplastic polyps (n = 18, 30.51％), villous/tubular adenoma (n = 6, 10.17％). Twenty (33.90％) lesions originated from the submucosa, including Brunner's glands adenoma (n = 4, 6.78％), ectopic pancreas (n = 5, 8.47％), lipoma (n = 4, 6.78％). There were 4 delayed bleeding, 5 intraoperative perforation. Two patients received extended surgical resection later, and all the 59 patients showed no recurrence during the followed up (range, 3 ～ 30 months) using endoscopy. Conclusion Endoscopic treatment is a safe, effective, valuable method for the management of duodenal lesions.