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Objective:To explore whether the regular feedback system in opportunistic screening of colorectal cancer can improve the adenoma detection rate (ADR) of endoscopists.Methods:This study was an observational study, divided into three stages: the baseline stage before intervention (the pre-intervention period), the regular feedback stage (the intervention period) and the post-intervention stage (the post-intervention period). In the pre-intervention period, all patients who underwent opportunistic screening of colorectal cancer in Department of Gastroenterology in Beijing Shijitan Hospital Affiliated to Capital Medical University from June 2017 to May 2018 were reviewed, and the ADR of each endoscopist was calculated. In the intervention period from June 2018 to November 2018, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist during the previous month was calculated at the beginning of each month and feedback was provided in the form of a report. In the post-intervention period from December 2018 to January 2019, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist was calculated after the feedback stopped. ADR and polyp detection rate (PDR) of three stages were compared.Results:A total of 1 768, 1 308 and 344 patients were enrolled for opportunistic screening of colorectal cancer during the pre-intervention, the intervention and the post-intervention period respectively. Eight endoscopists participated in the whole process of this study. The total ADR increased from 23.70% (419/1 768) in the pre-intervention period to 33.72% (441/1 308) in the intervention period ( χ2=37.449, P<0.05). Two months after intervention, ADR decreased slightly to 33.14% (114/344), but was still higher compared with before ( χ2=13.602, P<0.05). The total PDR increased from 47.17% (834/1 768) in the pre-intervention period to 52.68% (689/1 308) in the intervention period ( χ2=9.111, P<0.05). Two months after the intervention, PDR increased slightly to 53.78% (185/344), and still higher compared with before ( χ2=5.035, P<0.05). Conclusion:Regular feedback to endoscopists can improve ADR in opportunistic screening of colorectal cancer.
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Objective:To investigate the diagnostic value of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) for invasion depth prediction of superficial gastric cancer.Methods:A total of 84 patients with superficial gastric cancer underwent both CE and EUS before treatment at Beijing Shijitan Hospital from January 2011 to December 2019. The patients were divided into CE affirmation group (47 cases) and CE non-affirmation group (37 cases) according to the endoscopist′s affirmation in the results of CE. Diagnostic accuracy of each method was compared with the histology of the resected specimen. And influential factors for the diagnosis were analyzed.Results:The overall accuracy in determining the invasion depth of superficial gastric cancer was 73.8% (62/84) for CE and 81.0% (68/84) for EUS respectively ( P=0.092). In CE affirmation group, the diagnostic accuracy of CE was significantly higher than that in the CE non-affirmation group [93.6% (44/47) VS 48.7% (18/37), χ2=21.656, P<0.001]. Twenty (23.8%) of 84 lesions were over-staged by CE, dignosed as surgical candidates, and 8 (40.0%) of the over-staged diagnosis were modified by additional EUS assessment. Multivariate logistic analysis showed that influential factors associated with observer affirmation included uneven surface of lesion ( OR=5.076, 95% CI: 1.628-15.821, P=0.005), margin elevation ( OR=3.831, 95% CI: 1.238-11.857, P=0.020) and undifferentiated carcinoma ( OR=6.887, 95% CI: 1.882-25.204, P=0.004). Conclusion:For patients of CE affirmation in the invasion depth, the diagnostic accuracy is high. For those of non-affirmation, additional EUS can improve the diagnostic accuracy and help to develop a more appropriate regime.
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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 investigate the effect of comprehensive internal medical treatment including gastric endoscopy on patients with bezoar. Methods From 2010 to 2016,a retrospective study was conducted on fifty?two patients admitted to Beijing Shijitan Hospital, Capital Medical University. Results The main accompanying diseases were hypertension,coronary heart disease,diabetes mellitus and so on. Food that are easy to induce bezoar : banana, persimmon, hawthorn, chestnut, etc. The treatment included endoscopic treatment, intravenous proton pump suppression, and oral Coca?Cola and bicarbonate solution. The bezoar in two patients after 3 weeks of medical treatment were still not dissolved,finally surgery were performed. One patient's pathology showed early cardiac adenocarcinoma. Five patients had incomplete intestinal obstruction, after fasting and gastrointestinal decompression, and the bezoars were excreted through feces. All patients were cured without death. Conclusion Gastroscopy is a timely treatment that can help diagnose and treat gastric bezoar. The main predisposing factors include hypertension, coronary heart disease, diabetes mellitus and so on. Endoscopic treatment,intravenous proton pump inhibitor,sodium bicarbonate and Coca?Cola could dissolve most bezoar. We should be alert to the possibility of early cancer.
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Objective To explore the diagnostic value of the i-Scan for detection of polypoid lesions in right hemicolon during colonoscopy. Methods A total of 200 patients who underwent colonoscopy in Beijing Shijitan Hospital from January 2015 to December 2015 were enrolled. After completion of the first colonoscopy in right hemicolon, a second withdrawal was performed, using white light mode ( white light group, n=93) and i-Scan mode ( i-scan group, n=96) to detect polypoid lesions in the proximal colon. The detection rates of polyp and adenoma were compared between the two groups. Results During the twice withdrawal, compared with white light group, more polyps and adenomas were detected in i-Scan group (1. 469 VS 1. 011, P=0. 028; 0. 979 VS 0. 624,P=0. 039). The proportion of patients with more polyps and adenomas in the i-Scan group was significantly higher than that in the white light group [ 37. 5％( 36/96) VS 22. 6％ ( 21/93) , P=0. 025;24. 0％ ( 23/96) VS 11. 8％ ( 11/93) ,P=0. 030] . i-Scan mode detected more small polyps with diameter<5 mm [ 84. 0％ ( 42/50 ) VS 58. 3％ ( 14/24 ) , P=0. 016 ] . However, there were no differences between the two groups in the size, location, and morphology of the detected adenomas ( all P>0. 05) . The polyp detection rates of the i-Scan group and white light group were 61. 5％ (59/96) and 48. 4％ (45/93), respectively (P=0. 071), and the adenoma detection rates were 47. 9％ (46/96) and 35. 5％ (33/93), respectively (P=0. 083). Conclusion I-Scan mode can increase the detection rate of polyps and adenomas in right hemicolon, and improve detection of polypoid lesions and bsmall polyps in patients with multiple polyps and adenomas.
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Objective To investigate the value of NICE classification on real-time diagnosis for neoplastic and non-neoplastic colorectal polyps. Methods The histological type of 107 polypoid lesions from 50 patients detected by colonoscopy was predicted by 4 endoscopic physicians using NICE classification, including 1 chief physician, 2 associate chief physician, and 1 attending physician. Taking pathological result as gold standard, the real-time diagnostic accuracy of NICE classification for neoplastic colorectal polyps was evaluated, and the differences of diagnostic accuracy between the 4 endoscopic physicians were compared. Results Among the 107 polypoid lesions, 49 were neoplastic polyps and 58 were non-neoplastic polyps. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification on determination of the histological type of polyps were 81. 6% (40/49), 70. 0% (40/58), 74. 8% ( 80/107) , 70. 0%( 40/58) , and 81. 6%( 40/49) , respectively. There was no statistical difference on the prediction ability between the 4 physicians using NICE classification. Conclusion NICE classification is a feasible method for real-time prediction of histology type of colorectal polyps, and it is undemanding to the qualifications of physicians.
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Objective To investigate the value of NICE classification on real-time diagnosis for neoplastic and non-neoplastic colorectal polyps. Methods The histological type of 107 polypoid lesions from 50 patients detected by colonoscopy was predicted by 4 endoscopic physicians using NICE classification, including 1 chief physician, 2 associate chief physician, and 1 attending physician. Taking pathological result as gold standard, the real-time diagnostic accuracy of NICE classification for neoplastic colorectal polyps was evaluated, and the differences of diagnostic accuracy between the 4 endoscopic physicians were compared. Results Among the 107 polypoid lesions, 49 were neoplastic polyps and 58 were non-neoplastic polyps. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification on determination of the histological type of polyps were 81. 6% (40/49), 70. 0% (40/58), 74. 8% ( 80/107) , 70. 0%( 40/58) , and 81. 6%( 40/49) , respectively. There was no statistical difference on the prediction ability between the 4 physicians using NICE classification. Conclusion NICE classification is a feasible method for real-time prediction of histology type of colorectal polyps, and it is undemanding to the qualifications of physicians.
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Objective To analyze the clinical and endoscopic characteristics of fundic gland polyps (FGPs).Methods A case-control study was carried out at the Afifliated Beijing Shijitan Hospital of Capital Medical University from 2008 to 2015. The patients who accepted an upper endoscopy and found the gastric polyps for the ifrst time (diagnosed by pathology) were included in the study. Then, we analyzed the clinic and pathological characteristics of FGPs and non-FGPs.Results During the study period, 867 patients were enrolled, and 319 (36.8%) patients had FGPs. Compared the cases with the controls, the size of FGPs was smaller, an average is (0.40 ± 0.15) cm, single accounted for 67.7%, and 88.1% of FGPs were located at fundus and body. Helicobacter pylori infection of the cases detected was found in 6.1%, less than non-FGPs. There were statistically signiifcant differences observed in these aspects. From 2008 to 2015, the proportion of FGPs in gastric polyps and the detection rate of FGPs are both gradually elevated.Conclusions FGPs are the common gastric polyps, and its detection rate is gradually elevated. Most of the FGPs are mainly located at fundus and body, and single. Helicobacter pylori infection detected in the patients who have FGPs is rare.
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Objective:To investigate the correlation between the expression of angiogenic factors (MVD, IGF-1, and STAT3) in colorectal carcinoma and adenoma and the microvascular characteristics under narrow band imaging (NBI), in order to evaluate the fea-sibility of NBI in real-time observation of angiogenesis. Methods:Patients with pathologically confirmed colorectal polyps were re-cruited and examined by NBI. Vascular patterns were classified into typeⅠ(invisible or faintly visible), typeⅡ(clearly visible and regularly arranged in a round, oval honeycomb-like pattern), and typeⅢ(clearly visible and irregularly arranged in terms of size and caliber or irregularly winded). Immunohistochemical staining was performed to determine the expression of CD34, IGF-1, and STAT3. Histological results were compared with the vascular patterns under NBI. Results:The NBI endoscopy results of 64 sites (15 adenocar-cinomas, 29 adenomas, and 20 normal tissues) from 58 patients were introduced and examined in this study. Adenomas ranked the first (82.1%, 23/28) among the vascular patternⅡcases, whereas early adenocarcinomas dominated the vascular patternⅢcases (66.7%, 10/15). The expression levels of MVD-CD34 and IGF-1 in normal mucosa, adenomas, and adenocarcinomas were significantly differ-ent (P<0.0001 and P=0.0062, respectively). All the expression levels of MVD-CD34, IGF-1, and STAT3 in sites displaying vascular pat-ternsⅠ,Ⅱ, andⅢwere significantly different (P<0.0001, P=0.0010, and P=0.0055, respectively). Spearman correlation coefficients between the NBI vascular patterns and the MVD-CD34, IGF-1, and STAT3 expression levels were 0.67, 0.41, and 0.40, respectively. Conclusion:Vascular pattern analysis through an NBI system can be a promising tool to evaluate angiogenesis of colorectal lesions in real-time endoscopic observation.
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Objective_To evaluate the proangiogenesis of extracelluar matrix proteins SRPX2 on HUVECs.Meth-ods_pcDNA3.1-SRPX2 vector ( transfection group) and pcDNA3.1 vector ( negative group) were transfected into HEK293T cells, then divided into 3 groups including blank group.The proliferation of HUVECs ( absorbance, A450 ) was detected by CCK-8 kit.The transmembrane cell number was counted by Transwell migration and wound healing assay to evaluate the migration ability of HUVECs.A three dimensional culture system of cells was construc-ted on the Matrigel, and tube formation number of HUVECs was assessed.Results_The proliferation of HUVECs ( absorbance,A450 ) among transfection group,negative group and blank group failed to show significant difference (P>0.05).A signifiant difference was noted in the total branch point of capillary tubes among transfection group, negative group and blank group[(97 ±4)/field versus (57 ±3) and (54 ±3)/field] (P assay, the distance of transfection group compared to 0, 6 and 12 h were both significantly larger than that of nega-tive group and blank group [(90 ±6), (37 ±7),(36 ±4)μm and (135 ±5),(65 ±8),(63 ±4)μm respective-ly, both( P<0.05) ] .In Tranwell assay, the number of migrating cells in the transfection group was significantly more than negative group and blank group [(549 ±10)/field vs (334 ±11) and (329 ±12)/field(P<0.05)] af-ter co-culture 16 h.Conclusions_SRPX2 may promote angiogenesis by stimulating the migration and tubing on the Matrigel of HUVECs.
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Objective To summarize the clinical characteristics of liver cirrhosis complicated with chylous ascites.Methods From July,2007 to November,2012,patients diagnosed as liver cirrhosis complicated with chylous ascites were retrospectively analyzed.Analyze the etiology,liver function,ascites,imaging examination,treatment options and progonsis of these patients.Differences in measurement data were compared with U test.Results A total of 34 cases were enrolled,male 27 cases and female seven cases,average age (51.7±12.5) years old.Hepatitis B (20/34,58.8％) was the most common etiology of liver cirrhosis.Child-Pugh grading was grade B (26 cases) and C (eight cases).The appearance of aseites of 17 cases was chylous and the serm-ascites albumin gradient (SAAG) was 18.8 (2.6 to 32.5) g/L.The SAAG of 27 cases (84.4％) was no less than 11.0 g/L.The ascites triglyceride (TG) level was 2.94 (0.26 to 16.75) mmol/L,the TG of 27 cases (84.4％) was no less than 1.25 mmol/L.The level of TG (2.66(0.26 to 16.75) mmol/L) of patients with SAAG over 11.0 g/L was significantly lower than that of SAAG lower than 11 g/L (7.07(2.26 to 15.67) mmol/L,U=24.00,P=0.02).The lymphatic scintigraphy indicated that imaging agent leaked into peritoneal cavity in 29 cases (85.3 ％).Direct lymphangiography revealed lymphatic vessel structure abnormality in 15 cases (60 ％).Twelve patients received conservative treatment and four patients were effective,13 patients accepted peritoneal-venous shunting and 12 patients were effective,11 patients with microsurgical treatrnent and seven patients were effective.Conclusions Lymphatic struture is a possible cause of cirrhosis patients with chylous ascites.The characteristics of chylous ascites in cirrhosis patients are still the same as the characteristics of portal hypertension ascites.The SAAG remarkably increases,and the the level of SAAG probably depends on TG level.Lymphoscintigraphy has great value on the determination of the presence of ascites.And the direct lymphangiography could help to reveal lymphatic vessel structure abnormality.
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Objective To investigate the role of mucins secretion in the process that bifid triple viable capsule attenuates the recurrence of murine experimental colitis. Methods Mice were randomly allocated into BIFICO group (gavage with bifid triple viable capsule), 2,4,6-trinitrobenzenesulfonic acid (TNBS) group (gavage with phosphate-buffered saline), and normal control group. Intrarectal TNBS/ethanol challenge was given to mice on Day 0 followed by rechallenge on Day 5 ( 125 mg/kg and 180 mg/kg, respectively). On Day 5 several mice in both groups were randomly sacrificed before the second TNBS challenge and the remaining mice were sacrificed on Day 7. Disease activity index (DAI) was measured throughout the experiment. Inflammatory score was evaluated and MUC2 expression was determined using immunohistochemistry method. Results Recurrence of colitis was successfully simulated by challenging mice with two times of TNBS/ethanol solution. Compared with the TNBS group, DAI ( 1.39 ± 0. 68 vs. 2.39 ± 0.73, P = 0.003) and inflammatory score (2. 11 ± 0.78 vs. 3.22 ± 0. 97,P =0.03) were significantly decreased in BIFICO group after the second TNBS challenge. BIFICO administration significantly increased MUC2 expression (8. 67 ± 0. 87 vs. 7.86 ± 1.10, P = 0. 042 ) in BIFICO group compared with TNBS group before the second TNBS challenge. Conclusion Bifid triple viable capsule may enhance mucosal barriers by promoting mucins secretion, and thus attenuates the recurrence of murine colitis.