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.

A pilot study of closure of gastric full-thickness defect with metallic clips in a rabbit model / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, efficacy, and safety of metallic clips for closure of full-thickness defects in the stomach wall.</p><p><b>METHODS</b>Forty-eight rabbits were randomly divided into 4 groups with 12 in each group using random digits table. A 2 cm×2 cm full-thickness defect was created in the gastric body. No closure was performed in the first group; in the second group, mucosa closure with metallic clips; the third group, closure of full-thickness gastric tissue with metallic clip; the fourth group closure with 3-0 silk suture. After operation the animals were sacrificed at the third day and the seventh day. Wound healing was evaluated. Bursting pressure was recorded. HE and Masson staining was performed to inspect wound inflammation and tissue fibrosis situation.</p><p><b>RESULTS</b>After operation all the animals in the first group died within 34 hours, while those in other groups survived. No intraperitoneal bleeding or infection were seen in the survived animals. General observation showed that the metallic closure group caused less intraperitoneal adhesions. Operative time was shorter in the second and third group compared to the fourth group [(45.8 ± 1.6) min and (42.5 ± 1.5) min vs. (48.0 ± 1.4) min, P<0.05]. The bursting pressure on the third day was lower [(36.9 ± 4.6) mm Hg and (39.8 ± 4.1) mm Hg vs. (50.5 ± 4.2) mm Hg, P<0.05]. There was no significant difference in bursting pressure on the 7th day among the three groups [(95.0 ± 7.9) mm Hg and (97.8 ± 6.8) mm Hg vs. (98.5 ± 7.0) mm Hg, P>0.05]. HE staining revealed that metal closure had a better healing and Masson staining reflected no significant difference in healing at the same time point.</p><p><b>CONCLUSIONS</b>Metal clips closure full-thickness defects in the stomach, regardless in full thickness or mucosa closure, is as safe and effective as suture closure.</p>

Effects of peroral endoscopic myotomy on esophageal dynamics in patients with esophageal achalasia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia.</p><p><b>METHODS</b>From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed.</p><p><b>RESULTS</b>After POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients.</p><p><b>CONCLUSION</b>POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.</p>