Comparison of endoscopic submucosal dissection and surgery for circumferential superficial esophageal squamous cell neoplasm / 中华消化内镜杂志

Objective:To compare the efficacy of endoscopic submucosal dissection (ESD) and surgery for circumferential superficial esophageal squamous cell neoplasm.Methods:A retrospective analysis was performed on 153 patients with superficial esophageal squamous cell neoplasm who underwent ESD or surgery at Cancer Hospital, Chinese Academy of Medical Sciences from November 2013 to October 2021. There were 116 cases in ESD group and 37 cases in the surgical group. The en block resection rate, complete resection rate, operation time, perioperative complication incidence, postoperative quality of life, postoperative disease-free survival and overall survival were compared.Results:In the ESD group, the en block resection rate was 100.0% (116/116) and the complete resection rate was 96.6% (112/116). The longitudinal diameter of lesion had no significant correlation with complications or complete resection rate ( P>0.05). The operation time of the ESD group was significantly shorter than that of the surgical group (175.1±52.2 min VS 266.7±88.2 min, t=-5.991, P<0.001). There was no significant difference in the incidence of perioperative complications between the ESD group and surgical group [5.2% (6/116) VS 8.1% (3/37), P=0.452]. According to EORTC-QLQ-C30 and EORTC-QLQ-OES18, emotional function ( P=0.008),cognitive function ( P=0.013) and the total health level ( P<0.001) of the ESD group were significantly higher than those in the surgical group. Fatigue ( P=0.002), pain ( P<0.001), dyspnea ( P<0.001), insomnia ( P<0.001), anorexia ( P<0.001), diarrhea ( P<0.001) and reflux ( P<0.001) in the surgical group were significantly higher than those in ESD group. There was no significant difference in disease-free survival or overall survival between the two groups ( P>0.05). Polyglycolic acid combined with autologous esophageal mucosal transplantation combined with temporary esophageal stent implantation could reduce the rate of esophageal scar stenosis after ESD [53.3% (24/45) VS 100.0% (55/55), P<0.001] and significantly reduce the number of postoperative dilation [1.00 (0.00, 5.00) VS 9.00 (5.00, 14.00), P<0.001] compared with balloon dilation alone. Conclusion:ESD is superior to traditional surgery for the treatment of circumferential superficial esophageal squamous cell neoplasm because of high operational safety, shorter operation time, less trauma, better postoperative life quality. Postoperative esophageal stenosis can still be well cured after endoscopic treatment. Therefore, ESD can be used as the first choice for the treatment of circumferential superficial esophageal squamous cell neoplasm.

Application of artificial intelligence based on data enhancement and hybrid neural network to site identification during esophagogastroduodenoscopy / 中华消化内镜杂志

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

Performance of rural practitioners of endoscopic cleaning and disinfection on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers / 中华消化内镜杂志

Objective:To evaluate the performance of rural practitioners of endoscopic cleaning and disinfection participating in the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers and to analyze the influencing factors.Methods:The questionnaires for skill assessment were designed based on the skill scheme and clinical practice of the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China, and the App Early diagnosis, Early treatment was used as the examination platform. The practitioners in 539 county hospitals from 25 provinces participating in the program in 2019 were assessed for techniques and skills for endoscopic cleaning and disinfection and the excellence rate was calculated. Multivariate logistic regression model was used to analyze the influencing factors for the examination. Results:A total of 1 671 endoscopic cleaning and disinfection practitioners participated in the assessment with the score of 73.41±16.60. The passing rate was 85.82%, and the excellence rate was 44.94%. Among all questions, the correct rate of "opportunistic screening flow chart" was the highest (98.21%), and that of "the evaluation index for mass screening" was the lowest (57.89%). The multivariate logistic regression analysis showed that the excellence rate was high in practitioners who had a bachelor degree or above ( OR=1.627,95% CI:1.319-2.007, P<0.001), the career for 5 to <15 years (5 to <10 years: OR=1.329,95% CI:1.045-1.689, P=0.020; 10 to <15 years: OR=1.384,95% CI:1.026-1.867, P=0.033), working in eastern and central regions (eastern regions: OR=3.476,95% CI:2.368-5.103, P<0.001;central regions: OR=4.028,95% CI:2.679-6.057, P<0.001) and with full understanding of the screening scheme ( OR=1.547,95% CI:1.246-1.921, P<0.001) . Conclusion:Practitioners on the Early Diagnosis and Treatment Program for Upper Gastrointestinal Cancers in rural China have mastered the basic screening scheme and skills for endoscopic cleaning and disinfection. The education background, duration of the career, area and understanding of screening scheme are influencing factors for the excellence rate of endoscopic cleaning and disinfection.

Progress of endoscopic treatment for early-stage colorectal cancer and precancerous lesions / 肿瘤研究与临床

With the continuous development of endoscopic technology, more and more early-stage colorectal cancer and precancerous lesions have been found by endoscopy, and endoscopic treatment has dominated the treatment of early-stage colorectal cancer for its characteristics of small trauma, rapid recovery and good effect. At present, there are many methods of endoscopic treatment, but their indications are still controversial, and some new technologies still need further verified. Based on the latest guidelines at home and abroad and some hot issues, this article reviews the progress of endoscopic treatment of early-stage colorectal cancer and precancerous lesions, mainly including the indications of various endoscopic treatment methods, some important technical improvement of endoscopic treatment methods, and the application of some new endoscopic treatment technologies, in order to provide some references for the minimally invasive treatment of early-stage colorectal cancer and precancerous lesions.

Clinical effect of different plastic biliary stent indwelling methods on managing obstructive jaundice in unresectable hilar cholangiocarcinoma / 中华消化内镜杂志

Objective:To compare the clinical effect of three indwelling methods of plastic biliary stent on relieving obstructive jaundice caused by unresectable hilar cholangiocarcinoma.Methods:A retrospective study was performed on data of 61 patients with obstructive jaundice caused by unresectable hilar cholangiocarcinoma from April 2014 to December 2020 in Cancer Hospital, Chinese Academy of Medical Sciences. Plastic biliary stent placement was used to relieve jaundice, including 18 cases of intragastric indwelling at the end of biliary stent, 31 cases of duodenal papilla indwelling at the end of biliary stent, and 12 cases of horizontal portion of duodenum indwelling at the end of biliary stent. Incidence of fever within 2 weeks, perioperative mortality, 90-day obstruction rate, and median stent patency period were followed up and the results were analyzed.Results:The incidence of fever within 2 weeks of the three groups were significantly different [66.7% (12/18), 58.1% (18/31) and 16.7% (2/12), χ2=7.30, P=0.026]. There were no statistically differences in the perioperative mortality [0 (0/16), 3.2% (1/31) and 0 (0/10), χ2=1.09, P=1.000], 90-day obstruction rate [52.9% (9/17), 48.3% (14/29) and 40.0% (4/10), χ2=1.91, P=0.589], or median stent patency period (66.0 d, 91.5 d and 94.0 d, Z=4.96, P=0.084) among three groups. Conclusion:Patients with biliary plastic stents with ends placed at the horizontal portion of the duodenum show lower incidence of fever within two weeks after implantation, and similar median stent patency period, 90-day obstruction rate and perioperative mortality compared with intragastric indwelling and duodenal papilla indwelling groups. Therefore, biliary plastic stents with ends placed at the horizontal portion of the duodenum should be recommended as the preferred procedure.

Endoscopic submucosal dissection for early hypopharyngeal carcinoma and precancerous lesions / 中华消化内镜杂志

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for early hypopharyngeal carcinoma and precancerous lesions.Methods:Clinical data of 41 patients who received ESD for early hypopharyngeal carcinoma and precancerous lesions from August 2013 to August 2019 in the Department of Endoscopy of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively analyzed. Main outcome measurements included operation completion rate, operation time, en bloc resection rate, R0 resection rate, complication rate and recurrence.Results:ESD was successfully completed in all 41 cases, with a success rate of 100.0% and a mean time of 49.1 min (ranged 10-110 min). Fifty-four lesions underwent en bloc resection, with an en bloc resection rate of 98.2% (54/55), of which 41 had negative horizontal and vertical margins, and the R0 resection rate was 74.5% (41/55). During the operation of 55 lesions, there was a small amount of blood oozing on the wound surface, and electrocoagulation with thermal biopsy forceps could successfully stop the bleeding. No perforation occurred, and 2 cases (4.3%) had delayed bleeding after ESD, and hemostasis was successful under emergency endoscopy. Postoperative endoscopy showed that 1 case (2.2%) had esophageal entrance stenosis, and the obstruction was relieved after repeated water balloon dilatation. The follow-up period ranged from 3 to 72 months, and the median time was 18 months. One case was found to have mucosal lesions in the same part of the hypopharynx and received ESD treatment again. Follow-up to October 2020, no residual lesions and recurrence were found.Conclusion:ESD is a safe and effective option for the treatment of early hypopharyngeal carcinoma and precancerous lesions, which is worthy of clinical application.

Clinical analysis of salvage surgery after noncurative endoscopic resection for early gastric cancer / 中华普通外科杂志

Objective:To evaluate salvage surgery in patients with early gastric cancer after noncurative endoscopic resection .Method:A total of 56 cases with early gastric cancer receiving salvage surgery after noncurative endoscopic resection were enrolled and the clinicopathological and follow-up information were analyzed to evaluate the necessity and safety of salvage surgery.Results:Among the 44(79%)patients with submucosal invasion, 38 (68%) were with SM2 (invasion submucosal invasion≥500 μm) according to the pathological results after endoscopic resection. 33 (59%)cases had positive margin. The rate of lymph node metastasis and positive residual tumor as found by salvage gastrectomy were 11% (6/56) and 25% (14/56) . In the multivariate analysis, deeper submucosal invasion resulted as independent risk factor for residual tumor( OR=1.001, 95% CI=1.000-1.002, P=0.036). Among the 12(21%)cases with postoperative complications, 3 (5%)underwent unplanned reoperations because of anastomotic or intra-abdominal bleeding. There was no difference in the number of retrieved lymph nodes and rate of postoperative complications between laparoscopic and open surgery(all P>0.05). Conclusion:For patients with the risk factors of lymph node metastasis after noncurative endoscopic resection, salvage surgery was necessary and laparoscopic approach was safe and feasible.

Risk factors for esophageal refractory stenosis after large-scale endoscopic submucosal dissection of superficial esophageal neoplasms / 中华消化内镜杂志

Objective:To determine risk factors for postoperative esophageal refractory stenosis after endoscopic submucosal dissection (ESD) of large-scale early esophageal carcinomas and precancerous lesions.Methods:Two hundred and twelve early esophageal carcinomas or precancerous lesions in 186 patients who underwent ESD larger than 3/4 the total esophageal circumference in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, between July 2013 and December 2017 were divided into two groups according to session number of endoscopic balloon dilatation (EBD), the refractory stenosis group ( n=69, ≥6 EBD sessions) and non-refractory stenosis group ( n=117, ≤5 EBD sessions). Student′s t-test or Mann-Whitney U test was used for univariate analysis and χ2 test and Fisher exact test were used for comparison of categorical variables. Logistic regression was used for multivariate analysis. Results:Compared with the non-refractory stenosis group, the refractory stenosis group had statistically significant differences in the longitudinal diameter of lesions, the longitudinal diameter of artificial ulcer, lesion location, the circumferential range of lesions and the composition of the muscular layer injury (all P<0.05). After eliminating the factor of the vertical diameter of artificial ulcer (because there was significant correlation between the vertical diameter of artificial ulcer and the longitudinal diameter of lesion in clinical practice), multivariate logistic regression analysis showed that the longitudinal diameter of lesion>5 cm (VS ≤5 cm: P=0.003, OR=3.531, 95% CI:1.547-8.060), the location of lesion in the upper thoracic segment (VS lower thoracic segment: P=0.001, OR=36.720, 95% CI:4.233-318.551), in the cervical segment (VS lower thoracic segment: P=0.003, OR=24.959, 95% CI:2.927-212.795), the whole circumferential lesion (VS ≥3/4 but not the whole circumference: P<0.001, OR=10.082, 95% CI:4.196-24.226) and the presence of muscular layer injury ( P<0.001, OR=7.128, 95% CI:2.748-18.486) were more likely to lead to esophageal refractory stenosis after ESD. Conclusion:The longitudinal lesion diameter of more than 5 cm, the circumferential extent of esophageal ESD, cervical or upper-thoracic esophageal lesions, and muscular layer damage are independent risk factors for postoperative esophageal refractory stenosis after ESD for large-scale esophageal cancer and precancerous lesions.

Diagnostic value of thin-slice CT navigation combined with cytology in preoperative bronchoscopy of peripheral pulmonary lesions / 中华肿瘤杂志

Objective@#To evaluate the diagnostic value of thin-slice CT navigation combined with cytology in routine preoperative bronchoscopy of peripheral pulmonary lesions and compare the diagnostic effects of different cytological sampling methods.@*Methods@#The clinical data of peripheral lung cancer patients with preoperative bronchoscopy and cytology sampling guided by thin-slice CT from May 2015 to July 2016 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The diagnostic accuracy, sensitivity and specificity of different cytological sampling methods for peripheral pulmonary lesions guided by thin-slice CT were compared, the factors affected the diagnostic sensitivity were analyzed, and the complications induced by these methods were observed.@*Results@#The diagnostic sensitivity of thin-slice CT navigation combined with bronchoalveolar lavage for peripheral pulmonary lesions was 39.1%, and the positive diagnosis rate was 35.1%. The diagnostic sensitivity of thin-slice CT navigation combined with cell brush for peripheral pulmonary lesions was 51.7%, and the positive diagnosis rate was 46.4%. The diagnostic sensitivity of bronchoalveolar lavage combined with cell brush for peripheral pulmonary lesions was 57.5%, and the positive diagnosis rate was 51.5%. The positive diagnosis rate between brush sampling and bronchoalveolar lavage was statistically different (P=0.01). No significant difference was observed in the diagnostic rate between cell brush and cell brush combined with bronchoalveolar lavage (P=0.06). The factors affected diagnostic sensitivity of brush included the lesion location, size, and the relationship between the lesion and bronchial (all P<0.05). When the size of the peripheral lung lesion >2 cm, the diagnostic sensitivity of thin-slice CT navigation combined with cell brush for peripheral pulmonary lesions was 73.6%. Its positive diagnosis rate was 68% and the specificity was 100%, respectively. Two cases of mild bleeding were observed, and hemorrhage was terminated by conservative treatment.@*Conclusion@#Preoperative thin-slice CT navigation combined with cytological examination is an effective method for the diagnosis of peripheral pulmonary lesions, and the diagnostic efficiency of cell brush is higher than that of bronchoalveolar lavage, especially for the lesion size >2 cm.

Submucosal tunneling endoscopic resection for submucosal tumors originating from muscularis propria layer at esophagogastric junction / 中华肿瘤杂志

Objective@#To evaluate the short-term outcomes and safety of submucosal tunneling endoscopic resection (STER) for submucosal tumors (SMT) originating from muscularis propria (MP) layer at esophagogastric junction.@*Methods@#The clinical data of 31 patients with SMT originating from MP layer at esophagogastric junction underwent STER were collected and retrospectively analyzed.@*Results@#The success rate of STER of the thirty-one patients was 100%. The mean tumor size was (2.5±1.3) cm and the average operative time was (95.9±56.7) min. Perforation occurred in 3 patients and was successfully clipped by endo-clips during operation. One patient developed delayed bleeding and the bleeding was stopped by endoscopic hemostasis. Twenty-nine leiomyomas and two stromal tumors (GIST) were finally pathologically diagnosed. No local recurrence and distant metastasis were noted during the mean 15.4 months follow-up of 20 cases. According to the lesion size, 31 patients who received STER were divided into two groups. The operation time of maximum diameter ≥3.5 cm group was (134.0±70.6) min, significantly longer than (80.3±42.6) min of maximum diameter <3.5 cm group (P=0.014). However, the en bloc removal rate, postoperative hospital stay and the complication incidence between the two groups had no obvious differences (P>0.05). Univariate analysis showed that the piecemeal removal group had longer tumor diameter, higher incidence of irregular tumor morphology, and longer operative time than the en bloc removal group (all P<0.05). Stepwise logistic regression analysis showed that irregular shape was a risk factor for failure of en bloc removal (OR=18.000, 95% CI: 1.885~171.88, P=0.012).@*Conclusion@#As a new method of minimally invasive treatment, STER technology appears to be a safe and effective option for patients with SMT originating from MP layer at esophagogastric junction.

The therapeutic strategy after noncurative endoscopic submucosal dissection for early gastric cancer / 中华肿瘤杂志

Objective@#To investigate the therapeutic strategy in patients with early gastric cancer after noncurative endoscopic submucosal dissection (ESD).@*Methods@#A total of 107 cases with early gastric cancer receiving noncurative endoscopic submucosal dissection were collected and the patients were classified into an additional gastrectomy group (n=41) and a simple follow-up group (n=66) according to the therapeutic method used after noncurative ESD. The clinicopathological information, short- and long-term clinical outcomes between the two groups were analyzed and compared.@*Results@#The mean age of the patients in the gastrectomy group and follow-up group was(59.2±8.7)years old and(64.7±8.8)years old, respectively. The depth of submucosal invasion was (1445.83±803.12) and (794.71±815.79) μm, respectively. The difference between the two groups was statistically significant (P=0.020 for age and P=0.010 for depth of submucosal invasion). Compared with follow-up group, the patients with undifferentiated histologic type, deep invasion of submucosa (SM2), diffuse type, lymphovascular invasion and neural invasion were more common in the gastrectomy group (P<0.05). The R0 resection rate of ESD in the gastrectomy group was significantly lower than the follow-up group(26.8% vs 65.2%, P<0.001). The positive residual tumor rate and LNM rate of additional gastrectomy group were 31.7%(13/41)and 9.76%(4/41)according to the pathological results after gastrectomy. The gastrectomy group had 2 cases of local recurrence (2/41, 4.9%), while 5(5/66, 7.6%)in the follow-up group(4.9% vs 7.6%, P=0.883). There was no significant difference in overall survival (OS) and disease-free survival (DFS) between the two study groups (P=0.066 and 0.938, respectively).@*Conclusions@#Assessment of LNM risk should be performed in patients with noncurative endoscopic resection. For patients with low risk of LNM who are intolerance of additional gastrectomy due to old age and comorbidities, close follow-up with endoscopy can be considered as an alternative.

Clinical analysis of laparoscopic remedial surgery for endoscopic lesions in early colorectal cancer / 中华肿瘤杂志

Objective@#To investigate the safety and feasibility of laparoscopic remedial surgery in patients who didn′t reach the cure criterion of early colorectal cancer after endoscopic resection.@*Methods@#The clinical and follow-up data of 12 patients who didn′t reach the cure criterion of early colorectal cancer and then underwent endoscopic resection was collected. The clinicalpathological features and remedial indications were analyzed to evaluate the effects of laparoscopic remedial surgery.@*Results@#The average number of lymph nodes in the lymph node dissection was 15 during remedial surgery, and 3 of them had lymph node metastasis. Among the 3 patients with residual cancer, two cases were poorly differentiated, 1 case was moderately differentiated, 1 case was positive for basal margin, and 1 case had vascular invasion. No lymph node metastasis occurred in the 9 patients who had no residual cancer. Among these, 8 cases were moderately differentiated, 1 case was poorly differentiated and 2 cases had positive basal margin. The average follow-up duration was 40 months and all 12 patients were in a state of survival at the last follow-up. During the follow-up of the 3 patients with residual cancer, 1 patient received adjuvant chemotherapy with unknown prognosis; 1 patient received postoperative adjuvant radiochemotherapy, and lung metastasis occurred; 1 patient did not receive any treatment after surgery and survived for 33 months.@*Conclusions@#Laparoscopic remedial surgery is a safe and feasible remedy for patients who didn′t reach the cure criterion of early colorectal cancer after endoscopic resection. However, the choice of remedial strategy for colorectal carcinoma needs further investigation for patients with no vascular invasion, high degree of differentiation, and negative basal margin.

A new transition of the screening, early diagnosis and early treatment project of the upper gastrointestinal cancer: opportunistic screening / 中华预防医学杂志

The screening, early diagnosis and early treatment project of the upper gastrointestinal cancer had achieved good results since its launch. However, from a national perspective, the endoscopic screening of upper gastrointestinal cancer was still not optimistic, such as the poor rate of the early diagnosis, the low rate of 5-year survival in rural areas, and the disparity of the standardized screening and diagnosis in different areas. Therefore, the situation of upper gastrointestinal cancer prevention and treatment is still severe. Under the guidance of the "Healthy China 2030" plan, based on the international experience and domestic actual circumstance, it is suggested that the screening of high-risk population in high-risk areas should be changed into the opportunistic screening in primary medical institutions. The opportunistic screening could expand the coverage of the screening, early diagnosis and early treatment project of the upper gastrointestinal cancer, and increase the early diagnosis rate in rural areas and primary medical institutions, which could improve the 5-year survival rate of patients with the upper gastrointestinal cancer, and then achieve the sustainable development of the cancer prevention and treatment in China.

Status of non-steroidal anti-inflammatory drugs use in areas with a high incidence of upper gastrointestinal cancer in China: a multi-center cross-sectional survey / 中华预防医学杂志

Objective@#To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. @*Methods@#This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ2 test and Cochran-Armitage trend analysis method. @*Results@#Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). @*Conclusion@#The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

Screening results and influencing factors of upper gastrointestinal carcinoma and precancerous lesions in Feicheng City / 中华肿瘤杂志

Objective@#To clarify the situation of the detection of upper gastrointestinal cancer and precancerous lesions in the Feicheng city and discuss the possible influencing factors.@*Methods@#A cluster sampling method was used to determine the participants. A unified questionnaire was used to investigate the basic information including history of alcohol intake, smoking and chinese tea, as well as other eating habits, medical history of digestive tract and cancer. Endoscopy was used to to screen the patients with upper gastrointestinal cancer and precancerous lesions. Influential factors were explored by non-conditional logistic regression model.@*Results@#911 of 7 291participants were positive, and the total detection rate was 12.49%. The total positive detection rate of male and female was 17.94% and 8.71%, respectively (P<0.001). Multivariate logistic regression analysis showed that the sex (OR=0.527, 95%CI: 0.440-0.631), age (OR=2.037, 95%CI: 1.849-2.245), smoking (OR=1.240, 95%CI: 1.014-1.516) and alcohol consumption (OR=1.232, 95%CI: 1.012-1.500) , meat and protein intake (OR=0.794, 95%CI: 0.638-0.987) and drink tea (OR=1.233, 95%CI: 1.056-1.440) may be influencing factors of the total detection rate of upper gastrointestinal cancer and precancerosis.@*Conclusions@#In Feicheng city, intake of meat and protein is the protective factor of the upper gastrointestinal cancer and precancerous lesions. Men, aged, smoking, drinking and tea will increase the risk of upper gastrointestinal cancer and precancerous lesions.

Endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging for the diagnostic value of early colorectal cancer / 肿瘤研究与临床

Objective To investigate the diagnostic value of endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging (NBI-ME) in the diagnosis of early colorectal cancer.Methods A total of 187 patients with early colorectal cancer who were treated in Cancer Hospital Chinese Academy Medical Sciences and Peking Union Medical College from January 2015 to December 2017 were retrospectively analyzed.The patients were examined with NBI-ME along with endoscopic ultrasonography before endoscopic or surgical treatment,and the depth of invasion was judged.Finally,postoperative pathology was taken as the gold standard to evaluate the value of endoscopic ultrasonography combined with NBI-ME in the diagnosis of early colorectal cancer.Results The histopathological results were treated as the golden standard.The diagnostic accuracy rate of endoscopic ultrasonography and endoscopic ultrasonography combined with NBI-ME in 187 patients with early colorectal cancer was 84.0 ％ (157/187),92.5 ％ (173/187)respectively.Overall accuracy rate of the invasive depth of NBI-ME in the patients with early colorectal cancer was 87.2 ％ (166/187).Sensitivity of endoscopic ultrasonography combined with NBI-ME to Tm,Tsml and ≥Tsm2 in early colorectal cancer pathological tissues was 92.4 ％,90.4 ％,93.3 ％ respectively,and the corresponding specificity was 93.9 ％,90.1％,90.9 ％ respectively.The diagnostic accuracy rate of endoscopic ultrasonography combined with NBI-ME was higher than that of endoscopic ultrasonography,and there was a significant difference (x2 =6.594,P =0.010 2).Conclusion Endoscopic ultrasonography combined with NBI-ME has a high accuracy rate for evaluating the depth of invasion in early colorectal cancer,which contributes to a good application value for preoperative evaluation of early colorectal cancer.

China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2018 version) / 中国肺癌杂志

BACKGROUND@#Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice.@*METHODS@#The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China.@*RESULTS@#Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation.@*CONCLUSIONS@#A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.

Risk factors analysis of the early colorectal carcinoma after endoscopic non-curative resection: A retrospective clinical study of 56 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the risk factors contributing to the progression-free survival rate of patients undergoing endoscopic non-curative resection.</p><p><b>METHODS</b>Clinicopathological data of patients with early colorectal carcinoma and intraepithelial neoplasia undergoing endoscopic resection in our department from January 2009 to January 2015 were collected. Associated factors affecting the progression-free survival rate of the early colorectal carcinoma after endoscopic non-curative resection were analyzed. Any of the following conditions was defined as endoscopic non-curative resection: (1) positive lateral or vertical cutting margin; (2) submucosa invasion depth ≥1 000 μm; (3) vascular or lymphatic invasion; (4) low differentiation, including signet ring cell carcinoma or mucinous adenocarcinoma; (5) high grade tumor budding.</p><p><b>RESULTS</b>Clinicopathological data of 840 cases were collected. According to China's Endoscopic Screening, Diagnosis and Treatment Guidelines for Early Colorectal Cancer, 56(56/840, 6.7%) cases were defined as the non-curative resection, the metastasis or recurrence rate was 14.3%(8/56), 3-year progression-free survival rate was 85.7%(48/56), and 3-year overall survival rate was 94.6%(53/56). Univariate prognostic analysis showed that 3-year progression-free survival rate in low and moderate-high differentiation adenocarcinoma was 25.0% and 90.4%(χ=6.711, P=0.010), in patients with submucosa invasion depth ≥2 000 μm and <2 000 μm was 75.0% and 93.8%(χ=6.745, P=0.009), and in patients with and without vascular or lymphatic invasion was 60.0% and 88.2%(χ=7.708, P=0.005), whose differences were all significant. Multivariate Cox regression analysis revealed that low differentiation adencarcinoma (P=0.015, HR=8.021, 95%CI: 1.499-42.921), invasion depth ≥2 000 μm (HR=6.823, 95%CI: 1.299-35.848) and vascular or lymphatic invasion (HR=18.143, 95%CI: 2.079-158.358) were independent risk factors for the progression-free survival rate of the early colorectal carcinoma after endoscopic non-curative resection.</p><p><b>CONCLUSION</b>Pathology after endoscopic non-curative resection for early colorectal carcinoma indicates that low differentiation adenocarcinoma, submucosa invasion depth ≥2 000 μm and vascular or lymphatic invasion are independent risk factors of poor prognosis.</p>

Evaluation of a new closure technique of large defects after endoscopic full-thickness resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the security and efficacy of a new endoscopic closure method of large defects after endoscopic full-thickness resection (EFTR) double purse-string suture using two endoloops and metallic clips via single-channel endoscopy.</p><p><b>METHODS</b>Clinical data of 23 cases with submucosal tumors (SMT) who received endoscopic resection from June 2015 to July 2016 in our National Cancer Center were collected. For gastric and esophageal SMTs or the mucosa layer injured during submucosal tunneling endoscopic resection (STER), double purse-string suture was conducted after EFTR. The key steps of closure were as follows: the endoloop was installed onto the delivery system and inserted into the gastric cavity to the defect location with endoscopy and then opened; the clips were transported into the gastric cavity from the biopsy channel; the endoloop was fixed onto the full thickness of gastric wall along the edge of the defect by clips one by one between the interval of about 5 mm; the endoloop was tightened slowly till the entire circumference of the defect was sutured, thus, one purse-string suture was done; in accordance with the operation above, another endoloop was released, and the second endoloop was fixed at 5-10 mm to the outer edge of the original one, and tied the endoloop gently; this sequence was continued till there was no gap, thus, the double-purse string suture was finished. A total of 23 patients were enrolled in the study, including 18 with gastric tumor and 5 with esophageal tumor, 15 males and 8 females, with the average age of 56 (19 to 76) years.</p><p><b>RESULTS</b>Eighteen cases of gastric SMT were successfully treated by endoscopic EFTR and double purse-string suture. The esophageal mucosa layer of all the 5 cases of esophageal SMT, including tumors of 3 cases located in cervical esophagus at 15-20 cm from the fore-tooth, 1 esophageal leiomyoma case complicated with squamous cell carcinoma in situ, and 1 case of mucosal layer injury during submucosal tunneling endoscopic resection (STER), was successfully repaired by using double purse-string suture. The mean maximum diameter of tumor was 2.3 cm, and the average suture time was 22.8 min. Postoperative pathology showed that 13 cases were gastrointestinal stromal tumors (GIST), 7 cases were leiomyoma, 2 cases were neurilemmoma, and 1 case was leiomyoma complicated with early squamous cell carcinoma in situ. No severe complications occurred during or after the operation.</p><p><b>CONCLUSIONS</b>The double purse-string suture by using metallic clips and endoloops with single channel endoscope is a relatively safe, easy, and reliable technique for repairing large gastric defect after EFTR. For cervical esophageal SMT, or the SMT combined with superficial mucosal lesions, and for the mucosa layer injury during submucosal tunneling endoscopic resection(STER), double purse-string suture is helpful to perform the closure.</p>

Risk factors and survival analysis for synchronous esophageal carcinoma in patients with hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the risk factors and survival status of hypopharyngeal carcinoma with synchronous second primary carcinoma of the esophagus.@*Methods@#One hundred and sixty patients with newly diagnosed hypopharyngeal carcinoma from January 2009 to December 2012 were retrospectively reviewed. The clinical data, tumor-related information and follow-up results were collected and analyzed.@*Results@#Forty-three synchronous esophageal carcinomas (27%) were detected in 160 patients with hypopharyngeal carcinoma, and most patients (72%) were at an early stage. On univariate analysis, the median age of less than 55 years old (χ2=4.525, P=0.033), excessive alcohol consumption (χ2=6.942, P=0.008) and invasion site more than 3 anatomical regions (χ2=21.503, P=0.000) had a significant correlation with the occurrence of synchronous esophageal carcinomas. Multivariate analysis showed that excessive alcohol consumption (OR=4.787, P=0.029) and invasion site more than 3 anatomical regions (OR=14.391, P=0.000) were independent risk factors. The median survival time was 26 months in 43 patients with synchronous esophageal carcinomas, which was significantly lower than that (58 months) in patients without secondary primary esophageal carcinomas (χ2=11.981, P=0.001).@*Conclusions@#There is a high incidence of synchronous esophageal carcinoma in hypopharyngeal carcinoma patients, affecting the prognosis of hypopharyngeal carcinoma. Surveillance for esophageal carcinomas in patients with hypopharyngeal carcinoma, especially in excessive alcohol drinkers, is warranted.