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Objective:To explore the therapeutic effect of peroral endoscopic myotomy (POEM) for primary achalasia (AC) in patients aged over 60 years.Methods:Data of 146 patients aged ≥60 years (the elderly group) and 146 patients aged 18-59 years (the adult group) who received POEM from November 2010 to September 2019 at the Digestive Endoscopy Center of PLA General Hospital were retrospectively analyzed. Baseline data, surgery data, surgery-related complications and surgery-related efficacy were compared.Results:There was no significant difference in gender, Ling classification, HRM classification or previous treatment between the two groups ( P>0.05). All 292 patients successfully underwent POEM surgery. The clinical success (Eckardt score ≤3) rates in the elderly group and the adult group were 96.33% (105/109) and 96.77% (90/93), respectively with no significant difference between the two groups ( χ2=0.030， P>0.05). There was no significant difference in the length of myotomy between the two groups (7.09±2.49 cm VS 7.12±2.24 cm， t=0.472， P>0.05). Complications occurred in 26 cases (17.81%) in the elderly group and 21 cases (14.38%) in the adult group with no significant difference between the two groups ( χ2=0.634， P>0.05). There was no significant difference in the postoperative hospital stay (12.61±9.69 days VS 11.00±4.43 days, t=1.825, P>0.05) or the incidence of gastroesophageal reflux [43.33% (13/30) VS 51.52% (17/33), χ2=0.422, P>0.05] between the elderly group and the adult group. Conclusion:The efficacy of POEM for AC patients over 60 years old is equivalent to that of adult patients, and the incidence of complications is similar. POEM is safe and effective for AC patients over 60 years old.
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Objective:To investigate the predictive value of F-2-fluoro-2-deoxy-D-glucose ( 18F-FDG) PET-CT metabolic parameters for the recurrence of type 1 autoimmune pancreatitis (AIP). Methods:Eighty-six patients with type 1 AIP who met the International Consensus Diagnostic Criteria (ICDC) and underwent 18F-FDG PET-CT before interventional treatment at the PLA General Hospital between May 2009 and June 2021 were included and divided into recurrence group ( n=43) and no-recurrence group ( n=43) according to whether they recurred after treatment. The standard uptake value (SUV)≥2.5 fixed threshold was used to outline the pancreatic lesion volume of interest (VOI) in three dimensions, and the three-dimensional diameter of the lesion, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), target-to-bench ratio (TBR) and standardized uptake value ratio (SUVR) were measured to compare the clinical characteristics, biochemical indices and treatment of the two groups; univariate and multifactorial regression analysis were used to examine 18F-FDG PET/CT visual indices of pancreatic lesions and extra-pancreatic involved organs as well as metabolic parameters in the two groups. A recurrence prediction model was constructed and its predictive efficacy was assessed. Results:The proportion of patients receiving glucocorticoid maintenance therapy was significantly higher in the no-recurrence group than in the recurrence group (58% vs 23.3%), and the serum IgG4 levels before treatment were significantly higher in the recurrence group [(15 309±11 724) mg/L vs (8 816±7 169) mg/L]. The results of univariate analysis showed that the proportion of extra-pancreatic salivary gland involvement and VOI, SUVmax, SUVpeak, SUVR, TBR, MTV, and TLG were significantly higher in the recurrence group than in the no-recurrence group, and the differences were statistically significant (all P values <0.05); the results of multivariate analysis showed that VOI ( OR=1.012, 95% CI 1.001-1.023 ), SUV max ( OR=1.398, 95% CI 1.029-1.899), SUV peak ( OR=1.408, 95% CI1.002-1.978), SUVR ( OR=1.977, 95% CI1.036-3.771) and MTV ( OR=1.012, 95% CI1.000- 1.022) in the recurrence group were significantly higher than those in the no-recurrence group, and all differences were statistically significant (all P values <0.05). The prediction model was constructed by multifactorial binary logistic regression analysis of SUVR>2, MTV>36 cm 3, and IgG4>11 400 mg/L, which had an AUC of 0.800 (95% CI 0.704-0.897), sensitivity of 81.4% (95% CI 0.661-0.911), specificity of 74.4% (95% CI 0.585-0.860), and prediction accuracy of 77.9%. Conclusions:18F-FDG PET/CT metabolic parameters can be used as predictors of type 1 AIP recurrence; a multiparameter model constructed based on metabolic parameters SUVR, MTV and IgG4 has a good predictive efficacy for predicting type 1 AIP recurrence.
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Objective:To compare the efficacy and safety of endoscopic mucosal resection (EMR), EMR with pre-cutting (EMR-P), endoscopic submucosal dissection (ESD) and ESD with snare (ESD-S) for the treatment of colorectal laterally spreading tumors (LSTs).Methods:Between January 2016 and March 2018, a total of 146 patients with 146 colorectal LSTs undergone endoscopic resection at the first medical center of PLA General Hospital. Data of demographics, treatment information, pathology and follow-up results were retrospectively analyzed.Results:Among the 146 patients, EMR, EMR-P, ESD, and ESD-S were performed in 23, 29, 50 and 44 tumors, respectively. Median tumor diameter was 2.5 cm (ranged 1.2-10.0 cm). The en bloc resection rate of EMR, EMR-P, ESD and ESD-S were 73.9% (17/23), 72.4% (21/29), 96.0% (48/50), and 65.9% (29/44), respectively, with statistical difference ( P<0.001). And the R0 resection rate were 65.2% (15/23), 69.0% (20/29), 94.0% (47/50), and 63.6% (28/44), respectively, with statistical difference ( P=0.002). The en bloc resection rate and R0 resection rate of the ESD group were significantly higher than those of the other three groups (all P<0.05). The difference was not statistically significant in terms of perforation rate [0, 0, 6.0% (3/50), and 9.1% (4/44), respectively, P=0.269] and delayed hemorrhage rate [4.3% (1/23), 0, 2.0% (1/50), and 2.3% (1/44), respectively, P=0.768] among the four groups. Follow-up endoscopy was performed in 117 cases (80.1%) with a median period of 10.0 months (ranged 3.0-26.0 months), and local recurrence was identified in 7 (6.0%) cases. Conclusion:ESD could be the optimal method for the resection of colorectal LSTs, while LSTs smaller than 20 mm can be resected by EMR. EMR-P and ESD-S as modified methods have their respective advantages for the treatment of LSTs.
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Objective To assess the diagnostic accuracy of preoperative endoscopic ultrasonography (EUS) for tumor size and invasion of non-ampullary duodenal neuroendocrine tumors (NA-DETs) and to compare the efficacy and safety of endoscopic submucosal dissection ( ESD ) and modified ESD for the treatment of NA-DETs. Methods Data of 22 patients with 22 NAD-NETs confirmed by histopathological examinations from January 2007 to January 2018 were retrospectively analyzed. ESD was performed on 13 tumors, and modified ESD was performed on 9 tumors. R0 resection rate, procedure time and incidence of procedure-related complications in the ESD group and the modified ESD group were compared. The postoperative pathological results were used as the gold standard to assess the accuracy of preoperative EUS in diagnosing tumor size and invasion of NA-DETs. Results The mean size of NA-DETs was 6. 9 ± 1. 5 mm. The accuracy in assessing the invasion depth by EUS was 95. 5％ ( 21/22 ) compared with histological results. R0 resection was achieved in 13/13 ( 100. 0％) of the ESD group and in 7/9 ( 77. 8％) of the modified ESD group (P=1. 000). The procedure time was significantly shorter in the modified ESD group than that in the ESD group ( 16. 0 ± 2. 2 min VS 29. 8 ± 4. 9 min, P<0. 001 ) . Intraoperative perforation occurred in one patient and delayed perforation occurred in one patient in the ESD group. Delayed bleeding occurred in one patient in the modified ESD group. Follow-up data were available in all cases with a mean period of 30. 0±24. 8 months. No cases of local recurrence or distant metastasis were detected in the follow-up period. Conclusion EUS can accurately assess the size and depth of NAD-NETs. Modified ESD can provide comparable clinical outcomes to ESD for NAD-NETs ≤10 mm in diameter that are confined to the submucosa.
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Objective To investigate the clinical efficacy and application value of submucosal tunneling endoscopic resection(STER)for upper gastrointestinal submucosal tumors(SMTs). Methods A retrospective analysis was performed on the endoscopic and clinical data of 44 cases with SMTs who received STER from January 2015 to June 2016 in Chinese PLA General Hospital. Results The rate of complete resection was 88.6%(39/44). The operating time was 60.1±30.6 min. The hospitalization time was 10.1± 3.3 days. The rate of complications was 6.8%(3/44). The diagnosis of SMTs by pathology and endoscopic ultrasonography(EUS),the size of SMTs measured by EUS and ruler after STER,and the growing direction judged by EUS and CT were consistent. Conclusion STER for SMTs has a higher complete resection rate, shorter operating time and hospitalization time, and fewer complications. EUS combined with CT is an effective method for preoperative evaluation.
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<p><b>OBJECTIVE</b>To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms.</p><p><b>METHODS</b>A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis.</p><p><b>RESULTS</b>Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4∓5.2 mm(2)/min vs 12.2∓4.0 mm(2)/min, P<0.05). Despite a similar en bloc rate between the two groups (100% [11/11] vs 88.9% [16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8% [9/11] vs 66.7% [12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05).</p><p><b>CONCLUSION</b>ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.</p>
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Endoscopia , Neoplasias Esofágicas , Cirurgia Geral , Esôfago , Cirurgia Geral , Mucosa , Cirurgia Geral , Estudos RetrospectivosRESUMO
<p><b>OBJECTIVE</b>To compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM.</p><p><b>METHODS</b>POEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications.</p><p><b>RESULTS</b>All the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0∓18.0 min vs 74.1∓18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3∓9.0 min vs 45.4∓10.5 min; 10.2∓4.6 min vs 15.5∓5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis- related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula.</p><p><b>CONCLUSIONS</b>POEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.</p>