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Background:Peroral endoscopic myotomy (POEM) has been widely used in treatment of achalasia,and the efficacy is satisfactory.However,POEM is associated with high level of technical difficulty and high incidence of complications.Aims:To investigate the efficacy and safety of Flush knife and SB knife in POEM for treatment of achalasia.Methods:A total of 111 achalasia patients who had undergone POEM from April 2013 to April 2017 at Renmin Hospital of Wuhan University were enrolled,and were divided into Flush knife group,SB knife group and Dual knife group.Procedure-related parameters,complications,and follow-up data were compared among the three groups.Results:All the 111 patients underwent POEM successfully.The mean procedure time,mean frequency of hemostasis and mean frequency of device exchange were significant different among Flush knife group,SB knife group and Dual knife group (P all ＜ 0.05).Further comparisons showed that the above-mentioned procedure-related indices were significantly lower in Flush knife group and SB knife group than in Dual knife group (P all ＜ 0.05).The incidence of complications was significant different among the three groups (P =0.005).Further comparisons showed that incidence of complications was significantly lower in SB knife group than in Dual knife group (P =0.011),however,no significant difference was found between Flush knife group and Dual knife group (P =0.056).No significant difference in surgery success rate was found among the three groups (P ＞0.05).Conclusions:Flush knife and SB knife in POEM can shorten the procedure time and achieve similar success rate when compared with conventional Dual knife.
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Objective To evaluate the diagnostic value of blue laser imaging( BLI) combined with magnifying endoscopy for precancerous lesions and early gastric cancers. Methods From September 2015 to May 2016, a total of 249 gastric lesions detected with conventional white light endoscopy ( WLE) on the basis of the assessment of mucosal shape and color were enrolled in this study. The pathological results were used as golden standard,and diagnostic accuracy rates of precancerous lesions or early cancers by white light magnification alone,BLI?contrast magnification and BLI?bright magnifier were determined according to the VS criteria. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement ( Kappa ) test, and diagnostic value was compared with McNemar paired Chi?square test. Results Pathological examination showed chronic gastritis in 149 lesions, intestinal metaplasia in 67, low grade intra?epithelial neoplasia in 8, and high grade intra?epithelial neoplasia or early cancer in 25. The concordance rates of lesions were 76?7% for white light magnification alone, 85?1% for BLI?contrast magnification, and 86?7% for BLI?bright magnification. Kappa values were 0?571, 0?730, and 0?760 respectively. For the screening of high grade intra?epithelial neoplasia or early cancer, the diagnostic sensitivities were 72?0%, 92?0%, and 92?0%, respectively, the specificities were 95?5%, 98?2%, and 99?1%,the consistencies were 93?2%,97?6%,98?4%,and the Kappa values were 0?642,0?871,and 0?911. In contrast to white light magnification alone,the concordance between endoscopic diagnosis and pathological diagnosis of BLI?contrast magnification and BLI?bright magnification was significantly higher(P<0?05).And in the diagnosis of high?grade intraepithelial neoplasia or early gastric cancer,the concordance between endoscopic diagnosis and pathological diagnosis of BLI?contrast magnification and BLI?bright magnification was higher than that of white light magnification alone( P<0?05) . Conclusion BLI combined with magnifying endoscopy may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.