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Background: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common acute and severe clinical entities. As the limited medical resource in remote regions or primary hospitals, it is necessary to explore an effective endoscopic hemostasis method in such a medical condition. Aims: To investigate the efficacy of norepinephrine injection combined with electrocoagulation under conventional endoscopy in patients with ANVUGIB. Methods: Clinical data of 123 ANVUGIB patients were collected retrospectively from January 2019 to December 2021 at the Kashgar Prefecture Second People’s Hospital. According to the endoscopic hemostasis method used initially, these patients were divided into group A (submucosal injection of norepinephrine), group B (electrocoagulation), group C (clip hemostasis) and group D (direct norepinephrine injection combined with electrocoagulation). The success rate of immediate hemostasis, operation time, rebleeding rate within 72 hours, and rate of transfer to surgery were compared between the four groups. Furthermore, the relationship between visual field during hemostasis and success of immediate hemostasis was analyzed. Results: In group D, all patients achieved success immediate hemostasis, the success rate (100%) was significantly higher than that in group A, group B, and group C (all P0.05). In patients treated with combined hemostasis, including initial combination strategy and failed cases transferred to combination strategy, a clear endoscopic visual field could be obtained in 94.2% of the cases, and the success rate of immediate hemostasis was 98.1%. Conclusions: Submucosal injection of norepinephrine combined with electrocoagulation under conventional endoscopy has a higher immediate hemostasis rate with lower rates of rebleeding and surgical transfer in ANVUGIB patients. This strategy is worthy for popularizing in remote regions and primary hospitals.
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Objective:To analyze the predictive value of P504S for pathological upgrading of gastric low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD).Methods:Data of 117 patients (119 lesions) who underwent ESD for LGIN at Huadong Hospital from January 2015 to March 2019 were analyzed retrospectively. Biopsy and ESD specimens were collected. According to pathology, specimens were divided into the LGIN group (postoperative pathology of non-upgrade) and the upgrade group (postoperative pathology of upgrade). The positive rates of P504S were compared between biopsy and postoperative specimens of the LGIN group, and between biopsy and postoperative specimens of the upgrade group. The consistency of the expression of P504S was examined between the biopsy specimens and the postoperative specimens in the LGIN group and the upgrade group. Receiver operator characteristic (ROC) curve of the prediction of pathological upgrading was drawn by the results of P504S in biopsy, and the cutoff value of immunohistochemical staining score was calculated.Results:The positive rate of P504S in the biopsy specimens of the LGIN group (46.8%, 36/77) was lower than that in the biopsy specimens of the upgrade group (73.2%, 30/41) with significant difference ( P=0.006). The positive rate of P504S in the postoperative specimens of the LGIN group (51.9%, 40/77) was lower than that in the postoperative specimens of the upgrade group (82.9%, 34/41) with significant difference ( P=0.001). In the LGIN group, the positive rate of P504S in biopsy specimens (46.8%, 36/77) was lower than that in postoperative specimens (51.9%, 40/77) without significant difference ( P=0.289). The expression of P504S was consistent between biopsy specimens and postoperative specimens with good consistency( K=0.793, P<0.001). In the upgrade group, the positive rate of P504S in biopsy specimens (73.2%, 30/41) was lower than that in the postoperative specimens (82.9%, 34/41) without significant difference ( P=0.219). The expression of P504S was consistent between biopsy and postoperative specimens, and the consistency was general ( K=0.579, P<0.001). ROC curve was drawn for the prediction of pathological upgrading by the results of P504S in biopsy, and the cutoff value of immunohistochemical staining score was 100. The sensitivity and specificity of pathological upgrading for positive result were 0.659 and 0.740, respectively. Conclusion:P504S staining of the postoperative specimens facilitates identification of the degree of gastric mucosal neoplasia. When the cutoff value of staining score is 100, the staining of P504S in biopsy tissue plays a role in predicting the pathological upgrading.
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Objective To evaluate the value of near focus narrow-band imaging ( NF-NBI ) in differentiating hyperplastic polyp ( HP ) and sessile serrated adenomas/polyp ( SSA/P ) . Methods Data of 65 cases of pathologically confirmed HP or SSA/P with clear NF-NBI images in Huadong Hospital Affiliated to Fudan University from October 2017 to September 2018 were retrospectively analyzed. Three senior doctors observed the images of NF-NBI, including expanded crypt opening ( ECO ) and thick & branched vessel ( TBV) . The results were compared with pathological results in order to analyze differential diagnostic value of ECO and TBV for HP and SSA/P. Results Among 65 lesions, 44 were SSA/P and 21 were HP. The sensitivity, specificity, and accuracy of ECO, TBV, and ECO combined with TBV for differential diagnosis between HP and SSA/P were 80. 3％( 106/132 ) , 85. 7％( 54/63 ) and 82. 1％( 160/195 ); 38. 6％( 51/132) , 82. 5％( 52/63 ) , and 52. 8％( 103/195 ); and 84. 8％( 112/132 ) , 73. 0％( 46/63 ) , and 81. 0％(158/195), respectively. Conclusion ECO under NF-NBI has a high sensitivity for diagnosis of SSA/P . ECO combined with TBV is helpful for differential diagnosis between HP and SSA/P .
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Objective To investigate the risk factors of pathological discrepancy between biopsy and excisional specimen from gastric low-grade intraepithelial neoplasia (LGIN) and early gastric cancer (EGC). Methods A retrospective analysis was conducted on the data of 235 patients who underwent endoscopic submucosal dissection or surgical resection and diagnosed as LGIN or EGC ( including high-grade intraepithelial neoplasia) by postoperative pathology. Patients were grouped by whether there was significant pathological discrepancy between biopsy and excisional specimen. Univariate and multivariate analyses were used to analyze the risk factors for significant pathological discrepancy. Results Significant pathological discrepancy occurred in 33 cases (14. 0%). Univariate analysis showed that protruding lesion, non-reddish surface, without erosion or ulcer, diffused pathological type and number of biopsy were related to the pathological discrepancy (all P＜0. 05). Multivariate analysis suggested that small number of biopsy blocks (OR＝0. 574, 95%CI: 0. 363-0. 908, P＝0. 018) was an independent risk factor for significant pathological discrepancy. Conclusion The pathological discrepancy between biopsy and excisional specimen from gastric LGIN and EGC are common. Multiple biopsies can improve the accuracy of biopsy and reduce the occurrence of pathological discrepancy with excisional specimen.
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Objective To determine risk factors for the miss rate of colorectal adenomas during colonoscopy.Methods A total of 981 patients,diagnosed as having at least one polyp in colonoscopy,received a second colonoscopy in 6 months from November 2012 to March 2016.All polyps were removed in the second colonoscopy.Bio-information of patients such as sex,age,surveillance interval and features of polyps such as number,size,shape,location,pathology,withdrawal time,bowel preparation was retrospectively analyzed.Factors associated with the miss rates in these patients were analyzed with Chisquare and was also analyzed with Logistic regression model for multiple factors.Results A total of 981 patients were selected according to the inclusion and exclusion criteria,including 604 males and 377 females.Miss rates of males and females were 38.9％ (235/604) and 27.9％ (105/377) (P＜0.01)respectively.Age ranged from 25 to 87 years with mean age being 61.0±9.7 years.Miss rates of senior patients ＜65 and ≥65 years were 31.5％(195/619) and 40.1％(145/362) respectively (P＜0.01).A total of 1 728 adenomas were found in first colonoscopy.A total of 2 267 adenomas were found in the second colonoscopy.The adenoma miss rate was 23.8％ (539/2 267).The miss rate of adenoma whose size ≤ 5 mm was 42.5％ (311/732);and that of larger size of 6 to 9 mm was 17.8％ (194/1 090);that of even larger size,i.e.,≥10 mm,was 7.6％(34/445)(P＜0.01).Miss rates of Is,Isp,Ip,LST and Ⅱ adenomas in shape were 28.4％(489/1 720),9.3％(24/235),6.6％ (12/182),9.0％(6/67) 20.5％ (8/39) respectively (P＞0.05).Location with highest adenoma miss rate were descending colon,ascending colon and transverse colon,27.8％(64/230),25.5％(120/470),25.5％ (161/632) respectively.Miss rates of high and low risk adenoma were 44.8％ (277/618) and 17.4％ (63/363) (P＜0.01).The highest adenoma miss rate of all the pathology type was tubular adenoma.The adenoma miss rate was 26.9％ (449/1 671) (P＜0.01).Miss rates of good and poor bowel preparation were 30.2％ (271/897) and 82.1％ (69/84) (P＜0.01).Miss rates of adequate and inadequate withdrawal time were 24.3％ (174/717) and 62.9％ (166/264) (P＜0.01).Conclusion Male,old-age,diameter ≤ 5 mm,poor bowel preparation and inadequate withdrawal time,high risk adenoma are the risk factors for missed adenoma.But the shape and location of adenoma are not the risk factors.
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Background:Colonoscopy is considered as a standard method for detecting various kinds of colorectal polyps. However,conventional colonoscopy( CC)still has the chance to miss some lesions. Literatures have already reported that transparent hood assisted colonoscopy( THAC)can improve the detection of colorectal polyps. However,the effect of black hood assisted colonoscopy( BHAC)on detection of colorectal polyps is still unclear. Aims:To evaluate the effect of BHAC on detection of colorectal polyps. Methods:A total of 1 076 patients underwent CC and BHAC from Sept. 2014 to April 2015 at Huadong Hospital Affiliated to Fudan University were enrolled in this prospective randomized controlled study. Baseline characteristics,cecal intubation time,withdrawal time,number of polyps,detection rate of polyps,location, size,morphology and pathological diagnosis of polyps between two groups were compared. Results:Compared with CC group,cecal intubation time was significantly shorter in BHAC group than in CC group[(6. 31 ± 3. 51)min vs.(7. 05 ± 4. 15)min,P=0. 002]. No significant differences in withdrawal time and rate of cecal intubation were found between two groups(P>0. 05). Detection rate of polyps was significantly higher in BHAC group than in CC group(65. 4% vs. 48. 7%,P=0. 004). No significant differences in size,morphology of polyps were found between two groups(P>0. 05). Conclusions:Compared with CC,BHAC could significantly improve the detection of colorectal polyps,and shorten cecal intubation time.