Modified submucosal tunnelling endoscopic septum division for symptomatic esophageal diverticula is effective and safe: a prospective case series (with video).

BACKGROUND AND AIMS: Submucosal tunneling endoscopic septum division (STESD) is a valid endoscopic modality for treating esophageal diverticula. However, it requires highly skilled endoscopists. Here we propose a modified STESD method. METHODS: This is a single center prospective case series. We consecutively enrolled 8 patients diagnosed with esophageal diverticula. All the patients underwent the modified STESD by one experienced endoscopist. RESULTS: Only one patient had intraoperative bleeding and was successfully stopped endoscopically. The size of the diverticula were 3.16 ± 1.14 cm as mean ± SD. The operation time ranged from 27 to 68 min with the mean value of 40.88 min. The number of clips ranged from 4 to 8. The success rate was 100%. None of the patients had symptom recurrences during 2 - 25 months of follow-up. CONCLUSIONS: The modified STESD method for esophageal diverticula is effective and safe, further large prospective controlled studies are needed.

ESD with elastic ring traction is more effective and safer than conventional ESD in large proximal colon neoplastic lesions: a retrospective cohort study (with video).

BACKGROUND AND AIMS: Colorectal endoscopic submucosal resection (ESD), especially ESD in proximal colon, has always been challenging. We invented a novel elastic ring as a traction method to facilitate ESD. Our study aims to compare the safety and effectiveness of ESD with in vivo traction and conventional ESD without traction in the treatment of large proximal colon neoplastic lesions. METHODS: This retrospective cohort study included consecutive patients with large (≥ 20 mm in their maximal diameter) proximal colon neoplastic lesions who underwent ESD with in vivo elastic ring traction or conventional ESD without traction in our endoscopy center between June 2018 and April 2022 by one experienced endoscopist. RESULTS: The ESD with traction group has lower overall complication rate and lower perforation rate than those in the conventional ESD group (0% vs 14.71%, P = 0.021; 0% vs 11.76%, P = 0.048, respectively), and the differences are statistically significant. Although there are no significant differences in the rates of en bloc resection and R0 resection and bleeding rate, ESD with traction group still had higher en bloc resection and R0 resection rates and lower bleeding rate than conventional ESD group without traction (100% vs 94.12%, P = 0.226; 94.59% vs 85.29%, P = 0.189, 8.82% vs 2.70%, P = 0.276, respectively). CONCLUSION: ESD with elastic ring traction is potentially more effective and safer than conventional ESD in the treatment of large proximal colon neoplastic lesions. Further large, prospective controlled studies are needed to fully evaluate this novel method.

The evaluation of quality of life in the aged patients with ulcerative colitis / 中华老年医学杂志

Objective To investigate the quality of life (QOL) and its influential factors in the aged patients with ulcerative colitis (UC).Methods A cross-sectional survey of the UC patients was conducted by Chinese version of inflammatory bowel disease questionnaire (C-IBDQ).The influential factors for QOL in elderly patients with UC were evaluated and analyzed by correlation analysis and multiple linear regression analysis.Results A total of 90 aged UC patients finished the questionnaire study.The overall score of QOL in the aged UC patients was (175.7±37.6),and the score of each item was decreased,especially in the aspect of economic burden,emotional function and systemic symptoms.Multiple linear regression analysis indicated that the influential factors for QOL were sex,disease severity,duration,disease activity and the payment.The scores of bowel symptoms were higher in men than in women [(53.9±12.1) vs.(49.1±10.5),P=0.049].The QOL scores were lower in patients with the duration less than one year than over one year (P＜ 0.05).The QOL scores were lower in severe patients than in mild patients (P＜ 0.05).The QOL scores were lower in patients during active period than during remission period [(149.7 ± 35.1) vs.(193.9 ± 27.3),t=6.731,P=0.000].The QOL scores of patients whose medical cost was mainly paid by themselves were lower than those paid by insurance.And there were significant differences in systemic symptom,social function and economic burden (all P＜ 0.05).Conclusions The QOL of the aged UC patients is impaired in varying degree.The influential factors for QOL are sex,disease severity,duration,disease activity and the payment.The QOL in UC patients is obviously affected by economic burden.