Effective factors of peroral endoscopic myotomy for treatment of achalasia.

Introduction: Achalasia (AC) is an esophageal motility disorder clinically manifested as dysphagia. Aim: To investigate the effective factors of peroral endoscopic myotomy (POEM) for AC treatment. Material and methods: A total of 182 AC patients treated between August 2019 and September 2020 were enrolled to receive POEM. They were assigned to an effective group (n = 143) and an ineffective group (n = 39). Their clinical data were recorded. The biochemical indices were determined. Results: Compared with the ineffective group, the Eckardt score and incidence of reflux 1 year after the operation were lower in the effective group, and the effective rate 6 months and 1 year after the operation was higher (p < 0.05). Significant differences were observed in drinking history, Eckardt score 1 year after the operation, hemoglobin (Hb), alanine aminotransferease (ALT), white blood cells (WBC), interleukin-6 (IL-6) and high sensitivity C-reactive protein (hs-CRP) between the two groups (p < 0.05). The Eckardt score 1 year after the operation, WBC, IL-6 and hs-CRP were lower, while the levels of Hb and ALT were higher in the effective group than those in the ineffective group. Multivariate logistic analysis revealed that drinking history, Eckardt score at 1 year after the operation, Hb, ALT, WBC, IL-6, and hs-CRP were independent factors affecting the therapeutic effect of POEM on AC. The results were well fitted by evaluation discrimination and calibration of the nomogram model, with good consistency. Conclusions: POEM is safe, feasible and effective for AC treatment, based on factors such as drinking history, Eckardt score 1 year after the operation, Hb, ALT, WBC, IL-6, and hs-CRP.

Efficacy and Safety Analysis of Submucosal Tunnel Endoscopic Resection for Submucosal Masses in Esophageal Muscularis Propria.

Objective: To analyze the efficacy and safety of submucosal tunnel endoscopic resection (STER) for the treatment of submucosal masses in esophageal muscularis propria. Method: A total of 272 patients with submucosal masses in esophageal muscularis propria diagnosed and treated in our hospital from February 2019 to January 2022 were randomly selected for the study and then were randomly divided into the STER group (n = 136) and the endoscopic mucosal dissection (ESD) group (n = 136) according to the random number table method. Patients in the STER and ESD groups were treated with STER and ESD, respectively. The clinical data of patients from the two groups were collected and compared. The clinical effects and the changes of surgery-related indexes of patients after ESD and STER treatment were observed. The safety of ESD and STER was compared. The factors influencing the efficacy of STER treatment for submucosal masses in esophageal muscularis propria were analyzed. Result: There were significant differences between the STER group and the ESD group in terms of tumor size, lesion level, adhesion and surgical approaches (P < 0.05). The effective rates of ESD treatment and STER treatment were 98.53% and 88.97%, respectively. Meanwhile, the effective rates of STER treatment were significantly higher than those in the control group (P < 0.05). In addition, the patients in the STER group had longer operation time, less blood loss, and shorter hospital stay compared with those in the ESD group (P < 0.05). Adverse reactions occurred during ESD treatment and STER treatment included delayed bleeding, adhesion, perforation, and pleural effusion with the total incidence of adverse reactions of 4.41% and 13.97%, respectively. The adverse reactions in STER group were prominently less than these in the ESD group (P < 0.05). Logistic multivariate regression analysis showed that independent risk factors, including tumor size, lesion level, adhesion, and surgical approaches, affected the efficacy of STER in the treatment of submucosal masses in esophageal muscularis propria (P < 0.05). Conclusion: STER is an effective method for the treatment of submucosal masses in esophageal muscularis propria, which can exhibit a good effect with faster postoperative recovery and higher safety, thereby being worthy of clinical application and promotion. Tumor size, lesion level, adhesion, and surgical approaches are all related factors affecting the effect of STER treatment.

Acute pancreatitis associated with duodenal obstruction induced by groove pancreatitis: A case report.

RATIONALE: Groove pancreatitis (GP) is a rare form of chronic pancreatitis. Since GP presents with nonspecific symptoms, it can be challenging to diagnose. Duodenal obstruction is often caused by malignant diseases; however, when associated with acute pancreatitis, it is rarely induced by groove pancreatitis. PATIENTS CONCERNS: A 56-year-old man who presented with acute pancreatitis complained of recurrent upper abdominal discomfort. His concomitant symptoms included abdominal pain, postprandial nausea, and vomiting. Contrast-enhanced computed tomography (CT) of the abdomen showed thickening of the duodenum wall. Gastrointestinal radiographs and upper gastrointestinal endoscopy showed an obstruction of the descending duodenum. DIAGNOSIS: The pathologic diagnosis was groove pancreatitis. INTERVENTIONS: The patient underwent gastrojejunostomy to relieve the obstruction. OUTCOMES: The patient had an uneventful recovery with no complications. LESSONS: Groove pancreatitis should be considered in the differential diagnosis of patients presenting with acute pancreatitis and duodenal obstruction. These data can help to make a precise diagnosis and develop an appropriate treatment plan.

Feasibility and Efficacy of Transient Elastography using the XL probe to diagnose liver fibrosis and cirrhosis: A meta-analysis.

BACKGROUND: Transient elastography (TE) has been validated as an effective noninvasive tool for the assessment of liver fibrosis. The XL probe is a new probe that was initially designed for use in patients with obesity. A meta-analysis was performed to assess the feasibility and efficacy of TE using the XL probe. METHODS: In September 2016, we systematically searched the PubMed and Science Direct search engines. The feasibility of TE was evaluated based on the failure rate and the results of the unreliable liver stiffness measurement (LSM). The efficacy of TE was measured using sensitivity, specificity, and summary receiver-operating characteristic as measures/indices assessed in different stages of fibrosis. Heterogeneity was measured using the chi-squared test and the Q-statistic. We used the 95% confidence interval (95% CI) as an effect measure. RESULTS: We included 8 studies in the meta-analysis. When the XL was compared to the M probe, the former showed a lower risk of failure rate [relative risk (RR) 0.24, 95% CI 0.14-0.38]. In patients with a body mass index ≥30 kg/m, the XL probe showed a statistically significantly lower risk of failure rate (RR 0.16, 95% CI 0.08-0.32) but no significant improvement (RR 0.76, 95% CI 0.50-1.16) in the unreliable LSM result. In patients showing liver fibrosis stage ≥F2, the XL probe showed a sensitivity of 0.56 (95% CI 0.39-0.72), specificity of 0.71 (95% CI 0.61-0.79), and an area under the curve (AUC) of 0.71. The results observed in patients with liver fibrosis stage F4 were more promising with a sensitivity of 0.84 (95% CI 0.76-0.90), specificity of 0.78 (95% CI 0.70-0.84), and an AUC of 0.88. CONCLUSION: TE using the XL probe demonstrates significant diagnostic utility in patients with liver fibrosis and is likely to be more reliable than the M probe in patients with obesity. Large prospective multicenter studies are, however, necessary to establish the new cut-off values to be used for the XL probe in patients with obesity.

Incidence and clinical characteristics of inflammatory bowel disease in a developed region of Guangdong Province, China: a prospective population-based study.

BACKGROUND AND AIMS: The incidence of inflammatory bowel disease (IBD) is increasing in China with urbanization and socioeconomic development. There is however a lack of prospective, population-based epidemiology study on IBD in China. The aim of the study is to define the incidence and clinical characteristics of IBD in a developed region of Guangdong Province in China. METHODS: A prospective, population-based incidence study was conducted from July 2011 to June 2012 in Zhongshan, Guangdong, China. All newly diagnosed IBD cases in Zhongshan were included. RESULTS: In total, 48 new cases of IBD (17 Crohn's disease [CD]; 31 ulcerative colitis [UC]) were identified over a 1-year period from July 2011. Age-standardized incidence rates for IBD, UC, and CD were 3.14, 2.05, and 1.09 per 100,000 persons, respectively. The median age of UC was 38, and that of CD was 25. Terminal ileum involvement only (L1), isolated colonic disease (L2), and ileocolonic disease (L3) were reported in 24%, 6%, and 71% of patients with CD, respectively. Twenty-four percent of patients had coexisting upper gastrointestinal disease (L4). Inflammatory (B1), stricturing (B2), and penetrating (B3) behavior were seen in 65%, 24%, and 12% of CD patients, respectively. Fifty-nine percent of CD and 26% of UC patients had extra-intestinal manifestations. CONCLUSIONS: This is the first prospective, population-based IBD epidemiological study in a developed region of China. The incidence of IBD is similar to that in Japan and Hong Kong but lower than that in South Korea and Western countries.