Endoscopic submucosal dissection and endoscopic mucosal resection rely on submucosal injection cushions to effectively separate lesions from the muscularis propria,thereby expanding the operative field,improving resec...Endoscopic submucosal dissection and endoscopic mucosal resection rely on submucosal injection cushions to effectively separate lesions from the muscularis propria,thereby expanding the operative field,improving resection precision,and minimizing procedure-related complications.Although recent advances have yielded cushions with enhanced lift durabilities and biofunctional properties,their widespread clinical adoption remains limited.Key barriers include poor injectability,uncertain long-term biocompatibility,restricted multifunctionality,manufacturing and supply chain constraints,and a lack of robust clinical and reimbursement evidence.This article comprehensively evaluated the current submucosal injection materials and assessed their mechanical performance,biocompatibility,and intraoperative usability.It compares conventional agents with emerging functionalized materials,identifies critical translational hurdles,and proposes actionable strategies to overcome them.These include the implementation of standardized biosafety protocols,early engagement with regulatory agencies,optimization of production processes,and incorporation of clinical and cost-effectiveness analyses.Bridging the gap between laboratory innovation and routine clinical use requires coordinated efforts across biomaterial research,industrial scalability,regulatory science,and health policies.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bl...Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa,thereby preserving organ function and reducing the need for more radical surgical interventions.ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal,gastric,and colorectal carcinomas.This article examines the indications,procedural advancements,technical considerations,and outcomes associated with ESD in early GI cancers.The challenges and complications that can arise are also highlighted.Additionally,we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy.As the field progresses,ESD remains a cornerstone in managing early GI cancers,offering patients a promising option for organ preservation and long-term survival.展开更多
Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western wo...Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western world, its implementation has been slow and laborious. In this paper, the indications for ESD, its learning model, the available methods to predict the presence of deep submucosal invasion before the procedure and the published outcomes from Asia and Europe will be reviewed. Since ESD has several limitations in terms of learning achievement in the West, and completion of the procedure for the first cases is difficult in our part of the world, a short review on colorectal assisted ESD has been included. Finally, other endoscopic and surgical treatment modalities that are in competition with colorectal ESD will be summarized.展开更多
Hypoxemia is a common pathological state characterized by low oxygen saturation in the blood.This condition compromises mucosal barrier integrity particularly in the gut and oral cavity.However,the mechanisms underlyi...Hypoxemia is a common pathological state characterized by low oxygen saturation in the blood.This condition compromises mucosal barrier integrity particularly in the gut and oral cavity.However,the mechanisms underlying this association remain unclear.This study used periodontitis as a model to investigate the role of platelet activation in oral mucosal immunopathology under hypoxic conditions.Hypoxia upregulated methyltransferase-like protein 4(METTL4)expression in platelets,resulting in N6-methyladenine modification of mitochondrial DNA(mtDNA).This modification impaired mitochondrial transcriptional factor A-dependent cytosolic mtDNA degradation,leading to cytosolic mtDNA accumulation.Excess cytosolic mt-DNA aberrantly activated the cGAS-STING pathway in platelets.This resulted in excessive platelet activation and neutrophil extracellular trap formation that ultimately exacerbated periodontitis.Targeting platelet METTL4 and its downstream pathways offers a potential strategy for managing oral mucosa immunopathology.Further research is needed to examine its broader implications for mucosal inflammation under hypoxic conditions.展开更多
Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,h...Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,however,the development of anti-reflux mucosal intervention(ARMI),a novel strategy for treating GERD,has provided hope to such patients.ARMI comprises three main steps:Anti-reflux mucosectomy,anti-reflux mucosal ablation,and peroral endoscopic cardial constriction.ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents.This study compares different ARMI techniques,their therapeutic efficacy in treating GERD,indications and contraindications,endoscopic operational procedures,perioperative management,and adverse events,in an attempt to provide clinical guidance.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized ...BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.展开更多
BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia,which pose considerable challenges for endo-scopic surgical interventions.CASE SUMMARY We presen...BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia,which pose considerable challenges for endo-scopic surgical interventions.CASE SUMMARY We present a case involving early-stage esophageal cancer discovered in a resting room,notable for the rare manifestation of esophageal mucosal bridging.Following a comprehensive multidisciplinary discussion and the development of a treatment strategy,we proceeded with endoscopic submucosal dissection for the patient.During the procedure,we encountered operational challenges due to the presence of a diverticulum and a partial absence of the muscularis propria.To facilitate the retraction of a portion of the resected specimen,we utilized dental floss.Ultimately,we successfully excised the entire lesion.After a three-day period of fasting with a water-only diet,subsequent iodine water cholan-giography did not indicate any perforations,and the patient was advised to transition to a liquid diet.The patient was discharged five days post-operation.A follow-up endoscopy conducted three months later revealed scar-like changes in the mid-esophagus,with the patient reporting no significant discomfort.CONCLUSION In summary,although esophageal mucosal bridges are rarely documented,they should be considered in the differential diagnosis of mechanical dysphagia.Furthermore,endoscopic therapy represents a feasible approach for their mana-gement.展开更多
BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conver...BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conversational artificial intelligence(AI)tools like chat generative pretrained transformer(ChatGPT)are rapidly emerging as sources of medical information.AIM To evaluate ChatGPT’s reliability and usefulness regarding ESD and EMR for patients and healthcare professionals.METHODS In this study,30 specific questions related to ESD and EMR were identified.Then,these questions were repeatedly entered into ChatGPT,with two independent answers generated for each question.A Likert scale was used to rate the accuracy,completeness,and comprehensibility of the responses.Meanwhile,a binary category(high/Low)was used to evaluate each aspect of the two responses generated by ChatGPT and the response retrieved from Google.RESULTS By analyzing the average scores of the three raters,our findings indicated that the responses generated by ChatGPT received high ratings for accuracy(mean score of 5.14 out of 6),completeness(mean score of 2.34 out of 3),and comprehensibility(mean score of 2.96 out of 3).Kendall’s coefficients of concordance indicated good agreement among raters(all P<0.05).For the responses generated by Google,more than half were classified by experts as having low accuracy and low completeness.CONCLUSION ChatGPT provided accurate and reliable answers in response to questions about ESD and EMR.Future studies should address ChatGPT’s current limitations by incorporating more detailed and up-to-date medical information.This could establish AI chatbots as significant resource for both patients and health care professionals.展开更多
Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic sub...Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.展开更多
BACKGROUND To observe the endoscopic and pathological characteristics of laterally spreading tumors(LSTs)and explore the risk factors for carcinogenesis and submucosal infiltration.AIM To analyze the clinicopathologic...BACKGROUND To observe the endoscopic and pathological characteristics of laterally spreading tumors(LSTs)and explore the risk factors for carcinogenesis and submucosal infiltration.AIM To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion,providing evidence-based guidance for optimal treatment strategy selection.METHODS This study retrospectively analyzed the sex,age,and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024.Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration,and the factors with statistical significance were included in multivariate logistic regression analysis.RESULTS A total of 422 patients,including 224 males and 198 females,aged 63.45±9.23 years,were included.There were 456 LST lesions in total.The length of the endoscopically resected specimens was 3.01±0.48 cm,and the length of the lesions was 2.37±1.59 cm.It was located in 115 rectums(25.2%),40 sigmoid colon(8.8%),26 descending colon(5.7%),109 transverse colon(23.9%),112 ascending colon(24.6%),and 54 ileocecal regions(11.8%).Endoscopic submucosal dissection(ESD)was performed in 237 patients(52.0%),and endoscopic mucosal resection(EMR)was performed in 95 patients(20.8%).There were 113 EMR with precutting cases(24.8%),11 ESD with snare cases(2.4%),4 delayed bleeding cases and 5 intraoperative perforations.The pathological results revealed 119 cases of low-grade intraepithelial neoplasia(26.1%),221 cases of high-grade intraepithelial neoplasia(48.5%),82 cases of intramucosal carcinoma(18.0%),and 34 cases of submucous invasive carcinoma(7.5%).Multiple logistic regression analyses revealed that lesion size(>2 cm),lesion location(rectal)and endoscopic classification[false depressed tubulovillous adenoma(LST-NG pseudodepressed type,LST-NG-PD),type 1 particles(LST-G homogenous type),and LST-G nodular mixed type],accompanied by large nodules(with)were independent risk factors for carcinogenesis;endoscopic classification(LST-NG-PD)and the presence of large nodules were independent risk factors for submucosal infiltration.CONCLUSION These risk factors provide practical guidance for treatment selection:LST-NG-PD with large nodules should prioritize ESD,while high-risk rectal lesions>2 cm may require additional imaging evaluation before endoscopic resection.展开更多
Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in o...Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in our hospital between April 2022 and March 2024 were selected and divided into the control group and the observation group using the mean score method,each with 35 cases.In the control group,traditional endoscopic mucosal resection(EMR)was performed,and in the observation group,modified EMR(endoscopic mucosal resection with ligation apparatus[EMR-L])was performed.The operation time,hospitalization time,operation cost,and related complication rate of the two groups of patients were compared.Results:The operation time(20.36±1.46 min)and hospital stay(3.37±0.51 d)of patients in the observation group were shorter than those of the control group(31.44±2.65 min and 4.73±0.49 d).The cost of the operation in the observation group(7,695.85±1,521.42 yuan)was lower than that of the control group(8,418.62±1219.30 yuan),and the difference was statistically significant(P<0.05).The total incidence of postoperative related complications in the observation group was observed to be 11.42%,which was significantly lower than that of 31.42%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of modified EMR in R-NETs is remarkable,which can not only effectively shorten the operation time and hospital stay,but also further reduce the risk of related complications,and indirectly save a large amount of hospital costs;thus,it is recommended to be promoted and applied clinically.展开更多
Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the ea...Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the early diagnosis and treatment of patients with such tumors,and thus improving their prognosis.Methods:Seventy-two patients with rectal neuroendocrine tumors who underwent surgical treatment in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method,each with 36 cases.In the control group,traditional foreign body forceps combined with laparoscopic resection were performed,and in the observation group,modified EMR and ESD were performed as needed.The mass resection rate,histologically intact resection rate,postoperative serum vascular endothelial growth factors(VEGFA,VEGFB,VEGFC levels)in the postoperative period of 7d,and indicators of the rate of related complications of the two groups of patients were compared.Results:The mass resection rate of 91.67%and histological complete resection rate of 94.44%in the observation group were significantly higher than those of 72.22%and 66.67%in the control group;the VEGFA,VEGFB,and VEGFC levels of the observation group were 82.08±7.94 ng/ml,168.89±16.53 ng/ml,and 121.07±10.75 ng/ml,respectively,in the postoperative period of 7 d after surgery;the levels were significantly higher than those of the control group:68.39±6.82 ng/ml,141.06±14.12 ng/ml,and 98.45±9.87 ng/ml,respectively,and the difference was statistically significant(P<0.05);the patients in the observation group had a lower rate of surgical complications than those in the control group(2.78%vs 8.33%),the difference was not statistically significant(P>0.05).Conclusion:Modified EMR and ESD in rectal neuroendocrine tumors are effective,not only can it effectively improve the rate of mass resection and histological integrity of the resection rate,but it can also further improve the level of serum vascular endothelial growth factor(VEGFA,VEGFB,VEGFC);thus,it is recommended to be promoted for use in clinical practice.展开更多
BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver d...BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.展开更多
BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD....BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.展开更多
BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significan...BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.展开更多
BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to ...BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation.The pathophysiology of functional constipation(FC)is associated with a reduction in mucin-2(MUC2)secretion and microbial dysbiosis.AIM To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.METHODS Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action.FC model was induced via loperamide gavage(16 mg/kg)twice daily for 7 days.Applying defecation function and gastrointestinal motility to assess constipation severity.Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology.Transmission electron microscope was used to observe the ultrastructure of goblet cells(GCs).Immunofluorescence colocalization,quantitative PCR,and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway.16S rDNA was employed to sequence the gut mucosal microbiota.RESULTS RCNSP contained 12 components with potential laxative effects.It enhanced defecation function,accelerated gastrointestinal motility,and maintained colonic mucosal integrity.RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure.At the molecular level,RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway.Through 16S rDNA sequencing analysis,RCNSP significantly altered the mucosal microbiota composition.Specifically,it increased beneficial bacterial strains while reducing harmful ones.Simultaneously,RCNSP reduced butyrate-producing bacteria like Proteobacteria,Enterobacteriaceae,Blautia,and Eubacterium and decreased hydrogen sulfide-producing species,such as Prevotellaceae.It also reduced bile acidinhibiting species,such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acidproducing species,such as Colidextribacter.CONCLUSION Our findings suggested that RCNSP ameliorated constipation through a dual mechanism:It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.展开更多
This review emphasizes the exemplary safety and efficacy of rebamipide in the treatment of gastric ulcers and other mucosa-related disorders,positioning it as a viable candidate for inclusion in treatment guidelines a...This review emphasizes the exemplary safety and efficacy of rebamipide in the treatment of gastric ulcers and other mucosa-related disorders,positioning it as a viable candidate for inclusion in treatment guidelines across India and globally.An in-depth literature review of rebamipide was carried out on PubMed and Google Scholar.Rebamipide has a multifaceted mechanism of action,including prostaglandin synthesis,scavenging free radicals,and enhancing mucin produc-tion,leading to enhanced mucosal protection and ulcer healing.Rebamipide serves as a highly effective and safe treatment option for gastric ulcers and gas-troesophageal reflux disease.The efficacy of this drug in treating ulcers often surpasses that of routinely used agents such as pantoprazole,sucralfate,misop-rostol,famotidine,lansoprazole,and esomeprazole.This superiority of rebami-pide can be attributed to the low rate of adverse events associated with it and its mild side effects,contributing to its widespread adoption across Southeast Asia and Russia.This popularity extends to its application beyond gastrointestinal ailments.Notably,it has been successfully employed in the treatment of ophthal-mological,oncological,and bone regeneration-related issues.Rebamipide's exemplary safety and efficacy in treating gastric ulcers and other mucosa-related disorders support its potential for inclusion in treatment guidelines,not only in India but also globally.展开更多
In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance w...In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance with an area under the curve exceeding 0.90.However,limitations exist regarding its narrow temporal scope,potential overestimation due to feature collinearity and imputation opacity,and limited generalizability due to single-center derivation and validation.Moreover,no clear clinical implementation strategy was outlined.Prospective multicenter validation and integration of endoscopist variability,longitudinal outcome data,and deployment mechanisms are warranted to ensure broader applicability and clinical utility.展开更多
BACKGROUND The duodenum plays a significant role in metabolic regulation,and thickened mucous membranes are associated with insulin resistance.Duodenal mucosal resurfacing(DMR),a new-style endoscopic procedure using h...BACKGROUND The duodenum plays a significant role in metabolic regulation,and thickened mucous membranes are associated with insulin resistance.Duodenal mucosal resurfacing(DMR),a new-style endoscopic procedure using hydrothermal energy to ablate this thickened layer,shows promise for enhancing glucose and lipid metabolism in type 2 diabetes(T2D)patients.However,the mechanisms driving these improvements remain largely unexplored.AIM To investigate the mechanisms by which DMR improves metabolic disorders using a rat model.METHODS Rats with T2D underwent a revised DMR procedure via a gastric incision using a specialized catheter to abrade the duodenal mucosa.The duodenum was evaluated using histology,immunofluorescence,and western blotting.Serum assays measured glucose,lipid profiles,lipopolysaccharide,and intestinal hormones,while the gut microbiota and metabolomics profiles were analyzed through 16S rRNA gene sequencing and ultra performance liquid chromatography-mass spectrum/mass spectrum,severally.RESULTS DMR significantly improved glucose and lipid metabolic disorders in T2D rats.It increased the serum levels of cholecystokinin,gastric inhibitory peptide,and glucagon-like peptide 1,and reduced the length and depth of duodenal villi and crypts.DMR also enhanced the intestinal barrier integrity and reduced lipopolysaccharide translocation.Additionally,DMR modified the gut microbiome and metabolome,particularly affecting the Blautia genus.Correlation analysis revealed significant links between the gut microbiota,metabolites,and T2D phenotypes.CONCLUSION This study illustrates that DMR addresses metabolic dysfunctions in T2D through multifaceted mechanisms,highlighting the potential role of the Blautia genus on T2D pathogenesis and DMR’s therapeutic impact.展开更多
BACKGROUND Colon polyps represent a significant clinical challenge in elderly patients.While endoscopic mucosal resection(EMR)and argon plasma coagulation(APC)are widely used,their comparative effectiveness in elderly...BACKGROUND Colon polyps represent a significant clinical challenge in elderly patients.While endoscopic mucosal resection(EMR)and argon plasma coagulation(APC)are widely used,their comparative effectiveness in elderly populations remains unclear,particularly regarding postoperative recovery and complication profiles.AIM To compare the postoperative recovery,complications and efficacy of EMR and APC in elderly patients with colonic polyps.METHODS We retrospectively analyzed clinical data from 224 elderly patients with colon polyps treated at our center between January 2021 and July 2024.All patients were divided into the EMR group and APC group according to the surgical method they received.By comparing the operation time,intraoperative bleeding situation,hospital stays,postoperative inflammatory response index,complication rate and recurrence status of the two groups,the effect of the two surgical methods was comprehensively evaluated.RESULTS The APC group exhibited superior outcomes in terms of operative time(10.63 minutes vs 13.27 minutes,P<0.001),intraoperative bleeding situation(39.00%vs 52.42%,P=0.031),and length of hospital stay(1.63 days vs 3.87 days,P<0.001)compared to the EMR group.The one-time resection rate of the APC group(94.69%)was higher than that of the EMR group(89.14%)(P=0.026).The overall effective rates of the two groups were 94.35%and 92.00%,respectively.Postoperative procalcitonin and C-reactive protein levels were lower in the APC group than in the EMR group(P<0.001).The incidence of complications was comparable between the two groups(P=0.159).The recurrence rate was lower in the APC group(2.00%)than in the EMR group(8.06%)(P=0.045).CONCLUSION For elderly patients with colon polyps,APC showed certain advantages compared with EMR in promoting postoperative recovery,reducing the inflammatory response and the risk of complications.However,the study is limited by its single-center retrospective design and short follow-up period,and further multicenter prospective studies are needed to validate the findings.展开更多
文摘Endoscopic submucosal dissection and endoscopic mucosal resection rely on submucosal injection cushions to effectively separate lesions from the muscularis propria,thereby expanding the operative field,improving resection precision,and minimizing procedure-related complications.Although recent advances have yielded cushions with enhanced lift durabilities and biofunctional properties,their widespread clinical adoption remains limited.Key barriers include poor injectability,uncertain long-term biocompatibility,restricted multifunctionality,manufacturing and supply chain constraints,and a lack of robust clinical and reimbursement evidence.This article comprehensively evaluated the current submucosal injection materials and assessed their mechanical performance,biocompatibility,and intraoperative usability.It compares conventional agents with emerging functionalized materials,identifies critical translational hurdles,and proposes actionable strategies to overcome them.These include the implementation of standardized biosafety protocols,early engagement with regulatory agencies,optimization of production processes,and incorporation of clinical and cost-effectiveness analyses.Bridging the gap between laboratory innovation and routine clinical use requires coordinated efforts across biomaterial research,industrial scalability,regulatory science,and health policies.
文摘Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa,thereby preserving organ function and reducing the need for more radical surgical interventions.ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal,gastric,and colorectal carcinomas.This article examines the indications,procedural advancements,technical considerations,and outcomes associated with ESD in early GI cancers.The challenges and complications that can arise are also highlighted.Additionally,we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy.As the field progresses,ESD remains a cornerstone in managing early GI cancers,offering patients a promising option for organ preservation and long-term survival.
文摘Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western world, its implementation has been slow and laborious. In this paper, the indications for ESD, its learning model, the available methods to predict the presence of deep submucosal invasion before the procedure and the published outcomes from Asia and Europe will be reviewed. Since ESD has several limitations in terms of learning achievement in the West, and completion of the procedure for the first cases is difficult in our part of the world, a short review on colorectal assisted ESD has been included. Finally, other endoscopic and surgical treatment modalities that are in competition with colorectal ESD will be summarized.
基金supported by the National Natural Science Foundation of China(82325012)the Youth Fund of the National Natural Science Foundation of China(82301043)+1 种基金the Natural Science Basic Research Program of Shaanxi (Program No.2024JC-YBQN-0980)the Shaanxi Key Scientific and Technological Innovation Team(2020TD-033).
文摘Hypoxemia is a common pathological state characterized by low oxygen saturation in the blood.This condition compromises mucosal barrier integrity particularly in the gut and oral cavity.However,the mechanisms underlying this association remain unclear.This study used periodontitis as a model to investigate the role of platelet activation in oral mucosal immunopathology under hypoxic conditions.Hypoxia upregulated methyltransferase-like protein 4(METTL4)expression in platelets,resulting in N6-methyladenine modification of mitochondrial DNA(mtDNA).This modification impaired mitochondrial transcriptional factor A-dependent cytosolic mtDNA degradation,leading to cytosolic mtDNA accumulation.Excess cytosolic mt-DNA aberrantly activated the cGAS-STING pathway in platelets.This resulted in excessive platelet activation and neutrophil extracellular trap formation that ultimately exacerbated periodontitis.Targeting platelet METTL4 and its downstream pathways offers a potential strategy for managing oral mucosa immunopathology.Further research is needed to examine its broader implications for mucosal inflammation under hypoxic conditions.
基金Supported by National Natural Science Foundation of China,No.82200613Shanghai“Rising Stars of Medical Talents”Youth Development Program,No.SHWSRS(2025)_071+3 种基金The Healthcare Talents Youth Program of Shanghai Pudong New Area,No.2025PDWSYCQN-03Shanghai Municipal Health Commission,No.2024ZDXK0001the Medical Discipline Construction Project of Pudong Health Committee of Shanghai,No.PWZxq2022-6,No.2024-PWXZ-07,and No.2025PDWSYCBJ-01Shanghai East Hospital's Key Clinical Disciplines and Specialty Departments,No.2024-DFZD-005.
文摘Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,however,the development of anti-reflux mucosal intervention(ARMI),a novel strategy for treating GERD,has provided hope to such patients.ARMI comprises three main steps:Anti-reflux mucosectomy,anti-reflux mucosal ablation,and peroral endoscopic cardial constriction.ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents.This study compares different ARMI techniques,their therapeutic efficacy in treating GERD,indications and contraindications,endoscopic operational procedures,perioperative management,and adverse events,in an attempt to provide clinical guidance.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.
基金Supported by the Research Project of the Chinese Digestive Early Cancer Physicians’Joint Growth Program,No.GTCZ-2021-AH-34-0012.
文摘BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia,which pose considerable challenges for endo-scopic surgical interventions.CASE SUMMARY We present a case involving early-stage esophageal cancer discovered in a resting room,notable for the rare manifestation of esophageal mucosal bridging.Following a comprehensive multidisciplinary discussion and the development of a treatment strategy,we proceeded with endoscopic submucosal dissection for the patient.During the procedure,we encountered operational challenges due to the presence of a diverticulum and a partial absence of the muscularis propria.To facilitate the retraction of a portion of the resected specimen,we utilized dental floss.Ultimately,we successfully excised the entire lesion.After a three-day period of fasting with a water-only diet,subsequent iodine water cholan-giography did not indicate any perforations,and the patient was advised to transition to a liquid diet.The patient was discharged five days post-operation.A follow-up endoscopy conducted three months later revealed scar-like changes in the mid-esophagus,with the patient reporting no significant discomfort.CONCLUSION In summary,although esophageal mucosal bridges are rarely documented,they should be considered in the differential diagnosis of mechanical dysphagia.Furthermore,endoscopic therapy represents a feasible approach for their mana-gement.
基金Supported by Ningbo Top Medical and Health Research Program,No.2023020612the Ningbo Leading Medical&Healthy Discipline Project,No.2022-S04+1 种基金the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022KY315Ningbo Science and Technology Public Welfare Project,No.2023S133.
文摘BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conversational artificial intelligence(AI)tools like chat generative pretrained transformer(ChatGPT)are rapidly emerging as sources of medical information.AIM To evaluate ChatGPT’s reliability and usefulness regarding ESD and EMR for patients and healthcare professionals.METHODS In this study,30 specific questions related to ESD and EMR were identified.Then,these questions were repeatedly entered into ChatGPT,with two independent answers generated for each question.A Likert scale was used to rate the accuracy,completeness,and comprehensibility of the responses.Meanwhile,a binary category(high/Low)was used to evaluate each aspect of the two responses generated by ChatGPT and the response retrieved from Google.RESULTS By analyzing the average scores of the three raters,our findings indicated that the responses generated by ChatGPT received high ratings for accuracy(mean score of 5.14 out of 6),completeness(mean score of 2.34 out of 3),and comprehensibility(mean score of 2.96 out of 3).Kendall’s coefficients of concordance indicated good agreement among raters(all P<0.05).For the responses generated by Google,more than half were classified by experts as having low accuracy and low completeness.CONCLUSION ChatGPT provided accurate and reliable answers in response to questions about ESD and EMR.Future studies should address ChatGPT’s current limitations by incorporating more detailed and up-to-date medical information.This could establish AI chatbots as significant resource for both patients and health care professionals.
文摘Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.
文摘BACKGROUND To observe the endoscopic and pathological characteristics of laterally spreading tumors(LSTs)and explore the risk factors for carcinogenesis and submucosal infiltration.AIM To analyze the clinicopathological features of colorectal LSTs treated endoscopically and determine risk factors associated with carcinogenesis and submucosal invasion,providing evidence-based guidance for optimal treatment strategy selection.METHODS This study retrospectively analyzed the sex,age,and endoscopic and pathological features of patients who underwent endoscopic treatment for colorectal LSTs in our hospital from January 2021 to July 2024.Single-factor analysis was used to identify the risk factors for cancer and submucosal infiltration,and the factors with statistical significance were included in multivariate logistic regression analysis.RESULTS A total of 422 patients,including 224 males and 198 females,aged 63.45±9.23 years,were included.There were 456 LST lesions in total.The length of the endoscopically resected specimens was 3.01±0.48 cm,and the length of the lesions was 2.37±1.59 cm.It was located in 115 rectums(25.2%),40 sigmoid colon(8.8%),26 descending colon(5.7%),109 transverse colon(23.9%),112 ascending colon(24.6%),and 54 ileocecal regions(11.8%).Endoscopic submucosal dissection(ESD)was performed in 237 patients(52.0%),and endoscopic mucosal resection(EMR)was performed in 95 patients(20.8%).There were 113 EMR with precutting cases(24.8%),11 ESD with snare cases(2.4%),4 delayed bleeding cases and 5 intraoperative perforations.The pathological results revealed 119 cases of low-grade intraepithelial neoplasia(26.1%),221 cases of high-grade intraepithelial neoplasia(48.5%),82 cases of intramucosal carcinoma(18.0%),and 34 cases of submucous invasive carcinoma(7.5%).Multiple logistic regression analyses revealed that lesion size(>2 cm),lesion location(rectal)and endoscopic classification[false depressed tubulovillous adenoma(LST-NG pseudodepressed type,LST-NG-PD),type 1 particles(LST-G homogenous type),and LST-G nodular mixed type],accompanied by large nodules(with)were independent risk factors for carcinogenesis;endoscopic classification(LST-NG-PD)and the presence of large nodules were independent risk factors for submucosal infiltration.CONCLUSION These risk factors provide practical guidance for treatment selection:LST-NG-PD with large nodules should prioritize ESD,while high-risk rectal lesions>2 cm may require additional imaging evaluation before endoscopic resection.
基金Clinical Study on Endoscopic Resection of Colorectal Submucosal Tumors Using Underwater Combined with Metal Clip-Assisted Snare,China(Grant No.2441ZF271)。
文摘Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in our hospital between April 2022 and March 2024 were selected and divided into the control group and the observation group using the mean score method,each with 35 cases.In the control group,traditional endoscopic mucosal resection(EMR)was performed,and in the observation group,modified EMR(endoscopic mucosal resection with ligation apparatus[EMR-L])was performed.The operation time,hospitalization time,operation cost,and related complication rate of the two groups of patients were compared.Results:The operation time(20.36±1.46 min)and hospital stay(3.37±0.51 d)of patients in the observation group were shorter than those of the control group(31.44±2.65 min and 4.73±0.49 d).The cost of the operation in the observation group(7,695.85±1,521.42 yuan)was lower than that of the control group(8,418.62±1219.30 yuan),and the difference was statistically significant(P<0.05).The total incidence of postoperative related complications in the observation group was observed to be 11.42%,which was significantly lower than that of 31.42%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of modified EMR in R-NETs is remarkable,which can not only effectively shorten the operation time and hospital stay,but also further reduce the risk of related complications,and indirectly save a large amount of hospital costs;thus,it is recommended to be promoted and applied clinically.
基金Clinical Study on Endoscopic Resection of Colorectal Submucosal Tumors Using Underwater Combined with Metal Clip-Assisted Snare,China(Grant No.2441ZF271)。
文摘Objective:To analyze the application value of modified endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in rectal neuroendocrine tumors,with a view to providing new clinical options for the early diagnosis and treatment of patients with such tumors,and thus improving their prognosis.Methods:Seventy-two patients with rectal neuroendocrine tumors who underwent surgical treatment in a hospital between October 2023 and September 2024 were selected and divided into a control group and an observation group using the mean score method,each with 36 cases.In the control group,traditional foreign body forceps combined with laparoscopic resection were performed,and in the observation group,modified EMR and ESD were performed as needed.The mass resection rate,histologically intact resection rate,postoperative serum vascular endothelial growth factors(VEGFA,VEGFB,VEGFC levels)in the postoperative period of 7d,and indicators of the rate of related complications of the two groups of patients were compared.Results:The mass resection rate of 91.67%and histological complete resection rate of 94.44%in the observation group were significantly higher than those of 72.22%and 66.67%in the control group;the VEGFA,VEGFB,and VEGFC levels of the observation group were 82.08±7.94 ng/ml,168.89±16.53 ng/ml,and 121.07±10.75 ng/ml,respectively,in the postoperative period of 7 d after surgery;the levels were significantly higher than those of the control group:68.39±6.82 ng/ml,141.06±14.12 ng/ml,and 98.45±9.87 ng/ml,respectively,and the difference was statistically significant(P<0.05);the patients in the observation group had a lower rate of surgical complications than those in the control group(2.78%vs 8.33%),the difference was not statistically significant(P>0.05).Conclusion:Modified EMR and ESD in rectal neuroendocrine tumors are effective,not only can it effectively improve the rate of mass resection and histological integrity of the resection rate,but it can also further improve the level of serum vascular endothelial growth factor(VEGFA,VEGFB,VEGFC);thus,it is recommended to be promoted for use in clinical practice.
基金Supported by the National Key Research and Development Program,No.2023YFF0713700 and No.2023YFF0713705Common Technology R&D Platform of Shaanxi Province,No.2023GXJS-01-1-2the Cyrus Tang Foundation Chung Ying Young Scholars Program.
文摘BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.
文摘BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.
基金Supported by Natural Science Foundation of Anhui Medical University,No.2023xkj130.
文摘BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.
基金Supported by National Natural Science Foundation of China,No.82174309and Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Siming Fund Special Project for Scientific Research,No.SGKJ-202304.
文摘BACKGROUND Runchangningshen paste(RCNSP)is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey.It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation.The pathophysiology of functional constipation(FC)is associated with a reduction in mucin-2(MUC2)secretion and microbial dysbiosis.AIM To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.METHODS Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action.FC model was induced via loperamide gavage(16 mg/kg)twice daily for 7 days.Applying defecation function and gastrointestinal motility to assess constipation severity.Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology.Transmission electron microscope was used to observe the ultrastructure of goblet cells(GCs).Immunofluorescence colocalization,quantitative PCR,and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway.16S rDNA was employed to sequence the gut mucosal microbiota.RESULTS RCNSP contained 12 components with potential laxative effects.It enhanced defecation function,accelerated gastrointestinal motility,and maintained colonic mucosal integrity.RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure.At the molecular level,RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway.Through 16S rDNA sequencing analysis,RCNSP significantly altered the mucosal microbiota composition.Specifically,it increased beneficial bacterial strains while reducing harmful ones.Simultaneously,RCNSP reduced butyrate-producing bacteria like Proteobacteria,Enterobacteriaceae,Blautia,and Eubacterium and decreased hydrogen sulfide-producing species,such as Prevotellaceae.It also reduced bile acidinhibiting species,such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acidproducing species,such as Colidextribacter.CONCLUSION Our findings suggested that RCNSP ameliorated constipation through a dual mechanism:It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.
文摘This review emphasizes the exemplary safety and efficacy of rebamipide in the treatment of gastric ulcers and other mucosa-related disorders,positioning it as a viable candidate for inclusion in treatment guidelines across India and globally.An in-depth literature review of rebamipide was carried out on PubMed and Google Scholar.Rebamipide has a multifaceted mechanism of action,including prostaglandin synthesis,scavenging free radicals,and enhancing mucin produc-tion,leading to enhanced mucosal protection and ulcer healing.Rebamipide serves as a highly effective and safe treatment option for gastric ulcers and gas-troesophageal reflux disease.The efficacy of this drug in treating ulcers often surpasses that of routinely used agents such as pantoprazole,sucralfate,misop-rostol,famotidine,lansoprazole,and esomeprazole.This superiority of rebami-pide can be attributed to the low rate of adverse events associated with it and its mild side effects,contributing to its widespread adoption across Southeast Asia and Russia.This popularity extends to its application beyond gastrointestinal ailments.Notably,it has been successfully employed in the treatment of ophthal-mological,oncological,and bone regeneration-related issues.Rebamipide's exemplary safety and efficacy in treating gastric ulcers and other mucosa-related disorders support its potential for inclusion in treatment guidelines,not only in India but also globally.
基金Supported by the Wuhu Municipal Science and Technology Bureau Project,No.2024kj072.
文摘In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance with an area under the curve exceeding 0.90.However,limitations exist regarding its narrow temporal scope,potential overestimation due to feature collinearity and imputation opacity,and limited generalizability due to single-center derivation and validation.Moreover,no clear clinical implementation strategy was outlined.Prospective multicenter validation and integration of endoscopist variability,longitudinal outcome data,and deployment mechanisms are warranted to ensure broader applicability and clinical utility.
基金Supported by the National Natural Science Foundation of China,No.82474318the Jiangsu Administration of Traditional Chinese Medicine,No.zt202105+1 种基金Subject of Jiangsu Province Hospital of Chinese Medicine,No.Y2021rc22a Research Career Scientist。
文摘BACKGROUND The duodenum plays a significant role in metabolic regulation,and thickened mucous membranes are associated with insulin resistance.Duodenal mucosal resurfacing(DMR),a new-style endoscopic procedure using hydrothermal energy to ablate this thickened layer,shows promise for enhancing glucose and lipid metabolism in type 2 diabetes(T2D)patients.However,the mechanisms driving these improvements remain largely unexplored.AIM To investigate the mechanisms by which DMR improves metabolic disorders using a rat model.METHODS Rats with T2D underwent a revised DMR procedure via a gastric incision using a specialized catheter to abrade the duodenal mucosa.The duodenum was evaluated using histology,immunofluorescence,and western blotting.Serum assays measured glucose,lipid profiles,lipopolysaccharide,and intestinal hormones,while the gut microbiota and metabolomics profiles were analyzed through 16S rRNA gene sequencing and ultra performance liquid chromatography-mass spectrum/mass spectrum,severally.RESULTS DMR significantly improved glucose and lipid metabolic disorders in T2D rats.It increased the serum levels of cholecystokinin,gastric inhibitory peptide,and glucagon-like peptide 1,and reduced the length and depth of duodenal villi and crypts.DMR also enhanced the intestinal barrier integrity and reduced lipopolysaccharide translocation.Additionally,DMR modified the gut microbiome and metabolome,particularly affecting the Blautia genus.Correlation analysis revealed significant links between the gut microbiota,metabolites,and T2D phenotypes.CONCLUSION This study illustrates that DMR addresses metabolic dysfunctions in T2D through multifaceted mechanisms,highlighting the potential role of the Blautia genus on T2D pathogenesis and DMR’s therapeutic impact.
文摘BACKGROUND Colon polyps represent a significant clinical challenge in elderly patients.While endoscopic mucosal resection(EMR)and argon plasma coagulation(APC)are widely used,their comparative effectiveness in elderly populations remains unclear,particularly regarding postoperative recovery and complication profiles.AIM To compare the postoperative recovery,complications and efficacy of EMR and APC in elderly patients with colonic polyps.METHODS We retrospectively analyzed clinical data from 224 elderly patients with colon polyps treated at our center between January 2021 and July 2024.All patients were divided into the EMR group and APC group according to the surgical method they received.By comparing the operation time,intraoperative bleeding situation,hospital stays,postoperative inflammatory response index,complication rate and recurrence status of the two groups,the effect of the two surgical methods was comprehensively evaluated.RESULTS The APC group exhibited superior outcomes in terms of operative time(10.63 minutes vs 13.27 minutes,P<0.001),intraoperative bleeding situation(39.00%vs 52.42%,P=0.031),and length of hospital stay(1.63 days vs 3.87 days,P<0.001)compared to the EMR group.The one-time resection rate of the APC group(94.69%)was higher than that of the EMR group(89.14%)(P=0.026).The overall effective rates of the two groups were 94.35%and 92.00%,respectively.Postoperative procalcitonin and C-reactive protein levels were lower in the APC group than in the EMR group(P<0.001).The incidence of complications was comparable between the two groups(P=0.159).The recurrence rate was lower in the APC group(2.00%)than in the EMR group(8.06%)(P=0.045).CONCLUSION For elderly patients with colon polyps,APC showed certain advantages compared with EMR in promoting postoperative recovery,reducing the inflammatory response and the risk of complications.However,the study is limited by its single-center retrospective design and short follow-up period,and further multicenter prospective studies are needed to validate the findings.
