BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychologi...BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.展开更多
Amyotrophic lateral sclerosis(ALS)is a progressive neurodegenerative disease characterized by the loss of upper and lower motor neurons,clinically marked by muscle atrophy and weakness.Although the clinical course is ...Amyotrophic lateral sclerosis(ALS)is a progressive neurodegenerative disease characterized by the loss of upper and lower motor neurons,clinically marked by muscle atrophy and weakness.Although the clinical course is highly variable,the average time from the onset of symptoms to the need for respiratory support or death is 3-5 years.ALS is the most prevalent motor neuron disease in adults,occurring at a rate of 2 per 100,000 individuals and affecting 5.4 per 100,000 individuals overall.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.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
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(A...BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.展开更多
BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted end...BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.展开更多
Background: Wrist pain is prevalent. Activities such as dexterous sports, prolonged use of personal handheld devices, and extensive desktop keyboard usage are common contributors to wrist pain. Intersection syndrome, ...Background: Wrist pain is prevalent. Activities such as dexterous sports, prolonged use of personal handheld devices, and extensive desktop keyboard usage are common contributors to wrist pain. Intersection syndrome, a form of inflammatory tenosynovitis, occurs at the intersection of the first and second dorsal compartments of the wrist. The first dorsal compartment is comprised of the tendons of abductor pollicis longus and extensor pollicis brevis, while the second dorsal compartment contains the tendons of extensor carpi radialis longus and extensor carpi radialis brevis. Intersection syndrome is diagnosed by pain localized to the dorsoradial forearm, approximately five cm proximal to the wrist joint, which worsens with resisted wrist and thumb extension. To date, the use of hydro dissection with 5% dextrose under ultrasound guidance as a treatment for Intersection syndrome has not been reported. This case report presents the first report on ultrasound-guided hydro dissection as a therapeutic approach for intersection syndrome. Methods: A case report, with informed consent, involving a 32-year-old male athlete. The patient, a hurling player, presented with chronic right wrist pain diagnosed as intersection syndrome. The condition significantly affected his work, sporting activities, and daily living activities. Previous conservative management and physiotherapy had failed to alleviate his symptoms. To confirm the diagnosis, relevant imaging was performed, supplemented by dynamic ultrasound assessment. The procedure was performed aseptically. Continuous ultrasound guidance was employed to ensure accurate needle placement. Once the needle tip position was confirmed, an initial injection of 5 mL of 0.25% chirocaine was administered. 10 mL of 5% dextrose was injected under ultrasound guidance for hydro dissection, with good visualization of the solution’s distribution. Conclusion: Ultrasound-guided hydro dissection has not previously been documented as a treatment option for intersection syndrome. In this case, it proved to be an effective pain-relieving therapy with sustained effect at three-month clinical follow-up. Further studies are required.展开更多
BACKGROUND Conventional reusable endoscopes have high disinfection costs because of their large size.In this study,we compared the effectiveness,safety,and operation performance of the portable disposable large-channe...BACKGROUND Conventional reusable endoscopes have high disinfection costs because of their large size.In this study,we compared the effectiveness,safety,and operation performance of the portable disposable large-channel endoscope that we developed with those of a conventional gastroscope in endoscopic submucosal dissection(ESD).AIM To compare two gastroscopes in ESD for effectiveness and safety.METHODS Ten Bama pigs were subjected to gastroscopy and ESD after general anesthesia.The experiment was completed by four experienced endoscopists.First,two endoscopists randomly selected the portable disposable large-channel or conventional gastroscope to complete gastroscopy procedures.The other two endoscopists assessed the quality of endoscopic images.After endoscopy,all of the endoscopists randomly used the portable disposable large-channel endoscope or the conventional gastroscope for ESD.Endoscopic operation performance,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,success rate of en bloc resection,muscular injury rate,and complications were compared between the endoscopes.RESULTS No significant differences in gastroscopy duration or in the integrity,sharpness,saturation,and brightness of the gastroscopic images were observed between the gastroscopes.For ESD,no significant differences in endoscopic operation performance,incision time,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,or success rate of en bloc resection were observed between the gastroscopes.Neither gastroscope caused muscular injury or treatment-related complica-tions.CONCLUSION The portable disposable large-channel endoscope can be used safely and effectively for gastroscopy and treatment.展开更多
In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive ove...In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this tec...BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.展开更多
BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoi...BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.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
Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy pe...Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy persists,with evidence showing no significant survival advantage of extended dissection over the standard approach.Extended lymphadenectomy,while increasing the number of lymph nodes retrieved,is associated with longer operative times,greater blood loss,and higher morbidity.More importantly,lymph nodes serve as critical immune hubs,and excessive removal may compromise systemic immune surveillance,which is vital in the context of emerging immunotherapies for pan-creatic cancer.This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy,advocating for a personalized approach to lymph node management in pancreatic cancer surgery,focusing on balancing oncologic outcomes with immune preservation.展开更多
Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the e...Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.展开更多
BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma presents with various clinical presentations and endoscopic features.While gastric lesions are primarily assessed via endoscopic forceps biopsy,pathol...BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma presents with various clinical presentations and endoscopic features.While gastric lesions are primarily assessed via endoscopic forceps biopsy,pathological confirmation of MALT lymphoma is frequently challenging,with low detection rates commonly observed.CASE SUMMARY We describe a 61-year-old male patient with gastric MALT lymphoma due to intermittent abdominal discomfort lasting over six months.The initial endoscopic forceps biopsy was suggestive of gastric lymphoma.Confirmation of the MALT lymphoma diagnosis was ultimately obtained through a jumbo biopsy specimen harvested via endoscopic submucosal dissection(ESD).CONCLUSION We report a case of gastric MALT lymphoma diagnosed through ESD,highlighting its potential as a diagnostic tool when forceps biopsy yields negative or inconclusive results.展开更多
BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location ...BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.AIM To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.METHODS A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024.Patients were stratified into two groups based on tumor location:Group 1 included patients with tumors in the lower third of the stomach,while Group 2 included those with tumors in the middle or upper third.The following parameters were evaluated for each group:procedure duration,curative resection rate,en bloc resection rate,complete resection rate,incidence of complications,and depth of neoplastic invasion.RESULTS The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach(P=0.0011).En bloc resection rates for ESD in the distal and proximal stomach were 97.9%and 85.7%,respectively(P=0.0016),while complete resection rates were 93.9%and 73.4%,respectively(P=0.0002).Curative resection was achieved in 90.9%of distal lesions compared to 65.3%of proximal lesions(P=0.0001).Submucosal invasion was identified in 4.0%of distal lesions and 14.2%of proximal lesions(P=0.013).CONCLUSION ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach,independent of lesion size and histopathological characteristics.Additionally,proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.展开更多
BACKGROUND Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract.In the early stage,most patients are asymptomatic;after the onset of symptoms,there is often no specifici...BACKGROUND Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract.In the early stage,most patients are asymptomatic;after the onset of symptoms,there is often no specificity regarding symptoms.CASE SUMMARY Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon.One patient who came to our hospital with“dull pain in the left lower abdomen for 2 days”was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection.The final pathological results suggested cystic lymphangioma.One year later,no recurrence was found on re-examination via colonoscopy.CONCLUSION Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed.Endoscopy,imaging,histology,and immunohistochemical staining are useful for diagnosis.Surgical resection is the preferred treatment.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside ...Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.展开更多
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.
基金funded by Fondazione AriSLA ETS(Fondazione di ricerca per la SLA ETS),ReNicALS project to SAsupported by#NEXTGENERATIONEU(NGEU)and funded by the Ministry of University and Research(MUR),National Recovery and Resilience Plan(NRRP),project MNESYS(PE0000006)-A Multiscale Integrated Approach to the Study of the Nervous System in Health and Disease(DN.1553 October 11,2022)。
文摘Amyotrophic lateral sclerosis(ALS)is a progressive neurodegenerative disease characterized by the loss of upper and lower motor neurons,clinically marked by muscle atrophy and weakness.Although the clinical course is highly variable,the average time from the onset of symptoms to the need for respiratory support or death is 3-5 years.ALS is the most prevalent motor neuron disease in adults,occurring at a rate of 2 per 100,000 individuals and affecting 5.4 per 100,000 individuals overall.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
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The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
基金Supported by Hamad Medical Corporation,No.MRC-01-18-073.
文摘BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
基金Supported by Fujian Province National Key Clinical Specialty Construction Project(Minwei Medical Policy Letter),No.[2023]1594.
文摘BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.
文摘Background: Wrist pain is prevalent. Activities such as dexterous sports, prolonged use of personal handheld devices, and extensive desktop keyboard usage are common contributors to wrist pain. Intersection syndrome, a form of inflammatory tenosynovitis, occurs at the intersection of the first and second dorsal compartments of the wrist. The first dorsal compartment is comprised of the tendons of abductor pollicis longus and extensor pollicis brevis, while the second dorsal compartment contains the tendons of extensor carpi radialis longus and extensor carpi radialis brevis. Intersection syndrome is diagnosed by pain localized to the dorsoradial forearm, approximately five cm proximal to the wrist joint, which worsens with resisted wrist and thumb extension. To date, the use of hydro dissection with 5% dextrose under ultrasound guidance as a treatment for Intersection syndrome has not been reported. This case report presents the first report on ultrasound-guided hydro dissection as a therapeutic approach for intersection syndrome. Methods: A case report, with informed consent, involving a 32-year-old male athlete. The patient, a hurling player, presented with chronic right wrist pain diagnosed as intersection syndrome. The condition significantly affected his work, sporting activities, and daily living activities. Previous conservative management and physiotherapy had failed to alleviate his symptoms. To confirm the diagnosis, relevant imaging was performed, supplemented by dynamic ultrasound assessment. The procedure was performed aseptically. Continuous ultrasound guidance was employed to ensure accurate needle placement. Once the needle tip position was confirmed, an initial injection of 5 mL of 0.25% chirocaine was administered. 10 mL of 5% dextrose was injected under ultrasound guidance for hydro dissection, with good visualization of the solution’s distribution. Conclusion: Ultrasound-guided hydro dissection has not previously been documented as a treatment option for intersection syndrome. In this case, it proved to be an effective pain-relieving therapy with sustained effect at three-month clinical follow-up. Further studies are required.
文摘BACKGROUND Conventional reusable endoscopes have high disinfection costs because of their large size.In this study,we compared the effectiveness,safety,and operation performance of the portable disposable large-channel endoscope that we developed with those of a conventional gastroscope in endoscopic submucosal dissection(ESD).AIM To compare two gastroscopes in ESD for effectiveness and safety.METHODS Ten Bama pigs were subjected to gastroscopy and ESD after general anesthesia.The experiment was completed by four experienced endoscopists.First,two endoscopists randomly selected the portable disposable large-channel or conventional gastroscope to complete gastroscopy procedures.The other two endoscopists assessed the quality of endoscopic images.After endoscopy,all of the endoscopists randomly used the portable disposable large-channel endoscope or the conventional gastroscope for ESD.Endoscopic operation performance,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,success rate of en bloc resection,muscular injury rate,and complications were compared between the endoscopes.RESULTS No significant differences in gastroscopy duration or in the integrity,sharpness,saturation,and brightness of the gastroscopic images were observed between the gastroscopes.For ESD,no significant differences in endoscopic operation performance,incision time,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,or success rate of en bloc resection were observed between the gastroscopes.Neither gastroscope caused muscular injury or treatment-related complica-tions.CONCLUSION The portable disposable large-channel endoscope can be used safely and effectively for gastroscopy and treatment.
文摘In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.
基金Supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research,No.23K11902.
文摘BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.
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Lymph node dissection(lymphadenectomy)remains a critical component of pancreatic cancer surgery,contributing to accurate staging and guiding adjuvant therapy.The debate between standard and extended lymphadenectomy persists,with evidence showing no significant survival advantage of extended dissection over the standard approach.Extended lymphadenectomy,while increasing the number of lymph nodes retrieved,is associated with longer operative times,greater blood loss,and higher morbidity.More importantly,lymph nodes serve as critical immune hubs,and excessive removal may compromise systemic immune surveillance,which is vital in the context of emerging immunotherapies for pan-creatic cancer.This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy,advocating for a personalized approach to lymph node management in pancreatic cancer surgery,focusing on balancing oncologic outcomes with immune preservation.
文摘Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.
基金Supported by the Hebei Natural Science Foundation,No.H2023206912.
文摘BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma presents with various clinical presentations and endoscopic features.While gastric lesions are primarily assessed via endoscopic forceps biopsy,pathological confirmation of MALT lymphoma is frequently challenging,with low detection rates commonly observed.CASE SUMMARY We describe a 61-year-old male patient with gastric MALT lymphoma due to intermittent abdominal discomfort lasting over six months.The initial endoscopic forceps biopsy was suggestive of gastric lymphoma.Confirmation of the MALT lymphoma diagnosis was ultimately obtained through a jumbo biopsy specimen harvested via endoscopic submucosal dissection(ESD).CONCLUSION We report a case of gastric MALT lymphoma diagnosed through ESD,highlighting its potential as a diagnostic tool when forceps biopsy yields negative or inconclusive results.
文摘BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.AIM To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.METHODS A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024.Patients were stratified into two groups based on tumor location:Group 1 included patients with tumors in the lower third of the stomach,while Group 2 included those with tumors in the middle or upper third.The following parameters were evaluated for each group:procedure duration,curative resection rate,en bloc resection rate,complete resection rate,incidence of complications,and depth of neoplastic invasion.RESULTS The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach(P=0.0011).En bloc resection rates for ESD in the distal and proximal stomach were 97.9%and 85.7%,respectively(P=0.0016),while complete resection rates were 93.9%and 73.4%,respectively(P=0.0002).Curative resection was achieved in 90.9%of distal lesions compared to 65.3%of proximal lesions(P=0.0001).Submucosal invasion was identified in 4.0%of distal lesions and 14.2%of proximal lesions(P=0.013).CONCLUSION ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach,independent of lesion size and histopathological characteristics.Additionally,proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.
文摘BACKGROUND Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract.In the early stage,most patients are asymptomatic;after the onset of symptoms,there is often no specificity regarding symptoms.CASE SUMMARY Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon.One patient who came to our hospital with“dull pain in the left lower abdomen for 2 days”was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection.The final pathological results suggested cystic lymphangioma.One year later,no recurrence was found on re-examination via colonoscopy.CONCLUSION Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed.Endoscopy,imaging,histology,and immunohistochemical staining are useful for diagnosis.Surgical resection is the preferred treatment.
文摘Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.
