BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic co...BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.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
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 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
BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallo...BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days.Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction,which was resected by endoscopic submucosal dissection(ESD).Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface,with serous tumor-like complex glands in the submucosa which showing significant hyperplasia.This initially diagnosis was early gastric adenocarcinoma.However,we still observed a few points that did not meet the criteria for cancer such as lack of malignant features.Following multidisciplinary discussion and consultation with the experienced specialist pathologists,we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry.The follow-up examination results for the patient were satisfactory,with no evidence of tumor recurrence.And we summarize the ESGDAs reported in the literature,aiming to enhance understanding of this tumor type.CONCLUSION ESGDA is a benign tumor that can be cured by ESD.Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.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
For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions ori...For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.展开更多
BACKGROUND Submucosal tumors(SMTs)are rare conditions frequently encountered in clinical endoscopic practice.With advancements in endoscopic technology over the past decade,endoscopic management of SMTs has emerged as...BACKGROUND Submucosal tumors(SMTs)are rare conditions frequently encountered in clinical endoscopic practice.With advancements in endoscopic technology over the past decade,endoscopic management of SMTs has emerged as a significant research area.AIM To examine developments in this field,compare contributions from different countries,institutions,and authors,and identify potential research hotspots.METHODS Relevant publications on the endoscopic management of SMTs between January 2010 and June 2024 were extracted from the Web of Science Core Collection database.Microsoft Excel,VOSviewer,and CiteSpace were used to analyze publication trends and visualize key results.RESULTS Overall,339 publications by 1840 authors from 31 countries/regions were included.Surgical Endoscopy and Other Interventional Techniques was the most prominent journal in the field(62 articles,18.29%).Most research was conducted in China(n=212),followed by Japan(n=47),and the United States(n=28).Fudan University(China)was the most active institution,and Professor Zhou published the most papers(n=27)with had the highest citation count(n=1167).Emerging research topics include full-thickness resection devices,defect closure,and cooperative surgery.CONCLUSION The endoscopic management of SMTs has advanced rapidly over the past 14 years.However,national and regional development disparities persist,with limited high-level studies and weak inter-institutional and international collaboration.Device-assisted techniques and combined surgical endoscopic resections are emerging as key areas for future research.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
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
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 Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy o...BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.展开更多
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a...BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due...BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.AIM To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.METHODS Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023.The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence,which include en-bloc and curative resection(CR)rates,local recurrence and survival rates.RESULTS ESD was attempted on 111 lesions in 93 patients.95.0%of completed procedures achieved endoscopic clearance.74.3%were en-bloc resections and the rest were hybrid ESD with piecemeal resections.In all,34.7%achieved histological CR.Overall,disease recurrence was 10.9%at latest follow-up(63 months,median follow-up).Importantly 100%of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up.In the Indeterminate and Non-CR group,18.8%of lesions showed disease recurrence at subsequent endoscopic follow-ups.ESD changed the histological staging of 44.5%of lesions.Immediate complications were observed in 9.9%of all ESD procedures.The median survival time was 69 months post-ESD.The mean age at death is 82.2 years old.CONCLUSION The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.How...BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.展开更多
BACKGROUND Esophageal cancer is a clinically common malignant tumor of the digestive sys-tem.In 2022,it ranked fifth among the leading causes of cancer-related deaths in China.Its predominant symptom is dysphagia,and ...BACKGROUND Esophageal cancer is a clinically common malignant tumor of the digestive sys-tem.In 2022,it ranked fifth among the leading causes of cancer-related deaths in China.Its predominant symptom is dysphagia,and approximately 30%–40%of patients are prone to developing postoperative recurrent stenosis,necessitating repeated esophageal dilation,which significantly affects patients’quality of life.The self-dilation technique,performed by patients,enables preventive esophageal dilation and aims to reduce the frequency of recurrent stenosis.CASE SUMMARY We report the case of a 61-year-old man who underwent repeated esophageal di-lations following endoscopic submucosal dissection.During his eighth hospital admission,a multidisciplinary management team was established to implement an evidence-based self-help balloon dilation technique,facilitate early identifi-cation of nursing concerns and complications,and provide transitional care fo-llowing discharge.The patient reported a high level of satisfaction during the hospital stay.During the 6-month follow-up after discharge,the patient’s quality of life improved,with a substantial reduction in dysphagia.The esophageal stric-ture was successfully dilated from 5 mm to 6 mm,the interval between readmi-ssions was prolonged,and the patient’s weight increased from 49 kg to 50 kg.CONCLUSION The establishment of a multidisciplinary case management team,combined with the implementation of a self-help balloon dilation technique,early identification and management of nursing issues and complications,and person-alized extended care,can significantly enhance patient satisfaction during hospitalization,improve quality of life,and extend the interval between readmissions.These strategies can provide valuable practical guidance for the clinical treatment and nursing of patients with recurrent esophageal stenosis.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
BACKGROUND Tumor progression in patients with esophageal precancerous lesions(EPLs)or early esophageal carcinoma(EEC)is typically confined in both extent and location.Prompt and effective intervention significantly im...BACKGROUND Tumor progression in patients with esophageal precancerous lesions(EPLs)or early esophageal carcinoma(EEC)is typically confined in both extent and location.Prompt and effective intervention significantly improves treatment outcomes and prognosis for these individuals.AIM To determine the effect of endoscopic submucosal dissection(ESD)on efficacy,serum tumor markers(STMs),and 6-month postoperative recurrence rate in patients with either EPL or EEC.METHODS This study initially enrolled 120 patients with EPL or EEC,who were admitted from April 2021 to April 2024.Participants were divided into the control group(60 cases),which underwent thoracotomy,and the research group(60 cases)which received ESD treatment.The comparative analysis involved information regarding the efficacy(dissection area and resection rate per unit time),complications(delayed bleeding,wound infection,esophageal reflux,and postoperative esophageal stenosis),surgery-related parameters(bleeding volume,operation duration,and hospital length of stay),STMs[carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),and tumor-specific growth factor(TSGF)],and the 6-month postoperative recurrence rate of the two groups.RESULTS Data indicated statistically higher dissection area and resection rate per unit of time in the research group than in the control group.Meanwhile,the research group demonstrated a notably lower overall incidence rate of complications,bleeding volume,operation duration,and hospital length of stay.Further,the CEA,CA724,and TSGF were markedly reduced in the research group after treatment,which were statistically lower compared to the baseline and those of the control group.Finally,during the follow-up,a comparable 6-month postoperative recurrence rate was determined in the two groups.CONCLUSION ESD is clinically effective and safe for EPL and EEC and can significantly restore abnormally increased levels of STMs.展开更多
Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods...Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.展开更多
Endoscopic submucosal dissection(ESD)is an effective technique for treating early esophageal cancer,and the prevention of postoperative esophageal stricture has emerged as a significant research topic.Zhou et al utili...Endoscopic submucosal dissection(ESD)is an effective technique for treating early esophageal cancer,and the prevention of postoperative esophageal stricture has emerged as a significant research topic.Zhou et al utilized an experimental minipig model to demonstrate that Kangfuxin(KFX)can improve postoperative esophageal stricture following ESD by inhibiting transforming growth factor-β1-driven fibrosis and the downstream fibrotic mediators Smad2/3.In this letter,we primarily discuss recent advancements in the treatment of esophageal stricture,the clinical applications of KFX,and the mechanisms involved in alleviating postoperative esophageal stricture,aiming to provide insights for advancing clinical practice and research in esophageal stricture after ESD.展开更多
基金Supported by National Natural Science Foundation of China,No.82170555Shanghai Academic/Technology Research Leader,No.22XD1422400+2 种基金Shanghai“Rising Stars of Medical Talent”Youth Development Program,No.20224Z0005the 74th General Support of China Postdoctoral Science Foundation,No.2023M740675Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University.
文摘BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.
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 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BACKGROUND Esophageal submucosal gland duct adenoma(ESGDA)is very rare,and easily diagnosed as adenocarcinoma.CASE SUMMARY A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days.Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction,which was resected by endoscopic submucosal dissection(ESD).Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface,with serous tumor-like complex glands in the submucosa which showing significant hyperplasia.This initially diagnosis was early gastric adenocarcinoma.However,we still observed a few points that did not meet the criteria for cancer such as lack of malignant features.Following multidisciplinary discussion and consultation with the experienced specialist pathologists,we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry.The follow-up examination results for the patient were satisfactory,with no evidence of tumor recurrence.And we summarize the ESGDAs reported in the literature,aiming to enhance understanding of this tumor type.CONCLUSION ESGDA is a benign tumor that can be cured by ESD.Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.
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For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.
基金Supported by the Shanghai Municipal Science and Technology,No.22Y11907500 and No.22015831400the National Key R&D Program,No.2022YFC2505100 and No.2022YFC2505105the National Natural Science Foundation of China,No.81900548。
文摘BACKGROUND Submucosal tumors(SMTs)are rare conditions frequently encountered in clinical endoscopic practice.With advancements in endoscopic technology over the past decade,endoscopic management of SMTs has emerged as a significant research area.AIM To examine developments in this field,compare contributions from different countries,institutions,and authors,and identify potential research hotspots.METHODS Relevant publications on the endoscopic management of SMTs between January 2010 and June 2024 were extracted from the Web of Science Core Collection database.Microsoft Excel,VOSviewer,and CiteSpace were used to analyze publication trends and visualize key results.RESULTS Overall,339 publications by 1840 authors from 31 countries/regions were included.Surgical Endoscopy and Other Interventional Techniques was the most prominent journal in the field(62 articles,18.29%).Most research was conducted in China(n=212),followed by Japan(n=47),and the United States(n=28).Fudan University(China)was the most active institution,and Professor Zhou published the most papers(n=27)with had the highest citation count(n=1167).Emerging research topics include full-thickness resection devices,defect closure,and cooperative surgery.CONCLUSION The endoscopic management of SMTs has advanced rapidly over the past 14 years.However,national and regional development disparities persist,with limited high-level studies and weak inter-institutional and international collaboration.Device-assisted techniques and combined surgical endoscopic resections are emerging as key areas for future research.
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.
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.
基金Supported by the Basic and Applied Basic Research Foundation of Guangzhou,No.202201011331the National Natural Science Foundation of China,No.82373118the Natural Science Foundation of Guangdong Province,No.2023A1515010828.
文摘BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.
文摘BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.AIM To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.METHODS Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023.The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence,which include en-bloc and curative resection(CR)rates,local recurrence and survival rates.RESULTS ESD was attempted on 111 lesions in 93 patients.95.0%of completed procedures achieved endoscopic clearance.74.3%were en-bloc resections and the rest were hybrid ESD with piecemeal resections.In all,34.7%achieved histological CR.Overall,disease recurrence was 10.9%at latest follow-up(63 months,median follow-up).Importantly 100%of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up.In the Indeterminate and Non-CR group,18.8%of lesions showed disease recurrence at subsequent endoscopic follow-ups.ESD changed the histological staging of 44.5%of lesions.Immediate complications were observed in 9.9%of all ESD procedures.The median survival time was 69 months post-ESD.The mean age at death is 82.2 years old.CONCLUSION The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.
基金Supported by the Medical Education Research Project from Nanjing Drum Tower Hospital,No.2021-7the Clinical Trials Fund from Nanjing Drum Tower Hospital,No.2022-YXZX-XH-04National Natural Science Foundation of China,No.82203063.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.
文摘BACKGROUND Esophageal cancer is a clinically common malignant tumor of the digestive sys-tem.In 2022,it ranked fifth among the leading causes of cancer-related deaths in China.Its predominant symptom is dysphagia,and approximately 30%–40%of patients are prone to developing postoperative recurrent stenosis,necessitating repeated esophageal dilation,which significantly affects patients’quality of life.The self-dilation technique,performed by patients,enables preventive esophageal dilation and aims to reduce the frequency of recurrent stenosis.CASE SUMMARY We report the case of a 61-year-old man who underwent repeated esophageal di-lations following endoscopic submucosal dissection.During his eighth hospital admission,a multidisciplinary management team was established to implement an evidence-based self-help balloon dilation technique,facilitate early identifi-cation of nursing concerns and complications,and provide transitional care fo-llowing discharge.The patient reported a high level of satisfaction during the hospital stay.During the 6-month follow-up after discharge,the patient’s quality of life improved,with a substantial reduction in dysphagia.The esophageal stric-ture was successfully dilated from 5 mm to 6 mm,the interval between readmi-ssions was prolonged,and the patient’s weight increased from 49 kg to 50 kg.CONCLUSION The establishment of a multidisciplinary case management team,combined with the implementation of a self-help balloon dilation technique,early identification and management of nursing issues and complications,and person-alized extended care,can significantly enhance patient satisfaction during hospitalization,improve quality of life,and extend the interval between readmissions.These strategies can provide valuable practical guidance for the clinical treatment and nursing of patients with recurrent esophageal stenosis.
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.
文摘BACKGROUND Tumor progression in patients with esophageal precancerous lesions(EPLs)or early esophageal carcinoma(EEC)is typically confined in both extent and location.Prompt and effective intervention significantly improves treatment outcomes and prognosis for these individuals.AIM To determine the effect of endoscopic submucosal dissection(ESD)on efficacy,serum tumor markers(STMs),and 6-month postoperative recurrence rate in patients with either EPL or EEC.METHODS This study initially enrolled 120 patients with EPL or EEC,who were admitted from April 2021 to April 2024.Participants were divided into the control group(60 cases),which underwent thoracotomy,and the research group(60 cases)which received ESD treatment.The comparative analysis involved information regarding the efficacy(dissection area and resection rate per unit time),complications(delayed bleeding,wound infection,esophageal reflux,and postoperative esophageal stenosis),surgery-related parameters(bleeding volume,operation duration,and hospital length of stay),STMs[carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),and tumor-specific growth factor(TSGF)],and the 6-month postoperative recurrence rate of the two groups.RESULTS Data indicated statistically higher dissection area and resection rate per unit of time in the research group than in the control group.Meanwhile,the research group demonstrated a notably lower overall incidence rate of complications,bleeding volume,operation duration,and hospital length of stay.Further,the CEA,CA724,and TSGF were markedly reduced in the research group after treatment,which were statistically lower compared to the baseline and those of the control group.Finally,during the follow-up,a comparable 6-month postoperative recurrence rate was determined in the two groups.CONCLUSION ESD is clinically effective and safe for EPL and EEC and can significantly restore abnormally increased levels of STMs.
基金supported by Beijing Natural Science Foundation(L232101).
文摘Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.
基金Supported by National Natural Science Foundation of China,No.82370715,No.32270768,and No.82273970National Key R and D Program of China,No.2023YFC2507904Innovation Group Project of Hubei Province,No.2023AFA026.
文摘Endoscopic submucosal dissection(ESD)is an effective technique for treating early esophageal cancer,and the prevention of postoperative esophageal stricture has emerged as a significant research topic.Zhou et al utilized an experimental minipig model to demonstrate that Kangfuxin(KFX)can improve postoperative esophageal stricture following ESD by inhibiting transforming growth factor-β1-driven fibrosis and the downstream fibrotic mediators Smad2/3.In this letter,we primarily discuss recent advancements in the treatment of esophageal stricture,the clinical applications of KFX,and the mechanisms involved in alleviating postoperative esophageal stricture,aiming to provide insights for advancing clinical practice and research in esophageal stricture after ESD.
