Hybrid argon plasma coagulation for the treatment of Barrett’s esophagus:A prospective,multicenter study

BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.

Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract

BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up period.CONCLUSION GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.

Endoscopic submucosal dissection for foregut neuroendocrine tumors:An initial study

AIM:To evaluate the feasibility and efficacy of endoscopic submucosal dissection(ESD) for foregut neuroendocrine tumors(NETs).METHODS:From April 2008 to December 2010,patients with confirmed histological diagnosis of foregut NETs were included.None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography(EUS).ESD was attempted under general anesthesia.After making several marking dots around the lesion,a mixture solution was injected into the submucosa.The mucosa was incised outside the marking dots.Dissection of the submucosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen.Tumor features,clinicopathological characteristics,complete resection rate,and complications were evaluated.Foregut NETs were graded as G1,G2,or G3 on the basis of proliferative activity by mitotic count or Ki-67 index.All patients underwent regular follow-up to evaluate for any local recurrence or distant metastasis.RESULTS:Those treated by ESD included 24 patients with 29 foregut NETs.The locations of the 29 lesions are as follows:esophagus(n = 1),cardia(n = 1),stomach(n = 23),and duodenal bulb(n = 4).All lesions were found incidentally during routine upper gastrointestinal endoscopy for other indications,and none had symptoms of carcinoid syndrome.Preoperative EUS showed that all tumors were confined to the submucosa.Among the 24 gastric lesions,16 lesions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia,while the other 8 solitary lesions were type Ⅲ because of absence of atrophic gastritis in these cases.All of the tumors were removed in an en bloc fashion.The average maximum diameter of the lesions was 9.4 mm(range:2-30 mm),and the procedure time was 20.3 min(range:10-45 min).According to the World Health Organization 2010 classification,histological evaluation determined that 26 lesions were NET-G1,2 gastric lesions were NET-G2,and 1 esophageal lesion was neuroendocrine carcinoma(NEC).Complete resection was achieved in 28 lesions(28/29,96.6%),and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion.The remaining patient with NEC underwent additional surgery because the resected specimens revealed angiolymphatic and muscularis invasion,as well as incomplete resection.Delayed bleeding occurred in 1 case 3 d after ESD,which was managed by endoscopic treatment.There were no procedure-related perforations.During a mean follow-up period of 24.4 mo(range:12-48 mo),local recurrence occurred in only 1 patient 7 mo after initial ESD.This patient successfully underwent repeat ESD.Metastasis to lymph nodes or distal organs was not observed in any patient.No patients died during the study period.CONCLUSION:ESD appears to be a safe,feasible,and effective procedure for providing accurate histopathological evaluations and curative treatment for eligible foregut NETs.

Therapeutic effect of Liyan Baidu decoction combined with oxygen spray on radioactive stomatitis in patients with nasopharyngeal carcinoma

Objective: To observe the efficacy of Liyan Baidu Decoction combined with Oxygen Spray in the treatment of radiation oropharyngeal cancer in patients with nasopharyngeal carcinoma. Methods: Forty patients with radionomephicitis of nasopharyngeal carcinoma from 2015.03-2017.05 were randomly divided into treatment group (27 cases) and control group (23 cases). The treatment group was treated with Liyan Baidu Decoction combined with oxygen spray;the control group was treated with rehabilitation fluid. Results: Compared with the control group, the time of oral mucosal reaction was delayed (P < 0.05), the cumulative radiation of oral mucosal reaction increased (P < 0.05), and the oral mucosal reaction index decreased (P < 0.05). The degree of salivary gland damage was decreased (P < 0.05), and most of the KPS scores were improved compared with before treatment. However, the quality of life of Liyan Baidu Decoction group was higher than that of the control group (P < 0.05). Conclusion: Liyan Baidu decoction combined with oxygen spray may effectively delay the time of acute radioactive oral mucosal reaction in patients with nasopharyngeal carcinoma, and effectively reduce the radiation oral mucosal damage and salivary gland damage in patients with nasopharyngeal carcinoma. This study provides a clinical basis for the application of Liyan Baidu Decoction.

Long-term outcomes of endoscopic submucosal dissection for high-grade dysplasia and early-stage carcinoma in the colorectum

Background:Colorectal carcinomas(CRCs)arise from premalignant precursors in an adenoma-carcinoma sequence,in which adenoma with high-grade dysplasia(HGD)and early-stage carcinoma are defined as advanced neoplasia.A limited number of studies have evaluated the long-term outcomes of endoscopic submucosal dissection(ESD)for advanced colorectal neoplasia.This study aimed to assess the efficacy and safety of ESD for advanced colorectal neoplasia as well as the long-term outcomes,including local recurrence and metastasis.Methods:We analyzed data collected from 610 consecutive patients with 616 advanced colorectal neoplasia lesions treated with ESD between January 2007 and December 2013.Clinical,endoscopic,and histological data were col-lected over a median follow-up period of 58 months to determine tumor stage and type,resection status,complica-tions,tumor recurrence,and distant metastasis.Results:The overall rates of en bloc resection,histological complete resection,and major complications were 94.3%,89.4%,and 2.3%,respectively.Hybrid ESD was an independent factor of piecemeal resection.Tumor location in the colon was associated with increased risk of ESD-related complications.During the follow-up period,all patients remained free of metastasis.However,local recurrence occurred in 4 patients(0.8%);piecemeal resection was a risk factor.Conclusions:ESD is effective and safe for resection of advanced colorectal neoplasia,with a high en bloc resection rate and favorable long-term outcomes.ESD is indicated for the treatment of HGD and early-stage CRC to obtain cura-tive resection and reduce local recurrence rate.

Easy cross parameterization for articulated shapes

This paper presents a novel interactive system for establishing compatible meshes for articulated shapes.Given two mesh surfaces,our system automatically generates both the global level component correspondence and the local level feature correspondence.Users can use some sketch-based tools to specify the correspondence in an intuitive and easy way.Then all the other vertex correspondences could be generated automatically.The cross parameterization preserves both high level and low level features of the shapes.The technique showed in the system benefits various applications in graphics including mesh inter-polation,deformation transfer,and texture transfer.

Submucosal tunneling endoscopic biopsy and myotomy for management of unknown esophageal stenosis

Introduction Esophageal stenosis is usually congenital or secondary to esophageal injury,esophagitis,and esophageal neoplasia[1,2].The mainstay treatment for benign esophageal stenosis is dilatation with either balloons or esophageal bougienage[3,4].A self-expandable metal stent(SEMS)is recommended for malignant and refractory esophageal stenosis[5].The treatment can be distinct according to different etiology.Endoscopic ultrasonography-guided fine-needle aspiration/biopsy(EUS-FNA/FNB)may be conducive to clarifying the etiology of esophageal stenosis.However,the small amount of tissue obtained by EUS-FNA/FNB may provide less pathological information.Here we report a new technique—submucosal tunneling endoscopic biopsy and myotomy(STEBM)derived from the peroral endoscopic myotomy(POEM)procedure to relieve stenosis and get a sufficient amount of tissue to make a definite diagnosis.

RATE OF CONVERGENCE OF SCHWARZ ALTERNATING METHOD FOR TIME-DEPENDENT CONVECTION-DIFFUSION PROBLEM

Presents a study that examined the application of an overlapping domain decomposition method to the solution of time-dependent convection-diffusion problems. Background on the Schwartz alternating procedure; Application of two kinds of Schwartz alternating procedure to solve the numerical approximation problem; Numerical results.