Endoscopic features and treatments of gastric cystica profunda

BACKGROUND Gastric cystica profunda(GCP)represents a rare condition characterized by cystic dilation of gastric glands within the mucosal and/or submucosal layers.GCP is often linked to,or may progress into,early gastric cancer(EGC).AIM To provide a comprehensive evaluation of the endoscopic features of GCP while assessing the efficacy of endoscopic treatment,thereby offering guidance for diagnosis and treatment.METHODS This retrospective study involved 104 patients with GCP who underwent endoscopic resection.Alongside demographic and clinical data,regular patient followups were conducted to assess local recurrence.RESULTS Among the 104 patients diagnosed with GCP who underwent endoscopic resection,12.5%had a history of previous gastric procedures.The primary site predominantly affected was the cardia(38.5%,n=40).GCP commonly exhibited intraluminal growth(99%),regular presentation(74.0%),and ulcerative mucosa(61.5%).The leading endoscopic feature was the mucosal lesion type(59.6%,n=62).The average maximum diameter was 20.9±15.3 mm,with mucosal involvement in 60.6%(n=63).Procedures lasted 73.9±57.5 min,achieving complete resection in 91.3%(n=95).Recurrence(4.8%)was managed via either surgical intervention(n=1)or through endoscopic resection(n=4).Final pathology confirmed that 59.6%of GCP cases were associated with EGC.Univariate analysis indicated that elderly males were more susceptible to GCP associated with EGC.Conversely,multivariate analysis identified lesion morphology and endoscopic features as significant risk factors.Survival analysis demonstrated no statistically significant difference in recurrence between GCP with and without EGC(P=0.72).CONCLUSION The findings suggested that endoscopic resection might serve as an effective and minimally invasive treatment for GCP with or without EGC.

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.

Efficacy of image-enhanced endoscopy for colorectal adenoma detection:A multicenter,randomized trial

BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.

内镜黏膜下剥离术治疗巨大结直肠侧向发育型肿瘤的临床研究

目的评价内镜黏膜下剥离术(ESD)治疗巨大结直肠侧向发育型肿瘤(LST)中的疗效和安全性。方法对150例病灶直径>4 cm的结直肠LST的临床资料进行回顾性总结,分析LST形态分型、部位、病理结果、整块切除率、完全切除率和并发症。结果 150例患者中,颗粒型87例(58.0%),非颗粒型63例(42.0%)。部位分别为直肠109例(72.7%),乙状结肠13例(8.7%),降结肠5例(3.3%),横结肠8例(5.3%),升结肠13例(8.7%),盲肠2例(1.3%)。低级别上皮内瘤变23例,高级别上皮内瘤变104例,黏膜内癌7例,黏膜下癌16例。整块切除率为92.7%(139/150),完全切除率89.3%(134/150)。术中出血8.0%(12/150),术后出血1.3%(2/150),穿孔率为2.0%(3/150),术后狭窄2.0%(3/150)。结论非颗粒型巨大结直肠LST恶变率大。ESD治疗巨大结直肠LST是安全有效的。

内镜下放射状切开术治疗难治性上消化道良性狭窄的临床研究

目的探讨内镜下放射状切开术(ERI)治疗难治性上消化道良性狭窄的有效性和安全性。方法回顾性分析2017年11月-2020年1月苏北人民医院因上消化道良性狭窄行ERI治疗的患者14例,记录患者术前狭窄时间、术前接受治疗情况、术前术后吞咽困难症状、吻合口直径改善情况、术中术后并发症发生情况,并评估其疗效。结果14例患者均完成ERI术,平均操作时间(13.21±4.26)min,切开部位(2.17±0.58)处,所有患者均未出现穿孔和出血等并发症,术前吞咽困难评分为(3.08±0.52)分,术后第2天降至(1.14±0.35)分,术前术后比较,差异有统计学意义(P<0.05),术后3和6个月吞咽困难评分分别为(1.23±0.58)和(1.39±0.66)分,与术后第2天比较,差异无统计学意义(P>0.05),术前、术后当时和术后3个月狭窄处直径分别为(0.28±0.04)、(1.23±0.02)和(1.11±0.03)cm,3个时点比较,差异有统计学意义(P<0.05),术后当时与术后3个月比较,差异无统计学意义(P>0.05)。结论ERI治疗难治性上消化道良性狭窄是安全有效且可行的。

New progress in endoscopic treatment of esophageal diseases

The technique of endoscopic submucosal dissection(ESD),which was developed for en bloc resection of large lesions in the stomach,has been widely accepted for the treatment of the entire gastrointestinal tract.Many minimally invasive endoscopic therapies based on ESD have been developed recently.Endoscopic submucosal excavation,submucosal tunneling endoscopic resection and laparoscopic-endoscopic cooperative surgery have been used to remove submucosal tumors,especially tumors which originate from the muscularis propria of the digestive tract.Peroral endoscopic myotomy has recently been described as a scarless and less invasive surgical myotomy option for the treatment of achalasia.Patients benefit from minimally invasive endoscopic therapy.This article,in the highlight topic series,provides detailed information on the indications and treatments for esophageal diseases.

Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction

AIM:To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer(CRC)patients with acute colorectal obstruction(ACO).METHODS:From April 2008 to April 2012,surgeryrelated parameters,complications,overall survival(OS),and disease-free survival(DFS)of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent(SEMS)placement followed by one-stage open(n=58)or laparoscopic resection(n=16)were evaluated retrospectively.The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics.RESULTS:The characteristics of patients among these groups were comparable.The rate of conversion to open surgery was 12.5%in the stent-laparoscopy group.Bowel function recovery and postoperative hospital stay were significantly shorter(3.3±0.9 d vs 4.2±1.5 d and 6.7±1.1 d vs 9.5±6.7 d,P=0.016 and P=0.005),and surgical time was significantly longer(152.1±44.4 min vs 127.4±38.4 min,P=0.045)in the stent-laparoscopy group than in the stent-open group.Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group.There were no significant differences in the interval between stenting and surgery,intraoperative blood loss,OS,and DFS between the two stent groups.Compared with those in the stentlaparoscopy group,all surgery-related parameters,complications,OS,and DFS in the control group were comparable.CONCLUSION:The stent-laparoscopy approach is a feasible,rapid,and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.

Consensus on the digestive endoscopic tunnel technique

With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).

Comparative study on artificial intelligence systems for detecting early esophageal squamous cell carcinoma between narrow-band and white-light imaging

BACKGROUND Non-magnifying endoscopy with narrow-band imaging(NM-NBI)has been frequently used in routine screening of esophagus squamous cell carcinoma(ESCC).The performance of NBI for screening of early ESCC is,however,significantly affected by operator experience.Artificial intelligence may be a unique approach to compensate for the lack of operator experience.AIM To construct a computer-aided detection(CAD)system for application in NMNBI to identify early ESCC and to compare it with our previously reported CAD system with endoscopic white-light imaging(WLI).METHODS A total of 2167 abnormal NM-NBI images of early ESCC and 2568 normal images were collected from three institutions(Zhongshan Hospital of Fudan University,Xuhui Hospital,and Kiang Wu Hospital)as the training dataset,and 316 pairs of images,each pair including images obtained by WLI and NBI(same part),were collected for validation.Twenty endoscopists participated in this study to review the validation images with or without the assistance of the CAD systems.The diagnostic results of the two CAD systems and improvement in diagnostic efficacy of endoscopists were compared in terms of sensitivity,specificity,accuracy,positive predictive value,and negative predictive value.RESULTS The area under receiver operating characteristic curve for CAD-NBI was 0.9761.For the validation dataset,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CAD-NBI were 91.0%,96.7%,94.3%,95.3%,and 93.6%,respectively,while those of CAD-WLI were 98.5%,83.1%,89.5%,80.8%,and 98.7%,respectively.CAD-NBI showed superior accuracy and specificity than CAD-WLI(P=0.028 and P≤0.001,respectively),while CAD-WLI had higher sensitivity than CAD-NBI(P=0.006).By using both CAD-WLI and CAD-NBI,the endoscopists could improve their diagnostic efficacy to the highest level,with accuracy,sensitivity,and specificity of 94.9%,92.4%,and 96.7%,respectively.CONCLUSION The CAD-NBI system for screening early ESCC has higher accuracy and specificity than CAD-WLI.Endoscopists can achieve the best diagnostic efficacy using both CAD-WLI and CAD-NBI.

Emerging molecular classifications and therapeutic implications for gastric cancer

Gastric cancer(GC) is a highly aggressive and life-threatening malignancy.Even with radical surgical removal and front-line chemotherapy,more than half of GCs locally relapse and metastasize at a distant site.The dismal outcomes reflect the ineffectiveness of a one-size fits-all approach for a highly heterogeneous disease with diverse etiological causes and complex molecular underpinnings.The recent comprehensive genomic and molecular profiling has led to our deepened understanding of GC.The emerging molecular classification schemes based on the genetic,epigenetic,and molecular signatures are providing great promise for the development of more effective therapeutic strategies in a more personalized and precise manner.To this end,the Cancer Genome Atlas(TCGA) research network conducted a comprehensive molecular evaluation of primary GCs and proposed a new molecular classification dividing GCs into four subtypes:Epstein-Barr virus-associated tumors,microsatellite unstable tumors,genomically stable tumors,and tumors with chromosomal instability.This review primarily focuses on the TCGA molecular classification of GCs and discusses the implications on novel targeted therapy strategies.We believe that these fundamental findings will support the future application of targeted therapies and will guide our efforts to develop more efficacious drugs to treat human GCs.

Endoscopic submucosal dissection for foregut neuroendocrine tumors:An initial study

AIM： To evaluate the feasibility and efficacy of endo- scopic submucosal dissection （ESD） for foregut neuro- endocrine tumors （NETs）. METHODS： From April 2008 to December 2010, pa- tients 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 mark-ing dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submu- cosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological char- acteristics, 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 dis- tant 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 le- sions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preop- erative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 le- sions 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 av- erage maximum diameter of the lesions was 9.4 mm （range： 2-30 ram）, and the procedure time was 20.3 rain （range： 10-45 rain）. According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric le- sions were NET-G2, and 1 esophageal lesion was neu- roendocrine 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 re- maining patient with NEC underwent additional surgery because the resected specimens revealed angiolym- phatic and muscularis invasion, as well as incomplete resection. Delayed bleeding occurred in 1 case 3 d af- ter 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 too）, 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 dur- ing the study period. CONCLUSION： ESD appears to be a safe, feasible, and effective procedure for providing accurate histo- pathological evaluations and curative treatment for eligible foregut NETs.

Endoscopic biliary drainage for biliary obstruction

OBJECTIVE: To improve the successful rate of endoscopic biliary drainage. METHODS: Three hundred and fifty-two patients with biliary obstruction were given biliary drainage via duodenoscope from January 1998 to December 2002. 258 patients received endoscopic naso-biliary drainage (ENBD), 51 endoscopic retrograde biliary drainage (ERBD), and 43 endoscopic metal biliary endoprothesis (EMBE). RESULTS: Of the 352 patients with biliary obstruction, 337 succeeded in drainage by endoscopy and 15 failed. Ten ENBD failed patients were handled successfully by readjustment of the site of the naso-biliary tube. In 3 ERBD failed patients, 2 were given plastic stents with appropriate length and got a fluent drainage. Percutaneous transhepatic biliary drainage (PTBD) was performed in one patient after failure of endoscopic management. In 2 patients with failed EMBE, one stent could not exceed the site of tumor stricture and one was obstructed by tumor implantation only one month after EMBE. Placement of another metallic stent and a plastic stent through the previous prothesis for each patient ensured a successful drainage. CONCLUSIONS: The effect of endoscopic biliary drainage for biliary obstruction is definite. Drainage failure can be avoided or remedied as early as possible by taking some active measures.

Endoscopic resection of colorectal granular cell tumors

AIM: To determine the feasibility and effectiveness of endoscopic resection for the treatment of colorectal granular cell tumors(GCTs). METHODS: This was a retrospective study performed at a single institution. From January 2008 to April 2015, we examined a total of 11 lesions in 11 patients who were treated by an endoscopic procedure for colorectal GCTs in the Endoscopy Center, Zhongshan hospital of Fudan University, Shanghai, China. Either endoscopic mucosal resection or endoscopic submucosal dissection(ESD) was performed by three surgeons with expertise in endoscopic treatment. The pre- and postoperative condition and follow-up of these patients were evaluated by colonoscopy and endoscopic ultrasonography(EUS).RESULTS: Of these 11 lesions, 2 were located in the cecum, 3 were in the ileocecal junction, 5 were in the ascending colon, and 1 was in the rectum. The median maximum diameter of the tumors was 0.81 cm(range 0.4-1.2 cm). The en bloc rate was 100%, and the complete resection rate was 90.9%(10/11). postoperative pathology in one patient showed a tumor at the cauterization margin. however, during ESD, this lesion was removed en bloc, and no tumor tissue was seen in the wound. No perforations or delayed perforations were observed and emergency surgery was not required for complications. All patients were followed up to May 2015, and none had recurrence, metastasis, or complaints of discomfort.CONCLUSION: Endoscopic treatment performed by endoscopists with sufficient experience appears to be feasible and effective for colorectal GCTs.

Ligation-assisted endoscopic submucosal resection with circumferential mucosal incision for duodenal carcinoid tumor

Here we present the case of a 64-year-old female with a duodenal carcinoid tumor treated by ligation-assisted endoscopic submucosal resection(ESMR-L) with circumferential mucosal incision(CMI). Band ligation was effective in resecting the duodenal carcinoid tumor after CMI,with an uneventful post-procedural course. Histopathological examination showed clear tumor margins at deeper tissue levels. Thus,in the present case,ESMR-L with CMI was useful for the treatment of duodenal carcinoid tumor.

Endoscopic sphincterotomy or papillary balloon dilatation for choledocholithiasis

Objective: To assess the safety and effect of endoscopicsphincterotomy (EST) and endoscopic papillary bal-loon dilatation (EPBD) for choledocholithiasis.Methods: 328 patients with choledocholithiasis weresubjected to EST or EPBD; they included 174 patientswith single stone, 112 patients with two stones and 42patients with three stones (one patient with 20 stones).Patients with stones less than 10 mm in diameter un-derwent EPBD and those with stones larger than 11mm in diameter underwent EST.Results: EST and EPBD succeeded in 323 patients(98.5%), and failed in 5. Stones in 98 patients wereexcluded spontaneously after endoscopic therapy. 207patients were subjected to basket or balloon stone ex-traction. Stones in 14 patients were discharged bybasket lithotripsy. Four patients were given wavelithotripsy. Stones in 22 of the 323 patients were ex-tracted thoroughly after 2-3 times attempts. Totalcomplications were noted in 2.5% of the patients.Hemorrhage from the gastrointestinal tract was seenin one patient, cholangitis in 4 patients, and pancre-atitis in 3 patients. In 92 patients receiving digestivetract barium X-ray examination, 86 developed nobarium reflux to the baliary tract, 2 pneumobilia, 4barium reflux to the biliary tract.Conclusion: EST and EPBD are relatively safe and effec-tive in treatment of choledocholithiasis, and have fewcomplications.

Endoscopic diagnosis and treatment of an appendiceal mucocele:A case report

BACKGROUND Appendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin.We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.CASE SUMMARY A 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally.He was admitted to our hospital for a routine checkup without any symptoms.Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding.The preoperative diagnosis was non-neoplastic appendiceal mucocele,and endoscopic treatment was performed.The endoscopic findings and pathological results supported our preoperative diagnosis.The endoscopic treatment of appendiceal mucocele was feasible and effective,which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo.CONCLUSION Endoscopic therapy provides a new method for the treatment of appendiceal mucocele.

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.

Strategies and recommendations for the management of gastrointestinal surgery during the COVID-19 pandemic:experience shared by Chinese surgeons

Novel coronavirus disease-2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),is an ongoing public-health pandemic worldwide.Although SARS-CoV-2 has been known to spread primarily through respiratory droplets,recent evidence also supports fecal/oral as an additional route of transmission,raising concerns over gastrointestinal(GI)transmission of the infection.Herein,we,as the front-line Chinese GI surgeons,would like to share our experience and lessons in the combat against COVID-19.It is essential to create science-based,rational,and practical strategies during the outbreak of COVID-19.Here,we provide multi-institutional consensus on minimizing disease transmission while continuing to provide care from all aspects for patients in GI surgery,including outpatient clinics,inpatient units,gastrointestinal endoscopy centers,and adjustments in perioperative care.Our experiences and recommendations are worth sharing and may help to establish specific infection-control and outcome measures.

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.