Detachable string magnetically controlled capsule endoscopy for the noninvasive diagnosis of esophageal diseases:A prospective,blind clinical study

BACKGROUND Traditional esophagogastroduodenoscopy(EGD),an invasive examination method,can cause discomfort and pain in patients.In contrast,magnetically controlled capsule endoscopy(MCE),a noninvasive method,is being applied for the detection of stomach and small intestinal diseases,but its application in treating esophageal diseases is not widespread.AIM To evaluate the safety and efficacy of detachable string MCE(ds-MCE)for the diagnosis of esophageal diseases.METHODS Fifty patients who had been diagnosed with esophageal diseases were pros-pectively recruited for this clinical study and underwent ds-MCE and conven-tional EGD.The primary endpoints included the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for patients with esophageal diseases.The secondary endpoints consisted of visualizing the esophageal and dentate lines,as well as the subjects'tolerance of the procedure.RESULTS Using EGD as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of ds-MCE for esophageal disease detection were 85.71%,86.21%,81.82%,89.29%,and 86%,respectively.ds-MCE was more comfortable and convenient than EGD was,with 80%of patients feeling that ds-MCE examination was very comfortable or comfortable and 50%of patients believing that detachable string v examination was very convenient.CONCLUSION This study revealed that ds-MCE has the same diagnostic effects as traditional EGD for esophageal diseases and is more comfortable and convenient than EGD,providing a novel noninvasive method for treating esophageal diseases.

Therapeutic effect of Wendan Decoction combined with mosapride on gastroesophageal reflux disease after esophageal cancer surgery

BACKGROUND Gastroesophageal reflux disease(GERD)is a common complication of esophageal cancer surgery that can affect quality of life and increase the risk of esophageal stricture and anastomotic leakage.Wendan Decoction(WDD)is a traditional Chinese herbal formula used to treat various gastrointestinal disorders,such as gastritis,functional dyspepsia,and irritable bowel syndrome.Mosapride,a prokinetic agent,functions as a selective 5-hydroxytryptamine 4 agonist,enhancing gastrointestinal motility.AIM To evaluate the therapeutic effects of WDD combined with mosapride on GERD after esophageal cancer surgery.METHODS Eighty patients with GERD were randomly divided into treatment(receiving WDD combined with mosapride)and control(receiving mosapride alone)groups.The treatment was conducted from January 2021 to January 2023.The primary outcome was improved GERD symptoms as measured using the reflux disease questionnaire(RDQ).The secondary outcomes were improved esophageal motility(measured using esophageal manometry),gastric emptying(measured using gastric scintigraphy),and quality of life[measured via the Short Form-36(SF-36)Health Survey].RESULTS The treatment group showed a notably reduced RDQ score and improved esophageal motility parameters,such as lower esophageal sphincter pressure,peristaltic amplitude,and peristaltic velocity compared to the control group.The treatment group showed significantly higher gastric emptying rates and SF-36 scores(in both physical and mental domains)compared to the control group.No serious adverse effects were observed in either group.CONCLUSION WDD combined with mosapride is an effective and safe therapy for GERD after esophageal cancer surgery.It can improve GERD symptoms,esophageal motility,gastric emptying,and the quality of life of patients.Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

Behçet's disease(BD)is a chronic inflammatory disorder prone to frequent re-currences,with a high predilection for intestinal involvement.However,the ef-ficacy and long-term effects of surgical treatment for intestinal BD are unknown.In the current issue of World J Gastrointest Surg,Park et al conducted a retrospec-tive analysis of 31 patients with intestinal BD who received surgical treatment.They found that elevated C-reactive protein levels and emergency surgery were poor prognostic factors for postoperative recurrence,emphasizing the adverse impact of severe inflammation on the prognosis of patients with intestinal BD.This work has clinical significance for evaluating the postoperative condition of intestinal BD.The editorial attempts to summarize the clinical diagnosis and treatment of intestinal BD,focusing on the impact of adverse factors on surgical outcomes.We hope this review will facilitate more precise postoperative management of patients with intestinal BD by clinicians.

Endoscopic trans-esophageal submucosal tunneling surgery:A new therapeutic approach for diseases located around the aorta ventralis

AIM To assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery(EESTS) technique for diseases located around the aorta ventralis.METHODS Nine pigs were assigned to EESTs. The procedures were as follows: First, a long esophageal submucosal tunnel was established. Second, full-thickness myotomy was created. Third, an endoscope was entered into the abdominal cavity through a muscle incision and the endoscope was around the aorta ventralis. Eventually,celiac trunk ganglion neurolysis, partial hepatectomy and splenectomy, partial tissue resection in the area of the posterior peritoneum, and endoscopic submucosal dissection(ESD) combined with lymph node dissection were performed. The animals were given antibiotics for 5 d and necropsied 7 d after surgery.RESULTS In all surgeries, one pig died from intraperitoneal hemorrhage after doing partial splenectomy, while the other pigs were alive after successfully operating other surgeries. For surgery of celiac trunk ganglion damage, at necropsy, there was no exudation in the abdominal cavity. Regarding surgery of partial hepatectomy, the wound with part healing was observed in the left hepatic lobe, and no bleeding or obvious exudation was seen. In surgery of partial splenectomy, massive hemorrhage was observed on the splenic wound surface, and the metal clips could not stop bleeding. After surgery of retroperitoneal tissue resection, mild tissue adhesion was observed in the abdominal cavity of one animal, and another one suffered from severe infection. For surgery of ESD and lymph node dissection, a moderate tissue adhesion was observed.CONCLUSION EESTS is a feasible and safe technique for diseases located around the aorta ventralis.

Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease

AIM: To demonstrate the optimal surgical procedure for gastroesophageal reflux disease. METHODS: The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using metaanalysis. RESULTS: We ultimately identified a total of 32 references reporting nine randomized controlled trials, eight prospective cohort trials and 15 retrospective trials. These studies reported a total of 6236 patients, of whom 4252 (68.18%) underwent LNF and 1984 (31.82%) underwent LTF. There were no differences between LNF and LTF in patients' satisfaction, perioperative complications, postoperative heartburn, refluxrecurrence and reoperation. Both LNF and LTF enhanced the function of lower esophageal sphincter and improved esophagitis. The postoperative dysphagia, gasbloating syndrome, inability to belch and the need for dilatation after LNF were more common than after LTF. Subgroup analyses showed that dysphagia after LNF and LTF was similar in patients with normal esophageal peristalsis (EP), but occurred more frequently in patients with weak EP after LNF than after LTF. Furthermore, patients with normal EP after LNF still had a higher risk of developing dysphagia than did patients with abnormal EP after LTF.CONCLUSION: Compared with LNF, LTF offers equivalent symptom relief and reduces adverse results.

Oesophageal surgery

INTRODUCTIONThe origins of oesophageal surgery ,like most surgical treatments ,are based in the treatment of traumatic injury .The Smith Surgical Papyrus describes the examination, diagnosis and treatment of 'a gaping wound of throat, penetrating the gullet' [1].

Acute esophageal necrosis and liver pathology,a rare combination

Acute esophageal necrosis (AEN) or 'black esophagus' is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe a case of 'black esophagus', first of its kind, in the setting of liver cirrhosis and hepatic encephalopathy.

人工智能在心血管外科方面的应用研究进展

随着ChatGPT引发的人工智能(Artificial Intelligence,AI)热潮,AI在辅助心血管外科疾病诊疗中成为医学领域研究的热点之一。基于AI和深度学习技术开发的一系列辅助系统,包括疾病预测、风险分级、诊断和治疗方案规划等,为提高临床诊疗效率和准确性、降低错漏失误率、减少医疗资源浪费以及解决医疗资源短缺问题提供了新的途径和方法。本文首先总结分析了心血管外科与AI关注的共同点,随后列举了AI在血管外科手术和心外科手术中的应用实例,并深入分析其异同以及各种应用之间的系统关系,最后探讨了AI技术在心血管外科疾病领域的指导意义和研究进展,旨在为新一代AI辅助诊断和治疗方案规划软件的开发以及在心血管外科临床实践中的落地转化和推广应用提供参考。

DRG支付下子宫腔内病变手术患者住院费用影响因素分析

目的以子宫腔内病变手术组(疾病诊断相关分组编码为NE19)为切入点,分析影响患者住院费用的因素。方法本研究为回顾性横断面研究,资料来源于北京市某公立综合性三甲医院2022年3月15日—2023年11月30日所有入组NE19的患者病案首页信息。以住院费用为因变量,患者基本信息、治疗信息和重点关注因素作为自变量进行影响因素筛选和多重线性回归分析。在此基础上,结合临床实践情况,分析包含重点因素病历的盈亏状况及住院费用结构指标间的差异。结果共纳入2213份有效病历(均为女性患者),患者以45岁以下中青年女性为主(72.12%),日间手术病历931份(42.07%);诊断中包含子宫多发肌瘤的病历334份(15.09%),包含盆腔粘连的病历246份(11.12%);涉及卵巢、输卵管相关手术或操作的病历150份(6.78%),主要操作为腹腔镜子宫病损切除术的病历160份(7.23%),使用经宫腔镜子宫异常组织机械旋切术的病历38份(1.72%)。线性回归分析显示,是否涉及卵巢和输卵管相关手术或操作(βi=0.30)、主要操作是否为腹腔镜子宫病损切除术(βi=0.30)及是否采用经宫腔镜子宫异常组织机械旋切术(βi=0.20)对住院费用的影响较大。在对重点因素的分析中,涉及卵巢和输卵管相关手术或操作、主要操作为腹腔镜子宫病损切除术、子宫多发肌瘤、盆腔粘连的病历出现亏损的比例更高(P均<0.05),且“是否使用经宫腔镜子宫异常组织机械旋切术”和“是否为日间手术”对住院费用的多项结构指标有显著影响(P均<0.05)。结论本研究所在医院NE19组亏损率较高,患者病情严重程度、新技术的使用等因素均可影响住院费用,提示现有疾病诊断相关分组方案尚存在进一步优化空间,可对不同层级医疗机构建立分层支付标准,健全优化除外机制,推动新技术的顺利开展。医院内部应鼓励开展日间手术,以进一步提升医疗服务效率。

健康教育图文册的构建及在食管癌患者术后康复护理的应用

目的基于知识可视化构建健康教育图文册,并探讨其用于食管癌患者术后康复护理的效果。方法将116例食管癌手术患者按照入院时间顺序分组,试验组58例,采用由研究团队基于知识可视化构建的健康教育图文册进行术后健康教育;对照组58例,实施常规健康教育。出院时评价两组自我护理能力、恐惧疾病进展、术后康复指标及患者满意度。结果试验组自我护理能力总分显著高于对照组,疾病进展恐惧总分显著低于对照组,术后胸腔引流管留置时间、胃管留置时间显著短于对照组,患者满意度得分显著高于对照组(均P<0.05)。结论将健康教育图文册应用于食管癌术后患者,可提升患者自我护理能力及满意度,改善疾病恐惧水平,促进食管癌术后患者术后康复。

侵犯肾静脉的Castleman病误诊临床分析

目的探讨Castleman病(CD)的临床特点及鉴别诊断要点,以减少误诊误治。方法回顾性分析2023年收治的1例CD的临床资料,并复习相关文献。结果1例女性因发现腹腔占位10余天入院。入院完善相关检查,肿瘤标志物等未见异常。全腹部强化CT检查考虑畸胎瘤可能性大,腹膜后多发增大淋巴结。经多学科专家会诊后,行腹膜后病灶切除术、部分肾静脉切除术、肾静脉-下腔静脉自体大隐静脉搭桥术治疗,术后病理示CD,治愈出院。结论部分CD患者无明显临床表现,易误诊。临床鉴别CD与其他腹腔肿瘤时,应行多学科会诊并重视病理及免疫组织化学结果,仔细询问病史及查体,认真鉴别诊断,以减少或避免误诊误治。

Pathophysiology and treatment of Barrett's esophagus

Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the United States. About 10%-15% of patients with GERD develop Barrett’s esophagus, which can progress to adenocarcinoma, currently the most prevalent type of esophageal cancer. The esophagus is normally lined by squamous mucosa, therefore, it is clear that for adenocarcinoma to develop, there must be a sequence of events that result in transformation of the normal squamous mucosa into columnar epithelium. This sequence begins with gastroesophageal reflux, and with continued injury metaplastic columnar epithelium develops. This article reviews the pathophysiology of Barrett’s esophagus and implications for its treatment. The effect of medical and surgical therapy of Barrett’s esophagus is compared.

Perianal Crohn's disease: Is there something new?

Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.

Diagnostic dilemma between intestinal Behet disease and inflammatory bowel disease with pyoderma gangrenosum

TO THE EDITOR I have read with great interest the very recent article rifled ＂Intestinal Behcet＇s disease with pyoderma gangrenosum： A case report＂ of Nakamura T et al that was published in your journal. The authors stated that they presented a very rare case of intestinal Behcet＇s disease with pyoderma gangrenosum in a 16-year old patient. However, I would like to make some important contributions and suggestions to the presented case and have a few questions to ask the authors.

食管淋巴管瘤1例及文献复习

食管淋巴管瘤是一种罕见的食管疾病,因其临床表现通常无特异性而易被误诊,病理诊断对确诊食管淋巴管瘤起到了十分重要的作用。本文通过1例食管淋巴管瘤病例报道及相关文献复习,分析其临床和病理表现,以提高临床医生对该病的认识。

多学科诊疗模式下高危老年患者接受宫腔镜电切手术的安全性

目的探讨多学科诊疗模式(MDT)下多发合并症高危老年患者接受宫腔镜电切手术的安全性。方法回顾性分析2018年1月至2022年5月就诊于郑州大学第二附属医院接受宫腔镜电切手术的68例老年女性患者的病例资料。将接受MDT会诊的患者纳入观察组,未接受MDT会诊的患者纳入对照组。68例患者均合并两种或两种以上的内科疾病。比较两组患者手术时间、术后苏醒时间、术后并发症发生率及满意度。结果两组手术时间比较,差异无统计学意义(P>0.05),观察组术后苏醒时间短于对照组,术后并发症发生率低于对照组,患者满意度高于对照组(P<0.05)。结论术前常规MDT评估患者围手术期风险,可提高宫腔镜电切手术的安全性和满意度。

深度学习方法应用于食管疾病分类和识别的现状

目的通过深度学习方法对食管癌前病变和食管癌进行自动检测和分类。方法收集我院2011年5月至2019年5月食管癌前病变和食管癌图像,且经过病理学确诊,共从832例患者中选取1572张食管白光图像,包括食管癌、正常食管、食管癌前病变,同时进行标记和筛选图像。深度学习框架训练其中的1337张食管白光图像,其余235张图像进行卷积神经网络(convolutional neural network,CNN)目标检测。CNN是由两个子网组成,分别是O-流和P-流。O-流的主要作用是原始图像的输入,负责提取原始图像的全局特征和颜色。P-流的主要作用是输入预处理后的食管图像,提取原始图像的细节特征和纹理。结果双流CNN系统敏感度为95.64%,特异度为95.96%,总体准确度为86.74%。食管癌的检出率为78.72%,癌前病变的检出率为83.4%,正常食管的检出率为95.32%。其中47例食管癌患者中有10例被误诊为癌前病变,误诊率为21.28%。与正常食管相比,食管癌的诊断精确率相对较低。在数据集相同的情况下,将传统学习方法局部二值模式(local binary pattern,LBP)+支持向量机(support vector machine,SVM)和SVM+方向梯度直方图(histograms of oriented gradients,HOG)与本研究方法进行比较,结果表明深度学习方法准确度、敏感度、特异度均高于其他方法。结论双流CNN系统在图像识别上具有较高的特异度和敏感度,与目前较为传统的机器学习方法相比,此方法更胜一筹,因此,在帮助内镜医师诊断食管疾病上具有很大的应用前景。

原发性小肠肿瘤93例临床分析

目的 探讨小肠肿瘤类型、临床特点及其诊断。方法 回顾性病例分析。结果 小肠良性肿瘤中以平滑肌瘤为多 ,占 12 / 17;恶性肿瘤中以腺癌多见 ,占 45 / 76。小肠肿瘤可表现为消化道出血、腹痛、腹块、发热、黄疸等。上消化道钡餐 (GI)检查 2 8例 ,2 1例阳性 ;9例行动脉造影 ,手术证实病变部位与造影一致。结论 动脉造影对小肠肿瘤有定性定位诊断价值 ,逆行胰胆管造影 (ERCP)。

86例早期食管癌临床诊治探讨

目的:探讨提高早期食管癌的诊断率和远期生存率的体会。方法:对福建医科大学附属第二医院自1998年1月至2004年12月手术治疗的86例早期食管癌进行回顾性分析。结果:本组病例部分早期食管癌症状大多轻微,自觉不适病程长短不一,X线检出率为84.9%(73/86),电子胃镜检查确诊率为100%(86/86)(其中尚有1例经过3次镜检获得病理诊断)。手术切除率为100%(86/86),并发症发生率为14.0%(12/86)。术后均未再行辅助治疗,定期随访,5年生存率为94.2%(81/86)。结论:早期食管癌的病程进展比较缓慢,症状轻微,呈非特异性,容易忽视,应高度重视早期食管癌的症状,采用内镜结合碘染色等检查方法多次检查(必要时采用多项检查方法和定期复查),结合临床症状综合分析,将有助于提高早期食管癌的诊断率。一些分子生物学指标被用于食管癌的实验室诊断,亦将有助于提高早期食管癌的诊断。早期食管癌的手术治疗远期疗效佳,手术治疗(食管次全切除并常规区域淋巴结清扫)是治疗早期食管癌的有效方法。术后复发与转移是早期食管癌患者术后死亡的主要原因。早期食管癌手术治疗不能完全达到治愈目的,且术后患者生存期较长,应定期密切随访,以便尽早对食管复发癌或转移癌进行有效的治疗,提高患者的生存质量和远期生存率。

术前CT判断食管癌可切除性

目的 探讨术前CT扫描在食管癌可切除性评估中的价值。方法 10 7例食管癌患者 ,术前全部行胸部CT平扫 ,45例增强扫描。将CT扫描结果与手术、病理相对照。结果 10 7例中 ,10 2例行手术切除 ,食管癌切除率为 95 .3 %(10 2 /10 7) ;其余 5例因食管癌侵犯邻近组织而仅行探查术。食管癌术前表现与手术所见一致性较好 (Kappa =0 .482 ,P <0 .0 0 1)。结论 术前CT扫描判断食管癌能否切除具有很高的临床价值 ,可减少不必要的外科手术。