Prognosis value of heat-shock proteins in esophageal and esophagogastric cancer:A systematic review and meta-analysis

BACKGROUND Heat shock proteins(HSPs)are molecular chaperones that play an important role in cellular protection against stress events and have been reported to be overex-pressed in many cancers.The prognostic significance of HSPs and their regulatory factors,such as heat shock factor 1(HSF1)and CHIP,are poorly understood.AIM To investigate the relationship between HSP expression and prognosis in esophageal and esophagogastric cancer.METHODS A systematic review was conducted in accordance with PRISMA recommend-ations(PROSPERO:CRD42022370653),on Embase,PubMed,Cochrane,and LILACS.Cohort,case-control,and cross-sectional studies of patients with eso-phagus or esophagogastric cancer were included.HSP-positive patients were compared with HSP-negative,and the endpoints analyzed were lymph node metastasis,tumor depth,distant metastasis,and overall survival(OS).HSPs were stratified according to the HSP family,and the summary risk difference(RD)was calculated using a random-effect model.RESULTS The final selection comprised 27 studies,including esophageal squamous cell carcinoma(21),esophagogastric adenocarcinoma(5),and mixed neoplasms(1).The pooled sample size was 3465 patients.HSP40 and 60 were associated with a higher 3-year OS[HSP40:RD=0.22;95%confidence interval(CI):0.09-0.35;HSP60:RD=0.33;95%CI:0.17-0.50],while HSF1 was associated with a poor 3-year OS(RD=-0.22;95%CI:-0.32 to-0.12).The other HSP families were not associated with long-term survival.HSF1 was associated with a higher probability of lymph node metastasis(RD=-0.16;95%CI:-0.29 to-0.04).HSP40 was associated with a lower probability of lymph node dissemination(RD=0.18;95%CI:0.03-0.33).The expression of other HSP families was not significantly related to tumor depth and lymph node or distant metastasis.CONCLUSION The expression levels of certain families of HSP,such as HSP40 and 60 and HSF1,are associated with long-term survival and lymph node dissemination in patients with esophageal and esophagogastric cancer.

Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery （LVRS） can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms. Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups. Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO2, PaCO2, dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B. Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded the surgical indication for tumor patients.

Annual cost of illness of stomach and esophageal cancer patientsin urban and rural areas in China： A multi-center study

Objective： Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereasthere were few studies on the financial burden of the two cancers.Methods： Costs per hospitalization of all patients with stomach or esophageal cancer discharged betweenSeptember 2015 and August 2016 in seven cities/counties in China were collected, together with their demographicinformation and clinical details. Former patients in the same hospitals were sampled to collect information onannual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost wasobtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness （ACI）was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost,stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalizationwere itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars（1 USD：6.6423 RMB）.Results： Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urbanpatients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancerpatients were $10,449 and $13,029 in urban areas, and $2,927 and $3,504 in rural areas, respectively. Greater ACIwas associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries.Western medicine fee took the largest proportion of cost per hospitalization.Conclusions： The ACI of stomach and esophageal cancer was tremendous and varied substantially among thepopulation in China. Preferential policies of medical insurance should be designed to tackle with this burden andfurther reduce the health care inequalities.

Cell-free plasma hypermethylated CASZ1, CDH13 and ING2 are promising biomarkers of esophageal cancer

Identifying sensitive and specific biomarkers for early detection of cancer is immensely imperative for early diagnosis and treatment and better clinical outcome of cancer patients. This study aimed to construct a specific DNA methylation pattern of cancer suppressor genes and explore the feasibility of applying cell-free DNA based methylation as a biomarker for early diagnosis of esophageal squamous cell carcinoma(ESCC). We recruited early stage ESCC patients from Yangzhong County, China. The Illumina Infinium 450 K Methylation BeadChip was used to construct a genome-wide DNA methylation profile. Then, differentiated genes were selected for the validation study using the Sequenom MassARRAY platform. The frequency of methylation was compared between cancer tissues, matched cell-free DNAs and normal controls. The specific methylation profiles were constructed, and the sensitivity and specificity were calculated. Seven CG sites in three genes CASZ1, CDH13 and ING2 were significantly hypermethylated in ESCC as compared with normal controls. A significant correlation was found between the methylation of DNA extracted from cancer tissues and matched plasma cell-free DNA, either for individual CG site or for cumulative methylation analysis. The sensitivity and specificity reached 100% at an appropriate cut-point using these specific methylation biomarkers. This study revealed that aberrant DNA methylation is a promising biomarker for molecular diagnosis of esophageal cancer. Hypermethylation of CASZ1,CDH13 and ING2 detected in plasma cell-free DNA can be applied as a potential noninvasive biomarker for diagnosis of esophageal cancer.

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients:A phaseⅡclinical trial

Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and had treatment-naive,histologically proven inoperable locally advanced EC.Enrolled patients received radiotherapy with a total dose of 50-60 Gy in 25-30 fractions,concurrent with weekly infusion of nimotuzumab.The primary end point was the rate of more than grade 3 toxicities.Results:From June 2011 to July 2016,46 patients with stageⅡ-IV EC with a median age of 76.5 years were enrolled.There were 10,28 and 8 patients with stageⅡ,III and IV disease,respectively.The common acute toxicities included esophagitis(grade 1-2,75.4%;grade 3,8.7%),pneumonitis(grade 1,4.3%;grade 2,6.5%;grade3,2.2%),leukopenia(grade 1-2,60.9%;grade 3-4,4.4%),gastrointestinal reaction(grade 1-2,17.3%;grade 3,2.2%),thrombocytopenia(grade 1-2,21.7%;grade 3,2.2%),and radiothermitis(grade 1-2,39.2%).The incidence of grade 3-4 adverse effects was 17.4%.No grade 5 toxicities were observed.Clinical complete response,partial response,stable disease,and progressive disease were observed in 1(2.2%),31(67.4%),12(26.1%),and 2(4.3%)patients,respectively.The median overall survival(OS)and progression-free survival(PFS)were 17 and 10 months,respectively.The 2-,3-,and 5-year OS and PFS rates were 30.4%,21.7%,19.6%,and 26.1%,19.6%,19.6%,respectively.Conclusions:Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates.Further studies are warranted to confirm its therapeutic effects in elderly EC patients.

Covered nitinol stents for the treatment of esophageal strictures and leaks

AIM:To compare 2 different types of covered esophageal nitinol stents(Ultraflex and Choostent) in terms of efficacy,complications,and long-term outcome.METHODS:A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent(n = 33) or a Choostent(n = 32) from June 2001 to October 2009 was conducted.RESULTS:Stent placement was successful in all patients without hospital mortality.No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups.The median follow-up time was 6 mo(interquartile range 3-16 mo).Endoscopic reintervention was required in 9 patients(14%) because of stent migration or food obstruction.No significant difference in the rate of reintervention between the 2 groups was observed(P = 0.8).The mean dysphagia score 1 mo after stent placement was 1.9 ± 0.3 for the Ultraflex stent and 2.1 ± 0.4 for the Choostent(P = 0.6).At 1-mo follow-up endoscopy,the cover membrane of the stent appeared to be damaged more frequently in the Choostent group(P = 0.34).Removal of the Choostent was possible up to 8 wk without difficulty.CONCLUSION:Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks.Removal of the Choostent was easy and safe under mild sedation.

Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma

BACKGROUND The impact of body mass index(BMI)on survival in patients with esophageal squamous cell carcinoma(ESCC)undergoing surgery remains unclear.Therefore,a definition of clinically significant BMI in patients with ESCC is needed.AIM To explore the impact of preoperative weight loss(PWL)-adjusted BMI on overall survival(OS)in patients undergoing surgery for ESCC.METHODS This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011.The relationship between PWL-adjusted BMI and OS was examined,and a multivariate analysis was performed and adjusted for age,sex,TNM stage and adjuvant therapy.RESULTS Trends of poor survival were observed for patients with increasing PWL and decreasing BMI.Patients with BMI≥20.0 kg/m2 and PWL<8.8%were classified into Group 1 with the longest median OS(45.3 mo).Patients with BMI<20.0 kg/m2 and PWL<8.8%were classified into Group 2 with a median OS of 29.5 mo.Patients with BMI≥20.0 kg/m2 and PWL≥8.8%(HR=1.9,95%CI:1.5-2.5),were combined into Group 3 with a median OS of 20.1 mo.Patients in the three groups were associated with significantly different OS(P<0.05).In multivariate analysis,PWL-adjusted BMI,TNM stage and adjuvant therapy were identified as independent prognostic factors.CONCLUSION PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery.BMI might be an indicator for patients with PWL<8.8%rather than≥8.8%.

SURGICAL TREATMENT OF PRIMARY ESOPHAGEALADENOCARCINOMA

Objective: To study the biocharacteristics of primary esophageal adenocarcinoma (PEAC) and factors influencing patients’ prognosis and to find rational surgical indications and combined therapy. Methods: To analyze the clinical material of 106 patients with PEAC and compared with that of patients with esophageal squamous-cell carcinoma (ESCC). Results: The overall resectability, morbidity and 30-day mortality rates of PEAC were 92.5%, 23.5% and 2.8% respectively, similar to those of ESCC. The TNM staging, lymph node metastasis, extraesophageal invasion and the nature of operation were major determinants influencing long-term prognosis. The 5-year survival rate of PEAC was 21.0%, which was lower than that of ESCC (P<0.01). Metastasis or recurrence remained to be the cause of death in 82.4% of patients who lived longer than 5 years, which was higher than that of ESCC (P<0.01). Adjuvant radiation did not influence survival of the patients with lymph node metastasis, but appeared helpful to the patients with no lymph node metastasis. Conclusion: compared with ESCC, PEAC is a malignant disease with poor prognosis. Surgical resection is the first and chief choice of treatment. Surgical indications include patients in stage 0, I, II and some in stage III and even in stage IV of PEAC. Early detection, early diagnosis and early treatment as well as radical operation could improve prognosis. Adjuvant radiotherapy appears helpful only to the patients without lymph node metastasis.

THE DIAGNOSIS AND TREATMENT FOR RECURRENT DYSPHAGIA OF ESOPHAGEAL CARCINOMA AFTER RADICAL RADIOTHERAPY

Objective: To investigate the diagnosis and treatment for recurrent dysphagia of esophageal carcinoma after radical radiotherapy. Methods: The experince of 41 cases with recurrent dysphagia of esophageal carcinoma after radical radiotherapy were retrospectively summerized. Results: All of the cases were surgically treated form July, 1989 to May, 1997 with resectability rate in 97%, operative mortality in 4.8%, postoperative morbidity in 29%. Pathological examination showed squemous cell carcinoma in 82.8%, and serious radiation reaction in 13.2% after operation. The 1, 3, 5year survival rates after operation were 72.7%, 36.3%, 18.1% respectively, and those after radiation in 100%, 60%, and 35.5% respectively. Conclusion: Most of recurrent dysphagia for these cases were due to uncontrolled/recurrent cancer, and minority of them were due to constriction after radiotherapy. It is difficult to distinguish cancer with benigh constriction before operation. Some cases have lymphatic metastasis without local cancer recurrence. For those patients with recurrent disphagia should be treated with operation as early as possible.

Prediction of the Outcome of Esophageal Epithelium Dysplasia by High Resolution Image Analysis

Objective: To predict the outcome of dysplasia of esophageal epithelium by means of high resolution image analysis (HRIA). Methods: Asymptomatic adults were examined for balloon cytology of the esophagus in 1983 from Heshun Commune of Linxian County. 93 severe dysplasias and 122 mild dysplasias of the esophagus were selected. By means of an Axiomat-microscope equipped with TV-camera, 100 normal nuclei of well-preserved cells in the intermediate layer of Pap-stained squamous epithelium were randomly examined. Results: Of the 93 cytologically diagnosed severe dysplasia cases, 24, 14 and 7 progressed to carcinoma in 3, 5 and 9 years, respectively. In the other 48 cases, dysplasia remained stable or regressed to normal. The other cases were used as the control. According to chromatin features, correct diagnosis of cases was achieved by HRIA in 75.0% (18/24), 85.7% (12/14) and 85.7% (6/7) of the cases examined, respectively (P<0.001). Of the 122 cytologically diagnosed mild dysplasia, 16, 13 and 12 cases progressed to carcinoma in 3, 5 and 9 years, respectively. The other 81 cases remained stable or regressed to normal. Correct diagnosis was made by HRIA in 93.8% (15/16), 76.9% (10/13) and 83.3% (10/12) of the cases examined, respective1y (P<0.001). Conclusion: Chromatin nuclear features examined by HRIA can predict the outcome of precancerous lesions and discriminate progressor from non-progressor ones. It can be used as surrogate endpoint biomarkers for the evaluation of efficiency of chemo-prevention trial.

A STUDY ON CYCLOOXYGENASE -2 PROTEIN EXPRESSION IN ESOPHAGEAL CAICONOGENESIS

Objective: To investigate cyclooxygenase- 2(Cox-2) protein expression in esophageal cancer and precancerous lesions. Methods: One hundred twenty biopsy specimens from esophageal carcinoma and 113 from patients with esophageal premalingnant lesions, 27 from individuals with normal esophageal mucosa and 3 from Barrett’s esophagus were examined for Cox-2 protein expression by immunohistochemistry. Results: Cox-2 protein was not observed in normal esophageal squamous and glandular epithelium, hyperplasia from mild to severe dysplasia lesions and carcinoma in situ. Positive Cox-2 protein expression was found in 4 of 60 specimens of invasive squamous-cell carcinomas, 21 of 30 specimens of esophageal adenocarcinomas and in 3 of 3 Barret’s esophageal tissues. Conclusion: The Cox-2 protein expression may be associated with the development of the esophageal adenocarcinomas but not esophageal squamous-cell carcinomas.

EXPRESSION OF GST-л GENE IN HUMAN ESOPHAGEALCARCINOGENESIS

Objective: To investigate the possible role of GST-n in esophageal carcinogenesis. Methods: GST-nexpression at mRNA level was studied by in situhybridization (ISH) and at protein level byimmunohistochemistry (IHC). GST-n expression innormal epithelial cells (NC) of the esophagus,hyperplastic cells (HC), dysplastic cells (DC) from gradeI to III, carcinoma in situ (CIS) and all the cells insquamous cell carcinomas (SCC) were examined in thesame csophageal cancer specimens (n=48) whichprovided a model reflecting the process of esophagealcarcinogenesis. Results: The positive rate of IHCstaining was 87. 5% for NC, 95.3% for HC, 55.9% forDC (grade I: 73.9%, grade II: 47.4%, grade III:41.2%),36.4% for CIS and 45.8% for SCC. The positive rate ofGST-x mRNA expression was 81.2% for NC, 94.4% forHC, 61.9% for DC (grade I: 76.5%, grade II: 61.5%,grade III: 41.7%), 44.4% for CIS and 83.3% for grade ISCC, 30.0% for grade II SCC and 0% for grade IIISCC. There was no statistically sigllificant difference inGST-x expression at the mRNA and the protein level.Conclusion: There is a decreasing tendency of GST-nexpression from dysplasia to CIS and SCC. Thedecrease in GST-n expression is an early event inesophageal carcinogencsis.

Esophageal superficial adenosquamous carcinoma resected by endoscopic submucosal dissection:A rare case report

BACKGROUND Adenosquamous carcinoma(ASC),which is comprised of squamous cell carcinoma(SCC)and adenocarcinoma elements,is a rare histological type of esophageal carcinoma.Few reports have focused on the endoscopic findings and the effectiveness of the endoscopic treatment of early ASC.CASE SUMMARY A 77-year-old man underwent esophagogastroduodenoscopy for heartburn.A flat lesion with an uneven and slightly elevated central portion was found in the distal esophagus.Magnifying endoscopy with narrow-band imaging showed a well-demarcated brownish area with dendritically branched abnormal vessels and highly irregular intrapapillary capillary loops.A histopathological diagnosis of SCC was obtained by endoscopic biopsy.Endoscopic ultrasonography revealed a hypoechoic mass confined to the mucosa layer.The lesion was suspected to be SCC with invasion into the muscularis mucosa.The lesion was resected en bloc by endoscopic submucosal dissection and histologically diagnosed as esophageal ASC limited within the muscularis mucosa,which was completely resected without lymphovascular or neural invasion.The SCC element was the predominant element.The adenocarcinoma element formed ductal and nested structures distributed in a focal pattern.The patient underwent only endoscopic submucosal dissection and has been under annual endoscopic and radiographic surveillance for 3 years without recurrence.CONCLUSION For early ASC confined within the mucosal layer,complete endoscopic resection might also be a curative treatment.

A PROGNOSTIC EVALUATION ON ESOPHAGEAL CARCINOMA WITH LYMPH NODE METASTASIS──AN ANALYSIS OF 212 CASES

The authors studied retrospcctively lymph node metastatic status impacting on survival of 212 patients with thoracic esophageal squamous cell carcinoma 663 (19.4%) of the total 3, 419 lymph nodes examined (an average of 16. per patient) were proved to be positive.The overall 5-year survival rate was 19.3% (41/212).The results showed that no difference in survival was observed in relation to the site of the involved lymph node.Difference in survival based on the number of metastatic lymph nodes (1 or ≥2) and the frequence of Positive nodes ≤ 10% or≥10%) is statistically significant. The results indicated that the clinical staging of esophagcal carcinoma should be made according to the absolute number and the relative frequency of lymph nodes involved. The effectiveness and limitation of extended lymph node dissection in relation to prognosis was discussed.

INTRATUMORAL DNA PLOID HETEROGENEITY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA

In order to investigate the intratumoral DNA ploid heterogeneity (PH) in esophageal squamous cell carcinoma and its clinical-pathological significance, nuclear DNA ploidy of 80 cases of squamous cell carcinoma of the esophagus were determined with multiple samples removed from the same tumor, using a flow cytometry (FCM) technique. 240 samples for flow cytimetric DNA analysis were taken from 3 different parts if each tumor of 80 cases of specimens. DNA measurement was were present in a tumor or the variation in DI value among 3 peaks in each tumor was greater than 10%. Further more at last, comparison or clinical-pathological characteristics was performed between PHTs and N-PHT which has a similar ploid pattern in 3 sampling spots of each tumor (non PHT). DNA indices ranged from 0.77～1.74, and the incidence of DNA AN was 88. 8% (71/80) in this series. Of 80 cases, 38 cases (47. 5%, 38/80) showed intratumoral heterogeneity in DNA ploidy. The heterogeneity in DNA ploidy was related to the extent of wall penetration by the tumor,the incidence of lymph node metastasis and the patients's prognosis, not to histological grades and size of the tumor. There is PH phenomena in esophageal squmous cell carcinoma, and DNA PH may be a more exact indicator in reflecting the biological chatacteristics of the tumor and patient's prognosis.

CLINICAL EVALUATION OF CERVICAL ESOPHAGEAL RECONSTRUCTION AFTER RESECTION OF THORACIC ESOPHAGEAL CARCINOMA

The data of 3,714 patients with thoracic esophageal carcinoma from Apr, 1979 to Dec. 1994 were analysed in purpose to estimate the value of cervical esophagogastrotomy (cervical reconstruction) in the treatment of thoracic esophageal carcinoma. The results show that while cervical esophagogastrotomy was rarely used in the early years (only 8.8% of the treated cases), it has been recently used as the routine standard procedure in our hospital (94.1 %). This technic is of great importance and useful for the radical removal of tumor, the eradication of cervical and mediastinal lymph nodes, the reduction of post-operative complications and surgical mortality, as well as to improve the life quality of the patient. The operation indications, approach and the surgical efficacy are also discussed in the article.

New progress in esophageal cancer research of China

China has the highest incidence of esophageal squamous cell carcinoma(ESCC).Unlike esophageal adenocarcinoma in western countries,90%of esophageal cancer in China is squamous cell carcinoma,and there are distinct regional differences.Cancer stem cells,microecology,and epigenetics are closely related to esophageal cancer occurrence and development.The application of endoscopic ultrasonography,PET-CT,and MRI are conducive to the accurate staging of esophageal cancer.Advanced technologies such as neoadjuvant/definitive concurrent chemoradiotherapy,minimally invasive surgery,and photodynamic therapy have improved the overall survival and quality.The application of immunotherapy in advanced esophageal cancer has achieved remarkable results.

A CLINICAL STUDY ONINTRALUMINAL HYPERTHERMIA COMBINED WITH EXTERNAL IRRADIATION FOR ESOPHAGEAL CARCINOMA

A randomized trial of intracavitary microwave hyperthermia combined with external irradiation (R+H) versus radiation (R) alone in the treatment of esophageal cancer was performed form February 1986 to February 1988. In the R group, radiation was given by 8 MV X-ray with 2 Gy/fraction, 5 fractions per week with a total dose of 60 Gy/6 weeks. In the R+H group, the radiation was given as R group but with a total dose of 40 Gy/4 weeks. Intracavitary 915 Mhz microwave hyperthermia was given with a nominal temperature of 43.5℃ at the margin of the tumor surface, 45 minutes/session, 1-2 sessions/week for 4-8 session. The 1-, 3-, and 5-year survival rates in R+H group were 81.2% (48/59 cases), 42.4% (25/59) and 23.7% (14/59), while in the R group 59.0% (39/66 cases), 24.2% (16/66) and 16.7% (11/66) respectively. The differences in 1- and 3-year survival rates were statistically significant (P<0.05) between the 2 groups. Using the thermal dose T90 analysis, after the cases with T90<43℃ (insufficient thermal dose) were eliminated, 52 cases with T90 equal to or higher than 43 ℃ had 1, 3, and 5 year survival rates of 84.6%, 44.2% and 26.9%, respectively. Statistically significant differences in the 2 groups were also limited only to 1- and 3-year survivals. Higher 5-year survivals is anticipated if more cases are studied.

Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia:A metaanalysis

BACKGROUND Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer,both of which have high morbidity and mortality.Lymph node metastasis(LNM),as the most common metastasis mode of both diseases,is an important factor affecting tumor stage,treatment strategy and clinical prognosis.As a new fusion technology,endoscopic ultrasound(EUS)is becoming increasingly used in the diagnosis and treatment of digestive system diseases,but its use in detecting LNM in clinical practice remains limited.AIM To evaluate the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia.METHODS Using the search mode of“MeSH+Entry Terms”and according to the predetermined inclusion and exclusion criteria,we conducted a comprehensive search and screening of the PubMed,EMBASE and Cochrane Library databases from January 1,2000 to October 1,2022.Study data were extracted according to the predetermined data extraction form.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool,and the results of the quality assessment were presented using Review Manager 5.3.5 software.Finally,Stata14.0 software was used for a series of statistical analyses.RESULTS A total of 22 studies were included in our study,including 2986 patients.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic score and diagnostic odds ratio of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were 0.62[95%confidence interval(CI):0.50-0.73],0.80(95%CI:0.73-0.86),3.15(95%CI:2.46-4.03),0.47(95%CI:0.36-0.61),1.90(95%CI:1.51-2.29)and 6.67(95%CI:4.52-9.84),respectively.The area under the summary receiver operating characteristic curve was 0.80(95%CI:0.76-0.83).Sensitivity analysis indicated that the results of the meta-analysis were stable.There was considerable heterogeneity among the included studies,and the threshold effect was an important source of heterogeneity.Univariable meta-regression and subgroup analysis showed that tumor type,sample size and EUS diagnostic criteria were significant sources of heterogeneity in specificity(P<0.05).No significant publication bias was found.CONCLUSION Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia,but it cannot be used as a confirmatory or exclusionary test.

Duodenal ulcer caused by coil wiggle after digital subtraction angiography-guided embolization: A case report

BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.