Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients

BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.METHODS Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022.Among them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control group.We compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.RESULTS The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group.The intraoperative bleeding volume was higher in the experimental group than in the control group.The operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically significant(all P<0.05).The length of hospital stay was longer in the experi-mental group than in the control group,and the incidence of surgical complications,1-year postoperative recu-rrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group,and the differences were statistically significant(all P<0.05).However,the difference in the 1-year postoperative survival rate was not statistically significant between the two groups(P>0.05).Before discharge,PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period,and the above indexes were higher in the experimental group than those in the control group,and the differences were statistically significant(both P<0.05).Moreover,before discharge,PG II level was lower in both groups compared with the preoperative period,and the level was lower in the experimental group than in the control group,and the differences were all statistically significant(all P<0.05).CONCLUSION Compared with EMR,ESD surgery is more thorough.It reduces the rate of base residual focus,recurrence rate,surgical complications,and promotes the recovery of gastric cells and glandular function.It is safe and suitable for clinical application.

A Comprehensive Study on the digestive Endoscopic Technique and Narrow-Band Imaging for Early Gastric Cancer Screening

Objective:To explore the implementation of gastrointestinal endoscopy technology and endoscopic narrow-band imaging(NBI)in the early screening of gastric cancer and to observe and study their application effects.Methods:During the period from March 2023 to August 2023,312 patients who received gastroscopy in the Kunming Guandu District People’s Hospital were selected,and they underwent both conventional gastroscopy and endoscopic NBI,with clinicopathological tissue biopsy serving as the gold standard.The application value for early screening of gastric cancer was observed and analyzed.Results:The scoring data showed that the clarity of gastric mucosal glandular tube structure,microvascular structure clarity,and lesion contour scoring data of conventional gastroscopy were lower than those of the NBI technology(P<0.05).The screening rate of pathological biopsy in 312 patients was 18.59%(58 cases).Conventional gastroscopy showed a screening rate of 11.53%(36 cases),while NBI technology examined a screening rate of 17.63%(55 cases),and the two-by-two comparison of the screening rate data of the three groups was not statistically significant(P>0.05).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of conventional gastroscopy appeared to be lower than those of NBI technology(P<0.05).Conclusion:In the early screening of gastric cancer,endoscopic NBI technology can be applied to patients.Compared with conventional gastroscopy,it provides a clearer visualization of the structure of the gastric mucosal glandular structure and microvascular structure,with a certain screening rate.Additionally,its sensitivity,specificity,accuracy,positive predictive value,and negative predictive value are higher,demonstrating outstanding effectiveness.

The Effect of Partial Gastrectomy in the Treatment of Early Gastric Cancer and Its Impact on the Gastrointestinal Function of Patients

Objective:To investigate the impact of partial gastrectomy on gastrointestinal function in the treatment of patients with early gastric cancer.Methods:A sample of 20 patients with early-stage gastric cancer treated from January 2022 to January 2023 was randomly divided into two groups.Group A underwent partial gastrectomy,while Group B underwent distal subtotal gastrectomy.Surgical outcomes,complication rates,BMI indices,and quality of life were compared.Result:All surgical outcomes of patients with early gastric cancer in group A were better than those in group B(P<0.05);the postoperative complication rate for early gastric cancer in group A was lower than that in group B(P<0.05);the BMI index for patients with early gastric cancer in group A was higher than that in group B at different times(P<0.05);the postoperative quality of life(SF-36)score of group A for early gastric cancer was higher than that of group B(P<0.05).Conclusion:Partial gastrectomy for patients with early gastric cancer can increase BMI,optimize surgical outcomes,improve gastric function,and enhance the quality of life for gastric cancer patients.

Early esophagus cancer segmentation from gastrointestinal endoscopic images based on U-Net++model

Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routines.EEC has often been diagnosed at the late stage since early signs of cancer are not obvious,resulting in low survival rates.This work proposes a deep learning approach based on the U-Net++method to segment EEC in GIE images.A total of 2690 GIE images collected from 617 patients at the Digestive Endoscopy Center,West China Hospital of Sichuan University,China,have been utilized.The experimental result shows that our proposed method achieved promising results.Furthermore,the comparison has been made between the proposed and other U-Net-related methods using the same dataset.The mean and standard deviation(SD)of the dice similarity coefficient(DSC),intersection over union(IoU),precision(Pre),and recall(Rec)achieved by the proposed framework were DSC(%)=94.62±0.02,IoU(%)=90.99±0.04,Pre(%)=94.61±0.04,and Rec(%)=95.00±0.02,respectively,outperforming the others.The proposed method has the potential to be applied in EEC automatic diagnoses.

Indications and Findings of Upper Gastrointestinal Endoscopy in Elderly Patients in Parakou, Republic of Benin

Introduction: Elderly people are considered fragile and at greater risk of having malignant gastrointestinal tumors. The objective of this work was to report the reasons for performing gastrointestinal endoscopy and the lesions found during the endoscopy of this target population in Parakou. Patients and Study Methods: This was a descriptive and cross-sectional study with a retrospective collection of data from January 2016 to December 2017, then from January 2020 to December 2021. It took place in the Regional Teaching Hospital of Borgou-Alibori in Parakou and in the private gastrointestinal endoscopy center of Parakou (Northern Gastrointestinal Exploration Center). All patients aged at least 60 years who had undergone an upper gastrointestinal endoscopy during the study period were included. The variables studied were: the sex, age, indications for the examination, endoscopic lesions and data from the anatomo-pathological examination. Results: In total, out of 1540 upper gastrointestinal endoscopies performed during the study period, 249 (16.17%) involved patients aged 60 years and over. The sex ratio was 1.26. The main indication for the examination was epigastric pain (123 cases, i.e. 49.40%) followed by vomiting (53 cases, i.e. 21.29%). In terms of lesions, non-tumorous gastropathy came first in the stomach (206 cases, i.e. 82.73%) while esophageal lesions were dominated by esophageal candidiasis and cardial incompetence (39 cases, i.e. 15.66% in each of the two situations). In the duodenum, ulcer was noted in 30 patients (12.05%). In 38 patients, 12 (31.58%) were tested positive for Helicobacter pylori infection. Cancers of the gastrointestinal tract were confirmed in 11 patients (4.42%). Conclusion: Upper gastrointestinal endoscopy remains an excellent examination for the exploration of the upper gastrointestinal tract. In Parakou, epigastric pain represents the main indication for this examination in subjects over 60 years of age. Inflammatory or ulcerated non-tumorous gastropathy is the most commonly endoscopic lesion. Esophageal and gastric cancers are less common in this population group according to our study.

Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

A case of small intestinal hemorrhage secondary to metastatic lung cancer in the elderly

Gastrointestinal metastasis from primary lung cancer is rare. In the present study, we report the case of a 78-year-old male who was admitted to the emergency department with acute bleeding of the digestive tract. During evaluation, he was found to have lung adenocarcinoma metastasis in the small bowel leading to hemorrhage. A jejunum wedge resection was carried out and bleeding was controlled. However, 2 months after the operation, the patient died from severe pulmonary infection. We also review the published literature of primary lung cancer with gastrointestinal metastasis.

Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer

BACKGROUND Venous thromboembolism(VTE)is a major cause of unexpected and perioperative in-hospital deaths.It is characterized by high morbidity,high mortality,high misdiagnosis rate,and high missed diagnosis rates.VTE is a common postoperative complication in cancer patients.VTE is preventable,and early identification of risk factors leading to VTE and appropriate early preventive actions can reduce its occurrence and mortality.Presently,there is no uniform standard for the prevention and control of VTE in clinical practice,and hospitals in China lack mature and effective protocols for the assessment,prevention,and treatment of VTE.AIM To explore whether an early warning program could influence the occurrence of deep vein thrombosis(DVT)postoperatively.METHODS This is a comparative retrospective cohort study,which enrolled patients who underwent laparotomic or laparoscopic gastrointestinal tumor resection for gastrointestinal cancer between January 2016 and December 2019.Patients were divided into a control group and an early warning group depending on whether or not the early warning program was implemented.A venous thromboembolism prevention and control team was established.The outcomes included the occurrence of DVT,the correct rate of VTE assessment,the coagulation indicators,and the mastery of VTE knowledge by the nurses.RESULTS A total of 264 patients were included in this study,with 128 patients in the control group and 136 patients in the early warning group.The occurrence rate of DVT in the early warning group was 6.6%(9/136),compared with 14.1%(18/128)in the control group(P<0.05).The correct rates of VTE risk assessment by the nurses and standard implementation rate of VTE preventive measures were 86.8%vs 65.6%and 80.2%vs 57.8%in early warning and control groups,respectively(all P<0.001).The independent factors associated with postoperative DVT occurrence were age(OR=1.083,95%CI:1.070-3.265,P=0.032),Hyperlipidemia(OR=1.127,95%CI:1.139-2.564,P=0.042),preoperative high VTE risk(OR=2.131,95%CI:1.085-5.178,P=0.001),time of operation(OR=2.268,95%CI:2.005-5.546,P=0.026)and not adoption of early warning prevention(OR=3.747,95%CI:1.523-6.956,P=0.017).CONCLUSION The early warning strategy was independently associated with the decreasing occurrence of VTE,and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.

Endoscopic full-thickness resection using an over-the-scope device:A prospective study

BACKGROUND Endoscopic submucosal dissection to treat mucosal and submucosal lesions sometimes results in low rates of microscopically margin-negative(R0)resection.Endoscopic full-thickness resection(EFTR)has a high R0 resection rate and allows for the definitive diagnosis and treatment of selected mucosal and submucosal lesions that are not suitable for conventional resection techniques.AIM To evaluate the efficacy and safety of EFTR using an over-the-scope clip(OTSC).METHODS This prospective,single-center,non-randomized clinical trial was conducted at the endoscopy center of Shengjing Hospital of China Medical University.The study included patients aged 18-70 years who had gastric or colorectal submucosal tumors(SMTs)(≤20 mm in diameter)originating from the muscularis propria based on endoscopic ultrasound(EUS)and patients who had early-stage gastric or colorectal cancer(≤20 mm in diameter)based on EUS and computed tomography.All lesions were treated by EFTR combined with an OTSC for wound closure between November 2014 and October 2016.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.RESULTS A total of 68 patients(17 men and 51 women)with an average age of 52.0±10.5 years(32-71 years)were enrolled in this study,which included 66 gastric or colorectal SMTs and 2 early-stage colorectal cancers.The mean tumor diameter was 12.6±4.3 mm.The EFTR procedure was successful in all cases.The mean EFTR procedure time was 39.6±38.0 min.The mean OTSC defect closure time was 5.0±3.8 min,and the success rate of closure for defects was 100%.Histologically complete resection(R0)was achieved in 67(98.5%)patients.Procedure-related adverse events were observed in 11(16.2%)patients.The average post-procedure length of follow-up was 48.2±15.7 mo.There was no recurrence during follow-up.CONCLUSION EFTR combined with an OTSC is an effective and safe technique for the removal of select subepithelial and epithelial lesions that are not amenable to conventional endoscopic resection techniques.

Acceptance on colorectal cancer screening upper age limit in South Korea

BACKGROUND The Korea National Cancer Screening Program currently provides screening for colorectal cancer(CRC)for adults older than 50 years with no upper age limit.In general,people are likely to only pay attention to the benefits of cancer screening and to neglect its risks.Most consider the benefits of cancer screening as being far greater than the risks and are unaware that any potential benefits and harms can vary with age.AIM To report acceptance of an upper age limit for CRC screening and factors associated therewith among cancer-free individuals in Korea.METHODS The present study analyzed data from the Korea National Cancer Screening Survey 2017,a nationally representative random sample of 4500 Korean individuals targeted for screening for the five most common types of cancer.A total of 1922 participants were included in the final analysis.The baseline characteristics of the study population are presented as unweighted numbers and weighted proportions.Both univariate and multivariate logistic regression models were developed to examine factors related with acceptance of an upper age limit for CRC screening;subgroup analysis was also applied.RESULTS About 80%(1554/1922)of the respondents agreed that CRC screening should not be offered for individuals older than 80 years.Specifically,those who had never been screened for CRC had the highest acceptance rate(91%).Overall,screening history for CRC[screened by both fecal occult blood test and colonoscopy,adjusted odds ratio(aOR)=0.33,95%CI:0.22-0.50]and other cancers(aOR=0.55,95%CI:0.34-0.87),as well as a family history of cancer(aOR=0.66,95%CI:0.50-0.87),were negatively associated with acceptance of an upper age limit for CRC screening.In contrast,metropolitan residents(aOR=1.86,95%CI:1.29-2.68)and people who exercised regularly(aOR=1.42,95%CI:1.07-1.89)were more likely to accept an upper age limit.After subgrouping,we found gender,marital status,and lifetime smoking history among never-screened individuals and residential region,family history of cancer,and physical activity among never-screened individuals to be associated with acceptance of an upper age limit.CONCLUSION This study describes acceptance of an upper age limit for CRC screening and factors associated with it,and provides perspectives that should be considered,in addition to scientific evidence,when developing population-based cancer screening policies and programs.

Feasibility of gastric endoscopic submucosal dissection in elderly patients aged≥80 years

BACKGROUND Endoscopic resection,especially endoscopic submucosal dissection(ESD),is increasingly performed in elderly patients with early gastric cancer,and lesions beyond the expanded indications are also resected endoscopically in some patients.It is essential to assess whether gastric ESD is safe and suitable for elderly patients and investigate what type of lesions carry an increased risk of ESD-related complications.AIM To assess the efficacy and feasibility of gastric ESD for elderly patients,and define high-risk lesions and prognostic indicators.METHODS Among a total of 1169 sessions of gastric ESD performed in Kanagawa Cancer Center Hospital from 2006 to 2014,179 sessions(15.3%)were performed in patients aged≥80 years,and 172 of these sessions were done in patients with a final diagnosis of gastric cancer.These patients were studied retrospectively to evaluate short-term outcomes and survival.The short-term outcomes included the rates of en bloc resection and curative resection,complications,and procedurerelated mortality.Curability was assessed according to the Japanese Gastric Cancer Treatment Guidelines 2010.Fisher’s exact test was used to statistically analyze risk factors.Clinical characteristics of each group were compared using Fisher’s exact test and Mann-Whitney U test.Survival rates at each time point were based on Kaplan-Meier estimation.Overall survival rates were compared between patients with gastric cancer in each group with use of the log-rank test.To identify prognostic factors that jointly predict the hazard of death while controlling for model overfitting,we used the least absolute shrinkage and selection operator(LASSO)Cox regression model including factors curative/noncurative,age,gender,body mass index,prognostic nutritional index,Charlson comorbidity index(CCI),Glasgow prognostic score,neutrophil-to-lymphocyte ratio,and antithrombotic agent use.We selected the LASSO Cox regression model that resulted in minimal prediction error in 10-fold cross-validation.P<0.05 was considered statistically significant.RESULTS The en bloc dissection rate was 97.1%,indicating that a high quality of treatment was achieved even in elderly patients.As for complications,the rates of bleeding,perforation and aspiration pneumonitis were 3.4%,1.1%and 0.6%,respectively.These complication rates indicated that ESD was not associated with a particularly higher risk in elderly patients than in nonelderly patients.A dissection incision>40 mm,lesions associated with depressions,and lesions with ulcers were risk factors for post-ESD bleeding,and location of the lesion in the upper third of the stomach was a risk factor for perforation in elderly patients(P<0.05).Location of the lesion in the lower third of the stomach tended to be associated with a higher risk of bleeding.The overall survival(OS)did not differ significantly between curative and noncurative ESD(P=0.69).In patients without additional surgery,OS rate was significantly lower in patients with a high CCI(≥2)than in those with a low CCI(≤1)(P<0.001).CONCLUSION Gastric ESD is feasible even in patients aged≥80 years.Observation without additional surgery after noncurative ESD is reasonable,especially in elderly patients with CCI≥2.

Practical considerations for colorectal cancer screening in older adults

Recent guidelines recommend that colorectal cancer(CRC)screening after age 75 be considered on an individualized basis,and discourage screening for people over 85 due to competing causes of mortality.Given the heterogeneity in the health of older individuals,and lack of data within current guidelines for personalized CRC screening approaches,there remains a need for a clearer framework to inform clinical decision-making.A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment,post-treatment survival,and increasing life expectancy in the population.In this review,we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity,frailty,and cognitive status.We will also review screening modalities and endoscopic technique for minimizing risk,the risks of screening unique to older adults,and CRC treatment outcomes in older patients,in order to provide important information to aid CRC screening decisions for this age group.This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools,and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.

Uptake and outcomes of small intestinal and urinary tract cancer surveillance in Lynch syndrome

BACKGROUND Lynch syndrome(LS)is a hereditary cancer predisposition syndrome associated with increased risk of multiple cancers.While colorectal cancer surveillance decreases mortality in LS and is recommended by guidelines,there is lack of evidence for the efficacy of surveillance for extra-colonic cancers associated with LS,including small intestinal cancer(SIC)and urinary tract cancer(UTC).Given the limited evidence,guidelines do not consistently recommend surveillance for SIC and UTC,and it remains unclear how often individuals will choose to undergo and follow through with extra-colonic surveillance recommendations.AIM To study factors associated with SIC and UTC surveillance uptake and outcomes in LS.METHODS This is an IRB-approved retrospective analysis of individuals with LS seen at a tertiary care referral center.Included individuals had a pathogenic or likely pathogenic variant in MLH1,MSH2,MSH6,PMS2,or EPCAM,or were a confirmed obligate carrier,and had at least one documented visit to our center.Information regarding SIC and UTC surveillance was captured for each individual,and detailed personal and family history was obtained for individuals who had an initial LS management visit in our center’s dedicated high-risk LS clinic between January 1,2017 and October 29,2020.During these initial management visits,all patients had in-depth discussions of SIC and UTC surveillance with 1 of 3 providers experienced in LS management to promote informed decision-making about whether to pursue SIC and/or UTC surveillance.Statistical analysis using Pearson’s chi-squared test and Wilcoxon rank-sum test was completed to understand the factors associated with pursuit and completion of SIC and UTC surveillance,and a P value below 0.05 was deemed statistically significant.RESULTS Of 317 individuals with LS,86(27%)underwent a total of 105 SIC surveillance examinations,with 5 leading to additional work-up and no SICs diagnosed.Additionally,99(31%)patients underwent a total of 303 UTC surveillance examinations,with 19 requiring further evaluation and 1 UTC identified.Of 155 individuals who had an initial LS management visit between January 1,2017 and October 29,2020,63(41%)chose to undergo SIC surveillance and 58(37%)chose to undergo UTC surveillance.However,only 26(41%)and 32(55%)of those who initially chose to undergo SIC or UTC surveillance,respectively,successfully completed their surveillance examinations.Individuals with a pathogenic variant in MSH2 or EPCAM were more likely to initially choose to undergo SIC surveillance(P=0.034),and older individuals were more likely to complete SIC surveillance(P=0.007).Choosing to pursue UTC surveillance was more frequent among older individuals(P=0.018),and females more frequently completed UTC surveillance(P=0.002).Personal history of cancer and family history of SIC or UTC were not significantly associated with electing nor completing surveillance.Lastly,the provider discussing SIC/UTC surveillance was significantly associated with subsequent surveillance choices.CONCLUSION Pursuing and completing SIC/UTC surveillance in LS is influenced by several factors,however broad incorporation in LS management is likely unhelpful due to low yield and frequent false positive results.

基于健康信念模式的健康教育在消化道早癌筛查中的应用效果

目的探讨基于健康信念模式的健康教育在消化道早癌筛查中的应用效果。方法选取87例消化道早癌高危筛查患者,随机分为观察组(n=43)和对照组(n=44)。对照组接受常规的健康教育,观察组应用基于健康信念模式的健康教育,比较2组患者的筛查依从性,干预前后疾病知识掌握情况(包括消化道早癌相关知识、健康行为、筛查相关知识及心理疏导评分)、自我管理能力[自我管理能力测评量表(AHSMSRS)评分]、自护能力[自我护理能力量表(ESCA)评分]、健康行为[健康促进生活方式量表(HPLP-Ⅱ)评分]、负性情绪状况[焦虑自评量表(SAS)和抑郁自评量表(SDS)评分],护理满意度[纽卡斯尔护理服务满意度量表(NSNS)评分]。结果干预后,观察组疾病知识掌握情况各项评分、HPLP-Ⅱ、AHSMSRS和ESCA评分均高于对照组,SAS和SDS评分均低于对照组(P<0.05或P<0.001)。观察组总筛查依从率和总护理满意率均高于对照组(97.67%比81.82%,P<0.05;97.67%比79.55%,P<0.001)。结论将基于健康信念模式的健康教育应用于消化道早癌筛查患者中,能促进患者健康行为的养成,提高患者自护能力、筛查依从性,改善患者负性情绪状况。

认知行为干预对上消化道早癌行内镜下黏膜剥离术患者的效果研究

目的探讨基于人文关怀理念的认知行为干预对上消化道早癌患者疼痛、心理和康复效果的影响。方法选择196例上消化道早期癌症行内镜下黏膜剥离术(ESD)患者,随机分为对照组和观察组,每组98例。对照组给予上消化道早癌ESD知识宣教,观察组在此基础上给予基于人文关怀理念的认知行为干预。比较2组康复情况、疼痛视觉模拟评分法(VAS)评分、焦虑自评量表(SAS)评分、一般自我效能感量表(GSES)评分、术后并发症。结果观察组的术后肛门排气时间、术后首次排便时间和术后住院时间为(24.67±8.25)h、(43.90±10.27)h、(9.38±2.02)d,分别短于对照组的(27.83±9.40)h、(50.03±12.85)h、(10.26±2.37)d;手术24、48、72 h后观察组VAS评分为(2.63±0.67)、(1.84±0.52)、(1.33±0.38)分,分别低于对照组的(2.89±0.70)、(2.06±0.58)、(1.47±0.42)分;观察组干预后SAS评分为(38.73±7.40)分,低于对照组的(42.05±8.01)分;观察组干预后的GSES评分为(31.53±6.27)分,高于对照组的(29.28±5.96)分,差异均有统计学意义(P<0.05)。2组总并发症发生率比较,差异无统计学意义(P>0.05)。结论对上消化道早癌患者实施基于人文关怀理念的认知行为干预可减轻疼痛和焦虑情绪,促进患者快速康复。

内镜下黏膜剥离术治疗消化道早期癌及癌前病变的临床效果

目的探讨消化道早期癌及癌前病变患者给予内镜下黏膜剥离术治疗的效果。方法回顾性选取2021年1—12月龙岩市第二医院消化内科接受手术治疗的102例消化道早期癌及癌前病变患者的临床资料,按照临床手术干预方法分为两组,每组51例。对照组采取内镜下黏膜切除术治疗,观察组采取内镜下黏膜剥离术治疗。比较两组患者的手术切除情况、手术指标、并发症发生率和生活质量评分。结果治疗后,观察组的治愈性切除率为84.31%,整块切除率为96.08%,完整切除率为92.16%,均高于对照组的62.75%、78.43%、74.51%,差异有统计学意义(χ^(2)=6.095、7.141、5.718,P均<0.05)。观察组的近期、远期并发症发生率均低于对照组,差异有统计学意义(P均<0.05)。观察组术后3、6、12个月的生活质量评分均高于对照组,差异有统计学意义(P均<0.05)。结论采取内镜下黏膜剥离手术治疗能够提高切除效果,降低并发症发生率,提高患者的生活质量。

结直肠癌患者术后早期肠内营养支持的临床效果

目的探究结直肠患者术后及时给予早期肠内营养支持的临床效果。方法82例行结直肠癌手术的结直肠癌患者,依据随机数字表法分为观察组和对照组,每组41例。两组均在术后给予营养支持,对照组行肠外营养支持,观察组行早期肠内营养支持。对比两组的临床相关指标、营养状态指标、胃肠功能指标[生长抑素(SS)、血管活性肠肽(VIP)、胃泌素(GAS)、胃动素(MTL)]、炎性因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]及并发症发生率。结果观察组肛门首次排气时间(43.95±5.26)h、首次下床时间(40.37±7.92)h、住院天数(12.27±3.65)d均短于对照组的(58.87±6.94)h、(55.65±8.36)h、(14.86±4.06)d(P<0.05)。干预后,观察组前白蛋白、白蛋白、转铁蛋白水平分别为(267.47±19.94)mg/L、(39.18±4.95)g/L、(2.07±0.25)g/L,高于对照组的(244.23±18.58)mg/L、(35.47±3.45)g/L、(1.87±0.21)g/L(P<0.05)。干预后,观察组SS(47.87±4.54)ng/L低于对照组的(52.56±3.86)ng/L,GAS(118.34±15.74)ng/L、VIP(34.12±6.85)ng/L与MTL(66.31±10.22)ng/L高于对照组的(86.57±11.48)、(27.84±8.11)、(53.76±11.14)ng/L(P<0.05)。干预后,观察组TNF-α、IL-6与CRP水平分别为(182.38±14.43)ng/L、(254.28±33.76)ng/L、(9.32±1.85)mg/L,低于对照组的(238.94±25.51)ng/L、(336.57±34.52)ng/L、(11.89±2.68)mg/L(P<0.05)。观察组并发症发生率4.88%低于对照组的19.51%(χ^(2)=4.100,P=0.043<0.05)。结论针对结直肠癌患者,对其术后及时行早期肠内营养支持,可促进患者康复加速,改善营养状态、胃肠功能,同时有利于减轻炎症反应,控制并发症发生,价值突出。

内镜医师内镜黏膜下剥离术教学的实践与思考

内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)是目前消化道早癌的首选微创治疗方法,其操作难度大,是国内内镜教学培训的热点和难点。本研究以重庆医科大学附属第一医院青年医师和进修ESD操作的内镜医师为教学对象,建立了ESD规范化培训流程。培训周期共3月,教学内容包括理论培训、临床观摩、简易离体猪胃模型操作、真实患者实践操作,以及结业考核。通过问卷调查,100%的学员认为重庆医科大学附属第一医院内镜中心ESD教学培训对于掌握ESD技术是非常必要的,且能明显提高学员的ESD操作水平。因此,重庆医科大学附属第一医院内镜中心ESD规范化培训流程总体设置合理,为我国内镜医师的教学与培训提供一定的借鉴与参考。

胃复春对不同NLR水平的胃早癌ESD术后患者的消化道症状、胃肠激素、胃功能指标和血常规指标的影响

背景胃复春可治疗内镜下剥离术(endoscopic submucosal dissection,ESD)后的胃早癌患者,中性粒细胞-淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)可作为评估此类患者活动度和预后的指标.目前尚未确定不同NLR水平的ESD术后胃早癌患者是否存在与之相关的胃复春疗效差异.目的探讨胃复春对不同NLR水平的胃早癌ESD术后患者的治疗效果.方法选取本院2020-01/2022-12收治的160例胃早癌ESD术后患者,将其分为常规治疗组(n=40)和常规治疗+胃复春治疗组(n=120).将胃复春治疗组再按照NLR水平进行三分位分组,分为高三分位组(NLR≥3.23)40例,低三分位组(NLR≤1.74)40例,中三分位组(NLR:1.74-3.23)40例.比较以上各组治疗前后的主要的消化道症状评分、胃肠激素水平、胃功能指标及血常规指标水平,并计算治疗的总有效率.结果与治疗前比较,治疗后各组患者的胃脘灼热、胃脘胀满、胃脘疼痛和胃纳呆滞评分均降低(P<0.05),其中以低三分位组治疗效果最佳(P<0.05),总有效率最高(P<0.05).常规治疗不能改变患者NLR与血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)水平,而常规治疗+胃复春治疗能降低患者的NLR与PLR水平(P<0.05).治疗后,与常规治疗组比较,胃复春治疗组(低、中和高三分位组)的抑胃肽、胃动素、胃泌素、胃蛋白酶原Ⅰ和胃蛋白酶原比值水平均增高(P<0.05)、白细胞、胃蛋白酶原Ⅱ和癌胚抗原均降低(P<0.05),其中以低三分位组最为明显.结论胃复春在不同NLR水平的胃早癌ESD术后患者中均显示出改善消化道症状、胃肠激素、胃功能指标和血常规指标的作用,尤其对于低NLR水平患者而言,治疗效果最为显著.在选择治疗方法时,建议优先考虑低NLR水平的胃早癌ESD术后患者使用胃复春进行治疗.

腔镜Ivor-Lewis胃游离优化策略与经典全腔镜Ivor-Lewis治疗早中期食管癌的对比观察

目的比较腔镜Ivor-Lewis胃游离优化策略与经典全腔镜Ivor-Lewis手术治疗早中期食管癌的临床效果。方法选取2021年1月至2023年1月空军军医大学唐都医院收治的82例早中期食管癌患者,采用随机数字表法分为观察组和对照组,每组41例。对照组采用经典全腔镜Ivor-Lewis手术治疗,观察组采用腔镜Ivor-Lewis胃游离优化策略。比较两组手术一般情况、胃肠功能恢复进程、下床活动时间、手术前后血清胃肠激素[胃动素、胃泌素、胆囊收缩素(CCK)、生长抑素]和应激指标[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、丙二醛(MDA)、超氧化物歧化酶(SOD)]水平的变化以及术后并发症发生率、复发率、生存率。结果观察组术中出血量低于对照组,手术时间、肠鸣音恢复时间、首次排气时间、首次排便时间、经口进食时间短于对照组,差异均有统计学意义(P<0.05),而两组淋巴结清扫数、住院时间、下床活动时间及住院费用比较差异无统计学意义(P>0.05)。术前两组胃肠激素及应激指标水平比较差异无统计学意义(P>0.05);术后1 d及3 d时两组血清胃动素、胃泌素、CCK及SOD水平明显低于术前,且对照组明显低于观察组,而血清ACTH、Cor及MDA水平明显高于术前,且对照组明显高于观察组,差异均有统计学意义(P<0.05),两组术后血清生长抑素水平与术前比较差异无统计学意义(P>0.05)。观察组术后并发症发生率(12.20%)及术后1年复发率(5.00%)、生存率(97.50%)与对照组(分别为21.95%、10.26%、94.87%)比较差异均无统计学意义(P>0.05)。结论采用腔镜Ivor-Lewis胃游离优化策略治疗早中期食管癌患者可调节胃肠激素,减轻机体应激反应,减少出血量,缩短手术时间,促进胃肠功能快速恢复。