Factors associated with heterochronic gastric cancer development post-endoscopic mucosal dissection in early gastric cancer patients

BACKGROUND Endoscopic mucosal resection is an innovative method for treating early gastric cancer and has been widely used in clinical practice.AIM To analyze the factors associated with the development of heterochronic gastric cancer in patients with early gastric cancer who had undergone endoscopic mucosal dissection(EMD).METHODS A cohort of patients with early gastric cancer treated using EMD was retrospectively analyzed,and patients who developed heterochronic gastric cancer after the surgery were compared with those who did not.The effects of patient age,sex,tumor size,pathological type,and surgical technique on the development of heterochronic gastric cancer were assessed using statistical analysis.RESULTS Of the 300 patients with early gastric cancer,150 patients developed heterochronic gastric cancer after EMD.Statistical analysis revealed that patient age(P value=XX),sex(P value=XX),tumor size(P value=XX),pathological type(P value=XX),and surgical technique(P value=XX)were significantly associated with the occurrence of heterochronic gastric cancer.CONCLUSION Age,sex,tumor size,pathological type,and surgical technique are key factors influencing the occurrence of heterochronic gastric cancer after EMD in patients with early gastric cancer.To address these factors,postoperative follow-up and management should be strengthened to improve the prognosis and survival rate of patients.

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia. The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus. Soon after the procedure, the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus, and a mediastinal emphysema. An emergency right thoracotomy was performed, followed by a total esophagectomy with esophagogastroplasty and jejunostomy. The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal, submucosal and muscular layers. The diagnosis was esophageal perforation in eosinophilic esophagitis.

Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum

Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.

Early gastric cancer presenting as a typical submucosal tumor cured by endoscopic submucosal dissection:A case report

BACKGROUND Submucosal tumor(SMT)-like gastric cancer is rare,and almost all cases undergo curative surgical treatment because the submucosal layer is usually deeply invaded by tumor cells or because histopathologic types of SMT-like gastric cancer are undifferentiated or poorly differentiated.No report has been issued on an SMT-like gastric cancer cured by endoscopic resection alone or on changes in the endoscopic features of this type of tumor over several years.CASE SUMMARY We describe an exceptional case of a 53-year-old male with a 1.5 cm-sized SMTlike lesion covered by normal-appearing mucosa discovered by esophagogastroduodenoscopy(EGD)at the gastric antrum.Endoscopic ultrasound(EUS)visualized a homogeneous,well-circumscribed hypoechogenic lesion arising from the second sonographic layer with associated subtle obliteration of the third sonographic layer.Initial endoscopic biopsy was negative for neoplasm.The patient refused to undergo an invasive procedure and was subsequently lost to follow-up.Three years after initial detection,EGD revealed the lesion had become markedly erythematous,and at 4 years after initial EGD it had increased in size to 1.8 cm and developed a central ulcer and a heterogeneous EUS echo.Finally,endoscopic submucosal dissection(ESD)was performed,and histopathologic examination revealed a moderately differentiated adenocarcinoma had minutely invaded the submucosal layer(invasion depth 169μm)but without lymphovascular invasion and with negative resection margins.Fortunately,no additional surgical treatment was required.He has been followed for 4 years after ESD without any evidence of local or distant recurrence.CONCLUSION This report describes an extremely rare case of early gastric cancer presenting as SMT that was cured by ESD after a treatment delay of 4 years and the endoscopic changes that occurred during this period.The report highlights the importance of considering the possibility of gastric cancer when SMT is encountered in clinical practice.

Shear-thinning Catechol-modified Chitosan Hydrogel Loaded with Silver Nanoparticles for Endoscopic Submucosal Dissection

Shear-thinning hydrogels have emerged for endoscopic submucosal dissection,while wound intervention after surgery has rarely been mentioned.Herein,a catechol-modified chitosa n hydrogel with shear-thinning property was developed for simultaneously facilitating endoscopic submucosal dissection and postoperative wound healing.Benefiting from the shear-thinning and self-healing characteristics,the asprepared hydrogel showed easily endoscopic injectability.It also performed very well as submucosal cushion,which could remain above 70%after injection for 120 min in ex vivo porcine large intestine model.In fact,the cushion height of normal saline dramatically decreased to 46%of the initial height at 30 min.Ag nanoparticles encapsulated into the network endowed the hydrogel with almost reached 100%antibacterial effect against E.coli and S.aureus.The hemolysis ratio of the hydrogel was calculated to be as low as 0.8%.Combined with good hemocompatibility and cytocompatibility,the as-prepared hydrogel displayed much higher in vivo wound closu re and healing efficacy than normal saline.These results demonstrated the superiority of the shear-thinning chitosan hydrogel in facilitating clinical endoscopic submucosal dissection surgery.

Submucosal protuberance caused by a fish bone in the absence of preoperative positive signs:A case report

BACKGROUND Submucosal protuberance caused by fish bone insertion into the digestive tract has rarely been reported.These cases usually include patients with clear signs such as a history of fish intake,pain,and dysphagia,as well as positive findings on endoscopy and imaging.Here,we report a case of a fish bone hidden in the submucosal protuberance of the gastric antrum during endoscopic submucosal dissection without preoperative obvious positive signs.CASE SUMMARY A 58-year-old woman presented with epigastric pain for the past 20 d and a submucosal protuberance.Abdominal computed tomography and endoscopic ultrasonography did not indicate the presence of a fish bone.We assumed the cause to be an ordinary submucosal eminence and performed an endoscopic submucosal dissection to confirm its essence.During the operation,a fish bone approximately 20 mm in length was found incidentally.CONCLUSION Our report could potentially prevent the oversight of embedded fish bones and associated adverse effects in patients with similar presentation.