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.

Prevalence, risk factors, and BRAF mutation of colorectal sessile serrated lesions among Vietnamese patients

BACKGROUND Sessile serrated lesions(SSLs)are considered precancerous colorectal lesions that should be detected and removed to prevent colorectal cancer.Previous studies in Vietnam mainly investigated the adenoma pathway,with limited data on the serrated pathway.AIM To evaluate the prevalence,risk factors,and BRAF mutations of SSLs in the Vietnamese population.METHODS This is a cross-sectional study conducted on patients with lower gastrointestinal symptoms who underwent colonoscopy at a tertiary hospital in Vietnam.SSLs were diagnosed on histopathology according to the 2019 World Health Organi-zation classification.BRAF mutation analysis was performed using the Sanger DNA sequencing method.The multivariate logistic regression model was used to determine SSL-associated factors.RESULTS There were 2489 patients,with a mean age of 52.1±13.1 and a female-to-male ratio of 1:1.1.The prevalence of SSLs was 4.2%[95%confidence interval(CI):3.5-5.1].In the multivariate analysis,factors significantly associated with SSLs were age≥40[odds ratio(OR):3.303;95%CI:1.607-6.790],male sex(OR:2.032;95%CI:1.204-3.429),diabetes mellitus(OR:2.721;95%CI:1.551-4.772),and hypertension(OR:1.650,95%CI:1.045-2.605).The rate of BRAF mutations in SSLs was 35.5%.CONCLUSION The prevalence of SSLs was 4.2%.BRAF mutations were present in one-third of SSLs.Significant risk factors for SSLs included age≥40,male sex,diabetes mellitus,and hypertension.

Establishment of a prognosis predictive model for liver cancer based on expression of genes involved in the ubiquitin-proteasome pathway

BACKGROUND The ubiquitin-proteasome pathway(UPP)has been proven to play important roles in cancer.AIM To investigate the prognostic significance of genes involved in the UPP and develop a predictive model for liver cancer based on the expression of these genes.METHODS In this study,UPP-related E1,E2,E3,deubiquitylating enzyme,and proteasome gene sets were obtained from the Kyoto Encyclopedia of Genes and Genomes(KEGG)database,aiming to screen the prognostic genes using univariate and multivariate regression analysis and develop a prognosis predictive model based RESULTS Five genes(including autophagy related 10,proteasome 20S subunit alpha 8,proteasome 20S subunit beta 2,ubiquitin specific peptidase 17 like family member 2,and ubiquitin specific peptidase 8)were proven significantly correlated with prognosis and used to develop a prognosis predictive model for liver cancer.Among training,validation,and Gene Expression Omnibus sets,the overall survival differed significantly between the high-risk and low-risk groups.The expression of the five genes was significantly associated with immunocyte infiltration,tumor stage,and postoperative recurrence.A total of 111 differentially expressed genes(DEGs)were identified between the high-risk and low-risk groups and they were enriched in 20 and 5 gene ontology and KEGG pathways.Cell division cycle 20,Kelch repeat and BTB domain containing 11,and DDB1 and CUL4 associated factor 4 like 2 were the DEGs in the E3 gene set that correlated with survival.CONCLUSION We have constructed a prognosis predictive model in patients with liver cancer,which contains five genes that associate with immunocyte infiltration,tumor stage,and postoperative recurrence.

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

AIM:To investigate the usefulness of chromoendoscopy,using an acetic acid indigocarmine mixture(AIM),for gastric adenoma diagnosed by forceps biopsy.METHODS:A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection(ESD)between January 2011 and January 2012.AIM-chromoendoscopy(AIMCE)was performed followed by ESD.AIM solution was sprinkled and images were recorded every 30 s for 3min.Clinical characteristics such as tumor size(<2cm,≥2 cm),surface color in white light endoscopy(WLE)(whitish,normochromic or reddish),macroscopic appearance(flat or elevated,depressed),and reddish change in AIM-CE were selected as valuables.RESULTS:En bloc resection was achieved in all 54 cases,with curative resection of fifty two lesions(96.3%).Twenty three lesions(42.6%)were diagnosed as welldifferentiated adenocarcinoma and the remaining 31lesions(57.4%)were gastric adenoma.All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer.The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE(vs tumor size≥2 cm,P=0.016,vs normochromic or reddish surface color,P=0.046,vs depressed macroscopic type,P=0.0030).On the other hand,no significant differences were found in the specificity and accuracy.In univariate analysis,normochromic or reddish surface color in WLE(OR=3.7,95%CI:1.2-12,P=0.022)and reddish change in AIM-CE(OR=14,95%CI:3.8-70,P<0.001)were significantly related to diagnosis of early gastric cancer(EGC).In multivariate analysis,only reddish change in AIM-CE(OR=11,95%CI:2.3-66,P=0.0022)was a significant factor associated with diagnosis of EGC.CONCLUSION:AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.

Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.

Serrated polyps of the colon and rectum: Endoscopic features including image enhanced endoscopy

In this review, I outline the characteristic endoscopic findings of serrated lesions of the colorectum based on image enhanced endoscopy(IEE). Histopathologically, lesions with serrated structures are typically classified into the following three types based: hyperplastic polyps(HPs), traditional serrated adenomas(TSAs), and sessile serrated adenoma/polyps(SSA/Ps). Both HP and SSA/P often present as dark-green colors on auto fluorescence imaging(AFI) colonoscopy that are similar to the normal surrounding mucosa. In contrast, TSAs often have elevated shapes and present as magenta colors that are similar to the tubular adenomas. The superficial type of TSA also includes many lesions that present as magenta colors. When SSA/Ps are associated with cytological dysplasia, many lesions present with magenta colors, whereas lesions that are not associated with cytological dysplasia present with dark-green colors. When observed via narrow band imaging(NBI), many SSA/P include lesions with strong mucous adhesions. Because these lesions are observed with reddish mucous adhesions, we refer to them as "red cap sign" and place such signs among the typical findings of SSA/P. Because the dilatation of the pit in SSA/P is observed as a round/oval black dot on magnified observations, we refer to this finding as Ⅱ-dilatation pit(Ⅱ-D pit) and also positioned it as a characteristic finding of SSA/P. In contrast, dilatations of the capillary vessels surrounding the glands, such as those that occur in tubular adenoma, are not considered to be useful for differentiating HPs from SSA/Ps. However, in cases in which SSA/P is associated with cytological dysplasia, the dilatation of capillary vessels is observed in the same area. When submucosal layer invasion occurs in the same area, the blood flow presents with irregularities that are similar to those of common colorectal cancer at an early stage and disappears as the invasion proceeds deeply. The surface pattern of invasive cancer that is observed at the tumor surface is also likely to disappear. Based on the above results, we considered that the differentiations between HP and TSA, between TSA and SSA/P, and between HP and SSA/P might become easier due to the concomitant use of white light observation and IEE. We also concluded that AFI and NBI can be useful modalities for SSA/P lesions associated with cytological dysplasia.

Diagnostic utility of narrow-band imaging endoscopy for pharyngeal superfi cial carcinoma

AIM: To investigate the endoscopic features of pharyngeal superfi cial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) en-doscopy and non-magnifi ed/magnifi ed NBI endoscopy, followed by an endoscopic biopsy, for 445 superfi cial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superfi cial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defi ned as a superfi cial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnifi ed/ magnifi ed NBI endoscopy. An experienced pathologist who was unaware of the endoscopic fi ndings made the histological diagnoses. By comparing endoscopic fi ndings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classif ied as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was signif icantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy fi ndings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnifi ed NBI endoscopy, the incidence of a brownish area was signifi cantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnifi ed NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P =0.002), and irregularity (82% vs 31%, P < 0.001) was also signifi cantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnif ied NBI endoscopy was signif icantly higher in SC than non-SC lesions. Redness alone exhibited signifi cantly higher sensitivity and signifi cantly lower specifi city for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was signifi cantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnifi ed NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.

Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding:A systematic review and metaanalysis

AIM To compare the diagnostic accuracy of video capsule endoscopy(VCE) and double-balloon enteroscopy(DBE) in cases of obscure gastrointestinal bleeding(OGIB) of vascular origin.METHODS MEDLINE(via PubMed), LILACS(via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables(sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc software.RESULTS In the per-patient analysis, 17 studies(1477 lesions) were included. We identified3150 exams(1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864(58.5%) were diagnosed by VCE, and 613(41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84%(95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was92%(95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29(95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20(95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to90%.CONCLUSION The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.

Clinical relevance of fluorodeoxyglucose positron emission tomography/computed tomography and magnifying endoscopy with narrow band imaging in decision-making regarding the treatment strategy for esophageal squamous cell carcinoma

BACKGROUND Recent advances in endoscopic technology,especially magnifying endoscopy with narrow band imaging(ME-NBI)enable us to detect superficial esophageal squamous cell carcinoma(ESCC),but determining the appropriate method of resection,endoscopic resection(ER)vs surgical resection,is often challenging.Recently,several studies have reported that 18F-fluorodeoxyglucose positron emission tomography(FDG-PET)is a useful indicator for decision-making regarding treatment for superficial ESCC.Although,there are not enough reports on association between FDG-PET uptake and clinicopathological characteristics of superficial ESCC.And,there are not enough reports on evaluating the usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.This study evaluated clinical relevance of FDG-PET and ME-NBI in decision-making regarding the treatment strategy for ESCC.AIM To investigate the association between FDG uptake and the clinicopathological characteristics of superficial ESCC and its usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.METHODS A database of all patients with superficial ESCC who had undergone both MENBI and FDG-PET for pre-treatment staging at Aichi Cancer Center Hospital between January 2008 and November 2018 was retrospectively analyzed.FDG uptake was defined positive or negative whether the primary lesion was visualized or could be distinguished from the background,or not.The invasion depth of ESCC was classified according to the Japan Esophageal Society.Primary endpoint is to evaluate the association between FDG uptake and clinicopathological characteristics of superficial ESCC.Secondary endpoint is to investigate the efficacy of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.RESULTS A total of 82 lesions in 82 patients were included.FDG-PET showed positive uptake in 29(35.4%)lesions.Univariate analysis showed that uptake of FDG-PET had significant correlations with circumferential extension(P=0.014),pathological depth of tumor invasion(P<0.001),infiltrative growth pattern(P<0.001),histological grade(P=0.002),vascular invasion(P=0.001),and lymphatic invasion(P<0.001).On multivariate analysis,only depth of tumor invasion was independently correlated with FDG-PET/computed tomography visibility(P=0.018).The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of Type B2 in ME-NBI for the invasion depth of T1a muscularis mucosae and T1b upper submucosal layer were 68.4%/79.4%/50.0%/89.3%/76.8%,respectively,and those of Type B3 for the depth of T1b middle and deeper submucosal layers(SM2 and SM3)were 46.7%/100%/100%/89.3%/90.2%,respectively.On the other hand,those of FDGPET for SM2 and SM3 were 93.3%/77.6%/48.2%/98.1%/80.5%,respectively,whereas,if the combination of positive FDG uptake and type B2 and B3 was defined as an indicator for radical esophagectomy or definitive chemoradiotherapy,the sensitivity,specificity,PPV,NPV,and accuracy were 78.3%/91.5%/78.3%/91.5%/87.8%,respectively.CONCLUSION FDG uptake was correlated with the invasion depth of superficial ESCC.Combined use of FDG-PET and ME-NBI,especially with the microvascular findings of Type B2 and B3,is useful to determine whether ER is indicated for the lesion.

Detection of active bleeding from gastric antral vascular ectasia by capsule endoscopy

Gastric antral vascular ectasia(GAVE) has been recognized as one of the important causes of occult and obscure gastrointestinal bleeding.The diagnosis is typically made based on the characteristic endoscopic features,including longitudinal row of flat,reddish stripes radiating from the pylorus into the antrum that resemble the stripes on a watermelon.These appearances,however,can easily be misinterpreted as moderate to severe gastritis.Although it is believed that capsule endoscopy(CE) is not helpful for the study of the stomach with its large lumen,GAVE can be more likely to be detected at CE rather than conventional endoscopy.CE can be regarded as "physiologic" endoscopy,without the need for gastric inflation and subsequent compression of the vasculature.The blood flow of the ecstatic vessels may be diminished in an inflated stomach.Therefore,GAVE may be prominent in CE.We herein describe a case of active bleeding from GAVE detected by CE and would like to emphasize a possibility that CE can improve diagnostic yields for GAVE.

Clinicopathological features of minute pharyngeal lesions diagnosed by narrow-band imaging endoscopy and biopsy

AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop(IPCL) classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type Ⅳ and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection(ESD) at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72 lesions were located on the posterior oropharyngeal wall.All 93 lesions were flat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39 were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1 to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34 biopsied patients found the rate of complete resection by biopsy to be 79%.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.

Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy

BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography(DBERC)is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy.The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner.AIM To determine the accuracy of carbon dioxide insufflation enterography(CDE)at the branch for selecting the correct route during DBERC.METHODS We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017.Route selection via two methods(visual observation and CDE)was performed in each patient.We determined the correct rate of route selection using CDE.RESULTS Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis.The therapeutic target region was reached in 50 patients.The mean procedure times from the teeth to the target(total insertion time),from the teeth to the branch,and from the branch to the target,and the mean total examination time were 15.2,5.0,8.2,and 60.3 min,respectively.The rate of correct route selection using visual observation and CDE were 36/52(69.2%)and 48/52(92.3%),respectively(P=0.002).The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33(87.8%),and the rate in patients with a gastrojejunal anastomosis was 19/19(100%).CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

Endoscopy-based Kyoto classification score of gastritis related to pathological topography of neutrophil activity

BACKGROUND Endoscopy-based Kyoto classification for gastritis and pathological topographic distribution of neutrophil infiltration are correlated with gastric cancer risk.AIM To investigate the association between Kyoto classification and the topographic distribution of neutrophil activity.METHODS Kyoto classification score,ranging from 0 to 8,consisted of atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Neutrophil activity was scored according to the updated Sydney System using biopsy samples obtained from the greater curvature of the corpus and the antrum.The participants were divided into four categories,inactive stomach,antrumpredominant gastritis,pangastritis,and corpus-predominant gastritis,based on the topographic distribution of neutrophil activity.Effects of sex,age,body mass index,drinking habit,smoking habit,family history of gastric cancer,serum Helicobacter pylori(H.pylori)antibody,and Kyoto score on topography of neutrophil infiltration were analyzed.RESULTS A total of 327 patients(comprising 50.7%women,with an average age of 50.2 years)were enrolled in this study.H.pylori infection rate was 82.9%with a mean Kyoto score of 4.63.The Kyoto score was associated with the topographic distribution of neutrophil activity.Kyoto scores were significantly higher in the order of inactive stomach,antrum-predominant gastritis,pangastritis,and corpuspredominant gastritis(3.05,4.57,5.21,and 5.96,respectively).Each individual score of endoscopic findings(i.e.,atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness)was correlated with the topographic distribution of neutrophil activity.On multivariate analysis,the Kyoto score,age,and serum H.pylori antibody were independently associated with the topographic distribution of neutrophil activity.CONCLUSION The Kyoto classification score was associated with the topographic distribution of neutrophil activity.

Medical malpractice litigation related to gastrointestinal endoscopy in Japan:A two-decade review of civil court cases

AIM: To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan. METHODS: A retrospective review of cases tried in the civil court system during the 21-year period from 1985 to 2005, identified in a computerized legal database, was undertaken. RESULTS: Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to eso- phagogastroduodenoscopy, 4 (22%) to colonoscopy, 4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography. Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis. In 10 cases, the patient died of the complications. Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n = 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%). CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.

Endoscopic ultrasound guided radiofrequency ablation for pancreatic tumors: A critical review focusing on safety, efficacy and controversies

The role of endoscopic ultrasound(EUS)in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreatobiliary disorders.In recent years,its applications for treating pancreatic diseases have broadened,including the implementation of radiofrequency ablation(RFA),which has been traditionally used for treating solid tumors.In this critical indepth review,we summarized all the papers throughout the literature regarding EUS-RFA for pancreatic neuroendocrine neoplasms,adenocarcinoma,and pancreatic cystic lesions.Overall,for pancreatic neuroendocrine neoplasms we identified 16 papers that reported 96 patients who underwent EUS-RFA,with acceptable adverse events that were rated mild to moderate and a high complete radiological resolution rate of 90%.For pancreatic adenocarcinoma,we identified 8 papers with 121 patients.Adverse events occurred in 13%of patients,mostly rated mild.However,no clear survival benefit was demonstrated.For pancreatic cystic lesions,we identified 4 papers with 38 patients.The adverse events were mostly mild and occurred in 9.1%of patients,and complete or partial radiological resolution of the cysts was reported in 36.8%.Notably,the procedure was technically feasible for most of the patients.Nevertheless,a long road remains before this technique finds its definite place in guidelines due to several controversies.EUS-RFA for pancreatic tumors seems to be safe and effective,especially for pancreatic neuroendocrine neoplasms,but multicenter prospective trials are needed to consider this treatment as a gold standard.

Endoscopic and pathological characteristics of de novo colorectal cancer:Retrospective cohort study

BACKGROUND Endoscopy has rapidly developed in recent years and has enabled further investigation into the origin and features of intestinal tumors.The small size and concealed position of these tumors make it difficult to distinguish them from nonneoplastic polyps and carcinoma in adenoma(CIA).The invasive depth and metastatic potential determine the operation regimen,which in turn affects the overall survival and distant prognosis.The previous studies have confirmed the malignant features and clinicopathological features of de novo colorectal cancer(CRC).AIM To provide assistance for diagnosis and treatment,but the lack of a summary of endoscopic features and assessment of risk factors that differ from the CIA prompted us to conduct this retrospective study.METHODS In total,167 patients with small-sized CRCs diagnosed by endoscopy were reviewed.The patients diagnosed as advanced CRCs and other malignant cancers or chronic diseases that could affect distant outcomes were excluded.After screening,63 cases were excluded,including 33 de novo and 30 CIA cases.Patient information,including their follow-up information,was obtained from an electronic His-system.The characteristics between two group and risk factors for invasion depth were analyzed with SPSS 25.0 software.RESULTS Nearly half of the de novo CRCs were smaller than 1 cm(n=16,48.5%)and the majority were located in the distal colon(n=26,78.8%).The IIc type was the most common macroscopic type of de novo CRC.In a Pearson analysis,the differential degree,Sano,JNET,and Kudo types,surrounding mucosa,and chicken skin mucosa(CSM)were correlated with the invasion depth(P<0.001).CSM was a significant risk factor for deep invasion and disturbed judgment of endoscopic ultrasound.A high degree of tumor budding and tumor-infiltrating lymphocytes are accompanied by malignancy.Finally,de novo CRCs have worse outcomes than CIA CRCs.CONCLUSION This is the first comprehensive study to analyze the features of de novo CRCs to distinguish them from nonneoplastic polyps.It is also the first study paying attention to CSM invasive depth measurement.This study emphasizes the high metastatic potential of de novo CRCs and highlights the need for more research on this tumor type.

Impairment of secondary peristalsis in Barrett's esophagus by transnasal endoscopy-based testing

AIM:To investigate dysfunctions in esophageal peristalsis and sensation in patients with Barrett’s esophagus following acid infusion using endoscopy-based testing.METHODS:First,physiological saline was infused into the esophagus of five healthy subjects,at a rate of 10 mL/min for 10 min,followed by infusion of HCl.Esophageal contractions were analyzed to determine whether the contractions observed by endoscopy and ultrasonography corresponded to the esophageal peristaltic waves diagnosed by manometry.Next,using nasal endoscopy,esophageal sensations and contractions were investigated in patients with,as well as controls without,Barrett’s esophagus using the same infusion protocol.RESULTS:All except one of the propulsive contractions identified endoscopically were recorded as secondary peristaltic waves by manometry.Patients with long segment Barrett’s esophagus(LSBE)tended to have a shorter lag time than the control group,although the difference did not reach statistical significance(88±54s vs 162±150 s respectively,P=0.14).Furthermore,patients with LSBE had significantly fewer secondary contractions following the infusion of both saline and HCl than did either the control group or patients with short segment Barrett’s esophagus(4.1±1.2 vs 8.0±2.8,P<0.001 and 7.3±3.2,P<0.01,respectively,following saline infusion;5.3±1.2vs 8.4±2.4 and 8.1±2.9 respectively,P<0.01 for both,following infusion of HCl).CONCLUSION:Using nasal endoscopy and a simple acid-perfusion study,we were able to demonstrate disorders in secondary peristalsis in patients with LSBE.

RULE OF CARCINOGENETIC DEVELOPMENT OF GASTRIC CARDIA OBSERVED BY ENDOSCOPY

Objective： To study the rule of development of early cancer of gastric cardiac in vivo. Methods： A prospective cohort was held in the high incidence area of cancer of esophagus and stomach in china. One hundred and six persons were examined regularly by endoscopy to observe the change of pro-cancer lesions of gastric cardiac by taking biopsy specimen. All specimens were diagnosed through normal pathological process. Results： The 106 subjects were examined twice in 1998 and 2002. Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. Of 61 persons with chronic gastritis, 11 were observed to have gland atrophy, 4 with mild atypical hyperplasia, and 2 with highly atypical hyperplasia. Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early cancer stage, 3 turned to atypical hyperplasia. Conclusion： 1. The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, gland atrophy, and atypical hyperplasia. 2. The early cancer and pre-cancer lesions of gastric cardia is reversible, though possessing malignant possibility.

Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas

BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant potential.Endoscopic ultrasound(EUS)assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis.However,there is a paucity of data regarding the imaging assessment of these lesions.AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.METHODS This was an international,multicenter,retrospective,observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers.All cases with postoperative histology of SPN were included in the study.Data collected included clinical,biochemical,histological and EUS characteristics.RESULTS One hundred and six patients with the diagnosis of SPN were included.The mean age was 26 years(range 9 to 70 years),with female predominance(89.6%).The most frequent clinical presentation was abdominal pain(80/106;75.5%).The mean diameter of the lesion was 53.7 mm(range 15 to 130 mm),with the slight predominant location in the head of the pancreas(44/106;41.5%).The majority of lesions presented with solid imaging features(59/106;55.7%)although 33.0%(35/106)had mixed solid/cystic characteristics and 11.3%(12/106)had cystic morphology.Calcification was observed in only 4(3.8%)cases.Main pancreatic duct dilation was uncommon,evident in only 2 cases(1.9%),whilst common bile duct dilation was observed in 5(11.3%)cases.One patient demonstrated a double duct sign at presentation.Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern.EUS guided biopsy was performed using three different types of needles:Fine needle aspiration(67/106;63.2%),fine needle biopsy(37/106;34.9%),and Sonar Trucut(2/106;1.9%).The diagnosis was conclusive in 103(97.2%)cases.Ninety-seven patients were treated surgically(91.5%)and the post-surgical SPN diagnosis was confirmed in all cases.During the 2-year follow-up period,no recurrence was observed.CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment.The lesion tended to be located in the head or body of the pancreas.There was no consistent characteristic pattern apparent on either elastography or Doppler assessment.Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct.Importantly,we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool.The needle type used does not appear to have a significant impact on the diagnostic yield.Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features.EUS guided biopsy remains the gold standard in establishing the diagnosis.

Mechanism of ELL-associated factor 2 and vasohibin 1 regulating invasion,migration,and angiogenesis in colorectal cancer

BACKGROUND As a novel endogenous anti-angiogenic molecule, vasohibin 1(VASH1) is not only expressed in tumor stroma, but also in tumor tissue. Moreover, studies have shown that VASH1 may be a prognostic marker in colorectal cancer(CRC). Knockdown of VASH1 enhanced transforming growth factor-β1(TGF-β1)/Smad3 pathway activity and type Ⅰ/Ⅲ collagen production. Our previous findings suggest that ELL-associated factor 2(EAF2) may play a tumor suppressor and protective role in the development and progression of CRC by regulating signal transducer and activator of transcription 3(STAT3)/TGF-β1 signaling pathway. However, the functional role and mechanism of VASH1-mediated TGF-β1 related pathway in CRC has not been elucidated.AIM To investigate the expression of VASH1 in CRC and its correlation with the expression of EAF2. Furthermore, we studied the functional role and mechanism of VASH1 involved in the regulation and protection of EAF2 in CRC cells in vitro.METHODS We collected colorectal adenocarcinoma and corresponding adjacent tissues to investigate the clinical expression of EAF2 protein and VASH1 protein in patients with advanced CRC. Following, we investigated the effect and mechanism of EAF2 and VASH1 on the invasion, migration and angiogenesis of CRC cells in vitro using plasmid transfection.RESULTS Our findings indicated that EAF2 was down-regulated and VASH1 was upregulated in advanced CRC tissue compared to normal colorectal tissue. KaplanMeier survival analysis showed that the higher EAF2 Level group and the lower VASH1 Level group had a higher survival rate. Overexpression of EAF2 might inhibit the activity of STAT3/TGF-β1 pathway by up-regulating the expression of VASH1, and then weaken the invasion, migration and angiogenesis of CRC cells.CONCLUSION This study suggests that EAF2 and VASH1 may serve as new diagnostic and prognostic markers for CRC, and provide a clinical basis for exploring new biomarkers for CRC. This study complements the mechanism of EAF2 in CRC cells, enriches the role and mechanism of CRC cellderived VASH1, and provides a new possible subtype of CRC as a therapeutic target of STAT3/TGF-β1 pathway.