Standard-definition White-light,High-definition White-light versus Narrow-band Imaging Endoscopy for Detecting Colorectal Adenomas:A Multicenter Randomized Controlled Trial

Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.

SGK3 overexpression correlates with a poor prognosis in endoscopically resected superficial esophageal squamous cell neoplasia:A long-term study

BACKGROUND The expression status of serum and glucocorticoid-induced protein kinase 3(SGK3)in superficial esophageal squamous cell neoplasia(ESCN)remains unknown.AIM To evaluate the SGK3 overexpression rate in ESCN and its influence on the prognosis and outcomes of patients with endoscopic resection.METHODS A total of 92 patients who had undergone endoscopic resection for ESCN with more than 8 years of follow-up were enrolled.Immunohistochemistry was used to evaluate SGK3 expression.RESULTS SGK3 was overexpressed in 55(59.8%)patients with ESCN.SGK3 overexpression showed a significant correlation with death(P=0.031).Overall survival and disease-free survival rates were higher in the normal SGK3 expression group than in the SGK3 overexpression group(P=0.013 and P=0.004,respectively).Cox regression analysis models demonstrated that SGK3 overexpression was an independent predictor of poor prognosis in ESCN patients(hazard ratio 4.729;95% confidence interval:1.042-21.458).CONCLUSION SGK3 overexpression was detected in the majority of patients with endoscopically resected ESCN and was significantly associated with shortened survival.Thus,it might be a new prognostic factor for ESCN.

Interventional radiology followed by endoscopic drainage for pancreatic fluid collections associated with high bleeding risk: Two case reports

BACKGROUND Endoscopic ultrasound(EUS)-guided transluminal drainage is an advanced technique used to treat pancreatic fluid collections(PFCs). However, gastric varices and intervening vessels may be associated with a high risk of bleeding and are, therefore, listed as relative contraindications. Herein, we report two patients who underwent interventional embolization before EUS-guided drainage.CASE SUMMARY Two 32-year-old males developed symptomatic PFCs after acute pancreatitis and came to our hospital for further treatment. One patient suffered from intermittent abdominal pain and vomiting, and computed tomography(CT) imaging showed an encapsulated cyst 7.93 cm × 6.13 cm in size. The other patient complained of a mass inside the abdomen, which gradually became enlarged. Gastric varices around the ideal puncture site were detected by EUS when we evaluated the possibility of endoscopic drainage in both patients. Interventional embolization was recommended as the first procedure to decrease the risk of bleeding. After that, EUS-guided transluminal drainage was successfully conducted, without vascular rupture. No postoperative complications occurred during hospitalization, and no recurrence was detected at the last follow-up CT scan performed at 1 mo.CONCLUSION Interventional embolization is a safe, preoperative procedure that is performed before EUS-guided drainage in PFC patients with gastric varices or at high risk of bleeding.

Clinical validation of serum immunosignatures in early diagnosis of Crohn's disease

Background:The search for biomarkers suitable for early diagnosis of Crohn's disease(CD)is challenging.This study investigated the efficacy of serological markers for the early diagnosis of CD.Methods:This was a retrospective nested cohort study.Indirect immuno-fluorescence and enzyme‐linked immunosorbent assay were used to detect ASCA IgG,ASCA IgA,AYMA IgG,AYCA IgG,FI2Y IgG,p‐ANCA IgG,GAB IgG and PAB IgG in patient serum samples.Results:The positive rates of ASCA IgG,ASCA IgA,AYMA IgG,AYCA IgG,FI2Y IgG,p‐ANCA IgG,GAB IgG and PAB IgG in patients with early CD,advanced CD and other intestinal diseases were 37.0%versus 56.8%versus 27.8%;3.7%versus 20.5%versus 19.4%;14.8%versus 2.3%versus 2.8%;25.9%versus 9.1%versus 8.3%;18.5%versus 15.9%versus 8.3%;0.0%versus 2.8%,18.5%;13.6%versus 18.2%versus 16.7%;and 7.4%versus 20.5%versus 0.0%,respectively.The positive rates of ASCA IgG,AYCA IgG and PAB IgG were significantly different among the three groups(p<0.05).In 85.2%of early CD patients,at least one antibody was detected 1 year before diagnosis.The sensitivity of the ASCA/AYMA/AYCA/FI2Y/GAB combination for early diagnosis was 85.2%.The sensitivity of the ASCA/AYMA/AYCA/FI2Y/GAB/PAB/PANCA combination for differentiating CD from other diseases was 87.3%.Conclusions:ASCA IgG and AYCA IgG have potential value in identifying the course of CD.AYCA IgG may be a potential marker for the early diagnosis of CD,and ASCA IgG indicates an advanced stage.The combination of ASCA,AYMA,AYCA,FI2Y,and GAB improves early diagnostic accuracy of CD.