Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.01.006
Chuyan Long, Zhi He, Bota Cui, Ting Zhang, Quan Wen, Qianqian Li, Jie Zhang, G. Ji
Objective To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration. Methods This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated. Results A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases. Key words: Colonoscopy; Fecal microbiota transplantation; Enema; Transendoscopic enteral tubing
{"title":"Methodology, safety and applications of colonic transendoscopic enteral tubing (with video)","authors":"Chuyan Long, Zhi He, Bota Cui, Ting Zhang, Quan Wen, Qianqian Li, Jie Zhang, G. Ji","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.01.006","url":null,"abstract":"Objective \u0000To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration. \u0000 \u0000 \u0000Methods \u0000This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated. \u0000 \u0000 \u0000Results \u0000A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. \u0000 \u0000 \u0000Conclusion \u0000The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases. \u0000 \u0000 \u0000Key words: \u0000Colonoscopy; Fecal microbiota transplantation; Enema; Transendoscopic enteral tubing","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45233305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.01.007
Xi Wang, Xuecan Mei, Na Zhang
Objective To investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices. Methods A total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study. The cases were divided into bleeding group (n=54) and non-bleeding group (n=153) according to the presence or absence of rebleeding within 6 months after treatment. The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis. Results Univariate analysis showed that gender composition, age, presence or absence of portal vein thrombosis, smoking history, drinking history (P=0.05), hypertension, platelet count, total bilirubin level, albumin level, alanine aminotransferase level, prothrombin time, degree of esophageal varices, and surgical methods were not significantly different (all P≥0.05) between the bleeding group and the non-bleeding group. There were significant differences in diabetes, hemoglobin level, blood glucose level, ascites composition, and liver function grade composition between the two groups (all P<0.05). Combined diabetes (yes/no), hemoglobin levels, blood glucose levels, ascites (none-mild/medium-severe), liver function Child-Pugh classification (Grade A/B-C), and history of drinking (yes/no) were included in multivariate analysis, and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices (P=0.008, OR=2.973, 95%CI: 1.322-6.689). Conclusion After endoscopic treatment of liver cirrhosis patients with esophageal varices, rebleeding is more likely to occur in patients complicated with diabetes. Key words: Diabetes mellitus; Liver cirrhosis; Esophageal varices; Endoscopic variceal ligation; Endoscopic injection sclerotherapy; Rebleeding
{"title":"Effects of diabetes on rebleeding after endoscopic treatment in liver cirrhosis patients with esophageal varices","authors":"Xi Wang, Xuecan Mei, Na Zhang","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.01.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.01.007","url":null,"abstract":"Objective \u0000To investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices. \u0000 \u0000 \u0000Methods \u0000A total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study. The cases were divided into bleeding group (n=54) and non-bleeding group (n=153) according to the presence or absence of rebleeding within 6 months after treatment. The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis. \u0000 \u0000 \u0000Results \u0000Univariate analysis showed that gender composition, age, presence or absence of portal vein thrombosis, smoking history, drinking history (P=0.05), hypertension, platelet count, total bilirubin level, albumin level, alanine aminotransferase level, prothrombin time, degree of esophageal varices, and surgical methods were not significantly different (all P≥0.05) between the bleeding group and the non-bleeding group. There were significant differences in diabetes, hemoglobin level, blood glucose level, ascites composition, and liver function grade composition between the two groups (all P<0.05). Combined diabetes (yes/no), hemoglobin levels, blood glucose levels, ascites (none-mild/medium-severe), liver function Child-Pugh classification (Grade A/B-C), and history of drinking (yes/no) were included in multivariate analysis, and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices (P=0.008, OR=2.973, 95%CI: 1.322-6.689). \u0000 \u0000 \u0000Conclusion \u0000After endoscopic treatment of liver cirrhosis patients with esophageal varices, rebleeding is more likely to occur in patients complicated with diabetes. \u0000 \u0000 \u0000Key words: \u0000Diabetes mellitus; Liver cirrhosis; Esophageal varices; Endoscopic variceal ligation; Endoscopic injection sclerotherapy; Rebleeding","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42390926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.01.008
Xia Guili, W. Cai, Wei Gong, Fachao Zhi, Xi Huang, Xiaxi Li, Lei Zhengxia, D. Ling
Objective To investigate the cleaning effects of biofilm cleaning agent and two kinds of multi-enzyme detergents on endoscopic biofilm. Methods Endoscopic biofilm model was established using pseudomonas aeruginosa, and soaked with No. 1 multi-enzyme detergent, No. 2 multi-enzyme detergent, and biofilm cleaning agent respectively. The control group was cleaned with sterile water. After 5, 10, and 15 minutes at room temperature, the cleaning effects were evaluated by bacteria counting method and scanning electron microscope. Arova was used for the comparison of viable counts among groups. Results At 5, 10, and 15 minutes of soak, the standard colony counts (CFU/cm2) of biofilm was 5.31±0.10, 5.04±0.08 and 4.90±0.16 in the No.1 multi-enzyme detergent group, 5.53±0.30, 5.39±0.21 and 5.03±0.42 in the No.2 multi-enzyme detergent group, and 3.53±0.30, 3.01±0.07 and 2.82±0.26 in the biofilm cleaning agent group, and 7.92±0.21 in the blank control group. There was no significant difference in the colony counts between the two multi-enzyme detergent groups (P>0.05). However, the colony counts of biofilm cleaning agent group was less than that of the two multi-enzyme detergent groups (P<0.05), and decreased with time (P<0.05). Under scanning electron microscope, the biofilm cleaning agent group had the least residual biofilm and bacteria. Conclusion Biofilm cleaning agent can significantly improve the quality of endoscopic cleaning, and is worthy of clinical promotion. Key words: Endoscopes; Biofilms; Biofilm cleaning agent; Multi-enzyme detergent
{"title":"Comparison of biofilm cleaning agent and multi-enzyme detergent on endoscopic biofilm cleaning effects","authors":"Xia Guili, W. Cai, Wei Gong, Fachao Zhi, Xi Huang, Xiaxi Li, Lei Zhengxia, D. Ling","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.01.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.01.008","url":null,"abstract":"Objective \u0000To investigate the cleaning effects of biofilm cleaning agent and two kinds of multi-enzyme detergents on endoscopic biofilm. \u0000 \u0000 \u0000Methods \u0000Endoscopic biofilm model was established using pseudomonas aeruginosa, and soaked with No. 1 multi-enzyme detergent, No. 2 multi-enzyme detergent, and biofilm cleaning agent respectively. The control group was cleaned with sterile water. After 5, 10, and 15 minutes at room temperature, the cleaning effects were evaluated by bacteria counting method and scanning electron microscope. Arova was used for the comparison of viable counts among groups. \u0000 \u0000 \u0000Results \u0000At 5, 10, and 15 minutes of soak, the standard colony counts (CFU/cm2) of biofilm was 5.31±0.10, 5.04±0.08 and 4.90±0.16 in the No.1 multi-enzyme detergent group, 5.53±0.30, 5.39±0.21 and 5.03±0.42 in the No.2 multi-enzyme detergent group, and 3.53±0.30, 3.01±0.07 and 2.82±0.26 in the biofilm cleaning agent group, and 7.92±0.21 in the blank control group. There was no significant difference in the colony counts between the two multi-enzyme detergent groups (P>0.05). However, the colony counts of biofilm cleaning agent group was less than that of the two multi-enzyme detergent groups (P<0.05), and decreased with time (P<0.05). Under scanning electron microscope, the biofilm cleaning agent group had the least residual biofilm and bacteria. \u0000 \u0000 \u0000Conclusion \u0000Biofilm cleaning agent can significantly improve the quality of endoscopic cleaning, and is worthy of clinical promotion. \u0000 \u0000 \u0000Key words: \u0000Endoscopes; Biofilms; Biofilm cleaning agent; Multi-enzyme detergent","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"38-41"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41645760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2020.01.004
Min Zhu, Xiao Li, Xiu-jing Sun, Peng-Cheng Li, Qian Zhang
Objective To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging (ME-NBI), and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings. Methods Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration. Results A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach (OR=12.949, 95%CI: 2.148-78.070, P=0.005), middle third of the stomach (OR=7.534, 95%CI: 1.044-54.360, P=0.045), >2 cm in size (OR=6.828, 95%CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel (OR=6.856, 95%CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95%CI: 0.809-0.960) in the modeling group and 0.799 (95%CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score. Conclusion The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC. Key words: Stomach neoplasms; Early diagnosis; Tumor infiltrating; Forecasting models; Magnification endoscopy with narrow band imaging
{"title":"A model of predicting infiltration depth of early gastric cancers based on conventional white light endoscopy and magnifying endoscopy with narrow band imaging findings","authors":"Min Zhu, Xiao Li, Xiu-jing Sun, Peng-Cheng Li, Qian Zhang","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.01.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.01.004","url":null,"abstract":"Objective \u0000To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging (ME-NBI), and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings. \u0000 \u0000 \u0000Methods \u0000Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration. \u0000 \u0000 \u0000Results \u0000A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach (OR=12.949, 95%CI: 2.148-78.070, P=0.005), middle third of the stomach (OR=7.534, 95%CI: 1.044-54.360, P=0.045), >2 cm in size (OR=6.828, 95%CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel (OR=6.856, 95%CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95%CI: 0.809-0.960) in the modeling group and 0.799 (95%CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score. \u0000 \u0000 \u0000Conclusion \u0000The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC. \u0000 \u0000 \u0000Key words: \u0000Stomach neoplasms; Early diagnosis; Tumor infiltrating; Forecasting models; Magnification endoscopy with narrow band imaging","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44587117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Training of gastrointestinal endoscopy and endoscopists in the new era","authors":"Ye Gao, Yongpu Feng, Yu Liu","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.01.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.01.002","url":null,"abstract":"我国消化内镜技术近年来发展迅速，但内镜医师培训发展相对缓慢，未形成与人民诊疗需求相适应的内镜医师培训体系。美国、日本和英国等发达国家均形成了相对完善的内镜医师培训体系，对我国内镜医师培训工作具有重要借鉴意义。学习国际先进理念，结合我国实际国情，实现内镜医师培训统一报名准入、管理部署、课程学习、考核认证、监督质控，系统性地培养一大批合格、优秀的消化内镜医师，是提升我国新时代消化内镜诊疗水平的必由之路。本文就内镜医师成长轨迹，合格、优秀内镜医师应具备的能力素质和国内外消化内镜医师培训进展作一述评。","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"3-10"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43019085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accurately identifying early lesions under endoscopy is the key to improving the screening rate of early gastric cancer, and accurate pathological diagnosis is a powerful support for improving endoscopic diagnostic technology. Japan is one of the countries with very successful screening for early gastric cancer, and there are significant differences between the diagnostic standards for gastric cancer in Japan and those of the World Health Organization (WHO). This article introduces the pathological diagnostic criteria for gastric adenomas and early well differentiated adenocarcinoma in Japan, and compares them with WHO standards, in order to provide a reference for pathologists to understand the diagnostic criteria for gastric cancer in Japan.
{"title":"Pathologic diagnosis of gastric adenoma and early stage well differentiated adenocarcinoma in Japan","authors":"Zhenghua Piao, Xiao Ding, Haizhong Jiang","doi":"10.3760/CMA.J.ISSN.1007-5232.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2020.01.003","url":null,"abstract":"内镜下准确识别早期病变是提高早期胃癌筛查率的关键，而精准的病理学诊断是提高内镜诊断技术的有力后盾。日本是早期胃癌筛查工作非常成功的国家之一，而日本胃癌诊断标准和世界卫生组织(WHO)标准有较大差异。本文介绍了日本胃腺瘤及早期高分化腺癌的病理诊断标准，并与WHO标准进行比较，以期为病理医师理解日本胃癌诊断标准提供参考。","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"37 1","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43761331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.12.004
L. Huang, Xi Wu, Xiao-hong Sun, Lili You, L. Zou, Yizhen Zhang, Rui-yong Liu, Zhifeng Wang
Objective To study the effects of endoscopic submucosal dissection(ESD) on long-term quality of life (QOL) and gastric function of patients with distal early gastric cancer (EGC), compared with those of surgery. Methods Patients with EGC who received ESD or surgical resection in Peking Union Medical College Hospital over 1 year ago were selected to be followed up. QLQ-C30, SF-36, EQ-5D and dyspeptic symptom rating scale were used to evaluate QOL. Five-hour gastric emptying rate was used to evaluate distal gastric function. Electronic gastroscopy was used to observe whether the anastomotic stoma was stenotic. According to the age at resection, 1 to 1 matching was performed between the distal 1/3 gastric ESD (EP) group and the distal subtotal gastrectomy (SP) group, and then the QOL and gastric function between the two groups were compared. Results Twenty-five patients were included in group EP and group SP respectively. According to QLQ-C30, the scores of cognitive function were 83.3 (83.3, 83.3) in group EP and 83.3 (83.3, 100.0) in group SP (P=0.056). The proportion of patients with symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties) between the two groups were not statistically different. There was no statistical difference in the scores of EQ-5D and SF-36 between the two groups. According to dyspeptic symptom rating scale, 56.0% patients in group EPhad burning sensation, but only 28.0% in group SP had this symptom (P=0.054). 20.0% of patients in group SPreported nausea, while only 4.0% in group EP had this symptom (P=0.084). Gastric emptying results showed that the proportion of patients with abnormal 5-hour gastric emptying rate was 31.8% in group EP, while there was no abnormal emptying in group SP (P=0.003). Gastroscopy results showed that one patient in group EP had pyloric stenosis, but 5-hour gastric emptying rate was normal. All anastomotic stomas in group Sp were unobstructed. Conclusion ESD and surgical resection for distal EGC show similar long-term effects on QOL of patients. But the long-term gastric emptying function may decrease after distal gastric ESD. Key words: Stomach neoplasms; Early diagnosis; Quality of life; Endoscopic submucosal dissection
{"title":"Effects of endoscopic and surgical treatment for distal early gastric cancer on long-term quality of life and function","authors":"L. Huang, Xi Wu, Xiao-hong Sun, Lili You, L. Zou, Yizhen Zhang, Rui-yong Liu, Zhifeng Wang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.12.004","url":null,"abstract":"Objective \u0000To study the effects of endoscopic submucosal dissection(ESD) on long-term quality of life (QOL) and gastric function of patients with distal early gastric cancer (EGC), compared with those of surgery. \u0000 \u0000 \u0000Methods \u0000Patients with EGC who received ESD or surgical resection in Peking Union Medical College Hospital over 1 year ago were selected to be followed up. QLQ-C30, SF-36, EQ-5D and dyspeptic symptom rating scale were used to evaluate QOL. Five-hour gastric emptying rate was used to evaluate distal gastric function. Electronic gastroscopy was used to observe whether the anastomotic stoma was stenotic. According to the age at resection, 1 to 1 matching was performed between the distal 1/3 gastric ESD (EP) group and the distal subtotal gastrectomy (SP) group, and then the QOL and gastric function between the two groups were compared. \u0000 \u0000 \u0000Results \u0000Twenty-five patients were included in group EP and group SP respectively. According to QLQ-C30, the scores of cognitive function were 83.3 (83.3, 83.3) in group EP and 83.3 (83.3, 100.0) in group SP (P=0.056). The proportion of patients with symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties) between the two groups were not statistically different. There was no statistical difference in the scores of EQ-5D and SF-36 between the two groups. According to dyspeptic symptom rating scale, 56.0% patients in group EPhad burning sensation, but only 28.0% in group SP had this symptom (P=0.054). 20.0% of patients in group SPreported nausea, while only 4.0% in group EP had this symptom (P=0.084). Gastric emptying results showed that the proportion of patients with abnormal 5-hour gastric emptying rate was 31.8% in group EP, while there was no abnormal emptying in group SP (P=0.003). Gastroscopy results showed that one patient in group EP had pyloric stenosis, but 5-hour gastric emptying rate was normal. All anastomotic stomas in group Sp were unobstructed. \u0000 \u0000 \u0000Conclusion \u0000ESD and surgical resection for distal EGC show similar long-term effects on QOL of patients. But the long-term gastric emptying function may decrease after distal gastric ESD. \u0000 \u0000 \u0000Key words: \u0000Stomach neoplasms; Early diagnosis; Quality of life; Endoscopic submucosal dissection","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"891-896"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42190924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.12.006
Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Shanshan Wu, B. Yue, Shutian Zhang, Si-quan Zhu
Objective To assess the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) in the treatment of larger (≥10-15 mm) non-ampullary duodenal lesions. Methods The data of 21 patients with larger (≥10-15 mm) non-ampullary duodenal lesions, who underwent EPMR or ESD in Beijing Friendship Hospital from February 2013 to August 2018 were retrospectively analyzed. According to the treatment plan, the patients were divided into the EPMR group (n=13) and the ESD group (n=8). The operation time, pathological histological evaluation and complications of each group were summarized. Results In the EPMR group, all 13 lesions were originated from the mucosa. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 22±12 mm and 26±15 mm, respectively, the median operation time was 39.0 (23.0, 45.0) min, and 12 lesions were closed with metal clips. For pathological assessment, there were 2 cases of ectopia gastric mucosa, 7 cases of low grade intraepithelial neoplasia, and 4 cases of high grade intraepithelial neoplasia. And 5 cases were horizontal margin positive (low grade intraepithelial neoplasia) in the 13 lesions. Complications occurred in 2 patients, including 1 case of perioperative bacteremia, which was cured after anti-infective treatment, and another case of intraoperative perforation, which was recovered after emergency surgery. In the ESD group, there were 6 mucosal lesions and 2 submucosal lesions. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 17±5 mm and 20±7 mm, respectively, the median operation time was 47.5 (34.0, 68.0) min, and all 8 lesions were closed with metal clips. For pathological assessment, there were 3 cases of low grade intraepithelial neoplasia, 3 cases of high grade intraepithelial neoplasia, 1 case of submucosal cyst, and 1 case of lymphangioma. All 8 cases were horizontal margin negative, and low-grade intraepithelial neoplasia was suspected at the vertical margin of 1 case, which failed to achieve complete resection. Perioperative perforation occurred in 3 cases. One case recovered after endoscopic treatment, another case was unsatisfactory under endoscopy, and recovered after emergency surgery. The other case was recovered after laparoscopic treatment. Conclusion EPMR and ESD are both safe and effective for larger non-ampullary duodenal lesions, which is worthy of further clinical research. Key words: Duodenal diseases; Primary non-ampullary duodenal lesion; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection
{"title":"Clinical observation of endoscopic piecemeal mucosal resection and endoscopic submucosal dissection in the treatment of larger non-ampullary duodenal lesions","authors":"Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Shanshan Wu, B. Yue, Shutian Zhang, Si-quan Zhu","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.12.006","url":null,"abstract":"Objective \u0000To assess the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) in the treatment of larger (≥10-15 mm) non-ampullary duodenal lesions. \u0000 \u0000 \u0000Methods \u0000The data of 21 patients with larger (≥10-15 mm) non-ampullary duodenal lesions, who underwent EPMR or ESD in Beijing Friendship Hospital from February 2013 to August 2018 were retrospectively analyzed. According to the treatment plan, the patients were divided into the EPMR group (n=13) and the ESD group (n=8). The operation time, pathological histological evaluation and complications of each group were summarized. \u0000 \u0000 \u0000Results \u0000In the EPMR group, all 13 lesions were originated from the mucosa. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 22±12 mm and 26±15 mm, respectively, the median operation time was 39.0 (23.0, 45.0) min, and 12 lesions were closed with metal clips. For pathological assessment, there were 2 cases of ectopia gastric mucosa, 7 cases of low grade intraepithelial neoplasia, and 4 cases of high grade intraepithelial neoplasia. And 5 cases were horizontal margin positive (low grade intraepithelial neoplasia) in the 13 lesions. Complications occurred in 2 patients, including 1 case of perioperative bacteremia, which was cured after anti-infective treatment, and another case of intraoperative perforation, which was recovered after emergency surgery. In the ESD group, there were 6 mucosal lesions and 2 submucosal lesions. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 17±5 mm and 20±7 mm, respectively, the median operation time was 47.5 (34.0, 68.0) min, and all 8 lesions were closed with metal clips. For pathological assessment, there were 3 cases of low grade intraepithelial neoplasia, 3 cases of high grade intraepithelial neoplasia, 1 case of submucosal cyst, and 1 case of lymphangioma. All 8 cases were horizontal margin negative, and low-grade intraepithelial neoplasia was suspected at the vertical margin of 1 case, which failed to achieve complete resection. Perioperative perforation occurred in 3 cases. One case recovered after endoscopic treatment, another case was unsatisfactory under endoscopy, and recovered after emergency surgery. The other case was recovered after laparoscopic treatment. \u0000 \u0000 \u0000Conclusion \u0000EPMR and ESD are both safe and effective for larger non-ampullary duodenal lesions, which is worthy of further clinical research. \u0000 \u0000 \u0000Key words: \u0000Duodenal diseases; Primary non-ampullary duodenal lesion; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"901-905"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45800663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.12.007
Ya-ping Lan, C. Fang, Xiaoling Zheng, Wan-yin Deng, Jinhui Zheng, Chao Wang, Li-ping He
Objective To analysis the risk factors of postoperative bleeding of endoscopic submucosal dissection (ESD) for early gastrointestinal cancer. Methods A retrospective study was performed on the data of 430 patients (449 lesions) with early gastrointestinal cancer undergoing ESD in Fujian Provincial Hospital Digestive Endoscopic Center from June 2008 to February 2015 and in Fujian Provincial Hospital South Branch Digestive Endoscopic Center from May 2015 to April 2018. Patients with postoperative bleeding were compared with those without postoperative bleeding on the basis of general conditions, endoscopic performance, postoperative pathology and so on to analysis the risk factors for postoperative bleeding of ESD. Results Among the 430 cases (449 lesions)of early gastrointestinal cancer undergoing ESD, 16 cases (3.7%) had postoperative bleeding. According to whether the occurrence of postoperative hemorrhage, patients were divided into bleeding group (n=16) and not bleeding group (n=433). Univariate analysis suggested that whether had hypertension was statistically significant between the two groups (χ2=4.793, P=0.029), while patients age (t=0.465, P=0.642), gender (χ2=0.035, P=0.642), whether to have diabetes (χ2=0.647, P=0.421), whether to have coronary heart disease (P=1.000), lesion size (t=1.598, P=0.111), whether two or more lesions (P=1.000), lesion site (χ2=6.183, P=0.289), operation time (t=1.335, P=0.201), pathological grading (χ2=0.687, P=0.709), and lesion infiltration depth (χ2=0.134, P=0.714) were not statistically significant between the two groups. Logistic regression analysis showed that hypertension (OR=3.358, 95%CI: 1.227-9.186, P=0.018) was an independent risk factor of bleeding after ESD for early gastrointestinal cancer. Conclusion Hypertension is closely related to postoperative bleeding following ESD for early gastrointestinal cancer.Patients with hypertension are at a greater risk of bleeding after ESD. Key words: Risk factors; Early gastrointestinal cancer; Endoscopic submucosal dissection; Postoperative bleeding
{"title":"Risk factors of postoperative bleeding of endoscopic submucosal dissection for early gastrointestinal cancer","authors":"Ya-ping Lan, C. Fang, Xiaoling Zheng, Wan-yin Deng, Jinhui Zheng, Chao Wang, Li-ping He","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.12.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.12.007","url":null,"abstract":"Objective \u0000To analysis the risk factors of postoperative bleeding of endoscopic submucosal dissection (ESD) for early gastrointestinal cancer. \u0000 \u0000 \u0000Methods \u0000A retrospective study was performed on the data of 430 patients (449 lesions) with early gastrointestinal cancer undergoing ESD in Fujian Provincial Hospital Digestive Endoscopic Center from June 2008 to February 2015 and in Fujian Provincial Hospital South Branch Digestive Endoscopic Center from May 2015 to April 2018. Patients with postoperative bleeding were compared with those without postoperative bleeding on the basis of general conditions, endoscopic performance, postoperative pathology and so on to analysis the risk factors for postoperative bleeding of ESD. \u0000 \u0000 \u0000Results \u0000Among the 430 cases (449 lesions)of early gastrointestinal cancer undergoing ESD, 16 cases (3.7%) had postoperative bleeding. According to whether the occurrence of postoperative hemorrhage, patients were divided into bleeding group (n=16) and not bleeding group (n=433). Univariate analysis suggested that whether had hypertension was statistically significant between the two groups (χ2=4.793, P=0.029), while patients age (t=0.465, P=0.642), gender (χ2=0.035, P=0.642), whether to have diabetes (χ2=0.647, P=0.421), whether to have coronary heart disease (P=1.000), lesion size (t=1.598, P=0.111), whether two or more lesions (P=1.000), lesion site (χ2=6.183, P=0.289), operation time (t=1.335, P=0.201), pathological grading (χ2=0.687, P=0.709), and lesion infiltration depth (χ2=0.134, P=0.714) were not statistically significant between the two groups. Logistic regression analysis showed that hypertension (OR=3.358, 95%CI: 1.227-9.186, P=0.018) was an independent risk factor of bleeding after ESD for early gastrointestinal cancer. \u0000 \u0000 \u0000Conclusion \u0000Hypertension is closely related to postoperative bleeding following ESD for early gastrointestinal cancer.Patients with hypertension are at a greater risk of bleeding after ESD. \u0000 \u0000 \u0000Key words: \u0000Risk factors; Early gastrointestinal cancer; Endoscopic submucosal dissection; Postoperative bleeding","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"906-910"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41439914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After long-term clinical verification, the indications of capsule endoscopy have been basically clear. Due to the fact that a single examination of capsule endoscopy can generate approximately 60000 image data, it not only takes up a large amount of doctor reading time, but also increases the missed diagnosis rate after manual reading fatigue. Therefore, multiple image processing technologies rely on the powerful computing power of artificial intelligence and are constantly being attempted in the field of capsule endoscopy for capsule localization and disease assisted diagnosis, in order to reduce film reading time and improve examination efficiency. This article briefly summarizes the application and development prospects of deep learning artificial intelligence technology in the field of capsule endoscopy.
{"title":"Application of deep learning artificial intelligence in capsule endoscopy","authors":"J. Xia, Jun Pan, T. Xia, Z. Liao","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.12.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.12.001","url":null,"abstract":"胶囊内镜经过长期临床验证，其适应证已基本明确。因胶囊内镜一次检查可产生约6万张图像数据，不仅会占用医生大量阅片时间，而且人工阅片产生疲劳后，会增加漏诊率。因此多项图像处理技术依靠人工智能强大的计算能力，不断在胶囊内镜领域被尝试用于胶囊定位与疾病辅助诊断，以减少阅片时间，提高检查效率。本文简要总结在胶囊内镜领域中基于深度学习人工智能技术的应用与其发展前景。","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"877-880"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49090893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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