BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.展开更多
In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive ove...In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.展开更多
BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy o...BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.展开更多
BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoi...BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due...BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.AIM To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.METHODS Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023.The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence,which include en-bloc and curative resection(CR)rates,local recurrence and survival rates.RESULTS ESD was attempted on 111 lesions in 93 patients.95.0%of completed procedures achieved endoscopic clearance.74.3%were en-bloc resections and the rest were hybrid ESD with piecemeal resections.In all,34.7%achieved histological CR.Overall,disease recurrence was 10.9%at latest follow-up(63 months,median follow-up).Importantly 100%of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up.In the Indeterminate and Non-CR group,18.8%of lesions showed disease recurrence at subsequent endoscopic follow-ups.ESD changed the histological staging of 44.5%of lesions.Immediate complications were observed in 9.9%of all ESD procedures.The median survival time was 69 months post-ESD.The mean age at death is 82.2 years old.CONCLUSION The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.How...BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.展开更多
BACKGROUND Tumor progression in patients with esophageal precancerous lesions(EPLs)or early esophageal carcinoma(EEC)is typically confined in both extent and location.Prompt and effective intervention significantly im...BACKGROUND Tumor progression in patients with esophageal precancerous lesions(EPLs)or early esophageal carcinoma(EEC)is typically confined in both extent and location.Prompt and effective intervention significantly improves treatment outcomes and prognosis for these individuals.AIM To determine the effect of endoscopic submucosal dissection(ESD)on efficacy,serum tumor markers(STMs),and 6-month postoperative recurrence rate in patients with either EPL or EEC.METHODS This study initially enrolled 120 patients with EPL or EEC,who were admitted from April 2021 to April 2024.Participants were divided into the control group(60 cases),which underwent thoracotomy,and the research group(60 cases)which received ESD treatment.The comparative analysis involved information regarding the efficacy(dissection area and resection rate per unit time),complications(delayed bleeding,wound infection,esophageal reflux,and postoperative esophageal stenosis),surgery-related parameters(bleeding volume,operation duration,and hospital length of stay),STMs[carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),and tumor-specific growth factor(TSGF)],and the 6-month postoperative recurrence rate of the two groups.RESULTS Data indicated statistically higher dissection area and resection rate per unit of time in the research group than in the control group.Meanwhile,the research group demonstrated a notably lower overall incidence rate of complications,bleeding volume,operation duration,and hospital length of stay.Further,the CEA,CA724,and TSGF were markedly reduced in the research group after treatment,which were statistically lower compared to the baseline and those of the control group.Finally,during the follow-up,a comparable 6-month postoperative recurrence rate was determined in the two groups.CONCLUSION ESD is clinically effective and safe for EPL and EEC and can significantly restore abnormally increased levels of STMs.展开更多
BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy...BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.METHODS Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022.Among them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control group.We compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.RESULTS The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group.The intraoperative bleeding volume was higher in the experimental group than in the control group.The operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically significant(all P<0.05).The length of hospital stay was longer in the experi-mental group than in the control group,and the incidence of surgical complications,1-year postoperative recu-rrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group,and the differences were statistically significant(all P<0.05).However,the difference in the 1-year postoperative survival rate was not statistically significant between the two groups(P>0.05).Before discharge,PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period,and the above indexes were higher in the experimental group than those in the control group,and the differences were statistically significant(both P<0.05).Moreover,before discharge,PG II level was lower in both groups compared with the preoperative period,and the level was lower in the experimental group than in the control group,and the differences were all statistically significant(all P<0.05).CONCLUSION Compared with EMR,ESD surgery is more thorough.It reduces the rate of base residual focus,recurrence rate,surgical complications,and promotes the recovery of gastric cells and glandular function.It is safe and suitable for clinical application.展开更多
The increasing popularity of endoscopic submucosal dissection(ESD)as a treatment for early gastric cancer has highlighted the importance of quality assessment in achieving curative resections.This article emphasizes t...The increasing popularity of endoscopic submucosal dissection(ESD)as a treatment for early gastric cancer has highlighted the importance of quality assessment in achieving curative resections.This article emphasizes the significance of evaluating ESD quality,not only for curative cases but also for non-curative ones.Postoperative assessment relies on the endoscopic curability(eCura)classification,but management strategies for eCuraC-1 tumour with a positive horizontal margin are unclear.Current research primarily focuses on comparing additional surgical procedures in high-risk patients,while studies specifically targeting eCuraC-1 patients are limited.Exploring management strategies and follow-up outcomes for such cases could provide valuable insights.Furthermore,the application of molecular imaging using near-infrared fluorescent tracers holds promise for precise tumour diagnosis and navigation,potentially impacting the management of early-stage gastric cancer patients.Advancing research in these areas is essential for improving the overall efficacy of endoscopic techniques and refining treatment indications.展开更多
BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence ...BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To...BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.METHODS We conducted a systematic search of the electronic databases PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and CINAHL from inception till August 2023.We analyzed outcomes including recurrence rate,en bloc resection,R0 resection rate,perforation rate,procedure length,and hospital stay length applying a random-effects inverse-variance model.We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.RESULTS We pooled data from 11 studies involving 1013 participants.We found similar recurrence rates,with a pooled odds ratio of 0.545(95%CI:0.176-1.687).En bloc resection,R0 resection,and perforation rate values were also similar for both ESD and TES.The pooled analysis for procedure length indicated a mean difference of-4.19 min(95%CI:-22.73 to 14.35),and the hospital stay was on average shorter for ESDs by about 0.789 days(95%CI:-1.671 to 0.093).CONCLUSION Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes.Our findings show that individualized patient and surgeon preferences,alongside specific clinical contexts,can be considered when selecting between these two techniques.展开更多
Objective Esophageal and gastric lesions are effectively managed with minimally invasive upper endoscopic procedures such as endoscopic mucosa resection(EMR)and endoscopic submucosal dissection(ESD),offering patients ...Objective Esophageal and gastric lesions are effectively managed with minimally invasive upper endoscopic procedures such as endoscopic mucosa resection(EMR)and endoscopic submucosal dissection(ESD),offering patients alternatives to invasive interventions.While ESD is well established in Eastern Asia,its adoption in Denmark for superficial esophageal cancer is recent.This study presents real-world data on the feasibility,safety,and hospitalization duration associated with ESD and EMR for esophageal and gastric lesions.Methods A retrospective analysis was conducted on patients who underwent ESD or EMR at a specialized center in Denmark from October 2016 to June 2022.Data on treatment,indication,lesion location,hospitalization duration,procedure duration,specimen size,complications,recurrence,and one-year overall survival were collected.Statistical comparisons utilized the Mann-Whitney U test,independent sample median test,and chi-squared test.Results The study included 130 patients(144 procedures):72 underwent ESD and 58 underwent EMR.Compared with EMR,ESD resulted in greater percentages of en bloc and R0 resections(98.8%vs.64.1%,p<0.001;and 83.9%vs.23.8%,p<0.001),greater complication rates(28.7%vs.3.1%,p<0.001)and longer procedure times(119.5 min vs.37.0 min,p<0.001).The ESD procedure time significantly decreased over time(p=0.01).The local recurrence rates were 14.5%for ESD and 23.8%for EMR(p=0.767).The one-year overall survival rates were similar between the groups(95.8%vs.94.8%,p=0.553).Conclusion Both ESD and EMR are safe and viable for treating esophageal and gastric lesions.ESD offers advantages but requires more time and skill.These findings support the literature,emphasizing the importance of considering patient-specific factors and surgeon proficiency in selecting the appropriate procedure.展开更多
This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more att...This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.展开更多
BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological char...BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.AIM To analyze the features of gastric mucosal tumors at different differentiation levels,and to explore the prognostic factors of ESD.METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021,according to the latest Japanese guidelines(sixth edition),and divided them into low-grade intrae-pithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN),and computed tomography at 3,6 and 12 months after ESD.We compared clinicopathologic characteristics,ESD efficacy,and complications with different degrees of differentiation,and analyzed the related factors associated with ESD.RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients(P<0.001)and accounted for more 0-IIc(P<0.001),atrophic gastritis was common(P<0.001),and irregular microvascular patterns(IMVPs)and demarcation lines(DLs)were more obvious(P<0.001).There was more infiltration in the undifferentiated carcinoma tissue(P<0.001),more abnormal folds and poorer mucosal peristalsis(P<0.001),and more obvious IMVPs,irregular microsurface patterns and DLs(P<0.05)than in the LGIN and HGIN tissues.The disease-free survival rates at 2,5,and 8 years after ESD were 95.0%,90.1%,and 86.9%,respectively.Undifferen-tiated lesions(HR 5.066),white moss(HR 7.187),incomplete resection(HR 3.658),and multiple primary cancers(HR 2.462)were significantly associated with poor prognosis.CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics,which are closely related to the safety and efficacy of ESD.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal tract.AIM To develop an integrated management protocol and analyze its effects on surgica...BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal tract.AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD.METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management.RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group(P<0.05).The management group exhibited a higher incidence rate of postoperative complications than the control group(3 cases vs 11 cases;P=0.043).The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery(P<0.05).The management group gave more scores on the domains of patient familiarity to the responsible nurses,professional skills of responsible nurses,and general evaluation compared to the control group.The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group(P<0.01).The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery(P<0.01).CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.展开更多
BACKGROUND Gastric cancer(GC)endangers the survival and prognosis of patients worldwide.Improving the prognosis of patients with early GC(EGC)is crucial to prolong their survival time.AIM To analyze the effects of end...BACKGROUND Gastric cancer(GC)endangers the survival and prognosis of patients worldwide.Improving the prognosis of patients with early GC(EGC)is crucial to prolong their survival time.AIM To analyze the effects of endoscopic submucosal dissection(ESD)on gastrointestinal function and nutritional status in patients with EGC.METHODS Eighty patients with EGC between January 2021 and January 2024 were divided according to different surgical protocol into following two groups:42 patients who underwent ESD in the ESD group and 38 patients treated with endoscopic mucosal resection(EMR)in the EMR group.Two groups were compared in the operative indices,lesion resection rate,postoperative recovery of gastrointestinal function,nutritional status,and incidence of surgical complications.RESULTS The overall resection rate of the lesion in the ESD group was higher.The operative bleeding volume and operation time were higher and gastrointestinal ventilation time was shorter in the ESD group than those in the EMR group(P<0.05).The nutritional statuses of the two groups decreased after operation;however,the levels of albumin,prealbumin,hemoglobin,and transferrin were higher in the ESD group than in the EMR group(P<0.05).The post-operative pepsinogen(PG)I level in the ESD group was higher than that in the EMR group,and the PG II level was lower than that in the EMR group(P<0.05).The incidence of postoperative complications was compared between the two groups(P>0.05).CONCLUSION ESD can promote the immediate recovery of patient’s postoperative gastrointestinal function,improve their nutritional level,and signifies its application in patients with EGC.展开更多
BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stoma...BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stomach and small intestine,and the colon is less frequently involved,especially in females.CASE SUMMARY A 45-year-old woman was admitted to our hospital for physical examination.Gastroenteroscopy revealed a visible pedunculated polyp in the transverse colon,for which endoscopic submucosal dissection(ESD)was performed.Pathology suggested highly active proliferation of T lymphocytes with atypical hyperplasia.CONCLUSION A middle-aged female patient was found to have colonic T-cell lymphoma by endoscopy.The lesion was successfully removed by ESD,and the surgical margin was negative.It is essential to raise awareness of colonic T-cell lymphoma and choose the appropriate treatment.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is widely utilized for the treatment of large adenomas,submucosal lesions,and early gastric cancer.A significant arti-ficial ulcer typically forms after ESD.Delayed or i...BACKGROUND Endoscopic submucosal dissection(ESD)is widely utilized for the treatment of large adenomas,submucosal lesions,and early gastric cancer.A significant arti-ficial ulcer typically forms after ESD.Delayed or incomplete healing of these ulcers can result in complications such as delayed bleeding and perforation.However,a comprehensive review of the outcomes and risk factors related to ulcer healing following ESD is currently lacking.AIM To assess ulcer healing outcomes and identify risk factors associated with delayed ulcer healing.RESULTS Our analysis included 12 studies,involving a total of 3430 patients.The meta-analysis revealed an overall healing rate of 65.55%for ulcers following ESD[odds ratio(OR)=2.71;95%confidence interval(CI):2.45-3.00].The healing rate within eight weeks was 48.32%(OR=0.76;95%CI:0.35-1.66),while the rate beyond eight weeks was 88.32%(OR=6.73;95%CI:3.82-11.87).Risk factors included Helicobacter pylori(H.pylori)infection(OR:=5.32;95%CI:1.90-14.87;P=0.001),ulcer size(OR=2.08;95%CI:1.19-3.61;P=0.01),lesion site(OR=2.08;95%CI:1.19-3.11),and pathological type(OR=1.64;95%CI:1.06-2.52).Diabetes(OR=0.56;95%CI:0.05-5.80;P=0.63)and duration of operation(OR=1.00;95%CI:0.99-1.01;P=0.96)were not significant factors.CONCLUSION The healing rate of ulcers following ESD is high after eight weeks.Risk factors affecting the healing process include H.pylori infection,ulcer size,lesion site,and pathological type.展开更多
BACKGROUND Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection(ESD).AIM To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndr...BACKGROUND Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection(ESD).AIM To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome(PECS).METHODS In this prospective study,PECS was characterized by in-hospital fever(white blood cell count:≥10000μ/L or body temperature≥37.5℃)and abdominal pain(visual analog scale score≥30 mm during hospitalization or increased by≥20 mm from baseline at admission).High Joule heat was defined as 15390 J.Between April 2020 and April 2024,209 patients underwent colorectal ESD;those with intraoperative perforation or penetration were excluded.The remaining 202 patients were divided into the PECS and non-PECS groups.RESULTS PECS occurred in 30(14.9%)patients.Multivariate analysis revealed high Joule heat as an independent factor associated with PECS(odds ratio=7.96;95%confidence interval:2.91-21.8,P<0.01).The procedure time and presence of lesions in the right colon were not associated with PECS.CONCLUSION Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset.This thermal damage is likely a major component of the mechanism underlying PECS.展开更多
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
文摘In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.
基金Supported by the Basic and Applied Basic Research Foundation of Guangzhou,No.202201011331the National Natural Science Foundation of China,No.82373118the Natural Science Foundation of Guangdong Province,No.2023A1515010828.
文摘BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.
基金Supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research,No.23K11902.
文摘BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is increasingly used to treat gastric dysplasia and early neoplasia in the West.Unlike Eastern countries,data for Caucasian patients in the United Kingdom is limited due to its limited implementation in a few tertiary centres.AIM To evaluate the outcomes of ESD on gastric dysplasia and neoplasia in Caucasian patients.METHODS Our ten-year retrospective study at a single tertiary centre included data spanning from May 2012 to July 2023.The efficacy of ESD on gastric dysplasia and early neoplasia was measured using parameters set out by the National Institute for Health and Care Excellence,which include en-bloc and curative resection(CR)rates,local recurrence and survival rates.RESULTS ESD was attempted on 111 lesions in 93 patients.95.0%of completed procedures achieved endoscopic clearance.74.3%were en-bloc resections and the rest were hybrid ESD with piecemeal resections.In all,34.7%achieved histological CR.Overall,disease recurrence was 10.9%at latest follow-up(63 months,median follow-up).Importantly 100%of lesions in the CR group showed no disease recurrence at subsequent and latest follow-up.In the Indeterminate and Non-CR group,18.8%of lesions showed disease recurrence at subsequent endoscopic follow-ups.ESD changed the histological staging of 44.5%of lesions.Immediate complications were observed in 9.9%of all ESD procedures.The median survival time was 69 months post-ESD.The mean age at death is 82.2 years old.CONCLUSION The study affirms the long-term efficacy and safety of ESD for gastric dysplasia and early neoplasia in Caucasian patients.
基金Supported by the Medical Education Research Project from Nanjing Drum Tower Hospital,No.2021-7the Clinical Trials Fund from Nanjing Drum Tower Hospital,No.2022-YXZX-XH-04National Natural Science Foundation of China,No.82203063.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.
文摘BACKGROUND Tumor progression in patients with esophageal precancerous lesions(EPLs)or early esophageal carcinoma(EEC)is typically confined in both extent and location.Prompt and effective intervention significantly improves treatment outcomes and prognosis for these individuals.AIM To determine the effect of endoscopic submucosal dissection(ESD)on efficacy,serum tumor markers(STMs),and 6-month postoperative recurrence rate in patients with either EPL or EEC.METHODS This study initially enrolled 120 patients with EPL or EEC,who were admitted from April 2021 to April 2024.Participants were divided into the control group(60 cases),which underwent thoracotomy,and the research group(60 cases)which received ESD treatment.The comparative analysis involved information regarding the efficacy(dissection area and resection rate per unit time),complications(delayed bleeding,wound infection,esophageal reflux,and postoperative esophageal stenosis),surgery-related parameters(bleeding volume,operation duration,and hospital length of stay),STMs[carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),and tumor-specific growth factor(TSGF)],and the 6-month postoperative recurrence rate of the two groups.RESULTS Data indicated statistically higher dissection area and resection rate per unit of time in the research group than in the control group.Meanwhile,the research group demonstrated a notably lower overall incidence rate of complications,bleeding volume,operation duration,and hospital length of stay.Further,the CEA,CA724,and TSGF were markedly reduced in the research group after treatment,which were statistically lower compared to the baseline and those of the control group.Finally,during the follow-up,a comparable 6-month postoperative recurrence rate was determined in the two groups.CONCLUSION ESD is clinically effective and safe for EPL and EEC and can significantly restore abnormally increased levels of STMs.
基金Supported by Qiqihar Scientific and Technological Plan Joint Guidance Projects,No.LSFGG-2023015.
文摘BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.METHODS Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022.Among them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control group.We compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.RESULTS The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group.The intraoperative bleeding volume was higher in the experimental group than in the control group.The operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically significant(all P<0.05).The length of hospital stay was longer in the experi-mental group than in the control group,and the incidence of surgical complications,1-year postoperative recu-rrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group,and the differences were statistically significant(all P<0.05).However,the difference in the 1-year postoperative survival rate was not statistically significant between the two groups(P>0.05).Before discharge,PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period,and the above indexes were higher in the experimental group than those in the control group,and the differences were statistically significant(both P<0.05).Moreover,before discharge,PG II level was lower in both groups compared with the preoperative period,and the level was lower in the experimental group than in the control group,and the differences were all statistically significant(all P<0.05).CONCLUSION Compared with EMR,ESD surgery is more thorough.It reduces the rate of base residual focus,recurrence rate,surgical complications,and promotes the recovery of gastric cells and glandular function.It is safe and suitable for clinical application.
基金the China Postdoctoral Science Foundation,No.2022M712265.
文摘The increasing popularity of endoscopic submucosal dissection(ESD)as a treatment for early gastric cancer has highlighted the importance of quality assessment in achieving curative resections.This article emphasizes the significance of evaluating ESD quality,not only for curative cases but also for non-curative ones.Postoperative assessment relies on the endoscopic curability(eCura)classification,but management strategies for eCuraC-1 tumour with a positive horizontal margin are unclear.Current research primarily focuses on comparing additional surgical procedures in high-risk patients,while studies specifically targeting eCuraC-1 patients are limited.Exploring management strategies and follow-up outcomes for such cases could provide valuable insights.Furthermore,the application of molecular imaging using near-infrared fluorescent tracers holds promise for precise tumour diagnosis and navigation,potentially impacting the management of early-stage gastric cancer patients.Advancing research in these areas is essential for improving the overall efficacy of endoscopic techniques and refining treatment indications.
文摘BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.METHODS We conducted a systematic search of the electronic databases PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and CINAHL from inception till August 2023.We analyzed outcomes including recurrence rate,en bloc resection,R0 resection rate,perforation rate,procedure length,and hospital stay length applying a random-effects inverse-variance model.We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.RESULTS We pooled data from 11 studies involving 1013 participants.We found similar recurrence rates,with a pooled odds ratio of 0.545(95%CI:0.176-1.687).En bloc resection,R0 resection,and perforation rate values were also similar for both ESD and TES.The pooled analysis for procedure length indicated a mean difference of-4.19 min(95%CI:-22.73 to 14.35),and the hospital stay was on average shorter for ESDs by about 0.789 days(95%CI:-1.671 to 0.093).CONCLUSION Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes.Our findings show that individualized patient and surgeon preferences,alongside specific clinical contexts,can be considered when selecting between these two techniques.
文摘Objective Esophageal and gastric lesions are effectively managed with minimally invasive upper endoscopic procedures such as endoscopic mucosa resection(EMR)and endoscopic submucosal dissection(ESD),offering patients alternatives to invasive interventions.While ESD is well established in Eastern Asia,its adoption in Denmark for superficial esophageal cancer is recent.This study presents real-world data on the feasibility,safety,and hospitalization duration associated with ESD and EMR for esophageal and gastric lesions.Methods A retrospective analysis was conducted on patients who underwent ESD or EMR at a specialized center in Denmark from October 2016 to June 2022.Data on treatment,indication,lesion location,hospitalization duration,procedure duration,specimen size,complications,recurrence,and one-year overall survival were collected.Statistical comparisons utilized the Mann-Whitney U test,independent sample median test,and chi-squared test.Results The study included 130 patients(144 procedures):72 underwent ESD and 58 underwent EMR.Compared with EMR,ESD resulted in greater percentages of en bloc and R0 resections(98.8%vs.64.1%,p<0.001;and 83.9%vs.23.8%,p<0.001),greater complication rates(28.7%vs.3.1%,p<0.001)and longer procedure times(119.5 min vs.37.0 min,p<0.001).The ESD procedure time significantly decreased over time(p=0.01).The local recurrence rates were 14.5%for ESD and 23.8%for EMR(p=0.767).The one-year overall survival rates were similar between the groups(95.8%vs.94.8%,p=0.553).Conclusion Both ESD and EMR are safe and viable for treating esophageal and gastric lesions.ESD offers advantages but requires more time and skill.These findings support the literature,emphasizing the importance of considering patient-specific factors and surgeon proficiency in selecting the appropriate procedure.
基金Supported by Program for Youth Innovation in Future Medicine,Chongqing Medical University,No.W0138.
文摘This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.
基金Supported by Development Program of Shaanxi Province,No.2021SF-221.
文摘BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.AIM To analyze the features of gastric mucosal tumors at different differentiation levels,and to explore the prognostic factors of ESD.METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021,according to the latest Japanese guidelines(sixth edition),and divided them into low-grade intrae-pithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN),and computed tomography at 3,6 and 12 months after ESD.We compared clinicopathologic characteristics,ESD efficacy,and complications with different degrees of differentiation,and analyzed the related factors associated with ESD.RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients(P<0.001)and accounted for more 0-IIc(P<0.001),atrophic gastritis was common(P<0.001),and irregular microvascular patterns(IMVPs)and demarcation lines(DLs)were more obvious(P<0.001).There was more infiltration in the undifferentiated carcinoma tissue(P<0.001),more abnormal folds and poorer mucosal peristalsis(P<0.001),and more obvious IMVPs,irregular microsurface patterns and DLs(P<0.05)than in the LGIN and HGIN tissues.The disease-free survival rates at 2,5,and 8 years after ESD were 95.0%,90.1%,and 86.9%,respectively.Undifferen-tiated lesions(HR 5.066),white moss(HR 7.187),incomplete resection(HR 3.658),and multiple primary cancers(HR 2.462)were significantly associated with poor prognosis.CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics,which are closely related to the safety and efficacy of ESD.
基金the Ethics Committee of Ningbo Yinzhou No.2 Hospital(No.ZXIRB2022301).
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal tract.AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD.METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management.RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group(P<0.05).The management group exhibited a higher incidence rate of postoperative complications than the control group(3 cases vs 11 cases;P=0.043).The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery(P<0.05).The management group gave more scores on the domains of patient familiarity to the responsible nurses,professional skills of responsible nurses,and general evaluation compared to the control group.The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group(P<0.01).The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery(P<0.01).CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.
文摘BACKGROUND Gastric cancer(GC)endangers the survival and prognosis of patients worldwide.Improving the prognosis of patients with early GC(EGC)is crucial to prolong their survival time.AIM To analyze the effects of endoscopic submucosal dissection(ESD)on gastrointestinal function and nutritional status in patients with EGC.METHODS Eighty patients with EGC between January 2021 and January 2024 were divided according to different surgical protocol into following two groups:42 patients who underwent ESD in the ESD group and 38 patients treated with endoscopic mucosal resection(EMR)in the EMR group.Two groups were compared in the operative indices,lesion resection rate,postoperative recovery of gastrointestinal function,nutritional status,and incidence of surgical complications.RESULTS The overall resection rate of the lesion in the ESD group was higher.The operative bleeding volume and operation time were higher and gastrointestinal ventilation time was shorter in the ESD group than those in the EMR group(P<0.05).The nutritional statuses of the two groups decreased after operation;however,the levels of albumin,prealbumin,hemoglobin,and transferrin were higher in the ESD group than in the EMR group(P<0.05).The post-operative pepsinogen(PG)I level in the ESD group was higher than that in the EMR group,and the PG II level was lower than that in the EMR group(P<0.05).The incidence of postoperative complications was compared between the two groups(P>0.05).CONCLUSION ESD can promote the immediate recovery of patient’s postoperative gastrointestinal function,improve their nutritional level,and signifies its application in patients with EGC.
文摘BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stomach and small intestine,and the colon is less frequently involved,especially in females.CASE SUMMARY A 45-year-old woman was admitted to our hospital for physical examination.Gastroenteroscopy revealed a visible pedunculated polyp in the transverse colon,for which endoscopic submucosal dissection(ESD)was performed.Pathology suggested highly active proliferation of T lymphocytes with atypical hyperplasia.CONCLUSION A middle-aged female patient was found to have colonic T-cell lymphoma by endoscopy.The lesion was successfully removed by ESD,and the surgical margin was negative.It is essential to raise awareness of colonic T-cell lymphoma and choose the appropriate treatment.
基金Supported by the National Natural Science Foundation of China,No.81860104the Joint Project on Regional High-Incidence Diseases Research of Guangxi Natural Science Foundation,No.2023GXNSFDA026024+2 种基金the Development and Application of Medical and Health Appropriate Technology Project in Guangxi Zhuang Autonomous Region,No.S2018049the Self-financing Project of Health Commission of Guangxi Zhuang Autonomous Region,No.Z20200398the Innovation Project of Guangxi Graduate Education,No.YCBZ2022079.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is widely utilized for the treatment of large adenomas,submucosal lesions,and early gastric cancer.A significant arti-ficial ulcer typically forms after ESD.Delayed or incomplete healing of these ulcers can result in complications such as delayed bleeding and perforation.However,a comprehensive review of the outcomes and risk factors related to ulcer healing following ESD is currently lacking.AIM To assess ulcer healing outcomes and identify risk factors associated with delayed ulcer healing.RESULTS Our analysis included 12 studies,involving a total of 3430 patients.The meta-analysis revealed an overall healing rate of 65.55%for ulcers following ESD[odds ratio(OR)=2.71;95%confidence interval(CI):2.45-3.00].The healing rate within eight weeks was 48.32%(OR=0.76;95%CI:0.35-1.66),while the rate beyond eight weeks was 88.32%(OR=6.73;95%CI:3.82-11.87).Risk factors included Helicobacter pylori(H.pylori)infection(OR:=5.32;95%CI:1.90-14.87;P=0.001),ulcer size(OR=2.08;95%CI:1.19-3.61;P=0.01),lesion site(OR=2.08;95%CI:1.19-3.11),and pathological type(OR=1.64;95%CI:1.06-2.52).Diabetes(OR=0.56;95%CI:0.05-5.80;P=0.63)and duration of operation(OR=1.00;95%CI:0.99-1.01;P=0.96)were not significant factors.CONCLUSION The healing rate of ulcers following ESD is high after eight weeks.Risk factors affecting the healing process include H.pylori infection,ulcer size,lesion site,and pathological type.
文摘BACKGROUND Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection(ESD).AIM To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome(PECS).METHODS In this prospective study,PECS was characterized by in-hospital fever(white blood cell count:≥10000μ/L or body temperature≥37.5℃)and abdominal pain(visual analog scale score≥30 mm during hospitalization or increased by≥20 mm from baseline at admission).High Joule heat was defined as 15390 J.Between April 2020 and April 2024,209 patients underwent colorectal ESD;those with intraoperative perforation or penetration were excluded.The remaining 202 patients were divided into the PECS and non-PECS groups.RESULTS PECS occurred in 30(14.9%)patients.Multivariate analysis revealed high Joule heat as an independent factor associated with PECS(odds ratio=7.96;95%confidence interval:2.91-21.8,P<0.01).The procedure time and presence of lesions in the right colon were not associated with PECS.CONCLUSION Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset.This thermal damage is likely a major component of the mechanism underlying PECS.
