Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has been transformed from an innovative technique,into a viable alternative to enteral stenting and surgical gastrointestinal anastomosis for patients with gastric...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has been transformed from an innovative technique,into a viable alternative to enteral stenting and surgical gastrointestinal anastomosis for patients with gastric outlet obstruction.Even EUS-GE guided ERCP and EUS-guided gastrointestinal anastomosis for the treatment of afferent loop syndrome have been performed,giving patients more less invasive options.However,EUS-GE is still a technically challenging procedure.In order to improve EUS-GE,several techniques have been reported to improve the technical details.With EUS-GE widely performed,more data about EUS-GE’s clinical outcomes have been reported.The aim of the current review is to describe technical details updates,clinical outcomes,and adverse events of EUS-GE.展开更多
BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment o...BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment of the imaging features of appendiceal mucinous neoplasms using endoscopic ultrasound(EUS)by curved linear-array echoendoscope.METHODS A database of all patients with appendiceal mucinous neoplasms who had received EUS examination at our hospital between January 2018 and July 2023 was retrospectively analyzed.The EUS characteristics and patients’clinical data were reviewed.RESULTS Twenty-two patients were included in the study.The linear-array echoendoscope successfully reached the ileocecal region in every patient.In the endoscopic view,we could observe the protrusion in the appendiceal orifice in all patients.A volcano sign was observed in two patients,and an atypical volcano sign was seen in two patients.EUS showed that all 22 lesions were submucosal cystic hypoechoic lesions with clear boundaries.No wall nodules were observed,but an onion-peeling sign was observed in 17 cases.CONCLUSION Linear-array echoendoscope is safe to reach the ileocecal region under the guidance of EUS.Image features on endoscopic and echoendosonograhic views could be used to diagnose appendiceal mucinous neoplasms.展开更多
BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria(MP tumors).Three endoscopic resection techniques have been develope...BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria(MP tumors).Three endoscopic resection techniques have been developed to treat these tumors,including ligation-assisted endoscopic full-thickness resection(L-EFTR),snareassisted EFTR(S-EFTR),and endoscopic submucosal dissection-assisted EFTR(EEFTR).To date,no studies have compared these techniques.AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital,China.Standard demographic and clinicopathologic data,including sex,age,tumor size,surgeon details,and pathological results,were collected.Data regarding operation duration,cost,enbloc resection,and severe complications were also extracted and compared.RESULTS A total of 36 patients(27 women)with a mean age of 55.8±10.20 years were included in this study.The mean tumor size was 9.0±3.98 mm.All the methods showed a 100%en-bloc resection rate and 0%severe complication rate.There was no statistically significant difference among the three groups in the operation duration(P=0.148).The cost comparison for the whole procedure was as follows:E-EFTR>L-EFTR>S-EFTR(5837.5±7212.96 CNY,5970.7±3465.27 CNY,5852.0±6438.25 CNY,respectively,P<0.001).CONCLUSION S-EFTR,L-EFT,and E-EFTR are all effective for resection of small MP tumors in the gastric fundus.S-EFTR is superior in terms of cost-effectiveness.展开更多
BACKGROUND Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been widely used for the treatment of early gastrointestinal cancer.Endoscopic piecemeal mucosal resection(EPMR)is derived from...BACKGROUND Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been widely used for the treatment of early gastrointestinal cancer.Endoscopic piecemeal mucosal resection(EPMR)is derived from the combination of EMR and ESD.Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication,sometimes requiring surgery.There are some associated risk factors,including patient-(location,diameter,and presence of fibrosis)and procedure-related factors.Early recognition and timely treatment are crucial for its management.CASE SUMMARY We report a case in which delayed perforation with peritonitis was treated using endoscopic closure.A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature.Fifteen hours after endoscopic resection,peritonitis caused by delayed perforation occurred and gradually aggravated.Conservative treatment was ineffective and no obvious perforation was observed.After timely endoscopic closure,the patient was discharged on postoperative day 4.CONCLUSION In occasion of localized peritonitis aggravating without macroscopic perforation,endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.展开更多
BACKGROUND Laparoscopic resection of the pancreatic body and tail is the predominant methodology to remove lesions in these locations;its safety and surgical planning are relatively mature, but it remains a complex an...BACKGROUND Laparoscopic resection of the pancreatic body and tail is the predominant methodology to remove lesions in these locations;its safety and surgical planning are relatively mature, but it remains a complex and high-precision surgical operation, requiring abundant experience and skills in laparoscopic surgery, with a 10% rate of complications. AIM To verify the feasibility and safety, as well as to examine the complications of endoscopic pancreatectomy and healing mechanisms of pancreatic wounds after endoscopic resection. METHODS Transgastric endoscopic resections of varying sizes of pancreases were performed in 15 healthy Bama miniature pigs. The technical success rate, the incidence of serious complications, and the survival of the animals were studied. The healing of the wounds was evaluated by sacrificing the animals at various time points. Finally, the expression of transforming growth factor-β1 and Smad3/Smad7 in the surgical site was examined by immunohistochemistry to explore the role of these factors in wound healing of the pancreas. RESULTS Partial and total resections were successfully performed in two groups of animals, respectively. The technical success rate and the survival rate of the pigs were both 100%. We obtained 12 pancreatic tissue samples by endoscopic resection. The pancreatic wounds were closed with metal clips in one group and the wounds healed well by forming scars. There was a small amount of pancreatic leakage in the other group, but it can be fully encapsulated. The level of transforming growth factor-β1 (TGF-β1) in the wounds increased during the inflammatory and fibrous hyperplasia phases, and decreased in the scar phase. The expression of Smad3 paralleled that of TGF-β1, while the expression of Smad7 had an inverse relationship with the expression of TGF-β1. CONCLUSION Purely transgastric endoscopic resection of the pancreas is a safe, effective, and feasible procedure, but the incidence of pancreatic leakage in total pancreatic tail resection is high. The expression of TGF-β1 and Smad3/Samd7 is related to the progression of pancreatic wound healing.展开更多
BACKGROUND The effectiveness of regorafenib plus programmed cell death-1(PD-1)inhibitor in treating microsatellite stable(MSS)metastatic colorectal cancer(mCRC)remains controversial.AIM To investigate the benefits of ...BACKGROUND The effectiveness of regorafenib plus programmed cell death-1(PD-1)inhibitor in treating microsatellite stable(MSS)metastatic colorectal cancer(mCRC)remains controversial.AIM To investigate the benefits of regorafenib combined with PD-1 inhibitor in treating MSS mCRC and explore indicators predicting response.METHODS This retrospective study included a total of 30 patients with microsatellite stable metastatic colorectal cancer treated with regorafenib combined with programmed cell death-1 inhibitor at Henan Provincial People’s Hospital between December 2018 and December 2020.During a 4-wk treatment cycle,regorafenib was performed for 3 continuous weeks.PD-1 inhibitor was intravenously injected starting on the first day of the oral intake of regorafenib.We reviewed tumor response,progression-free survival(PFS),overall survival,and treatment-related adverse events(TRAEs)and evaluated association between platelet-tolymphocyte ratio(PLR)and outcomes in this retrospective study.RESULTS Stable disease and progressive disease were found in 18(60.0%)and 12(40.0%)patients,respectively.The disease control rate was 60.0%.The median follow-up time was 12.0 mo,and median PFS was 3.4 mo[95%confidence interval(CI):2.2-4.6 mo].Of the 12 patients with progressive disease,10(83.3%)had liver metastasis before starting the combined treatment.Among the 18 patients with SD,10(55.6%)did not have liver metastases.One patient without liver metastases at baseline was found with a substantially prolonged PFS of 11.2 mo.The liver metastasis,the choice of programmed cell death-1 inhibitor other than nivolumab or pembrolizumab and previous exposure to regorafenib was’t associated with treatment outcome.The median PFS in the low-PLR group was 4.2 mo(95%CI:3.5-4.9 mo),compared with 2.8 mo(95%CI:1.4-4.2 mo)in the high-PLR group(P=0.005).The major TRAEs included hand-foot syndrome(33.3%),hypertension(23.3%),malaise(20.0%),and gastrointestinal reaction(16.7%).The incidence of grade 3 TRAEs was 13.3%(4/30),which comprised abnormal capillary proliferation(n=1),transaminase elevation(n=1),and hand-foot syndrome(n=2).No grade 4 or higher toxicity was observed.CONCLUSION Regorafenib combined with PD-1 inhibitor could lead to a longer PFS in some patients with MSS mCRC.The PLR might be a prediction of the patient response to this therapy.展开更多
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has been transformed from an innovative technique,into a viable alternative to enteral stenting and surgical gastrointestinal anastomosis for patients with gastric outlet obstruction.Even EUS-GE guided ERCP and EUS-guided gastrointestinal anastomosis for the treatment of afferent loop syndrome have been performed,giving patients more less invasive options.However,EUS-GE is still a technically challenging procedure.In order to improve EUS-GE,several techniques have been reported to improve the technical details.With EUS-GE widely performed,more data about EUS-GE’s clinical outcomes have been reported.The aim of the current review is to describe technical details updates,clinical outcomes,and adverse events of EUS-GE.
基金Hebei Medical Science Research Project,No.20191279.
文摘BACKGROUND Preoperative diagnosis of appendiceal mucinous neoplasms is challenging,and there are few reports regarding the endosonographic characteristics of these neoplasms.AIM To provide a retrospective assessment of the imaging features of appendiceal mucinous neoplasms using endoscopic ultrasound(EUS)by curved linear-array echoendoscope.METHODS A database of all patients with appendiceal mucinous neoplasms who had received EUS examination at our hospital between January 2018 and July 2023 was retrospectively analyzed.The EUS characteristics and patients’clinical data were reviewed.RESULTS Twenty-two patients were included in the study.The linear-array echoendoscope successfully reached the ileocecal region in every patient.In the endoscopic view,we could observe the protrusion in the appendiceal orifice in all patients.A volcano sign was observed in two patients,and an atypical volcano sign was seen in two patients.EUS showed that all 22 lesions were submucosal cystic hypoechoic lesions with clear boundaries.No wall nodules were observed,but an onion-peeling sign was observed in 17 cases.CONCLUSION Linear-array echoendoscope is safe to reach the ileocecal region under the guidance of EUS.Image features on endoscopic and echoendosonograhic views could be used to diagnose appendiceal mucinous neoplasms.
文摘BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria(MP tumors).Three endoscopic resection techniques have been developed to treat these tumors,including ligation-assisted endoscopic full-thickness resection(L-EFTR),snareassisted EFTR(S-EFTR),and endoscopic submucosal dissection-assisted EFTR(EEFTR).To date,no studies have compared these techniques.AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital,China.Standard demographic and clinicopathologic data,including sex,age,tumor size,surgeon details,and pathological results,were collected.Data regarding operation duration,cost,enbloc resection,and severe complications were also extracted and compared.RESULTS A total of 36 patients(27 women)with a mean age of 55.8±10.20 years were included in this study.The mean tumor size was 9.0±3.98 mm.All the methods showed a 100%en-bloc resection rate and 0%severe complication rate.There was no statistically significant difference among the three groups in the operation duration(P=0.148).The cost comparison for the whole procedure was as follows:E-EFTR>L-EFTR>S-EFTR(5837.5±7212.96 CNY,5970.7±3465.27 CNY,5852.0±6438.25 CNY,respectively,P<0.001).CONCLUSION S-EFTR,L-EFT,and E-EFTR are all effective for resection of small MP tumors in the gastric fundus.S-EFTR is superior in terms of cost-effectiveness.
基金Supported by Natural Science Foundation of Liaoning Province,No.20170541024Shengjing Free Researcher Project Foundation,No.201702。
文摘BACKGROUND Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)have been widely used for the treatment of early gastrointestinal cancer.Endoscopic piecemeal mucosal resection(EPMR)is derived from the combination of EMR and ESD.Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication,sometimes requiring surgery.There are some associated risk factors,including patient-(location,diameter,and presence of fibrosis)and procedure-related factors.Early recognition and timely treatment are crucial for its management.CASE SUMMARY We report a case in which delayed perforation with peritonitis was treated using endoscopic closure.A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature.Fifteen hours after endoscopic resection,peritonitis caused by delayed perforation occurred and gradually aggravated.Conservative treatment was ineffective and no obvious perforation was observed.After timely endoscopic closure,the patient was discharged on postoperative day 4.CONCLUSION In occasion of localized peritonitis aggravating without macroscopic perforation,endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.
文摘BACKGROUND Laparoscopic resection of the pancreatic body and tail is the predominant methodology to remove lesions in these locations;its safety and surgical planning are relatively mature, but it remains a complex and high-precision surgical operation, requiring abundant experience and skills in laparoscopic surgery, with a 10% rate of complications. AIM To verify the feasibility and safety, as well as to examine the complications of endoscopic pancreatectomy and healing mechanisms of pancreatic wounds after endoscopic resection. METHODS Transgastric endoscopic resections of varying sizes of pancreases were performed in 15 healthy Bama miniature pigs. The technical success rate, the incidence of serious complications, and the survival of the animals were studied. The healing of the wounds was evaluated by sacrificing the animals at various time points. Finally, the expression of transforming growth factor-β1 and Smad3/Smad7 in the surgical site was examined by immunohistochemistry to explore the role of these factors in wound healing of the pancreas. RESULTS Partial and total resections were successfully performed in two groups of animals, respectively. The technical success rate and the survival rate of the pigs were both 100%. We obtained 12 pancreatic tissue samples by endoscopic resection. The pancreatic wounds were closed with metal clips in one group and the wounds healed well by forming scars. There was a small amount of pancreatic leakage in the other group, but it can be fully encapsulated. The level of transforming growth factor-β1 (TGF-β1) in the wounds increased during the inflammatory and fibrous hyperplasia phases, and decreased in the scar phase. The expression of Smad3 paralleled that of TGF-β1, while the expression of Smad7 had an inverse relationship with the expression of TGF-β1. CONCLUSION Purely transgastric endoscopic resection of the pancreas is a safe, effective, and feasible procedure, but the incidence of pancreatic leakage in total pancreatic tail resection is high. The expression of TGF-β1 and Smad3/Samd7 is related to the progression of pancreatic wound healing.
基金Supported by the Henan Provincial Department of Science and Technology,No. 212102310047
文摘BACKGROUND The effectiveness of regorafenib plus programmed cell death-1(PD-1)inhibitor in treating microsatellite stable(MSS)metastatic colorectal cancer(mCRC)remains controversial.AIM To investigate the benefits of regorafenib combined with PD-1 inhibitor in treating MSS mCRC and explore indicators predicting response.METHODS This retrospective study included a total of 30 patients with microsatellite stable metastatic colorectal cancer treated with regorafenib combined with programmed cell death-1 inhibitor at Henan Provincial People’s Hospital between December 2018 and December 2020.During a 4-wk treatment cycle,regorafenib was performed for 3 continuous weeks.PD-1 inhibitor was intravenously injected starting on the first day of the oral intake of regorafenib.We reviewed tumor response,progression-free survival(PFS),overall survival,and treatment-related adverse events(TRAEs)and evaluated association between platelet-tolymphocyte ratio(PLR)and outcomes in this retrospective study.RESULTS Stable disease and progressive disease were found in 18(60.0%)and 12(40.0%)patients,respectively.The disease control rate was 60.0%.The median follow-up time was 12.0 mo,and median PFS was 3.4 mo[95%confidence interval(CI):2.2-4.6 mo].Of the 12 patients with progressive disease,10(83.3%)had liver metastasis before starting the combined treatment.Among the 18 patients with SD,10(55.6%)did not have liver metastases.One patient without liver metastases at baseline was found with a substantially prolonged PFS of 11.2 mo.The liver metastasis,the choice of programmed cell death-1 inhibitor other than nivolumab or pembrolizumab and previous exposure to regorafenib was’t associated with treatment outcome.The median PFS in the low-PLR group was 4.2 mo(95%CI:3.5-4.9 mo),compared with 2.8 mo(95%CI:1.4-4.2 mo)in the high-PLR group(P=0.005).The major TRAEs included hand-foot syndrome(33.3%),hypertension(23.3%),malaise(20.0%),and gastrointestinal reaction(16.7%).The incidence of grade 3 TRAEs was 13.3%(4/30),which comprised abnormal capillary proliferation(n=1),transaminase elevation(n=1),and hand-foot syndrome(n=2).No grade 4 or higher toxicity was observed.CONCLUSION Regorafenib combined with PD-1 inhibitor could lead to a longer PFS in some patients with MSS mCRC.The PLR might be a prediction of the patient response to this therapy.
基金Project supported by the National Natural Science Foundation of China(No.21573239)the Guangdong Provincial Project for Science and Technology(Nos.2014TX01N14,2015B010135008,and 2016B010114003)+1 种基金the Guangzhou Municipal Project for Science and Technology(No.201509010018)the K.C.WONG Education Foundation,China。
