BACKGROUND Given the poor prognosis of patients with lymph node metastasis,estimating the lymph node status in patients with early esophageal cancer is crucial.Indicators that could be used to predict lymph node metas...BACKGROUND Given the poor prognosis of patients with lymph node metastasis,estimating the lymph node status in patients with early esophageal cancer is crucial.Indicators that could be used to predict lymph node metastasis in early esophageal cancer have been reported in many recent studies,but no recent studies have included a review of this subject.AIM To review indicators predicting lymph node metastasis in early esophageal squamous cell carcinoma(ESCC)and early esophageal adenocarcinoma(EAC).METHODS We searched PubMed with“[early esophageal cancer(Title/Abstract)]and[lymph node(Title/Abstract)]”or“[early esophageal carcinoma(Title/Abstract)]and[lymph node(Title/Abstract)]”or“[superficial esophageal cancer(Title/Abstract)]and[lymph node(Title/Abstract)].”A total of 29 studies were eligible for analysis.RESULTS Preoperative imaging(size),serum markers(microRNA-218),postoperative pathology and immunohistochemical analysis(depth of invasion,tumor size,differentiation grade,lymphovascular invasion,neural invasion,expression of PIM-1<30%)were predictive factors for lymph node metastasis in both early ESCC and EAC.Serum markers(thymidine kinase 1≥3.38 pmol/L;cytokeratin 19 fragment antigen 21-1>3.30 ng/mL;stathmin-1)and postoperative pathology and immunohistochemical analysis(overexpression of cortactin,mixed-lineage leukaemia 2,and stanniocalcin-1)were predictive for lymph node metastasis in early ESCC.Transcription of CD69,myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive of lymph node metastasis in early EAC.A total of 6 comprehensive models for early ESCC,including logistic regression model,nomogram,and artificial neural network(ANN),were reviewed.The areas under the receiver operating characteristic curve of these models reached 0.789-0.938,and the ANN performed best.As all these models relied on postoperative pathology,further models focusing on serum markers,imaging and immunohistochemical indicators are still needed.CONCLUSION Various factors were predictive of lymph node metastasis in early esophageal cancer,and present comprehensive models predicting lymph node metastasis in early ESCC mainly relied on postoperative pathology.Further studies focusing on serum markers,imaging and immunohistochemical indicators are still in need.展开更多
BACKGROUND Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage.With the widespread application of endoscopic technologies,the need for early detection and diagnosis of esophageal ...BACKGROUND Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage.With the widespread application of endoscopic technologies,the need for early detection and diagnosis of esophageal cancer has gradually been realized.Endoscopic submucosal dissection(ESD)has become the standard of care for managing early tumors of the esophagus,stomach,and colon.However,due to the steep learning curve,difficult operation,and technically demanding nature of the procedure,ESD has currently been committed to the development of various assistive technologies.AIM To explore the feasibility and applicability of magnetic anchor technique(MAT)-assisted ESD for early esophageal cancer.METHODS Isolated pig esophagi were used as the experimental model,and the magnetic anchor device was designed by us.The esophagi used were divided into two groups,namely the operational and control groups,and 10 endoscopists completed the procedure.The two groups were evaluated for the following aspects:The total operative time,perforation rate,rate of whole mucosal resection,diameter of the peering mucosa,and scores of endoscopists’feelings with the procedure,including the convenience,mucosal surface exposure degree,and tissue tension.In addition,in the operational group,the soft tissue clip and the target magnet(TM)were connected by a thin wire through a small hole at the tail end of the TM.Under gastroscopic guidance,the soft tissue clip was clamped to the edge of the lesioned mucosa,which was marked in advance.By changing the position of the anchor magnet(AM)outside the esophagus,the pulling force and pulling direction of the TM could be changed,thus exposing the mucosal peeling surface and assisting the ESD.RESULTS Herein,each of the two groups comprised 10 isolated esophageal putative mucosal lesions.The diameter of the peering mucosa did not significantly differ between the two groups(2.13±0.06 vs 2.15±0.06,P=0.882).The total operative time was shorter in the operational group than in the control group(17.04±0.22 min vs 21.94±0.23 min,P<0.001).During the entire experiment,the TM remained firmly connected with the soft tissue clip and did not affect the opening,closing,and release of the soft tissue clip.The interaction between the TM and AM could provide sufficient tissue tension and completely expose the mucosa,which greatly assists the surgeon with the operation.There was no avulsion of the mucosa,and mucosal lesions were intact when peeled.Therefore,the scores of endoscopists’feelings were higher in the operational group than in the control group in terms of the convenience(9.22±0.19 vs 8.34±0.15,P=0.002),mucosal surface exposure degree(9.11±0.15 vs 8.25±0.12,P<0.001),and tissue tension(9.35±0.13 vs 8.02±0.17,P<0.001).The two groups did not significantly differ in the perforation rate and rate of whole mucosal resection.CONCLUSION We found MAT-assisted ESD safe and feasible for early esophageal cancer.It could greatly improve the endoscopic operation experience and showed good clinical application prospects.展开更多
AIM To evaluate the accuracy of endoscopic ultrasound(EUS) in early esophageal cancer(EC) performed in a highvolume tertiary cancer center. METHODS A retrospective review of patients undergoing esophagectomy was perfo...AIM To evaluate the accuracy of endoscopic ultrasound(EUS) in early esophageal cancer(EC) performed in a highvolume tertiary cancer center. METHODS A retrospective review of patients undergoing esophagectomy was performed and patients with c T1 N0 and c T2 N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student's t test and Fisher's exact test or χ~2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS accuracy.RESULTS Between 2000 and 2015, 139 patients with clinical stage Ⅰ or Ⅱ?A esophageal cancer undergoing esophagectomy were identified. There were 25(18%) female and 114(82%) male patients. The tumor location included the middle third of the esophagus in 11(8%) and lower third and gastroesophageal junction in 128(92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients(21%) were under-staged by EUS; of those, 19(14%) had unrecognized nodal disease. Positron emission tomography(PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients(6%) in whom both EUS and PET were negative for nodal involvement. CONCLUSION EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.展开更多
Due to the rapid progression and poor prognosis of esophageal cancer(EC),the early detection and diagnosis of early EC are of great value for the prognosis improvement of patients.However,the endoscopic detection of e...Due to the rapid progression and poor prognosis of esophageal cancer(EC),the early detection and diagnosis of early EC are of great value for the prognosis improvement of patients.However,the endoscopic detection of early EC,especially Barrett's dysplasia or squamous epithelial dysplasia,is difficult.Therefore,the requirement for more efficient methods of detection and characterization of early EC has led to intensive research in the field of artificial intelligence(AI).Deep learning(DL)has brought about breakthroughs in processing images,videos,and other aspects,whereas convolutional neural networks(CNNs)have shone lights on detection of endoscopic images and videos.Many studies on CNNs in endoscopic analysis of early EC demonstrate excellent performance including sensitivity and specificity and progress gradually from in vitro image analysis for classification to real-time detection of early esophageal neoplasia.When AI technique comes to the pathological diagnosis,borderline lesions that are difficult to determine may become easier than before.In gene diagnosis,due to the lack of tissue specificity of gene diagnostic markers,they can only be used as supplementary measures at present.In predicting the risk of cancer,there is still a lack of prospective clinical research to confirm the accuracy of the risk stratification model.展开更多
BACKGROUND It is well known that an alcohol consumption habit together with inactive heterozygous aldehyde dehydrogenase-2(ALDH2)is an important risk factor for the development of esophageal squamous cell carcinoma(ES...BACKGROUND It is well known that an alcohol consumption habit together with inactive heterozygous aldehyde dehydrogenase-2(ALDH2)is an important risk factor for the development of esophageal squamous cell carcinoma(ESCC).It remains controversial whether human papillomavirus(HPV)infection contributes to the occurrence/development of ESCC.There has been no study in which the relationship between ESCC and HPV in addition to alcohol dehydrogenase-1B(ADH1B)and ALDH2 genotypes was evaluated.AIM To evaluate relationships between HPV infection and development of esophageal cancer,particularly early esophageal cancer,based on ADH1B/ALDH2 polymorphisms.METHODS We conducted an exploratory retrospective study using new specimens,and we enrolled 145 patients who underwent endoscopic resection for superficial ESCC and had been observed for more than two years by both physical examination and endoscopic examination in Hokkaido University Hospital.Saliva was collected to analyze genetic polymorphisms of ADH1B/ALDH2.We performed in situ hybridization for resected specimens to detect HPV by using an HPV type 16/18 probe.RESULTS HPV was detected in 15(10.3%)of the 145 patients with ESCC.HPV-positive rates in inactive ALDH2*1/*2 and ALDH2*1/*1+*2/*2 were 10.8%and 9.8%,respectively(P=1.00).HPV-positive rates in slow-metabolizing ADH1B*1/*1 and ADH1B*1/*2+*2/*2 were 12.0%and 10.0%,respectively(P=0.72).HPV-positive rates in the heavy or moderate alcohol consumption group and the light or rare consumption group were 11.1%and 8.7%,respectively(P=0.68).HPV-positive rates in the heavy smoking group and the light or no smoking group were 11.8%and 8.3%,respectively(P=0.59).The 3-year incidence rates of secondary ESCC or head and neck cancer after initial treatment in the HPV-positive and HPVnegative groups were 14.4%and 21.4%(P=0.22),respectively.CONCLUSION In the present situation,HPV status is considered to be less important than other risk factors,such as alcohol consumption,smoking habit,ADH1B/ALDH2 polymorphisms,and HPV status would therefore have no effect on ESCC risk management.展开更多
BACKGROUND Gastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus.To date,there h...BACKGROUND Gastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus.To date,there have been no reports of esophageal xanthoma combined with esophageal cancer.Herein,we present the first case in the literature of a diffuse xanthoma complicated with early esophageal cancer.Moreover,this combination makes the endoscopic diagnosis difficult if it is not in mind.CASE SUMMARY A 68-year-old man visited our department with a 2-mo history of epigastric discomfort.He underwent surgery for gastric cancer 6 years ago.Esophagogastroduodenoscopy showed a semi-circumferential irregular yellowish-colored and granular lesion in the esophagus(30-35 cm from the incisors).Using magnifying endoscopy with narrow band imaging,aggregated minute and yellowish-colored spots with tortuous microvessels on the surface were observed,and background coloration was clearly seen in the lesion.As endoscopic biopsy suggested a histologically high-grade dysplasia;the lesion was completely resected en bloc by endoscopic submucosal dissection(ESD).The resected specimen was confirmed to be a squamous cell carcinoma in situ with extensive foamy cells in the superficial mucosal layer.Immunohistochemically,the observed foamy cells were strongly positive for CD68,which is characteristic of xanthoma.The clinical course was favorable,and no recurrence was observed 2 years and 7 mo after ESD.CONCLUSIONDiffuse xanthoma concurrent with early esophageal cancer is extremely rare.The characteristic endoscopic features may assist endoscopists in diagnosing similar lesions.展开更多
BACKGROUND Esophageal stenosis is one of the main complications of endoscopic submucosal dissection(ESD)for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions(≥3/4 of ...BACKGROUND Esophageal stenosis is one of the main complications of endoscopic submucosal dissection(ESD)for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions(≥3/4 of the lumen).Oral prednisone is useful to prevent esophageal stenosis,but the curative effect remains controversial.AIM To share our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.METHODS Between June 2019 and March 2022,we enrolled patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced who underwent ESD.Prednisone(50 mg/d)was administered orally on the second morning after ESD for 1 mo,and tapered gradually(5 mg/wk)for 13 wk.RESULTS In total,14 patients met the inclusion criteria.All patients received ESD without operation-related bleeding or perforation.There were 11 patients with≥3/4 and<7/8 of lumen mucosal defects and 1 patient with≥7/8 of lumen mucosal defect and 2 patients with the entire circumferential mucosal defects due to ESD.The longitudinal extension of the esophageal mucosal defect was<50 mm in 3 patients and≥50 mm in 11 patients.The esophageal stenosis rate after ESD was 0%(0/14).One patient developed esophageal candida infection on the 30th d after ESD,and completely recovered after 7 d of administration of oral fluconazole 100 mg/d.No other adverse events of oral steroids were found.CONCLUSION Oral prednisone(50 mg/d)and prolonged prednisone usage time may effectively prevent esophageal stricture after ESD without increasing the incidence of glucocorticoid-related adverse events.However,further investigation of larger samples is required to warrant feasibility and safety.展开更多
The development of esophageal cancer(EC)from early to advanced stage results in a high mortality rate and poor prognosis.Advanced EC not only poses a serious threat to the life and health of patients but also places a...The development of esophageal cancer(EC)from early to advanced stage results in a high mortality rate and poor prognosis.Advanced EC not only poses a serious threat to the life and health of patients but also places a heavy economic burden on their families and society.Endoscopy is of great value for the diagnosis of EC,especially in the screening of Barrett’s esophagus and early EC.However,at present,endoscopy has a low diagnostic rate for early tumors.In recent years,artificial intelligence(AI)has made remarkable progress in the diagnosis of digestive system tumors,providing a new model for clinicians to diagnose and treat these tumors.In this review,we aim to provide a comprehensive overview of how AI can help doctors diagnose early EC and precancerous lesions and make clinical decisions based on the predicted results.We analyze and summarize the recent research on AI and early EC.We find that based on deep learning(DL)and convolutional neural network methods,the current computer-aided diagnosis system has gradually developed from in vitro image analysis to real-time detection and diagnosis.Based on powerful computing and DL capabilities,the diagnostic accuracy of AI is close to or better than that of endoscopy specialists.We also analyze the shortcomings in the current AI research and corresponding improvement strategies.We believe that the application of AI-assisted endoscopy in the diagnosis of early EC and precancerous lesions will become possible after the further advancement of AI-related research.展开更多
Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routin...Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routines.EEC has often been diagnosed at the late stage since early signs of cancer are not obvious,resulting in low survival rates.This work proposes a deep learning approach based on the U-Net++method to segment EEC in GIE images.A total of 2690 GIE images collected from 617 patients at the Digestive Endoscopy Center,West China Hospital of Sichuan University,China,have been utilized.The experimental result shows that our proposed method achieved promising results.Furthermore,the comparison has been made between the proposed and other U-Net-related methods using the same dataset.The mean and standard deviation(SD)of the dice similarity coefficient(DSC),intersection over union(IoU),precision(Pre),and recall(Rec)achieved by the proposed framework were DSC(%)=94.62±0.02,IoU(%)=90.99±0.04,Pre(%)=94.61±0.04,and Rec(%)=95.00±0.02,respectively,outperforming the others.The proposed method has the potential to be applied in EEC automatic diagnoses.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is an established technique for the treatment of early gastrointestinal neoplasia.Generally,multi-day(M-D)admission is required for patients undergoing ESD due to potent...BACKGROUND Endoscopic submucosal dissection(ESD)is an established technique for the treatment of early gastrointestinal neoplasia.Generally,multi-day(M-D)admission is required for patients undergoing ESD due to potential complications.AIM To evaluate the feasibility of a same-day(S-D)discharge strategy for ESD of the esophagus or stomach.METHODS The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital.The propensity score matching(PSM)method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups.Intraoperative and postoperative parameters were compared between the matched groups.RESULTS Among the 479 patients reviewed,470 patients,including 91 in the S-D group and 379 in the M-D group,fulfilled the inclusion and exclusion criteria.Following PSM,78 patients in each group were paired using the 1:1 nearest available score match algorithm.No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events(AEs).Tumor size,complete resection rate,and procedural duration were comparable between the groups.The S-D group demonstrated a significantly shorter length of hospital stay(P<0.001)and lower overall medical expenses(P<0.001)compared with the M-D group.CONCLUSION The S-D discharge strategy may be feasible and effective for esophagogastric ESD,and the procedural-related AEs can be managed successfully.展开更多
BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the ...BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the feasibility,safety,efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection(ESTD)for treating EESCC in patients with cirrhosis.METHODS This was a single-center retrospective cohort study.We examined 590 EESCC patients who underwent ESTD between July 14,2014,and May 26,2021,from a large-scale tertiary hospital.After excluding 25 patients with unclear lesion areas or pathological results,the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching.A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis.Parametric and nonparametric statistical methods were used to compare the differences between the two groups.The Kaplan–Meier method was used to create survival curves,and differences in survival curves were compared by the log-rank test.RESULTS Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients,there were no significant differences in intraoperative bleeding(P=0.234),30-d post-ESTD bleeding(P=0.099),disease-specific survival(P=0.075),or recurrence-free survival(P=0.8196).The mean hospitalization time and costs were significantly longer(P=0.007)and higher(P=0.023)in the cirrhosis group than in the noncirrhosis group.The overall survival rate was significantly lower in the cirrhosis group(P=0.001).CONCLUSION ESTD is technically feasible,safe,and effective for patients with EESCC and liver cirrhosis.EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.展开更多
Esophageal cancer(EC)is a common malignant tumor of the digestive tract and originates from the epithelium of the esophageal mucosa.It has been confirmed that early EC lesions can be cured by endoscopic therapy,and th...Esophageal cancer(EC)is a common malignant tumor of the digestive tract and originates from the epithelium of the esophageal mucosa.It has been confirmed that early EC lesions can be cured by endoscopic therapy,and the curative effect is equivalent to that of surgical operation.Upper gastrointestinal endoscopy is still the gold standard for EC diagnosis.The accuracy of endoscopic examination results largely depends on the professional level of the examiner.Artificial intelligence(AI)has been applied in the screening of early EC and has shown advantages;notably,it is more accurate than less-experienced endoscopists.This paper reviews the application of AI in the field of endoscopic detection of early EC,including squamous cell carcinoma and adenocarcinoma,and describes the relevant progress.Although up to now most of the studies evaluating the clinical application of AI in early EC endoscopic detection are focused on still images,AIassisted real-time detection based on live-stream video may be the next step.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)post-procedure stricture is a relatively common long-term complication following ESD treatment.A range of approaches has been implemented for the treatment of post-proce...BACKGROUND Endoscopic submucosal dissection(ESD)post-procedure stricture is a relatively common long-term complication following ESD treatment.A range of approaches has been implemented for the treatment of post-procedural stricture using endoscopic techniques such as endoscopic dilation,self-expandable metallic stent insertion,local steroid injection in the esophagus,oral steroid administration,radial incision and cutting(RIC).The actual efficacy of these different therapeutic options is highly variable,and uniform international standards for the prevention or treatment of stricture.CASE SUMMARY In this report,we describe the case of a 51-year-old male diagnosed with early esophageal cancer.To protect against esophageal stricture,the patient was administered oral steroids and underwent self-expandable metallic stent insertion for 45 d.Despite these interventions,stricture was detected at the lower edge of the stent following its removal.The patient remained refractory to multiple rounds of endoscopic bougie dilation treatment,and thus suffered from complex refractory benign esophageal stricture.As such,RIC combined with bougie dilation and steroid injection was employed to treat this patient more effectively,ultimately achieving satisfactory therapeutic efficacy.CONCLUSION Combination of RIC,dilation,and steroid injection can be safely and effectively implemented to treat cases of post-ESD refractory esophageal stricture.展开更多
Early gastrointestinal(GI)cancer has been the core of clinical endoscopic work.Its early detection and treatment are tightly associated with patients’prognoses.As a novel technology,artificial intelligence has been i...Early gastrointestinal(GI)cancer has been the core of clinical endoscopic work.Its early detection and treatment are tightly associated with patients’prognoses.As a novel technology,artificial intelligence has been improved and applied in the field of endoscopy.Studies on detection,diagnosis,risk,and prognosis evaluation of diseases in the GI tract have been in development,including precancerous lesions,adenoma,early GI cancers,and advanced GI cancers.In this review,research on esophagus,stomach,and colon was concluded,and associated with the process from precancerous lesions to early GI cancer,such as from Barrett’s esophagus to early esophageal cancer,from dysplasia to early gastric cancer,and from adenoma to early colonic cancer.A status quo of research on early GI cancers and artificial intelligence was provided.展开更多
Subject Code:H16With the support by the National Natural Science Foundation of China,a collaborative study by the Research groups led by Prof.Fu Li(付利)from the Cancer Research Center,Shenzhen University School of Me...Subject Code:H16With the support by the National Natural Science Foundation of China,a collaborative study by the Research groups led by Prof.Fu Li(付利)from the Cancer Research Center,Shenzhen University School of Medicine and Prof.Guan Xinyuan(关新元)from the University of Hong Kong reported that an展开更多
Endoscopic submucosal dissection(ESD)is a common procedure to treat early and precancerous gastrointestinal lesions.Via submucosal injection,a liquid cushion is created to lift and separate the lesion and malignant pa...Endoscopic submucosal dissection(ESD)is a common procedure to treat early and precancerous gastrointestinal lesions.Via submucosal injection,a liquid cushion is created to lift and separate the lesion and malignant part from the muscular layer where the formed indispensable space is convenient for endoscopic incision.Saline is a most common submucosal injection liquid,but the formed liquid pad lasts only a short time,and thus repeated injections increase the potential risk of adverse events.Hydrogels with high osmotic pressure and high viscosity are used as an alternate;however,with some drawbacks such as tissue damage,excessive injection resistance,and high cost.Here,we reported a nature derived hydrogel of gelatin-oxidized alginate(G-OALG).Based on the rheological analysis and compare to commercial endoscopic mucosal resection(EMR)solution(0.25%hyaluronic acid,HA),a designed G-OALG hydrogel of desired concentration and composition showed higher performances in controllable gelation and injectability,higher viscosity and more stable structures.The G-OALG gel also showed lower propulsion resistance than 0.25%HA in the injection force assessment under standard endoscopic instruments,which eased the surgical operation.In addition,the G-OALG hydrogel showed good in vivo degradability biocompatibility.By comparing the results acquired via ESD to normal saline,the G-OALG shows great histocompatibility and excellent endoscopic injectability,and enables create a longer-lasting submucosal cushion.All the features have been confirmed in the living both pig and rat models.The G-OALG could be a promising submucosal injection agent for esophageal ESD.展开更多
基金Natural Science Foundation of Tibetan Autonomous Region,No.XZ202101ZR0015GMedical Program of Group Aid to Tibet,Natural Science Foundation of Tibetan Autonomous Region,No.XZ2021ZR-ZY27(Z).
文摘BACKGROUND Given the poor prognosis of patients with lymph node metastasis,estimating the lymph node status in patients with early esophageal cancer is crucial.Indicators that could be used to predict lymph node metastasis in early esophageal cancer have been reported in many recent studies,but no recent studies have included a review of this subject.AIM To review indicators predicting lymph node metastasis in early esophageal squamous cell carcinoma(ESCC)and early esophageal adenocarcinoma(EAC).METHODS We searched PubMed with“[early esophageal cancer(Title/Abstract)]and[lymph node(Title/Abstract)]”or“[early esophageal carcinoma(Title/Abstract)]and[lymph node(Title/Abstract)]”or“[superficial esophageal cancer(Title/Abstract)]and[lymph node(Title/Abstract)].”A total of 29 studies were eligible for analysis.RESULTS Preoperative imaging(size),serum markers(microRNA-218),postoperative pathology and immunohistochemical analysis(depth of invasion,tumor size,differentiation grade,lymphovascular invasion,neural invasion,expression of PIM-1<30%)were predictive factors for lymph node metastasis in both early ESCC and EAC.Serum markers(thymidine kinase 1≥3.38 pmol/L;cytokeratin 19 fragment antigen 21-1>3.30 ng/mL;stathmin-1)and postoperative pathology and immunohistochemical analysis(overexpression of cortactin,mixed-lineage leukaemia 2,and stanniocalcin-1)were predictive for lymph node metastasis in early ESCC.Transcription of CD69,myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive of lymph node metastasis in early EAC.A total of 6 comprehensive models for early ESCC,including logistic regression model,nomogram,and artificial neural network(ANN),were reviewed.The areas under the receiver operating characteristic curve of these models reached 0.789-0.938,and the ANN performed best.As all these models relied on postoperative pathology,further models focusing on serum markers,imaging and immunohistochemical indicators are still needed.CONCLUSION Various factors were predictive of lymph node metastasis in early esophageal cancer,and present comprehensive models predicting lymph node metastasis in early ESCC mainly relied on postoperative pathology.Further studies focusing on serum markers,imaging and immunohistochemical indicators are still in need.
基金the Key Research&Development Program-Social Development of Shaanxi Province of China,No.2021SF-163and the Innovation Capability Support Plan of Shaanxi Province of China,No.2020KJXX-022.
文摘BACKGROUND Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage.With the widespread application of endoscopic technologies,the need for early detection and diagnosis of esophageal cancer has gradually been realized.Endoscopic submucosal dissection(ESD)has become the standard of care for managing early tumors of the esophagus,stomach,and colon.However,due to the steep learning curve,difficult operation,and technically demanding nature of the procedure,ESD has currently been committed to the development of various assistive technologies.AIM To explore the feasibility and applicability of magnetic anchor technique(MAT)-assisted ESD for early esophageal cancer.METHODS Isolated pig esophagi were used as the experimental model,and the magnetic anchor device was designed by us.The esophagi used were divided into two groups,namely the operational and control groups,and 10 endoscopists completed the procedure.The two groups were evaluated for the following aspects:The total operative time,perforation rate,rate of whole mucosal resection,diameter of the peering mucosa,and scores of endoscopists’feelings with the procedure,including the convenience,mucosal surface exposure degree,and tissue tension.In addition,in the operational group,the soft tissue clip and the target magnet(TM)were connected by a thin wire through a small hole at the tail end of the TM.Under gastroscopic guidance,the soft tissue clip was clamped to the edge of the lesioned mucosa,which was marked in advance.By changing the position of the anchor magnet(AM)outside the esophagus,the pulling force and pulling direction of the TM could be changed,thus exposing the mucosal peeling surface and assisting the ESD.RESULTS Herein,each of the two groups comprised 10 isolated esophageal putative mucosal lesions.The diameter of the peering mucosa did not significantly differ between the two groups(2.13±0.06 vs 2.15±0.06,P=0.882).The total operative time was shorter in the operational group than in the control group(17.04±0.22 min vs 21.94±0.23 min,P<0.001).During the entire experiment,the TM remained firmly connected with the soft tissue clip and did not affect the opening,closing,and release of the soft tissue clip.The interaction between the TM and AM could provide sufficient tissue tension and completely expose the mucosa,which greatly assists the surgeon with the operation.There was no avulsion of the mucosa,and mucosal lesions were intact when peeled.Therefore,the scores of endoscopists’feelings were higher in the operational group than in the control group in terms of the convenience(9.22±0.19 vs 8.34±0.15,P=0.002),mucosal surface exposure degree(9.11±0.15 vs 8.25±0.12,P<0.001),and tissue tension(9.35±0.13 vs 8.02±0.17,P<0.001).The two groups did not significantly differ in the perforation rate and rate of whole mucosal resection.CONCLUSION We found MAT-assisted ESD safe and feasible for early esophageal cancer.It could greatly improve the endoscopic operation experience and showed good clinical application prospects.
文摘AIM To evaluate the accuracy of endoscopic ultrasound(EUS) in early esophageal cancer(EC) performed in a highvolume tertiary cancer center. METHODS A retrospective review of patients undergoing esophagectomy was performed and patients with c T1 N0 and c T2 N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student's t test and Fisher's exact test or χ~2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS accuracy.RESULTS Between 2000 and 2015, 139 patients with clinical stage Ⅰ or Ⅱ?A esophageal cancer undergoing esophagectomy were identified. There were 25(18%) female and 114(82%) male patients. The tumor location included the middle third of the esophagus in 11(8%) and lower third and gastroesophageal junction in 128(92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients(21%) were under-staged by EUS; of those, 19(14%) had unrecognized nodal disease. Positron emission tomography(PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients(6%) in whom both EUS and PET were negative for nodal involvement. CONCLUSION EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.
基金Key Research and Development Program of Science and Technology Department of Sichuan Province,No.2018GZ0088Science&Technology Bureau of Chengdu,China,No.2017-CY02-00023-GX.
文摘Due to the rapid progression and poor prognosis of esophageal cancer(EC),the early detection and diagnosis of early EC are of great value for the prognosis improvement of patients.However,the endoscopic detection of early EC,especially Barrett's dysplasia or squamous epithelial dysplasia,is difficult.Therefore,the requirement for more efficient methods of detection and characterization of early EC has led to intensive research in the field of artificial intelligence(AI).Deep learning(DL)has brought about breakthroughs in processing images,videos,and other aspects,whereas convolutional neural networks(CNNs)have shone lights on detection of endoscopic images and videos.Many studies on CNNs in endoscopic analysis of early EC demonstrate excellent performance including sensitivity and specificity and progress gradually from in vitro image analysis for classification to real-time detection of early esophageal neoplasia.When AI technique comes to the pathological diagnosis,borderline lesions that are difficult to determine may become easier than before.In gene diagnosis,due to the lack of tissue specificity of gene diagnostic markers,they can only be used as supplementary measures at present.In predicting the risk of cancer,there is still a lack of prospective clinical research to confirm the accuracy of the risk stratification model.
文摘BACKGROUND It is well known that an alcohol consumption habit together with inactive heterozygous aldehyde dehydrogenase-2(ALDH2)is an important risk factor for the development of esophageal squamous cell carcinoma(ESCC).It remains controversial whether human papillomavirus(HPV)infection contributes to the occurrence/development of ESCC.There has been no study in which the relationship between ESCC and HPV in addition to alcohol dehydrogenase-1B(ADH1B)and ALDH2 genotypes was evaluated.AIM To evaluate relationships between HPV infection and development of esophageal cancer,particularly early esophageal cancer,based on ADH1B/ALDH2 polymorphisms.METHODS We conducted an exploratory retrospective study using new specimens,and we enrolled 145 patients who underwent endoscopic resection for superficial ESCC and had been observed for more than two years by both physical examination and endoscopic examination in Hokkaido University Hospital.Saliva was collected to analyze genetic polymorphisms of ADH1B/ALDH2.We performed in situ hybridization for resected specimens to detect HPV by using an HPV type 16/18 probe.RESULTS HPV was detected in 15(10.3%)of the 145 patients with ESCC.HPV-positive rates in inactive ALDH2*1/*2 and ALDH2*1/*1+*2/*2 were 10.8%and 9.8%,respectively(P=1.00).HPV-positive rates in slow-metabolizing ADH1B*1/*1 and ADH1B*1/*2+*2/*2 were 12.0%and 10.0%,respectively(P=0.72).HPV-positive rates in the heavy or moderate alcohol consumption group and the light or rare consumption group were 11.1%and 8.7%,respectively(P=0.68).HPV-positive rates in the heavy smoking group and the light or no smoking group were 11.8%and 8.3%,respectively(P=0.59).The 3-year incidence rates of secondary ESCC or head and neck cancer after initial treatment in the HPV-positive and HPVnegative groups were 14.4%and 21.4%(P=0.22),respectively.CONCLUSION In the present situation,HPV status is considered to be less important than other risk factors,such as alcohol consumption,smoking habit,ADH1B/ALDH2 polymorphisms,and HPV status would therefore have no effect on ESCC risk management.
基金the Basic Public Welfare Research Program of Zhejiang Province,China,No.LGF19H160022.
文摘BACKGROUND Gastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus.To date,there have been no reports of esophageal xanthoma combined with esophageal cancer.Herein,we present the first case in the literature of a diffuse xanthoma complicated with early esophageal cancer.Moreover,this combination makes the endoscopic diagnosis difficult if it is not in mind.CASE SUMMARY A 68-year-old man visited our department with a 2-mo history of epigastric discomfort.He underwent surgery for gastric cancer 6 years ago.Esophagogastroduodenoscopy showed a semi-circumferential irregular yellowish-colored and granular lesion in the esophagus(30-35 cm from the incisors).Using magnifying endoscopy with narrow band imaging,aggregated minute and yellowish-colored spots with tortuous microvessels on the surface were observed,and background coloration was clearly seen in the lesion.As endoscopic biopsy suggested a histologically high-grade dysplasia;the lesion was completely resected en bloc by endoscopic submucosal dissection(ESD).The resected specimen was confirmed to be a squamous cell carcinoma in situ with extensive foamy cells in the superficial mucosal layer.Immunohistochemically,the observed foamy cells were strongly positive for CD68,which is characteristic of xanthoma.The clinical course was favorable,and no recurrence was observed 2 years and 7 mo after ESD.CONCLUSIONDiffuse xanthoma concurrent with early esophageal cancer is extremely rare.The characteristic endoscopic features may assist endoscopists in diagnosing similar lesions.
文摘BACKGROUND Esophageal stenosis is one of the main complications of endoscopic submucosal dissection(ESD)for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions(≥3/4 of the lumen).Oral prednisone is useful to prevent esophageal stenosis,but the curative effect remains controversial.AIM To share our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.METHODS Between June 2019 and March 2022,we enrolled patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced who underwent ESD.Prednisone(50 mg/d)was administered orally on the second morning after ESD for 1 mo,and tapered gradually(5 mg/wk)for 13 wk.RESULTS In total,14 patients met the inclusion criteria.All patients received ESD without operation-related bleeding or perforation.There were 11 patients with≥3/4 and<7/8 of lumen mucosal defects and 1 patient with≥7/8 of lumen mucosal defect and 2 patients with the entire circumferential mucosal defects due to ESD.The longitudinal extension of the esophageal mucosal defect was<50 mm in 3 patients and≥50 mm in 11 patients.The esophageal stenosis rate after ESD was 0%(0/14).One patient developed esophageal candida infection on the 30th d after ESD,and completely recovered after 7 d of administration of oral fluconazole 100 mg/d.No other adverse events of oral steroids were found.CONCLUSION Oral prednisone(50 mg/d)and prolonged prednisone usage time may effectively prevent esophageal stricture after ESD without increasing the incidence of glucocorticoid-related adverse events.However,further investigation of larger samples is required to warrant feasibility and safety.
基金Heilongjiang Province Education Science"13th Five-Year Plan"2020 Key Project,No.GJB1320190.
文摘The development of esophageal cancer(EC)from early to advanced stage results in a high mortality rate and poor prognosis.Advanced EC not only poses a serious threat to the life and health of patients but also places a heavy economic burden on their families and society.Endoscopy is of great value for the diagnosis of EC,especially in the screening of Barrett’s esophagus and early EC.However,at present,endoscopy has a low diagnostic rate for early tumors.In recent years,artificial intelligence(AI)has made remarkable progress in the diagnosis of digestive system tumors,providing a new model for clinicians to diagnose and treat these tumors.In this review,we aim to provide a comprehensive overview of how AI can help doctors diagnose early EC and precancerous lesions and make clinical decisions based on the predicted results.We analyze and summarize the recent research on AI and early EC.We find that based on deep learning(DL)and convolutional neural network methods,the current computer-aided diagnosis system has gradually developed from in vitro image analysis to real-time detection and diagnosis.Based on powerful computing and DL capabilities,the diagnostic accuracy of AI is close to or better than that of endoscopy specialists.We also analyze the shortcomings in the current AI research and corresponding improvement strategies.We believe that the application of AI-assisted endoscopy in the diagnosis of early EC and precancerous lesions will become possible after the further advancement of AI-related research.
基金supported by the National Natural Science Foundation under Grants No.62271127,No.61872405,and No.81171411Natural Science Foundation of Sichuan Province,China under Grant No.23NSFSC0627Medico-Engineering Cooperation Funds from University of Electronic Science and Technology of China and West China Hospital of Sichuan University under Grants No.ZYGX2022YGRH011 and No.HXDZ22005.
文摘Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routines.EEC has often been diagnosed at the late stage since early signs of cancer are not obvious,resulting in low survival rates.This work proposes a deep learning approach based on the U-Net++method to segment EEC in GIE images.A total of 2690 GIE images collected from 617 patients at the Digestive Endoscopy Center,West China Hospital of Sichuan University,China,have been utilized.The experimental result shows that our proposed method achieved promising results.Furthermore,the comparison has been made between the proposed and other U-Net-related methods using the same dataset.The mean and standard deviation(SD)of the dice similarity coefficient(DSC),intersection over union(IoU),precision(Pre),and recall(Rec)achieved by the proposed framework were DSC(%)=94.62±0.02,IoU(%)=90.99±0.04,Pre(%)=94.61±0.04,and Rec(%)=95.00±0.02,respectively,outperforming the others.The proposed method has the potential to be applied in EEC automatic diagnoses.
基金Wu Jie-Ping Medical Foundation Special Fund for Clinical Research,No.320.6750.2021-04-71Open Research Fund of NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases,No.KF202101+3 种基金Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences,No.2020-PT330-003Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support,No.XMLX202143Capital’s Funds for Health Improvement and Research,No.2020-2-2155Beijing Municipal Administration of Hospitals Incubating Program,No.PX2020047.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is an established technique for the treatment of early gastrointestinal neoplasia.Generally,multi-day(M-D)admission is required for patients undergoing ESD due to potential complications.AIM To evaluate the feasibility of a same-day(S-D)discharge strategy for ESD of the esophagus or stomach.METHODS The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital.The propensity score matching(PSM)method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups.Intraoperative and postoperative parameters were compared between the matched groups.RESULTS Among the 479 patients reviewed,470 patients,including 91 in the S-D group and 379 in the M-D group,fulfilled the inclusion and exclusion criteria.Following PSM,78 patients in each group were paired using the 1:1 nearest available score match algorithm.No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events(AEs).Tumor size,complete resection rate,and procedural duration were comparable between the groups.The S-D group demonstrated a significantly shorter length of hospital stay(P<0.001)and lower overall medical expenses(P<0.001)compared with the M-D group.CONCLUSION The S-D discharge strategy may be feasible and effective for esophagogastric ESD,and the procedural-related AEs can be managed successfully.
基金Supported by the Sichuan Science and Technology Program,No.22GJHZ0177 and No.2019YJ0102.
文摘BACKGROUND Although early esophageal squamous cell carcinoma(EESCC)with cirrhosis is a relatively rare clinical phenomenon,the management of EESCC in cirrhotic patients continues to be a challenge.AIM To evaluate the feasibility,safety,efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection(ESTD)for treating EESCC in patients with cirrhosis.METHODS This was a single-center retrospective cohort study.We examined 590 EESCC patients who underwent ESTD between July 14,2014,and May 26,2021,from a large-scale tertiary hospital.After excluding 25 patients with unclear lesion areas or pathological results,the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching.A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis.Parametric and nonparametric statistical methods were used to compare the differences between the two groups.The Kaplan–Meier method was used to create survival curves,and differences in survival curves were compared by the log-rank test.RESULTS Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients,there were no significant differences in intraoperative bleeding(P=0.234),30-d post-ESTD bleeding(P=0.099),disease-specific survival(P=0.075),or recurrence-free survival(P=0.8196).The mean hospitalization time and costs were significantly longer(P=0.007)and higher(P=0.023)in the cirrhosis group than in the noncirrhosis group.The overall survival rate was significantly lower in the cirrhosis group(P=0.001).CONCLUSION ESTD is technically feasible,safe,and effective for patients with EESCC and liver cirrhosis.EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.
文摘Esophageal cancer(EC)is a common malignant tumor of the digestive tract and originates from the epithelium of the esophageal mucosa.It has been confirmed that early EC lesions can be cured by endoscopic therapy,and the curative effect is equivalent to that of surgical operation.Upper gastrointestinal endoscopy is still the gold standard for EC diagnosis.The accuracy of endoscopic examination results largely depends on the professional level of the examiner.Artificial intelligence(AI)has been applied in the screening of early EC and has shown advantages;notably,it is more accurate than less-experienced endoscopists.This paper reviews the application of AI in the field of endoscopic detection of early EC,including squamous cell carcinoma and adenocarcinoma,and describes the relevant progress.Although up to now most of the studies evaluating the clinical application of AI in early EC endoscopic detection are focused on still images,AIassisted real-time detection based on live-stream video may be the next step.
基金Supported by The Sichuan Medical Association Digestive Endoscopy Special Committee Special Topic,China,No.2021XHNJ05。
文摘BACKGROUND Endoscopic submucosal dissection(ESD)post-procedure stricture is a relatively common long-term complication following ESD treatment.A range of approaches has been implemented for the treatment of post-procedural stricture using endoscopic techniques such as endoscopic dilation,self-expandable metallic stent insertion,local steroid injection in the esophagus,oral steroid administration,radial incision and cutting(RIC).The actual efficacy of these different therapeutic options is highly variable,and uniform international standards for the prevention or treatment of stricture.CASE SUMMARY In this report,we describe the case of a 51-year-old male diagnosed with early esophageal cancer.To protect against esophageal stricture,the patient was administered oral steroids and underwent self-expandable metallic stent insertion for 45 d.Despite these interventions,stricture was detected at the lower edge of the stent following its removal.The patient remained refractory to multiple rounds of endoscopic bougie dilation treatment,and thus suffered from complex refractory benign esophageal stricture.As such,RIC combined with bougie dilation and steroid injection was employed to treat this patient more effectively,ultimately achieving satisfactory therapeutic efficacy.CONCLUSION Combination of RIC,dilation,and steroid injection can be safely and effectively implemented to treat cases of post-ESD refractory esophageal stricture.
文摘Early gastrointestinal(GI)cancer has been the core of clinical endoscopic work.Its early detection and treatment are tightly associated with patients’prognoses.As a novel technology,artificial intelligence has been improved and applied in the field of endoscopy.Studies on detection,diagnosis,risk,and prognosis evaluation of diseases in the GI tract have been in development,including precancerous lesions,adenoma,early GI cancers,and advanced GI cancers.In this review,research on esophagus,stomach,and colon was concluded,and associated with the process from precancerous lesions to early GI cancer,such as from Barrett’s esophagus to early esophageal cancer,from dysplasia to early gastric cancer,and from adenoma to early colonic cancer.A status quo of research on early GI cancers and artificial intelligence was provided.
文摘Subject Code:H16With the support by the National Natural Science Foundation of China,a collaborative study by the Research groups led by Prof.Fu Li(付利)from the Cancer Research Center,Shenzhen University School of Medicine and Prof.Guan Xinyuan(关新元)from the University of Hong Kong reported that an
基金the the National Science Foundation of China(No.81802982)ChongQing Science&Technology Commission Fund(No.CSTC2018jcyjAX0102).
文摘Endoscopic submucosal dissection(ESD)is a common procedure to treat early and precancerous gastrointestinal lesions.Via submucosal injection,a liquid cushion is created to lift and separate the lesion and malignant part from the muscular layer where the formed indispensable space is convenient for endoscopic incision.Saline is a most common submucosal injection liquid,but the formed liquid pad lasts only a short time,and thus repeated injections increase the potential risk of adverse events.Hydrogels with high osmotic pressure and high viscosity are used as an alternate;however,with some drawbacks such as tissue damage,excessive injection resistance,and high cost.Here,we reported a nature derived hydrogel of gelatin-oxidized alginate(G-OALG).Based on the rheological analysis and compare to commercial endoscopic mucosal resection(EMR)solution(0.25%hyaluronic acid,HA),a designed G-OALG hydrogel of desired concentration and composition showed higher performances in controllable gelation and injectability,higher viscosity and more stable structures.The G-OALG gel also showed lower propulsion resistance than 0.25%HA in the injection force assessment under standard endoscopic instruments,which eased the surgical operation.In addition,the G-OALG hydrogel showed good in vivo degradability biocompatibility.By comparing the results acquired via ESD to normal saline,the G-OALG shows great histocompatibility and excellent endoscopic injectability,and enables create a longer-lasting submucosal cushion.All the features have been confirmed in the living both pig and rat models.The G-OALG could be a promising submucosal injection agent for esophageal ESD.
