AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:...AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patter展开更多
AIM: To identify the features of early signet ring cell gastric carcinoma using magnification endoscopy with narrow band imaging(NBI).METHODS: A retrospective review was conducted of 12 cases of early signet ring cell...AIM: To identify the features of early signet ring cell gastric carcinoma using magnification endoscopy with narrow band imaging(NBI).METHODS: A retrospective review was conducted of 12 cases of early signet ring cell gastric carcinoma who underwent treatment in a single institution between January 2009 and April 2013. All patients had magnification endoscopy with NBI and indigo carmine contrast to closely examine the mucosal architecture, including the microvasculature and arrangement of gastric pits. Histologic examination of the final endoscopic submucosal dissection or gastrectomy specimen was performed and compared with the endoscopic findings to identify patterns specific to signet ring cell carcinoma.RESULTS: Twelve patients with early signet ring cell gastric carcinoma were identified; 75% were male, and average age was 61 years. Most of the lesions were stage T1a(83%), while the remainder were T1b(17%). The mean lesion size was 1.4 cm2. On standard endoscopy, all 12 patients had a pale, flat lesion without any evidence of mucosal abnormality such as ulceration, elevation, or depression. On magnification endoscopywith NBI, all of the patients had irregularities in the glands and microvasculature consistent with early gastric cancer. In addition, all 12 patients exhibited the "stretch sign", an elongation or expansion of the architectural structure. Histologic examination of the resected specimens demonstrated an expanded and edematous mucosal layer infiltrated with tumor cells.CONCLUSION: The "stretch sign" appears to be specific for signet ring cell carcinoma and may aid in the early diagnosis and treatment of this aggressive pathology.展开更多
BACKGROUND The undifferentiated-type(UDT)component profoundly affects the clinical course of early gastric cancers(EGCs).However,an accurate preoperative diagnosis of the histological types is unsatisfactory.To date,f...BACKGROUND The undifferentiated-type(UDT)component profoundly affects the clinical course of early gastric cancers(EGCs).However,an accurate preoperative diagnosis of the histological types is unsatisfactory.To date,few studies have investigated whether the UDT component within mixed-histological-type(MT)EGCs can be recognized preoperatively.AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.METHODS This was a single-center retrospective study.First,we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component.Histopathological examination investigated each lesion’s UDT component:(1)Whole mucosal layer occupation of the UDT component;(2)UDT component exposure to the surface of the mucosa;and(3)existence of a clear border between the differentiated-type and UDT components.Then,preoperative endoscopic images with magnifying endoscopy with narrowband imaging(ME-NBI)were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination.The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.RESULTS In the histopathological examination,the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3%(33/49)and 79.6%(39/49)of samples,respectively.A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3%(32/49)of MT lesions.In the endoscopic examination,the preoperative endoscopic images showed that only 24.5%(12/49)of MT EGCs revealed the UDT component within the area where it was present histopathologically.Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component findi展开更多
BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to...BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONC展开更多
Iatrogenic gastric perforation is one of the most serious complications during therapeutic endoscopy,despite significant advances in endoscopic techniques and devices.This case study evaluated the clinical efficacy an...Iatrogenic gastric perforation is one of the most serious complications during therapeutic endoscopy,despite significant advances in endoscopic techniques and devices.This case study evaluated the clinical efficacy and safety of the rescue endoscopic band ligation (EBL) technique in iatrogenic gastric wall perforation following the failure of primary endoclip closure.Five patients were enrolled in this study.These patients underwent emergency endoscopy following the onset of acute gastric wall perforation during endoscopic procedures.The outcome measurements were primary technical success and immediate or delayed procedure-related complications.Successful endoscopic closure using band ligation was reported in all patients,with no complication occurring.We conclude that EBL may be a feasible and safe alternate technique for the management of acute gastric perforation,especially in cases where closure is difficult with endoclips.展开更多
Gastric cancer is the fifth most common cancer and in 2018,it was the third most common cause of cancer-related deaths worldwide.Endoscopic advances continue to be made for the diagnosis and management of both early g...Gastric cancer is the fifth most common cancer and in 2018,it was the third most common cause of cancer-related deaths worldwide.Endoscopic advances continue to be made for the diagnosis and management of both early gastric cancer and premalignant gastric conditions.In this review,we discuss the epidemiology and risk factors of gastric cancer and emphasize the differences in early vs latestage gastric cancer outcomes.We then discuss endoscopic advances in the diagnosis of early gastric cancer and premalignant gastric lesions.This includes the implementation of different imaging modalities such as narrow-band imaging,chromoendoscopy,confocal laser endomicroscopy,and other experimental techniques.We also discuss the use of endoscopic ultrasound in the diagnosis and staging of early gastric cancer.We then discuss the endoscopic advances made in the treatment of these conditions,including endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid techniques such as laparoscopic endoscopic cooperative surgery.Finally,we comment on the current suggested recommendations for surveillance of both gastric cancer and its premalignant conditions.展开更多
AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double ...AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.展开更多
BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capil...BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI 展开更多
The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varice...The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.展开更多
BACKGROUND Minute gastric cancers(MGCs)have a favorable prognosis,but they are too small to be detected by endoscopy,with a maximum diameter≤5 mm.AIM To explore endoscopic detection and diagnostic strategies for MGCs...BACKGROUND Minute gastric cancers(MGCs)have a favorable prognosis,but they are too small to be detected by endoscopy,with a maximum diameter≤5 mm.AIM To explore endoscopic detection and diagnostic strategies for MGCs.METHODS This was a real-world observational study.The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed.Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed.RESULTS All MGCs in our study were of a single pathological type,97.38%(186/191)of which were differentiated-type tumors.White light endoscopy(WLE)detected 84.29%(161/191)of MGCs,and the most common morphology of MGCs found by WLE was protruding.Narrow-band imaging(NBI)secondary observation detected 14.14%(27/191)of MGCs,and the most common morphology of MGCs found by NBI was flat.Another three MGCs were detected by indigo carmine third observation.If a well-demarcated border lesion exhibited a typical neoplastic color,such as yellowish-red or whitish under WLE and brownish under NBI,MGCs should be diagnosed.The proportion with high diagnostic confidence by magnifying endoscopy with NBI(ME-NBI)was significantly higher than the proportion with low diagnostic confidence and the only visible groups(94.19%>56.92%>32.50%,P<0.001).CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs.A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs.MENBI improves the endoscopic diagnostic confidence of MGCs.展开更多
Objective:To explore the implementation of gastrointestinal endoscopy technology and endoscopic narrow-band imaging(NBI)in the early screening of gastric cancer and to observe and study their application effects.Metho...Objective:To explore the implementation of gastrointestinal endoscopy technology and endoscopic narrow-band imaging(NBI)in the early screening of gastric cancer and to observe and study their application effects.Methods:During the period from March 2023 to August 2023,312 patients who received gastroscopy in the Kunming Guandu District People’s Hospital were selected,and they underwent both conventional gastroscopy and endoscopic NBI,with clinicopathological tissue biopsy serving as the gold standard.The application value for early screening of gastric cancer was observed and analyzed.Results:The scoring data showed that the clarity of gastric mucosal glandular tube structure,microvascular structure clarity,and lesion contour scoring data of conventional gastroscopy were lower than those of the NBI technology(P<0.05).The screening rate of pathological biopsy in 312 patients was 18.59%(58 cases).Conventional gastroscopy showed a screening rate of 11.53%(36 cases),while NBI technology examined a screening rate of 17.63%(55 cases),and the two-by-two comparison of the screening rate data of the three groups was not statistically significant(P>0.05).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of conventional gastroscopy appeared to be lower than those of NBI technology(P<0.05).Conclusion:In the early screening of gastric cancer,endoscopic NBI technology can be applied to patients.Compared with conventional gastroscopy,it provides a clearer visualization of the structure of the gastric mucosal glandular structure and microvascular structure,with a certain screening rate.Additionally,its sensitivity,specificity,accuracy,positive predictive value,and negative predictive value are higher,demonstrating outstanding effectiveness.展开更多
Confocal laser endomicroscopy(CLE)is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the mucosa.CLE has a higher sensitivity,specificity,and diagnosti...Confocal laser endomicroscopy(CLE)is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the mucosa.CLE has a higher sensitivity,specificity,and diagnostic accuracy in detecting atrophic gastritis as compared to chromoendoscopy and narrow-band imaging.It can even predict low-grade and high-grade intraepithelial neoplasia by analyzing gastric pit patterns.CLE may have some advantages over the standard biopsy protocol,such as higher diagnostic yield and fewer biopsy requirements.Its diagnostic accuracy in detecting superficial gastric cancer is higher than that of white-light endoscopy.Inherent limitations,such as a narrow field of vision,can be surpassed by technological advancements and integration with other detection methods.Artificial intelligence holds promise in automated analysis of histopathological images.Thus,CLE can be helpful in screening for early gastric cancer and may help reduce the risk of complications from repeated biopsies,such as mucosal damage,bleeding,and infection.展开更多
Upper gastrointestinal bleeding from oesophageal or gastric varices is an important medical condition in patients with portal hypertension.Despite the emergence of a number of novel endoscopic and radiologic therapies...Upper gastrointestinal bleeding from oesophageal or gastric varices is an important medical condition in patients with portal hypertension.Despite the emergence of a number of novel endoscopic and radiologic therapies for oesophagogastric varices,controversy exists regarding the indication,timing and modality of therapy.The aim of this review is to provide a concise and practical evidence-based overview of these issues.展开更多
Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in earl...Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC.Therefore,the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients.In recent years,technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients.Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection(ESD),indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation.This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.展开更多
Gastric antral vascular ectasia (GAVE) is an uncommon and often neglected cause of gastric hemorrhage. The treatments for GAVE include surgery, endoscopy and medical therapies. Here, we report an unusual case of GAVE....Gastric antral vascular ectasia (GAVE) is an uncommon and often neglected cause of gastric hemorrhage. The treatments for GAVE include surgery, endoscopy and medical therapies. Here, we report an unusual case of GAVE. A 72-year-old man with a three-month history of recurrent melena was diagnosed with GAVE. Endoscopy revealed the classical “watermelon stomach” appearance of GAVE and complete pyloric involvement. Melena reoccurred three days after argon plasma coagulation treatment, and the level of hemoglobin dropped to 47 g/L. The patient was then successfully treated with distal gastrectomy with Billroth II anastomosis. We propose that surgery should be considered as an effective option for GAVE patients with extensive and severe lesions upon deterioration of general conditions and hemodynamic instability.展开更多
Laparoscopic adjustable gastric banding (LAGB) is currently one of the most common bariatric surgical procedures performed worldwide for the treatment of morbid obesity. Among bariatric surgeries, the percentage of LA...Laparoscopic adjustable gastric banding (LAGB) is currently one of the most common bariatric surgical procedures performed worldwide for the treatment of morbid obesity. Among bariatric surgeries, the percentage of LAGB has increased from 24.4% to 42.3%. In North America alone, the number of LAGB procedures has increased exponentially by 944.2% (from 9,270 to 96, 800 cases). Though early and late complications following LAGB are well-understood, data regarding long term complications remains indefinite due to the limited follow-up periods. We report a case of acute gastric necrosis associated with band slippage presenting as a surgical emergency five years after LAGB. Gastric necrosis represents a rare, but life threatening complication of gastric banding that has been reported in the early post-operative period. To the best of our knowledge, this case report is the longest time-interval reported between LAGB and the diagnosis of this very rare complication. Accurate diagnosis is often delayed due to its rarity and nonspecific clinical presentation. Increased awareness of this delayed complication should facilitate early recognition as it often requires urgent surgical intervention to prevent fatal outcomes.展开更多
Background Most incidental gastric polyps identified during upper endoscopy are considered low-risk.However,current guidelines recommend sampling all gastric polyps for histopathologic analysis.We aimed to devise a si...Background Most incidental gastric polyps identified during upper endoscopy are considered low-risk.However,current guidelines recommend sampling all gastric polyps for histopathologic analysis.We aimed to devise a simple narrow-band imaging(NBI)classification to reduce the need for routine biopsies of low-risk gastric polyps.Methods Pairs of NBI and white-light images were collected from 73 gastric polyps for which concurrent histopathologic diagnosis was available.A diagnostic accuracy cohort study was performed.Two blinded endoscopists independently analysed NBI features of each polyp for color,vessel pattern,surface pattern,and any combinations thereof to develop a classification scheme to differentiate low-risk polyps(fundic-gland or hyperplastic)from high-risk polyps(adenomatous or adenocarcinoma)and fundic-gland polyps(FGPs)from non-FGPs.Results An isolated lacy vessel pattern and a homogenous absence of surface pattern successfully differentiated low-risk from high-risk gastric polyps.Combining both descriptors into a single algorithm resulted in a negative predictive value(NPV)of 100%[95%confidence interval(CI):100%–100%],positive predictive value(PPV)of 13.7%(95%CI:2.6–24.8),sensitivity of 100%(95%CI:100%–100%),and specificity of 53.7%(95%CI:45.3%–62.0%)for high-risk polyps.This would reduce the number of polyps requiring biopsy by 50%,while still capturing all high-risk polyps.Regarding FGPs,using a rule not to biopsy polyps with isolated lacy vessels resulted in a 94.9%NPV(95%CI:89.2%–100%),63.2%PPV(95%CI:47.2%–79.2%),94.8%sensitivity(95%CI:89.5%–100%),and 63.6%specificity(95%CI:51.3%–76.0%)for non-FGPs.Conclusion In this derivation cohort study,NBI is helpful for differentiating between high-risk and low-risk gastric polyps,thereby reducing the need for routine sampling of low-risk polyps.These results need to be validated in a separate test population.展开更多
Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility ...Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is controversial and differs based on the type of surgery. Most of the reported cases occurred with laparoscopic adjustable gastric banding. To our knowledge, there are only three reported cases of achalasia after Roux-en-Y gastric bypass and no reported cases after revision of the surgery. We present a case of a 70-year-old female who had a previous history of Roux-en-Y gastric bypass with revision. She presented with persistent nausea and regurgitation for one month. Esophagogastroduodenoscopy showed a dilated esophagus without strictures or stenosis. A barium study was performed after the endoscopy and was suggestive of achalasia. Those findings were confirmed by a manometry. The patient was referred for laparoscopic Heller's myotomy.展开更多
This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that a...This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that adjustable gastric bands in the process of migration need not be removed surgically in patients who are asymptomatic.展开更多
文摘AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
文摘AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patter
文摘AIM: To identify the features of early signet ring cell gastric carcinoma using magnification endoscopy with narrow band imaging(NBI).METHODS: A retrospective review was conducted of 12 cases of early signet ring cell gastric carcinoma who underwent treatment in a single institution between January 2009 and April 2013. All patients had magnification endoscopy with NBI and indigo carmine contrast to closely examine the mucosal architecture, including the microvasculature and arrangement of gastric pits. Histologic examination of the final endoscopic submucosal dissection or gastrectomy specimen was performed and compared with the endoscopic findings to identify patterns specific to signet ring cell carcinoma.RESULTS: Twelve patients with early signet ring cell gastric carcinoma were identified; 75% were male, and average age was 61 years. Most of the lesions were stage T1a(83%), while the remainder were T1b(17%). The mean lesion size was 1.4 cm2. On standard endoscopy, all 12 patients had a pale, flat lesion without any evidence of mucosal abnormality such as ulceration, elevation, or depression. On magnification endoscopywith NBI, all of the patients had irregularities in the glands and microvasculature consistent with early gastric cancer. In addition, all 12 patients exhibited the "stretch sign", an elongation or expansion of the architectural structure. Histologic examination of the resected specimens demonstrated an expanded and edematous mucosal layer infiltrated with tumor cells.CONCLUSION: The "stretch sign" appears to be specific for signet ring cell carcinoma and may aid in the early diagnosis and treatment of this aggressive pathology.
文摘BACKGROUND The undifferentiated-type(UDT)component profoundly affects the clinical course of early gastric cancers(EGCs).However,an accurate preoperative diagnosis of the histological types is unsatisfactory.To date,few studies have investigated whether the UDT component within mixed-histological-type(MT)EGCs can be recognized preoperatively.AIM To clarify the histopathological characteristics of the endoscopically-resected MT EGCs for investigating whether the UDT component could be recognized preoperatively.METHODS This was a single-center retrospective study.First,we attempted to clarify the histopathological characteristics of the endoscopically-resected MT EGCs with emphasis on the UDT component.Histopathological examination investigated each lesion’s UDT component:(1)Whole mucosal layer occupation of the UDT component;(2)UDT component exposure to the surface of the mucosa;and(3)existence of a clear border between the differentiated-type and UDT components.Then,preoperative endoscopic images with magnifying endoscopy with narrowband imaging(ME-NBI)were examined to identify whether the endoscopic UDT component finding was recognizable within the area where it was present in the histopathological examination.The preoperative biopsy results and comparative relationships between endoscopic and histopathological findings were also examined.RESULTS In the histopathological examination,the whole mucosal layer occupation of the UDT component and exposure of the UDT component to the mucosal surface were observed in 67.3%(33/49)and 79.6%(39/49)of samples,respectively.A clear distinction of the border between the differentiated-type and UDT components could not be drawn in 65.3%(32/49)of MT lesions.In the endoscopic examination,the preoperative endoscopic images showed that only 24.5%(12/49)of MT EGCs revealed the UDT component within the area where it was present histopathologically.Histopathological UDT predominance was the single significant factor associated with the presence of the endoscopic UDT component findi
基金Supported by the Guizhou Provincial Science and Technology Program,No.[2020]4Y004.
文摘BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONC
基金Supported by Grant of the Korea Healthcare Technology Rand D Project,Ministry of Health and Welfare,South Korea,NoA100054
文摘Iatrogenic gastric perforation is one of the most serious complications during therapeutic endoscopy,despite significant advances in endoscopic techniques and devices.This case study evaluated the clinical efficacy and safety of the rescue endoscopic band ligation (EBL) technique in iatrogenic gastric wall perforation following the failure of primary endoclip closure.Five patients were enrolled in this study.These patients underwent emergency endoscopy following the onset of acute gastric wall perforation during endoscopic procedures.The outcome measurements were primary technical success and immediate or delayed procedure-related complications.Successful endoscopic closure using band ligation was reported in all patients,with no complication occurring.We conclude that EBL may be a feasible and safe alternate technique for the management of acute gastric perforation,especially in cases where closure is difficult with endoclips.
文摘Gastric cancer is the fifth most common cancer and in 2018,it was the third most common cause of cancer-related deaths worldwide.Endoscopic advances continue to be made for the diagnosis and management of both early gastric cancer and premalignant gastric conditions.In this review,we discuss the epidemiology and risk factors of gastric cancer and emphasize the differences in early vs latestage gastric cancer outcomes.We then discuss endoscopic advances in the diagnosis of early gastric cancer and premalignant gastric lesions.This includes the implementation of different imaging modalities such as narrow-band imaging,chromoendoscopy,confocal laser endomicroscopy,and other experimental techniques.We also discuss the use of endoscopic ultrasound in the diagnosis and staging of early gastric cancer.We then discuss the endoscopic advances made in the treatment of these conditions,including endoscopic mucosal resection,endoscopic submucosal dissection,and hybrid techniques such as laparoscopic endoscopic cooperative surgery.Finally,we comment on the current suggested recommendations for surveillance of both gastric cancer and its premalignant conditions.
基金Supported by Department of Anesthesiology,Northwestern University
文摘AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.
文摘BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI
文摘The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.
基金Supported by the National Science Foundation Committee of China,No 81372348and Clinical Research Fund Project of Zhejiang Medical Association,No 2020ZYC-A10.
文摘BACKGROUND Minute gastric cancers(MGCs)have a favorable prognosis,but they are too small to be detected by endoscopy,with a maximum diameter≤5 mm.AIM To explore endoscopic detection and diagnostic strategies for MGCs.METHODS This was a real-world observational study.The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed.Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed.RESULTS All MGCs in our study were of a single pathological type,97.38%(186/191)of which were differentiated-type tumors.White light endoscopy(WLE)detected 84.29%(161/191)of MGCs,and the most common morphology of MGCs found by WLE was protruding.Narrow-band imaging(NBI)secondary observation detected 14.14%(27/191)of MGCs,and the most common morphology of MGCs found by NBI was flat.Another three MGCs were detected by indigo carmine third observation.If a well-demarcated border lesion exhibited a typical neoplastic color,such as yellowish-red or whitish under WLE and brownish under NBI,MGCs should be diagnosed.The proportion with high diagnostic confidence by magnifying endoscopy with NBI(ME-NBI)was significantly higher than the proportion with low diagnostic confidence and the only visible groups(94.19%>56.92%>32.50%,P<0.001).CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs.A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs.MENBI improves the endoscopic diagnostic confidence of MGCs.
文摘Objective:To explore the implementation of gastrointestinal endoscopy technology and endoscopic narrow-band imaging(NBI)in the early screening of gastric cancer and to observe and study their application effects.Methods:During the period from March 2023 to August 2023,312 patients who received gastroscopy in the Kunming Guandu District People’s Hospital were selected,and they underwent both conventional gastroscopy and endoscopic NBI,with clinicopathological tissue biopsy serving as the gold standard.The application value for early screening of gastric cancer was observed and analyzed.Results:The scoring data showed that the clarity of gastric mucosal glandular tube structure,microvascular structure clarity,and lesion contour scoring data of conventional gastroscopy were lower than those of the NBI technology(P<0.05).The screening rate of pathological biopsy in 312 patients was 18.59%(58 cases).Conventional gastroscopy showed a screening rate of 11.53%(36 cases),while NBI technology examined a screening rate of 17.63%(55 cases),and the two-by-two comparison of the screening rate data of the three groups was not statistically significant(P>0.05).The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of conventional gastroscopy appeared to be lower than those of NBI technology(P<0.05).Conclusion:In the early screening of gastric cancer,endoscopic NBI technology can be applied to patients.Compared with conventional gastroscopy,it provides a clearer visualization of the structure of the gastric mucosal glandular structure and microvascular structure,with a certain screening rate.Additionally,its sensitivity,specificity,accuracy,positive predictive value,and negative predictive value are higher,demonstrating outstanding effectiveness.
文摘Confocal laser endomicroscopy(CLE)is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the mucosa.CLE has a higher sensitivity,specificity,and diagnostic accuracy in detecting atrophic gastritis as compared to chromoendoscopy and narrow-band imaging.It can even predict low-grade and high-grade intraepithelial neoplasia by analyzing gastric pit patterns.CLE may have some advantages over the standard biopsy protocol,such as higher diagnostic yield and fewer biopsy requirements.Its diagnostic accuracy in detecting superficial gastric cancer is higher than that of white-light endoscopy.Inherent limitations,such as a narrow field of vision,can be surpassed by technological advancements and integration with other detection methods.Artificial intelligence holds promise in automated analysis of histopathological images.Thus,CLE can be helpful in screening for early gastric cancer and may help reduce the risk of complications from repeated biopsies,such as mucosal damage,bleeding,and infection.
文摘Upper gastrointestinal bleeding from oesophageal or gastric varices is an important medical condition in patients with portal hypertension.Despite the emergence of a number of novel endoscopic and radiologic therapies for oesophagogastric varices,controversy exists regarding the indication,timing and modality of therapy.The aim of this review is to provide a concise and practical evidence-based overview of these issues.
文摘Gastric signet-ring cell gastric carcinoma(GSRC)is an unfavorable subtype of gastric cancer(GC)that presents with greater invasiveness and poorer prognosis in advanced stage than other types of GC.However,GSRC in early stage is often considered an indicator of less lymph node metastasis and more satisfying clinical outcome compared to poorly differentiated GC.Therefore,the detection and diagnosis of GSRC at early stage undoubtedly play a crucial role in the management of GSRC patients.In recent years,technological advancement in endoscopy including narrow-band imaging and magnifying endoscopy has significantly improved the accuracy and sensitivity of the diagnosis under endoscopy for GSRC patients.Researches have confirmed that early stage GSRC that meets the expanded criteria of endoscopic resection showed comparable outcomes to surgery after receiving endoscopic submucosal dissection(ESD),indicating that ESD could be considered standard treatment for GSRC after thorough selection and evaluation.This article summarizes the current knowledge and updates pertaining to the endoscopic diagnosis and treatment of early stage signet-ring cell gastric carcinoma.
文摘Gastric antral vascular ectasia (GAVE) is an uncommon and often neglected cause of gastric hemorrhage. The treatments for GAVE include surgery, endoscopy and medical therapies. Here, we report an unusual case of GAVE. A 72-year-old man with a three-month history of recurrent melena was diagnosed with GAVE. Endoscopy revealed the classical “watermelon stomach” appearance of GAVE and complete pyloric involvement. Melena reoccurred three days after argon plasma coagulation treatment, and the level of hemoglobin dropped to 47 g/L. The patient was then successfully treated with distal gastrectomy with Billroth II anastomosis. We propose that surgery should be considered as an effective option for GAVE patients with extensive and severe lesions upon deterioration of general conditions and hemodynamic instability.
文摘Laparoscopic adjustable gastric banding (LAGB) is currently one of the most common bariatric surgical procedures performed worldwide for the treatment of morbid obesity. Among bariatric surgeries, the percentage of LAGB has increased from 24.4% to 42.3%. In North America alone, the number of LAGB procedures has increased exponentially by 944.2% (from 9,270 to 96, 800 cases). Though early and late complications following LAGB are well-understood, data regarding long term complications remains indefinite due to the limited follow-up periods. We report a case of acute gastric necrosis associated with band slippage presenting as a surgical emergency five years after LAGB. Gastric necrosis represents a rare, but life threatening complication of gastric banding that has been reported in the early post-operative period. To the best of our knowledge, this case report is the longest time-interval reported between LAGB and the diagnosis of this very rare complication. Accurate diagnosis is often delayed due to its rarity and nonspecific clinical presentation. Increased awareness of this delayed complication should facilitate early recognition as it often requires urgent surgical intervention to prevent fatal outcomes.
文摘Background Most incidental gastric polyps identified during upper endoscopy are considered low-risk.However,current guidelines recommend sampling all gastric polyps for histopathologic analysis.We aimed to devise a simple narrow-band imaging(NBI)classification to reduce the need for routine biopsies of low-risk gastric polyps.Methods Pairs of NBI and white-light images were collected from 73 gastric polyps for which concurrent histopathologic diagnosis was available.A diagnostic accuracy cohort study was performed.Two blinded endoscopists independently analysed NBI features of each polyp for color,vessel pattern,surface pattern,and any combinations thereof to develop a classification scheme to differentiate low-risk polyps(fundic-gland or hyperplastic)from high-risk polyps(adenomatous or adenocarcinoma)and fundic-gland polyps(FGPs)from non-FGPs.Results An isolated lacy vessel pattern and a homogenous absence of surface pattern successfully differentiated low-risk from high-risk gastric polyps.Combining both descriptors into a single algorithm resulted in a negative predictive value(NPV)of 100%[95%confidence interval(CI):100%–100%],positive predictive value(PPV)of 13.7%(95%CI:2.6–24.8),sensitivity of 100%(95%CI:100%–100%),and specificity of 53.7%(95%CI:45.3%–62.0%)for high-risk polyps.This would reduce the number of polyps requiring biopsy by 50%,while still capturing all high-risk polyps.Regarding FGPs,using a rule not to biopsy polyps with isolated lacy vessels resulted in a 94.9%NPV(95%CI:89.2%–100%),63.2%PPV(95%CI:47.2%–79.2%),94.8%sensitivity(95%CI:89.5%–100%),and 63.6%specificity(95%CI:51.3%–76.0%)for non-FGPs.Conclusion In this derivation cohort study,NBI is helpful for differentiating between high-risk and low-risk gastric polyps,thereby reducing the need for routine sampling of low-risk polyps.These results need to be validated in a separate test population.
文摘Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is controversial and differs based on the type of surgery. Most of the reported cases occurred with laparoscopic adjustable gastric banding. To our knowledge, there are only three reported cases of achalasia after Roux-en-Y gastric bypass and no reported cases after revision of the surgery. We present a case of a 70-year-old female who had a previous history of Roux-en-Y gastric bypass with revision. She presented with persistent nausea and regurgitation for one month. Esophagogastroduodenoscopy showed a dilated esophagus without strictures or stenosis. A barium study was performed after the endoscopy and was suggestive of achalasia. Those findings were confirmed by a manometry. The patient was referred for laparoscopic Heller's myotomy.
文摘This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that adjustable gastric bands in the process of migration need not be removed surgically in patients who are asymptomatic.
