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Chinese Medical Journal 2024年第3期137卷 255-256页

作者： Wengang Zhang ningli chai Qingzhen Wu Enqiang Linghu Department of Gastroenterology Chinese PLA General HospitalBeijing 100853China

Indeterminate biliary stricture(IBS)refers to biliary stricture with an uncertain histological diagnosis^([1])and can be classified as non-neoplastic stricture or neoplastic *** former is mainly caused by various inflammatory biliopancreatic diseases,congenital malformations,or postoperative bile duct injury,while the latter exists in neoplastic lesions such as cholangiocarcinoma,invasion from pancreatic cancer,and adenomas in the bile *** non-neoplastic strictures can be relieved by endoscopic or conservative medical treatment,and only a few require surgical ***,radical surgery or palliative biliary drainage should be applied for neoplastic strictures according to the progression of the ***,it is essential to obtain an accurate diagnosis for IBS in clinical work.

关键词： diagnosis stricture biliary

Role of submucosal injection in radiofrequency ablation of gastric low-grade dysplasia: Effects on symptoms and outcomes

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中华医学杂志(英文版) 2024年第17期137卷 2099-2110页

作者： Niu Xiaotong Wang Nanjun Wang Yan Feng Jia Li Longsong Han Ke chai ningli Linghu Enqiang Medical School of Chinese PLA General Hospital Beijing China Department of Gastroenterology and Hepatology The First Medical Center Chinese PLA General Hospital Beijing China Nankai University School of Medicine Nankai University Tianjin China Department of Gastroenterology Bethune International Peace Hospital ShijiaZhuang Hebei China

Background: To date, there is still a lack of standardized management strategies for gastric low-grade dysplasia (LGD), which is a direct neoplastic precancerous lesion and requires specifically superficial destruction. Radiofrequency ablation (RFA) is expected to be an effective method for gastric LGD, but post-RFA pain may affect patients’ satisfaction and compliance. The current study aimed to evaluate the value of a submucosal injection prior to RFA (SI-RFA) for postoperative pain and treatment ***: Between October 2014 and July 2021, gastric LGDs without risk factors (size >2 cm, unclear boundary, and abnormal microsurface and microvascularity) undergoing regular RFA and SI-RFA were retrospectively analyzed. Postoperative pain scores, wound healing, and clinical efficacy were compared. Propensity score matching, stratified analysis, and multivariable logistic regression were performed to control the confounding ***: One hundred and ninety-seven gastric LGDs in 151 patients received regular RFA. Forty-nine gastric LGDs in 36 patients received SI-RFA. Thirty-six pairs of patients were selected for the assessment of postoperative pain by propensity score matching. Compared to regular RFA, SI-RFA significantly decreased the degree and duration of postoperative pain (OR, 0.32; 95% CI, 0.13-0.84;P = 0.020), improved wound healing rate (80.0% [36/45]vs. 58.9% [89/151],P = 0.012), increased the complete ablation rate (91.8% [45/49]vs. 86.3% [170/197],χ2 = 1.094,P = 0.295), but correlated with higher rates of local recurrence and progression (25.6% [10/39]vs. 13.2% [18/136],χ2 = 3.471,P = 0.062; 8.3% [3/36]vs. 0.9% [1/116],P = 0.042). The multivariable logistic regression model confirmed that submucosal injection was associated with local recurrence (OR, 2.93; 95% CI, 1.13-7.58;P = 0.027).Conclusions: Submucosal injections prior to RFA may reduce postoperative pain and scar formation while ensuring complete ablation of gastric LGD. However, lo

关键词： Gastric low-grade dysplasia Radiofrequency ablation Submucosal injection Postoperative pain Treatment outcome

Impact of pancreatic and biliary stent on post-endoscopic papillectomy complications: A single-center retrospective study

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中华医学杂志(英文版) 2024年第17期137卷 2024 May 27页

作者： Ru Nan chai ningli Zhang Bo Li Longsong Bi Yawei Linghu Enqiang Department of Gastroenterology The First Medical Center of Chinese People’s Liberation Army General Hospital Beijing China Digestive Endoscopy Center The First Medical Center of Chinese People’s Liberation Army General Hospital Beijing China

Background: Endoscopic papillectomy (EP) is recommended as the first-line therapy for ampullary tumors, despite a relatively high incidence of complications. Pancreatic and/or biliary stents are placed at the endoscopist’s discretion to prevent post-EP complications. The present study aimed to evaluate the efficacy of different ***: A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study. These patients were divided into a pancreatic stent group (PS group,n = 47), a biliary stent group (BS group,n = 38), and a two-stent group (PBS [PS and BS] group,n = 32). Relevant clinical data were collected and compared among the three groups. Multivariate logistic analyses were performed to explore risk factors for post-EP ***: The incidence of all complications was 37.6% (44/117). Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5% (17/117) and 17.9% (21/117). The incidence rates of post-EP pancreatitis were 10.6% (5/47), 23.7% (9/38), and 9.4% (3/32) in the PS group, BS group, and PBS group, respectively, with no significant differences. There were also no significant differences in other complications among the three groups. Age (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.91-0.99;P = 0.022) was independently associated with post-EP pancreatitis while tumor size (OR: 1.66; 95% CI: 1.06-2.60;P = 0.028) was independently associated with post-EP ***: While pancreatic stenting is the first choice to prevent post-EP pancreatitis, biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic cannulation. Two-stent (biliary and pancreatic stent) placement is unnecessary unless it is required due to other concerns.

关键词： Endoscopic papillectomy Complications Preventive measures Pancreatitis Hemorrhage

Risk factors of major intraoperative bleeding and postoperative bleeding associated with endoscopic submucosal dissection for gastric neoplasms

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Chinese Medical Journal 2022年第3期135卷 309-316页

作者： Shanshan Xu ningli chai Xiaowei Tang Enqiang Linghu Shasha Wang Nankai University School of Medicine Nankai UniversityTianjin 300071China Department of Gastroenterology and Hepatology The First Medical Center of Chinese People's Liberation Army General HospitalBeijing 100853China

Background:Endoscopic resection bleeding(ERB)classification was proposed by the authors’team to evaluate the severity of intraoperative bleeding(IB)during endoscopic submucosal dissection(ESD).This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB(MIB)and postoperative bleeding(PB)associated with ESD for gastric neoplastic ***:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General *** patients were divided into the non-MIB group(including ERB-0,ERB-controlled 1[ERB-c1],and ERB-c2)and the MIB group(including ERB-c3 and ERB-uncontrolled[ERB-unc])according to the ERB *** factors of major MIB and risk factors of PB were analyzed using a logistic regression ***:Among the 1334 patients,773(57.95%)had ERB-0,477(35.76%)had ERB-c1,77(5.77%)had ERB-c2,7(0.52%)had ERB-c3,and no patients had *** rate of PB in patients with IB classifications of ERB-0,ERB-c1,ERB-c2,and ERB-c3 were 2.20%(17/773),3.35%(16/477),9.09%(7/77),and 2/7,*** multivariate analysis,proximal location(odds ratio[OR]:1.488;95%confidence interval[CI]:1.045-3.645;P=0.047)was the only significant risk factor of *** kidney disease(CKD)(OR:7.844;95%CI:1.637-37.583;P=0.010)and MIB(ERB-c3)(OR:13.932;95%CI:2.585-74.794;P=0.002)were independent risk factors of ***:Proximal location of lesions was a significant risk factor of ***,CKD and MIB(ERB-c3)were independent risk factors of *** attention should be paid to these high-risk patients for MIB and PB.

关键词： Endoscopic resection bleeding classification Endoscopic submucosal dissection Gastric neoplasms

早期胃癌内镜下非治愈性切除术后追加外科手术患者的临床结果分析

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中华消化内镜杂志 2024年第1期41卷 30-34页

作者：王佳凤王鑫鑫关达王润梓柴宁莉令狐恩强解放军医学院北京100853 解放军总医院第一医学中心消化内科北京100853 解放军总医院第一医学中心普通外科北京100853

目的分析早期胃癌内镜下非治愈性切除患者追加外科手术的必要性。方法回顾分析2009年7月至2023年5月于解放军总医院就诊的内镜下非治愈性切除术后追加外科手术的73例早期胃癌患者资料。主要观察指标包括术后标本病理类型、水平切缘情况... 详细信息

目的分析早期胃癌内镜下非治愈性切除患者追加外科手术的必要性。方法回顾分析2009年7月至2023年5月于解放军总医院就诊的内镜下非治愈性切除术后追加外科手术的73例早期胃癌患者资料。主要观察指标包括术后标本病理类型、水平切缘情况、垂直切缘情况、标本浸润深度、是否脉管侵犯、eCura评分、阳性淋巴结例数以及总体生存率。结果73例被判定为内镜下非治愈性切除的早期胃癌患者均追加了外科手术,其中男58例、女15例,平均年龄61岁(53~67岁)。发病部位方面,37例位于胃上部,24例位于胃下部,11例位于胃中部,1例为多发部位病变。病理类型分型方面,43例为高中分化管状腺癌,16例为黏液/印戒细胞癌,10例为低分化管状腺癌,4例为高级别上皮内瘤变。根据巴黎分型,22例为0-Ⅱa型,43例为0-Ⅱb型,8例为0-Ⅲ型。浸润深度方面,17例为黏膜内癌,23例黏膜下侵犯不足500μm,33例黏膜下侵犯超过500μm。脉管浸润方面,8例存在淋巴管侵犯,8例存在静脉侵犯。73例患者中,4例被判断为eCuraA,5例为eCuraB,4例为eCuraC1,60例为eCuraC2。在60例被判断为eCuraC2的患者中,根据外科术后病理标本评估,仅2例(3.3%)发现存在胃周淋巴结转移。73例内镜下标本中,7例患者水平切缘阳性,21例垂直切缘阳性,2例水平及垂直切缘均为阳性,总计30例患者存在水平或垂直切缘阳性,根据外科术后病理标本评估,9例(30.0%)发现原部位肿瘤残留。73例患者中,5例失访,4例死亡,总体生存率为94.12%(64/68),疾病特异生存率98.53%(67/68),患者随访时间为61.37(10~166)个月。结论对于内镜下非治愈性切除评估结果为eCura C2的早期胃癌患者,追加手术是可行的,但是实际存在淋巴结转移的患者比例较低。

关键词：胃肿瘤早期胃癌非治愈性切除淋巴结转移补救性切除假阳性切缘

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Chinese Medical Journal 2022年第24期135卷 3022-3023页

作者： Mingming Meng ningli chai Shengzhen Liu Xiuxue Feng Enqiang Linghu Department of Gastroenterology and Hepatology The First Medical CentreChinese PLA General HospitalBeijing 100853China Department of Gastroenterology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

To the Editor:Proximal gastrectomy(PG)is the traditional treatment for early-stage adenocarcinoma of the esophagogastric junction(AEG).The new concept of super minimally invasive surgery(SMIS)by endoscopic submucosal dissection(ESD)and endoscopic submucosal tunnel dissection(ESTD)has the same curative effect as traditional surgery,with the advantage of not anatomically changing the digestive tract.[1]With the higher success rate of this therapy,health-related quality of life(HRQoL)has become an important outcome parameter.

关键词： surgery gastrectomy adenocarcinoma

计算机辅助检测系统提高腺瘤检出率的回顾性研究

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中华消化内镜杂志 2024年第6期41卷 443-448页

作者：王鹏举李隆松张波程雅宣孟凡奇肖稳柴宁莉解放军总医院第一医学中心消化内科医学部北京100853 慧维智能医疗科技有限公司长沙410005

目的探讨基于双流算法开发的新型息肉检测系统在结肠镜检查中的作用。方法研究回顾性纳入2023年3月至6月解放军总医院第一医学中心在计算机辅助检测(computer-aided detection,CADe)系统辅助下行结肠镜检查的833例受试者为试验组,2022年... 详细信息

目的探讨基于双流算法开发的新型息肉检测系统在结肠镜检查中的作用。方法研究回顾性纳入2023年3月至6月解放军总医院第一医学中心在计算机辅助检测(computer-aided detection,CADe)系统辅助下行结肠镜检查的833例受试者为试验组,2022年3月至6月在同一操作间接受常规结肠镜检查的770例受试者为对照组。主要观察指标是腺瘤检出率,次要观察指标包括息肉检出率、腺瘤检出数和息肉检出数。结果试验组腺瘤检出率[29.3%(244/833)比21.7%(167/770),χ^(2)=12.133,P<0.001]和息肉检出率[47.9%(399/833)比37.9%(292/770),χ^(2)=16.241,P<0.001]显著高于对照组。对于≤5 mm的腺瘤[23.5%(196/833)比16.1%(124/770),χ^(2)=13.808,P<0.001]和平坦型腺瘤[15.1%(126/833)比7.3%(56/770),χ^(2)=24.519,P<0.001],试验组检出率显著高于对照组。试验组每例腺瘤检出数[0(0,1)枚比0(0,1)枚,Z=-3.698,P<0.001]和每例息肉检出数[0(0,1)枚比0(0,1)枚,Z=-4.424,P<0.001]与对照组相比差异有统计学意义。与无CADe系统辅助相比,CADe系统显著提高低年资医师腺瘤检出率[29.5%(167/566)比18.9%(89/472),χ^(2)=15.709,P<0.001]和息肉检出率[47.3%(268/566)比33.3%(157/472),χ^(2)=21.123,P<0.001];在高年资医师中,有无CADe系统辅助的腺瘤检出率[28.8%(77/267)比26.2%(78/298),χ^(2)=0.502,P=0.479]和息肉检出率[49.1%(131/267)比45.3%(135/298),χ^(2)=0.800,P=0.371]差异无统计学意义。结论CADe系统可显著提高腺瘤和息肉的检出率,尤其对于微小和平坦型病变检出具有明显优势。低年资医师相较于高年资医师使用CADe系统的获益更大。

关键词：人工智能结肠息肉结肠镜检查计算机辅助检测

IgG4相关自身免疫性胰腺炎临床及超声内镜特征分析

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中华消化内镜杂志 2024年第2期41卷 127-130页

作者：孙红翼柴宁莉李金平李惠凯王祥耀茹楠令狐恩强南开大学医学院天津300071 解放军总医院第一医学中心消化内科医学部北京100853

目的分析弥漫型与局灶型IgG4相关自身免疫性胰腺炎(IgG4-related autoimmune pancreatitis,IgG4-AIP)的临床及超声内镜检查(endoscopic ultrasonography,EUS)结果差异。方法回顾性收集2011年9月至2022年4月于解放军总医院行EUS并临床诊断为IgG4-AIP的患者资料,对一般临床资料、EUS特征、术后病理等相关资料进行描述,获得特征差异。结果共纳入40例患者,年龄(60.03±10.87)岁,男性多见(85.0%,34/40)。所有患者行EUS,其中28例患者行EUS引导下细针穿刺。40例患者中,29例(72.5%)为弥漫型,11例(27.5%)为局灶型。弥漫型患者中腹痛[65.5%(19/29)比18.2%(2/11),χ^(2)=5.393,P=0.020]和胆管壁增厚[51.7%(15/29)比9.1%(1/11),χ^(2)=4.394,P=0.036]更多见,局灶型患者中主胰管扩张[45.5%(5/11)比10.3%(3/29),χ^(2)=4.146,P=0.042]更多见,且病灶位置以胰头最常见(90.9%,10/11)。两组在慢性胰腺炎实质改变上差异无统计学意义[34.5%(10/29)比27.3%(3/11),χ^(2)=0.003,P=0.955]。结论弥漫型和局灶型AIP在腹痛及胆胰管病变中具有一定差异,慢性胰腺炎特征在两组中均未见高水平表达,这对临床实践中的AIP分型有提示作用。

关键词：胰腺炎自身免疫性 IgG4相关自身免疫性胰腺炎临床特征超声内镜

Long-term outcomes of peroral endoscopic myotomy with simultaneous submucosal and muscle dissection (POEM-SSMD) for achalasia with severe interlayer adhesions

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Chinese Medical Journal 2022年第6期135卷 724-726页

作者： Jiancong Feng ningli chai Wengang Zhang Longsong Li Xiaowei Tang Jiale Zou Lu Ye Enqiang Linghu Medical School of Chinese People's Liberation Army Beijing 100853China Department of Gastroenterology and Hepatology The First Medical Center of Chinese People's Liberation Army General HospitalBeijing 100853China

Many previous studies have confirmed the effectiveness and safety of peroral endoscopic myotomy(POEM)to treat ***,severe interlayer adhesions preclude the establishment of a submucosal tunnel and then result in aborted POEM *** address this challenge,we introduced POEM with simultaneous submucosal and muscle dissection(POEM-SSMD)in 2014.[1]During the short-term follow-up,the symptoms of the patient were significantly ***,for patients with esophageal interlayer adhesions,the relative indications of POEM may be ***,only a few case reports using this technique with a shorter follow-up have been published to ***,the present study aimed to further report the long-term outcomes of POEM-SSMD for achalasia with severe interlayer adhesions in a relatively larger population.

关键词： dissection interlayer simultaneous

Outcomes of super minimally invasive surgery *** for superficial esophageal squamous cell carcinoma:a single-center study based on propensity score matching

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Chinese Medical Journal 2022年第20期135卷 2491-2493页

作者： Jiancong Feng ningli chai Enqiang Linghu Xiuxue Feng Longsong Li Chen Du Wengang Zhang Qingzhen Wu Medical School of Chinese People's Liberation Army Beijing 100853China Department of Gastroenterology and Hepatology The First Medical Center of Chinese People's Liberation Army General HospitalBeijing 100853China

Super minimally invasive surgery(SMIS)is a new concept proposed in 2016,which is defined as“curing the disease while preserving the integrity of human organ anatomy.”[1]Its concept has been accepted by the World Endoscopy Organization and Chinese Society of Digestive *** obvious advantage of SMIS is to cure diseases without damaging the structure and function of *** cancer patients,it can ensure a normal survival time and postoperative quality of life(QoL).

关键词： superficial anatomy surgery