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New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy

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World Journal of Gastroenterology 2013年第4期19卷 556-560页

作者： Hui-Kai Li en-qiang linghu Department of Gastroenterology PLA General Hospital

AIM:To propose a new endoscopic classification of achalasia for selecting patients appropriate for undergoing peroral endoscopic myotomy(POEM).METHODS:We screened out the data of patients with achalasia examined from October 2000 to September 2011 at our Digestive endoscopic Center with endoscopic pictures clear enough to reveal the morphology of middle and lower *** analyzing the correlation between the endoscopic morphology of the esophageal lumen and POEM,we proposed a new endoscopic classification(Ling classification) of achalasia according to three kinds of endoscopically viewed structures:multi-ring structure,crescent-like structure and diverticulum *** were three types based on the criteria of Ling classification:type Ⅰ,smooth without multi-ring,crescent-like structure or diverticulum structure;type Ⅱ,with multi-ring or crescent-like structure but without diverticulum structure;and type Ⅲ,with diverticulum *** Ⅱ was classified into three subtypes:Ling Ⅱa,Ling Ⅱb and Ling Ⅱc;and type Ⅲ also had three subtypes:Ling Ⅲl,Ling Ⅲr and Ling Ⅲ*** endoscopists made a final decision upon mutual agreement through discussion if their separately recorded characteristics were ***:Among the 976 screened patients with achalasia,636 patients with qualified endoscopic pictures were selected for the analysis,including 405 males and 231 *** average age was 42.7 years,ranging from 6 to 93 *** Ⅰ was the most commonly observed type of achalasia,accounting for 64.5%(410/636),and type Ⅲ was the least commonly observed type of achalasia,accounting for 2.8%(18/636).And type Ⅱ accounted for 32.7%(208/636) and subtype of Ling Ⅱa,Ling Ⅱb and Ling Ⅱc accounted for 14.6%(93/636),9.9%(63/636) and 8.2%(52/636),*** subtype of Ling Ⅲl,Ling Ⅲr and Ling Ⅲlr accounted for 0.8%(5/636),0.3%(2/636) and 1.7%(11/636),***:A new endoscopic classification of achalasia is proposed that might help in determini

关键词： endoscopy Classification Achalasia Selection Peroral endoscopic myotomy

Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy: A retrospective study at a single center

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World Journal of Gastroenterology 2017年第9期23卷 1637-1644页

作者： Wen-Gang Zhang en-qiang linghu Hui-Kai Li Departmen of Gastroenterology Chinese PLA General HospitalBeijing 100853China

AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy(POEM).METHODS Twenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, Eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy(EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during *** All 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had ahole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients(two patients required 5 m L fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d(range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furth

关键词： Fibrin sealant Mucosal penetration Peroral endoscopic myotomy Efficacy Safety

Reveal more mechanisms of precondition mesenchymal stem cells inhibiting inflammation

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World Journal of Stem Cells 2024年第4期16卷 459-461页

作者： Yi Li Qian-Qian Chen en-qiang linghu Department of Gastroenterology First Medical Center of Chinese PLA General HospitalBeijing 100853China Department of Gastroenterology and Hepatology First Medical Center of Chinese PLA General HospitalBeijing 100853China

Hypoxia can get more ability to inhibit *** how it impact on survival time of mesenchymal stem cells(MSCs)is confusing and how preconditioned MSCs inhibiting inflammation are partially *** issues decided the value of ... 详细信息

关键词： Mesenchymal stem cell Hypoxia-inducible factor 1α Hypoxia Inflammation Macrophage

endoscopic submucosal tunnel dissection for largesuperficial esophageal squamous cell neoplasms

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World Journal of Gastroenterology 2016年第1期22卷 435-445页

作者： Ya-Qi Zhai Hui-Kai Li en-qiang linghu Department of Gastroenterology and Hepatology Chinese People’s Liberation Army General HospitalBeijing 100853China

endoscopic submucosal dissection(ESD)is a wellestablished treatment for superficial esophageal squamous cell neoplasms(SESCNs)with no risk of lymphatic ***,for large SESCNs,especially when exceeding two-thirds of the esophageal circumference,conventional ESD is time-consuming and has an increased risk of adverse *** on the submucosal tunnel conception,endoscopic submucosal tunnel dissection(ESTD)was first introduced by us to remove large SESCNs,with excellent *** from different centers also reported favorable *** with conventional ESD,ESTD has a more rapid dissection speed and R0 resection *** in China,ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique,as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis ***,not all patients with SESCNs are candidates for ESTD,and postoperative esophageal strictures should also be taken into consideration,especially for lesions with a circumference greater than *** this article,we describe our experience,review the literature of ESTD,and provide detailed information on indications,standard procedures,outcomes,and complications of ESTD.

关键词： endoscopic submucosal tunnel dissection Esophageal squamous cell neoplasms Digestiveendoscopic tunnel technique endoscopic submucosaldissection

New classifications of intraoperative bleeding and muscularis propria injury in endoscopic resection

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Chinese Medical Journal 2019年第15期132卷 1856-1858页

作者： en-qiang linghu Department of Gastroenterology and Hepatology Chinese PLA General Hospital Beijing 100853 China

With the development of endoscopic techniques and equipment,endoscopic surgery has been widely performed to treat many diseases,such as early gastrointestinal cancer,submucosal tumors,and *** surgery can be classified as digestive endoscopic tunnel technique (DETT) and non-tunnel *** non-tunnel technique includes endoscopic mucosal resection,endoscopic piecemeal mucosal resection,endoscopic submucosal dissection (ESD),multi-band mucosectomy,endoscopic submucosal excavation,and endoscopic full-thickness resection.[1] endoscopic submucosal tunnel dissection (ESTD),peroral endoscopic myotomy (POEM),and submucosal tunneling endoscopic resection (STER) are considered types of *** resection is safer and more minimally invasive than open surgery and video-assisted surge ry.[2,3] The complication rate of resection is regarded as the main standard to evaluate the safety of endoscopic surgery,while bleeding and “perforation” are reported to be the most common intraoperative complications.[4,5]

关键词： endoscopic resection intraoperative bleeding muscularis propria injury

Ling classification describes endoscopic progressive process of achalasia and successful peroral endoscopy myotomy prevents endoscopic progression of achalasia

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World Journal of Gastroenterology 2017年第18期23卷 3309-3314页

作者： wen-gang zhang en-qiang linghu ning-li chai hui-kai li Department of Gastroenterology Chinese PLA General Hospital

AIM To verify the hypothesis that the Ling classification describes the endoscopic progressive process of achalasia and determine the ability of successful peroral endoscopic myotomy (POEM) to prevent endoscopic progression of achalasia. METHODS We retrospectively reviewed the endoscopic findings, symptom duration, and manometric data in patients with achalasia. A total of 359 patients (197 women, 162 men) with a mean age of 42.1 years (range, 12-75 years) were evaluated. Symptom duration ranged from 2 to 360 mo, with a median of 36 mo. Patients were classified with Ling type I (n = 119), II a (n = 106),II b (n = 60),II c (n = 60), or III (n = 14), according to the Ling classification. Of the 359 patients, 349 underwent POEM, among whom 21 had an endoscopic follow-up for more than 2 years. Pre-treatment and post-treatment Ling classifications of these 21 patients were compared. RESULTS Symptom duration increased significantly with increasing Ling classification (from I to III) (p ence in sex ratio or onset age among the Ling types, although the age at time of diagnosis was higher in Ling types I c and III than in Ling types I, IIa, and I b. Of the 21 patients, 19 underwent high-resolution manometry both before and after treatment. The mean preoperative and postoperative lower esophageal sphincter pressure were 34.6 mmHg (range, 15.3-59.4 mmHg) and 15.0 mmHg (range, 2.1-21.6 mmHg), respectively, indicating a statistically significant decrease after POEM. All of the 21 patients were treated successfully by POEM (postoperative Eckardt score ents the endoscopic progressive process of achalasia and may be able to serve as an endoscopic assessment criterion for achalasia. Successful POEM (Eckardt sco

关键词： Ling classification Achalasia Progression Peroral endoscopic myotomy endoscopy

Autophagy and its role in gastrointestinal diseases

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World Journal of Gastroenterology 2024年第36期30卷 4014-4020页

作者： Bo-Zong Shao Wen-Gang Zhang Zhen-Yu Liu en-qiang linghu Department of Gastroenterology First Medical Center of Chinese People’s Liberation Army General HospitalBeijing 100853China

Gastrointestinal disorders encompass a spectrum of conditions affecting various organs within the digestive system,such as the esophagus,stomach,colon,rectum,pancreas,liver,small intestine,and bile *** role of autophagy in the etiology and progression of gastrointestinal diseases has garnered significant *** paper seeks to evaluate the impact and mechanisms of autophagy in gastrointestinal disorders by synthesizing recent research ***,we delve into inflammation-related gastrointestinal conditions,including ulcerative colitis,Crohn’s disease,and pancreatitis,as well as gastrointestinal cancers such as esophageal,gastric,and colorectal ***,we provide commentary on a recent publication by Chang et al in the World Journal of *** objective is to offer fresh perspectives on the mechanisms and therapeutic approaches for these gastrointestinal *** review aims to offer new perspectives on the mechanisms and therapeutic strategies for gastrointestinal disorders by critically analyzing relevant *** discussed,the role of autophagy in gastrointestinal diseases is complex and,at times,*** harness the full therapeutic potential of autophagy in treating these conditions,more in-depth research is imperative.

关键词： Autophagy Inflammation Cancer Inflammatory bowel disease Pancreatitis

endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms

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World Journal of Gastroenterology 2020年第23期26卷 3213-3224页

作者： Chen Du Ning-Li Chai en-qiang linghu Hui-Kai Li Xiu-Xue Feng Department of Gastroenterology and Hepatology Chinese PLA General HospitalBeijing 100853China

With the development of cross-sectional imaging modalities and the increasing attention being paid to physical examinations, the prevalence of pancreatic cystic neoplasms(PCNs) has increased. PCNs comprise a broad differential spectrum with some PCNs having low or no malignant potential and others having high malignant potential. The morbidity and mortality rates related to major pancreatic surgical resection are high. Long-term surveillance may not only increase the financial burden and psychological stress for patients but also result in a missed malignancy. Minimally invasive endoscopic ultrasound(EUS)-guided ethanol ablation was first reported in 2005. Several other agents, such as paclitaxel, lauromacrogol, and gemcitabine, were reported to be effective and safe for the treatment of PCNs. These ablative agents are injected through a needle inserted into the cyst via transgastric or transduodenal puncture. This treatment method has been substantially developed in the last 15 years and is regarded as a promising treatment to replace surgical resection for PCNs. While several reviews of EUS-guided ablation have been published, no systematic review has evaluated this method from patient preparation to follow-up in detail. In the present review, we systematically describe EUS-guided injective ablation with regard to the indications, contraindications, preoperative treatment, endoscopic procedure, postoperative care and follow-up, evaluation method, treatment efficiency, safety profile, tips and tricks, and current controversies and perspectives.

关键词： endoscopic ultrasound-guided ablation Pancreatic cystic neoplasm Ethanol Paclitaxel Lauromacrogol Gemcitabine

Umbilical cord-derived mesenchymal stem cells alleviate liver fibrosis in rats

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World Journal of Gastroenterology 2016年第26期22卷 6036-6048页

作者： Ning-Li Chai Xiao-Bin Zhang Si-Wen Chen Ke-Xing Fan en-qiang linghu Department of Gastroenterology PLA General Hospital Department of Gastroenterology Nan Lou Clinic PLA General Hospital Institute of Oncology the Second Military Medical University

AIM: To evaluate the efficacy of umbilical cord-derived mesenchymal stem cells(UC-MSCs) transplantation in the treatment of liver ***: Cultured human UC-MSCs were isolated and transfused into rats with liver fibrosis induced by dimethylnitrosamine(DMN). The effects of UC-MSCs transfusion on liver fibrosis were then evaluated by histopathology; serum interleukin(IL)-4 and IL-10 levels were also measured. Furthermore, Kupffer cells(KCs) in fibrotic livers were isolated and cultured to analyze their phenotype. Moreover, UC-MSCs were cocultured with KCs in vitro to assess the effects of UCMSCs on KCs' phenotype, and IL-4 and IL-10 levels were measured in cell culture supernatants. Finally, UCMSCs and KCs were cultured in the presence of IL-4 antibodies to block the effects of this cytokine, followed by phenotypical analysis of ***: UC-MSCs transfused into rats were recruited by the injured liver and alleviated liver fibrosis, increasing serum IL-4 and IL-10 levels. Interestingly, UC-MSCs promoted mobilization of KCs not only in fibrotic livers, but also in vitro. Co-culture of UC-MSCs with KCs resulted in increased production of IL-4 and IL-10. The addition of IL-4 antibodies into the coculture system resulted in decreased KC ***: UC-MSCs could increase IL-4 and promote mobilization of KCs both in vitro and in vivo, subsequently alleviating the liver fibrosis induced by DMN.

关键词： Liver fibrosis Mesenchymal stem cells Kupffer cells Interleukin-4 Dimethylnitrosamine DMN