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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 ling type (from I to III) (p 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 ling type during a mean follow-up period of 37.8 mo (range, 24-51 mo). CONCLUSION The ling classification represents 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

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

SGK3 overexpression correlates with a poor prognosis in endoscopically resected superficial esophageal squamous cell neoplasia:A long-term study

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World Journal of Gastroenterology 2023年第23期29卷 3658-3667页

作者： ning Xu Long-Song li Hui li li-Hua Zhang Nan Zhang Peng-Ju Wang Ya-Xuan Cheng Jing-Yuan Xiang En-Qiang linghu ning-li chai Senior Department of Gastroenterology The First Medical Center of PLA General HospitalBeijing 100853China Department of Gastroenterology Air Force Medical CenterBeijing 100142China Department of Pathology The Fourth Medical Center of PLA General HospitalBeijing 100142China

BACKGROUND The expression status of serum and glucocorticoid-induced protein kinase 3(SGK3)in superficial esophageal squamous cell neoplasia(ESCN)remains *** To evaluate the SGK3 overexpression rate in ESCN and its influence on the prognosis and outcomes of patients with endoscopic *** A total of 92 patients who had undergone endoscopic resection for ESCN with more than 8 years of follow-up were *** was used to evaluate SGK3 *** SGK3 was overexpressed in 55(59.8%)patients with ***3 overexpression showed a significant correlation with death(P=0.031).Overall survival and disease-free survival rates were higher in the normal SGK3 expression group than in the SGK3 overexpression group(P=0.013 and P=0.004,respectively).Cox regression analysis models demonstrated that SGK3 overexpression was an independent predictor of poor prognosis in ESCN patients(hazard ratio 4.729;95% confidence interval:1.042-21.458).CONCLUSION SGK3 overexpression was detected in the majority of patients with endoscopically resected ESCN and was significantly associated with shortened ***,it might be a new prognostic factor for ESCN.

关键词： Superficial esophageal squamous cell neoplasia Serum and glucocorticoid-induced protein kinase Endoscopic submucosal dissection Immunohistochemistry Overall survival

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

Endoscopic trans-esophageal submucosal tunneling surgery:A new therapeutic approach for diseases located around the aorta ventralis

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World Journal of Gastroenterology 2019年第1期25卷 85-94页

作者： Ying Xiong Qian-Qian Chen ning-li chai Shun-Chang Jiao En-Qiang ling Hu Department of Gastroenterology and Hepatology Chinese PLA General HospitalBeijing 100853China Department of Gastroenterology and Hepatology No.1 Central Hospital of BaodingBaoding 071000Hebei ProvinceChina Department of Oncology Chinese PLA General HospitalBeijing 100853China

AIM To assess the efficiency of endoscopic trans-esophageal submucosal tunneling surgery(EESTS) technique for diseases located around the aorta *** Nine pigs were assigned to EESTs. The procedures were as follows: First, a long esophageal submucosal tunnel was established. Second, full-thickness myotomy was created. Third, an endoscope was entered into the abdominal cavity through a muscle incision and the endoscope was around the aorta ventralis. Eventually,celiac trunk ganglion neurolysis, partial hepatectomy and splenectomy, partial tissue resection in the area of the posterior peritoneum, and endoscopic submucosal dissection(ESD) combined with lymph node dissection were performed. The animals were given antibiotics for 5 d and necropsied 7 d after *** In all surgeries, one pig died from intraperitoneal hemorrhage after doing partial splenectomy, while the other pigs were alive after successfully operating other surgeries. For surgery of celiac trunk ganglion damage, at necropsy, there was no exudation in the abdominal cavity. Regarding surgery of partial hepatectomy, the wound with part healing was observed in the left hepatic lobe, and no bleeding or obvious exudation was seen. In surgery of partial splenectomy, massive hemorrhage was observed on the splenic wound surface, and the metal clips could not stop bleeding. After surgery of retroperitoneal tissue resection, mild tissue adhesion was observed in the abdominal cavity of one animal, and another one suffered from severe infection. For surgery of ESD and lymph node dissection, a moderate tissue adhesion was *** EESTS is a feasible and safe technique for diseases located around the aorta ventralis.

关键词： Endoscopic trans-esophageal submucosal tunneling surgery Diseases around the aorta ventralis Endoscopic submucosal tunneling technique Abdominal surgery Animal model

Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia

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World Journal of Gastrointestinal Oncology 2022年第3期14卷 724-733页

作者： Nan-Jun Wang ning-li chai Xiao-Wei Tang Long-Song li Wen-Gang Zhang En-Qiang linghu Department of Gastroenterology and Hepatology The First Medical Center of Chinese PLA General HospitalBeijing 100853China

BACKGROUND The use of radiofrequency ablation(RFA)has been reported in the treatment of gastric low-grade intraepithelial neoplasia(LGIN).However,its efficacy and prognostic risk factors have not been well *** To explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large,long-term follow-up clinical *** The clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective *** on operative parameters,complications,and follow-up outcomes including curative rates were recorded and *** The curative rates of endoscopic RFA for gastric LGIN at 3 mo,6 mo,and 1-5 years after the operation were 93.3%,92.8%,91.5%,90.3%,88.5%,85.7%,and 83.3%,*** analyses revealed that Helicobacter pylori(***)infection and disease duration>1 year had a significant effect on the curative rate(Plications after RFA,and the main discomfort was postoperative abdominal *** RFA was safe and effective for gastric LGIN during long-term *** infection and disease course>1 year may be the main risk factors for relapse of LGIN after RFA.

关键词： Endoscopic radiofrequency ablation Gastric low-grade intraepithelial neoplasia Clinical efficacy Prognostic risk factors

Effect of polyglycolic acid sheet plus esophageal stent placement in preventing esophageal stricture after endoscopic submucosal dissection in patients with earlystage esophageal cancer: A randomized, controlled trial

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World Journal of Gastroenterology 2018年第9期24卷 1046-1055页

作者： ning-li chai Jia Feng Long-Song li Sheng-Zhen liu Chen Du Qi Zhang En-Qiang linghu Department of Gastroenterology Chinese PLA General Hospital

AIM To assess the effect of polyglycolic acid(PGA) plus stent placement compared with stent placement alone in the prevention of post-endoscopic submucosal dissection(ESD) esophageal stricture in early-stage esophageal cancer(EC) patients. METHODS Seventy EC patients undergoing ESD were enrolled in this randomized, controlled study. Patients were allocated randomly at a 1:1 ratio into two groups as follows:(1) PGA plus stent group(PGA sheet-coated stent placement was performed); and(2) Stent group(only stent placement was performed). This study was registered on http://***(No. chictrinr-16008709). RESULTS The occurrence rate of esophageal stricture in the PGA plus stent group was 20.5%(n = 7), which was lower than that in the stent group(46.9%, n = 15)(P = 0.024). The mean value of esophageal stricture time was 59.6 ± 16.1 d and 70.7 ± 28.6 d in the PGA plus stent group and stent group(P = 0.174), respectively. Times of balloon dilatation in the PGA plus stent group were less than those in the stent group [4(2-5) vs 6(1-14), P = 0.007]. The length(P = 0.080) and diameter(P = 0.061) of esophageal strictures were numerically decreased in the PGA plus stent group, whereas no difference in location(P = 0.232) between the two groups was found. Multivariate logistic analysis suggested that PGA plus stent placement(P = 0.026) was an independent predictive factor for a lower risk of esophageal stricture, while location in the middle third(P = 0.034) and circumferential range = 1/1(P = 0.028) could independently predict a higher risk of esophageal stricture in EC patients after ESD. CONCLUSION PGA plus stent placement is more effective in preventing post-ESD esophageal stricture compared with stent placement alone in EC patients with earlystage disease.

关键词： Esophageal cancer Endoscopic submucosal dissection Polyglycolic acid plus stent placement Esophageal stricture

Oxymatrine liposome attenuates hepatic fibrosis via targeting hepatic stellate cells

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World Journal of Gastroenterology 2012年第31期18卷 4199-4206页

作者： ning-li chai Qiang Fu Hui Shi Chang-Hao Cai Jun Wan Shi-Ping Xu Ben-Yan Wu Department of Gastroenterology South Build-ing of Chinese People's Liberation Army General Hospital Bei-jing 100853 China Department of Gastroenterology Xi'an Children'sHospital Xi'an 710002 Shaanxi Province China

AIM： To investigate the potential mechanism of Arg- Gly-Asp （RGD） peptide-labeled liposome loading oxy- matrine （OM） therapy in CCI4-induced hepatic fibrosis in rats. METHODS： We constructed a rat model of CCh- induced hepatic fibrosis and treated the rats with dif- ferent formulations of OM. To evaluate the antifibrotic effect of OM, we detected levels of alkaline phospha- tase, hepatic histopathology （hematoxylin and eosin stain and Masson staining） and fibrosis-related gene expression of matrix metallopeptidase （MMP）-2, tis- sue inhibitor of metalloproteinase （TIMP）-I as well as type I procollagen via quantitative real-time poly- merase chain reaction. To detect cell viability and apop- tosis of hepatic stellate cells （HSCs）, we performed 3-（4,5）-dimethylthiahiazo（-z-yl）-3,5-diphenytetrazoli- umromide assay and flow cytometry. To reinforce the combination of oxymatrine with HSCs, we constructed fluorescein-isothiocyanate-conjugated Arg-Gly-Asp peptide-labeled liposomes loading OM, and its targeting of HSCs was examined by fluorescent microscopy. RESULTS： OM attenuated CCh-induced hepatic fibro- sis, as defined by reducing serum alkaline phosphatase （344.47± 27.52 U/L vs 550.69 ± 43.78 U/L, P 〈 0.05）, attenuating liver injury and improving collagen deposits （2.36% ± 0.09% vs 7.70% ±0.60%, P 〈 0.05） and downregulating fibrosis-related gene expression, that is, MMP-2, TIMP-1 and type I procollagen （P 〈 0.05）. OM inhibited cell viability and induced apoptosis of HSCs in vitro. RGD promoted OM targeting of HSCs and en- hanced the therapeutic effect of OM in terms of serum alkaline phosphatase （272.51 ± 19.55 U/L vs 344.47 ± 27.52 U/L, P 〈 0.05）, liver injury, collagen deposits （0.26%± 0.09% vs 2.36% ± 0.09%, P 〈 0.05） and downregulating fibrosis-related gene expression, that is, MMP-2, TIMP-1 and type I procollagen （P 〈 0.05）. Moreover, in vitro assay demonstrated that RGD en- hanced the effect of OM on HSC viability and apoptosis. CONCLUSION： OM attenuated hepatic fi

关键词： Oxymatrine Arg-Gly-Asp peptide Hepaticstellate cell Hepatic fibrosis Target therapy

Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal

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World Journal of Gastroenterology 2012年第12期18卷 1295-1307页

作者： ning-li chai En-Qiang ling-Hu Yoshinori Morita Daisuke Obata Takashi Toyonaqa Takeshi Azuma Ben-Yan Wu Department of Gastroenterology Division of South Building Chinese People's Liberation ArmyGeneral Hospital Beijing 100853 China Department of Gastroenterology ChinesePeople's Liberation Army General Hospital Beijing 100853China TakeshiAzuma Department of gastroenterology and endoscopy KobeUniversity Graduate School of Medicine Kobe 650-0017 Japan

Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at *** submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent *** technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the ***,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in *** the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or ***,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying ***,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc *** will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.

关键词： Magnifying endoscopy with narrow-band im-aging Upper gastroenterology Assessment Endoscopicsubmucosal dissection Endoscopic mucosal resection