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endoscopic features and treatments of gastric cystica profunda

World Journal of Gastroenterology 2024年第7期30卷 673-684页

作者： Zi-Han Geng Yan Zhu Pei-Yao Fu Yi-Fan Qu Wei-Feng Chen Xia Yang Ping-Hong Zhou Quan-Lin Li Endoscopy Center and Endoscopy Research Institute Zhongshan HospitalFudan UniversityShanghai 200032China

BACKGROUND Gastric cystica profunda(GCP)represents a rare condition characterized by cystic dilation of gastric glands within the mucosal and/or submucosal layers.GCP is often linked to,or may progress into,early gastric cancer(EGC).AIM To provide a comprehensive evaluation of the endoscopic features of GCP while assessing the efficacy of endoscopic treatment,thereby offering guidance for diagnosis and treatment.METHODS This retrospective study involved 104 patients with GCP who underwent endoscopic resection.Alongside demographic and clinical data,regular patient followups were conducted to assess local recurrence.RESULTS Among the 104 patients diagnosed with GCP who underwent endoscopic resection,12.5%had a history of previous gastric procedures.The primary site predominantly affected was the cardia(38.5%,n=40).GCP commonly exhibited intraluminal growth(99%),regular presentation(74.0%),and ulcerative mucosa(61.5%).The leading endoscopic feature was the mucosal lesion type(59.6%,n=62).The average maximum diameter was 20.9±15.3 mm,with mucosal involvement in 60.6%(n=63).Procedures lasted 73.9±57.5 min,achieving complete resection in 91.3%(n=95).Recurrence(4.8%)was managed via either surgical intervention(n=1)or through endoscopic resection(n=4).Final pathology confirmed that 59.6%of GCP cases were associated with EGC.Univariate analysis indicated that elderly males were more susceptible to GCP associated with EGC.Conversely,multivariate analysis identified lesion morphology and endoscopic features as significant risk factors.Survival analysis demonstrated no statistically significant difference in recurrence between GCP with and without EGC(P=0.72).CONCLUSION The findings suggested that endoscopic resection might serve as an effective and minimally invasive treatment for GCP with or without EGC.

关键词： Gastric cystica profunda Early gastric cancer endoscopic features endoscopic resection Endoscopy

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endoscopic classification and pathological features of primary intestinal lymphangiectasia

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World Journal of Gastroenterology 2022年第22期28卷 2482-2493页

作者： Ming-Ming Meng Kui-Liang Liu Xin-Ying Xue Kun Hao Jian Dong Chun-Kai Yu Hong Liu Cang-Hai Wang Hui Su Wu Lin Guo-Jun Jiang Nan Wei Ren-Gui Wang Wen-Bin Shen Jing Wu Department of Gastroenterology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Respiratory and Critical Care Medicine Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Departments of Lymphatic Surgery Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Departments of Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Departments of Pathology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND The appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia(PIL).AIM To classify the endoscopic features of the intestinal mucosa in PIL under endoscopy,combine the patients’imaging and pathological characteristics of the patients,and explain their causes.METHODS We retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1,2007 and December 31,2018.We compared and analyzed all endoscopic images,classified them into four types according to the endoscopic features of the intestinal mucosa,and analyzed the post-lymphographic computed tomography(PLCT)and pathological characteristics of each type.RESULTS According to the endoscopic features of PIL in 123 patients observed during endoscopy,they were classified into four types:nodular-type,granular-type,vesicular-type,and edematous-type.PLCT showed diffuse thickening of the small intestinal wall,and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types.Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types.Analysis of the small intestinal mucosal pathology revealed that nodular-type and granulartype lymphangiectasia involved the small intestine mucosa in four layers,whereas ectasia of the vesicular-and edematous-type lymphatic vessels largely involved the lamina propria mucosae,submucosae,and muscular layers.CONCLUSION endoscopic classification,combined with the patients’clinical manifestations and pathological examination results,is significant and very useful to clinicians when scoping patients with suspected PIL.

关键词： Primary intestinal lymphangiectasia endoscopic features Post-lymphangiographic computed tomography Pathology

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Usefulness of analyzing endoscopic features in identifying the colorectal serrated sessile lesions with and without dysplasia

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World Journal of Clinical Cases 2023年第29期11卷 6995-7003页

作者： Rui-Gang Wang Yu-Tang Ren Xuan Jiang Lai Wei Xiao-Fei Zhang Hao Liu Bo Jiang Department of Gastroenterology Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China Center for Hepatobiliary and Pancreatic Diseases Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China Center for Clinical Epidemiology and Statistics Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China Department of Pathology Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China

BACKGROUND Sessile serrated lesions(SSLs)are often missed on colonoscopy,and studies have shown this to be an essential cause of interstitial colorectal cancer.The SSLs with dysplasia(SSL-D+),in particular,have a faster rate of carcinogenesis than conventional tubular adenomas.Therefore,there is a clinical need for some endoscopic features with independent diagnostic value for SSL-D+s to assist endoscopists in making immediate diagnoses,thus improving the quality of endoscopic examination and treatment.AIM To compare the characteristics of SSLs,including those with and without dysplasia(SSL-D+and SSL-D-),based on white light and image-enhanced endoscopy,to achieve an immediate differential diagnosis for endoscopists.METHODS From January 2017 to February 2023,cases of colorectal SSLs confirmed by colonoscopy and histopathology at the Gastrointestinal Endoscopy Center of Beijing Tsinghua Changgung Hospital were collected.The general,endoscopic,and histopathological data were reviewed and analyzed to determine the diagnostic utility.Univariate analysis was used to find potential diagnostic factors,and then multivariate regression analysis was performed to derive endoscopic features with independent diagnostic values for the SSL-D+.RESULTS A total of 228 patients with 253 lesions were collected as a result.There were 225 cases of colorectal SSL-D-s and 28 cases of SSL-D+s.Compared to the colorectal SSL-D-,the SSL-D+was more common in the right colon(P=0.027)with complex patterns of depression,nodule,and elevation based on cloud-like surfaces(P=0.003),reddish(Pendoscopic feature that

关键词： Sessile serrated lesions Dysplasia endoscopic features

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Current progress on the endoscopic features of colorectal sessile serrated lesions

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World Journal of Clinical Oncology 2023年第4期14卷 171-178页

作者： Rui-Gang Wang Lai Wei Bo Jiang Department of Gastroenterology Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China Department of Digestive Medicine Beijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijing 102218China

Along with the discovery and refinement of serrated pathways,the World Health Organization amended the classification of digestive system tumors in 2019,recommending the renaming of sessile serrated adenomas/polyps to sessile serrated lesions(SSLs).Given the particularity of the endoscopic appearance of SSLs,it could easily be overlooked and missed in colonoscopy screening,which is crucial for the occurrence of interval colorectal cancer.Existing literature has found that adequate bowel preparation,reasonable withdrawal time,and awareness of colorectal SSLs have improved the quality and accuracy of detection.More particularly,with the continuous advancement and development of endoscopy technology,equipment,and accessories,a potent auxiliary tool is provided for accurate observation and immediate diagnosis of SSLs.Highdefinition white light endoscopy,chromoendoscopy,and magnifying endoscopy have distinct roles in the detection of colorectal SSLs and are valuable in identifying the size,shape,character,risk degree,and potential malignant tendency.This article delves into the relevant factors influencing the detection rate of colorectal SSLs,reviews its characteristics under various endoscopic techniques,and expects to attract the attention of colonoscopists.

关键词： Colorectal cancer Sessile serrated lesions endoscopic features

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Chicken skin mucosa surrounding small colorectal cancer could be an endoscopic predictive marker of submucosal invasion

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 1062-1072页

作者： Ying-Jie Zhang Wu Wen Fan Li Yi Jian Chuan-Ming Zhang Meng-Xia Yuan Ye Yang Feng-Lin Chen Department of Digestive Diseases Chengdu Second People’s HospitalChengdu 610000Sichuan ProvinceChina Graduate School Chengdu Medical CollegeChengdu 610000Sichuan ProvinceChina

BACKGROUND Chicken skin mucosa(CSM)surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening.Although reports about CSM surrounding small colorectal cancer are scarce,and its clinical significance in intramucosal and submucosal cancers is unclear,previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps.Currently,because of the inaccurate preoperative evaluation by endoscopists,many small colorectal cancers,particularly lesions with a diameterendoscopic or surgical treatment,including endoscopic mucosal resection and submucosal dissection.Clinical pathology and endoscopy parameters,including tumor size,invasion depth,anatomical position,and morphology,were reviewed.Fisher’s exact test,theχ2 test,and Student’s t-test were used to analyze the patient’s basic characteristics.Logistic regression analysis was used to examine the relationship between morphological characteristics,size,CSM prevalence,and ECC invasion depth under white light endoscopy.Statistical significance was set at P<0.05.RESULTS The submucosal carcinoma(SM stage)was larger than the mucosal carcinoma(M stage)with a significant difference(17.2±4.1 vs 13.4±4.6 mm,P<0.01).M-and SM-stage cancers were common in the left colon;however,no significant differences were found between

关键词： Chicken skin mucosa Colonoscopy Colorectal cancer Submucosal invasion White light endoscopy endoscopic features

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Construction and analysis of an ulcer risk prediction model after endoscopic submucosal dissection for early gastric cancer

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1823-1832页

作者： San-Dong Gong Huan Li Yi-Bin Xie Xiao-Hui Wang Department of Gastroenterology Hainan Hospital of Chinese PLA General HospitalSanya 572013Hainan ProvinceChina Department of Gastroenterology Sixth Medical Center of Chinese PLA General HospitalBeijing 100048China Department of Pancreatic and Gastric Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

BACKGROUND endoscopic submucosal dissection(ESD) has been widely used in the treatment of early gastric cancer(EGC). A personalized and effective prediction method for ESD with EGC is urgently needed.AIM To construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression.METHODS A total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were divided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic(ROC) curve was used to estimate the predictive model performance.RESULTS One month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41%(40/196)(ulcer group), and the incidence of no ulcers was 79.59%(156/196)(non-ulcer group). There were statistically significant differences in the course of disease, Helicobacter pylori infection history, smoking history, tumor number, clopidogrel medication history, lesion diameter, infiltration depth, convergent folds, and mucosal discoloration between the groups. Gray’s medication history, lesion diameter, convergent folds, and mucosal discoloration, which were the 4 nonzero regression coefficients, were screened by LASSO regression analysis. Further multivariate logistic analysis showed that lesion diameter [Odds ratios(OR) = 30.490, 95%CI: 8.584-108.294], convergent folds(OR = 3.860, 95%CI: 1.060-14.055), mucosal discoloration(OR = 3.191, 95%CI: 1.016-10.021), and history of clopidogrel(OR = 3.554, 95%CI: 1.009-12.515) were independent risk factors for ulcers after ESD in patients with EGC(P < 0.05). The ROC curve showed that the area under the curve of the risk predic

关键词： endoscopic submucosal dissection Early gastric cancer endoscopic features Ulcer Model

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endoscopic and pathological characteristics of de novo colorectal cancer:Retrospective cohort study

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World Journal of Gastroenterology 2023年第18期29卷 2836-2849页

作者： Shi-Yang Li Mei-Qi Yang Yi-Ming Liu Ming-Jun Sun Hui-Jing Zhang Department of Endoscopy The First Affiliated Hospital of China Medical UniversityShenyang 110001Liaoning ProvinceChina

BACKGROUND Endoscopy has rapidly developed in recent years and has enabled further investigation into the origin and features of intestinal tumors.The small size and concealed position of these tumors make it difficult to distinguish them from nonneoplastic polyps and carcinoma in adenoma(CIA).The invasive depth and metastatic potential determine the operation regimen,which in turn affects the overall survival and distant prognosis.The previous studies have confirmed the malignant features and clinicopathological features of de novo colorectal cancer(CRC).AIM To provide assistance for diagnosis and treatment,but the lack of a summary of endoscopic features and assessment of risk factors that differ from the CIA prompted us to conduct this retrospective study.METHODS In total,167 patients with small-sized CRCs diagnosed by endoscopy were reviewed.The patients diagnosed as advanced CRCs and other malignant cancers or chronic diseases that could affect distant outcomes were excluded.After screening,63 cases were excluded,including 33 de novo and 30 CIA cases.Patient information,including their follow-up information,was obtained from an electronic His-system.The characteristics between two group and risk factors for invasion depth were analyzed with SPSS 25.0 software.RESULTS Nearly half of the de novo CRCs were smaller than 1 cm(n=16,48.5%)and the majority were located in the distal colon(n=26,78.8%).The IIc type was the most common macroscopic type of de novo CRC.In a Pearson analysis,the differential degree,Sano,JNET,and Kudo types,surrounding mucosa,and chicken skin mucosa(CSM)were correlated with the invasion depth(Pendoscopic ultrasound.A high degree of tumor budding and tumor-infiltrating lymphocytes are accompanied by malignancy.Finally,de novo CRCs have worse outcomes than CIA CRCs.CONCLUSION This is the first comprehensive study to analyze the features of de novo CRCs to distinguish them from nonneoplastic polyps.It is als

关键词： De novo colorectal cancer Carcinoma in adenoma endoscopic features Clinical characteristics Pathological features

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endoscopic diagnosis for colorectal sessile serrated lesions

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World Journal of Gastroenterology 2021年第13期27卷 1321-1329页

作者： Toshihiro Nishizawa Shuntaro Yoshida Akira Toyoshima Tomoharu Yamada Yoshiki Sakaguchi Taiga Irako Hirotoshi Ebinuma Takanori Kanai Kazuhiko Koike Osamu Toyoshima Department of Gastroenterology and Hepatology International University of Health and Welfare Narita HospitalNarita 2868520Japan Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 1570066Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 1508935Japan Department of Gastroenterology The University of TokyoTokyo 1138655Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal Medicine Irako ClinicTokyo 1560052Japan Division of Gastroenterology and Hepatology Department of Internal MedicineKeio University School of MedicineShinjuku-ku 1608582TokyoJapan

BACKGROUND Hyperplastic polyps are considered non-neoplastic, whereas sessile serrated lesions(SSLs) are precursors of cancer via the ‘‘serrated neoplastic pathway’’. The clinical features of SSLs are tumor size(> 5 mm), location in the proximal colon, coverage with abundant mucus called the ‘‘mucus cap’’, indistinct borders, and a cloud-like surface. The features in magnifying narrow-band imaging are varicose microvascular vessels and expanded crypt openings. However, accurate diagnosis is often difficult.AIM To develop a diagnostic score system for SSLs.METHODS We retrospectively reviewed consecutive patients who underwent endoscopic resection during colonoscopy at the Toyoshima endoscopy clinic. We collected data on serrated polyps diagnosed by endoscopic or pathological examination. The significant factors for the diagnosis of SSLs were assessed using logistic regression analysis. Each item that was significant in multivariate analysis was assigned 1 point, with the sum of these points defined as the endoscopic SSL diagnosis score. The optimal cut-off value of the endoscopic SSL diagnosis score was determined by receiver-operating characteristic curve analysis.RESULTS Among 1288 polyps that were endoscopically removed, we analyzed 232 diagnosed as serrated polyps by endoscopic or pathological examination. In the univariate analysis, the location(proximal colon), size(> 5 mm), mucus cap, indistinct borders, cloud-like surface, and varicose microvascular vessels were significantly associated with the diagnosis of SSLs. In the multivariate analysis, size(> 5 mm;P = 0.033), mucus cap(P = 0.005), and indistinct borders(P = 0.033) were independently associated with the diagnosis of SSLs. Size > 5 mm, mucus cap, and indistinct borders were assigned 1 point each and the sum of these points was defined as the endoscopic SSL diagnosis score. The receiver-operating characteristic curve analysis showed an optimal cut-off score of 3, which predicted pathological SSLs with 75% sensitivity, 80% specificity, and 78.4% accura

关键词： Sessile serrated lesion Mucus cap Indistinct borders Hyperplastic polyp endoscopic features Size

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