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Gastric endoscopic submucosal dissection in Western countries:Indications,applications,efficacy and training perspective

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World Journal of gastrointestinal Surgery 2021年第10期13卷 1180-1189页

作者： Luca De Luca Massimiliano Di Berardino Benedetto Mangiavillano Alessandro Repici Gastroenterology and Digestive endoscopy Unit Riuniti Marche North HospitalPesaro 61121Italy gastrointestinal endoscopy Unit Humanitas-Mater DominiCastellanza 21053Italy Digestive endoscopy Unit Humanitas Clinical and Research CenterHumanitas UniversityRozzano 20089Italy

Endoscopic submucosal dissection was introduced in Japan for the mini-invasive treatment of early gastric cancer,as part of national screening program considering high prevalence of disease in these latitudes.This technique allows en-bloc curative oncological excision and to obtain in a single step R0-resection,characterization,histological staging and potential cure of the tumor with a very high cost-benefit balance.Over the years,Western endoscopists have adopted endoscopic submucosal dissection,achieving good rates of efficacy,long-term improved outcomes and safety,with low risk of local recurrence comparable to those obtained in Asian institutes.However,according to some authors,the excellent outcomes from East country could not be representative of the Western experience.Despite epidemiological differences of early gastric cancer,scant volume data and limitations in training opportunities between Western and Eastern countries,European Society of gastrointestinal endoscopy have adopted Japanese guidelines and developed a European core curriculum for endoscopic submucosal dissection training.Endoscopists should be able to estimate the probability of performing a curative resection by considering the benefit/risk relationship case-by-case in order to implement a correct decision-making process.

关键词： Endoscopic submucosal dissection Western experience Early gastric cancer Curative oncological excision Long-term outcome Training perspective

Diagnostic performance of endoscopic ultrasound-guided tissue acquisition of splenic lesions:systematic review with pooled analysis

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Gastroenterology Report 2022年第1期10卷 356-362页

作者： Andrea Lisotti Stefano Francesco Crino` Benedetto Mangiavillano Anna Cominardi Andrew Ofosu Nicole Brighi Flavio Metelli Rocco Maurizio Zagari Antonio Facciorusso Pietro Fusaroli Gastroenterology Unit Hospital of ImolaUniversity of BolognaImolaItaly Department of Medicine Gastroenterology and Digestive Endoscopy UnitThe Pancreas InstituteUniversity Hospital of VeronaVeronaItaly gastrointestinal endoscopy Unit Humanitas—Mater Domini CastellanzaVareseItaly Gastroenterology and Hepatology Stanford UniversityStanfordCAUSA Department of Medical Oncology IRCSS Istituto Romagnolo per lo Studio dei Tumori(IRST)“Dino Amadori”MedolaItaly Department of Medical and Surgical Sciences—DIMEC University of BolognaBolognaItaly Department of Surgical and Medical Sciences Section of GastroenterologyUniversity of FoggiaFoggiaItaly

Background Focal splenic lesions are usually incidentally discovered on radiological assessments.Although percutaneous tissue acquisition(TA)under trans-abdominal ultrasound guidance is a well-established technique for obtaining cyto-histological diagnosis of focal splenic lesions,endoscopic ultrasound(EUS)-guided TA has been described in several studies,reporting different safety and outcomes.The aimwas to assess the pooled safety,adequacy,and accuracy of EUS-TA of splenic lesions.Methods A comprehensive review of available evidence was conducted at the end of November 2021.All studies including more than five patients and reporting about the safety,adequacy,and accuracy of EUS-TA of the spleen were included.Results Six studies(62 patients)were identified;all studies have been conducted using fine-needle aspiration(FNA)needles.Pooled specimen adequacy and accuracy of EUS-TA for spleen characterization were 92.8%[95%confidence interval(CI),86.3%–99.3%]and 88.2%(95%CI,79.3%–97.1%),respectively.The pooled incidence of adverse events(six studies,62 patients)was 4.7%(95%CI,0.4%–9.7%).Conclusion EUS-FNA of the spleen is a safe technique with high diagnostic adequacy and accuracy.The EUS-guided approach could be considered a valid alternative to the percutaneous approach for spleen TA.

关键词： biopsy cancer lymphoma metastasis leukemia

Safety and feasibility of laparoscopic pancreatoduodenectomy

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Hepatobiliary Surgery and Nutrition 2022年第2期11卷 330-332页

作者： Nobuhiko Nakagawa Yuichi Nagakawa Shingo Kozono Department of gastrointestinal and Pediatric Surgery Tokyo Medical UniversityTokyoJapan

Laparoscopic pancreaticoduodenectomy(LPD)has been safely performed by experts with favorable surgical outcomes.However,the feasibility of LPD remains controversial.LPD is generally considered a challenging operation that requires advanced laparoscopic techniques.In particular,pancreatic reconstruction can be safely performed by only laparoscopic experts.Thus,guidelines created by LPD experts are valuable in indicating the future direction of LPD.Qin et al.developed practical guidelines regarding the safety and feasibility of LPD with 28 international experts from eight countries(1).To create these guidelines,the first summit on minimally invasive pancreatico-biliary surgery was held in Wuhan,China,to promote the development of LPD.Based on a systematic literature review and expert opinions,16 statements were created by the experts.These statements provide useful guidelines not only for surgical trainees who will attempt LPD but also for specialized surgeons.This expert consensus will contribute to the safe implementation of LPDs in the future.

关键词： laparoscopic specialized safely

Role of pancreatography in the endoscopic management of encapsulated pancreatic collections-review and new proposed classification

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World Journal of Gastroenterology 2020年第45期26卷 7104-7117页

作者： Igor Mendonca Proença Marcos Eduardo Lera dos Santos Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Sergio Eiji Matuguma Spencer Cheng Thomas R McCarty Epifanio Silvino do Monte Junior Paulo Sakai Eduardo Guimaraes Hourneaux de Moura gastrointestinal endoscopy Unit Department of GastroenterologyHospital das ClinicasUniversity of Sao PauloSao Paulo 05403000Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s Hospital-Harvard Medical SchoolBostonMA 02115United States

Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated.Within the last decade,endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous drainage.Proper understanding of anatomic landmarks,including assessment of the main pancreatic duct and any associated lesions–such as disruptions and strictures-are key to achieving clinical success,reducing the need for reintervention or recurrence,especially in cases with suspected disconnected pancreatic duct syndrome.Additionally,proper review of imaging and anatomic landmarks,including collection location,are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic stents.Pancreatography to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde cholangiopancreatography.Despite the critical need to understand anatomy via pancrea tography and assess the main pancreatic duct,a standardized approach or uniform assessment strategy has not been described in the literature.Therefore,the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.

关键词： Endoscopic retrograde cholangiopancreatography endoscopy Endoscopic ultrasound Pseudocyst Endosonography Pancreatic ducts

Chinese Medicine Prolongs Overall Survival of Chinese Patients with advanced Gastric Cancer: Treatment Pattern and Survival Analysis of a 20-Year Real-World Study

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Chinese Journal of Integrative Medicine 2024年第6期30卷 489-498页

作者： CAO Ni-da ZHU Xiao-hong MA Fang-qi XU Yan DONG Jia-huan QIN Meng-meng LIU Tian-shu ZHU Chun-chao GUO Wei-jian DING Hong-hua GUO Yuan-biao LIU Li-kun SONG Jin-jie WU Ji-ping CHENG Yue-lei ZENG Lin ZHAO Ai-guang Oncology Department I Longhua Hospital Shanghai University of Traditional Chinese MedicineShanghai200032China Oncology Department Zhongshan HospitalFudan UniversityShanghai200032China gastrointestinal Surgery Department Renji HospitalShanghai Jiaotong University School of MedicineShanghai200127China Oncology Department Fudan University Shanghai Cancer CenterShanghai200032China Oncology Department Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghai200080China Traditional Chinese Medicine Department Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai200025China Oncology Department Shanxi Traditional Chinese Medicine HospitalTaiyuan030012China Oncology Department Xiyuan HospitalChina Academy of Chinese Medical ScienceBeijing102445China Oncology Department Yunnan Province Hospital of Traditional Chinese MedicineKunming650021China Oncology Department Shuguang HospitalShanghai University of Traditional Chinese MedicineShanghai201203China Shanghai NewCore Biotechnology Co. Ltd.Shanghai200240China

Objective To describe the treatment patterns and survival status of advanced gastric cancer(AGC)in China in the past two decades,and objectively evaluate the impact of standardized Chinese medicine(CM)treatment on the survival of AGC patients.Methods This multicenter registry designed and propensity score analysis study described the diagnosis characteristics,treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1,2000 and July 31,2021.Overall survival(OS)was evaluated between non-CM cohort(standard medical treatment)and CM cohort(integrated standard CM treatment≥3 months).Propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)were performed to adjust any difference in average outcomes for bias.Results A total of 2,001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled.Among them,1,607 received systemic chemotherapy,215(10.74%)accepted molecular targeted therapy,44(2.2%)received checkpoint inhibitor therapy,and 769(38.43%)received CM.Two-drug regimen was the main choice for first-line treatment,with fluoropyrimidine plus platinum as the most common regimen(530 cases,60.09%).While 45.71%(16 cases)of patients with HER2 amplification received trastuzumab in first-line.The application of apatinib increased(33.33%)in third-line.The application of checkpoint inhibitors has increased since 2020.COX analysis showed that Lauren mixed type(P=0.017),cycles of first-line treatment>6(P=0.000),CM(P=0.000),palliative gastrectomy(P=0.000),trastuzumab(P=0.011),and apatinib(P=0.008)were independent prognostic factors for the OS of AGC.After PSM and IPTW,the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months,respectively(P<0.001).Conclusions In real-world practice for AGC in China,therapy choices consisted with guidelines.Two-drug regimen was the main first-line choice.Standardized CM treatment was an independent prognostic factor and could prolong the OS of C

关键词： advancedgastriccancer real-world study treatment pattern survival analysis Chinese medicine

Epidemiology and early screening strategies for colorectal cancer in China

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Chinese Journal of Cancer Research 2023年第6期35卷 606-617页

作者： Yong Yang Zhaoya Gao An Huang Jingyi Shi Zhuang Sun Haopeng Hong Jin Gu Department of gastrointestinal Surgery Peking University Shougang HospitalBeijing 100144China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China

China ranks the first worldwide in the number of new colorectal cancer(CRC) cases and CRC-related deaths. The increasing incidence of early-onset CRC in recent years highlights the challenges related to CRC screening and prevention. High-quality colonoscopy is the universally used gold standard for CRC screening. Risk assessment combined with a two-step screening strategy based on colonoscopy and non-invasive examinations was proven to be highly effective. However, systematic use of well-established risk factors associated with CRC, beyond age, could better identify those who might harbor advanced colorectal neoplasia, improve the diagnostic yield of current screening modalities, and optimize the selection of individuals who might benefit most from preventive strategies.“Personalization” and “Standardization” are the future development directions of CRC screening, from the initiation of screening in those at high risk for CRC to follow-up after treatment, which are the key to ensure the screening efficiency.

关键词： Colorectal cancer epidemiology early screening review

Associate factors for endoscopic submucosal dissection operation time and postoperative delayed hemorrhage of early gastric cancer

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World Journal of gastrointestinal Surgery 2023年第1期15卷 94-104页

作者： Ren-Song Cai Wei-Zhong Yang Guang-Rui Cui Digestive endoscopy Department the Second Affiliated Hospital of Hainan Medical UniversityHaikou 570311Hainan ProvinceChina

BACKGROUND Endoscopic submucosal dissection(ESD)is a treatment for early gastric cancer with the advantages of small invasion,fewer complications,and a low local recurrence rate.However,there is a high risk of complications such as bleeding and perforation,and the operation time is also longer.ESD operation time is closely related to bleeding and perforation.AIM To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning,early identification,and prevention of complications.METHODS We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021.The baseline data,clinical features,and endoscopic and pathological characteristics of patients were collected.The multivariate linear regression model was used to investigate the influencing factors of ESD operation time.Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.RESULTS The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815%of ESD operation time when other influencing factors remained unchanged.The operation time increased by 3.766%or 10.247%if the lesion was mixed or concave.The operation time increased by 4.417%if combined with an ulcer or scar.The operation time increased by 3.692%if combined with perforation.If infiltrated into the submucosa,it increased by 2.536%.Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion,lesion morphology,and ESD operation time were independent influencing factors for delayed hemorrhage after ESD.Patients with lesion≥3.0 cm(OR=3.785,95%CI:1.165-4.277),lesion morphology-concave(OR=10.985,95%CI:2.133-35.381),and ESD operation time≥60 min(OR=2.958,95%CI:1.117-3.526)were prone to delayed hemorrhage after ESD.CONCLUSION If the maximum diameter of

关键词： Early gastric cancer Endoscopic submucosal dissection Operation time Delayed hemorrhage

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World Journal of gastrointestinal Oncology 2023年第2期15卷 352-367页

作者： Wen-Guang Pei Wen-Zheng Chen Yu-Kang Wu Sheng-Xing Tan Zhi-Gang Jie Department of gastrointestinal Surgery First Affiliated Hospital of Nanchang UniversityNanchang 330006Jiangxi ProvinceChina

BACKGROUND Immune checkpoint inhibitors(ICIs)have shown promising efficacy in treatment and clinical management of advanced gastric and gastroesophageal junction cancer.However,the inhibitors also cause immune-related adverse events(irAEs).The current systematic review and meta-analysis study aimed to investigate the incidence and nature of irAEs caused by ICIs.AIM To investigate the incidence and nature of irAEs in advanced gastric and gastroesophageal junction cancer.METHODS This systematic review was registered with PROSPERO(Reg.number:CRD42020152291).Data included in this study were collected from patients diagnosed with advanced gastric cancer or gastroesophageal junction cancer and treated with ICIs.A systematic literature search was conducted using the PubMed,EMBASE,and Cochrane Library databases.Meta-analysis was carried out using the single sample rate method.Synthesis and analysis of the data was conducted using Stata/SE and Review Manager Software.RESULTS The patients enrolled in the present study included 14 patients from 14 case reports,326 patients from 6 case series,and 1249 patients from 8 clinical trials.It was found that the overall incidence of irAEs was 16%[95%confidence interval(CI):11-20]for all grades and 3%(95%CI:2-4)for the severe grade.It was evident that the incidence of irAEs varied with the type of inhibitor and organs.A comparative study of the anti-programmed cell death receptor-1(PD-1)and antiprogrammed death receptor-ligand 1(PD-L1)treatments showed that the antiPD-1 group had a higher overall incidence of irAEs(20%)as compared with that of the anti-PD-L1 group(13%).Results of this study showed that the endocrine system experienced the highest incidence of organ-specific irAEs(7.4%),including hypothyroidism,hyperthyroidism,thyroiditis,diabetes,and adrenal insufficiency,followed by gastroenterology(2.2%),pulmonology(1.8%),neurology(1.4%),dermatology(1.4%),hematology(0.8%),and hepatology(0.7%).In clinical trials,it was found that the incidence of death related to irAEs was 1%(95%CI:

关键词： Immune checkpoint inhibitors advanced gastric and gastroesophageal junction cancer Systematic review Meta-analysis

Machine learning-based decision tool for selecting patients with idiopathic acute pancreatitis for endosonography to exclude a biliary aetiology

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世界胃肠病学杂志:英文版 2023年第35期29卷 5138-5153页

作者： Simon Sirtl Michal Żorniak Eric Hohmann Georg Beyer Miriam Dibos Annika Wandel Veit Phillip Christoph Ammer-Herrmenau Albrecht Neesse Christian Schulz Jörg Schirra Julia Mayerle Ujjwal Mukund Mahajan Department of Medicine II LMU University HospitalMunich 81377Germany Department of endoscopy Maria Sklodowska-Curie National Research Institute of OncologyGliwice 44-113Poland Department of Internal Medicine II School of MedicineUniversity Hospital Rechts der IsarTechnical University of MunichMunich 81675Germany Department of Gastroenterology Gastrointestinal Oncology and EndocrinologyUniversity Medical CenterGöttingen 37075Germany

BACKGROUND Biliary microlithiasis/sludge is detected in approximately 30%of patients with idiopathic acute pancreatitis(IAP).As recurrent biliary pancreatitis can be prevented,the underlying aetiology of IAP should be established.AIM To develop a machine learning(ML)based decision tool for the use of endosonography(EUS)in pancreatitis patients to detect sludge and microlithiasis.METHODS We retrospectively used routinely recorded clinical and laboratory parameters of 218 consecutive patients with confirmed AP admitted to our tertiary care hospital between 2015 and 2020.Patients who did not receive EUS as part of the diagnostic work-up and whose pancreatitis episode could be adequately explained by other causes than biliary sludge and microlithiasis were excluded.We trained supervised ML classifiers using H_(2)O.ai automatically selecting the best suitable predictor model to predict microlithiasis/sludge.The predictor model was further validated in two independent retrospective cohorts from two tertiary care centers(117 patients).RESULTS Twenty-eight categorized patients’variables recorded at admission were identified to compute the predictor model with an accuracy of 0.84[95%confidence interval(CI):0.791-0.9185],positive predictive value of 0.84,and negative predictive value of 0.80 in the identification cohort(218 patients).In the validation cohort,the robustness of the prediction model was confirmed with an accuracy of 0.76(95%CI:0.673-0.8347),positive predictive value of 0.76,and negative predictive value of 0.78(117 patients).CONCLUSION We present a robust and validated ML-based predictor model consisting of routinely recorded parameters at admission that can predict biliary sludge and microlithiasis as the cause of AP.

关键词： Acute pancreatitis Idiopathic acute pancreatitis Biliary pancreatitis Microlithiasis Sludge Endosonography