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Colonoscopy in the diagnosis and management of appendiceal disease

World Journal of gastrointestinal endoscopy 2024年第4期16卷 187-192页

作者： Yuan Gao Bing Hu Department of Gastroenterology and Hepatology/Medical Engineering Integration Laboratory of Digestive endoscopy West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

In this editorial,we comment on the article published in the recent issue of the World Journal of gastrointestinal endoscopy.We focused on the understanding of appendiceal disease,and the various options for diagnosis and treatment via endoscopy.Some factors affecting the diagnosis and management of appendiceal diseases are also discussed.The existence of any organ has its natural rationality,and the appendix is such a magical organ.A growing number of experts and scholars have gradually come to a consensus that the appendix is not a useless evolutionary relic.There are many lymphocytes and lymph nodes in the appendix wall,which has a strong immune function,and this function is particularly important for children and adolescents.Many intestinal probiotics in the appendix are very helpful for maintaining the balance of the intestinal flora.With the continuous progress of endoscopic technology,endoscopic treatment involving preservation of the appendix has shown great advantages over surgery.In the diagnosis of appendiceal inflammation and neoplasms,colonoscopy,endoscopic retrograde appendicography and choledochoscopy help assess conditions of the appendix.Endoscopic retrograde appendicitis therapy,abscess drainage under colonoscopy,fenestration of abscess under colonoscopy,and endoscopic or natural orifice transluminal endoscopic surgery resection of appendiceal neoplasms are safe and effective endoscopic treatments for appendiceal disease.New breakthroughs in the application of endoscopy in the appendix are expected to occur in the near future.

关键词： Appendicitis Appendiceal neoplasms Colonoscopy Endoscopic ultrasonography

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Management of early oesophageal cancer:An overview

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World Journal of gastrointestinal Surgery 2024年第5期16卷 1255-1258页

作者： Gavin G Calpin Matthew G Davey Noel E Donlon Department of Surgery Royal College of Surgeons in IrelandDublin D2Ireland Department of Upper gastrointestinal Surgery Beaumont HospitalDublin D09V2N0Ireland

The incidence of esophageal cancer,namely the adenocarcinoma subtype,continues to increase exponentially on an annual basis.The indolent nature of the disease renders a significant proportion inoperable at first presentation,however,with the increased utilisation of endoscopy,many early lesions are now being identified which are suitable for endotherapeutic approaches.This article details the options available for dealing with early esophageal cancer by endoscopic mean obviating the need for surgery thereby avoiding the potential morbidity and mortality of such intervention.

关键词： Esophageal cancer Endotherapy Endoscopic submucosal resection Endoscopic mucosal resection endoscopy

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Progress in clinical diagnosis and treatment of colorectal cancer with rare genetic variants

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Cancer Biology & Medicine 2024年第6期21卷 473-483页

作者： Shuyi Chen Jing Gu Kaichun Wu Xiaodi Zhao Yuanyuan Lu State Key Laboratory of Holistic Integrative Management of gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases Xijing Hospital of Digestive Diseases Fourth Military Medical University School of Basic Medical Sciences Fourth Military Medical University

Targeted therapy is crucial for advanced colorectal cancer(CRC) positive for genetic drivers. With advances in deep sequencing technology and new targeted drugs, existing standard molecular pathological detection systems and therapeutic strategies can no longer meet the requirements for careful management of patients with advanced CRC. Thus, rare genetic variations require diagnosis and targeted therapy in clinical practice. Rare gene mutations, amplifications, and rearrangements are usually associated with poor prognosis and poor response to conventional therapy. This review summarizes the clinical diagnosis and treatment of rare genetic variations, in genes including erb-b2 receptor tyrosine kinase 2(ERBB2), B-Raf proto-oncogene, serine/threonine kinase(BRAF), ALK receptor tyrosine kinase/ROS proto-oncogene 1, receptor tyrosine kinase(ALK/ROS1), neurotrophic receptor tyrosine kinases(NTRKs), ret proto-oncogene(RET), fibroblast growth factor receptor 2(FGFR2), and epidermal growth factor receptor(EGFR), to enhance understanding and identify more accurate personalized treatments for patients with rare genetic variations.

关键词： Genetic variation gene amplification gene mutation gene rearrangement targeted therapy

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How to avoid overtreatment of benign colorectal lesions:Rationale for an evidence-based management

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World Journal of Gastroenterology 2022年第47期28卷 6619-6631页

作者： Marco Bustamante-Balén gastrointestinal endoscopy Unit Gastrointestinal Endoscopy Research GroupHospital Universitari Ⅰ Politècnic La FeHealth Research Institute Hospital La Fe(ⅡSLaFe)Valencia 46026Spain

Implementing population-based screening programs for colorectal cancer has led to an increase in the detection of large but benign histological lesions.Currently,endoscopic mucosal resection can be considered the standard technique for the removal of benign lesions of the colon due to its excellent safety profile and good clinical results.However,several studies from different geographic areas agree that many benign colon lesions are still referred for surgery.Moreover,the referral rate to surgery is not decreasing over the years,despite the theoretical improvement of endoscopic resection techniques.This article will review the leading causes for benign colorectal lesions to be referred for surgery and the influence of the endoscopist experience on the referral rate.It will also describe how to categorize a polyp as complex for resection and consider an endoscopist as an expert in endoscopic resection.And finally,we will propose a framework for the accurate and evidence-based treatment of complex benign colorectal lesions.

关键词： Colorectal polyps Endoscopic mucosal resection Colorectal surgery

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Outpatient management of obscure gastrointestinal bleeding:A new perspective in high-risk patients

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World Journal of Gastroenterology 2024年第19期30卷 2502-2504页

作者： Maria Elena Riccioni Clelia Marmo Digestive endoscopy Unit Fondazione Policlinico Universitario Agostino GemelliIRCCSUniversitàCattolica del Sacro CuoreLargo Agostino GemelliRome 00168Italy CEMAD Centro Malattie Dell’Apparato Digerente Fondazione Policlinico Universitario Agostino GemelliIRCCSUniversitàCattolica del Sacro CuoreLargo Agostino GemelliRome 00168Italy

Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.

关键词： gastrointestinal bleeding Small bowel bleeding Recurrent bleeding Rebleeding risk Rebleeding Outpatient management

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Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis

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World Journal of gastrointestinal Surgery 2024年第3期16卷 700-709页

作者： Kai Liu Chun-Xiao Wu Hui Liang Tao Wang Ji-Yuan Zhang Xiao-Tao Wang Department of Radiation and Oncology Traditional Chinese Hospital of Lu’an affiliated to Anhui University of Traditional Chinese MedicineLu’an 237000Anhui ProvinceChina Department of Gastroenterology Ehu branch of Xishan People’s Hospital of Wuxi CityWuxi 214116Jiangsu ProvinceChina Department of gastrointestinal Surgery The First Affiliated Hospital of Guangzhou University of Traditional Chinese MedicineGuangzhou 510400Guangdong ProvinceChina Department of gastrointestinal Surgery Hunan Provincial People’s HospitalChangsha 410002Hunan ProvinceChina Department of Traditional Chinese medicine Ehu branch of Xishan People’s Hospital of Wuxi CityWuxi 214116Jiangsu ProvinceChina

BACKGROUND Gastric cancer(GC)is the fifth most common type of cancer and has the fourth highest death rate among all cancers.There is a lack of studies examining the impact of liver metastases on the effectiveness of immunotherapy in individuals diagnosed with GC.AIM To investigate the influence of liver metastases on the effectiveness and safety of immunotherapy in patients with advanced GC.METHODS This retrospective investigation collected clinical data of patients with advanced stomach cancer who had immunotherapy at our hospital from February 2021 to January 2023.The baseline attributes were compared using either the Chi-square test or the Fisher exact probability method.The chi-square test and Kaplan-Meier survival analysis were employed to assess the therapeutic efficacy and survival duration in GC patients with and without liver metastases.RESULTS The analysis comprised 48 patients diagnosed with advanced GC,who were categorized into two groups:A liver metastasis cohort(n=20)and a non-liver metastatic cohort(n=28).Patients with liver metastasis exhibited a more deteriorated physical condition compared to those without liver metastasis.The objective response rates in the cohort with metastasis and the cohort without metastasis were 15.0%and 35.7%(P>0.05),respectively.Similarly,the disease control rates in these two cohorts were 65.0%and 82.1%(P>0.05),respectively.The median progression-free survival was 5.0 months in one group and 11.2 months in the other group,with a hazard ratio of 0.40 and a significance level(P)less than 0.05.The median overall survival was 12.0 months in one group and 19.0 months in the other group,with a significance level(P)greater than 0.05.CONCLUSION Immunotherapy is less effective in GC patients with liver metastases compared to those without liver metastasis.

关键词： Gastric cancer Spread of cancer to the liver Treatment with immunotherapy Effectiveness of treatment

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Distal margin distance in radical resection of locally advanced rectal cancer after neoadjuvant therapy

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Chinese Journal of Cancer Research 2024年第2期36卷 226-232页

作者： Jun Luo Mingxuan Zhu Long Zhao Meiwen He Bei Li Yifan Liu Yuhan Sun Guoqing Lyu Zhanlong Shen Department of gastrointestinal Surgery Peking University Shenzhen HospitalShenzhen 518036China Department of Gastroenterological Surgery Laboratory of Surgical OncologyBeijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment ResearchPeking University People's HospitalBeijing 100044China School of Medicine the Chinese University of Hong KongShenzhen 518172China

Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced rectal cancer, with the common goal of improving oncological outcomes while preserving function. The controversy regarding the circumferential resection margin distance in rectal cancer surgery has been resolved. With the promotion of neoadjuvant therapy concepts and advancements in technology, treatment strategies have become more diverse.Following tumor downstaging, there is an increasing trend towards extending the safe distance of distal rectal margin. This provides more opportunities for patients with low rectal cancer to preserve their anal function.However, there is currently no consensus on the specific distance of distal resection margin.

关键词： Colorectal cancer distal resection margin neoadjuvant therapy

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Construction of prognostic markers for gastric cancer and comprehensive analysis of pyroptosis-related long non-coding RNAs

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World Journal of gastrointestinal Surgery 2024年第7期16卷 2281-2295页

作者： Yu Wang Di Li Jing Xun Yu Wu Hong-Lei Wang Department of gastrointestinal Surgery Hospital of Integrated Chinese and Western MedicineTianjin UniversityTianjin 300100China

BACKGROUND China's most frequent malignancy is gastric cancer(GC),which has a very poor survival rate,and the survival rate for patients with advanced GC is dismal.Pyroptosis has been connected to the genesis and development of cancer.The function of pyroptosis-related long non-coding RNAs(PRLs)in GC,on the other hand,remains uncertain.AIM To explore the construction and comprehensive analysis of the prognostic characteristics of long non-coding RNA(lncRNA)related to pyroptosis in GC patients.METHODS The TCGA database provided us with 352 stomach adenocarcinoma samples,and we obtained 28 pyroptotic genes from the Reactome database.We examined the correlation between lncRNAs and pyroptosis using the Pearson correlation coefficient.Prognosis-related PRLs were identified through univariate Cox analysis.A predictive signature was constructed using stepwise Cox regression analysis,and its reliability and independence were assessed.To facilitate clinical application,a nomogram was created based on this signature.we analyzed differences in immune cell infiltration,immune function,and checkpoints between the high-risk group(HRG)and low-risk group(LRG).RESULTS Five hundred and twenty-three PRLs were screened from all lncRNAs(absolute correlation coefficient>0.4,P<0.05).Nine PRLs were included in the risk prediction signature that was created through stepwise Cox regression analysis.We determined the risk score for GC patients and employed the median value as the dividing line between HRG and LRG.The ability of the risk signature to predict the overall survival(OS)of GC is demonstrated by the Kaplan-Meier analysis,risk curve,receiver operating characteristic curve,and decision curve analysis curve.The risk signature was shown to be an independent prognostic factor for OS in both univariate and multivariate Cox regression analyses.HRG showed a more efficient local immune response or modulation compared to LRG,as indicated by the predicted signal pathway analysis and examination of immune cell infiltration,function,and check

关键词： Gastric cancer Pyroptosis Prognosis Immune checkpoint Long non-coding RNA Immune cell infiltrating

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Effectiveness and tolerability of programmed cell death protein-1 inhibitor+chemotherapy compared to chemotherapy for upper gastrointestinal tract cancers

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World Journal of gastrointestinal Oncology 2024年第4期16卷 1613-1625页

作者： Xiao-Min Zhang Ting Yang Ying-Ying Xu Bao-Zhong Li Wei Shen Wen-Qing Hu Cai-Wen Yan Liang Zong Department of Central Laboratory Changzhi People’s HospitalThe Affiliated Hospital of Changzhi Medical CollegeChangzhi 046000Shanxi ProvinceChina Department of gastrointestinal Surgery Yizheng People’s HospitalThe Affiliated Hospital of Yangzhou UniversityYangzhou 225000Jiangsu ProvinceChina Department of General Surgery Anyang Tumor HospitalAnyang 455000Henan ProvinceChina Department of General Surgery Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxi 214023Jiangsu ProvinceChina Department of gastrointestinal Surgery Changzhi People’s HospitalThe Affiliated Hospital of Changzhi Medical CollegeChangzhi 046000Shanxi ProvinceChina Department of Gastroenterology Changzhi People’s HospitalThe Affiliated Hospital of Changzhi Medical CollegeChangzhi 046000Shanxi ProvinceChina

BACKGROUND The combination of programmed cell death protein-1(PD-1)inhibitor and che-motherapy is approved as a standard first-or second-line treatment in patients with advanced oesophageal or gastric cancer.However,it is unclear whether this combination is superior to chemotherapy alone.AIM To assess the comparative effectiveness and tolerability of combining PD-1 inhibitors with chemotherapy vs chemotherapy alone in patients with advanced gastric cancer,gastroesophageal junction(GEJ)cancer,or oesophageal carcinoma.METHODS We searched the PubMed and Embase databases for studies that compared the efficacy and tolerance of PD-1 inhibitors in combination with chemotherapy vs chemotherapy alone in patients with advanced oesophageal or gastric cancer.We employed either random or fixed models to analyze the outcomes of each clinical trial,en-compassing data on overall survival(OS),progression-free survival(PFS),objective response rate,and adverse events(AEs).RESULTS Nine phase 3 clinical trials(7016 advanced oesophageal and gastric cancer patients)met the inclusion criteria.Our meta-analysis demonstrated that the pooled PD-1 inhibitor+chemotherapy group had a significantly longer OS than the chemotherapy-alone group[hazard ratio(HR)=0.76,95%confidence interval(CI):0.71-0.81];the pooled PFS result was consistent with that of OS(HR=0.67,95%CI:0.61-0.74).The count of patients achieving an objective response in the PD-1 inhibitor+chemotherapy group surpassed that of the chemotherapy-alone group[odds ratio(OR)=1.86,95%CI:1.59-2.18].AE incidence was also higher in the combination-therapy group than in the chemotherapy-alone group,regardless of whether≥grade 3 only(OR=1.30,95%CI:1.07-1.57)or all AE grades(OR=1.88,95%CI:1.39-2.54)were examined.We performed a subgroup analysis based on the programmed death-ligand 1(PD-L1)combined positive score(CPS)and noted extended OS and PFS durations within the CPS≥1,CPS≥5,and CPS≥10 subgroups of the PD-1 inhibitor+chemotherapy group.CONCLUSION In contrast to chemotherapy alone,the combina

关键词： Programmed cell death protein-1 inhibitor Chemotherapy Oesophageal squamous cell carcinoma Gastric/gastroesophageal junction adenocarcinoma Overall survival Progression-free survival Objective response rate Adverse event

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Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation:A systematic review and meta-analysis

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World Journal of Clinical Cases 2022年第22期10卷 7844-7858页

作者： Hui Pan Xiao-Ling Zheng Chao-Ying Fang Lan-Zai Liu Jian-Su Chen Chao Wang Yu-Dai Chen Jian-Min Huang Yu-Shen Zhou Li-Ping He gastrointestinal endoscopy Center Fujian Provincial HospitalThe Shengli Clinical Medical CollegeFujian Medical UniversityFuzhou 350001Fujian ProvinceChina gastrointestinal endoscopy Center Fujian Provincial Hospital South BranchFuzhou 350001Fujian ProvinceChina

BACKGROUND Split-dose regimens(SpDs)of 4 L of polyethylene glycol(PEG)have been established as the“gold standard”for bowel preparation;however,its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses.Meanwhile,the same-day single-dose regimens(SSDs)of PEG has been recommended as an alternative;however,its superiority compared to other regimens is a matter of debate.AIM To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.METHODS We searched MEDLINE/PubMed,the Cochrane Library,RCA,EMBASE and Science Citation Index Expanded for randomized trials comparing(2 L/4 L)SSDs to large-volume(4 L/3 L)SpDs PEG-based regimens,regardless of adjuvant laxative use.The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness,sleep disturbance,willingness to repeat the procedure using the same preparation and adverse effects.A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.RESULTS A total of 18 studies were included.There was no statistically significant difference of adequate bowel preparation(relative risk=0.97;95%CI:0.92-1.02)(14 trials),right colon Boston Bowel Preparation Scale(mean difference=0.00;95%CI:-0.04,0.03)(9 trials)and right colon Ottawa Bowel Preparation Scale(mean difference=0.04;95%CI:-0.27,0.34)(5 trials)between(2 L/4 L)SSDs and large-volume(4 L/3 L)SpDs,regardless of adjuvant laxative use.The pooled analysis favored the use of SSDs with less sleep disturbance(relative risk=0.52;95%CI:0.40,0.68)and lower incidence of abdominal pain(relative risk=0.75;95%CI:0.62,0.90).During subgroup analysis,patients that received low-volume(2 L)SSDs showed more willingness to repeat the procedure using the same preparation than SpDs(P0.05).CONCLUSION Regardless of adjuvant laxative use,the(2 L/4 L)SSD PEG-based arm

关键词： Bowel preparation Colonoscopy Polyethylene glycol Same-day single-dose Split-dose Metaanalysis

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