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Gastroenterology Report 2023年第1期11卷 527-529页

作者： Jingyi Liu Bing Li Pinghong Zhou Mingyan Cai Yunshi Zhong endoscopy Center Zhongshan Hospital of Fudan UniversityShanghaiP.R.China endoscopy Research Institute of Fudan University ShanghaiP.R.China Shanghai Collaborative Innovation Center of endoscopy ShanghaiP.R.China endoscopy Center Xuhui HospitalZhongshan Hospital of Fudan UniversityShanghaiP.R.China

Introduction gastrointestinal stromal tumors(GISTs)in adults are nearly 10%–30%with a potential malignant tendency[1].Colorectal GISTs account for 5%of all cases and have a higher progression risk with a poor prognosis[2,3].Rectal GISTs usually need radical operations such as laparoscopy to obtain tumor-free margins.Sometimes,it is difficult for surgery to preserve the anal function because of the tumor size and location.Here,we report a case of a 70-year-old female with a giant GIST located in the lower rectum,which was removed by function-preserving endoscopic minimally invasive resection after routine imatinib therapy.

关键词： rectum resection routine

Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design

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Chinese Journal of Cancer Research 2023年第2期35卷 163-175页

作者： Yinkui Wang Fanling Hong Shuangxi Li Fei Shan Yongning Jia Rulin Miao Zhemin Li Ziyu Li Jiafu Ji Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China endoscopy Center Zhongshan HospitalFudan University(Xiamen Branch)Xiamen 361015China

Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.

关键词： Adenocarcinoma of esophagogastric junction laparoscopic surgery transhiatal approach lower mediastinal lymph node dissection IDEAL 2a research

Risk stratification in gastric cancer lung metastasis: Utilizing an overall survival nomogram and comparing it with previous staging

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World Journal of gastrointestinal Surgery 2024年第2期16卷 357-381页

作者： Zhi-Ren Chen Mei-Fang Yang Zhi-Yuan Xie Pei-An Wang Liang Zhang Ze-Hua Huang Yao Luo Department of Science and Education Xuzhou Medical UniversityXuzhou Clinical CollegeXuzhou 221000Jiangsu ProvinceChina Department of Neurology Xuzhou Medical UniversityXuzhou 221000Jiangsu ProvinceChina Department of Neurology Clinical LaboratoryGastrointestinal SurgeryCentral Hospital of XuzhouCentral Hospital of XuzhouXuzhou 221000Jiangsu ProvinceChina Department of Public Health Xuzhou Central HospitalXuzhou 221000Jiangsu ProvinceChina Department of Gastroenterology Xuzhou Centre HospitalXuzhou 221000Jiangsu ProvinceChina Department of Public Health Xuzhou Medical UniversityXuzhou 221000Jiangsu ProvinceChina

BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(rel

关键词： Gastric cancer Lung metastasis Nomograms Surveillance Epidemiology Surveillance epidemiology and end results program database Overall survival Prognosis

High-definition colonoscopy with i-Scan:Better diagnosis for small polyps and flat adenomas

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世界胃肠病学杂志：英文版 2012年第37期18卷 5231-5239页

作者： Pier Alberto Testoni Chiara Notaristefano Cristian Vailati Milena Di Leo Edi Viale Division of Gastroenterology and gastrointestinal endoscopy Vita-Salute San Raffaele UniversityScientific Institute San Raffaele

AIM:To investigate if high-definition (HD) colonoscope with i-Scan gave a higher detection rate of mucosal lesions vs standard white-light instruments. METHODS:Data were collected from the computerized database of the endoscopy unit of our tertiary referral center. We retrospectively analyzed 1101 consecutive colonoscopies that were performed over 1 year with standard white-light (n = 849) or HD+ with i-Scan (n = 252) instruments by four endoscopists, in an outpatient setting. Colonoscopy records included patients' main details and family history for colorectal cancer, indication for colonoscopy (screening, diagnostic or surveillance), type of instrument used (standard white-light or HD+ plus i-Scan), name of endoscopist and bowel preparation. Records for each procedure included whether the cecum was reached or not and the reason for failure, complications during or immediately after the procedure, and number, size, location and characteristics of the lesions. Polyps or protrudinglesions were defined as sessile or pedunculated, and nonprotruding lesions were defined according to Paris classification. For each lesion, histological diagnosis was recorded. RESULTS:Eight hundred and forty-nine colonoscopies were carried with the standard white-light video colonoscope and 252 with the HD+ plus i-Scan video colonoscope. The four endoscopists did 264, 300, 276 and 261 procedures, respectively; 21.6%, 24.0%, 21.7% and 24.1% of them with the HD+ plus i-Scan technique. There were no significant differences between the four endoscopists in either the number of procedures done or the proportions of each imaging technique used. Both techniques detected one or more mucosal lesions in 522/1101 procedures (47.4%). The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left. A significantly higher number of colonoscopies recognized lesions in the HD+ plus i-Scan mode (171/252 = 67.9%) than with the standard white-light technique (408/849 = 48.1%) (P < 0.0001). HD+ with i-Scan colonoscopies identi

关键词：病理诊断结肠镜检查菲亚特检测程序 CAN技术肉仪器类型

Double-tract reconstruction is superior to esophagogastrostomy in controlling reflux esophagitis and enhancing quality of life after proximal gastrectomy:Results from a prospective randomized controlled clinical trial in China

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Chinese Journal of Cancer Research 2023年第6期35卷 645-659页

作者： Yinan Zhang Hongtao Zhang Yan Yan Ke Ji Ziyu Jia Heli Yang Biao Fan Anqiang Wang Xiaojiang Wu Ji Zhang Jiafu Ji Xin Ji Zhaode Bu Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China Guowen(Changchun)International Hospital Changchun 136199China State Key Laboratory of Holistic Integrative Management of gastrointestinal Cancers Beijing Key Laboratory of Carcinogenesis and Translational ResearchEndoscopy CenterPeking University Cancer Hospital&InstituteBeijing 100142China State Key Laboratory of Holistic Integrative Management of gastrointestinal Cancers Beijing Key Laboratory of Carcinogenesis and Translational ResearchGastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China

Objective:The aim of this study was to prospectively compare double-tract reconstruction(DTR)and esophagogastrostomy(EG)after proximal gastrectomy(PG)regarding the incidence of reflux esophagitis,quality of life(QOL),nutritional status and surgical safety.Methods:This study was a randomized controlled trial.Patients eligible for PG were enrolled and randomly assigned to the EG group and DTR group.The characteristics of patients,parameters for surgical safety,incidence of reflux esophagitis,nutrition status and QOL were collected and compared between the two groups.Univariate analysis and multivariate analysis were performed to determine the significant factors affecting the incidence of reflux esophagitis after PG.Results:Thirty-seven patients of the EG group and 36 patients of the DTR group were enrolled.The incidence of reflux esophagitis was significantly lower in the DTR group than in the EG group(8.3%vs.32.4%,P=0.019).The DTR group demonstrated a more favorable QOL than the EG group after PG.The nutritional status was balanced within the EG group and the DTR group.The operation time was longer in the DTR group than in the EG group(191 min vs.221 min,P=0.001),while surgical safety was similar in the two groups.Conclusions:Our research demonstrated that DTR is superior to EG after PG in terms of the incidence of reflux esophagitis and provides a more satisfactory QOL without increasing surgical complications or sacrificing nutritional status.

关键词： Double-tract reconstruction proximal gastrectomy quality of life reflux esophagitis

Gastric per-oral endoscopic myotomy:Indications,technique,results and comparison with surgical approach

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World Journal of gastrointestinal Surgery 2022年第1期14卷 12-23页

作者： Maria Chiara Verga Stefano Mazza Francesco Azzolini Fabrizio Cereatti Clara Benedetta Conti Andrea Drago Sara Soro Biagio Elvo Roberto Grassia Gastroenterology and Digestive endoscopy Unit ASST CremonaCremona 26100Italy Gastroenterology and Digestive endoscopy Unit Ospedale San Raffaele IRCCSMilano 20132Italy Digestive and Interventional endoscopy Unit ASST MonzaMonza 20800Italy

Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying,without the presence of a stenosis.For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis.Studies with EndoFLIP,a device that assesses pyloric distensibility,increased the knowledge about pylorospasm.Based on this data,several pyloric-targeted therapies were developed to treat refractory gastroparesis:Surgical pyloroplasty and endoscopic approach,such as pyloric injection of botulinum and pyloric stenting.Notwithstanding,the success of most of these techniques is still not complete.In 2013,the first human gastric per-oral endoscopic myotomy(GPOEM)was performed.It was inspired by the POEM technique,with a similar dissection method,that allows pyloromyotomy.Therapeutical results of GPOEM are similar to surgical approach in term of clinical success,adverse events and post-surgical pain.In the last 8 years GPOEM has gained the attention of the scientific community,as a minimally invasive technique with high rate of clinical success,quickly prevailing as a promising therapy for gastroparesis.Not surprisingly,in referral centers,its technical success rate is 100%.One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.

关键词： Gastric per-oral endoscopic myotomy Pyloroplasty Gastroparesis EndoFLIP Pyloromyotomy Gastroparesis cardinal symptom index

First-line camrelizumab(a PD-1 inhibitor)plus apatinib(an VEGFR-2 inhibitor)and chemotherapy for advanced gastric cancer(SPACE):a phase 1 study

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Signal Transduction and Targeted Therapy 2024年第4期9卷 1760-1767页

作者： Xiaofeng Chen Hao Xu Xiaobing Chen Tongpeng Xu Yitong Tian Deqiang Wang Fen Guo Kangxin Wang Guangfu Jin Xiao Li Rong Wang Fengyuan Li Yongbin Ding Jie Tang Yueyu Fang Jing Zhao Liang Liu Ling Ma Lijuan Meng Zhiguo Hou Rongrong Zheng Yang Liu Ni Guan Bei Zhang Shuang Tong Shiqing Chen Xing Li Yongqian Shu Department of Oncology The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina Gusu School Nanjing medical UniversitySuzhouChina Jiangsu Key Lab of Cancer Biomarkers Prevention and TreatmentCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjingChina Department of General surgery The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina Department of Oncology Henan Cancer Hospital Affiliated Cancer Hospital of Zhengzhou UniversityZhengzhouChina Henan Engineering Research Center of Precision Therapy of gastrointestinal Cancer&Zhengzhou Key Laboratory for Precision Therapy of gastrointestinal Cancer ZhengzhouChina Department of Oncology Digestive Disease Institute&Cancer Institute of Jiangsu UniversityAffiliated Hospital of Jiangsu UniversityZhenjiangChina Department of Oncology Suzhou Hospital of Nanjing Medical UniversitySuzhouChina Department of Oncology Nanjing PuKou People’s HospitalNanjingChina Department of Epidemiology School of Public HealthNanjing Medical UniversityNanjingChina Department of Pathology The First Affiliated Hospital with Nanjing Medical UniversityNanjingChina Department of general surgery Jurong Branch hospital of Jiangsu Province People HospitalJurongChina Department of Medical Oncology Liyang People’s HospitalLiyangChina Department of radiology Nanjing PuKou People’s HospitalNanjingChina Jiangsu Hengrui Pharmaceuticals ShanghaiChina Department of Medical Affairs 3D Medicines Inc.ShanghaiChina Shanghai OrigiMed Co. Ltd.ShanghaiChina

Patients with advanced gastric cancer typically face a grim prognosis.This phase 1a(dose escalation)and phase 1b(dose expansion)study investigated safety and efficacy of first-line camrelizumab plus apatinib and chemotherapyfor advanced gastric or gastroesophageal junction adenocarcinoma.The primary endpoints included maximum tolerated dose(MTD)in phase 1a and objective response rate(ORR)across phase 1a and 1b.Phase 1a tested three dose regimens of camrelizumab,apatinib,oxaliplatin,and S-1.Dose regimen 1:camrelizumab 200 mg on day 1,apatinib 250 mg every other day,oxaliplatin 100 mg/m^(2) on day 1,and S-140 mg twice a day on days 1-14.Dose regimen 2:same as dose regimen 1,but oxaliplatin 130mg/m.Dose regimen3:same as dose regimen 2,but apatinib 250 mg daily.Thirty-four patients were included(9 in phase 1a,25 in phase 1b).No dose-limiting toxicities occurred so no MTD was identified.Dose 3 was set for the recommended phase 2 doses and administered in phase 1b.The confrmed ORR was 76.5%(95%CI 58.8-89.3).The median progression-free survival was 8.4 months(95%CI 5.9-not evaluable[NE]),and the median overall survival(OS)was not mature(11.6-NE).Ten patients underwent surgery after treatment and the multidisciplinary team evaluation.Among 24 patients without surgery,the median OS was 19.6 months(7.8-NE).Eighteen patients(52.9%)developed grade≥3 treatment-emergent adverse events.Camrelizumab plus apatinib and chemotherapy showed favorable clinical outcomes and manageable safety for untreated advanced gastric cancer(ChiCTR2000034109).

关键词： regimen cancer doses

A dose-up of ursodeoxycholic acid decreases transaminases in hepatitis C patients

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World Journal of Gastroenterology 2009年第22期15卷 2782-2786页

作者： Shuichi Sato Tatsuya Miyake Hiroshi Tobita Naoki Oshima Junichi Ishine Takuya Hanaoka Yuji Amano Yoshikazu Kinoshita Department of Gastroenterology and Hepatology Shimane UniversitySchool of Medicine Division of gastrointestinal endoscopy Shimane University Hospital

AIM:To examine whether a dose-up to 900 mg of ursodeoxycholic acid(UDCA) decreases transaminases in hepatitis C patients.METHODS:From January to December 2007,patients with chronic hepatitis C or compensated liver cirrhosis with hepatitis C virus(HCV)(43-80 years old) showing positive serum HCV-RNA who had already taken 600 mg/d of UDCA were recruited into this study.Blood parameters were examined at 4,8 and 24 wk after increasing the dose of oral UDCA from 600 to 900 mg/d.RESULTS:Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),and gamma-glutamyl transpeptidase(GGT) levels were signifi cantly decreased following the administration of 900 mg/d as compared to 600 mg/d.The decrease in ALT from immediately before the dose-up of UDCA to 8 wk after the dose-up was 14.3 IU/L,while that for AST was 10.5 IU/L and for GGT was 9.8 IU/L.Platelet count tended to increase after the dose-up of UDCA,although it did not show a statistically signifi cant level(P=0.05).Minor adverse events were observed in 3 cases,although no drop-outs from the study occurred.CONCLUSION:Oral administration of 900 mg/d of UDCA was more effective than 600 mg/d for reducing ALT,AST,and GGT levels in patients with HCV-related chronic liver disease.

关键词：丙氨酸转氨酶丙型肝炎病毒熊去氧胆酸加剂量患者阳性血清国际单位谷草转氨酶

Shouhui Tongbian Capsule in treatment of constipation: Treatment and mechanism development

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Chinese Herbal Medicines 2024年第2期16卷 239-247页

作者： Liping Gong Hang Du Xin Guo Jianchao Li Xiaomin Zhu Xianhui Shen Zhiyan Huang Kaiyi Wu Guimin Zhang Rong Sun The Second Hospital of Shandong University Jinan 250033China State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine Lunan Pharmaceutical Group Co.Ltd.Linyi 276006China Tianjin University of Traditional Chinese Medicine Tianjin 301617China Shandong University of Traditional Chinese Medicine Jinan 250355China advanced Medical Research Institute Shandong UniversityJinan 250012China

Constipation is common in the diseases of the digestive system in clinics.With the change in diet structure and the increase in life pressure,the prevalence rate increases year by year.In traditional Chinese medicine(TCM),the location of the disease of constipation is in the large intestine,which is related to the dysfunction of lung,spleen,liver,kidney and other viscera.Its pathogenesis is conductive dysfunction of large intestine.Based on the theory,Shouhui Tongbian Capsule(SHTB)is composed of eight traditional Chinese medicines,including Polygoni multiflori Radix(Heshouwu in Chinese),Aloe(Luhui in Chinese),Cassiae Semen(Juemingzi in Chinese),Ginseng Radix et Rhizoma(Renshen in Chinese),Lycii Fructus(Gouqizi in Chinese),Asini Corii Colla(Ejiao in Chinese),Aurantii Fructus Immaturus(Zhishi in Chinese),and Atractylodis Macrocephalae Rhizoma(Baizhu in Chinese),which could help to release excessive turbid,and nourishing yin and supplementing qi in the treatment.This study has been carried out to review the latest advances of SHTB in the treatment of constipation.The results showed that significant effect of SHTB was found in the treatment of constipation,such as functional constipation,and constipation associated with tumor chemotherapy,colitis,type 2 diabetes and chronic cardiac failure.Besides,obvious adverse reactions were not observed.SHTB could effectively treat five types of constipation,provide direction for the future exploration of SHTB in the treatment of other types of constipation。

关键词： constipation gastrointestinal hormones interstitial cells of cajal intestinal fluid secretion intestinal motility Shouhui Tongbian Capsule

The efficacy of full-thickness endoscopic resection of subepithelial tumors in the gastric cardia

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World Journal of gastrointestinal Oncology 2023年第12期15卷 2111-2119页

作者： En-Pan Xu Zhi-Peng Qi Bing Li Zhong Ren Ming-Yan Cai Shi-Lun Cai Zhen-Tao Lyv Zhang-Han Chen Jing-Yi Liu Qiang Shi Yun-Shi Zhong endoscopy Center Zhongshan Hospital Fudan UniversityShanghai 200032China

BACKGROUND Gastric subepithelial tumors(SETs)may harbor potential malignancy.Although it is well recognized that large SETs should be resected,the precise treatment strategy remains controversial.Compared to surgical resection,endoscopic resection(ER)has many advantages;however,ER of SETs in the cardia is challenging.AIM To evaluate the safety and efficacy of endoscopic full-thickness resection(EFTR)for the treatment of gastric cardia SETs.METHODS We retrospectively reviewed data from all patients with SETs originating from the muscularis propria layer in the gastric cardia that were treated by EFTR or submucosal tunneling ER(STER)at Zhongshan Hospital Fudan University between November 2014 and May 2022.Baseline characteristics and clinical outcomes,including procedure times and complications rates,were compared between groups of patients receiving EFTR and STER.RESULTS A total of 171 tumors were successfully removed[71(41.5%)tumors in the EFTR and 100(58.5%)tumors in the STER group].gastrointestinal stromal tumors(GISTs)were the most common SET.The en bloc resection rate was 100%in the EFTR group vs 97.0%in STER group(P>0.05).Overall,the EFTR group had a higher complete resection rate than the STER group(98.6%vs 91.0%,P<0.05).The procedure time was also shorter in the EFTR group(44.63±28.66 min vs 53.36±27.34,P<0.05).The most common major complication in both groups was electrocoagulation syndrome.There was no significant difference in total complications between the two groups(21.1%vs 22.0%,P=0.89).CONCLUSION EFTR of gastric cardia SETs is a very promising method to facilitate complete resection with similar complications and reduced operative times compared to STER.In cases of suspected GISTs or an unclear diagnosis,EFTR should be recommended to ensure complete resection.

关键词： Endoscopic full-thickness resection Submucosal tunneling endoscopic resection gastrointestinal stromal tumor Gastric cardia Gastric subepithelial tumors