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Difficult colorectal polypectomy:Technical tips and recent advances

World Journal of Gastroenterology 2023年第17期29卷 2600-2615页

作者： Sukit Pattarajierapan Hiroyuki Takamaru Supakij Khomvilai Surgical endoscopy Colorectal Division Department of SurgeryFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan

Colonoscopy has been shown to be an effective modality to prevent colorectal cancer(CRC)development.CRC reduction is achieved by detecting and removing adenomas,which are precursors of CRC.Most colorectal polyps are small and do not pose a significant challenge for trained and skilled endoscopists.However,up to 15%of polyps are considered“difficult”,potentially causing life-threatening complications.A difficult polyp is defined as any polyp that is challenging for the endoscopist to remove owing to its size,shape,or location.advanced polypectomy techniques and skills are required to resect difficult colorectal polyps.There were various polypectomy techniques for difficult polyps such as endoscopic mucosal resection(EMR),underwater EMR,Tip-in EMR,endoscopic submucosal dissection(ESD),or endoscopic full-thickness resection.The selection of the appropriate modality depends on the morphology and endoscopic diagnosis.Several technologies have been developed to aid endoscopists in performing safe and effective polypectomies,especially complex procedures such as ESD.These advances include video endoscopy system,equipment assisting in advanced polypectomy,and closure devices/techniques for complication management.Endoscopists should know how to use these devices and their availability in practice to enhance polypectomy performance.This review describes several useful strategies and tips for managing difficult colorectal polyps.We also propose the stepwise approach for difficult colorectal polyps.

关键词： Adenoma Colonic polyps Colonoscopy Endoscopic mucosal resection Endoscopic submucosal dissection Polypectomy

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Advances in traction methods for endoscopic submucosal dissection:What is the best traction method and traction direction?

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World Journal of Gastroenterology 2022年第1期28卷 1-22页

作者： Mitsuru Nagata Department of endoscopy Shonan Fujisawa Tokushukai HospitalKanagawa 251-0041Japan

Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract,unlike surgeons in regular surgery.It is difficult to obtain sufficient tension in the dissection plane and a good field of vision.Therefore,ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection.Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure.However,traction direction is limited in most traction methods,resulting in insufficient effect in some cases.Although traction direction is considered important,there have been few investigations of its effect.In the first half of this review,important traction methods are discussed,including traction direction.In second half,appropriate traction methods for each organ are considered.Other important considerations for traction method,such as ability to adjust traction strength,interference between traction device and endoscope,and the need for specialized devices are also discussed.

关键词： Endoscopic submucosal dissection Traction method Countertraction Traction direction Vertical traction

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Sedation and analgesia in gastrointestinal endoscopy: What’s new?

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World Journal of Gastroenterology 2010年第20期16卷 2451-2457页

作者： Lorella Fanti Pier Alberto Testoni Division of Gastroenterology and gastrointestinal endoscopy Vita-Salute San Raffaele UniversityScientific Institute San Raffaele20132 MilanItaly

Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endoscopy would include rapid onset and offset of action,analgesic and anxiolytic effects,ease of titration to desired level of sedation,rapid recovery and an excellent safety prof ile.Therefore there is an impulse for development of new approaches to endoscopic sedation.This article provides an update on the methods of sedation today available and future directions in endoscopic sedation.

关键词： gastrointestinal endoscopy Analgesia Sedation Propofol

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Synchronized early gastric cancer occurred in a patient with serrated polyposis syndrome:A case report

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World Journal of Clinical Cases 2022年第8期10卷 2644-2649页

作者： Ying-Ze Ning Guan-Yi Liu Xiao-Long Rao Yong-Chen Ma Long Rong Department of endoscopy Center Peking University First HospitalBeijing 100032China

BACKGROUND Serrated polyposis syndrome(SPS)is a relatively rare disease that is characterized by multiple serrated lesions/polyps.Very little is known regarding the extracolonic cancers associated with SPS.The genetic basis of the process remains unknown.CASE SUMMARY A 67-year-old male patient initially presented with belching and abdominal distension for a year as well as diarrhea for over 2 mo.The patient underwent colonoscopy and was diagnosed with serrated polyposis syndrome.Half a year later,a gastroscopy was performed during the postoperative re-examination to screen for other lesions of the upper gastrointestinal tract.An elevated lesion was detected in the anterior wall of the gastric antrum.Curative en bloc resection of the lesion was achieved via endoscopic submucosal dissection.The pathological result was high-grade dysplasia with focal intramucosal carcinoma.Exome sequencing was performed for the patient and five gastric cancer-associated variants(methylenetetrahydrofolate reductase,metaxin 1,coiled-coil domain containing 6,glutamate ionotropic receptor delta type subunit 1,and aldehyde dehydrogenase 1)were identified.CONCLUSION This paper reports a case that presented with both SPS and early gastric cancer.Genetic mutations that were potentially responsible for this condition were sought by exome sequencing.

关键词： Serrated polyposis syndrome Early gastric cancer Gene mutation endoscopy Exome sequencing Case report

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The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023

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Cancer Communications 2024年第1期44卷 127-172页

作者： Feng-Hua Wang Xiao-Tian Zhang Lei Tang Qi Wu Mu-Yan Cai Yuan-Fang Li Xiu-Juan Qu Hong Qiu Yu-Jing Zhang Jie-Er Ying Jun Zhang Ling-Yu Sun Rong-Bo Lin Chang Wang Hao Liu Miao-Zhen Qiu Wen-Long Guan Sheng-Xiang Rao Jia-Fu Ji Yan Xin Wei-Qi Sheng Hui-Mian Xu Zhi-Wei Zhou Ai-Ping Zhou Jing Jin Xiang-Lin Yuan Feng Bi Tian-Shu Liu Han Liang Yan-Qiao Zhang Guo-Xin Li Jun Liang Bao-Rui Liu Lin Shen Jin Li Rui-Hua Xu Department of Medical Oncology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP.R.China Department of gastrointestinal Oncology Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education)Peking University Cancer HospitalBeijingP.R.China Department of Radiology Peking University Cancer HospitalBeijingP.R.China Department of endoscopy Center Peking University Cancer HospitalBeijingP.R.China Department of Pathology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongP.R.China Department of Gastric Surgery Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP.R.China Department of Medical Oncology The First Hospital of China Medical UniversityShenyangLiaoningP.R.China Department of Medical Oncology Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and TechnologyWuhanHubeiP.R.China Department of Radiotherapy Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP.R.China Department of Medical Oncology Zhejiang Cancer HospitalHangzhouZhejiangP.R.China Department of Medical Oncology Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiP.R.China Department of Surgical Oncology The Fourth Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangP.R.China Department of Medical Oncology Fujian Cancer HospitalFuzhouFujianP.R.China Tumor Center The First Hospital of Jilin UniversityChangchunJilinP.R.China Department of General Surgery Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongP.R.China Department of Radiology Zhongshan HospitalFudan UniversityShanghaiP.R.China Department of

The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-based medicine,healthcare resource availability,and precision medicine.These updates address the differences in epidemiological characteristics,clinicopatho-logical features,tumor biology,treatment patterns,and drug selections between Eastern and Western gastric cancer patients.Key revisions include a structured template for imaging diagnosis reports,updated standards for molecular marker testing in pathological diagnosis,and an elevated recommendation for neoadju-vant chemotherapy in stage III gastric cancer.For advanced metastatic gastric cancer,the guidelines introduce new recommendations for immunotherapy,anti-angiogenic therapy and targeted drugs,along with updated management strategies for human epidermal growth factor receptor 2(HER2)-positive and deficient DNA mismatch repair(dMMR)/microsatellite instability-high(MSI-H)patients.Additionally,the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer.The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice,particularly in the heterogeneous healthcare landscape of China,while maintaining a commitment to scientific rigor,impartiality,and timely revisions.

关键词： Chinese Society of Clinical Oncology(CSCO) gastric cancer diagnosis surgery neoadjuvant adjuvant radiotherapy chemotherapy targeted therapy immunotherapy

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Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition:a systematic review and meta-analysis

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Gastroenterology Report 2022年第1期10卷 544-551页

作者： Antonio Facciorusso Stefano Francesco Crino Paraskevas Gkolfakis Daryl Ramai Andrea Lisotti Ioannis S Papanikolaou Benedetto Mangiavillano Ilaria Tarantino Andrea Anderloni Carlo Fabbri Konstantinos Triantafyllou Pietro Fusaroli Gastroenterology Unit Department of Surgical and Medical SciencesUniversity of FoggiaFoggiaItaly Department of Medicine Gastroenterology and Digestive Endoscopy UnitThe Pancreas InstituteUniversity Hospital of VeronaVeronaItaly Department of Gastroenterology Hepatopancreatologyand Digestive OncologyCUB Erasme HospitalUniversite Libre de Bruxelles(ULB)BrusselsBelgium Gastroenterology and Hepatology University of Utah HealthSalt Lake CityUTUSA Gastroenterology Unit Hospital of ImolaUniversity of BolognaImolaItaly Hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticMedical SchoolNational and Kapodistrian University of Athens‘Attikon’University General HospitalAthensGreece gastrointestinal endoscopy Unit Humanitas Mater DominiCastellanzaVareseItaly endoscopy Service Department of Diagnostic and Therapeutic ServicesIRCCS-ISMETTPalermoItaly Digestive endoscopy Unit Humanitas Clinical and Research Center—IRCCSRozzanoMilanoItaly Gastroenterology and Digestive endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly

Background:Endoscopic ultrasound(EUS)-guided tissue acquisition represents the choice of methods for suspected lymph nodes(LNs)located next to the gastrointestinal tract.This study aimed to compare the pooled diagnostic performance of EUS-guided fine-needle biopsy(EUS-FNB)and fine-needle aspiration(EUS-FNA)for LNs sampling.Methods:We searched PubMed/MedLine and Embase databases through August 2021.Primary outcome was diagnostic accuracy;secondary outcomes were sensitivity,specificity,sample adequacy,optimal histological core procurement,number of passes,and adverse events.We performed a pairwise meta-analysis using a random-effects model.The results are presented as odds ratio(OR)or mean difference along with 95%confidence interval(CI).Results:We identified nine studies(1,276 patients)in this meta-analysis.Among these patients,66.4%were male;the median age was 67 years.Diagnostic accuracy was not significantly different between the two approaches(OR,1.31;95%CI,0.81–2.10;P=0.270).The accuracy of EUS-FNB was significantly higher when being performed with newer end-cutting needles(OR,1.87;95%CI,1.17–3.00;P=0.009)and in abdominal LNs(OR,2.48;95%CI,1.52–4.05;P<0.001)than that of EUSFNA.No difference in terms of sample adequacy was observed between the two approaches(OR,1.40;95%CI,0.46–4.26;P=0.550);however,histological core procurement and diagnostic sensitivity with EUS-FNB were significantly higher than those with EUS-FNA(OR,6.15;95%CI,1.51–25.07;P=0.010 and OR,1.87;95%CI,1.27–2.74,P=0.001).The number of needle passes needed was significantly lower in the EUS-FNB group than in the EUS-FNA group(mean difference,-0.54;95%CI,-0.97 to -0.12;P=0.010).Conclusions EUS-FNA and EUS-FNB perform similarly in LN sampling;however,FNB performed with end-cutting needles outperformed FNA in terms of diagnostic accuracy.

关键词： EUS FNA FNB cancer metastases lymphoma

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Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

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World Journal of Gastroenterology 2016年第40期22卷 8991-8998页

作者： Sandro Passaretti Giorgia Mazzoleni Cristian Vailati Pier Alberto Testoni Gastroenterology and gastrointestinal endoscopy Division IRCCS San Raffaele Scientific Institute Vita-Salute San Raffaele University

AIM To investigate the relationship between pathological oropharyngeal(OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes.METHODS In this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease(GERD). We enrolled only patients with a reflux symptom index(RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal highresolution manometry(HRM). Patients were divided into two groups on the basis of a normal or pathological p H-metric finding(Ryan Score) and all manometric characteristics of the two groups were compared.RESULTS We examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure(median 71 mmH g vs 126 mmH g, P = 0.004) and the median proximal contractile integral(median 215.5 cm·mmH g·s vs 313.5 cm·mmH g·s, P = 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mm Hg isobaric contour(38.7% vs 15.38%, P < 0.0001).CONCLUSION In patients with suspected GERD-related extraesophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility.

关键词：食管活动性 Oropharyngeal 倒流 Gastroesophageal 倒流疾病高分辨率 manometry pH-metry

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Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature

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World Journal of gastrointestinal Surgery 2019年第2期11卷 53-61页

作者： Benedetto Mangiavillano Mouen A Khashab Ilaria Tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici gastrointestinal endoscopy Unit Humanitas-Mater Domini Humanitas Huniversity Division of Gastroenterology and Hepatology Johns Hopkins Hospital Gastroenterology and endoscopy Unit Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) Digestive endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center IRCCS Digestive endoscopy Unit Istituto Clinico Humanitas Research Hospital Unit of Gastroenterology Department of Medical and Surgical Sciences S. Orsola-Malpighi Hospital University of Bologna Gastroenterology and Digestive endoscopy Unit Ospedali Riuniti Marche Nord Digestive endoscopy Unit Division of Gastroenterology Humanitas Research Hospital

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography(EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP). The advent of lumen-apposing metal stents(LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.

关键词： Malignant biliary strictures Malignant duodenal stenosis Bilio-duodenal stenosis Biliary self-expandable metal stent Duodenal self-expandable metal stent Lumen-apposing metal stents Gastro-jejunostomy

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Pancreatitis after endoscopic retrograde cholangiopancreatography:A narrative review

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World Journal of Gastroenterology 2021年第20期27卷 2495-2506页

作者： Igor Braga Ribeiro Epifanio Silvino do Monte Junior Antonio Afonso Miranda Neto Igor Mendonça Proença Diogo Turiani Hourneaux de Moura Mauricio Kazuyoshi Minata Edson Ide Marcos Eduardo Lera dos Santos Gustavo de Oliveira Luz Sergio Eiji Matuguma Spencer Cheng Renato Baracat Eduardo Guimarães Hourneaux de Moura Department of gastrointestinal endoscopy Unit University of São Paulo School of MedicineSão Paulo 05403-010Brazil

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk patients.Pre-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events.Several studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage time.This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

关键词： Endoscopic retrograde cholangiopancreatography Pan-creatitis Postendoscopic retrograde cholangiopancreatography pancreatitis Adverse events Pancreatitis Prevention

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Efficacy and safety of PD-1 blockade plus long-course chemoradiotherapy in locally advanced rectal cancer(NECTAR):a multi-center phase 2 study

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Signal Transduction and Targeted Therapy 2024年第4期9卷 1721-1729页

作者： Zhengyang Yang Jiale Gao Jianyong Zheng Jiagang Han Ang Li Gang Liu Yi Sun Jie Zhang Guangyong Chen Rui Xu Xiao Zhang Yishan Liu Zhigang Bai Wei Deng Wei He Hongwei Yao Zhongtao Zhang Department of General Surgery Beijing Friendship HospitalCapital Medical UniversityState Key Lab of Digestive HealthNational Clinical Research Center for Digestive DiseasesBeijingChina Department of gastrointestinal Surgery The First Affiliated Hospital of Air Force Medical UniversityXi'anChina Department of General Surgery Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Department of General Surgery Beijing Xuanwu HospitalCapital Medical UniversityBeijingChina Department of General Surgery Tianjin Medical University General HospitalTianjinChina Department of Anorectal Tianjin People's HospitalTianjinChina Department of Radiology Beijing Friendship Hospital Capital Medical UniversityBeijingChina Department of Pathology Beijing Friendship HospitalCapital Medical UniversityBeijingChina Department of Thoracic Surgery/Institute of Thoracic Oncology West China HospitalSichuan UniversityChengduChina

Adding PD-1 blockade in the neoadjuvant regimens for locally advanced rectal cancer(LARC)patients with microsatellite stable(MsS)/mismatch repair-proficient(pMMR)tumors is an attractive,but debatable strategy.This phase 2,multicenter,prospective,single-arm study enrolled patients from 6 centers from June 2021 to November 2022.Locally advanced rectal cancer(LARC,cT_(3-4a)N_(0)M_(0) and cT_(1-4a)N_(1-2)M_(0))patients aged≥18 years with the distance from distal border of tumor to anal verge≤10 cm(identified by Magnetic Resonance Imaging)were qualifed for inclusion.The patients received long-course radiotherapy(50 Gy/25 fractions,2 Gy/fraction,5 days/week)and three 21-day cycles capecitabine(850-1000 mg/m2,bid,po,day1-14)and three 21-day cycles tislelizumab(200 mg,iv.gtt,day8)as neoadjuvant.Total mesorectal excision(TME)was 6-12 weeks after the end of radiotherapy to achieve radical resection.A total of 50 patients were enrolled in this study.The pathological complete response rate was 40.0%[20/50,95%confidence interval(CI):27.61-53.82%],while 15(30.0%,95%CI:19.1-43.75%),9(18.0%,95%CI:9.77-30.8%),2(4.0%,95%CI:1.10-13.46%)patients respectively achieved grade 1,2,and 3 tumor regression.Treatment-related adverse events(TRAEs)occurred in 28(56.0%)LARC patients,including 26(52.0%)with grade I-II and 2(4.0%)with grade II(1 with grade 3 immune-related colitis and 1 with grade 3 rash).PD-1 blockade plus long-course chemoradiotherapy(CRT)showed promising therapeutic effects according to pathological complete response rate and is well-tolerated in LARC patients.A larger randomized controlled study is desired to further validate the above findings.

关键词： rectal cancer phase

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