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Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

World Journal of gastrointestinal Oncology 2024年第4期16卷 1334-1343页

作者： Zi-Wei Li Xiao-Juan Luo Fei Liu Xu-Rui Liu Xin-Peng Shu Yue Tong Quan Lv Xiao-Yu Liu Wei Zhang Dong Peng Department of gastrointestinal Surgery The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China Department of endoscopy center The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400012China

BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with *** The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,*** mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for *** quality of the included studies was evaluated using the Newcastle-Ottawa Scale *** used Stata(V.16.0)software for data *** This study consists of six studies involving 878 elderly *** analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

关键词： Enhanced recovery after surgery Gastric cancer Elderly Mortality

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Early postoperative complications after transverse colostomy closure,a retrospective study

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World Journal of gastrointestinal Surgery 2024年第3期16卷 807-815页

作者： Fei Liu Xiao-Juan Luo Zi-Wei Li Xiao-Yu Liu Xu-Rui Liu Quan Lv Xin-Peng Shu Wei Zhang Dong Peng Department of gastrointestinal Surgery The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China endoscopy center The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400012China

BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal *** To analyze the complications after transverse colostomy *** Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical *** differences between the complication group and the no complication group were *** regression analyses were conducted to find independent factors for overall complications or incision *** A total of 102 patients who underwent transverse colostomy closure were enrolled in the current ***(68.6%)patients underwent transverse colostomy because of CRC related *** complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(Pcenter was incision *** operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative *** should pay more attention to aseptic techniques.

关键词： Transverse colostomy closure Surgery Complications A single clinical centre Risk factors

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Endoscopic features and treatments of gastric cystica profunda

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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 *** 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 *** This retrospective study involved 104 patients with GCP who underwent endoscopic *** demographic and clinical data,regular patient followups were conducted to assess local *** Among the 104 patients diagnosed with GCP who underwent endoscopic resection,12.5%had a history of previous gastric *** 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 *** analysis indicated that elderly males were more susceptible to GCP associated with ***,multivariate analysis identified lesion morphology and endoscopic features as significant risk *** 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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Identification of breath volatile organic compounds to distinguish pancreatic adenocarcinoma,pancreatic cystic neoplasm,and patients without pancreatic lesions

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World Journal of gastrointestinal Oncology 2024年第3期16卷 894-906页

作者： Kasenee Tiankanon Nuttanit Pungpipattrakul Thanikan Sukaram Roongruedee Chaiteerakij Rungsun Rerknimitr Division of Gastroenterology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand center of Excellence for Innovation and endoscopy in gastrointestinal Oncology King Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok 10330Thailand

BACKGROUND Volatile organic compounds(VOCs)are a promising potential biomarker that may be able to identify the presence of *** To identify exhaled breath VOCs that distinguish pancreatic ductal adenocar-cinoma(PDAC)from intraductal papillary mucinous neoplasm(IPMN)and healthy *** We collected exhaled breath from histologically proven PDAC patients,radiological diagnosis IPMN,and healthy volunteers using the ReCIVA®device between 10/2021-11/*** were identified by thermal desorption-gas chromatography/field-asymmetric ion mobility spectrometry and compared between *** A total of 156 participants(44%male,mean age 62.6±10.6)were enrolled(54 PDAC,42 IPMN,and 60 controls).Among the nine VOCs identified,two VOCs that showed differences between groups were dimethyl sulfide[0.73 vs 0.74 vs 0.94 arbitrary units(AU),respectively;P=0.008]and acetone dimers(3.95 vs 4.49 vs 5.19 AU,respectively;P<0.001).After adjusting for the imbalance parameters,PDAC showed higher dimethyl sulfide levels than the control and IPMN groups,with adjusted odds ratio(aOR)of 6.98(95%CI:1.15-42.17)and 4.56(1.03-20.20),respectively(P<0.05 both).Acetone dimer levels were also higher in PDAC compared to controls and IPMN(aOR:5.12(1.80-14.57)and aOR:3.35(1.47-7.63),respectively(P<0.05 both).Acetone dimer,but not dimethyl sulfide,performed better than CA19-9 in PDAC diagnosis(AUROC 0.910 vs 0.796).The AUROC of acetone dimer increased to 0.936 when combined with CA19-9,which was better than CA19-9 alone(P<0.05).CONCLUSION Dimethyl sulfide and acetone dimer are VOCs that potentially distinguish PDAC from IPMN and healthy *** prospective studies are required to validate these findings.

关键词： Volatile organic compound Pancreas Adenocarcinoma Pancreatic intraductal neoplasms Breathing

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METTL5 promotes gastric cancer progression via sphingomyelin metabolism

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World Journal of gastrointestinal Oncology 2024年第5期16卷 1925-1946页

作者： Ya-Qiong Zhang Jian Li Zhe Qin De-Ming Li Fang-Zhou Ye Song-Hua Bei Xiao-Hong Zhang Li Feng endoscopy center Minhang Hospital Affiliated to Fudan UniversityShanghai 201100China

BACKGROUND The treatment of gastric cancer(GC)has caused an enormous social burden *** studies have reported that N6-methyladenosine(m6A)is closely related to tumor ***5 is a m6A methyltransferase that plays a pivotal role in maintaining the metabolic stability of ***,its aberrant regulation in GC has not been fully *** To excavate the role of METTL5 in the development of *** METTL5 expression and clinicopathological characteristics were analyzed via The Cancer Genome Atlas dataset and further verified via immunohistochemistry,western blotting and real-time quantitative polymerase chain reaction in tissue microarrays and clinical *** tumor-promoting effect of METTL5 on HGC-27 and AGS cells was explored in vitro by Cell Counting Kit-8 assays,colony formation assays,scratch healing assays,transwell assays and flow *** tumor-promoting role of METTL5 in vivo was evaluated in a xenograft tumor *** EpiQuik m6A RNA Methylation Quantification Kit was used for m6A ***,liquid chromatography-mass spectrometry was used to evaluate the association between METTL5 and sphingomyelin metabolism,which was confirmed by Enzyme-linked immunosorbent assay and rescue *** addition,we investigated whether METTL5 affects the sensitivity of GC cells to cisplatin via colony formation and transwell *** Our research revealed substantial upregulation of METTL5,which suggested a poor prognosis of GC *** METTL5 expression indicated distant lymph node metastasis,advanced cancer stage and pathological *** increased level of METTL5 correlated with a high degree of m6A ***5 markedly promotes the proliferation,migration,and invasion of GC cells in ***5 also promotes the growth of GC in animal ***5 knockdown resulted in significant changes in sphingomyelin metabolism,which implies that METTL5 may impact the development of GC via sphin

关键词： Gastric cancer METTL5 Sphingomyelin metabolism Cisplatin

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Biopsy forceps are useful for measuring esophageal varices in vitro

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World Journal of gastrointestinal Surgery 2024年第2期16卷 539-545页

作者： Zhi-Hui Duan Sheng-Yun Zhou endoscopy center Xingtai People’s HospitalXingtai 054000Hebei ProvinceChina

BACKGROUND To avoid acute variceal bleeding in cirrhosis,current guidelines recommend screening for high-risk esophageal varices(EVs)by determining variceal size and identifying red wale ***,visual measurements of EV during routine endoscopy are often *** To determine whether biopsy forceps(BF)could be used as a reference to improve the accuracy of binary classification of variceal *** An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was *** online image-based survey comprising 11 endoscopic images of simulated EV without BF and 11 endoscopic images of EV with BF was assembled and sent to 84 *** endoscopists were blinded to the actual EV size and evaluated the 22 images in random *** The respondents included 48 academic and four private *** accuracy of EV size estimation was low in both the visual(13.81%)and BF-based(20.28%)*** use of open forceps improved the ability of the endoscopists to correctly classify the varices by size(small≤5 mm,large>5 mm)from 71.85%to 82.17%(P<0.001).CONCLUSION BF may improve the accuracy of EV size assessment,and its use in clinical practice should be investigated.

关键词： Accuracy Liver cirrhosis Esophageal varices endoscopy Measurement

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Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi

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World Journal of gastrointestinal Surgery 2024年第6期16卷 1726-1733页

作者： Kai Fu Ying-Ying Yang Hui Chen Guang-Xin Zhang Yan Wang Zhi Yin Department of Gastroentero endoscopy center Yixing Hospital of Traditional Chinese MedicineWuxi 214200Jiangsu ProvinceChina

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP),with its clinical ad-vantages of less trauma and faster recovery,has become the primary treatment for *** To investigate the effects of different ERCP procedures on the sphincter of *** The clinical data of 91 patients who underwent ERCP at Yixing Hospital of Traditional Chinese Medicine between February 2018 and February 2021 were analyzed *** patients were divided into endoscopic sphinc-terotomy(EST,n=24)and endoscopic papillary balloon dilation(EPBD,n=67)*** duration of operation,pancreatic development,pancreatic sphinc-terotomy,intubation difficulties,stone recurrence,and incidence of reflux cho-langitis and cholecystitis were statistically analyzed in patients with a history of choledocholithiasis,pancreatitis,and Oddi sphincter dysfunction in the EST and EPBD *** Differences in hypertension,diabetes,increased bilirubin,small diameter of the common bile duct,or ampullary diverticulum between the two groups were not *** significant differences were observed between the two groups concerning sex and age(<60 years).Patients with a history of choledocholithiasis,pancreatitis,and Oddi sphincter dysfunction were higher in the EST group than in the EPBD *** number of cases of pancreatic development,pancreatic duct sphincterotomy,and difficult intubation were higher in the EST group than in the EPBD *** number of Oddi’s sphincter manometries,ERCP surgical outcomes,and guidewires entering the pancreatic duct several times in EST group were lower than those in the EPBD *** numbers of stone recurrences,reflux cholangitis,and cholecystitis were higher in the EST group than in the EPBD *** In summary,common bile duct stones,pancreatitis history,and multiple guided wire introductions into the pancreatic duct are independent risk factors for EST and *** on this evidence,this study can provide

关键词： Oddi Cholangiopancreatography Endoscopic retrograde Risk factors Endoscopic sphincterotomy Endoscopic papillary balloon dilation

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Serum urate is associated with an increased risk of inflammatory bowel disease: A bidirectional Mendelian randomization study

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World Journal of Clinical Cases 2024年第5期12卷 891-902页

作者： Song Zhang Xue Fang Le Kang Xiang-Yu Sui Miao Liu Yu-Jia Luo Shuo Fu Zhao-Shen Li Sheng-BingZhao Yu Bai Department of Gastroenterology Changhai HospitalShanghai 200433China Department of Gastroenterology Changhai HospitalSecond Military Medical University/Naval Medical UniversityShanghai 200433China Digestive endoscopy center Changhai HospitalNaval/Second Military Medical UniversityShanghai 200433China National Clinical Research center for Digestive Diseases Shanghai 200433China

BACKGROUND Previous studies have indicated bidirectional associations between urate levels and inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD).However,it remains unclear whether the observations are causal because of confounding *** To investigate the causal associations between urate levels and IBD using bidirec-tional Mendelian randomization(MR).METHODS Independent genetic variants for urate levels and IBD were selected as instru-mental variables from published genome-wide association studies(GWASs).Summary statistics for instrument-outcome associations were retrieved from three separate databases for IBD(the UK Biobank,the FinnGen database and a large GWAS meta-analysis)and one for urate levels(a large GWAS meta-analysis).MR analyses included the inverse-variance-weighted method,weighted-median estimator,MR-Egger and sensitivity analyses(MR-PRESSO).A meta-analysis was also conducted to merge the data from separate outcome databases using a fixed-effects *** Genetically higher serum urate levels were strongly associated with an increased risk of UC[odds ratio(OR):1.95,95%confidence interval(CI):1.86-2.05]after outlier correction,and the ORs(95%CIs)for IBD and CD were 0.94(95%CI:0.86-1.03)and 0.91(95%CI:0.80-1.04),*** studies have confirmed the positive association between urate levels and ***,genetically predicted IBD was inversely related to urate levels(OR:0.97,95%CI:0.94-0.99).However,no association was observed between genetically influenced UC or CD and urate *** Urate levels might be risk factors for UC,whereas genetically predicted IBD was inversely associated with urate *** findings provide essential new insight for treating and preventing IBD.

关键词： Inflammatory bowel disease Urate levels Antioxidant Mendelian randomization Single nucleotide polymorphism

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Asymptomatic low-grade appendiceal mucinous neoplasm:A case report

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World Journal of Clinical Cases 2024年第2期12卷 361-366页

作者： Min-Quan Yao Yu-Peng Jiang Yuan-Yu Wang Yi-Ping Mou Jin-Xing Fan Department of gastrointestinal Surgery Tongxiang First People’s HospitalJiaxing 314500Zhejiang ProvinceChina Department of General Surgery Zhejiang Provincial People’s HospitalHangzhou 310014Zhejiang ProvinceChina endoscopy center Tongxiang First People’s HospitalJiaxing 314500Zhejiang ProvinceChina

BACKGROUND Low-grade appendiceal neoplasms(LAMN)are characterized by low incidence and atypical clinical presentations,often leading to misdiagnosis as acute or chronic appendicitis before *** primary diagnostic tool for LAMN is abdominal computed tomography(CT)*** resection remains the cornerstone of LAMN management,necessitating en bloc tumor excision to minimize the risk of iatrogenic ***,known for its minimal invasiveness,reduced postoperative discomfort,and expedited recovery,is a safe and reliable approach for LAMN *** the possibility of pseudomyxoma peritonei development,appendectomy and partial appendectomy generally result in negative tumor margins and favorable outcomes,which can be attributed to the disease’s slow growth and lower *** SUMMARY A 71-year-old male patient was admitted to our hospital with a pelvic spaceoccupying lesion detected 1 mo *** examination showed a soft abdomen without tenderness or rebound and no palpable *** shifting dullness was noted,and digital rectal examination revealed no palpable *** revealed a raised,smooth-surfaced mass measuring 3.0 cm in the *** contrast-enhanced CT showed a markedly thickened and dilated appendix with visible cystic *** surgery was performed and revealed a significantly dilated appendix,leading to laparoscopic resection of the appendix and part of the ***-surgical pathologic analysis confirmed *** patient received symptomatic and supportive post-operative care and was discharged on postoperative day 4 without complications such as abdominal bleeding,intestinal obstruction,or incision *** tumor recurrence was observed during a 7-mo follow-up *** LAMN is a rare disease that lacks specific clinical *** CT plays a crucial role in diagnosing LAMN,and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.

关键词： Low-grade appendiceal mucinous neoplasm Pseudomyxoma peritonei Computed tomography Laparoscopy appendectomy Case report

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Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract

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World Journal of Clinical Oncology 2024年第2期15卷 282-289页

作者： Zi-Han Geng Yan Zhu Pei-Yao Fu Yi-Fan Qu Shi-Yao Chen Yun-Shi Zhong Yi-Qun Zhang Wei-Feng Chen Wen-Zheng Qin Jian-Wei Hu Ming-Yan Cai Li-Qing Yao Quan-Lin Li Ping-Hong Zhou endoscopy center and endoscopy Research Institute Zhongshan HospitalFudan UniversityShanghai 200032China Shanghai Collaborative Innovation center of endoscopy Shanghai 200032China

BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)*** To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and *** This retrospective study included 36 patients diagnosed with CFTs of the GI *** collected demographic and clinical information and conducted regular follow-ups to assess for local *** The stomach was the most commonly involved site,accounting for 72.2%of the 36 *** mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous ***,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 *** average maximum diameter of the tumors was 10.6±4.3 *** complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 *** addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up *** GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.

关键词： Endoscopic resection Calcifying fibrous tumor gastrointestinal tract

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