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Endoscopic features and treatments of gastric cystica profunda

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 layers.GCP 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 treatment.METHODS This retrospective study involved 104 patients with GCP who underwent endoscopic resection.Alongside demographic and clinical data,regular patient followups were conducted to assess local recurrence.RESULTS Among the 104 patients diagnosed with GCP who underwent endoscopic resection,12.5%had a history of previous gastric procedures.The 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 EGC.Univariate analysis indicated that elderly males were more susceptible to GCP associated with EGC.Conversely,multivariate analysis identified lesion morphology and endoscopic features as significant risk factors.Survival 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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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 worldwide.Accumulating studies have reported that N6-methyladenosine(m6A)is closely related to tumor progression.METTL5 is a m6A methyltransferase that plays a pivotal role in maintaining the metabolic stability of cells.However,its aberrant regulation in GC has not been fully elucidated.AIM To excavate the role of METTL5 in the development of GC.METHODS 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 samples.The 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 cytometry.The tumor-promoting role of METTL5 in vivo was evaluated in a xenograft tumor model.The EpiQuik m6A RNA Methylation Quantification Kit was used for m6A quantification.Next,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 tests.In addition,we investigated whether METTL5 affects the sensitivity of GC cells to cisplatin via colony formation and transwell experiments.RESULTS Our research revealed substantial upregulation of METTL5,which suggested a poor prognosis of GC patients.Increased METTL5 expression indicated distant lymph node metastasis,advanced cancer stage and pathological grade.An increased level of METTL5 correlated with a high degree of m6A methylation.METTL5 markedly promotes the proliferation,migration,and invasion of GC cells in vitro.METTL5 also promotes the growth of GC in animal models.METTL5 knockdown resulted in significant changes in sphingomyelin metabolism,which implies that METTL5 may impact the development of GC via sphingomyelin metabolism.In addition,high METTL5 expr

关键词： Gastric cancer METTL5 Sphingomyelin metabolism Cisplatin

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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)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic 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 tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In 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 period.CONCLUSION 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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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 markings.However,visual measurements of EV during routine endoscopy are often inaccurate.AIM To determine whether biopsy forceps(BF)could be used as a reference to improve the accuracy of binary classification of variceal size.METHODS An in vitro self-made EV model with sizes ranging from 2 to 12 mm in diameter was constructed.An 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.The endoscopists were blinded to the actual EV size and evaluated the 22 images in random order.RESULTS The respondents included 48 academic and four private endoscopists.The accuracy of EV size estimation was low in both the visual(13.81%)and BF-based(20.28%)groups.The 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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Propensity score matching analysis for clinical impact of braided-type versus laser-cut-type covered self-expandable metal stents for endoscopic ultrasound-guided hepaticogastrostomy

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 181-185页

作者： Mitsuki Tomita Takeshi Ogura Akitoshi Hakoda Saori Ueno Atsushi Okuda Nobu Nishioka Yoshitaro Yamamoto Hiroki Nishikawa 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical UniversityOsakaJapan endoscopy center Osaka Medical and Pharmaceutical UniversityOsakaJapan

Background:To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS),intra-scope channel release technique is important,but is unfamiliar to non-expert hands.The self-expandable metal stent(SEMS)is an additional factor to prevent stent migration.However,no compara-tive studies of laser-cut-type and braided-type during EUS-HGS have been reported.The aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut-type and braided-type SEMS.Methods:To evaluate stent anchoring function,we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS,one day after EUS-HGS,and 7 days after EUS-HGS.Also,propensity score matching was performed to create a propensity score for using laser-cut-type group and braided-type group.Results:A total of 142 patients were enrolled in this study.Among them,24 patients underwent EUS-HGS using a laser-cut-type SEMS,and 118 patients underwent EUS-HGS using a braided-type SEMS.EUS-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists(n=21);EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists(n=98).The distance after 1 day was significantly shorter in the laser-cut-type group than that in the braided-type group[2.00(1.70-3.75)vs.6.90(3.72-11.70)mm,P<0.001].In addition,this distance remained significantly shorter in the laser-cut-type group after 7 days.Although these results were similar after propensity score matching analysis,the distance between hepatic parenchyma and stomach after 7 days was increased by 4 mm compared with the distance after 1 day in the braided-type group.On the other hand,in the laser-cut-type group,the distance after 1 day and 7 days was almost the same.Conclusions:EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration,even in non-expert hands.

关键词： Endoscopic ultrasound-guided hepaticogastrostomy Endoscopic ultrasound-guided biliary drainage Endoscopic retrograde cholangiopancreatography

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Non-improvement of atrophic gastritis in cases of gastric cancer after successful Helicobacter pylori eradication therapy

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World Journal of Clinical Cases 2024年第14期12卷 2342-2349页

作者： Yuto Suzuki Yasumi Katayama Yo Fujimoto Ikuhiro Kobori Masaya Tamano Department of Gastroenterology Dokkyo medical University Saitama Medical CenterKoshigayaSaitama 343-8555Japan endoscopy center Dokkyo Medical University Saitama Medical CenterKoshigayaSaitama 343-8555Japan

BACKGROUND Helicobacter pylori(H.pylori)infection is closely related to the development of gastric cancer(GC).However,GC can develop even after H.pylori eradication.Therefore,it would be extremely useful if GC could be predicted after eradication.The Kyoto classification score for gastritis(GA)is closely related to cancer risk.However,how the score for GC changes after eradication before onset is not well understood.AIM To investigate the characteristics of the progression of Kyoto classification scores for GC after H.pylori eradication.METHODS Eradication of H.pylori was confirmed in all patients using either the urea breath test or the stool antigen test.The Kyoto classification score of GC patients was evaluated by endoscopy at the time of event onset and three years earlier.In ad-dition,the modified atrophy score was evaluated and compared between the GC group and the control GA group.RESULTS In total,30 cases of early GC and 30 cases of chronic GA were evaluated.The pathology of the cancer cases was differentiated adenocarcinoma,except for one case of undifferentiated adenocarcinoma.The total score of the Kyoto classifi-cation was significantly higher in the GC group both at the time of cancer onset and three years earlier(4.97 vs 3.73,P=0.0034;4.2 vs 3.1,P=0.0035,respectively).The modified atrophy score was significantly higher in the GC group both at the time of cancer onset and three years earlier and was significantly improved only in the GA group(5.3 vs 5.3,P=0.5;3.73 vs 3.1,P=0.0475,respectively).CONCLUSION The course of the modified atrophy score is useful for predicting the onset of GC after eradication.Patients with severe atrophy after H.pylori eradication require careful monitoring.

关键词： Helicobacter pylori Kyoto classification Gastritis Eradication therapy Gastric cancer

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Association between Serum Ferritin Levels and Metabolic-associated Fatty Liver Disease in Adults:a Cross-sectional Study Based on the NHANES

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Current Medical Science 2024年第3期44卷 494-502页

作者： Jiang-hui LI Xue-yao MA Yun YI Lu-rao LI Zhi-yong XU Ying CHANG Department of Gastroenterology Zhongnan Hospital of Wuhan UniversityWuhan430071China Hubei Clinical center and Key Laboratory of Intestinal and Colorectal Diseases Wuhan430071China endoscopy center The People’s Hospital of YingshanHuanggang438799China

Objective Ferritin,initially acting as an iron-storage protein,was found to be associated with metabolic diseases.Our study was designed to investigate the association between serum ferritin and metabolic-associated fatty liver disease(MAFLD)using data from the National Health and Nutrition Examination Survey(NHANES)of the United State of America.Methods A cross-sectional study was conducted,enrolling a total of 2145 participants from the NHANES in the 2017–2018 cycles.Hepatic steatosis and liver fibrosis were assessed by ultrasound images and several non-invasive indexes.Multiple regression analysis was conducted to determine the associations between serum ferritin concentration and MAFLD and liver fibrosis.Results The analysis revealed that participants with higher serum ferritin levels(Q3 and Q4 groups)had a higher prevalence of MAFLD than those with the lowest serum ferritin levels[Q3 vs.Q1:OR=2.17(1.33,3.53),Padvanced liver fibrosis in patients.Elevated serum ferritin levels combined with diabetes are important risk factors for liver fibrosis.

关键词： serum ferritin liver fibrosis metabolic-associated fatty liver disease National Health and Nutrition Examination Survey

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Lactobacillus plantarum AR495 improves stress-induced irritable bowel syndrome in rats by targeting gut microbiota and Mast cell-PAR2-TRPV1 signaling pathway

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Food Science and Human Wellness 2024年第2期13卷 698-708页

作者： Hongyun Zhang Guangqiang Wang Zhiqiang Xiong Zhuan Liao Yangyan Qian Xin Song Li Sui Lianzhong Ai Yongjun Xia Shanghai Engineering Research center of Food Microbiology School of Health Science and EngineeringUniversity of Shanghai for Science and TechnologyShanghai 200093China Department of Gastroenterol Digestive Endoscopy CenterShanghai HospitalShanghai 200093China

Probiotics have great potential in regulating intestinal pain.In this study,the effects of Lactobacillus plantarum AR495 on the visceral sensitivity and gut microbiota of irritable bowel syndrome(IBS)rats were studied.The results showed that tryptase released after mast cell activation and degranulation plays a key role in visceral pain,and L.plantarum AR495 reduced the stimulation of colonic mast cells and the expression of protease-activated receptor 2(PAR2)and TRPV1 in dorsal root ganglia.Research further showed that supplementation with L.plantarum AR495 increased the level of short-chain fatty acids(SCFAs)and enhanced the barrier function of the colon.In addition,the microbiota analysis of the colon indicated that L.plantarum AR495 promoted the proliferation of Bifidobacterium and inhibited the proliferation of Lachnospiraceae,which alleviated the imbalance of the intestinal microbiota caused by IBS to a certain extent.In total,L.plantarum AR495 might reduce visceral sensitivity through the Mast cell-PAR2-TRPV1 signaling pathway by maintaining the homeostasis of the intestinal barrier.

关键词： Lactobacillus plantarum Irritable bowel syndrome Visceral sensitivity Dorsal root ganglia Tryptase Microbiota

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

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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 GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By 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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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 cancers.AIM To identify exhaled breath VOCs that distinguish pancreatic ductal adenocar-cinoma(PDAC)from intraductal papillary mucinous neoplasm(IPMN)and healthy volunteers.METHODS We collected exhaled breath from histologically proven PDAC patients,radiological diagnosis IPMN,and healthy volunteers using the ReCIVA®device between 10/2021-11/2022.VOCs were identified by thermal desorption-gas chromatography/field-asymmetric ion mobility spectrometry and compared between groups.RESULTS 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 participants.Additional prospective studies are required to validate these findings.

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

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