Radiation-free one-stage bedside endoscopic stone removal and biliary drainage for severe acute cholangitis (SAC) caused by choledocholithiasis in intensive care unit (ICU) has not been reported. Herein, we introduce our preliminary experience of such intervention. Radiation-free bedside digital cholangioscope-assisted one-stage endoscopic stone removal and biliary drainage was performed in an urgent manner. Data on clinical outcomes and follow-up from thirty patients were retrospectively analyzed. Time interval was 7.6 ± 4.7 (2–18) h between ICU admission and endoscopic intervention, and was 35.5 ± 14.5 (5–48) h between the seizure and endoscopic intervention. A 100% technical success was achieved. Except for one mild pancreatitis, no other complication occurred. Patients showed good responses to endoscopic interventions, which were reflected by ameliorated disease severities and laboratory findings. Time lengths of ICU stay and total in-hospital stay were 8.7 ± 4.9 (2–23) days and 14.5 ± 7.4 (5–39) days, respectively. In-hospital mortality occurred in three patients. According to a 6-month follow-up, two patients died of pneumonia and acute myocardial infarction. No SAC and/or biliary stone residual occurred. The current intervention demonstrated favorable results compared to traditional endoscopic retrograde cholangiopancreatography. Our study provides a novel bedside endoscopic intervention method for SAC caused by choledocholithiasis.
Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.
Objective:To evaluate the clinical efficacy of single-wide-tunnel endoscopic submucosal dissection with single-clip-line traction (W-ESTD) for the treatment of early esophageal cancer and precancerous lesions with large area (≥ 3/4 circumference).Methods:A retrospective analysis was performed on patient data of large early esophageal cancer or precancerous lesions treated with digestive endoscopy at the Affiliated Huai'an NO.1 People's Hospital of Nanjing Medical University from January 2018 to January 2023. Patients were divided into W-ESTD group and endoscopic submucosal double-tunnel dissection (D-ESTD) group based on the technique used. Surgical speed, en bloc resection rate, R0 resection rate, curative resection rate, intraoperative and postoperative complications were compared between the two groups.Results:A total of 44 patients with large early esophageal cancer or precancerous lesions were included in this study, including 23 cases in the W-ESTD group and 21 cases in the D-ESTD group. There was no statistically significant difference in baseline data between the two groups ( P>0.05). The operating speeds of W-ESTD and D-ESTD groups were 29.97±11.89 mm2/min and 22.65±6.30 mm2/min, respectively, with significant difference ( t=2.580, P=0.014). There was no statistically significant difference between the two groups in terms of en bloc resection rate [95.7% (22/23) VS 100.0% (21/21), P=1.000], R0 resection rate [87.0% (20/23) VS 90.5% (19/21), P=1.000], or curative resection rate [73.9% (17/23) VS 85.7% (18/21), P=0.462]. No recurrence occurred. Intraoperative muscular injury occurred in 3 cases in the W-ESTD group and 5 cases in the D-ESTD group, and postoperative esophageal stricture occurred in 11 cases and 8 cases respectively, with no significant differences between the two groups ( P>0.05). Conclusion:Compared to D-ESTD, W-ESTD can significantly improve surgical speed and demonstrate itself as a safe and effective approach for treating large early esophageal cancer and precancerous lesions.
Objective:To evaluate the effect of linaclotide combined with compound polyethylene glycol (PEG) on bowel preparation for colonoscopy.Methods:This trial was a multicenter randomized controlled study. Subjects scheduled for colonoscopy in 3 digestive endoscopy centers of The First Affiliated Hospital of Naval Medical University, Shanxi Province People's Hospital and the 900th Hospital of Joint Logistics Support Force from November 2021 to March 2022 were randomly assigned to 3 groups using completely random method. The bowel preparation of group A was 3-day linaclotide with 3 L PEG, that of group B was only 3 L PEG, and group C was 3-day linaclotide with 2 L PEG. The primary outcome was the rate of adequate bowel preparation, and the secondary outcomes were the rate of excellent bowel preparation, the completion rate of bowel preparation and the willingness to repeat the corresponding bowel preparation regimen.Results:A total of 130 subjects were enrolled, including 46 in group A, 43 in group B, and 41 in group C. There was no significant difference among the 3 groups in the rate of adequate bowel preparation [95.7% (44/46), 93.0% (40/43) and 95.1% (39/41), χ2=0.465, P=0.893], the rate of excellent bowel preparation [43.5%(20/46), 25.6% (11/43) and 34.1% (14/41), χ2=3.151, P=0.207], or the completion rate of bowel preparation [95.7% (44/46), 95.3% (41/43) and 100.0% (41/41), χ2=1.909, P=0.544]. However, there were significant differences in the willingness to repeat the corresponding bowel preparation regimen among the 3 groups [89.1% (41/46), 74.4% (32/43) and 100.0% (41/41), χ2=12.862, P=0.002]. The bowel preparation completion and willingness rate of subjects in group C were both 100.0%, which were higher than those in group A and group B. Conclusion:Linaclotide is able to improve the quality of bowel preparation and reduce the amount of PEG.
Objective:To compare the role and efficacy of serum Helicobacter pylori ( HP) antibody combined with pepsinogen (PG) (ABC method), serum PG combined with gastrin-17 (G-17) (new ABC method) and a new gastric cancer screening scoring system for early gastric cancer screening in healthy people. Methods:Serological examinations were performed on healthy people who underwent physical examination and gastroscopy at the Physical Examination Center of Shanghai Songjiang District Central Hospital from January 2019 to December 2021. The population were divided into low-risk population, medium-risk population and high-risk population based on the above three primary screening methods for gastric cancer. Using gastroscopy and biopsy pathology as the gold standard, the ratio of each risk stratification and the detection rate of gastric cancer of the three screening methods were calculated. Advantages and disadvantages of the three methods were evaluated.Results:A total of 3 199 people who completed physical examination and gastroscopy were included in the study. Ten cases (0.31%) of esophageal cancer were detected by endoscopy, all of whom were early esophageal cancer. Thirty-seven cases (1.16%) of gastric cancer were detected,and the detection rate of early gastric cancer was 86.49%(32/37). The three gastric cancer screening methods were used to evaluate the risk of gastric cancer. According to ABC method, there were 1 853 cases (7.92%) in the low-risk group, 1 339 cases (41.86%) in the medium-risk group, and 7 cases (0.22%) in the high-risk group. The detection rates of gastric cancer were 0.97% (18/1 853), 1.42% (19/1 339), and 0.00%, respectively. According to the new ABC method, there were 2 362 cases (73.84%) in the low-risk group, 804 cases (25.13%) in the medium-risk group, and 33 cases (1.03%) in the high-risk group. The detection rates of gastric cancer were 1.14% (27/2 362), 1.24% (10/804), and 0.00%, respectively. According to the new gastric cancer screening scoring system, there were 1 448 cases (45.26%) in the low-risk group, 1 213 cases (37.92%) in the medium-risk group and 538 cases (16.82%) in the high-risk group. The detection rates of gastric cancer were 0.28% (4/1 448), 1.32% (16/1 213) and 3.16% (17/538), respectively. The detection rate of gastric cancer in the medium- and high-risk groups in total was significantly higher than that in the low-risk group with significant difference ( χ 2=17.935, P<0.001). The ROC curve showed that the AUC of the ABC method, the new ABC method and the new gastric cancer screening scoring system were 0.546, 0.503 and 0.760, respectively. The AUC of the new gastric cancer screening scoring system was significantly higher than those of the ABC method and the new ABC method, and the differences were statistically significant ( P<0.001). Conclusion:The detection rate of gastric cancer in the medium- and high-risk groups of the new gastric cancer screening scoring system is higher than that of the low-risk group, and the missed diagnosis rate of the new gastric cancer screening scoring system is lower than those of the ABC method and the new ABC method. The screening score is of high value for early gastric cancer screening in the healthy population.
胃癌分为早期胃癌和进展期胃癌，其中早期胃癌患者五年生存率达90%以上，而进展期胃癌五年生存率尚不足20%。因此，了解胃癌前病变发病机制，做到胃癌的早期筛诊和干预，对于胃癌患者的预后至关重要。本文总结并探讨了目前胃癌前病变发病机制及胃癌早期筛查方法的最新进展，旨在为今后胃癌前病变的干预及早期胃癌的筛查研究提供理论基础。
Zenker憩室是常见的食管发育畸形，可导致食管支气管瘘等严重并发症，传统治疗手段以外科手术为主，创伤大，并发症多。目前多采取内镜下治疗，本文报道1例经内镜下黏膜剥离术联合金属夹封闭术成功治疗的食管入口处Zenker憩室，创伤小，效果好，基本无并发症，旨在为该类疾病的临床治疗提供参考。
经口内镜下肌切开术（peroral endoscopic myotomy，POEM）是一种通过切开食管下括约肌，改善贲门失弛缓症临床症状的微创内镜技术。作为近年来的新兴内镜技术，POEM症状缓解率高、并发症发生率低，且具有恢复快、费用低等优势。随着研究者们对POEM的关注度越来越高，有关POEM的手术方式有了新的研究进展，本文就POEM标准术式的改进、改良术式及衍生术式作一概述。
浅表锯齿状腺瘤是2018年提出的一种新型锯齿状病变，具有独特临床病理和分子特征，表现出典型的混合性腺瘤和锯齿状特征。分子机制上，浅表锯齿状腺瘤病变表现为β-连环蛋白的核积累和MYC过表达，提示WNT信号通路激活，同时浅表锯齿状腺瘤显示出与相关传统锯齿状腺瘤一致的KRAS突变和RSPO融合或过表达，提示浅表锯齿状腺瘤可能是KRAS突变的传统锯齿状腺瘤重要前体。本文重点讲述浅表锯齿状腺瘤的特点以引起内镜医师对该病变的重视。
Esophageal and gastric cancers are two of the common malignant tumors in Midwest China, posing a serious threat to public health. In recent years, magnifying endoscopy has been widely used in the screening and diagnosis of early esophageal cancer and gastric cancer. Through conducting multiple discussions with numerous experts, and combining the latest research progress in the diagnosis and treatment of early upper gastrointestinal cancer by magnifying endoscopy, the consensus of magnifying endoscopy for upper gastrointestinal tumors in high-risk populations in Midwest China was developed. The expert opinion aims to further increase the detection rate of early upper gastrointestinal cancer and promote the standardized application of magnifying endoscopy.
Objective:To explore the application value of the new gastric cancer screening scoring system for risk populations in the island of Fujian province.Methods:From April to June 2019, gastric cancer screening was performed on the population of Nanri Island, Putian City, Fujian Province, and epidemiological data of all subjects were prospectively collected. Participants underwent gastroscopy based on gastric cancer risk stratification of the new scoring system. Suspected positive cases further received magnifying endoscopy and biopsy. Additional endoscopic procedures and other surgical treatments were conducted. The detection rates of gastric cancer and precancerous lesions in each group of gastric cancer risk stratification were compared, and the Chi-square test was used for statistical analysis.Results:A total of 1 423 subjects were included, and 19 cases (1.34%) of gastric cancer were detected. The detection rates of gastric cancer were 0.88% (9/1 025) in the low-risk group, 1.76% (6/341) in the medium-risk group, and 7.02% (4/57) in the high-risk group. Paired comparison between the low-risk group and the high-risk group showed significant difference ( χ2=12.364, P=0.003). There was no significant difference between the low-risk group and medium-risk group, or between the medium-risk group and high-risk group ( P>0.05). Among all participants, 87 (6.11%) cases of gastric precancerous lesions were identified. The detection rates of precancerous lesions in the low-risk, medium-risk, and high-risk groups were 6.24% (64/1 025), 5.87% (20/341), and 5.26% (3/57) respectively, with no significant difference among the three groups ( P>0.05) .Conclusion:During gastric cancer screening, the novel gastric cancer screening scoring system helps to stratify gastric cancer risk for population in the islands of Fujian province, serving as a foundation for subsequent detailed endoscopy.
Objective:To evaluate modified Lanza score (MLS) of gastric mucosa for predicting the prognosis of geriatric patients with sepsis.Methods:Data of 50 patients with sepsis, who were over 60 years old and underwent gastroscopy for suspected gastrointestinal bleeding in the Department of Geriatric Critical Care Medicine of Guangdong Provincial People's Hospital from January 2019 to April 2022, were retrospectively analyzed. Patients were divided into the death group ( n=32) and the survival group ( n=18) according to their regression within 28 days after gastroscopy. Their gastric mucosa was scored by using MLS system, and the mortality of patients with MLS≥1 was calculated, then the patients were further divided into 2 groups, MLS=0-2 ( n=23, less than 2 regions of lesions ) and MLS=3-5 ( n=27, two or more regions of lesions). The relationship between MLS and acute physiology and chronic health status evaluation (APACHE) Ⅱ score, risk factor of death and mortality in each group were compared. The correlation between MLS and mortality was analyzed. The influence of geriatric sepsis risk factors affecting the prognosis of patients within 28 days were analyzed by using logistic regression. Results:Among the 50 geriatric patients with sepsis, those with gastric mucosal lesions, i.e., MLS ≥1, accounted for 68.00% (34/50), including 84.38% (27/32) patients with MLS≥1 in the death group, which was significantly higher than the 38.89% (7/18) patients with MLS≥1 in the survival group ( χ 2=10.593, P<0.001). Patients with MLS=3-5 had significantly higher APACHE Ⅱ scores (26.09±6.47 VS 18.57±7.66, t=3.527, P=0.001) and higher mortality [85.19% (23/27) VS 39.13% (9/23), χ 2=11.434, P=0.001] compared with MLS=0-2. Correlation analysis showed a significant correlation between MLS and mortality ( r=0.886, P=0.019). Multivariate logistic regression analysis showed that MLS=4-5 was an independent risk factor for death in geriatric patients with sepsis ( OR=17.055, 95% CI: 1.387-209.744, P=0.027). Conclusion:MLS presents high sensitivity in predicting 28-day outcomes for geriatric patients with sepsis. Two or more than 2 regions of gastric mucosal lesions can significantly increase the risk of death in geriatric patients with sepsis.
术后胃轻瘫是保留幽门胃切除术后常见并发症之一，严重影响患者的生活质量。本文报道1例早期胃癌患者行机器人辅助保留幽门中段胃切除术，半年后因胃排空障碍再次入院，经多种保守治疗手段治疗无效，行经口内镜下幽门肌切开术治疗。
Objective:To compare the knowledge of endoscopic screening of gastrointestinal cancers between digestive healthcare workers and new chatbots (chatGPT and new Bing).Methods:A test with twenty-three questions of endoscopic screening of gastrointestinal cancers was conducted, focusing on the appropriate age of screening, high-risk factors, the follow-up time, and the advantages and risks of digestive endoscopy. Digestive healthcare workers were invited to complete the test through electronic questionnaires. New Bing and chatGPT were used to answer each question for 10 rounds. The primary endpoint was the correct rate of all answers. The answer accuracy between digestive healthcare workers and new chatbots were compared using variance analysis, and the factors that affected the accuracy of the answers in digestive healthcare workers were explored using univariate and multivariable liner regression analysis.Results:The results of the test completed by 76 digestive healthcare workers (21 residents, 28 digestive nurses, and 27 digestive doctors) were analyzed. The accuracies were 36.4%±10.9%, 34.5%±10.2%, 52.2%± 12.6%, 46.3%±9.8% and 67.1%±9.3% in residents, digestive nurses, digestive doctors, chatGPT, and new Bing, respectively, with significant difference ( F=22.6, P<0.001). The accuracy was highest in new Bing ( P<0.001). The accuracy was comparable between chatGPT and digestive doctors (LSD- t=-1.398, P=0.166), and both higher than that of digestive nurses (LSD- t=2.956, P=0.004; LSD- t=5.955, P<0.001) and residents (LSD- t=2.402, P=0.018; LSD- t=4.951, P<0.001). Furthermore, the accuracy was comparable between digestive nurses and residents (LSD- t=-0.574, P=0.567). Compared with new Bing, digestive doctors had lower accuracy in answering questions related to adverse events of screening, follow-up recommendation of intestinal metaplasia, high risk factors and screening methods for colon cancer ( P<0.05), but higher accuracy in answering questions related to endoscopic adverse events and screening methods for esophageal cancer ( P<0.05). Multivariable liner regression analysis showed that being digestive doctors ( β=11.7, t=3.054, P=0.003) and questionnaire response time (≥7.6 min) ( β=7.8, t=2.894, P=0.005) were independent factors for the answer accuracy of digestive healthcare workers. Conclusion:Compared with digestive healthcare workers, New chatbots—new Bing has higher accuracy in answering gastrointestinal cancer screening-related questions, but performs poorly in answering questions such as adverse events of endoscopy and screening methods for esophageal cancer.
Objective:To evaluate the new model of group screening combined with opportunistic screening for the diagnosis and treatment of gastric cancer.Methods:Group screening combined with opportunistic screening was used for gastric cancer screening. (1) Group screening. Cluster sampling was used to screen gastric cancer by endoscopy in high-risk population (aged 40-<70 years) of rural residents in Weihai from July 2017 to December 2020, and biopsy was obtained for histopathology if necessary. Main collection parameters included the detection rate of advanced gastric cancer, early gastric cancer and high-grade intraepithelial neoplasia (HGIN). (2) Opportunistic screening. The changes of the detection rates of early gastric cancer in opportunistic screening in 2 hospitals in Weihai area were observed during the same period of time.Results:(1) In group screening, from July 2017 to December 2020, the first batch of 8 000 cases of gastric cancer screening were completed. The cases of advanced gastric cancer, early gastric cancer and HGIN were 36, 28, and 62, respectively. The detection rates of gastric cancer and early gastric cancer were 0.80% (64/8 000) and 43.75% (28/64), respectively. The proportion of early gastric cancer+HGIN who received endoscopic submucosal dissection (ESD) was 77.78% (70/90), and the rate of curative resection was 100.00%(70/70). (2) Opportunistic screening: from July 2017 to December 2020, the annual early gastric cancer detection rates in opportunistic screening in Wendeng District Traditional Chinese and Western Medicine Hospital were 16.67% (1/6), 20.00% (3/15), 23.53% (4/17), and 33.33% (6/18) in the consecutive 4 years, respectively. The annual detection rates of early gastric cancer in opportunistic screening in Ru Shan Peoples Hospital were 14.74% (14/95), 23.80% (60/252), 25.49% (65/255), and 24.04% (50/208), respectively. The detection rates of opportunistic screening for early gastric cancer in hospitals in Weihai city increased year by year.Conclusion:In areas with high incidence of gastric cancer, a certain scale of group screening can lead to a wider range of opportunistic screening, resulting in the increase of the detection rate of early gastric cancer. The new model of diagnosis and treatment of gastric cancer is worth recommendation.
A retrospective study was conducted on data of 23 patients with pancreatic duct diseases who were underwent peroral pancreatoscopy (POPS) at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from August 2020 to October 2022. The intraoperative observation, postoperative complications, and the diagnosis and treatment of POPS for pancreatic duct diseases were analyzed. All patients underwent POPS and achieved technical success. Among them, 7 patients were diagnosed as having intraductal papillary mucinous neoplasm of pancreas and 3 pancreatic malignant tumor. Eight patients with pancreatolithiasis accepted laser or eletrohydraulic lithotripsy under POPS. Abdominal pain improved in 2 patients with chronic pancreatitis after treatment. Melena disappeared in 2 patients with pancreatic duct hemorrhage or pancreatic enterostomy inflammation after conservative treatment. The symptom of 1 patient with pancreatic enterostomy stenosis improved after balloon dilation. There was no complication in the 23 patients, and the operation time was 35-90 min. The results indicate POPS is safe, effective with distinctive advantages in the diagnosis and treatment for pancreatic duct diseases.
To investigate the effects of streptavidin and dimethylsilicone oil on the detection rate of microscopic lesions under gastroscopy, a total of 353 patients who underwent painless gastroscopy were categorized into the experimental group (given streptavidin combined with sodium bicarbonate, n=176) and the control group (given dimethylsilicone oil combined with sodium bicarbonate, n=177). Clinical indexes such as visual field clarity, examination duration, number of rinses, detection rate of micro lesions, early cancer detection rate and incidence of adverse reactions were recorded in the gastroscopy examination of the two groups. The experimental and control groups were compared in terms of visual field clarity (1.84±0.51 points VS 2.15±0.48 points, t=-5.900), fundus mucus properties (1.04±0.43 points VS 1.46±0.76 points, t=-6.347) and number of rinses (0.76±0.66 times VS 1.18±0.72 times, t=-5.628) with significant differences ( P<0.001). The examination time in the experimental group was slightly higher than that in the control group (10.01±4.40 min VS 8.98±4.22 min, t=2.239, P=0.026). The detection rate of microscopic lesions was significantly higher in the experimental group than that in the control group [97.73%(172/176) VS 91.53%(162/177), χ2=6.665, P=0.010]. There was no significant difference in the detection rate of inflammatory hyperplasia, polyps, precancerous lesions or cancer between the experimental group and the control group ( P>0.05). There was no preoperative drinking discomfort in either group, and 4 cases of intraoperative choking occurred in each of the experimental and the control group with no significant difference ( P>0.999). No postoperative adverse reaction occurred in either group. Taking streptavidin before operation could significantly improve visual field clarity and the detection rate of microscopic lesions, which helps to detect early lesions in stomach.
Objective:To apply endoscopic ultrasound (EUS) elastography to the evaluation of EUS-guided fine needle injection (EUS-FNI) for insulinoma.Methods:Clinical data of 21 patients with insulinoma who were treated with EUS-FNI at the digestive endoscopy center of the First Affiliated Hospital of Guangxi Medical University from April 2016 to March 2021 were collected. Some patients underwent EUS real-time elastography before and after the treatment. The minimum blood glucose, synchronous insulin, synchronous C peptide, elastic imaging color pattern, elastic score, a-elasticity, elastic imaging strain rate before and after the treatment were analyzed.Results:Among the 21 cases with 24 lesions, there were 5 males and 16 females. There were totally 39 times of injection, where 8 cases underwent single injection, and 13 cases repeated injection. After the operation, patients' symptoms improved, the minimum blood glucose increased in different degree [2.59 (1.95, 3.82) mmol/L VS 1.50 (1.00, 2.00) mmol/L, Z=-4.278, P<0.001], the level of synchronous insulin [96.69 (44.80, 249.30) pmol/L VS 159.10 (100.30, 373.70) pmol/L, Z=-1.445, P=0.148] and C peptide [3.56 (2.98, 8.05) ng/mL VS 6.16 (3.74, 11.47) ng/mL, Z=-1.825, P=0.068] decreased, but no statistical difference compared with those before the operation. Sixteen cases underwent preoperative endoscopic elastography, with elastic score of 2.00 (2.00, 3.00), and 15 cases underwent postoperative elastography with elastic score of 5.00 (5.00, 5.00). Preoperative a-elasticity was recorded in 15 cases with value of 0.16 (0.08, 0.30), and postoperative a-elasticity was recorded in 12 cases with value of 0.07 (0.05, 0.18). The preoperative strain rate were recorded in 14 cases with 2.28 (1.67, 4.38), and postoperative strain rate were recorded in 12 cases with 5.16 (2.08, 8.17). Compared with those before the operation, the postoperative elastic score increased ( Z=-4.694, P<0.001), the a-elasticity decreased ( Z=-2.099, P=0.036), and the difference in strain ratio was not statistically significant ( Z=-1.492, P=0.136). Meanwhile, the lesions of insulinoma became harder, the elastic imaging mode changed from green to blue. There were no complications such as abdominal pain, fever, or pancreatitis during and after the operation. Conclusion:EUS-FNI is safe and effective for the treatment of insulinoma. Endoscopic elastography, as a new means to evaluate the efficacy of the operation, can be used to evaluate lesion ablation and guide injection therapy.
Objective:To evaluate rapid on-site evaluation (ROSE) in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic solid lesions, and to compare the difference in ROSE performance between cytopathologists and trained endoscopists.Methods:A total of 168 consecutive patients with pancreatic solid lesions who underwent EUS-FNA from January 2014 to December 2020 at Fuding Hospital, Fujian University of Traditional Chinese Medicine were recruited. The patients who did not receive ROSE from January 2014 to November 2017 were included in N-ROSE group ( n=67). Since December 2017, the patients who intended to receive EUS-FNA were divided into E-ROSE group ( n=59, patients who received EUS-FNA and ROSE by endoscopists trained with cytopathology) and C-ROSE group ( n=42,patients who received EUS-FNA by untrained endoscopists and ROSE by cytopathologists) according to random number table. The number of punctures, sample adequacy, cytological diagnosis, final diagnosis and diagnostic efficiency (including the sensitivity, the specificity, the positive predictive value, the negative predictive value and the accuracy) in 3 groups were compared. Results:(1) The puncture number in N-ROSE group (4.22±0.76) was significantly more than E-ROSE group (3.12±0.79, P<0.001) and C-ROSE group (3.24±0.91, P<0.001). (2) The proportions of adequate samples in N-ROSE group [82.09% (55/67)] was significantly lower than those of E-ROSE group [96.61% (57/59), χ2=5.308, P=0.021] and C-ROSE group [97.62% (41/42), χ2=4.541, P=0.033]. The proportion of negative cytological diagnosis in N-ROSE group [40.30% (27/67)] was significantly higher than those of E-ROSE group [20.34% (12/59), χ2=5.848, P=0.016] and C-ROSE group [19.05% (8/42), χ2=5.348, P=0.021]. (3) The sensitivity of N-ROSE group [74.07% (40/54)] was significantly lower than those of E-ROSE group [94.00% (47/50), χ2=6.151, P=0.013] and C-ROSE group [94.44% (34/36), χ2=4.817, P=0.028]. The accuracy in N-ROSE group [79.10% (53/67)] was significantly lower than those of E-ROSE group [94.92% (56/59), χ2=5.433, P=0.020] and C-ROSE group [95.24% (40/42), χ2=4.155, P=0.042]. (4) There was no significant difference in any observational index between E-ROSE group and C-ROSE group ( P>0.05). Conclusion:ROSE in EUS-FNA can improve sample adequacy, the diagnostic sensitivity and accuracy, and reduce the number of punctures. The sample adequacy and diagnostic efficiency of endoscopists trained with cytopathology are comparable to those of cytopathologists.
以黏膜下肿瘤形态为特征的胃癌不易被胃镜检出。胃黏液腺癌是胃癌中较为少见的组织学分型，以癌组织中含有大量黏液为特征，早期胃黏液腺癌更为罕见，一般认为胃黏液腺癌更易发生腹膜及淋巴结转移。本文报道了1例随访3年无进展的以胃窦黏膜下肿瘤形态为特征的黏液腺癌。
