BACKGROUND:Hemangiomas represent 3% of all benign esophageal tumors. Conventional esophagectomy is the standard treatment with its invasive nature and possible surgical complications. Now, less invasive techniques are used with better results. Endoscopic submucosal dissection (ESD) is one of the novel noninvasive methods used for en bloc removal of tumors. No available data about the use of ESD in removing esophageal hemangioma. Here, we studied the validity and safety of ESD as a minimally invasive procedure to remove esophageal hemangioma.METHODS:Three patients were diagnosed with esophageal hemangioma and underwent ESD with en bloc resection. Endoscopic ultrasound (EUS) was performed before ESD to better evaluate the layer of origin and vascularity and guard against perforation. Patients were followed up postintervention to document possible complications.RESULTS:Among the 3 studied patients, one presented with chronic abdominal pain, the second was complaining of dysphagia, and the third patient was diagnosed accidentally. Pathology reports confirmed the diagnosis of hemangiomas in all cases with no atypia and complete removal of the lesions. No complications were reported during the procedure or over the follow-up period.CONCLUSIONS:ESD is a proper, minimally invasive method with good en bloc resection that can be used in cases of esophageal hemangiomas.

Simultaneous endoscopic submucosal dissection (ESD) is occasionally used in synchronous multiple gastric neoplastic lesions (SMGL). Therefore, we aim to evaluate the safety and efficacy of simultaneous ESD for SMGL compared with ESD for single lesions. A total of 1058 patients who received ESD from November 2006 to September 2019 were retrospectively evaluated in this study, including 997 single gastric epithelial lesions treated by single ESD (unifocal group) and 125 SMGL from 61 patients treated by simultaneous ESD (multifocal group). The mean procedure time was 49.2 ± 41.30 min and 89.5 ± 66.33 min in unifocal group and multifocal group, respectively (p < 0.001). There was no significant difference in postoperative stenosis rate (1.0% vs. 0.0%, p = 1.000), intraoperative bleeding (endoscopic resection bleeding-c3 grade) rate (0.5% vs. 1.6%, p = 0.696), postoperative bleeding rate (1.3% vs. 0.0%, p = 0.461), and perforation rate (0.9% vs. 1.6%, p = 0.449) between the two groups. In addition, en block resection rate (p = 0.825), complete resection rate (p = 0.856) and curative resection rate (p = 0.709) were comparable between the two groups. During the follow-up, the local recurrence rate per patient: p = 0.363; per lesion: p = 0.235) was not significantly different between the two groups, however, the cumulative incidence of metachronous lesions after treatment was significantly higher in the multifocal group than the other group (10.0% vs. 3.2%, p = 0.004). Simultaneous ESD is safe and effective in the treatment of SMGL. However, separate ESD is recommended for SMGL with longer procedure time. Besides, the metachronous gastric neoplastic lesions should be paid attention to during follow-up.

早期食管癌内镜黏膜下剥离术(ESD)治疗最关键的是术前要明确病变的深度、位置、大小、是否粘连。黏膜下浸润的，既往做过内镜下治疗的病变，黏膜下注射隆起程度会不好，甚至不隆起。面积大、位置高的病变，也会增加操作难度。

Objective: The present study aimed to analyze the risk factors and clinical outcomes of the incomplete endoscopic resection of rectal neuroendocrine tumors (rNETs). Methods: This study retrospectively analyzed the cases of 428 patients with rNETs who had undergone endoscopic treatment in the Department of Gastroenterology at the PLA General Hospital, China, between January 2010 and September 2019. Results: Of the 428 patients with rNETs, 266 were men (62.1%) and 162 were women (37.9%). Of these, 54 had been pathologically diagnosed with positive incisal margins without lymphatic vessel invasion, and the incomplete resection (R1) rate was 12.6%. Among the R1 patients, 28 had received endoscopic submucosal dissection, 22 had received endoscopic mucosal resection, two had received snare resection, and two had undergone removal with forceps. In addition, there were 31 cases of grade G1 R1 resection (11.2%; 31/277), 13 cases of grade G2 R1 resection (23.2%; 13/56), and 10 cases whose grading was not described. The univariate analysis showed the pathological grade was statistically correlated with R1 resection (P < 0.05), and the grade G2 R1 resection rate was higher than that of grade G1. The multivariate logistic regression analysis showed that grade G2 was an independent risk factor leading to R1 resection (P = 0.02). All patients with R1 resection were followed up for 10-110 months, with an average of 38 months. No salvage treatment was performed. The endoscopic monitoring showed there were no recurrences during the follow-up period. Conclusion: Endoscopic resection is a good option for rNETs, with a high complete resection rate and good prognosis, with rare recurrence even if endoscopic resection is not complete.

胃癌是消化道常见的恶性肿瘤,其发病率仅次于肺癌,位居第2位,死亡率位居第3位,严重威胁人民的健康[1].胃癌的初步诊断,依靠腹部影像学和病理学检查进行定性、定位和分期.其中病理组织学结果是胃癌的诊断的金标准,也是手术治疗前的必要步骤.胃癌根据其发育形态进行国际认可的Borrmann分型[2],其中Borrmann Ⅳ型为胃壁弥漫性增厚和硬化,黏膜皱襞明显肥大、糜烂或溃疡.癌组织可以浸润性生长在黏膜层下,称为皮革胃.其被认为是起源与黏膜最深层的腺体或黏膜肌层或黏膜下层的异位腺体,常累及整个胃腔,黏膜层仅受到轻微的影响,因此内镜下活检确诊困难.本文报道了一种诊断胃壁增厚疾病的新方法,即采用"超声内镜引导下黏膜切除后创面活检术(endoscopic ultrasonography-guided post-mucosectomy biopsy,EPMB)"确诊大块黏膜活检阴性的Borrmann Ⅳ型胃癌1例.

To the Editor: Endoscopic submucosal dissection (ESD) has developed into an advanced technique extensively used in the treatment of early esophageal cancer. However, the disadvantages of ESD are its technical difficulty and it is linked to a high incidence of complications, the demand for sophisticated endoscopic techniques, and a lengthy procedure time. Studies have confirmed that ESD time is closely correlated with perforation, bleeding, and deep vein thrombosis, post-operative pneumonia, CO2 retention, or increased medical costs.[1–4] The time required for ESD operation is one of the best indexes to measure the difficulty of ESD operation. If the difficulty of operation can be assessed, then the program time can be predicted. It will be supremely useful to schedule surgery to reduce ESD time and prevent possible complications. We present a total of 197 patients with 201 early esophageal cancer cases. Data were collected, and the determinants of ESD time were analyzed. ESD time was defined as the time from peripheral labeling to complete resection of early esophageal cancer. Under endoscopy, the degree of submucosal fibrosis was classified according to the observation of the injection of glycerol mixture. Fibrosis was defined as a whitish muscle-like structure in the submucosal layers during ESD. Pearson correlation coefficient was used for the preliminary univariate analysis. A multiple logistic regression analysis was used to determine independent predictors of procedure time. SPSS software, version 18.0, (SPSS Inc, Chicago, IL, USA) was used for data processing. In this study, all ESD procedures were performed by endoscopists with >15 years of experience using the same equipment. The maximum diameter of the resected lesions was 3.0 cm (0.8–8.5 cm). The median procedure time was 66.9 min (10–190 min). The univariate analysis of procedural time variables is shown in Table 1. The macroscopic type, tumor size, the proportion of circumferential extension, adhesion, and perforation during the procedure had a significant impact on the procedural time. Multiple linear regression analysis revealed that ESD time was positively correlated with macroscopic type, tumor size, proportion, adhesion, and perforation during the procedure [Supplementary Table 1, https://links.lww.com/CM9/A451]. The multivariate logistic regression analysis using these variables showed that the presence of adhesion, the proportion of circumferential extension of >1/2, and tumor size >2 cm were independent factors with a significant difference [Supplementary Table 2, https://links.lww.com/CM9/A451]. More than 66.9 min of procedural time was considered a long amount of time. Table 1 - Categorical variables and endoscopic submucosal dissection time. Procedure time (min) Predictive factors n Mean ± SD Median (IQR) P Total patients 201 66.9 ± 39.5 60.0 (10.0–190.0) Age (years) 70.0 ± 8.7 61.0 (30.0–83.0) 0.970 Sex Male 142 62.8 ± 38.1 56.0 (10.0–180.0) 0.640 Female 59 76.8 ± 41.2 68.0 (17.0–190.0) Location Upper esophagus 6 58.7 ± 34.7 44.0 (30.0–110.0) 0.490 Middle esophagus 137 65.2 ± 39.1 59.0 (10.0–190.0) Lower esophagus 58 71.2 ± 41.0 61.0 (12.0–175.0) Macroscopic type 0–I/IIa 18 50.4 ± 35.7 32.0 (16.0–143.0) 0.001 0–IIb/IIc 174 66.3 ± 37.2 60.0 (10.0–180.0) Combined 9 111.7 ± 59.1 112.0 (49.0–190.0) Tumor size ≤2.0 cm 63 41.0 ± 26.7 33.0 (10.0–184.0) <0.001 2.0–4.0 cm 102 64.9 ± 27.5 62.0 (16.0–169.0) ≥4.0 cm 36 118.1 ± 39.3 112.0 (10.0–190.0) The proportion of circumferential extension <1/2 125 50.1 ± 27.1 44.0 (10.0–184.0) <0.001 1/2–3/4 58 81.4 ± 33.1 79.0 (30.0–175.0) >3/4 18 137.3 ± 35.6 135.0 (63.0–190.0) Adhesion Y 20 107.6 ± 37.1 111.0 (60.0–184.0) <0.001 N 181 62.4 ± 37.2 55.0 (10.0–190.0) Depth of invasion Mucosa 181 65.8 ± 38.4 59.0 (10.0–190.0) 0.210 Submucosa 20 77.6 ± 47.9 66.0 (17.0–180.0) Perforation during procedure Y 6 129.5 ± 45.6 126.0 (70.0–190.0) <0.001 N 195 65.0 ± 37.8 58.0 (10.0–184.0) IQR: Interquartile range; SD: Standard deviation; N: No; Y:Yes. The ESD procedures in the present study, which were performed by the same operator using the same equipment, were identical among different patients. Therefore, the influence of procedural differences on ESD time was excluded. However, as far as we all know, no investigation of ESD procedure time has been performed in a large group of patients with early esophageal cancer. Our multivariate analysis showed that adhesion, tumor size, and the proportion of circumferential extension were significant predictors of procedure time. Our results showed that the existence of adhesion, the proportion of circumferential extension of >1/2, and tumor size >2 cm were independent factors affecting ESD time. In previous studies, submucosal fibrosis was an independent predictor of a longer ESD time.[5,6] Our research likewise draws the corresponding conclusion. Fibrotic adhesion under the mucosa will evidently lead to the difficulty of submucosal dissection, consequently prolonging the operation time. Longer procedure times have been involved in increased risks of complications.[7,8] Therefore, reducing ESD procedure time can decrease the occurrence of complications during and after ESD operation. The prediction of procedural time is a matter of great concern for both patients and operators. First, if the ESD time is expected to be long, we can arrange senior experts to complete the operation, so as to shorten the operation time. Second, depending on the length of the operation time, the anesthesiologist can use different methods. Finally, the prediction of ESD time is helpful for operators to take appropriate measures to prevent ESD complications such as aspiration during operation, venous thrombosis, or post-operative pneumonia. There are a few limitations to our research. First, this study was based on a single-center analysis with small sample size. As a result, possible bias could not be eliminated. Second, we did not have a strict, standardized description of the severity of bleeding during the procedure. Therefore, the impact of bleeding during the procedure could not be analyzed. All in all, our results revealed that large tumor size, presence of tumor in more than one-half of the circumference of the esophagus, perforation, and adhesion predict a long ESD time. The results of this study may provide some references for making a reasonable operation schedule. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s)/patient's guardians has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the article. The patients/patient's guardians understand that their names and initials will not be published and due efforts will be made to conceal the identity of the patient, although anonymity cannot be guaranteed. Funding This work was supported by the Scientific Research Project of the Henan Medical Science and Technology Research (No. LHGJ 20190881). Conflicts of interest None.

Gastric schwannoma (GS) is not well clinically recognized and surgical resection (SR) remains the mainstay of treatment. Recently, endoscopic resection (ER) appears to be a safe and effective alternative. However, its comparative outcomes with SR is lacking. Our aim was to first compare clinical outcomes and costs between ER and SR in the management of GSs. A total of 46 consecutive patients with GSs who underwent ER (n = 16) or SR (n = 30) in our large tertiary center between July 2007 and Oct 2018 were included. Clinicopathologic features, clinical outcomes, medical costs and follow-up were retrospectively reviewed and compared between two groups. Baseline characteristics are comparable except for a smaller tumor size in ER group (22.9 vs 41.0 mm, p = 0.002). Complete resection was achieved in 87.5% of patients with ER and 100% of patients with SR (p = 0.116). The ER group had a significant shorter operative time (91.6 vs 128.2 min), less blood loss (16.9 vs 62.7 mL) and lower operation cost (21,054.4 vs 30,843.4 RMB) than SR group (all p < 0.05). There was no significant difference in adverse events (12.5% vs 10%, p = 0.812) and length of postoperative hospital stay (8.3 vs 8.2 days, p = 0.945). During a long-term follow-up of mean 37.4 months (range 6–140 months), no residue, recurrence or metastasis was observed in both groups. Compared with SR, ER has the similar safety and efficacy in the management of GSs, but contributes to a shorter operation time and lower medical costs. ER may be considered as the first-line treatment, especially for patients with GSs smaller than 30 mm.

INTRODUCTION:Endoscopic resection for the treatment of gastrointestinal neuroendocrine tumors has a risk of resection margin residues. The related risk factors and prognosis of post-endoscopic resection margin residues have not been fully evaluated.AIM:To investigate the associated risk factors and prognostic impact of resection margin residues after endoscopic resection of gastrointestinal neuroendocrine tumors.MATERIAL AND METHODS:We conducted a retrospective analysis of 129 patients who underwent endoscopic resection for the treatment of gastrointestinal neuroendocrine tumors. Sex, age, location, diameter of tumor, depth of invasion, endoscopic treatment methods, endoscopic ultrasonography (EUS) evaluation, and the work experience of endoscopists were evaluated as potential risk factors. In addition, the prognoses of patients with positive resection margins were analyzed.RESULTS:A total of 18 (18/129, 14.0%) patients exhibited positive resection margins after endoscopic resection. Among 16 successfully followed-up patients, 1 died due to rupture of pulmonary artery aneurysms, 2 underwent supplementary surgical operations, and 2 underwent additional endoscopic submucosal dissection. The remaining 11 patients were periodically followed up, and no recurrences were found. The results of univariate analysis suggested that endoscopic treatment method, the depth of invasion, and EUS evaluation correlated with positive resection margin. Multivariate regression analysis suggested that the depth of invasion and EUS evaluation were risk factors for resection margin residues.CONCLUSIONS:The depth of invasion and EUS evaluation are independent risk factors for positive resection margins after endoscopic resection. This finding suggests that a greater depth of invasion increases the risk for positive resection margins, while EUS evaluation before resection decreases this risk.

目的 回顾性分析内镜切除术治疗T1bSM2期(黏膜下层≥200μm)早期食管鳞状细胞癌的安全性、有效性.方法 选取2009年1月至2017年7月于解放军总医院第一医学中心接受内镜切除术治疗且术后病理提示病变累及M3层(黏膜肌层)、SM1层(黏膜下层＜200 μm)和SM2层(黏膜下层≥200 μm)的79例患者为研究对象,根据浸润深度分为相对适应证组和拓展适应证组,分析比较两组患者的基本资料及术后并发症的差异,Kaplan-Meier生存分析总体生存率及无进展生存率.结果 两组患者的基本资料、术后并发症、预后、总体生存率及无进展生存率比较,差异无统计学意义.结论 对于T1 bSM2期食管鳞状细胞癌,内镜切除术也是一种可以选择的治疗方式.

There are no previous reports of Mallory-Weiss tears occurring as complications during esophageal endoscopic submucosal dissection (ESD). We present 3 cases of Mallory-Weiss tears occurring during treatment of superficial squamous cell neoplasms through ESD. Carbon dioxide was used for air insufflation, and the patient was adequately sedated without retching or struggling during the operation. No significant bleeding from the lesion was observed during ESD; however, active bleeding caused by the Mallory-Weiss tear was identified endoscopically. Bleeding was controlled by closure of the tear with metal clips or repeated flushing with adrenaline saline. Hemorrhage did not recur until completion of the operation. Therefore, during the operation, it is necessary to maintain adequate depth of anesthesia and reduce the operation time, and also reduce air and water injections, to avoid occurrence of such complications.

This study aimed to investigate the intestinal microbiota in duodenal ulcer (DU) patients, effects of proton pump inhibitors,clarithromycin and amoxicillin, PCA) for Helicobacter pylori (H. pylori) and Bacillus subtilis and Enterococcus faecium (BSEF) on intestinal microbiota. DU patients were randomly assigned to receive either PCA (group TT) or PCA plus BSEF(group TP). The fecal microbiome was conducted using high throughput 16S rDNA gene and internal transcribed spacer sequencings. The diversity and abundance of intestinal bacteria in the DU were significantly lower than health check control (HC) group. In the TT group, the abundance and diversity of both intestinal bacteria and fungi decreased after PCA treatment, compared with those before treatment, whereas in the TP group no obvious changes were observed. In the TT group at all the time points, both the intestinal bacteria and fungi were different from those in the HC group. However, in the TP group, at 10w the bacterial flora abundance was close to that in the HC group. The results indicate that anti- H. pylori treatment induced significant decrease in the diversity of intestinal microbiota, while the combined therapy supplemented with BSEF could protect and restore the intestinal microbiota.

Endoscopic resection (ER) is an effective and safe method for gastric submucosal tumors, mostly composed of gastrointestinal stromal tumors and leiomyomas. The role of ER in gastric schwannoma (GS) has rarely been described. Our aim was to evaluate the efficacy and safety of ER for GS. This is a retrospective study in consecutive patients who underwent ER for GS from March 2013 to October 2018 at our center. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. A total of 16 consecutive patients (9 females, 56.3%) were included, with a mean age of 50.4 years (range 25–75 years). The mean tumor size was 22.9 ± 15.1 mm (range 10–55 mm). Thirteen tumors (81.3%) were located in the middle third of the stomach and 12 tumors (75%) grew with intraluminal pattern. Endoscopic submucosal excavation (ESE) was performed in 7 patients while endoscopic full-thickness resection (EFTR) was done in 9 patients. R0 resection was achieved in 14 patients (87.5%). The mean operative time was 91.6 ± 52.8 min (range 36–203 min) and the mean postoperative length of hospital stays was 8.3 ± 2.7 days (range 6–13 days). No adverse events were encountered except for fevers in 2 patients. No patients required surgical resection or intervention. During long-term follow-up of mean 21.8 months (range 6–62 months), no residue, recurrence, or metastasis was observed. ER is effective and safe for patients with GS with favorable long-term outcomes.

OBJECTIVES:To evaluate the healing efficacy of rebamipide and lansoprazole combination therapy with lansoprazole alone for endoscopic submucosal dissection (ESD)-induced ulcers and clarify the ulcer healing-associated factors. METHODS:Three hundred patients were randomized into control and experimental groups after they underwent ESD. The patients received intravenous pantoprazole (30 mg) every 12 hours and oral rebamipide (100 mg, experimental group) or placebo (control group) 3 times daily on days 1-3. On days 4-56, patients received oral lansoprazole (30 mg daily) and rebamipide (100 mg) or placebo 3 times daily. Endoscopic evaluations were performed at postoperative weeks 4 and 8. RESULTS:At week 4, the ulcer reduction rate was significantly higher in the experimental than in the control group (0.97 ± 0.034 vs. 0.94 ± 0.078; P < 0.001). The ulcer healing (18.2% vs 20.3%; P = 0.669) and ulcer improvement rates (94.2% vs 88.7%; P = 0.109) in the 2 groups were not significantly different. At week 8, the ulcer healing and ulcer improvement rates were 90.6% and 100%, respectively, in both groups. Multivariate analysis showed that the combination treatment was an independent factor associated with ulcer area reduction after ESD. The maximum diameter of the initial ulcer (≥35.5 mm vs <35.5 mm) was an independent factor associated with the ulcer improvement rate after ESD. CONCLUSIONS:The rebamipide and lansoprazole combination therapy can help accelerate the reduction rate of post-ESD ulcer compared with the lansoprazole monotherapy at 4 weeks of therapy.

The techniques and indications for endoscopic submucosal dissection (ESD) and endoscopic submucosal tunnel dissection (ESTD) to remove superficial neoplasia at the esophagogastric junction (EGJ) have been developed and expanded. However, the resection of superficial neoplasia at the EGJ by ESD remains challenging, and the long-term clinical outcomes of curative and non-curative resections based on histological criteria remain unclear. We conducted a retrospective analysis on the safety and efficacy of the ESD and ESTD procedure with these patients. The records of 209 consecutive patients at the Chinese PLA General Hospital who received ESD and ESTD to treat EGJ superficial neoplasia from November 2006 to December 2016 were reviewed for this retrospective cohort study. We divided patients into two groups (curative and non-curative resection). Of all 14 additional surgeries, 1 patient in the curative group and 13 in the non-curative group underwent surgical operation with residual tumor in 7 specimens. During a median follow-up period of 46.4 months (range 12.2–142.3 months), the 5-year survival rate was 98.6%. Two patients died 91 months and 66 months after surgery due to subarachnoid hemorrhage and lymphoma, respectively. One patient died of gastric cancer 1 year after the surgery. The 5-year disease-specific survival rate was 99.5%. Local tumor recurrence was detected in 9 of 209 cases. In conclusion, ESD was shown to be a safe and effective treatment strategy for early EGJ neoplasia. Mucosal adhesion may increase the difficulty of piecemeal curative resection, but the superficial depth of such an invasion favors better clinical outcomes. Additional surgical resection is a good choice for non-curative ESD, and re-ESD is also an alternative, in conjunction with intensive follow-up.

Objective To investigate the recurrence and risk factors of gastric high-grade intraepithelial neoplasia(HGIN)and early gastric cancer(EGC)after endoscopic submucosal dissection (ESD). Methods The clinical and follow-up data on 444 patients(451 lesion)with HGIN and EGC undergoing ESD in Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016 were summarized, and the risk factors of recurrence were analyzed. Results A total of 410 patients were followed-up, and the recurrence rate was 3.2%(13 patients, 13 lesions), with mean recurrence time of 17.6±9.6 months(6-38 months). Univariate and multivariate analysis revealed that the size of the lesion>4.0 cm was the only risk factor of recurrence(P=0.012,OR=10.855,95%CI:1.673~70.442). Conclusion The rate of recurrence is increasing with the EGC extending, therefore, postoperative monitoring should be strengthened to patients with larger lesion.

Aim. To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). Methods. The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. Results. The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P=0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P=0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). Conclusions. ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.

Objective To analyze the relative factors of lymphovascular invasion of early gastric cancer(EGC) treated by endoscopic submucosal dissection(ESD).Methods A retrospective study was performed on 261 cases of EGC patients who were admitted and underwent ESD from November 2006 to January 2016.The conduct follow-up was performed on survival status of patients with positive lymphovascular invasion and the relative factors were analyzed.Results Among the total 261 cases of EGC patients,9 cases showed positive lymphovascular invasion,with a positive incidence of 3.4%(9/261),including 7 cases were given additional surgery,2 cases were not given additional surgery.The follow-up visit lasted for a period of 31 to 108 months,the survival rate was 100.0%.The lym-phovascular invasion was relevant to tumor differentiation degree and invasion depth.Conclusion Close attention should be given to the possibility of lymphovascular invasion when giving ESD treatment to EGC patients with poor differentiation degree and submucosal invasion.

Submucosal tunneling endoscopic resection (STER) is increasingly used for the treatment of submucosal tumors (SMTs) originating from the muscularis propria layer; however, endoscopic submucosal excavation (ESE) is still performed in many hospitals for its low-skill and experience requirements. This study aimed to compare STER with ESE for cardial SMTs.

Introduction: Endoscopic submucosal dissection (ESD) has been widely accepted for resecting superficial esophageal squamous cell neoplasms (ESCNs). The aim of this study was to evaluate the predictors for postoperative stricture after ESD for large ESCNs (>3/4 circumferential mucosal defect). Methods: We consecutively enrolled 63 patients with large ESCNs(Histologic depth0.05). After multivariate analysis, circumferential mucosal defect (≥ 7/8) and not taking prophylactic measures are predictors for stricture development in patients with large ESCNs after ESD. Conclusion: Circumferential mucosa defect >7/8 is the main factor leading to the stricture of the esophagus after ESD for large early ESCNs. For patients with post- operative circumferential mucosa defect >3/4, appropriate preventive measures can effectively reduce the incidence of postoperative stricture after ESD.354_A Figure 1. Groups according to circumferential mucosal defect. Patients who underwent ESD or ESTD for large superficial esophageal squamous cell carcinoma(ESCC):Group A, ≥3/4 and <7/8; Group B, ≥7/8 and <4/4; Group C, entire circumferential mucosal defect(4/4)354_B Figure 2. Stricture was encountered after submucosal dissection (ESD) involving total circumferential resection. A. Chromoendoscopy with iodine staining revealed a discolored area in the lower esophagus. B. Entire (4/4) circumferential mucosal defect after ESD. C. Resected sleeved specimen with the lesion in an en bloc resection, the length of which was approximately 4.5 cm. D. A fully covered esophageal stent was implanted for prevention of stricture. E. Endoscopy displayed stricture 63 days after ESD. F. Endoscopic balloon dilatation is performed against the postoperative stricture. G. The stricture site was dilated after balloon dilatation, a 9.8-mm-diameter esophagogastroduodenoscopy (EGD) could be passed through this lumen. H. The lumen 7 months after ten EBD treatments.354_C Figure 3. The detailed data of the 63 patients enrolled in the study.

In the original article, there are two errors in Table 3: 1. There were 8 patients undergoing VATE suffer from moderate fever, not 9. 2. In the fourth line of outcomes, saying "pneumothorax, moderate fever and moderate fever," "moderate fever" was repeated.