目的 分析首都医科大学附属北京世纪坛医院结肠镜发现的肿块型回肠肿瘤的临床诊治情况.方法 通过电子病历系统检索收集2010年1月至2019年12月在首都医科大学附属北京世纪坛医院住院的、诊治资料完整的、经结肠镜发现的回肠肿瘤患者(肿块型),共5例.收集所有患者的年龄、性别、临床表现、既往史、体征、实验室检查、腹部影像学检查、结肠镜结果、手术和术后病理、其他治疗和随访等,并进行分析.结果 5例患者中,男3例,女2例,年龄28～58岁.腹痛、便血、排气排便减少、大便习惯改变为主要临床表现.4例腹部CT提示小肠-结肠型肠套叠,1例提示回盲部占位、伴肝转移.结肠镜提示:1例于回肠末端见一4 cm×3 cm大小分叶肿物,色稍红,于回盲瓣和小肠内滑进滑出;2例提示结肠肝曲肿物,头端2～4 cm大小,色红,表面黏液附着,可见"长蒂"(小肠绒毛)连接至回盲部,活检病理1例提示非霍奇金淋巴瘤、1例提示炎症;1例提示一累及回盲部和升结肠的巨大肿物,根部可见小肠绒毛样结构,活检病理提示炎症;1例提示回肠末端肿物,约占据1/2管腔,活检病理提示炎症.5例患者均经腹腔镜手术切除肿物,术后病理分别提示脂肪瘤、高级别B细胞淋巴瘤、炎症性肌纤维母细胞瘤、促纤维组织增生性小圆细胞肿瘤和神经纤维瘤.结论 结肠镜发现的肿块型回肠肿瘤临床和内镜表现均无特征性,部分可出现小肠-结肠型肠套叠,腹部CT是重要的术前诊断方法,手术是重要的诊治手段,确诊需手术病理.

BACKGROUND The appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia (PIL). AIM To classify the endoscopic features of the intestinal mucosa in PIL under endoscopy, combine the patients' imaging and pathological characteristics of the patients, and explain their causes. METHODS We retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1, 2007 and December 31, 2018. We compared and analyzed all endoscopic images, classified them into four types according to the endoscopic features of the intestinal mucosa, and analyzed the post-lymphographic computed tomography (PLCT) and pathological characteristics of each type. RESULTS According to the endoscopic features of PIL in 123 patients observed during endoscopy, they were classified into four types: nodular-type, granular-type, vesicular-type, and edematous-type. PLCT showed diffuse thickening of the small intestinal wall, and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types. Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types. Analysis of the small intestinal mucosal pathology revealed that nodular-type and granular-type lymphangiectasia involved the small intestine mucosa in four layers, whereas ectasia of the vesicular- and edematous-type lymphatic vessels largely involved the lamina propria mucosae, submucosae, and muscular layers. CONCLUSION Endoscopic classification, combined with the patients' clinical manifestations and pathological examination results, is significant and very useful to clinicians when scoping patients with suspected PIL.

Objective:To explore whether the regular feedback system in opportunistic screening of colorectal cancer can improve the adenoma detection rate (ADR) of endoscopists.Methods:This study was an observational study, divided into three stages: the baseline stage before intervention (the pre-intervention period), the regular feedback stage (the intervention period) and the post-intervention stage (the post-intervention period). In the pre-intervention period, all patients who underwent opportunistic screening of colorectal cancer in Department of Gastroenterology in Beijing Shijitan Hospital Affiliated to Capital Medical University from June 2017 to May 2018 were reviewed, and the ADR of each endoscopist was calculated. In the intervention period from June 2018 to November 2018, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist during the previous month was calculated at the beginning of each month and feedback was provided in the form of a report. In the post-intervention period from December 2018 to January 2019, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist was calculated after the feedback stopped. ADR and polyp detection rate (PDR) of three stages were compared.Results:A total of 1 768, 1 308 and 344 patients were enrolled for opportunistic screening of colorectal cancer during the pre-intervention, the intervention and the post-intervention period respectively. Eight endoscopists participated in the whole process of this study. The total ADR increased from 23.70% (419/1 768) in the pre-intervention period to 33.72% (441/1 308) in the intervention period ( χ2=37.449, P<0.05). Two months after intervention, ADR decreased slightly to 33.14% (114/344), but was still higher compared with before ( χ2=13.602, P<0.05). The total PDR increased from 47.17% (834/1 768) in the pre-intervention period to 52.68% (689/1 308) in the intervention period ( χ2=9.111, P<0.05). Two months after the intervention, PDR increased slightly to 53.78% (185/344), and still higher compared with before ( χ2=5.035, P<0.05). Conclusion:Regular feedback to endoscopists can improve ADR in opportunistic screening of colorectal cancer.

DNA proficient mismatch repair colon cancer (pMMR CC) is the most common subtype of sporadic CC. We aimed to investigate the role of long noncoding RNAs (lncRNAs) in pMMR CC carcinogenesis. In the present study, we conducted transcriptomic analysis of lncRNAs-mRNAs in five low-grade intraepithelial neoplasia (LGIN), five high-grade intraepithelial neoplasia (HGIN), four pMMR CC, and five normal control (NC) tissues. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment pathway, and coexpression network analyses were performed to elucidate the functions of lncRNAs and mRNAs as well as their interactions. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to validate five dysregulated lncRNAs in a large set of colon tissues. Receiver-operating characteristic (ROC) curves were employed to evaluate the performance of the candidate lncRNAs. A set of 5783 differentially expressed lncRNAs and 4483 differentially expressed mRNAs were detected among the LGIN, HGIN, pMMR CC, and NC samples. These differentially expressed lncRNAs and mRNAs were assigned to 275 significant GO terms and 179 significant KEGG enriched pathways. qRT-PCR confirmed that the expression of five selected lncRNAs (ENST00000521815, ENST00000603052, ENST00000609220, NR_026543, and ENST00000545920) were consistent with the microarray data. ROC analysis showed that four lncRNAs (ENST00000521815, ENST00000603052, ENST00000609220, and NR_026543) had larger area under the ROC curve (AUC) values compared to serum carcinoembryonic antigens, thereby distinguishing NC from pMMR CC. In conclusion, several lncRNAs play various roles in the adenoma-carcinoma sequence and may serve as potential biomarkers for the early diagnosis of pMMR CC.

Background Esophagogastric junction outflow obstruction (EGJOO) detected by manometry in the supine position is prevalent in patients with morbid obesity, but not all EGJOOs are clinically significant. We investigated whether including upright swallows during high-resolution manometry (HRM) could help identify non-clinically significant EGJOO in patients with morbid obesity. Methods We performed a retrospective study of consecutive morbidly obese patients diagnosed with EGJOO by HRM from July 2012 through July 2018. The HRM protocol included 10 supine and five upright 5-mL water swallows. Endoscopy, esophagram, and computed tomography were performed to identify whether the patients should be diagnosed as having clinically significant EGJOO. Key Results A total of 230 patients with morbid obesity underwent HRM in the supine position during the study period. Fifty (21.7%) patients were diagnosed with EGJOO, among which 32 completed HRM both in the supine and upright positions. Only 8/32 patients were diagnosed with EGJOO in an upright position. Fewer artifacts were displayed in esophageal pressure topography in the upright position. None of the 32 patients could be diagnosed as clinically significant EGJOO based on all the examinations. Median esophageal gastric junction pressure, integrated relaxation pressure, and distal contractile integral were higher, and median distal latency was longer in the supine position compared with the upright position (allP < .05). Conclusions and Inferences Esophagus manometry in the upright position could reduce EGJOO overdiagnosis in patients with morbid obesity. Prolongation of the HRM study with some swallows in the upright position could be recommended in obese patients.

Background: To analyze whether face-to-face education before colonoscopy improves the quality of bowel preparation and increases the detection of adenomas. Methods: A retrospective cross-sectional study of adult patients with colorectal polyps identified by colonoscopy as outpatients was performed. The patients underwent an added colonoscopy inpatient for resection of colorectal polyps. As outpatients, we gave the patients written bowel preparation instructions; however, when they were inpatients, we supplied face-to-face education. We analyzed the data from the two colonoscopies of the same group of patients out- and in-patients, including the quality of the intestinal preparation, the time to reach the ileocecal region, and the detection of adenomas. Results: A total of 260 patients {age 63 [ 56, 68] years old, male/female (169/91)} were retrospectively included in our study. Two hundred fifty-two patients with a total of 685 adenomas were detected, 94 patients with 179 adenomas overlooked in the first colonoscopy. The BBPS Score during inpatient was higher than that during outpatient, {9 [8, 9] vs. 7 [6, 9]}, P<0.05, the Bubble Score during inpatient was lower than that during outpatient [0 (0.00, 0.00) vs. 0 (0.00, 1.00)], P<0.05. The time to reach the ileocecal region during inpatient is shorter than that during outpatient {6 [5, 9] vs. 7.5 [5, 11] min}, P<0.05. Poor bowel preparation, flat adenoma morphology, and adenoma diameter lower than 5mm were related adenoma misdiagnoses, P<0.05. Conclusions: Face-to-face patient education can improve the quality of bowel preparation, then shorten the time to reach the ileocecal region, and increase detection of colorectal adenomas.

目的 分析不明原因回肠末端病变临床、内镜特点,探讨不明原因回肠末端病变与过敏性疾病的关系.方法 选择2009年01月至2019年09月于首都医科大学附属北京世纪坛医院进行全结肠镜检查并首次发现回肠末端病变且诊断不明确的患者为研究对象.排除自身免疫性疾病史、应用非甾体类抗炎药(NSAIDs)相关药物史、各种原因未活检行病理检查者、回肠末端病变结合临床和病理明确诊断其他疾病者.收集患者的一般资料、既往过敏性疾病史、接受结肠镜检查的原因、结肠镜下表现、活检病理、胃镜结果、随访等进行分析.结果 共纳入286例患者,男性192例(67.1％),女性94例(32.9％),平均年龄(46.4±13.5)岁(13 ～83岁).回肠末端病变内镜下表现为:黏膜糜烂169例(59.1％)、溃疡46例(16.1％)、黏膜充血肿胀50例(17.5％)、多发黏膜隆起18例(6.3％)、绒毛粗大或变短3例(1.0％).其中36例(12.6％)活检病理提示嗜酸性粒细胞计数增多.79例(27.6％)存在过敏性疾病史:其中过敏性鼻炎38例、支气管哮喘5例、湿疹27例、荨麻疹7例和过敏性结膜炎2例;结肠镜下以黏膜糜烂为主要表现(60.8％,48/79),16.5％(13/79)活检病理提示嗜酸性粒细胞计数增多.有无过敏性疾病史患者的临床、内镜特征差异均无统计学意义.结论 回肠末端病变诊断困难,需注意甄别过敏性疾病相关的回肠末端病变;结肠镜检查发现回肠末端病变除病变处进行活检外,还应结肠多点活检,为临床诊断提供病理学依据.

Introduction: Sixty-three patients with gastric phytobezoars were reviewed. Methods: forty-eight (76.2%) patients received endoscopic combined with chemical therapies and 15 (23.8%) received only chemical therapy initially. Fifty-one (81.0%) patients achieved complete removal (only chemical therapy 14/15), while 12 (19.0%) received further endoscopic therapies. Results: finally, 62 (98.4%) patients achieved a complete removal. Considering only patients with combined treatment as a first approach, treatment success was associated with a softer phytobezoar consistency (p = 0.023). Conclusion: in conclusion, most patients achieve a favorable outcome. Chemical therapy is useful in selected cases. Repeated endoscopic therapies may be needed in order to completely remove phytobezoars with a hard consistency.

DNA mismatch repair-proficient colon cancer is the most common type of colon cancer, but its initiation and progression are still unknown. Our previous study has revealed that a long noncoding RNA (lncRNA) ENST00000455974 was significantly associated with TNM stage and distant metastasis in patients with DNA mismatch repair-proficient (pMMR) colon cancer (CC). Here, firstly, we observed that ENST00000455974 was gradual increased across colon normal-adenoma-carcinoma-metastasis sequence by quantitative real-time PCR. Secondly, ENST00000455974 showed a better sensitivity and specificity than CEA and CA19-9 in the diagnosis of pMMR CC by drawing the receiver operating characteristic (ROC) curve. Thirdly, a higher level of ENST00000455974 was associated with a poorer patient survival. Furthermore, Knockdown of ENST00000455974 led to reduced proliferation and migration of colon cancer cells. Mechanistically, ENST00000455974 was mainly located in the nucleus of colon cancer cells and it promoted the growth and metastasis of pMMR CC cells through up-regulating JAG2.

目的 该研究旨在分析食管内异物住院患者的临床特征、手术方法、相关的并发症、术后住院时间以及多科协作的优势.方法 回顾性分析71例食管内异物住院患者,将患者分为两组(A组,误食异物24 h内得到有效治疗;B组,误食异物超过24 h得到有效治疗).比较两组患者的病历资料、食道异物的种类、并发症和术后住院时间方面的差异.结果 最常见的异物为枣核、动物骨头和鱼骨.食管上段异物常见,其中A组比B组更常见.两组间的并发症发生率和术后住院时间存在明显差异.B组患者并发症发生率高,术后住院时间长,多科协作治疗能给患者提供更合适的治疗方法.结论 大多数食管内异物能在内镜下取出,24 h内有效的治疗能减少并发症和缩短术后住院时间,消化内科、耳鼻喉科及胸外科多科协作能给患者提供有效安全的治疗.

Objective To investigate the effect of comprehensive internal medical treatment including gastric endoscopy on patients with bezoar. Methods From 2010 to 2016,a retrospective study was conducted on fifty?two patients admitted to Beijing Shijitan Hospital, Capital Medical University. Results The main accompanying diseases were hypertension,coronary heart disease,diabetes mellitus and so on. Food that are easy to induce bezoar : banana, persimmon, hawthorn, chestnut, etc. The treatment included endoscopic treatment, intravenous proton pump suppression, and oral Coca?Cola and bicarbonate solution. The bezoar in two patients after 3 weeks of medical treatment were still not dissolved,finally surgery were performed. One patient's pathology showed early cardiac adenocarcinoma. Five patients had incomplete intestinal obstruction, after fasting and gastrointestinal decompression, and the bezoars were excreted through feces. All patients were cured without death. Conclusion Gastroscopy is a timely treatment that can help diagnose and treat gastric bezoar. The main predisposing factors include hypertension, coronary heart disease, diabetes mellitus and so on. Endoscopic treatment,intravenous proton pump inhibitor,sodium bicarbonate and Coca?Cola could dissolve most bezoar. We should be alert to the possibility of early cancer.

Objectives To investigate the clinical, pathological and endoscopic characteristics of colorectal polyps treated by endoscopic mucosal resection (EMR), then evaluate its therapeutic effect and security, and analyze its significance in diagnosis and treatment. Methods Clinical and pathological data of 437 patients (687 lesions), who underwent EMR from August, 2014 to August, 2015 were collected. A retrospective analysis was made, and lesions were statistically analyzed by variables such as age, sex, endoscopic features and clinical and pathological characteristics, and so on, according to the group procedure of adenoma cancerization and 'high risk adenomas - low risk adenomas - non-adenoma polyps' to observe the curative effect and safety on EMR. Results 48.28% of the patients who received colonoscopy examines were detected with polyps, and 34.90% of them were operated EMR, including advanced adenomas, which were 17.08% of the total quantity. From non-adenoma to advanced adenoma, with a increasing possibility of carcinogenesis, the location of polyps are transferred from proximal colon to distal colon and lesions are readily to be pedunculated ones with a higher level of mucosal lobulation and other kinds of mucosal changing. The degeneration of the colorectum is associated with pedunculated polyps, distal colorectal polyps, the size (>1.0 cm), adenomas containing villous structures and mucosal lobulation. As for EMR treatment, the en bloc resection rate can reach as high as 99.70%, with a complication rate of 1.14%. Conclusions Some special characteristics can be found in the site and the endoscopic feature of advanced adenomas and degenerated adenomas. To polyps sizing in 0.5 ~ 3.0 cm, EMR with endoclips has a remarkable effect and a low complication incidence. It can reduce the process of colorectal adenoma degenerates to multiple colorectal adenocarcinoma, which can be regarded as an effective method to prevent and cure the colorectal carcinoma.

BACKGROUND:Long noncoding RNAs (lncRNAs) have been suggested to be biomarkers for diagnosis and prognosis of sporadic colorectal cancer.AIMS:This study aimed to characterize the expression profile of lncRNAs in DNA mismatch repair-proficient (pMMR) early-stage colon cancer (CC).METHODS:The microsatellite instability (MSI) status was examined by a multiplex PCR. The expression of lncRNA and mRNA was analyzed by microarrays. The differentially expressed lncRNAs and mRNAs were determined by bioinformatic analyses and validated in 44 CC samples and 32 non-tumor colonic specimens by quantitative real-time polymerase chain reaction (qRT-PCR).RESULTS:We found that 16 out of 67 CC had MSI-L CC and 7 with MSI-H. In comparison with that in five non-tumor colonic samples, microarray indicated that 1492 lncRNAs and 1639 mRNAs were upregulated while 1804 lncRNAs and 1073 mRNAs downregulated in four pMMR early-stage CC. Bioinformatic analyses revealed that the differentially expressed mRNAs were involved in the process of cell division, angiogenesis, apoptotic, differentiation, the PI3K-Akt/p53/TNF pathways and others. The co-expression lncRNA and mRNA networks indicated five hot spots with significantly high co-expression degrees. Further quantitative RT-PCR revealed that 4 out of 6 lncRNAs were significantly upregulated while the other 2 lncRNAs were downregulated in the CC. Stratification analysis demonstrated that 5 out of 6 lncRNAs were significantly associated with TNM stage and/or distant metastasis in this population.CONCLUSION:Differentially expressed lncRNAs were significantly associated with clinical features of patients with pMMR CC and may participate in the tumorigenesis of pMMR CC.

Objective To analyze the clinical and endoscopic characteristics of fundic gland polyps (FGPs).Methods A case-control study was carried out at the Afifliated Beijing Shijitan Hospital of Capital Medical University from 2008 to 2015. The patients who accepted an upper endoscopy and found the gastric polyps for the ifrst time (diagnosed by pathology) were included in the study. Then, we analyzed the clinic and pathological characteristics of FGPs and non-FGPs.Results During the study period, 867 patients were enrolled, and 319 (36.8%) patients had FGPs. Compared the cases with the controls, the size of FGPs was smaller, an average is (0.40 ± 0.15) cm, single accounted for 67.7%, and 88.1% of FGPs were located at fundus and body. Helicobacter pylori infection of the cases detected was found in 6.1%, less than non-FGPs. There were statistically signiifcant differences observed in these aspects. From 2008 to 2015, the proportion of FGPs in gastric polyps and the detection rate of FGPs are both gradually elevated.Conclusions FGPs are the common gastric polyps, and its detection rate is gradually elevated. Most of the FGPs are mainly located at fundus and body, and single. Helicobacter pylori infection detected in the patients who have FGPs is rare.

Objective To investigate the value of NICE classification on real-time diagnosis for neoplastic and non-neoplastic colorectal polyps. Methods The histological type of 107 polypoid lesions from 50 patients detected by colonoscopy was predicted by 4 endoscopic physicians using NICE classification, including 1 chief physician, 2 associate chief physician, and 1 attending physician. Taking pathological result as gold standard, the real-time diagnostic accuracy of NICE classification for neoplastic colorectal polyps was evaluated, and the differences of diagnostic accuracy between the 4 endoscopic physicians were compared. Results Among the 107 polypoid lesions, 49 were neoplastic polyps and 58 were non-neoplastic polyps. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification on determination of the histological type of polyps were 81. 6% (40/49), 70. 0% (40/58), 74. 8% ( 80/107) , 70. 0%( 40/58) , and 81. 6%( 40/49) , respectively. There was no statistical difference on the prediction ability between the 4 physicians using NICE classification. Conclusion NICE classification is a feasible method for real-time prediction of histology type of colorectal polyps, and it is undemanding to the qualifications of physicians.

To evaluate the effectiveness of systematic training in the application of narrow‐band imaging (NBI) International Colorectal Endoscopic (NICE) classification for the prediction of the histology of colorectal polyps.

Objective To investigate the role of high resolution manometry ( HRM) and Chicago classification 2012 in esophageal motility evaluation. Methods The clinical characteristics of patients underwent esophageal HRM in the Beijing Shijitan Hospital Affiliated to Capital Medical University were analyzed retrospective. Patients were divided into reflux symptoms group and non-reflux symptoms group. The results of manometric datas and Chicago classification were collected and analyzed. Results A total of 130 patients were included in this analysis, with abnormal findings in 53 pa-tients (40. 8%). 8 patients (all in reflux symptom group) were diagnosed as achalasia;9 patients were diagnosed as EGJ outflow obstruction (5 in non-reflux symptom group, all with swallowing discomfort;4 in relux symptom group, 1 patient with poststernal pain) . More patients were classified into EGJ type of Ⅱ and Ⅲ in reflux symptom group than non-reflux symprom group ( P<0 . 05 ) . Most detected findings in reflux symptom group were esophageal peristalsis ab-normality, with 14 of weak peristalsis, 5 of frequent failed peristalsis. Conclusion HRM with Chicago Classification plays a major role in addressing esophageal motility diseases, especially achalasia. Chicago Classification may help to i-dentify impairment of esophageal peristalsis in patients with reflux symptoms. The clinical relationship of some classifica-tions ( i. e. EGJ outflow obstruction) remains to be determined.