Aims The aim of this study was to determine the baseline characteristics, diagnosis, and management of stump appendicitis (SA), and evaluate and compare the feasibility, safety and efficacy of treating SA with surgical approaches and endoscopic retrograde appendicitis therapy (ERAT).

Text A 59-year-old male occurred esophagogastric anastomotic fistula after radical resection of cardia adenocarcinoma. Symptoms didn't improve and he can't eat orally after 6 months treatment in other department. We performed two times endoscopic debridement of necrotic tissue in fistula combined with gastric wall full-thickness resection. On the third day after the treatment, the patient was started on a through oral fluid diet. One month endoscopy follow-up saw the wound cleaning, the healing process was good, and the patient started a normal diet. 18 months later, endoscopy showed fistula had healed completely. His weight increased 9kg during follow up. [1] [2] [3] [4]

Endoscopic submucosal dissection (ESD) is an effective method for resecting early-stage tumors in the digestive system. To achieve a low injection pressure of the injected fluid and continuous elevation of the mucosa following injection during the ESD technique, we introduced an innovative injectable sodium-alginate-based drug-loaded microsphere (Cipro-ThSA) for ESD surgery, which was generated through an emulsion reaction involving cysteine-modified sodium alginate (ThSA) and ciprofloxacin. Cipro-ThSA microspheres exhibited notable adhesiveness, antioxidant activity, and antimicrobial properties, providing a certain level of postoperative wound protection. In vitro cell assays confirmed the decent biocompatibility of the material. Lastly, according to animal experiments involving submucosal elevation of porcine colons, Cipro-ThSA microspheres ensure surgically removable lift height while maintaining the mucosa for approximately 246% longer than saline, which could effectively reduce surgical risks while providing sufficient time for operation. Consequently, the Cipro-ThSA microsphere holds great promise as a novel submucosal injection material, in terms of enhancing the operational safety and effectiveness of ESD surgery.

A 72-year-old woman was admitted to our hospital with a 20-year history of intermittent subxiphoid pain, which intensified in the past 2 months. Physical examination revealed dermal manifestations suggestive of neurofibromatosis ([Fig. 1]a). Enhanced computed tomography identified thickening of the distal esophageal wall. During upper endoscopy, a mass was observed stretching from the lower esophagus to the gastric cardia, leading to partial esophageal obstruction ([Fig. 1]b). Endoscopic ultrasound depicted a hypoechoic submucosal mass, distinguished by several anechoic lesions extending into the esophageal lumen ([Fig. 1]c). With informed consent from the patient, the mass was successfully excised using endoscopic submucosal dissection ([Fig. 1]d, [Video 1]). The extracted specimen measured 3.0 × 5.0 × 5.0 cm ([Fig. 1]e). Histopathological evaluation confirmed neurofibromatosis, identified by neurofibromatous cells encircling the specimen ([Fig. 1]f). The patient experienced no symptoms and showed no signs of recurrence or residual mass on follow-up endoscopic evaluations over 1 year.

Clinical application of natural orifice transluminal endoscopic surgery (NOTES) has been increasingly used over the past decades. Natural orifices provide a natural entry into the abdominal cavity for clinical diagnosis of abdominal disease, such as the transgastric abdominal exploration. Transgastric abdominal exploration combined with biopsy in the diagnosis of abdominal disease is a feasible and safe technique. In this chapter, we have introduced the indication, detailed endoscopic procedures, and potential complication of transgastric NOTES for abdominal diseases. The advantages of NTOES, such as improved cosmesis; reduced systemic inflammatory responses; elimination of incision infection; and a reduction in local pain and convalescence time, as well as hernia formation and adhesions have caught the great interests of many endoscopists. Regarding this procedure, safe and effective closure of the incision is a crucial aspect in the NOTES procedure in abdominal exploration.

Aims To evaluate the feasibility, safety, and efficacy of massive continuous irrigation combined with endoscopic debridement for the treatment of refractory abscess-fistula complexes.

目的:探讨伴有黏膜面破溃的胃间质瘤的危险因素及预后.方法:收集2015年6月至2021年2月于郑州大学第一附属医院接受内镜或外科手术完整切除的408例胃间质瘤患者的临床病理资料,根据患者术前胃镜结果判断胃间质瘤黏膜面是否破溃,将患者分为破溃组(n=179)和非破溃组(n=229),比较两组患者的临床病理特征及预后差异.采用Logistic回归分析胃间质瘤黏膜面破溃的危险因素,采用log-rank检验比较两组的无复发生存情况.结果:破溃组与非破溃组首发症状、肿瘤部位、肿瘤最大径、核分裂象计数、Ki-67指数、危险度分级、手术方式比较差异有统计学意义(P<0.05).Logistic回归分析显示,肿瘤位于胃底贲门(OR=2.954,95％CI:1.253～6.960)、肿瘤最大径>5 cm(OR=4.732,95％CI:2.919～7.673)、核分裂象计数>5个/50 HPF(OR=1.721,95％CI:1.011～2.930)及Ki-67指数>5％(OR=1.733,95％CI:1.039～2.892)是胃间质瘤黏膜面破溃的危险因素.Log-rank检验显示,破溃组较非破溃组患者预后差(P=0.009).结论:肿瘤部位、肿瘤最大径、核分裂象计数及Ki-67指数是胃间质瘤黏膜面破溃的危险因素.伴有黏膜面破溃的胃间质瘤患者预后较差.

BACKGROUND:Percutaneous drainage (PCD) and endoscopic approaches have largely replaced surgical drainage as the initial approach for (peri) pancreatic fluid collections (PFC)s, while complications associated with endoscopic stent implantation are common. AIM:To introduce a novel endoscopic therapy named endoscopic transgastric fenestration (ETGF), which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation, and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall. METHODS:Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled. Indications for intervention were consistent with related guidelines. We analyzed patients baseline characteristics, technical and clinical success rate, recurrence and reintervention rate, procedure-related complications and adverse events. RESULTS:Seventy-two eligible patients were retrospectively identified (ETGF = 34, PCD = 38) from October 2017 to May 2021. Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group (97.1 vs 76.3%, P = 0.01). There were no statistically significant differences regarding recurrence, reintervention and incidence of complication between the two groups. While long-term catheter drainage was very common in the PCD group. CONCLUSION:Compared with PCD, ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall. ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.

See also: Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experienceEndoscopy 2022; 54(01): 16-24DOI: 10.1055/a-1345-0044

消化内镜历经百余年的发展进入电子内镜时代,使一系列内镜下高难度治疗变为现实.内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)奠定了各种内镜下治疗技术的发展基础.我国的消化内镜专家开创了内镜下全层切除术(endoscopic full-thickness resection,EFTR)、内镜下固有肌层剥离术(endoscopic muscular dissection,EMD)、内镜经黏膜下隧道肿瘤切除术(sub-mucosal tunneling endoscopic resection,STER)等一系列新技术.经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)让内镜下微创治疗达到了一个新的高度.机器人内镜和AI技术的应用,将会引领内镜发展的新潮流.

Oridonin (ORI) is known to pose anticancer activity against cancer, which could induce the therapeutic impact of chemotherapy drugs. However, such simple combinations have numerous side effects such as higher toxicity to normal cells and tissues. To enhance the therapeutic effects with minimal side effects, here we used ORI in combination with cisplitin (CIS) against different esophageal squamous cell carcinoma (ESCC) cell lines in vitro, to investigate the synergistic anticancer effects of the two drugs against ESCC. Calcusyn Graphing Software was used to assess the synergistic effect. Apoptosis, wound healing and cell invasion assay were conducted to further confirm the synergistic effects of ORI and CIS. Intracellular glutathione (GSH) and reactive oxygen species assay, immunofluorescence staining and western blot were used to verify the mechanism of synergistic cytotoxicity. ORI and CIS pose selective synergistic effects on ESCC cells with p53 mutations. Moreover, we found that the synergistic effects of these drugs are mediated by GSH/ROS systems, such that intracellular GSH production was inhibited, whereas the ROS generation was induced following ORI and CIS application. In addition, we noted that DNA damage was induced as in response to ORI and CIS treatment. Overall, these results suggest that ORI can synergistically enhance the effect of CIS, and GSH deficiency and p53 mutation, might be biomarkers for the combinational usage of ORI and CIS.

目的 探索隧道法内镜黏膜下肿物切除术(STER)治疗起源于固有肌层(MP)的食管上段黏膜下肿瘤(SMT)的疗效及影响因素.方法 回顾性分析该院采用STER治疗的,起源于MP的41例食管上段SMT患者的临床资料.结果 病变距门齿22.0(20.0,23.0)cm,病变直径1.5(1.2,3.0)cm,长隧道STER(隧道长度≥3.0 cm)切除15例(36.6％),短隧道STER(隧道长度<3.0 cm)切除26例(63.4％),平均手术时间60.0(34.0,93.0)min.肿瘤整块切除率80.5％(33/41).术中3例(7.3％)出现并发症.其中,隧道黏膜损伤2例(4.9％),大出血1例(2.4％).术后皮下气肿4例(9.8％),高热3例(7.3％),均通过保守治疗好转,术后住院时间6.0(4.5,7.0)d.肿瘤长径≥3.0 cm组与肿瘤长径<3.0 cm组比较,手术时间长(P=0.000),术后并发症多(P=0.014),整块切除率低(P=0.036).短隧道组与长隧道组的肿瘤大小、肿瘤形状、手术时间、术中并发症、整块切除率、术后并发症和术后住院时间比较,差异均无统计学意义(P>0.05).病理诊断为平滑肌瘤39例,神经鞘瘤2例.术后随访(34.2±18.7)个月,均无肿瘤复发,无食管狭窄发生.结论 STER治疗起源于MP的食管上段SMT是安全有效的,尤其适用于长径<3.0 cm的食管SMT.短隧道STER治疗食管上段SMT的安全性也得到了初步证实.

目的:探讨消化道颗粒细胞瘤(GCT)临床特点及内镜治疗的有效性和安全性.方法:回顾性分析2016年1月至2020年12月在郑州大学第一附属医院消化内镜中心行内镜治疗的21例消化道GCT患者的临床特点及内镜治疗效果.结果:21例消化道GCT位于食管15例、胃3例、回肠1例、结肠2例.所有患者均表现为非特异性的消化道症状,21例术前胃镜、19例术前超声内镜检查均观察到黏膜下隆起性病变,病灶直径均＜2 cm.1例术前行活检,病理提示食管鳞状细胞癌.1例经内镜活检后烧灼清除;余20例均行内镜下切除,包括圈套切除10例、内镜下黏膜切除术7例、内镜黏膜下剥离术3例,术中、术后均无并发症发生.所有患者随访0.0～48.1个月,均未见肿瘤复发.结论:内镜切除是治疗消化道GCT的安全、有效手段,能够实现对病灶的完全切除,短期观察术后无复发,可作为消化道GCT患者的首选治疗手段.

Clinical data of 62 patients with gastrointestinal submucosal tumors (diameter ≥1 cm) who were treated with kissing suture by single-channel endoscope after endoscopic full-thickness resection (EFR) in the First Affiliated Hospital of Zhengzhou University from February 2017 to May 2019 were analyzed retrospectively to evaluate the clinical value of kissing suture technique by single-channel endoscope in defect closure after EFR. All the post-EFR defects were successfully closed (100%). No postoperative anastomotic leakage or other serious complications occurred. The mean maximum diameter of lesions was 3 cm (ranged 1-7 cm), and 13 (21%) of them were greater than or equal to 5 cm.The mean number of clips used was 25.7 (ranged 7-78). The mean procedure time was 168 min (ranged 44-300 min), and the mean suture time was 63 min (ranged 13-211 min). The mean postoperative hospital stay was 7 days (ranged 4-12 days). Endoscopic reexamination 3-6 months after operation showed that all wounds healed well. Kissing suture method by single-channel endoscope is a safe, effective, easy and feasible for closing gastrointestinal defect after EFR.

Objective:To evaluate endoscopic retrograde appendicitis therapy in treatment of children with acute uncomplicated appendicitis.Methods:Sixty children patients were admitted at the Affiliated Hospital of Zhengzhou University from Oct 2019 to Jun 2021 and were divided into ERAT group ( n=30) and LA group ( n=30). Results:All operations were successfully performed . ERAT children started oral feeding earlier [(6.8±2.0) h vs. (12.3±2.0) h, t=-10.636, P<0.001], postoperative hospital stay was shorter [(3.2±1.3) d vs. (5.0±1.3) d, t=-5.360, P<0.001]. After 14 months follow up, the recurrence rate in the ERAT group was 6%. The complication rate of LA was 10%. Conclusion:ERAT is a safe and effective therapy in treating children with acute uncomplicated appendicitis with low,acceptable recurrence rate.

目的:调查结直肠癌(CRC)患者一级亲属(FDRs)对CRC筛查的认知现状,探讨CRC筛查中存在的问题.方法:采用目标抽样法选取2019年1—12月于本院结直肠外科进行CRC手术治疗且术后经病理诊断为CRC的患者的FDRs 49名(年龄40～75岁),对FDRs进行问卷调查并收集调查数据,分析FDRs对CRC筛查的认知现状.结果:CRC患者FDRs中40～50岁者21名,51～75岁者28名;男性27名,女性22名;CRC患者的子女31名,兄弟姐妹10名,父母8名.26.5％(13/49)FDRs知晓"FDRs的CRC发病风险增加",22.4％(11/49)FDRs"过去5年内做过结肠镜检查".75.5％(37/49)FDRs无"医务人员建议大于40岁行结肠镜检查".年龄40～50岁、大专及大专以上学历和居住地为城市者"FDRs的CRC发病风险增加"知晓率和"过去5年内做过结肠镜检查"率高于51～75岁、大专以下学历和农村居住者(P<0.05).过去5年内未做过结肠镜检查的38名CRC患者FDRs中,认为"无身体不适症状不需要进行结肠镜检查"、恐惧结肠镜检查过程和认为结肠镜检查繁琐费时等是影响FDRs进行结肠镜筛查的主要原因;经过沟通,22名FDRs(57.9％)改变了认知,愿意接受结肠镜筛查.结论:CRC患者FDRs对CRC筛查的认知严重不足.加大CRC筛查的健康宣教力度和医保政策的支持,是提高CRC筛查率的重要措施.

目的 探讨克罗恩病(CD)患者接受抗肿瘤坏死因子-α(TNF-α)治疗3个月及12个月时的回、结肠各节段黏膜病变愈合情况,以评估抗TNF-α治疗对不同部位肠道病变的疗效.方法 回顾性收集2018年10月至2021年6月在郑州大学第一附属医院接受抗TNF-α治疗的34例中、重度CD患者,分析治疗前和治疗后3、12个月时患者炎症指标和回、结肠各肠段(末端回肠、升结肠、横结肠、降结肠和乙状结肠、直肠)的内镜下黏膜病变愈合情况.结果 与治疗前相比,治疗3个月及12个月的炎症指标改善(P<0.05),治疗12个月时炎症指标较3个月时无变化(P>0.05);治疗3个月及12个月时升结肠及横结肠的内镜下黏膜愈合较治疗前改善(P<0.05);末端回肠、降结肠及乙状结肠和直肠内镜下黏膜愈合率较治疗前无改善(P>0.05).结论 回结肠不同肠段CD病变对抗TNF-α治疗的反应不同,结肠段总体黏膜愈合情况优于末端回肠,横结肠和升结肠的黏膜愈合率最高.

目的 探讨内镜下切除盲肠近阑尾口病变的安全性及治疗效果.方法 盲肠近阑尾口病变患者10例,术前均行超声内镜检查确定病灶位置及病灶大小,行内镜下圈套器切除术或内镜下黏膜切除术,术后切除标本行组织病理检查.观察内镜下病变组织切除情况、术中及术后并发症发生情况;术后6～12个月,复查结肠镜,观察阑尾口狭窄及残余病变情况;随访3～51个月,观察患者胃肠道不适发生情况.结果 10例患者术前超声内镜检查显示病变均起源于黏膜下层或固有肌层,病灶直径为7.7～27.6 mm.8例行内镜下圈套器切除术,2例行内镜下黏膜切除术,术中均未发生出血、穿孔并发症,术后均未出现发热、穿孔、迟发性出血等并发症;术后组织病理检查结果显示潴留性囊肿8例,单纯性黏液囊肿1例,脂肪瘤1例.术后6～12个月,8例患者复查结肠镜,均未发现阑尾口狭窄及残余病变;中位随访时间42个月,10例患者均未出现腹痛等胃肠道不适症状.结论 内镜下切除盲肠近阑尾口病变安全、有效,创伤小,并发症少.