The optimal fecal occult blood test (FOBT) and hemoglobin (Hb) threshold for balancing diagnostic accuracy and endoscopic demand in colorectal cancer (CRC) screening among Chinese outpatients remained unclear. A prospective multicenter trial was conducted from January 2017 to April 2021 across eight tertiary hospitals. Eligible outpatients were enrolled, whose stool samples were analyzed using quantitative fecal immunochemical test (FIT), self-administered qualitative FIT, general qualitative FIT, and gFOBT. All participants underwent colonoscopy. The primary outcome was the sensitivity of FOBTs for CRC detection. A total of 2,930 participants were enrolled, with 2,618 participants meeting inclusion criteria and completing FOBTs and colonoscopies. At the threshold of 5.2 µg/g, quantitative FIT demonstrated comparable sensitivity for CRC detection (90.1%) to self-administered qualitative FIT (87.1%), general qualitative FIT (91.1%), and gFOBT (82.2%) (all P > 0.05). The positive rate of quantitative FIT (12.4%) was significantly lower than that of self-administered qualitative FIT (27.5%), general qualitative FIT (24.2%), and gFOBT (23.0%) (all P < 0.05). Quantitative FIT showed superior specificity (93.9%) compared to self-administered qualitative FIT (79.5%), general qualitative FIT (83.6%), and gFOBT (80.7%) (all P < 0.05). Furthermore, quantitative FIT at 5.2 µg/g exhibited higher PPV and LR + for CRC, advanced adenoma (AA) and advanced neoplasia (AN) than other FOBTs. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) revealed excellent accuracy for CRC detection (AUC: 0.951, 95% CI: 0.920-0.981). The quantitative FIT with a threshold of 5.2 µg/g demonstrated superior performance for early CRC screening in Chinese outpatients.

Background Gastrointestinal (GI) tract cancers are the second leading cause of cancer-related mortality, often due to late detection. There is a critical need for non-invasive, highly sensitive biomarkers for early-stage cancer and precancerous lesion detection to enable timely intervention. This study aimed to develop a blood-based method specifically optimized for early GI cancer detection and population-level screening. Methods Using large-scale public tissue methylation data and the Twist probe cfDNA profiles, we developed SPOGIT (Screening for the Presence of Gastrointestinal Tumors), a multi-algorithm model (Logistic Regression/Transformer/MLP/Random Forest/SGD/SVC) for early GI cancer detection. The model was rigorously validated through an internal (n = 83) and multicenter external validation (386 cancers/113 controls/580 precancers), with an interception model assessing its clinical potential. Results SPOGIT demonstrated high accuracy in detecting GI cancers, with a sensitivity of 88.1 % and a specificity of 91.2 %. Notably, it effectively identified early-stage (0-II) cancers with 83.1 % sensitivity. The model also showed significant potential for intercepting premalignant progression, detecting advanced adenomas (AA) and gastric precancerous lesions with sensitivities of 56.5 % and up to 62.4 %, respectively. In the external independent validation cohort, a complementary model CSO (Cancer Signal Origin) demonstrated an accuracy of 83 % for colorectal cancer and 71 % for gastric cancer. Most importantly, simulation analyses projected that SPOGIT implementation could significantly reduce late-stage diagnoses and increase 5-year survival rate by 27.02 % through early interception. Conclusions This study introduced a novel, dual-model blood architecture (SPOGIT/CSO) that enables highly accurate, early detection of GI cancers and their precursors. By facilitating timely clinical intervention, SPOGIT/CSO represented a paradigm-shifting strategy with the potential to significantly improve patient survival outcomes and transform GI cancer management.

Lynch syndrome (LS)-associated colorectal cancer (CRC) always ascribes to pathogenic germline mutations in mismatch repair (MMR) genes. However, the penetrance of CRC varies among those with the same MMR gene mutation. Thus, we hypothesized that the gut microbiota is also involved in CRC development in LS families. This prospective, observational study was performed from December 2020 to March 2023. We enrolled 72 individuals from 9 LS families across six provinces in China and employed 16S rRNA gene amplicon sequencing to analyze the fecal microbiota components among LS-related CRC patients (AS group), their spouses (BS group), mutation carriers without CRC (CS group), and non-mutation carriers (DS group) using alpha and beta diversity indices. There were no apparent differences in age or gender among the four groups. Alpha and beta diversity indices exhibited no significant differences between the AS and BS groups, verifying the role of germline mutations in the occurrence of CRC in LS families. Beta diversity analysis exhibited significant differences between the AS and CS groups, revealing the importance of the gut microbiota for the occurrence of CRC in LS families. A greater difference (both alpha and beta diversity indices) was shown between the AS and DS groups, demonstrating the combined impact of the gut microbiota and genetic germline mutations on the occurrence of CRC in LS families. Compared with those in the CS and DS groups, we identified ten microbial genera enriched in the AS group, and one genus (Bacteroides) decreased in the AS group. Among the elevated genera in the AS group, Agathobacter, Coprococcus and Prevotellaceae_NK3B31_group were butyrate-producing genera. This study found the development of CRC in the LS families can be attributed to the combined effects of gene germline mutations as well as the gut microbiota and provided novel insights into the prevention and treatment of CRC in the LS families.

Human umbilical cord mesenchymal stem cells (HUMSCs) are effective therapies for inflammatory bowel disease. However, the mechanisms remain unresolved. We found HUMSCs express CD126 (IL-6 receptor), which indicated CD126 sub-populations might show a distinct response to inflammation. In the present study, we explored whether CD126 is a critical molecule for HUMSCs in regulating inflammation. We assessed the regulatory effects of CD126 high (CD126hi) on the T lymphocyte subpopulations and related cytokines in the dextran sulfate sodium (DSS)-induced colitis model. The effect of CD126hi was evaluated by Hematoxylin and Eosin (H E) staining, fluorescence-activated cell sorting (FACS), and enzyme-linked immunosorbent assay (ELISA) analyses. Statistical significance was typically determined using Student’s t-test or one-way analysis of variance (ANOVA) with Tukey test. The disease symptoms were markedly ameliorated and the interleukin-6 (IL-6), interleukin-17 (IL-17), interferon-γ (IFN-γ), Tumor necrosis factor-α (TNF-α), and interleukin-4 (IL-4) levels were significantly reduced in DSS-treated mice administered with CD126hi HUMSCs but not in DSS-treated mice administered with CD126 low (CD126lo) HUMSCs. Intriguingly, CD126hi HUMSCs significantly increased the levels of transforming growth factor-β (TGF-β1) and interleukin-10 (IL-10) in DSS-treated mice, accompanied by an increase in regulatory T cells (Treg cells). In vitro experiments showed that CD126hi HUMSCs secreted TGF-β1 in response to IL-6 stimulation, while CD126lo HUMSCs were latent in the inflammatory environment. We considered that TGF-β1 secreted by CD126hi HUMSCs regulated the balance of Treg cells and thus promoted the recovery of murine colitis. Our results revealed a mechanism wherein CD126hi HUMSCs function as inflammatory sensors and secrete anti-inflammatory cytokines to rebalance the population of T cells. This study shed light on the potential therapeutic application of CD126hi HUMSCs for inflammatory diseases such as inflammatory bowel disease.

OBJECTIVE:This study aimed to compare the performance of standard-definition white-light endoscopy (SD-WL), high-definition white-light endoscopy (HD-WL), and high-definition narrow-band imaging (HD-NBI) in detecting colorectal lesions in the Chinese population. METHODS:This was a multicenter, single-blind, randomized, controlled trial with a non-inferiority design. Patients undergoing endoscopy for physical examination, screening, and surveillance were enrolled from July 2017 to December 2020. The primary outcome measure was the adenoma detection rate (ADR), defined as the proportion of patients with at least one adenoma detected. The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression. RESULTS:Out of 653 eligible patients enrolled, data from 596 patients were analyzed. The ADRs were 34.5% in the SD-WL group, 33.5% in the HD-WL group, and 37.5% in the HD-NBI group (P=0.72). The advanced neoplasm detection rates (ANDRs) in the three arms were 17.1%, 15.5%, and 10.4% (P=0.17). No significant differences were found between the SD group and HD group regarding ADR or ANDR (ADR: 34.5% vs. 35.6%, P=0.79; ANDR: 17.1% vs. 13.0%, P=0.16, respectively). Similar results were observed between the HD-WL group and HD-NBI group (ADR: 33.5% vs. 37.7%, P=0.45; ANDR: 15.5% vs. 10.4%, P=0.18, respectively). In the univariate and multivariate logistic regression analyses, neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL (HD-WL: OR 0.91, P=0.69; HD-NBI: OR 1.15, P=0.80). CONCLUSION:HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients. It can be concluded that HD-NBI or HD-WL is not superior to SD-WL, but more effective instruction may be needed to guide the selection of different endoscopic methods in the future. Our study's conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources, especially advanced imaging technologies.

Adequate bowel cleansing is crucial for endoscopic diagnosis and treatment, and the recovery of gut microbiota after intestinal cleansing is also important. A hypertonic syrup predominantly comprising L-arabinose and D-xylose (20% xylo-oligosaccharides) can be extracted from the hemicellulose of corn husks and cobs. L-Arabinose and xylo-oligosaccharides have been reported to relieve constipation and improve the gut microbial environment. This study evaluated the bowel cleansing effect of the aforementioned syrup and its influence on the organism and intestinal microbiota after cleansing in comparison with polyethylene glycol-4000 (PEG-4000) in mice. Bowel cleansing was performed using syrup or PEG-4000 in C57BL/6J mice, and the effect of intestinal preparation and its influence on serum electrolytes and gut microbiota after bowel cleansing were evaluated. The volume of intestinal residual feces in the syrup group was significantly lower than that in the PEG-4000 group. Additionally, syrup disturbed serum electrolytes more mildly than PEG-4000. Alpha diversity in the gut microbiota was significantly higher in the syrup group than in the PEG-4000 group on the first day after bowel cleansing. However, no difference in beta diversity was observed between the two groups. Syrup increased the abundance of Bifidobacteria and Christensenella and decreased the abundance of Akkermansia in comparison with PEG-4000 on the first day after bowel cleansing. Thus, this syrup has potential clinical use as a bowel cleansing agent given the above effects, its benefits and safety, and better taste and acceptability.

Early squamous cell carcinoma (SCC) in esophageal diverticula is rare, with an unclear pathogenesis [1]. Endoscopic septotomy is used to treat patients at high risk for surgical resection of a diverticulum [2], and endoscopic submucosal dissection (ESD) is recommended for selected early esophageal carcinoma [3]. ESD for early cancer in diverticula is challenging for endoscopists, as diverticula have characteristically thin walls and endoscopic treatment carries a higher risk of perforation [1] [4]. Here, we report a case of ESD curing early esophageal SCC in diverticula.

目的 探讨Over-The-Scope-Clip system(OTSC)治疗难治性消化道瘘的应用价值.方法 收集2018年11月至2021年12月于中国人民解放军总医院第七医学中心接受内镜下OTSC治疗的12例难治性消化道瘘患者临床资料,评价OTSC疗效.结果 12例难治性消化道瘘患者共17处病变,包括食管气管瘘5例,食管纵隔瘘、食管胃吻合口瘘、食管小肠吻合口瘘、十二指肠瘘各1例,直肠阴道瘘2例、直肠吻合口瘘1例,男6例,女6例,年龄(52.2±14.7)岁(23～75岁).瘘口形成时间为(6.3±6.7)个月(1～24个月);瘘口边缘全瘢痕占比83.3％;瘘口黏膜厚度(0.5±0.1)cm(0.2～0.8 cm);瘘口直径(0.6±0.6)cm(0.3～2.5 cm),其中<1.0 cm 8例、1.0～2.0 cm 3例、>2.0 cm 1例.术后随访,7例实现黏膜愈合,2例因瘘口未愈合追加外科手术,2例置入食管支架,1例自行愈合;OTSC治疗成功率为58.3％.进一步分析临床特征,OTSC操作成功率在直肠瘘中显著低于非直肠瘘,差异有统计学意义(0 vs 77.8％,P=0.045);失败组OTSC操作时间显著长于成功组,差异有统计学意义[(15.0±4.9)min vs(7.9±5.4)min,U=4.00,P=0.03].结论 OTSC是治疗难治性消化道瘘的有效方法,但需进一步掌握适应证、控制操作时间.

Background Achalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove FCARMS implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. The aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM. Methods A propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups. Results A total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group ( p < 0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8 ± 2.4 (vs 2.1 ± 1.8 of POEM) ( p = 0.00 < 0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively ( p = 0.39), and the 2-year remission rates were 61% and 90%, respectively ( p = 0.00). Conclusions Stent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 months) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years), POEM is better than FCARMS. HRMIIis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.

目的 探讨贲门失弛缓症患者临床症状与精神心理特征的关系.方法 对150例贲门失弛缓症患者采用艾森克人格问卷简式量表中国版(EPQ-RSC)、症状自评表(SCL-90)和明尼苏达多项个性调查表(MMIP)进行调查.结果 贲门失弛缓症患者EPQ-RSC的内外向、神经质、精神质和掩饰性评分显著高于全国常模(P＜0.05);SCL-90测得贲门失弛缓症患者的躯体化、强迫、抑郁、焦虑、敌对、恐怖、精神病性、阳性项目数和总分评分显著高于全国常模(P＜0.05).贲门失弛缓症患者反食症状在不同躯体化等级间差异明显.吞咽困难、胸痛、咳嗽的症状不受躯体化、强迫、人际敏感等级影响.吞咽困难与神经质呈负相关,咳嗽与精神质呈负相关.咳嗽与疑病因子具有线性相关,反食与疑病、精神病态、精神衰弱、精神分裂症、轻躁狂呈线性相关,吞咽困难、胸痛、Eckardt总分与疑病、精神病态、精神衰弱、精神分裂症、轻躁狂无线性相关.疾病严重程度高,精神质分数高,掩饰性分数低,差异有统计学意义(P＜0.05).结论 贲门失弛缓症患者部分存在轻度的心理健康问题,临床治疗中了解患者的精神及心理状态并进行适时的精神心理干预,达到辅助改善贲门失弛缓症疗效的目的.

目的 探讨幼年性息肉(juvenile polyp,JP)及幼年性息肉综合征(juvenile polyposis syndrome,JPS)患儿临床及内镜特征.方法 对2012年1月至2017年12月在我院诊断为JP或JPS,年龄≤14岁的83例患儿的临床及内镜资料进行分析.结果 93.98％(78/83)的患儿临床症状表现为便血.结肠镜检查发现,结直肠单发息肉患儿77例(92.77％),其中1例患儿有JP家族史;2～4枚息肉者2例(2.41％),均无JP家族史;≥5枚息肉者4例(4.82％),2例有JP家族史.单发息肉患儿中,息肉形态均为0-Ⅰ型,多分布于左半结肠,其中直径≤3 cm者73例(94.81％).2～4枚息肉患儿中,息肉形态均为0-Ⅰ型,直径0.8～1.5 cm,主要分布于左半结肠.结直肠息肉≥5枚患儿中,2例有JP家族史;2例有胃多发息肉.5例JPS患儿中,1例患儿检测到BMPR1A基因突变.结论 JP和JPS患儿临床上多表现为便血,息肉多为0-Ⅰ型,对于JPS患儿,应行全结肠镜检查及早期行胃镜检查,以制定个性化监测方案.

目的 评价应用器械辅助小肠镜(device-assisted enteroscopy,DAE)取出小肠异物的有效性及安全性.方法 纳入2010年4月至2019年11月在我院确诊为小肠异物且尝试通过DAE取出的患者,评价应用DAE取出异物的有效性及安全性.结果 共纳入16例小肠异物患者,男7例,女9例,年龄2～78岁,中位年龄38岁.9例(56.3％)患者有临床症状,主要为腹痛和呕吐.其中14例患者的异物经DAE成功取出,成功率为87.5％,2例胶囊滞留患者行外科手术治疗.最多的异物为滞留的胶囊内镜(6例,37.5％),其次为异位的金属支架(4例,25.0％)和小肠结石(3例,18.8％).成功取出的异物最长为10 cm.所有患者在DAE检查过程中及检查后均无明显不适,无操作相关并发症发生.结论 经DAE取出小肠异物是一种安全有效的方法.

Objective:To prospectively follow up the patients with ileocecal inflammatory lesions, to explore the characteristics of Crohn′s disease(CD) at early stage, and to provide references for early diagnosis of CD.Methods:From January 2013 to December 2018, at Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, 232 patients with unexplained ileocecal inflammatory lesions under colonoscopy examination were enrolled, which were followed up for more than one year. Chi-square test and Fisher exact probability text were used to compare the patients with early CD, with non-specific enteritis and intestinal tuberculosis in abdominal symptoms (abdominal pain, diarrhea, abdominal distension, constipation, hematochezia, changes in bowel habits), accompanying symptoms (oral ulcer, arthralgia), the proportion of patients with elevated erythrocyte sedimentation rate (ESR) or elevated C-reactive protein (CRP) level, serum antineutrophilic cytoplasmic antibody (ANCA), anti-saccharomyces cerevisiae antibody (ASCA), tuberculosis infection of T cells spot test, positive rate of fecal occult blood, lesion size, morphology, involvement site under endoscopy and histopathological results. Multivariate binary logistic regression was used to analyze the related factors of early CD.Results:Among 232 patients, 155 were males and 77 were females, and the age of first diagnosis was (43.9±13.8) years old. The follow-up period (range) was 27 months (12 to 79 months). Twenty-nine cases (12.5%) were diagnosed as early CD, 45 cases (19.4%) were intestinal tuberculosis, 105 cases (45.3%) were non-specific enteritis, and 53 cases (22.8%) as undetermined. All of 29 patients with early CD had abdominal symptoms, which accounted for 16.9% (29/172) of 172 patients with ileoceccal inflammatory lesion as well as abdominal symptoms. In early CD patients, the proportions of patients with abdominal pain, elevated CRP level and ESR level, positive rate of ASCA, positive rate of tuberculosis infection T cells and percentage of patients with thickened intestinal wall were all higher than those in patients with non-specific enteritis (62.1%, 18/29 vs. 33.3%, 35/105; 13.8%, 4/29 vs. 0; 13.8%, 4/29 vs. 1.0%, 1/105; 24.1%, 7/29 vs. 1.0%, 1/105; 20.7%, 6/29 vs. 3.8%, 4/105; 95.7%, 22/23 vs. 0), and the proportion of patients without abdominal symptoms was lower than that of patients with non-specific enteritis (0 vs. 31.4%, 33/105). And the differences were statistically significant ( χ2=6.692, Fisher exact probability text, χ2=7.162, χ2=17.826, χ2=7.497, Fisher exact probability text, and Fisher exact probability text, all P<0.05). Early CD patients were more likely to have multiple lesion sites (55.2%, 16/29), and mainly deep ulcers (55.2%, 16/29) and ulcers with a long diameter of 5 to 10 mm (39.3%, 11/28). The lesions of non-specific enteritis were mostly confined to the end of ileum (75.2%, 79/105), which were mainly superficial ulcers (41.0%, 43/105) and ulcers with a long diameter less than 5 mm (69.0%, 49/71). The proportion of patients without abdominal symptoms and the positive rate of tuberculosis infection of T cells spot test of early CD patients were both lower than those of intestinal tuberculosis group (0 vs. 15.6%, 7/45 and 20.7%, 6/29 vs. 68.9%, 31/45). The positive rate of ASCA and the proportion of patients with thickened intestinal wall were higher than those of intestinal tuberculosis group (24.1%, 7/29 vs. 0 and 95.7%, 22/23 vs. 11/19), and the differences were statistically significant (Fisher exact probability text, χ2=13.713, Fisher exact probability text and χ2=6.710, all P<0.05). The results of multivariate binary logistic regression analysis showed that abdominal pain and positive ASCA were independent risk factors for early CD (odds ratio ( OR)=2.855, 95% confidence interval ( CI) 1.014 to 8.037, P=0.047; OR=10.033, 95% CI 2.274 to 44.250, P=0.002). Conclusions:Prospective follow-up for more than one year in patients with unexplained ileocecal inflammatory lesions can effectively identify and diagnose early CD. Ileocecal inflammatory lesions with abdominal symptoms are one of the early manifestations of CD. Abdominal pain and positive serum ASCA at the initial diagnosis are independent risk factors for early diagnosis of CD.

Abstract In patients with Roux-en-Y (R-Y) anastomosis (including hepaticojejunostomy and R-Y gastric bypass) and Whipple operation, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We retrospective analyses our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with R-Y anastomosis and Whipple operation. ERCP was performed in 15 patients (4 pancreaticoduodenectomy and 10cholangiojejunostomy and 1 Subtotal gastrectomy with R-Y reconstruction; age ranging from 4 to 63 years) with BAE. Double- and single-balloon enteroscopy was applied in 5 and 10 patients, respectively. Bile duct cannulation was successful in 13 of 15 cases (86.7%), including simple stenosis of the anastomotic stoma (n = 2), intrahepatic bile duct stones (n = 10), and pancreatic cancer (n = 1). Cannulation failed because the guidewire could not pass through the anastomotic stenosis in 1 patient and because the endoscope could not enter the acute angle of the anastomosis of the afferent limb in the other patient. Adverse events included jaundice (n = 1) and perforation (n = 1), which were successfully treated by conservative therapy. ERCP with BAE in patients with R-Y anastomosis and Whipple operation is safe and useful but has unique complications. The success rate is lower than that of conventional ERCP.

目的:探讨内镜吻合夹(over-the-scope clip，OTSC)在闭合医源性肠道穿孔中的疗效。方法:对应用OTSC夹封闭肠道穿孔患者的临床资料进行回顾性分析。结果:20例患者穿孔长径为1.0～4.0 cm，均在内镜下一次成功闭合，平均封闭时间为9.1 min，平均住院6.5 d，术后无迟发性穿孔、出血等并发症发生，无病患死亡。结论:使用OTSC封闭医源性肠道穿孔是一种安全、有效的治疗方法。

Objective To evaluate the clinical value of epithelial vessel branch detected by non-magnifying narrow-band imaging ( NM-NBI ) in diagnosis of early esophageal cancer. Methods A retrospective analysis was performed on data of 59 patients, who underwent endoscopy with NM-NBI and iodine staining to screen early esophageal cancer in PLA General Hospital from January 2013 to May 2015. The final diagnosis for all lesions were determined by pathology. The diagnostic accuracy, sensitivity and specificity of NM-NBI and iodine staining for early esophageal cancer were compared. Results The accuracy, sensitivity and specificity of NM-NBI on the epithelial vessel branch in diagnosis of early esophageal cancer were 83. 1％ (49/59), 91. 3％ (21/23) and 77. 8％ (28/36), respectively, and the corresponding statistical values of iodine staining were 55. 9％ ( 33/59) , 95. 7％ ( 22/23) and 30. 6％ ( 11/36), respectively. The accuracy (χ2=1. 45, P=0. 028) and specificity (χ2=21. 4, P=0. 000) of epithelial vessel branch by NM-NBI were significantly higher than those of iodine staining, and there was no significant difference in the sensitivity between the two methods (χ2=22. 3, P=1. 000) . Conclusion The observation of epithelial vessel branch using NM-NBI was useful and reliable in diagnosis of early esophageal cancer with high accuracy and specificity, and can be possible for application in the clinic.

A 35-year-old man who had experienced substernal pain for 3 years and dysphagia for 6 months was admitted to our hospital. Laboratory data were negative for the autoantibodies and T-SPOT.TB test. A chest computed tomography scan showed thickening of the esophageal wall. Colonoscopy indicated multiple ulcers in the terminal ileum and ileocecal valve ([Fig. 1]). Pathology indicated moderate active chronic colitis with erosion and crypt abscess ([Fig. 2]). Gastroscopy demonstrated scarring changes and severely ulcerated lesions of the esophagus ([Fig. 3]). The pathology revealed only granulation tissue ([Fig. 4]). The esophageal ulcers were longitudinal with annular stenosis. Ultrasonic gastroscopy indicated that the lesions involved the submucosa and muscular layer. Therefore, the patient was diagnosed as having Crohn’s disease (esophagus involved, stenosis type, active, moderate).

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited intestinal polyposis syndrome accounting for about 1% of colorectal cancers (CRC). Despite increasing researches on the molecular pathogenesis of CRC, we are still unclear about metabolic pathways and alterations probably involved in the development of CRC. To obtain new insights into the mechanisms underlying APC mutation and to elucidate the mechanisms of CRC development, we performed to identify the potential metabolites in FAP based on metabolomic strategy. Serum metabolites from FAP patients (n = 30) and healthy individuals (n = 34) were detected and qualified using Ultra Performance Liquid Chromatography and Tandem Mass Spectrometry (UPLC- MS/MS). 118 metabolites were identified with statistical tests of orthogonal partial least-squares-discriminant analysis (OPLS-DA), with the conditions of variable importance in projection (VIP) >1, p < 0.05 using the Mann-Whitney U test, and fold change (FC) ≥2 or ≤0.5. OPLS-DA model was useful for distinguishing FAP patients from healthy controls. Unique metabolic signatures were pooled in FAP patients covering tricarboxylic acid (TCA) cycle, amino acids metabolism, vitamin D, fatty acids metabolism, and bile acids (BAs) metabolism. Our results demonstrated that metabolites alterations in FAP can be helpful for further analysis of metabonomics induced by APC mutation, and these alterations might be involved in the progress of intestinal carcinogenesis.