Clinical data of 210 patients with early colorectal cancer and precancerous lesion treated by endoscopic submucosal dissection (ESD) in the Digestive Endoscopy Center of the Seventh Medical Center of Chinese PLA General Hospital from January 2015 to March 2018 were collected and analyzed retrospectively. Patients were divided into two groups according to the age: the elderly group (≥65 years old, 100 cases) and the non-elderly group (<65 years old, 110 cases). The en bloc resection rate, complete resection rate,and curative resection rate of the elderly group were 92.0% (92/100), 91.0% (91/100) and 89.0% (89/100), respectively. The above indicators of the non-elderly group were 90.9% (100/110) ( P=0.972), 90.0% (99/110) ( P=0.991) and 88.2% (97/110) ( P=1.000), respectively. The incidence of intraoperative perforation in the elderly group was 4.0% (4/100) and in the non-elderly group was 6.4% (7/110) ( P=0.543). Delayed postoperative bleeding rate was 2.0% (2/100) in the elderly group, and 0 (0/110) in the non-elderly group ( P=0.226). ESD is effective and safe in treating early colorectal cancer and precancerous lesion in elderly patients.

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.

目的 探讨新型冠状病毒肺炎(COVID-19)防控期间消化内镜中心感染控制管理与内镜诊疗的安全.方法 在COVID-19疫情防控期间,通过组织与防控培训,包括成立应急防控小组、拟定疫情期间消化内镜诊疗规范及重新布局诊疗区域、疫情培训、岗位调整等,从急诊内镜诊疗前对COVID-19的筛查到诊疗过程中的防控,以及隐匿患者应急处理等方面设定科学合理防护工作规范及感染防控方案.对2020年2月在解放军总医院第七医学中心消化内镜中心行急诊内镜检查患者的COVID-19疫情防控情况进行评估分析.结果 2020年2月1日至2020年2月28日,共行急诊内镜检查及治疗患者24例,男:女为19∶5,中位年龄61.5岁(12～89岁);行胃镜检查10例(41.67％),行结肠镜检查5例(20.83％),行ERCP 9例(37.5％).其中6例患者CT显示肺部感染.在此期间,所有内镜操作间空气消毒达标.对24例患者及家属进行随访发现均未感染COVID-19.结论 适应防控形势发展趋势,拟定特殊时期防控诊疗规范,做法科学性强,措施有效可行.

Objective To evaluate the clinical efficacy of pre-procedure simethicone on detection of pharynx by upper gastrointestinal endoscopy. Methods A total of 100 patients with esophageal squamous cell carcinomas ( ESCCs) were enrolled in this prospective controlled trial and randomly assigned into two groups. The study group was given gargle with 5 mL simethicone plus 5 mL water combined with conventional procedure before gastroscopy. The control group was prepared according to the conventional procedure. The age, gender, tumor stage, lesion size, doctor＇s satisfaction and examination time between two groups were analyzed. Results The basic conditions between the two groups, including age, gender, and tumor stage were not significantly different (all P＞0. 05). The detection rate of superficial lesion in pharynx was higher in the study group than that in the control group, with no significant difference [8. 16%(4/49) VS 2. 04%( 1/49), P＝0. 362]. The median time of pharyngeal observation in the study group was less than that in the control group (21. 7 s VS 33. 9 s, P＝0. 000). The doctor was more satisfied in the study group than the control group (P＝0. 001). Conclusion Pre-procedure with simethicone improves the endoscopic visibility and detection rate of superficial squamous cell carcinoma with less observation time.