Abstract Background: Patients with early gastric cancer whose pathological evaluation was eCuraC-2 after ESD had a high risk of lymph node metastasis and were recommended for further surgery. But previous studies showed that only 5.7-8.2% of patients with non-curative resection actually have lymph node metastasis. For elderly patients, whether additional surgery is beneficial needs to be further explored due to their poor physical fitness. Objectives: To compare the long-term outcome of additional surgery and follow-up in elderly patients with early gastric cancer and a pathological evaluation of eCuraC-2 after ESD, and analyze the factors affecting their survival. Design: A retrospective cohort study. Methods: The data of the patients at our center from April 2014 to September 2020 were retrospectively analyzed. The patients were divided into the follow-up group and additional surgery group. Propensity score matching was used to control for confounding factors between the two groups. The prognosis of the two groups was compared and the factors affecting survival were analyzed. Results: The follow-up group was older on average and had a higher incidence of ulcers, larger tumor diameters, and less involvement of SM2/SM3 compared to the additional surgery group. After propensity matching, there was no significant difference in the long-term outcomes between the two groups. Univariate and multivariate analysis revealed that the CCI (Charlson Comorbidity Index), PNI (prognostic nutritional index), and lymphovascular invasion were independent factors affecting OS (overall survival) and lymphovascular invasion was an independent factor affecting DSS (disease-specific survival) in elderly patients with early gastric cancer who underwent ESD and had a pathological evaluation of eCuraC-2. Conclusion: Elderly patients with early gastric cancer and a pathological evaluation of eCuraC-2 after ESD can be safely monitored with caution. Additionally, CCI, PNI, and lymphovascular invasion can be used to predict their long-term outcomes.

A 53 years old man, with a history of autoimmune thyroiditis, developed acid reflux without obvious cause and was found to have hypergastrinemia 2 years ago. Gastroscopy showed a polypoid mucosal lesion in gastric body, which was treated with argon therapy (Fig. 1a,b). Biopsy revealed the presence of a WHO grade 1 neuroendocrine tumour (G1 NET) with increased serum gastrin level (320.30 pg/mL) and a weakly positive IgG anti-parietal cell antibody. The lesion had dilated blood vessels by NBI (Fig. 1c), and mini-probe endosonography showed thickened fundal gastric mucosa with a 1.9 × 1.3 mm hypoechoic lesion in the muscularis mucosa (Fig. 1d). Furthermore, two round-like hypoechoic masses can be seen in the body of the pancreas (Fig. 1e). Somatostatin receptor scintigraphy showed high signal uptak in the antrum, pancreatic lesions, duodenum, and thyroid (Fig. 1f). Whole exome sequencing found a pathogenic variant of multiple endocrine neoplasia type 1 (MEN1) gene, which is located on Chromosome 11(Fig. 2). The patient's daughter was asked to undergo genetic testing, and MEN1 gene mutation was not found. According to the classification of gastric neuroendocrine tumors, type 2 gastric neuroendocrine tumor is associated with MEN1. Serum gastrin levels in type 2 NETs are significantly elevated (often higher than 1000 pg/mL), and endoscopy often finds ulcer formation, manifesting as hypertrophic gastritis. The gastroscopy of our patient did not find peptic ulcer or thickening of gastric folds, and gastrin was not high enough to suspect gastrinoma, combined with the positive anti-parietal cell antibody confirmed the existence of autoimmune gastritis, which can be diagnosed as type 1 g-NET. MEN1; NM_130799.2:c.851C > A(p.Ala284Glu) heterozygous variant was detected by whole exome sequencing, and the pathogenicity of this variant has been reported. According to the ACMG guideline, this variant was identified as a suspected pathogenic variant, PS4_Supporting+PM1 + PM2 + PM6 + PP2 + PP3. In summary, our patient was considered to have type 1 gastric neuroendocrine tumor with MEN-1, which is extremely rare. MEN1 is inherited in an autosomal dominant fashion. Our patient has no family history of MEN1, and his daughter also had no MEN1 gene mutation. Therefore, the diagnosis cannot be denied just because there is no family history. For patients who do not meet the diagnostic criteria of MEN1 but are accompanied by atypical endocrine tumors, it is recommended to conduct genetic analysis for early diagnosis, early treatment, and close follow-up of confirmed patients.

Introduction: The aim of this study was to investigate outcomes of patients with duodenal Brunner's gland adenomas (BGAs) that were treated endoscopically. Methods: We identified 71 consecutive patients treated at our center with endoscopic submucosal dissection (ESD) for their duodenal tumors diagnosed pathologically as BGAs over the period between January 1, 2011 and December 31, 2021. We retrospectively analyzed our experience and short- and long-term outcomes of ESD therapy on patients with BGAs. Results: Among 71 BGA patients with an average age of 57 +/- 11.7 years (range: 30-82), 48 (67.6%) were male and 23 (32.4%) were female. The accuracy of preoperative diagnosis with endoscopic ultrasonography was 44.0% (22/50). The H. pylori infection was found in 29 patients (29/71, 40.8%). The median size of BGAs was 1.5 cm (interquartile range [IQR] 0.8-2.7 cm). The most common location was the duodenum bulb (50/71, 64.8%). For the ESD procedure, the median operation time was 15.0 min (IQR 9.5-25.5 min). The en bloc and the complete resection rates were 97.2% and 92.3%, respectively. ESD-related mild acute obstructive pancreatitis was present in 2 patients (2/4, 50%) with BGAs located in the ampulla region. During the follow-up period, 1 patient with a positive peripheral margin experienced tumor recurrence 2 years after the initial ESD. There was no disease-related death for the cohort. Conclusion: ESD was an effective and safe therapeutic option for BGA patients with excellent outcomes. Long-term follow-up is needed. (c) 2023 S. Karger AG, Basel

目的 探讨胃神经内分泌肿瘤G1/G2 患者经内镜切除与外科手术的疗效及预后,寻找肿瘤复发的危险因素.方法 收集我院 2006 年 11 月至 2022 年 5 月确诊为胃神经内分泌肿瘤 G1/G2 的病例,分析其临床病理特征及术后疗效,并用 Cox回归分析肿瘤复发的危险因素.结果 92 例胃神经内分泌肿瘤患者中 G1 65 例,G2 27 例.70 例行内镜切除,22 例行外科手术,两组肿瘤直径均较小,均以胃体多见,浸润深度多局限于黏膜层及黏膜下层.内镜切除组住院天数、住院费用均显著少于外科手术组,且术中出血发生率显著低于外科手术组(P 均<0.001).内镜切除组 1、3 年疾病复发率分别为 7.1%、30.0%;外科手术组分别为 4.5%、13.6%.单因素分析显示,切缘、肿瘤分型与 G1/G2 肿瘤复发相关(P<0.05),而年龄、性别、肿瘤部位、浸润深度、病理分级、手术方式、临床症状对肿瘤复发无影响(P>0.05).多因素 Cox回归显示,肿瘤分型、切缘是影响肿瘤复发的独立危险因素.结论 对于胃神经内分泌肿瘤 G1/G2 患者,内镜切除和外科手术远期疗效未见明显差异,但内镜切除创伤小、住院时间短、住院花费少,更应放在首位考虑.

Objective:To compare the histopathological features and treatment efficacy of different methods for metachronous early gastric cancer (MEGC) in the remnant stomach.Methods:A total of 66 patients [38 endoscopic submucosal dissection (ESD) and 28 gastrectomy] with MEGC in the remnant stomach from January 2014 to December 2020 in Drum Tower Hospital were divided into the ESD group and the gastrectomy group. The baseline characteristics, histopathological features, treatment efficacy, and cost differences of the two groups were analyzed.Results:The MEGC in the remnant stomach mostly occurred in elderly male patients, with the mean age of 69.7±8.5 years. The mean interval of the occurrence of MEGC in the remnant stomach was 6 years. As for the tumor location, the gastric body (31.6%) was the main location in the ESD group and gastric cardia (53.6%) in the gastrectomy group with significant difference ( χ2=11.07, P=0.026). The mean operation time, hospital stay, postoperative fasting time, and total treatment cost were 80.0 min, 6.0 d, 1.5 d, ￥19 436 in the ESD group and 215.0 min, 19.0 d, 6.5 d, and ￥68 665 in the gastrectomy group, respectively, with significant differences between the two groups ( P<0.05). The overall survival rate during follow-up was 76.3% in the ESD group and 71.4% in the gastrectomy group with no significant difference between the two groups ( χ2=0.736, P=0.778). In terms of postoperative complications, the incidences of bleeding and infection were 7.9% and 5.3% in the ESD group, and those of obstruction and infection were both 14.3% in the gastrectomy group. There was significant difference in the incidences of postoperative obstruction between the two groups ( P<0.05). Conclusion:ESD is safe and effective for MEGC in the remnant stomach and is better than gastrectomy in terms of the treatment cost and operation time, but the long-term efficacy still needs to be validated by large-scale prospective studies.

Background: Readmission shortly after discharge is indicative of an increased disease severity for patients with ulcerative colitis (UC) and ineffectiveness to medical therapy, which may contribute to a dismal prognosis. Objectives: This study aimed to explore prognostic variables with a nomogram to predict unplanned UC-related readmission within 1 year after discharge. Design: A retrospective cohort study. Methods: Electronic medical records of all UC patients treated at our center between 1 January 2014 and 31 June 2021 were reviewed. A comprehensive analysis of various characteristics, such as demographics, comorbidities, medical history, follow-up appointments, admission endoscopy, histopathologic features, etc., was used to determine the primary end point, which was unplanned UC-related calendar year readmission. Results: We found that the unplanned UC-related readmission rate within 1 year was 20.8%. In multivariable cox analysis, the predictors of the Elixhauser comorbidity index [Hazard ratio (HR): 3.50, 95% confidence interval (CI): 1.93–6.37], regular follow-up (HR: 0.29, 95% CI: 0.16–0.53), any history of corticosteroid use (HR: 3.38, 95% CI: 1.83–6.27), seral level of C-reactive protein (HR: 1.01, 95% CI: 1.00–1.02), and the UC endoscopic index of severity (HR: 1.29, 95% CI: 1.05–1.57) independently predicted calendar year readmission after discharge. The established nomogram had a consistently high accuracy in predicting calendar year readmission in the training cohort, with a concordance index of 0.784, 0.825, and 0.837 at 13, 26, and 52 weeks, respectively, which was validated in both the internal and external validation cohorts. Therefore, UC patients were divided into clinically low-, high-, and extremely high-risk groups for readmission, based on the calculated score of 272.5 and 378. Conclusion: The established nomogram showed good discrimination and calibration powers in predicting calendar year readmission in high-risk UC patients, who may need intensive treatment and regular outpatient visits.

Background and Aims: The objective of this study was to compare the safety and efficacy of endoscopic resection with surgical resection in the treatment of intermediate-risk gastric gastrointestinal stromal tumors (GISTs) and to further evaluate whether imatinib adjuvant treatment is necessary for resected intermediate-risk gastric GIST by ER. Methods: We retrospectively studied 128 cases for intermediate-risk gastric GISTs that were distributed in endoscopic (n = 33) and surgical groups (n = 95) at our center between December 2009 to July 2020. We statistically compared the clinical features, pathological reports, perioperative data, and long-term follow-up outcomes. Results: Compared with the surgery group, the endoscopy group was associated with smaller tumor size (2.4 ± 1.0 vs. 6.0 ± 1.7 cm, p < 0.001), shorter operating time (67.3 ± 36.5 vs. 145.9 ± 74.8 min, p < 0.001), fewer incidence of short-term postoperative complications (3% vs. 32.6%, p = 0.002). Shorter postoperative hospital days (4.5 ± 1.4 vs. 8.5 ± 2.4 days, p < 0.001), shorter gastric functional recovery time (p < 0.001), and a lower overall medical cost of hospitalization (p < 0.001) was detected in the endoscopy group. During the median 44.5 months follow-up period, there were no cases of recurrence, metastasis, and death in the endoscopy group. Among 128 patients, 68 accepted adjuvant therapy with imatinib after resection. It was observed that the OS of the adjuvant treatment group with imatinib was lower than that of the group without imatinib (p = 0.033). Conclusion: Endoscopic resection for intermediate-risk gastric GIST is a feasible and safe method, and there is no significant benefit for patients with intermediate-risk gastric GIST to accept imatinib adjuvant treatment after ER.

目的 探讨老年中危胃间质瘤病人的临床病理特征及长期预后.方法 回顾性分析2009年12月至2020年7月鼓楼医院收治的62例老年中危胃间质瘤病人的临床病理特征及长期预后.结果 62例老年中危胃间质瘤病人平均年龄为(67.7±5.3)岁.临床表现主要为体检发现24例(38.7％)及腹部不适30例(48.4％).病变部位以胃上1/3(46.8％)及胃中1/3(46.8％)多见.肿瘤平均直径为(5.4±2.3)cm,核分裂像≤5/50高倍镜视野(HPF)者40例(64.5％),>5/50HPF 22例(35.5％).49例(79％)病人采用外科手术治疗,13例(21％)病人采用内镜手术.外科手术组及内镜手术组术后予伊马替尼治疗的病人分别为23例和3例.中位随访时间为53个月,外科手术组出现2例非疾病特异性死亡病例.62例患者均未出现复发及转移,总体生存率为96.3％,疾病特异性生存率为100％.结论 老年中危胃间质瘤病人无论术后是否使用伊马替尼辅助治疗,预后都较好.内镜治疗老年病人的中危胃间质瘤可能是一种安全、有效的方式.