BACKGROUND Gastric cancer (GC) is a significant health problem worldwide, and early detection and accurate diagnosis are crucial for improving patient outcomes. Crawling-type gastric adenocarcinoma is a rare subtype of GC that has unique histopathological and clinical characteristics, and its diagnosis and management can be challenging. This pathological type of GC is also rare. CASE SUMMARY Here, we report the case of a patient who underwent ordinary endoscopy, narrow-band imaging, and endoscopic ultrasonography intending to determine the extent of tumor invasion and upper abdominal enhanced computed tomography and whether there was tumor metastasis. Then, endoscopic submucosal dissection was performed. After pathological and immunohistochemical examination, the pathological diagnosis was crawling-type gastric adenocarcinoma. This is a very rare and special pathological type of tumor. This case highlights the importance of using advanced endoscopic techniques and pathological examination in diagnosing and managing gastric crawling-type adenocarcinoma. Moreover, the findings underscore the need for continued research and clinical experience in this rare subtype of GC to improve patient outcomes. CONCLUSION The “crawling-type” GC is a rare and specific tumor pathology. It is difficult to identify and diagnose gliomas via endoscopy. The tumor is ill-defined, with a flat appearance and indistinct borders due to the lack of contrast against the background mucosa. Pathology revealed that the tumor cells were hand-like, so the patient has diagnosed with “crawling-type” gastric adenocarcinoma.

This letter to the editor discusses the publication on gut microbiome supplementation as therapy for metabolic syndrome. Gut microbiome dysbiosis disrupts intestinal bacterial homeostasis and is related to chronic inflammation, insulin resistance, cardiovascular diseases, type 2 diabetes mellitus, and obesity. Previous research has found that increasing the abundance of beneficial microbiota in the gut modulates metabolic syndrome by reducing chronic inflammation and insulin resistance. Prebiotics, probiotics, synbiotics, and postbiotics are often used as supplements to increase the number of beneficial microbes and thus the production of short-chain fatty acids, which have positive effects on the gut microbiome and metabolic syndrome. In this review article, the author summarizes the available supplements to increase the abundance of beneficial gut microbiota and reduce the abundance of harmful microbiota in patients with metabolic disorders. Our group is also researching the role of the gut microbiota in chronic liver disease. This article will be of great help to our research. At the end of the letter, the mechanism of the gut microbiota in chronic liver disease is discussed.

Gastrointestinal stromal tumour (GIST) is a malignant tumour of the gastrointestinal lobe tissue, which mostly occurs in the gastrointestinal tract. Clinical manifestations can range from being benign to malignant. It mainly occurs in the gastric and small intestine. It may also develop in the colon, oesophagus, and bowel membranes, or outside the gastrointestinal tract and intestines. The pathological diagnosis of GIST depends on morphological measurements and immunohistochemistry. We report an interesting case in which the patient’s gastroscopy indicated gastric malignant tumours, and the results of the contrast-enhanced computed tomography (CT) of the upper abdomen showed malignant stomach tumour accompanied by liver metastasis. After the patient knew about this diagnosis, she wanted to give up treatment. Finally, the gastric biopsy suggested positive CD34, CD117, DOG1, and Ki-67, which supported the diagnosis of GIST. We hope that, through this case, we could improve clinicians’ understanding of GIST and improve its diagnosis and treatment.

Immunoglobulin G4-related disease (IgG4-RD) is a fibrous inflammatory process related to immunomodulation. The involvement of the pancreato-biliary tract, retroperitoneum/aorta, head and neck, and salivary glands are the most frequently observed disease phenotypes, differing in their epidemiological features, serological findings, and prognostic outcomes. IgG4-RD was combined with oesophageal ulcers, and the patients were infected with cytomegalovirus at the time of the examination. This constituted a huge challenge in the diagnosis and treatment of oesophageal ulcers. We report the case of a 53-year-old male who experienced nausea, vomiting, and anaemia recurrently for many years. According to his medical records, an upper gastrointestinal endoscopy revealed an oesophageal ulcer, and he had had numerous hospital visits for anaemia but with no definitive diagnosis, and he had responded poorly to therapy. However, with persistent symptoms, he came to our hospital and, according to the results of the upper gastrointestinal endoscopy, a serum IgG4 test, and histopathological and immunohistochemical staining, he was finally diagnosed with IgG4-related oesophageal disease combined with a cytomegalovirus infection. We hope that through this case, we can learn more about IgG4-RD and, at the same time, give clinicians a better understanding of IgG4-RD combined with oesophageal ulceration, a new understanding of cytomegalovirus infections, and improved clinical knowledge.

目的 总结分析结直肠息肉癌变的临床、内镜及组织学特点.方法 2017年1月—2019年12月共3934例患者在上海市松江区中心医院经内镜诊断为结直肠息肉并行内镜下切除治疗,其中117例术后病理证实存在息肉癌变,对其临床资料进行回顾性分析.结果 117例结直肠息肉癌变患者中男性71例,女性46例;年龄29～86岁,平均(62.7±10.9)岁;行内镜下黏膜剥离术(ESD)16例,内镜下黏膜切除术(EMR)101例;术后大体病理类型为高级别上皮内瘤变89例,腺癌28例;所有病灶均顺利切除,无大出血、感染及穿孔等严重并发症;术后追加手术13例,随访时间为3～43个月,平均(23.9±10.5)个月,术后出现膀胱癌1例,肺癌1例,并已行手术治疗,目前患者全部存活.单因素分析结果显示:术前病理类型、息肉部位、大小、大体形态均与结直肠息肉癌变相关(P<0.05);而性别,年龄与息肉癌变无明显相关(P>0.05).结论 结直肠息肉癌变与息肉部位、大小、大体形态和病理类型相关,其临床和病理特点有迹可循,及早干预癌变结直肠息肉有利于改善患者预后.