BACKGROUND AND AIMS:Circumferential endoscopic submucosal dissection (C-ESD) is increasingly used for circumferential superficial esophageal squamous cell carcinoma (C-ESCC), although outcome data remain sparse. This study aimed to evaluate the short- and long-term outcomes of C-ESD in patients with C-ESCC. METHODS:Clinical outcomes of patients with C-ESCC undergoing C-ESD at 2 Chinese centers were analyzed. Short-term outcomes included en bloc resection rate, curative resection rate, operation time, and adverse events. Long-term outcomes comprised overall survival (OS), disease-specific survival (DSS), cumulative recurrence rate (CRR), and the efficacy of stricture prevention and management. RESULTS:A final assessment was conducted in 100 patients (100 lesions). The median lesion length was 5.2 cm (IQR, 4.5-6.0). Technical success rates were as follows: en bloc resection, 92.0% (95% CI, 85.0-96.4); R0 resection, 84.0% (95% CI, 75.6-90.5); and curative resection, 81.0% (95% CI, 72.3-88.3). The median procedure duration was 97.5 minutes (IQR, 70.5-138.3). Adverse events included delayed bleeding (3.0%), perforation (1.0%), and strictures (88.0%). With a median follow-up of 47.4 months (IQR, 34.3-65.2), 3- and 5-year OS and DSS were identical at 95.6% (95% CI, 91.4-99.9). Cumulative recurrence increased from 16.2% (3 years) to 19.8% (5 years). Prophylactic measures reduced stricture incidence (80% vs 100%; P = .007) and median number of endoscopic dilation sessions, 3 (IQR, 1-6) vs 4 (IQR, 3-9.8); P = .028. Stricture resolution was achieved in 95.5% of cases. CONCLUSIONS:C-ESD is an effective treatment for C-ESCCs. Although it achieves reliable oncological control with a favorable prognosis, its value is tempered by high stricture rates and a nonnegligible recurrence risk (∼20%). To optimize patient outcomes, advancing stricture prevention and ensuring rigorous long-term management are crucial future directions.

Securing large duodenal defects after endoscopic full-thickness resection (EFTR) is challenging because of anatomic constraints. This case report describes an innovative closure technique using a modified long transparent cap in a 48-year-old man who underwent EFTR for a 2.0 × 2.5-cm duodenal bulb gastrointestinal stromal tumor, resulting in a 1.5 × 2.5-cm full-thickness defect. Titanium clips closure failed. A long ligation device cap (inner diameter 0.9 cm, outer diameter 1.1 cm) was used to suction opposing mucosal edges, enabling precise titanium clip placement under endoscopic guidance. The cap-assisted technique achieved secure defect closure. Margin-negative resection was confirmed, and the patient recovered without adverse events. To our knowledge, we report the first use of a long transparent cap that helped successfully close a large duodenal defect following EFTR, offering a practical alternative in anatomically challenging locations or resource-limited settings.

Gastric cancer is a major global health challenge, associated with high mortality and limited therapeutic options. Ginsenoside Rg3 (Rg3), a bioactive compound derived from ginseng, has been shown to possess significant anticancer properties, particularly through immune modulation. In this study, we explored the therapeutic potential of Ginsenoside Rg3 hydrogel in the treatment of gastric cancer, focusing on its ability to target fibroblast activation protein (FAP), a key mediator of tumor progression. Using reverse molecular docking and gene expression analysis, we identified FAP as a primary molecular target of Rg3. Preclinical evaluations revealed that Rg3 hydrogel effectively inhibited the proliferation and invasion of gastric cancer cells in vitro. Furthermore, the hydrogel promoted immunogenic cell death, resulting in a robust immune response against the tumor. Our findings suggest that Ginsenoside Rg3 hydrogel holds promise as a novel immune-based therapeutic strategy for gastric cancer, offering a potential pathway to improved clinical outcomes and treatment strategies.

Identify risk factors for esophageal stricture persisting despite standard oral steroid prophylaxis after endoscopic submucosal dissection (ESD) for large-area superficial esophageal cancer.Methods: Retrospective analysis of 202 patients undergoing ESD (≥ 2/3 circumferential resection) with postoperative oral steroids. Patients were stratified by stricture occurrence. Univariate and multivariate logistic regression evaluated lesion/ESD-related risk factors. Refractory stricture (RS; requiring ≥ 5 endoscopic dilations) and non-refractory stricture (NRS) groups were compared for endoscopic balloon/bougie dilation (EBD) continuation rates.Results: The overall stricture rate was 35.2% (71/202). Multivariate analysis identified four independent risk factors: longitudinal diameter ≥ 5 cm (OR 3.06, 95%CI 1.38–6.80), circumferential involvement > 4/5 (OR 6.41, 95%CI 2.79–14.67), entire circumferential involvement (OR 54.91, 95%CI 11.02-273.68), and muscular injury (OR 21.89, 95%CI 4.04-118.58). EBD continuing rates at 1 year were 70% (RS) vs.22.9% (NRS); at 3 years, rates decreased to 20% (RS) and 2.1% (NRS). RS showed significantly higher EBD continuation (Chi-square 8.404, P = 0.004).Conclusion: In patients with large superficial esophageal cancers involving ≥ 2/3 circumference who receive oral steroid prophylaxis, circumferential involvement ≥ 4/5 or entire circumferential involvement, longitudinal lesions ≥ 5 cm, and muscular injury independently predict steroid-resistant strictures post-ESD. High-risk patients require cautious ESD planning and novel stricture prevention strategies. RS necessitates prolonged EBD management, reflecting poorer therapeutic response.

BACKGROUND:Single-balloon enteroscopy (SBE) is an established procedure for evaluating small bowel lesions. While its efficacy is well recognized, the incidence of major complications and their associated risk factors in a large population remain unclear. AIM:To investigate the complications and risk factors associated with diagnostic SBE. METHODS:This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024. Data on baseline characteristics, procedural parameters, indications, findings, and major complications were collected and analyzed. RESULTS:A total of 2865 SBE procedures were performed in 1840 patients. The mean age was 51 ± 18 years, and 64.5% were male. The most common indication was obscure gastrointestinal bleeding (57.1%), followed by abdominal pain (30.5%). The major complication rate was 0.4% (7/1840), all of which involved acute intestinal perforation identified during the procedure. Among the perforation cases, 6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding. The perforation sites included the ileum (6/7) and duodenum (1/7). All cases were successfully managed surgically. Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation (P value < 0.001 for both). In subgroup analysis, perforation rates were 2.1% (6/288) in patients with prior abdominal surgery and 1.6% (7/428) with abdominal compression. CONCLUSION:Acute intestinal perforation is a rare but serious complication. Prior abdominal surgery and abdominal compression are important risk factors, and careful patient selection is recommended to minimize complications.

To evaluate the safety and effectiveness of the novel long transparent cap-assisted clip closure technique in closing gastrointestinal defects. A retrospective analysis was performed on clinical data of patients who underwent endoscopic resection for gastric submucosal tumors at the First Affiliated Hospital of Zhengzhou University from January 2020 to November 2023. Patients were categorized into the Long Transparent Cap-Assisted Clip Closure group (LTCCC group) and the Purse-String Suture group (PSS group) based on the method of wound closure after ER. Primary outcomes included closure success rates and closure time, and secondary outcomes covered postoperative hospital stays, occurrence of adverse events, tumor characteristics, and follow-up status. The closure success rate was 100

The esophagogastric junction (EGJ) has a complex anatomy and critical physiological functions, making postoperative quality of life an important consideration in the surgical resection of gastrointestinal stromal tumors at this location (EGJ-GISTs). We conducted a propensity score-matched (1:1) analysis to compare the safety and efficacy of endoscopic resection (ER) and laparoscopic resection (LR) for patients with EGJ-GIST treated at the First Affiliated Hospital of Zhengzhou University, China, from December 2013 to November 2023. We reviewed 176 patients (ER 82; LR 94) with EGJ-GIST, of whom 85 patients with a tumor size of 2-5 cm met the matching criteria (ER 42; LR 43), yielding 20 pairs of patients. ER showed advantages over LR, with a shorter postoperative nil per os time (4.0 days (IQRs, 3.0-5.0) vs. 5.5 days (IQRs, 4.3-7.8), p = 0.005) and postoperative hospitalization time (6.0 days (IQRs, 5.0-6.8) vs. 8.5 days (IQRs, 6.0-11.8, p = 0.002). Long-term adverse events were significantly lower in the ER group (15% vs. 55%, p = 0.005). No recurrence or metastasis was observed in either group during a mean follow-up of 42.3 months. These findings suggest that for 2-5 cm EGJ-GISTs, ER is a safe and effective alternative, offering minimal invasiveness, faster recovery, fewer complications, and improved long-term quality of life.

Gastric cancer (GC), notorious for its poor prognosis, often advances to peritoneal dissemination, a crucial determinant of detrimental outcomes. This study intricately explores the role of the TGFβ-Smad-LIF axis within the tumor microenvironment in propagating peritoneal metastasis, with a specific emphasis on its molecular mechanism in instigating Neutrophil Extracellular Traps (NETs) formation and encouraging GC cellular functions. Through a blend of bioinformatics analyses, utilizing TCGA and GEO databases, and meticulous in vivo and in vitro experiments, LIF was identified as pivotally associated with GC metastasis, notably, enhancing the NETs formation through neutrophil stimulation. Mechanistically, TGF-β was substantiated to elevate LIF expression via the activation of the Smad2/3 complex, culminating in NETs formation and consequently, propelling peritoneal metastasis of GC. This revelation uncovers a novel potential therapeutic target, promising a new avenue in managing GC and mitigating its metastatic propensities.