OBJECTIVE:To explore the application value of white light image (WLI), endoscopic ultrasonography (EUS) and magnifying endoscopy with narrow band imaging (ME-NBI) in the endoscopic treatment of early gastric cancer (EGC), and to provide basis for decision-making in clinical diagnosis and treatment.METHODS:The clinicopathological data of EGC patients who underwent endoscopic submucosal dissection (ESD) at West China Hospital, Sichuan University between December 2013 and October 2020 were included. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EGC invasive depth were compared between WLI and EUS. The role of ME-NBI in predicting the differentiation types of EGC was analyzed.RESULTS:A total of 280 patients (291 lesions) were enrolled in the study. Among them, 199 patients (207 lesions) received EUS and 160 patients (168 lesions) received ME-NBI. The overall accuracy of WLI in diagnosing the invasive depth of EGC was 87.0%, significantly higher than that of EUS (46.4%, P<0.001). When WLI was combined with EUS, the diagnostic accuracy (87.4%) was not significantly improved. The overall accuracy of determining the differentiation degree of EGC with ME-NBI was 92.3% (155/168), and the accuracy of determining undifferentiated EGC with ME-NBI was significantly lower than that of differentiated EGC (41.2% vs. 98.0%, P<0.001).CONCLUSION:In the evaluation of indications for endoscopic treatment of EGC, WLI showed better performance in predicting the invasive depth of EGC, while EUS demonstrated limited value. ME-NBI showed better accuracy for predicting the differentiation degree of most EGC, especially for differentiated EGC.

Su, Xing MM1; Luo, Binyang MM1; Li, Yu BN1; Wu, Junchao MD1; Yang, Jinlin MD1; Deng, Kai MD1 Author Information

This study aims to compare the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) in the treatment of large area rectal laterally spreading tumors (LST). The clinical data, operation procedures and pathology of rectal LST treated with ESD and ESTD from August 2011 to February 2019 in the Center of Digestive Endoscopy, West China Hospital of Sichuan University were retrospectively analyzed. The rates of en bloc, curative resection, complications and recurrence of tumors were compared and analyzed, then we evaluated the safety and effectiveness of ESD and ESTD in the treatment of large area LSTs. There were 122 patients with rectal LST in ESD and ESTD groups. The lesion area was 12.6±14.1 cm2, 24.5±19.9 cm2, respectively, p < 0.001.;the en bloc resection rate was 88.3% ,97.8%,respectively,p=0.066; the dissection speed was 23.3±18.3 mm2/min, 27.1±13.2 mm2/min, respectively, p=0.239; the curative resection rate was 98.7%, 86.7%, respectively,p=0.006; There were 7 cases of non-curative resection in the two groups after operation, of which 6 cases underwent additional surgery. Postoperative complications were mainly fever and hematochezia without endoscopic intervention, with fewer serious complications. The overall canceration rate of LST was 17.3%. The follow-up time of the two groups was 16.4 ±16.0 months and 23.20±16.3 months, respectively. Only one case recurred in ESD group. In the analysis of large area lesions(>3cm), there were 90 patients with large area LST, 50 patients in ESD group and 40 patients in ESTD group .The lesion areas of the two groups was 17.4±15.5 cm2 , 26.0±19.8cm2, respectively, p=0.025;the en bloc resection rate was 85%, 97.5%, respectively, p=0.034; the dissection speed was 28.4±20.3 mm2/min, 28.3 ±12.9 mm2/min, respectively, p=0.991; the curative resection rate was 92.5%, 100%, respectively, p=0.084. Both ESD and ESTD can safely and effectively resect rectal LST, which was not affected by the size of lesions. There was no significant difference in the dissection speed and the curative resection rate. When large area LST was resected, the rate of en bloc resection of ESTD was higher than that of ESD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

In early gastric cancer(EGC) with little or no risk lymph nodes metastases(LNM), endoscopic submucosal dissection(ESD) has become the standard treatment.Recent advances in mucin immunohistochemistry have shown that differentiated type tumors may be subclassifified into three distinct groups based on their mucin phenotype: foveolar, intestinal andcombined.

Advancements in endoscopic treatment have enabled early esophageal cancers with low risk of lymph node metastasis to be treated by endoscopic submucosal dissection(ESD). Many factors associated with the risk of lymph node metastasis have been reported, and the depth of tumor invasion is considered a key factor. Therefore, invasion depth prediction of esophageal squamous cell carcinoma is crucial for choosing the therapeutic strategy. This study aimed to compare the efficacy between Inoue's classification and Japan esophageal scociety (JES) classification for evaluating the invasion depth of esophageal squamous cell carcinoma.

Gastritis cystica profunda(GCP),also known as gastritis cystica polypsa in the past,is a rare gastric submucosal lesion.It is caused by the destruction of gastric mucosa caused by various reasons.The glands of gastric mucosa grow below the muscularis mucosa and form cystic dilatation.In the past,the disease was considered as a benign disease,but now more and more studies reveal that the GCP is a precancerous disease with the potential of malignant progress.In recent years,with the rapid development of endoscopy technology and the continuous improvement of pathological diagnosis,great progress has been made in the understanding,diagnosis and treatment of GCP.This article reviews the etiology,pathogenesis,nature,diagnosis,differential diagnosis,treatment and prognosis of cystic gastritis,so as to provide a reference for clinical rational diagnosis and treatment of the disease.

Endoscopic submucosal tunnel dissection (ESTD) is an optimization and improvement based on traditional endoscopic submucosal dissection (ESD), and its clinical application is one of the research hotspots in recent years. ESTD technique has been used successfully in the resection of large size of esophageal neoplastic lesions, but the application of ESTD in the treatment of colorectal neoplastic lesions is just beginning, and its technical advantages are still uncertain compared with ESD. The aim of this study was to compare the efficacy and safety of ESTD and ESD in the treatment of laterally spreading tumors (LST).

OBJECTIVE To explore endoscopic characteristics and pathological changes of esophageal low-grade intraepithelial neoplasm (LGIN) as well as its risk factors. METHODS A total of 201 LGIN lesions from 169 cases were included from January 2009 to August 2017. The endoscopic characteristics and pathological changes were analysis. Logistic regression analysis was used to analyze the risk factors of LGIN. The endoscopic morphologic findings of esophageal mucosa lesions and the pathological findings of simple inflammatory lesions were enrolled as controls. RESULTS LGIN occurred more common in elderly patients, the ratio of male to female was 2.5∶1. The maximum transverse and the maximum longitudinal diameter (MLD) were (0.9±0.8) cm,(1.4±1.3) cm, respectively. The most common location of lesion was in the middle segment of esophagus (52.2%). The morphological types of lesions were dominantly 0-Ⅱb (45.8%) and 0-Ⅱa (31.8%). There were 42 LGIN lesions with reflux esophagitis. Multiple dysplastic lesions accounted for 57.4%. After (10.3±12.1) months follow-up, 58.2% lesions were pathological reversal with 24.9% (50/201) of the lesion completely disappeared, and 28.9% lesions had no pathological changes, but 12.9% (26/201) lesions progressed to high-grade intraepithelial neoplasia and invasive cancer. Multivariate analysis indicated that age (compared to <45 years old) and longitudinal diameter of the lesion (compared to ≤0.5 cm) were independent risk factors for LGIN. The risk of esophageal LGIN in lesions with MLD > 0.5-1 cm was 1.96 times higher than that in lesions with MLD ≤ 0.5 cm. CONCLUSIONS The MLD of esophageal mucosal lesions >0.5 cm and age >45 years old may increase the possibility of esophageal LGIN. Close follow-up is required for LGIN lesions with MLD>1 cm.