Chunyan Peng

The diagnostic value of EUS in pancreatic cystic neoplasms compared with CT and MRI

Background and Objectives: Pancreatic cystic neoplasms (PCNs) are being increasingly identified. Recent reports have described the utility of endoscopic ultrasound (EUS) in the characterization of PCNs. This study presents the diagnostic value of EUS in PCNs. Materials and Methods: A total of 108 patients (78 women and 30 men; average age, 50 years) who were confirmed pathologically to have PCNs were analyzed retrospectively. We analyzed the clinical characteristics of 108 patients and compared the diagnostic performance of computed tomography (CT), magnetic resonance imaging (MRI), and EUS with or without fine-needle aspiration (FNA). Results: EUS with or without FNA significantly increased the accuracy for diagnosing PCNs compared with CT (P = 0.002) and MRI (P = 0.006). According to the tumor size, the further analysis of these impacts was provided. EUS was superior to CT in the characterization of PCNs in small (< 3 cm) lesions (P = 0.003), similarly superior to MRI in large (>3 cm) lesions (P = 0.030). Furthermore, EUS is valuable for precisely characterizing internal structures, for example, septa (P = 0.004, compared with CT; P = 0.033, compared with MRI) and mural nodules (P = 0.028, compared with CT). Conclusions: In our study, EUS with or without FNA is the ideal tool for providing detailed imaging of PCNs and performed better than MRI and CT.

Downregulation of FOXP3 inhibits invasion and immune escape in cholangiocarcinoma

FOXP3 is known as a master control of regulatory T cells with recently studies indicating its expression in several tumor cells. In order to study the precise role of FOXP3 in cholangiocarcinoma, FOXP3 was knocked down in cholangiocarcinoma cell lines. Down regulation of FOXP3 inhibits tumor cell invasion by reducing the quantity of MMP-9 and MMP-2. With FOXP3 knocking down, IL-10 and TGF-β1 secreted by cancer cells diminishes and the cell survival of T cells is significant up-regulation. These results suggest that FOXP3 plays an important role in tumor malignant phenotype, especially the invasion and immune escape.

Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms

Background Little is known about the outcomes of endoscopic submucosal dissection in elderly patients with superficial squamous esophageal neoplasms. Objective To assess the efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasms in elderly patients (≥65 years) compared with non-elderly patients. Methods All patients with superficial squamous esophageal neoplasms receiving endoscopic submucosal dissection were retrospectively analyzed. Among them, 130 were aged 65 or older (group A), and 201 were aged younger than 65 years (group B). Therapeutic efficacy, adverse events, and follow-up data were evaluated. Results Group A had a higher prevalence of concomitant diseases than group B (52.3% vs. 14.9%, respectively). R0 resection rate was 82.3% in group A and 84.6 % in group B (P = 0.717). The curative resection rate was 80.8% in group A and 83.6% in group B (P = 0.653). The rate of procedure-related non-cardiopulmonary adverse events was 20.8% in group A and 16.9% in group B (P = 0.377). The incidence of cardiopulmonary adverse events during or after the procedure was 6.2% in group A and 2.5% in group B (P = 0.094). No procedure-related mortality was reported in either group. Conclusion Endoscopic submucosal dissection is effective and safe for treating superficial squamous esophageal neoplasms in elderly patients.

Different scoring systems in predicting survival in Chinese patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic shunt.

Background Transjugular intrahepatic portosystemic shunt (TIPS) is an established minimal-invasive procedure to treat complications of portal hypertension, and several scoring systems have been used to help choose suitable patients. However, its accuracy remains controversial. Aim To compare the performance of the Child–Turcotte–Pugh (CTP) classification system, model for end-stage liver disease (MELD) score, Emory score, Bonn TIPS early mortality (BOTEM) score, and serum bilirubin and platelet count (SB/PLT model) in predicting survival in Chinese patients with liver cirrhosis undergoing TIPS. Patients and methods The clinical data of patients undergoing TIPS in our department were retrospectively analyzed to compare the five scoring systems on the basis of survival after TIPS. Results A cohort of 159 patients was analyzed. The survival curves showed a statistical significance between classification B and C of CTP (&khgr;2=9.451, P=0.002), between MELD less than 10 and MELD at least 10 (&khgr;2=10.099, P=0.001), and between low-risk and moderate-risk groups of the Emory score (&khgr;2=4.656, P=0.031), indicating a better discriminatory ability. By ROC curves and a logistic regression model, the MELD score and the CTP system had better power to predict 3-, 12-, and 24-month survival. The MELD score and the CTP classification system had smaller values of −2 Ln(L), Akaike Information criterion, and Schwarz–Bayesian criterion, respectively. Conclusion The MELD score and the CTP classification system provide better prognostic stratification for a cohort of Chinese patients with advanced cirrhosis undergoing TIPS. However, the MELD score is not significantly superior to the CTP system.

Limited stage small cell carcinoma of the gastrointestinal tract: a clinicopathologic and prognostic analysis of 27 cases

Small cell carcinoma of the gastrointestinal tract is a rare and aggressive neuroendocrine tumor. This study aims to analyze the clinical characteristics and potential prognostic factors for patients with limited stage small cell carcinoma of the gastrointestinal tract. The records of 27 patients with limited stage small cell carcinoma of the gastrointestinal tract, who all received surgery with lymphadenectomy, were retrieved and analyzed retrospectively. The median age of patients was 60 years old (range 38–79). The primary locations of tumor were the esophagus (74.1%) and stomach (14.8%). The rate of preoperative accurate diagnosis (16.7%) was low for small cell carcinoma of the esophagus and stomach. 40.7% of all the patients had regional lymph node metastases. Five patients underwent surgery alone, and the other 22 were treated with surgery + postoperative chemotherapy. All patients had disease progression or recurrence. The overall median survival time was 10 months and the 1-year survival rate was 37.0%. Patients who received postoperative chemotherapy had a median survival time of 12 months, which was superior to the 5-month survival of for those who only had surgery (P<0.0001). TNM stage (P=0.02) and postoperative chemotherapy (P<0.0001) were considered as two prognostic factors in uni-variate analysis. Postoperative chemotherapy was a significant independent prognostic factor in multivariate analysis (P=0.01). The prognosis for patients with limited stage small cell carcinoma of the gastrointestinal tract remains dismal, however, postoperative chemotherapy may have the potential to improve the outcome for these patients.

Differential analysis of lymph node metastasis in histological mixed-type early gastric carcinoma in the mucosa and submucosa

AIM To investigate the relationship between histological mixed-type of early gastric cancer (EGC) in the mucosa and submucosa and lymph node metastasis (LNM). METHODS This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated (pure D), pure undifferentiated (pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. Furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC. RESULTS Of the 298 patients, 165 (55.4%) had mucosa-confined EGC and 133 (44.6%) had submucosa-invasive EGC. Only 13 (7.9%) cases of mucosa-confined EGC and 30 (22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion (OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type (OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixed-type (OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixed-type group (P = 0.012) and pure U group (P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group (P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixed-type (P = 0.012) and pure U group (P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group (P = 0.375). Multivariate logistic analysis showed that only female sex (OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion (OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC (P = 0.106). CONCLUSION For mucosal EGC, histological mixed-type is not an independent risk factor for LNM and could be managed in the same way as the undifferentiated type.

Modified prophylactic 5-fr pancreatic duct stent enhances the rate of spontaneous dislodgement: A multicenter randomized controlled trial

Background and objectives Prophylactic pancreatic duct stent placement effectively reduces post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients, but the optimal stent remains unclear. We modified a 5-Fr, 3 cm pancreatic stent by removing the flange on the pancreatic side and compared the rate of spontaneous dislodgement and complications with the ordinary stent. Methods This was a randomized controlled trial at six tertiary endoscopic centers. Patients deemed high risk for post-endoscopic retrograde cholangiopancreatography pancreatitis randomly received modified or ordinary pancreatic stent. The primary outcome was spontaneous stent dislodgement at five days and 14 days. Secondary outcomes were the success rate of stent placement and complications. Results A total of 276 patients were randomly assigned to receive modified stents (mS group) and ordinary stents (oS group). The placement of a pancreatic stent was successful in all 276 patients. There were no significant differences between groups with respect to age, sex, major diagnosis, or indications for stenting. At five days the spontaneous dislodgement rate was 47.72% for the mS group and 15.67% for the oS group (p<0.001); at 14 days the rates were 84.21% and 42.65%, respectively (p < 0.001). Post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 6.52% of all patients. There were no significant differences regarding the incidences of post-endoscopic retrograde cholangiopancreatography pancreatitis, hemorrhage or fever. Conclusions The modified short 5-Fr stent has a higher spontaneous dislodgement rate than ordinary pancreatic stent, thus obviating the need for endoscopic removal. The modified pancreatic stent does not increase the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis or other complications. The endoscopist can consider removing the flange on the pancreatic duct side for prophylactic pancreatic duct manipulation.

Risk factors for gastric intraepithelial neoplasia in Chinese adults: a case–control study

Background Gastric carcinoma (GC) is the third most frequent malignancy and the second most common cancer-related cause of death cause worldwide. Gastric intraepithelial neoplasia (GIN) is a well-documented precancerous lesion of GC. In this case–control study, we comprehensively explored the clinical and pathological characteristics of GIN, with the aim to identify its potential risk factors. Patients and methods A total of 630 consecutive patients who underwent endoscopic submucosal dissection or mucosal resection for GIN were initially included. The detailed characteristics of all eligible patients and well-matched healthy controls were recorded and analyzed. Both univariate and multivariate logistic regression analyses were performed and presented with odds ratio (OR) and 95% confidential interval (CI), with additional subgroup analyses based on lesion location. Results A total of 485 GIN-eligible patients were selected, among which 156 had proximal GIN. After follow-up, 434 patients with GIN and 310 age- and gender-matched healthy controls were included in the comparative analyses. Family cancer history (FCH); alcohol abuse; tobacco abuse; intake of high sodium, preserved food, spicy food, and less fruit; Helicobacter pylori (Hp) infection; and atrophic gastritis with intestinal metaplasia were more frequent in GIN patients. Thus, FCH (OR =3.485, 95% CI: 2.031–5.981), high sodium intake (OR =2.830, 95% CI: 1.645–4.868), less fruit intake (OR =4.082, 95% CI: 2.515–6.625), Hp infection (OR =2.307, 95% CI: 1.417–3.755), and atrophic gastritis with intestinal metaplasia (OR =15.070, 95% CI: 8.999–25.237) were independent risk factors for GIN. Further subgroup analyses demonstrated that the specific independent risk factor for proximal GIN was age (OR =2.001, 95% CI: 1.003–3.994), whereas that for distal GIN was intake of high sodium (OR =3.467, 95% CI: 1.896–6.338). Conclusion This study reported a comprehensive overview of the clinical and pathological characteristics of GIN. FCH, high sodium intake, less fruit intake, Hp infection, and atrophic gastritis were identified as the independent risk factors for GIN.

Esophageal foreign body ingestion in adults on weekdays and holidays: A retrospective study of 1058 patients

Abstract The purpose of this study is to compare the clinicopathological characteristics and outcomes of esophageal foreign body (FB) ingestion in adults between weekdays and holidays. This is a retrospective study including 1058 patients with esophageal FB ingestion from 2012 to 2016. Patient characteristics, the types and locations of FB, and clinical outcomes were compared between patients on weekdays and holidays. Furthermore, independent risk factors of complication on weekdays and holidays respectively were evaluated. The locations of FB, underlying diseases, and complications significantly differed between weekdays and holidays groups, while no difference was found in the types of FB. Patients got higher percentage of erosion complication on holidays than that on weekdays (60.8% vs 47.6%, P < .0001). Multivariate logistic regression analysis revealed that jujube shell was a significant predictor of complication on weekdays (P < .001). However, complication was significantly associated with nonfood bolus FB ingestion on holidays (P < .001). Our data suggest that there were different clinicopathological characteristics of FB ingestion between weekdays and holidays, and more patients got complications on holidays. On holidays, a latex protector hood or an overtube should be applied to patients who swallowed nonfood bolus in order to reduce esophageal mucosal damage.