Silin Huang

Top‐cited articles in digestive system disease from 1950 to 2013

Examination of top‐cited articles is a tool that can help to identify and monitor outstanding scientific researches and landmark papers. We aimed to identify the 100 most cited published papers in peer‐reviewed biomedical journals in the field of digestive diseases and to examine their characteristics.

Training in early gastric cancer diagnosis improves the detection rate of early gastric cancer: an observational study in China.

Abstract Few studies have analyzed the training of endoscopists in the diagnosis of early gastric cancer (EGC). This study assessed whether specific training of endoscopists improves the detection rate of EGC. The rates of detection of EGC by endoscopists at the Digestive Endoscopy Center of the Affiliated Nanfang Hospital of China Southern Medical University between January 2013 and May 2014 were retrospectively analyzed. Because some endoscopists received training in the diagnosis of EGC, beginning in September 2013, the study was divided into 3 time periods: January to September 2013 (period 1), September 2013 to January 2014 (period 2), and January to May 2014 (period 3). The rates of EGC detection during these 3 periods were analyzed. From January 2013 to May 2014, a total of 25,314 gastroscopy examinations were performed at our center, with 48 of these examinations (0.2%) detecting EGCs, accounting for 12.1% (48/396) of the total number of gastric cancers detected. The EGC detection rates by trained endoscopists during periods 1, 2, and 3 were 0.3%, 0.6%, and 1.5%, respectively, accounting for 22.0%, 39.0%, and 60.0%, respectively, of the gastric cancers detected during these time periods. In comparison, the EGC detection rates by untrained endoscopists during periods 1, 2, and 3 were 0.05%, 0.08%, and 0.10%, respectively, accounting for 3.1%, 6.0%, and 5.7%, respectively, of the gastric cancers detected during these times. After training, the detection rate by some trained endoscopists markedly increased from 0.2% during period 1 to 2.3% during period 3. Further, the use of magnifying endoscopy with narrow-band imaging (M-NBI) (odds ratio = 3.1, 95% confidence interval 2.4–4.1, P < 0.001) contributed to the diagnosis of EGC. In conclusion, specific training could improve the endoscopic detection rate of EGC. M-NBI contributed to the diagnosis of EGC.

Endoscopic Submucosal Tunnel Dissection for Upper Gastrointestinal Submucosal Tumors Originating from the Muscularis Propria Layer: A Single-Center Study

Background/Aims In recent years, endoscopic submucosal tunnel dissection (ESTD) has gained popularity worldwide. The aim of this study was to evaluate the safety and efficacy of ESTD in treating upper gastrointestinal submucosal tumors (SMTs) in a large-volume endoscopic center. Methods Patients with SMTs were enrolled in this study between January 2012 and January 2015. Demographic data, clinical data, and treatment outcome were collected and analyzed. Results Seventy SMTs originating from the muscularis propria (MP) layer were identified in 69 patients. All patients successfully underwent the ESTD procedure. The mean procedure time was 49.0±29.5 minutes, and the mean tumor size was 18.7±7.2 mm. Among all lesions, the majority (70.0%) were located in the esophagus, 12.9% in the cardia, and 17.1% in the stomach. Complete resection was achieved in 67 lesions (95.7%). Perforation occurred in three patients (4.3%), who were treated by endoclips. Pneumothorax occurred in two patients (2.9%) and was successfully managed by thoracic drainage. During a median follow-up of 18.1 months, patients were free of local recurrence or distant metastasis. Conclusions Our results demonstrated the feasibility and safety of ESTD in treating upper gastrointestinal SMTs originating from the MP layer. Large-scale comparative studies with other treatment methods should be conducted in the future.

Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients

Peroral endoscopic myotomy (POEM) has been proven to be effective for treating achalasia, but there are limited data on POEM in elderly patients. We therefore aimed to assess the role of POEM for achalasia in patients aged ≥60 years.

Endoscopic submucosal tunnel dissection of upper gastrointestinal submucosal tumors: A comparative study of hook knife vs hybrid knife

AIM To compare the efficacy and safety of a hook knife (HO) with a hybrid knife (HK) during endoscopic submucosal tunnel dissection (ESTD) procedure. METHODS Between August 2012 and December 2015, the ESTD procedure was performed for 83 upper GI submucosal lesions, which originated from the muscularis propria layer identified by upper endoscopy and endoscopic ultrasonography. Of these, 34 lesions were treated by a HO, whereas 49 lesions were treated by a HK. Data regarding age, gender, presenting symptoms, tumor location and size, procedure time, complications, en bloc resection rate and others were analyzed and compared between the two groups. RESULTS There were no significant differences in the age, gender, presenting symptoms and tumor location between the two groups. ESTD was successfully completed in all the patients, and no case was converted to laparoscopy. The mean procedure time was significantly shorter in the HK group than in the HO group (41.3 ± 20.3 min vs 57.2 ± 28.0 min, P = 0.004). The mean frequency of device exchange was 1.4 ± 0.6 in the HK group and significantly less than 3.3 ± 0.6 in the HO group (P < 0.001). The differences in tumor size and histopathological diagnoses were not significant between the two groups (P = 0.813, P = 0.363, respectively). Both groups had an equal en bloc resection rate and complete resection rate. Additionally, the complication rate was similar between the two groups (P = 0.901). During the follow-up, no recurrence occurred in either group. CONCLUSION We demonstrate for the first time that HO and HK do not differ in efficacy or safety, but HK reduces the frequency of device exchange and procedure time.

Gastrointestinal: Peroral endoscopic myotomy for distal esophageal spasm: Gastrointestinal: Peroral endoscopic myotomy for distal esophageal spasm

A 63-year-old man was referred with 2 years of dysphagia. His esophagogram and esophagogastroduodenoscopy showed synchronous contractions in the middle and lower parts of the esophagus (Fig. 1a,b). High-resolution esophageal manometry revealed premature spastic contractions (distal latency: 4.1 s), normal esophagogastric junction relaxation, and high distal contraction integral (1255.2 cm*s*mmHg) (Fig. 2a). Based on the Chicago classification, he was diagnosed with distal esophageal spasm. After obtaining written informed consent, peroral endoscopic myotomy (POEM) was performed using a high-definition gastroscope fitted with a transparent cap. The patient was under general anesthesia with endotracheal intubation. The procedural steps are demonstrated in Figure 1c–h. The POEM procedure was performed successfully without complication, and the patient was discharged after 5 days with proton pump inhibitor therapy. At 12 months, his dysphagia symptom scores had markedly improved (Eckardt score: 2), and his esophagogram showed complete absence of abnormal contractions on the anterior wall of esophagus (Fig. 1i). Additionally, highresolution esophageal manometry after POEM disclosed that the distal contraction integral (22.6 cm*s*mmHg) decreased significantly (Fig. 2b). Presently, POEM has been demonstrated to be effective and safe for achalasia. The technique cuts the esophageal circular muscle bundle by creating a submucosal tunnel, to access the entire esophageal body. Myotomy is performed where needed. In addition to achalasia, POEM was also used for treating some spastic esophageal disorders, also with excellent clinical outcomes. A longer myotomy is usually required. In this case, extensive myotomy with the length of 19 cm was performed, doubling the typical length performed for achalasia. Our case demonstrates the efficacy and safety of POEM for distal esophageal spasm. Further clinical trials are warranted to clearly define the durability of the procedure.

EDUCATION AND IMAGING. Gastrointestinal: Endoscopic submucosal tunnel dissection of a giant cardiac leiomyoma.

Figure 1 (a) A submucosal tumor (SMT) located at the cardia. (b) Endoscopic ultrasonography revealed a 3.9×1.8 cmhypoechoic submucosal lesion originating from the muscularis propria layer. (c,d) After submucosal injection, a longitudinal mucosal incision wasmade, approximately 4 cm proximal to the SMT; submucosal dissection was done, creating a submucosal tunnel until the tumor was visible. (e) Dissection was performed along the margin of the tumor until it was completely dissected. (f,g) The tumor was fragmentated by snare and extracted by piecemeal through the tunnel. (h) Endoscopic view of submucosal tunnel after removal of tumor. (i) Endoclips were used to close the entry of the submucosal tunnel. igure 2 (a) The resected specimen consisted of eight piecemeal leions and measured 8 cm in size. (b) Pathological examination revealed at the resected specimens were leiomyoma.

Gastrointestinal: Endoscopic submucosal tunnel dissection of a giant cardiac leiomyoma: Endoscopic dissection of leiomyoma

Figure 1 (a) A submucosal tumor (SMT) located at the cardia. (b) Endoscopic ultrasonography revealed a 3.9×1.8 cmhypoechoic submucosal lesion originating from the muscularis propria layer. (c,d) After submucosal injection, a longitudinal mucosal incision wasmade, approximately 4 cm proximal to the SMT; submucosal dissection was done, creating a submucosal tunnel until the tumor was visible. (e) Dissection was performed along the margin of the tumor until it was completely dissected. (f,g) The tumor was fragmentated by snare and extracted by piecemeal through the tunnel. (h) Endoscopic view of submucosal tunnel after removal of tumor. (i) Endoclips were used to close the entry of the submucosal tunnel. igure 2 (a) The resected specimen consisted of eight piecemeal leions and measured 8 cm in size. (b) Pathological examination revealed at the resected specimens were leiomyoma.

Gastrointestinal: Endoscopic submucosal tunnel dissection of a giant cardiac leiomyoma

Figure 1 (a) A submucosal tumor (SMT) located at the cardia. (b) Endoscopic ultrasonography revealed a 3.9×1.8 cmhypoechoic submucosal lesion originating from the muscularis propria layer. (c,d) After submucosal injection, a longitudinal mucosal incision wasmade, approximately 4 cm proximal to the SMT; submucosal dissection was done, creating a submucosal tunnel until the tumor was visible. (e) Dissection was performed along the margin of the tumor until it was completely dissected. (f,g) The tumor was fragmentated by snare and extracted by piecemeal through the tunnel. (h) Endoscopic view of submucosal tunnel after removal of tumor. (i) Endoclips were used to close the entry of the submucosal tunnel. igure 2 (a) The resected specimen consisted of eight piecemeal leions and measured 8 cm in size. (b) Pathological examination revealed at the resected specimens were leiomyoma.