Xin-Li Mao

Submucosal tunnelling endoscopic resection for the treatment of esophageal submucosal tumours originating from the muscularis propria layer: An analysis of 15 cases

BACKGROUND AND AIMS The aim of this prospective study was to evaluate the feasibility of submucosal tunnelling endoscopic resection of esophageal tumours originating from the muscularis propria layer. METHODS Fifteen patients with esophageal submucosal tumours originating from the muscularis propria layer underwent submucosal tunnelling endoscopic resection between August 2011 and February 2012. The key steps were: (1) creating a submucosal tunnel from 5 cm above the tumour between the submucosal and muscular layers with a hook knife or hybrid knife; (2) dissecting the tumour by the technique of endoscopic submucosal dissection; (3) closing the mucosal incision site with clips after the tumour was removed. RESULTS Submucosal tunnelling endoscopic resection was successfully performed in all cases. The en bloc resection rate was 100%. The average tumour diameter was 1.8 cm (range 1.0-3.0 cm). During the procedure, perforation occurred in 3 patients, who recovered after conservative treatment. No residual tumour or tumour recurrence was detected during the follow-up period (mean: 3.5 months, range: 1-9 months). Pathological diagnoses of these tumours were leiomyomas (12/15) and gastrointestinal stromal tumours (3/15). CONCLUSIONS Submucosal tunnelling endoscopic resection is a feasible method for the treatment of small esophageal submucosal tumours originating from the muscularis propria layer.

Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer: results from a large study in China.

Background and Aim: In this retrospective study, we investigated the safety and efficacy of endoscopic excavation of gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. Materials and Methods: Between November 2007 and June 2012, 212 patients with gastric SETs originating from the MP layer were treated via endoscopic excavation. The key procedures were: (1) injecting a mixture solution (100 mL saline+2 mL indigo carmine+1 mL epinephrine) into the submucosa around the tumor; (2) making a cross-incision of the mucosa and then excavating the tumor by the technique of endoscopic excavation. After the tumor was completely excavated from the MP layer, it was removed using a snare; (3) closing the artificial ulcer with clips. Results: The mean diameter of the 212 tumors was 16.5 mm. Complete resection by endoscopic excavation was achieved in 204 cases (96.2%). The rate of complete resection was significantly higher for tumors <2 cm (98.0%) than for tumors >2 cm (91.9%) (P=0.035). Perforation occurred in 32 cases (15.1%), and massive bleeding occurred in 9 cases (4.2%) during the procedure. The rate of perforation was significantly higher for the fundus and the body than for antrum (21.5%, 11.5%, 0%, respectively; P=0.036), and also differed significantly in relation to histologic diagnosis (23.7% for gastrointestinal stromal tumors vs. 7.8% for leiomyoma; P=0.001). Histologic diagnosis showed that the density of gastrointestinal stromal tumors located in the fundus and the body of the stomach was significantly higher than in the antrum (44.1%, 51.9%, 13.3%, respectively; P=0.036). Conclusions: Endoscopic excavation is a safe and efficient method for resecting small (>3.5 cm) gastric SETs originating from the MP layer.

Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer

Minimally invasive endoscopic resection has become an increasingly popular method for patients with small (less than 3.5 cm in diameter) gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.

Safety of Endoscopic Resection for Upper Gastrointestinal Subepithelial Tumors Originating from the Muscularis Propria Layer: An Analysis of 733 Tumors

Objectives:Although endoscopic resection is an accepted technique for upper gastrointestinal subepithelial tumors (SETs) originating from the muscularis propria (MP) layer, published data regarding its complications are highly variable and limited to small data series. This study aimed to analyze the safety of endoscopic resection in a large case series.Methods:A total of 726 consecutive patients with 733 upper gastrointestinal SETs originating from the MP layer underwent endoscopic resection from June 2005 to December 2014. The complete resection rate, perioperative perforation rate, and perioperative bleeding rate were the main outcome measurements.Results:The complete resection rate was 97.1%. Ninety-four patients had complications (12.9%), including 88 with perioperative perforations (12.1%), 13 with perioperative bleeding (1.8%), 5 with localized peritonitis (0.7%), and one with delayed bleeding (0.1%). Eleven patients required surgery; the others were treated endoscopically. Risk factors for incomplete resection were extensive connection of the tumor to the MP layer (P=0.007) and extraluminal growth (P=0.048). Risk factors for perioperative perforation were larger tumor size (≤2.0 cm vs. 2.1–3.0 cm vs. >3.0 cm, P=0.021), extraluminal growth (P=0.046), and extensive connection (P<0.001). A risk factor for perioperative bleeding was larger tumor size (P=0.045). No residual or recurrent lesions were detected during the follow-up period (median: 28 months).Conclusions:Endoscopic resection is an effective and reasonably safe therapeutic method for treating/removing upper gastrointestinal SETs originating from the MP layer when managed by an experienced endoscopic team.

Endoscopic treatment of a sigmoid perforation caused by an ingested fish bone

A 68-year-old man was admitted with severe abdominal pain since the previous day. His physical examination was unremarkable, except for mild lower abdominal tenderness without rebound tenderness. Laboratory tests showed he had an elevated white blood cell count (11800 cells/μL) and increased C-reactive protein (CRP) level (105mg/L). A computed tomography (CT) scan revealed a radiodense linear foreign body that was extending transmurally through the wall of the sigmoid colon (▶Fig. 1). Colonoscopy demonstrated a fish bone stuck in the sigmoid colon wall (▶Fig. 2). The fish bone was carefully removed using foreign body forceps, leaving an approximately 0.5 ×0.5-cm perforation in the sigmoid colon wall. The perforation was closed by an over-the-scope clip (OTSC; Ovesco Endoscopy Ag, Germany) (▶Video1). After this endoscopic procedure, the patient’s lower abdominal discomfort immediately disappeared. He was treated with antibiotics for 3 days and was discharged from hospital without any early complications. Ingestion of foreign bodies, such as poultry bones, fish bones, coins, and dentures, is a common occurrence among elderly patients, children, alcoholics, patients with psychiatric disorders, and fast eaters [1]. Most foreign bodies are able to pass through the gastrointestinal tract without consequence, while some may lead to perforation, fistula, hemorrhage, or obstruction of the gastrointestinal tract [2]. Perforation of the sigmoid colon caused by an ingested fish bone is rare. Surgical treatment is usually inevitable if foreign bodies cannot be extracted endoscopically [3]; however, a case where a fish bone-induced sigmoid colonic perforation was successfully treated by conservative management had previously been reported [4]. In our case, the fish bone that had stuck in the wall of the sigmoid colon was successful-

Huge Lymphangioma of the Esophagus Resected by Endoscopic Piecemeal Mucosal Resection

We present an unusual case of a 41-year-old male patient with a large lymphangioma of the esophagus. Endoscopy revealed that the structure measured 60 × 10 mm in the mucosa and the submucosa and had a heterogenous echo pattern. The esophageal mass was successfully resected by endoscopic piecemeal mucosal resection. However, most esophageal lymphangiomas that are larger than 2 cm in diameter reported in the literature can be removed only through open surgery. Thus far, we know of no reported cases of endoscopic resection as a treatment for this case.

455 Endoscopic Full-Thickness Resection With Defect Closure by Clips and an Endoloop for Gastric Subepithelial Tumors Arising From the Muscularis Propria

Background and aims This retrospective study evaluated the safety and efficacy of endoscopic full-thickness resection (eFTR) with defect closure using clips and an endoloop for the treatment of gastric subepithelial tumors (SETs) arising from the muscularis propria (MP).

Long-term outcomes of endoscopic resection for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors originating from the muscularis propria layer

AIM To evaluate the long-term efficacy of endoscopic resection (ER) for small (≤ 4.0 cm) gastric gastrointestinal stromal tumors (GISTs) originating from the muscularis propria layer. METHODS Between June 2005 and February 2015, we retrospectively analyzed 229 consecutive patients with gastric MP-GISTs who underwent ER with a follow-up at least 36 mo. The main outcome measurements included complete resection rate, complications, and long-term follow-up outcomes. RESULTS ER included endoscopic muscularis excavation in 179 cases, endoscopic full-thickness resection in 32 cases, and submucosal tunneling endoscopic resection in 18 cases. The median size of GISTs was 1.90 cm. Of the 229 GISTs, 147 were very low risk, 72 were low risk, 8 were intermediate risk, and 2 were high risk. Short-term outcomes showed the complete resection rate was 96.5%, and 8 patients (3.5%) had complications. Of the 8 patients with complications, only one patient required surgical intervention. Long-term outcomes showed 225 patients were actively followed-up until composition of this manuscript. The remaining 4 patients were lost because of unrelated death. During the follow-up period (median, 57 mo), no residual, recurrent lesions, or distant metastasis were detected in any patients. Binary logistic regression analysis showed tumor size was a risk factor associated with a high mitotic index (≥ 5/50 HPF) of GISTs (P = 0.002). CONCLUSION ER seems to be an effective and safe method for gastric MP-GISTs ≤ 4.0 cm, and, for some intermediate or high risk GISTs, adjuvant therapy and/or additional surgery might be required to reduce the risk of recurrence or metastasis.

Capsaicin inhibits glycolysis in esophageal squamous cell carcinoma by regulating hexokinase‑2 expression

Capsaicin is a principal component of hot red peppers and chili peppers. Previous studies have reported that capsaicin exhibits antitumor functions in a variety of tumor models. Although various mechanisms underlying the capsaicin‑mediated inhibition of tumor growth have been demonstrated, the impact of capsaicin on tumor metabolism has rarely been reported. The present study demonstrated that capsaicin exhibited an inhibitory effect on tumor glycolysis in esophageal squamous cell carcinoma (ESCC) cells. Following treatment with capsaicin, glucose consumption and lactate production in ESCC cells was decreased. Capsaicin resulted in a decrease of hexokinase‑2 (HK‑2) expression, which is known for its important role in tumor glycolysis. Further investigations demonstrated that phosphatase and tensin homolog (PTEN) expression was increased in ESCC cells treated with capsaicin, and that the RAC‑α serine threonine‑protein kinase signaling pathway was downregulated. In PTEN‑knockdown KYSE150 cells, the decrease in HK‑2 and inhibition of glycolysis caused by capsaicin was attenuated, which suggested that the impact of capsaicin on tumor metabolism was associated with its effect on PTEN.

MiR-542-3p controls hepatic stellate cell activation and fibrosis via targeting BMP-7: JI et al.

There has been an increasing number of studies about microRNAs as key regulators in the development of hepatic fibrosis. Here, we demonstrate that miR‐542‐3p can promote hepatic fibrosis by downregulating the expression of bone morphogenetic protein 7 (BMP‐7), which is known to antagonize transforming growth factor β1 (TGFβ1)‐mediated fibrogenesis effect. The expression of miR‐542‐3p is increased in activated hepatic stellate cells (HSCs). Downregulation of MiR‐542‐3p by antisense inhibitors can inhibit HSCs activation markers, including α‐smooth muscle actin (α‐SMA) and collagen as well as TGFβ signaling pathways. MiR‐542‐3p was significantly upregulated in carbon tetrachloride (CCl4)‐induced hepatic fibrosis in mice, and downregulation of miR‐542‐3p by lentivirus could prevent the development of hepatic fibrosis. In addition, miR‐542‐3p can directly bind to the 3′‐untranslated region of BMP‐7 mRNA, indicating that its profibrotic effect appears to be caused by its inhibition of BMP‐7. Our results suggest that downregulation of miR‐542‐3p prevents liver fibrosis both in vitro and in vivo, highlighting its potential as a novel biomarker or therapeutic target for hepatic fibrosis.