Zhenyu Chen

Comparison of the diagnostic efficacy of white light endoscopy and magnifying endoscopy with narrow band imaging for early gastric cancer : a meta-analysis

AbstractObjectiveMagnifying endoscopy with narrow band imaging (ME-NBI) is nwidely used in gastroscopy, especially in the diagnosis of early gastric cancer. The purpose of this meta-analysis is to compare the diagnostic efficacy of white light imaging (WLI) and that of ME-NBI for early gastric cancer.MethodsPubMed/MEDLINE, EMBASE, and the Cochrane Library were searched to identify studies which met the inclusion criteria. A random-effects model was used to calculate overall sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) to assess the diagnostic efficacy of WLI and ME-NBI in early gastric cancer. Sensitivity analysis was performed to assess the stability of the results.ResultsTen studies met the inclusion criteria, and included 1724 patients and 2153 lesions. The pooled sensitivity, specificity, and AUC for the diagnosis of early gastric cancer using WLI were 0.48 [95xa0% confidence interval (CI) 0.39–0.57; I2xa0=xa078.6xa0%], 0.67 (95xa0% CI 0.62–0.71; I2xa0=xa081.9xa0%), and 0.62, respectively. The pooled sensitivity, specificity, and AUC using ME-NBI were 0.83 (95xa0% CI 0.79–0.87; I2xa0=xa079.8xa0%), 0.96 (95xa0% CI 0.95–0.97; I2xa0=xa089.3xa0%), and 0.96, respectively. The studies showed a high degree of heterogeneity. Further sensitivity analysis was mainly performed for the studies of small lesions (mean sizexa010xa0mm or less) and the studies with a the scorexa0of 12 points or greater in the literature quality assessment, and the AUCs for ME-NBI for diagnosis of early gastric cancer were between 0.93 and 0.98, which suggested that the diagnostic value was still high and stable.ConclusionCompared with WLI, ME-NBI can effectively diagnose early gastric cancer.

Assessment of Risk Factors for Delayed Colonic Post-Polypectomy Hemorrhage: A Study of 15553 Polypectomies from 2005 to 2013

Background and Aim Delayed colonic postpolypectomy bleeding is the commonest serious complication after polypectomy. This study aimed to utilize massive sampling data of polypectomy to analyze risk factors for delayed postpolypectomy bleeding. Patients and Methods The endoscopic data of 5600 patients with 15553 polyps removed (2005 to 2013) were analyzed retrospectively through univariate analysis and multiple logistic regression analysis to evaluate the risk factors for delayed bleeding. Results Delayed postpolypectomy bleeding occurred in 99 polyps (0.6%). The rates of bleeding for different polypectomy methods including hot biopsy forcep, biopsy forcep, Argon Plasma Coagulation (APC), Endoscopy piecemeal mucosal resection (EPMR), Endoscopic Mucosal Resection (EMR), and snare polypectomy were 0.1%, 0.0%, 0.0%, 6.9%, 0.9% and 1.0%, respectively. The risk factors for delayed bleeding were the size of polyps over 10 mm (odds ratio [OR]u200a=u200a4.6, 95% CI, 2.9–7.2), pathology of colonic polyps (inflammatory/hyperplastic, ORu200a=u200a1; adenomatous, ORu200a=u200a1.4, 95% CI, 0.7–2.6; serrated, ORu200a=u200a1.5, 95% CI, 0.2–11.9; juvenile, ORu200a=u200a4.3, 95% CI, 1.8–11.0; Peutz-Jegher, ORu200a=u200a3.3, 95% CI, 1.0–10.7), and immediate postpolypectomy bleeding (ORu200a=u200a2.9, 95% CI, 1.4–5.9). In addition, although polypectomy method was not a risk factor, compared with hot biopsy forcep, snare polypectomy, EMR, and EPMR had increased risks of delayed bleeding, with ORs of 3.2 (0.4–23.3), 2.8 (0.4–21.7) and 5.1 (0.5–47.7), respectively. Conclusion Polyp size over 10 mm, pathology of colonic polyps (especially juvenile, Peutz-Jegher), and immediate postpolypectomy bleeding were significant risk factors for delayed postpolypectomy bleeding.

Double balloon enteroscopy in the old: Experience from China

AIMnTo evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases.nnnMETHODSnDBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis.nnnRESULTSnFifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively.nnnCONCLUSIONnDBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.

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 ratiou200a=u200a3.1, 95% confidence interval 2.4–4.1, Pu200a<u200a0.001) 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.

The evaluation of the OMOM capsule endoscopy with similar pictures elimination mode

BACKGROUND AND OBJECTIVEnThe reading of capsule endoscopy (CE) is time-consuming. Thus, several time-saving features have been added to the CE software by different CE companies. However, the similar pictures elimination mode in the OMOM capsule endoscopy software has not been evaluated yet. Our aim is to evaluate the sensitivity and specificity of the similar pictures elimination mode.nnnMETHODSnWe retrospectively studied 200 consecutive capsule endoscopy procedures in Nanfang Hospital between April 2012 and July 2012, among which 52 cases were excluded for poor bowel preparation, failure to reach the colon or data missing. All images of the small-bowel were re-evaluated with four different reading modes (conventional mode and three levels of similar pictures elimination mode) by four experienced endoscopists. Then, the reading time, the number of detected lesions, κ value, sensitivity and specificity were compared between 4 methods.nnnRESULTSnThe mean reading time with levels I to III, respectively, was significantly shorter than with conventional mode (P<0.001, conventional mode 33.25min, level I 24.90min, level II 20.54min, level III 14.96min). The sensitivity between conventional mode and level I were similar (93.8% vs. 87.7%, P=0.073), while the sensitivity of levels II and III was significantly lower than conventional mode (77.8% vs. 93.8%, 70% vs. 93.8%, respectively). The specificity between all 4 modes were similar (100% for conventional mode, 98.5% for levels I to III).nnnCONCLUSIONSnLevel I reading mode was as efficient as the conventional mode and less time-consuming. Its sensitivity and specificity were similar compared with the conventional mode.

Relationships of capsule endoscopy Lewis score with clinical disease activity indices, C-reactive protein, and small bowel transit time in pediatric and adult patients with small bowel Crohnʼs disease

Abstract Relationships between the capsule endoscopy Lewis score (LS) and clinical disease activity indices and C-reactive protein (CRP) are controversial in adult patients with Crohns disease (CD). Also, data on pediatric patients are relatively less. However, correlation between LS and small bowel transit time (SBTT) remains investigational. The aim of the present study was to explore the correlations between LS and clinical disease activity indices, CRP, SBTT in pediatric, and adult patients with small bowel CD. Retrospective, single-center study on consecutive inpatients with established small bowel CD was conducted. The clinical disease activity index was determined using the abbreviated Pediatric Crohns Disease Activity Index (aPCDAI) in patients aged <18 years and the Harvey–Bradshaw Simple Index (HBI) in adults. Spearmans rank correlation coefficient was used to assess the correlations of LS with aPCDAI, HBI, CRP, and SBTT, respectively. 150 patients were enrolled (30 children and adolescents). In pediatric patients, correlations between LS and aPCDAI, CRP were moderate (r1u200a=u200a0.413; r2u200a=u200a0.379; P1u200a=u200a.023; P2u200a=u200a.044). There was no correlation between LS and SBTT (ru200a=u200a–0.029; Pu200a=u200a.88). In adults, weak correlations were found between LS and HBI, SBTT (r1u200a=u200a0.213; r2u200a=u200a0.237; P1u200a=u200a.019; P2u200a=u200a.009). Correlation between LS and CRP was moderate (ru200a=u200a0.326; Pu200a<u200a.001). Strong correlations were found between CRP and HBI, aPCDAI (r1u200a=u200a0.522; r2u200a=u200a0.650; Pu200a<u200a.001). The follow-up patients were all in clinical remission after treatment within 4 months, whereas only a minority reached mucosal healing. HBI, aPCDAI, CRP, and LS in all patients were reduced after treatment, whereas difference in CRP in pediatric patients and difference in LS in adults between baseline and follow-up were not found to be statistically significant. Also, the average SBTT at baseline was not found to be different from that at follow-up in all patients. The role of capsule endoscopy should be emphasized both in pediatric and adult patients with small bowel CD. Furthermore, the small bowel transit time may not be affected by the grade of small intestinal inflammation.

Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE).

AbstractTissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis. The aims of this study were to evaluate the diagnostic performances of biopsy, magnifying endoscopy with narrow-band imaging (ME-NBI), and biopsy plus ME-NBI for GEN.This study retrospectively analyzed 101 cases diagnosed as GEN using ER samples. The discrepancies between biopsy and ER, as well as between biopsy plus ME-NBI and ER in the diagnosis of GEN were evaluated. Factors that contributed to such discrepancies were analyzed. The sensitivity and specificity of biopsy and ME-NBI for the diagnosis of high-grade neoplasia (HGN) were determined.The discrepancy in the pathological diagnosis between biopsy and ER was 39.6% for GEN and 54.2% for HGN. The discrepancy between biopsy combined with ME-NBI and ER was 15.9% for GEN and 10.2% for HGN. Factors that undermined the diagnostic accuracy of biopsy included the lesion size (⩽10u200amm, odds ratio [OR] 1; 10–20u200amm, OR 0.2, 95% confidence interval [CI] 0.1–0.7; >20u200amm, OR 0.5, 95% CI 0.1–2.1, Pu200a=u200a0.03) and the number of biopsy fragments (OR 0.6, 95% CI 0.5–0.8, Pu200a=u200a0.001). The sensitivity and specificity for HGN were 45.8% (33.7%–58.3%) and 100% (87.5%–100%) for biopsy, and 88.1% (77.5%–94.1%) and 92.9% (81.0%–97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution. Biopsy combined with ME-NBI can contribute to the diagnosis of GEN, which improves diagnostic consistency with pathological result of ER specimens.

Sedation With Propofol Has No Effect on Capsule Endoscopy Completion Rates: A Prospective Single-Center Study

AbstractPatients who need both capsule endoscopy (CE) and colonoscopy often undergo both examinations on the same day to avoid repeated bowel preparation and fasting. Sedation can relieve pain and is commonly used for colonoscopies but may influence the CE completion rate.To determine whether sedation with propofol influences the completion rate and small-bowel transit time (SBTT) of CE.From July 2014 to December 2014, patients (18–65 years old) who needed both CE and colonoscopy were assessed consecutively for enrollment in our study. Colonoscopies were performed with or without sedation based on patient preferences on the day of capsule ingestion. The completion rate, SBTT, and diagnostic yield of CEs were recorded. Patients’ satisfaction and pain scores were also recorded.Sedation with propofol had no significant effect on CE completion rates (83.3% sedation group vs 81.8% nonsedation group, Pu200a=u200a0.86) but was associated with increased SBTT (403.6u200a±u200a160.3 sedation group vs 334.5u200a±u200a134.4 nonsedation group, Pu200a=u200a0.006). The diagnostic yields in the sedation and nonsedation groups were 69.4% and 65.9%, respectively (Pu200a=u200a0.74). The median satisfaction scores were 8.6 in the sedation group and 3.5 in the nonsedation group (Pu200a<u200a0.001). Median pain scores were 1.4 in the sedation group and 6.7 in the nonsedation group (Pu200a<u200a0.001).Sedation with propofol increased SBTT but had no effect on CE completion rates, suggesting that CE and colonoscopy with propofol can be performed on the same day (clinical trial registration number: ChiCTR-ONRC-14004866).

Risk factors for surgery in patients with retention of endoscopic capsule

Abstract Objectives: Surgery is still the main means for removing retained endoscopic capsules. This study intended to evaluate risk factors for surgery in patients with capsule retention. Materials and methods: The data of 5348 consecutive capsule endoscopy examinations were retrospectively analyzed. Cox regression analysis was used to evaluate risk factors. Results: Seventy-seven patients (1.4%) had capsule retention. Spontaneous passage occurred in 16 patients, of which 14 were asymptomatic. Successful retrieval by double-balloon enteroscopy (DBE) was achieved in 14 patients, of which 11 did not need surgery during clinical follow-up. A total of 50 patients underwent surgery. The cumulative rates of surgery were 44.2%, 53.2%, 55.8%, 62.3% and 64.9% at 1, 3, 6, 12 and 60 months after capsule retention, respectively. Intestinal obstruction [hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.12–3.76; pu2009=u2009.020] and overt small bowel bleeding (HR 2.01, 95%CI 1.08–3.71; pu2009=u2009.027) during capsule retention were independently associated with an increased risk for surgery. Specific treatment for primary disease (HR 0.22, 95%CI 0.07–0.74, pu2009=u2009.014) and successful endoscopic retrieval (HR 0.20, 95%CI 0.06–0.66; pu2009=u2009.008) were independently associated with a decreased risk for surgery. Conclusions: For asymptomatic patients, specific medical treatment for primary disease can be maintained until the capsule spontaneously passes or symptoms appear. For patients with slight abdominal pain, DBE can be performed. For patients with intestinal obstruction or overt small bowel bleeding, early surgical consultation should be considered.

Impact of capsule endoscopy on prevention of postoperative recurrence of Crohn’s disease

BACKGROUND AND AIMSnCapsule endoscopy (CE) can detect lesions outside the scope of ileocolonoscopy in postoperative patients with Crohns disease (CD). However, the impact of such findings on patient outcomes remains unknown. This study is intended to evaluate the impact of CE findings on clinical management and outcomes in asymptomatic patients with CD without pharmacologic prophylaxis after ileocolonic resection.nnnMETHODSnIn this retrospective cohort study, 37 patients (group 1) received ileocolonoscopy together with CE within 1 year after surgery, whereas 46 patients (group 2) only received ileocolonoscopy. Patients with endoscopic recurrence detected by either ileocolonoscopy or CE received pharmacologic therapy with azathioprine or infliximab. One year later, disease activity was re-evaluated.nnnRESULTSnIn group 1, all patients with ileocolonoscopy-identified recurrence also had CE-identified recurrence. In addition, CE detected endoscopic recurrence in 11 patients missed by ileocolonoscopy. Endoscopic remission identified by ileocolonoscopy was confirmed by CE in 13 patients. One year later, endoscopic remission identified by ileocolonoscopy was maintained in all 24 patients, and none had clinical recurrence. Conversely, in group 2, of those with ileocolonoscopy-identified remission, both ileocolonoscopy-identified recurrence and clinical recurrence occurred in 9 of 31 patients 1 year later. The total clinical recurrence rate was 2.7% (1/37) in group 1 versus 21.7% (10/46) in group 2 (Pxa0= .019).nnnCONCLUSIONSnIf endoscopic remission identified by ileocolonoscopy was confirmed by CE, patients could remain free of pharmacologic prophylaxis. If recurrence outside the scope of ileocolonoscopy was detected by CE, initiation of active pharmacologic therapy would be needed.