Background:CpG island methylator phenotype(CIMP)involving tumor suppressor gene( TSG)on short arm of chromosome 3(chromosome 3p)has been found in various types of cancers. However,its correlation with gastric cancer has not been clarified. Aims:To study the clinical significance of CIMP involving TSG on chromosome 3p in gastric cancer. Methods:Methylation specific PCR(MSP)was used to examine methylation profiles for hOGG1,VHL,RAR-B, hMLH1,SEMA3B,RASSF1A,BLU and FHIT harbored in chromosome 3p in 100 gastric cancer and paired paracancerous tissues. High CIMP( CIMP-H)was referred for those samples having four or more synchronously methylated genes. Relationship between CIMP-H and clinicopathological characteristics in gastric cancer was analyzed. Results:Positive methylation rates of VHL(P = 0. 030),hMLH1(P < 0. 001),SEMA3B(P = 0. 003),RASSF1A(P < 0. 001)and FHIT(P < 0. 001)were significantly higher in gastric cancer tissue than in paracancerous tissue. Incidence of CIMP-H rate in gastric cancer tissue was significantly higher than that in paracancerous tissue(44. 0% vs. 4. 0% ,P < 0. 001). CIMP-H was negatively correlated with degree of tumor differentiation(P = 0. 004),and positively correlated with lymph node metastasis(P = 0. 005),but not correlated with gender,age,tumor location,tumor size,depth of infiltration and TNM staging(P > 0. 05). Conclusions:CIMP on chromosome 3p may occur in early stage of oncogenesis of gastric cancer,and influencing tumor differentiation and lymph node metastasis.

Objective To compare the feasibility and safety of endoscopy with laparoscopy and without for gastric stromal tumor.Methods A retrospective and comprehensive analysis was made based on the clinical data of endoscopic (53 cases) and laparoscopic (39 cases) resection for gastric stromal tumor (diameter ＜ 3 cm with clear boundary),by comparing the operation time,intraoperative blood loss,indwelling time of postoperative gastric tube,recovery time of bowel functions,postoperative complications,hospitalization time,metastasis,recurrence rate.Results Compared with the laparoscopic group,the endoscopic group required shorter operation time [50(48-58) min VS 70 (50-95) min,U =1575.00,P ＜ 0.01],less intraoperative blood loss [10 (5-15) ml VS 20 (20-30) ml,U =1794.00,P ＜ 0.01],earlier recovery of bowel functions [18 (8-36) h VS 24 (20-40) h,U =1666.00,P ＜ 0.01],hospitalization time,indwelling time of the postoperative gastric tube and postoperative complications showed no statistical difference (P ＞ 0.05).The postoperative follow-up time were (27 + 15) and (24 + 11) months in the endoscopic and laparoscopic group,respectively (t =0.3084,P ＞ 0.05).During the follow-up,no tumor recurrence or distant metastasis was discovered,nor was death of gastric stromal tumor.Conclusion Endoscopy without the assist of laparoscopy for the gastric stromal tumor,whose diameter is less than 3 cm with clear boundary,is safe and less invasive,and leads to quick recovery.

Objective To evaluate a new type of endoloop for closure of full-thickness gastric defects left by EFR.Methods A total of 32 patients who underwent EFR at our hospital between October 2014 and February 2015 with gastric fundus submucosal tumors were retrospectively analyzed.After the resection,LeCampTM endoloops and Olympus endoloops were used respectively to close the gastric defect in the study group (n =14) and the control group(n =18).The closure success rates,closure time,complications and the healing rates were compared.Results All lesions were removed by using EFR technique.The closure success rates of the two groups were both 100％.The closure time were 13.86 ± 4.62 minutes and 18.28 ± 6.48 minutes in study group and control group respectively with significant difference (P ＜ 0.05).9.43 ±4.09 metallic clips and 1.00 ±0.00 endoloops were used in study group and 9.67 ± 3.61 metallic clips and 1.06 ± 0.24 endoloops were used in control group (P ＞ 0.05).One patient in study group and 2 patients in control group received abdominal puncture for relieving the pneumoperitoneum during the operation (P ＞ 0.05).No complications such as subcutaneous emphysema,pneumothorax,pneumomediastinum,delayed bleeding,or abdominal infection were found after the operations in either group.The wounds healed in all patients in 2 months after the procedure.Conclusion The use of novel endoloop and metallic clips is a relatively safe,easy,and feasible method for repairing large gastric post-EFR defects,which is of good clinical application value.

OBJECTIVETo evaluate the diagnostic value of endoscopic ultrasonography (EUS) for submucosal tumors (SMTs) of upper gastrointestinal tract.

METHODSA retrospective analysis was made based on clinical data of 206 upper gastrointestinal SMTs patients from January 2009 to July 2013 in The First Affiliated Hospital of Soochow University. Preoperative EUS findings were compared with postoperative pathological diagnosis, and the sensitivity, specificity and accuracy of EUS diagnosis in property and layer origin of SMTs were calculated.

RESULTSThe sensitivity, specificity and accuracy of EUS diagnosis in SMTs property were 60.2%, 67.1% and 61.2%. The sensitivity, specificity and accuracy of EUS diagnosis in layer origin of SMTs were 98.0%, 98.2% and 98.1%.

CONCLUSIONEUS has limited value in the diagnosis of property of SMT, and has high accuracy of identifying the origin layer, which is helpful to choose therapeutic schedule of SMT under endoscopy.

To establish a quantitative estimate model for diagnosing traditional Chinese medicine (TCM) syndromes of patients with osteoporosis.

To establish diagnostic criteria for common traditional Chinese medicine (TCM) syndromes in osteoporosis.

Objective To evaluate the therapeutic value of endoscopic jejunal tube placement, endoscopic clipping, and over the scope clip ( OTSC) for digestive fistula. Methods Data of 38 patients with digestive fistulas at the First Affiliated Hospital of Soochow University admitted from July 2015 to July 2017 were retrospectively analyzed. Treatments were chosen according to the size and the site of the fistulas. Thirteen patients underwent jejunal tube placement ( the jejunal tube group ) , 20 underwent endoscopic clipping( the endoscopic clipping group) , and 5 underwent OTSC( the OTSC group) . The technical success rate, clinical cure rate and postoperative hospital stay were analyzed. Results All patients received the endoscopic operation successfully with no significant complications. In the jejunal tube group, 4 patients′fistulas fully healed, lesion was smaller after treatment in 3 patients, lesion didn′t change in 5 patients, and 1 patient died. The complete cure rate was 30. 8％ (4/13), and the postoperative hospital stay was 47. 4± 14. 1 days. For the endoscopic clipping group, 16 patients′ fistulas fully healed, lesion was no smaller compared with that before treatment in 3 cases, and 1 patient died. The complete cure rate was 80. 0％ ( 16/20) , and the postoperative hospital stay was 17. 9 ± 8. 9 days. Total patients in the OTSC group were completely cured, with 100. 0％( 5/5) of complete cure rate. One patient with refractory esophageal fistula underwent OTSC repeatedly with endoscopic clipping, and the healing time of fistula was 102 days. The postoperative hospital stay of 4 others was 5. 3±1. 7 days. The cure rate of fistula was higher (P=0. 03, P<0. 001) and the postoperative hospital stay was shorter ( P=0. 04, P<0. 001) in the OTSC group compared with the clipping group and the jejunal tube group. Conclusion Endoscopic management is safe and effective for digestive fistulas with less trauma, easy performance and short time of healing.

Objective To evaluate the feasibility and safety of endoscopic treatment for gastric stromal tumors with maximum diameter of 3 to 5 cm. Methods From April 2010 to April 2016, a retrospective analysis was performed on the data of patients with gastric stromal tumors undergoing endoscopic (29 cases)or laparoscopic(26 cases)resection in the First Affiliated Hospital of Soochow University. Baseline data, perioperative data and follow-up data were collected and analyzed. Results There was significant difference on tumor location between the two groups(χ2=12.173, P=0.007). Tumors mainly located at gastric fundus in the endoscopic group(65.5%,19/29),while at gastric body in the laparoscopic group(61.5%, 16/26). Compared with the laparoscopic group, patients in the endoscopic group had shorter operation time[45(35, 60)min VS 70(60, 85)min, U = 686.000, P<0.05], lesser intraoperative blood loss[15(10,15)mL VS 20(10, 20)mL, U=513.000, P=0.017], and earlier recovery time of gastrointestinal function[12(6, 24)h VS 20(18, 24)h, U=585.500, P<0.001]. Compared with the laparoscopic group, the patients in the endoscopic group had a higher complication rate[55.2%(16/29)VS 11.5%(3/26), χ2=11.543, P<0.001]and a lower intact tumor removal rate [89.7%(26/29)VS 100.0%(26/26),χ2=23.989,P<0.001]. The other perioperative parameters such as the incidence of intraoperative major bleeding, postoperative peritonitis, postoperative fasting time, hospitalization time and total hospitalization expenses showed no statistical different(all P>0.05). The postoperative follow-up time was 30.0(17.5,50.0)and 38.5(26.0,49.8)months in the endoscopic and laparoscopic group,respectively. There was no significant difference in the recurrence rate between the two group[3.4%(1/29)VS 7.7%(2/26),χ2=0.009,P=0.922]. Conclusion Endoscopic resection may be an alternative therapeutic approach for large gastric stromal tumors with shorter operation time, less intraoperative blood loss,and earlier recovery time of gastrointestinal function.

Objective To evaluate effects and safety of mixed solution of sodium hyaluronate, normal saline and indicarmine during endoscopic submucosal dissection(ESD). Methods A total of 233 patients with gastric, esophageal and colonic lesions diagnosed by endoscopy in the digestive endoscopy center of the First Affiliated Hospital of Soochow University between September 2015 and November 2016 were randomly divided into the experimental group(173 patients)and the control group(50 patients). The experimental group was injected with sodium hyaluronate 100 mg+normal saline 60 mL+0.2% indicarmine 4 mL, and the control group with normal saline 70 mL+0.2% indicarmine 4 mL. The solutions were used for multi-point injection in submucosa outside markers of lesions, respectively, and ESD was performed until lesions were effectively lifted up. The location and size of lesions, operation time, dose of injection and the incidence of complications were compared between the two groups. Results The diameter of resected specimen was 1.9± 1.3 cm in the experimental group, slightly less than that in the control group(2.0 ± 1.8 cm,P>0.05). The operation time from lesion mark to the end of ESD in the experimental group was 59.5±26.7 min,significantly less than that in the control group(68.6±29.0 min, P<0.05). The dose of injection in the experimental group(55.5 ± 31.8 mL)was obviously lower than that in the control group (66.7±35.1 mL,P<0.05). The rate of delayed bleeding in the experimental group was 1.16%(2/173),which was significantly lower than that in the control group[12.00%(6/50), P<0.05]. No delayed perforation occurred in the experimental group,while 3 cases(6.00%)occurred in the control group(P<0.05). Conclusion ESD shows better effects and high safety after the submucosal injection of mixed solution of sodium hyaluronate,normal saline and indicarmine.

Objective To analyze the clinical characteristics and prognosis of patients with rectal gastrointestinal stromal tumor ( GIST) . Methods We collected the data of 31 rectal GIST patients definitely demonstrated by pathology and immunohistochemistry in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University, and Suzhou Wuzhong People′s Hospital from January 2008 to December 2016. The clinical characteristics, therapeutic modalities, and prognoses were retrospectively analyzed. Results Among the 31 rectal GIST patients, 16 underwent local resection and 15 underwent radical surgery. There was no significant difference on the three-year survival rate between the two groups [ 93. 8％ ( 15/16 ) VS 73. 3％ ( 11/15 ) , P=0. 135 ] . There was no significant difference on the survival rate between the oral imatinib patients and non-oral imatinib patients in the local resection group [ 75. 0％ ( 3/4) VS 100. 0％ ( 12/12) , P=0. 083] and the radical surgery group[ 77. 8％ ( 7/9) VS 66. 7％(4/6), P=0. 579]. The postoperative recurrence and metastasis rate of the two groups was no significantly different[31. 3％ (5/16) VS 53. 3％ (8/15), P=0. 213]. Conclusion The choice of surgical procedure has no significant effects on the survival rate and postoperative recurrence for rectal GIST patients, and whether oral imatinib or not has no significant effects on the survival of patients.