Gastrointestinal benign stricture is a common disease with symptoms of dysphagia,abdominal pain and difficult defecation,which severely impair the quality of life for patients.Endoscopic intervention is the first-line treatment,and the available methods include balloon dilation,local drug injection and stent insertion,etc.Endoscopic incision was first used for the treatment of Schatzki's rings,and later it was used for the treatment of other gastrointestinal benign strictures,and the promising results were achieved.

Objective To investigate the risk factors and incidence of gas-related complications in peroral endoscopic myotomy for easophageal achalasia.Methods Clinical data of 216 patients with achalasia treated by peroral endoscopic myotomy from August 2011 to November 2013 were collected.Potential risk factors for gas-related complications were analyzed by univariate and multivariate analysis.Results The incidence of gas-related complications was 10.2％ (22/216).Univariate analysis showed risk factors for complications were Sigmoid type esophagus,simple longitudinal incision for tunnel entry,tunnel width ≤3 cm,degree of myotomy,and operation time (P ＜ 0.05),while multivariate analysis showed the risk factors were Sigmoid type esophagus,simple longitudinal incision for tunnel entry,and tunnel width ≤3 cm(P ＜ 0.05).Conclusion Simple longitudinal incision for tunnel entry,tunnel width≤3 cm and sigmoid type esophagus are risk factors of gas-related complications in POEM,while myotomy depth is not.

Objective To compare the efficacy and safety of full-thickness peroral endoscopic myotomy (POEM) and circular myotomy for patients with severe achalasia.Methods The clinical data of 123 patients with severe achalasia who were admitted to the Second Xiangya Hospital of Central South University from August 2011 to May 2013 were retrospectively analyzed.Seventy patients who received full-thickness POEM were in the full-thickness myotomy group,and the other 53 patieuts who received circular myotomy were in the circular myotomy group.The clinical efficacies and incidences of complications of the 2 groups were compared.Patients in the 2 groups were followed up at the out-patient department till May 2014.The consecutive measurement data were presented by (x) ± s and analyzed using thc t test; the non-consecutive data were presented by M (range) and analyzed using the Wilcoxon rank test.Data before and after operation were compared using the repeated measure of analysis of variance.The count data were analyzed using the chi-square test.Results All the patients successfully received POEM.The operation time of the full-thickness myotomy group and the circular myotomy group were (57 ± 8)minutes and (63 ± 12)minutes,with significant difference between the 2 groups (t =3.421,P ＜0.05).The incidences of complications of the full-thickness myotomy group and the circular myotomy group were 14.3％ (10/70) and 11.3％ (6/53),with no significant difference between the 2 groups (x2=0.234,P ＞0.05).Atotal of 119 patients were followed up,with the median time of 18 months (range,12-24 months).The Eckardt scores at postoperative month 6 and 12 were 0 (range,0-3) and 0 (range,0-3) in the full-thickness myotomy group,and 0 (range,0-2) and 0 (range,0-3) in the circular myotomy group,with no significant difference between the 2 groups (Z =0.525,1.476,P ＞ 0.05).The sussess rates of the full-thickness myotomy group and the circular myotomy group were 98.6％ (69/70) and 98.1％ (52/53),with no significant difference between the 2 groups (x2=0.040,P ＞ 0.05).The diameters of the esophagus at postoperative month 6 of the full-thickness myotomy group and the circular myotomy group were (3.2 ± 0.3) cm and (3.4 ± 0.4) cm,with no significant difference between the 2 groups (t =1.927,P ＞ 0.05).The diameters of the esophagus at postoperative month 6 and 12 were significantly lesser than (5.9 ± 1.0) cm and (5.9 ± 1.0) cm before operation (F =780.923,493.018,P ＜ 0.05).No recurrence was detected in the 2 groups during the follow-up.Conclusion The short-term efficacy and incidence of complications of full-thickness myotomy and circular myotomy are comparable,while the operation time of patients who received full-thickness myotomy is shorter.

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) till August 2014.Measurement data with normal distribution were presented as average (range).Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes).Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days).All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.

Background:There have been several studies about peroral endoscopic myotomy( POEM)for treating esophageal achalasia( EA). Although the feasibility,safety and effectiveness of POEM have been demonstrated,comparative studies of full-thickness and circular muscle myotomy were rare. Aims:To evaluate the efficacy and safety of POEM for treating patients with EA. Methods:A total of 216 patients with EA admitted from Aug. 2011 to Nov. 2013 at the Second Xiangya Hospital of Central South University were treated with POEM,of whom 133 received full-thickness myotomy and 83 received circular muscle myotomy. Data about Eckardt ’s score, diameter of esophageal lumen, intra- and post-operative complications and recurrence before and/or during periodical follow-up were collected,and the efficacy of full-thickness and circular muscle myotomy was compared. Results:All the 216 patients successfully underwent POEM with an average operation time of 59. 1 minutes. Average length of tunnel and myotomy were 13. 3 cm and 10. 1 cm,respectively. Symptoms remitted in all of the 216 patients,Eckardt’s score decreased significantly,diameter of esophageal lumen was reduced(pre-treatment vs. 6 months after treatment,53. 7 mm vs. 30. 8 mm,P<0. 001),and complications occurred in 13. 0%(28/216)of the cases. Success treatment was achieved in 99. 1%(214/216)of the cases with a follow-up of 3-30 months( mean 13. 8 months),no recurrence was noted. The operation time,efficacy and complications were comparable between full-thickness and circular muscle myotomy(P>0. 05). Conclusions:POEM is an effective and safe method for treating EA. Full-thickness myotomy did not increase the operation time and procedure-related complications, however,its long-term efficacy and complications need to be further assessed.

Objective To evaluate the efficacy and safety of peroral endoscopic full-thickness myotomy for patients with severe esophageal achalasia.Methods A total of 64 patients with severe achalasia,whose Eckardt's score ≥6,esophageal diameter ≥6 cm or with S-type esophagus,were treated by peroral endoscopic full-thickness myotomy.Data of Eckardt's score,complications,recurrence,gastroscopy and esophageal barium radiography were collected before and during periodical follow-up.Results All the 64 patients underwent peroral endoscopic myotomy (POEM) successfully,mean operation time was 55 minutes,average length of tunnel and myotomy were 14.1 cm and 10.6 cm respectively,and full-thickness myotomy was performed beyond 6 cm near esophagogastric junction.Symptoms remitted in all patients.Eckardt's score decreased significantly [pre-treatment VS post-treatment,(7.4 ± 1.5) VS (0.6 ± 0.8),P ＜ 0.001],the diameter of esophageal lumen reduced[pre-treatment VS post-treatment,(59.7 ± 13.0) mm VS (31.4 ±3.3) mm,P ＜ 0.001),and the diameter of cardia increased [pre-treatment VS post-treatment,(15.6 ± 10.1) mm VS (33.4 ± 8.9) mm,P ＜ 0.001].Complications occurred in 9.4％ (6/64) of the cases,gas-related complications was 6.3％ (4/64).Treatment success was achieved in 98.4％ cases (63/64) with a follow-up of 6 ～20 months (median 12.3 months),with no recurrence cases.Conclusion Peroral endoscopic full-thickness myotomy is an effective and safe method for severe achalasia.Long-term efficacy and complications need further assessment.

Objective:To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for treatment of duodenal lesions.Methods:A retrospective analysis was performed on the data of 45 patients with 46 duodenal lesions who underwent ESD at the Second Xiangya Hospital of Central South University from January 2011 to May 2019. The lesion features, en bloc resection rate, complete resection rate, complications, postoperative pathology and recurrence were assessed.Results:Among the 45 patients, 20 were males and 25 were females, with age of 52.0±11.8 years. Of the 46 lesions, 31 (67.4%) were located in the duodenal bulb, 12 (26.1%) in the descending part, and 3 (6.5%) at the junction of bulb and descending part. The diameter of the lesions was 2.4±1.9 cm. There were 14 (30.4%) lesions originated from mucosal layer, 29 (63.1%) from submucosal layer, and 3 (6.5%) from muscularis propria.Postoperative pathology showed 11 (23.9%) cases of Brunner gland tumors, 9 (19.6%) neuroendocrine tumors, 5 (10.9%) ectopic pancreas, 5 (10.9%) lipomas, and 16 (34.8%) other pathological patterns. All 45 patients with 46 lesions underwent ESD successfully, and the en bloc resection rate was 100.0% (46/46), complete resection rate was 91.3% (42/46). Intraoperative bleeding occurred in 1 case (2.2%), which was successfully treated by endoscopy. One (2.2%) delayed perforation occurred and was treated by surgical intervention. Electrocoagulation syndrome occurred in 1 case (2.2%), which was relieved after conservative medical therapy. Two cases received further surgery after ESD. The mean hospital stay was 6.2 days (ranged 2-21 days) and no death occurred. Forty-one cases were followed up for 1-78 months, with mean time of 30 months. During the follow-up period, local recurrence occurred in 1 patient (2.4%).Conclusion:ESD is an effective and safe treatment for duodenal lesions and has a good clinical practical value.

From June 2017 to May 2021, 11 patients with insulinomas received endoscopic ultrasound-guided fine needle injection (EUS-FNI) at the Department of Gastroenterology, the Second Xiangya Hospital of Central South University. During a median follow-up of 45 months (12-60 months), symptoms of 6 patients were relieved with only 1 procedure of EUS-FNI, 4 relieved with 2 procedures, and only 1 patient required more than 2 procedures. The results above preliminarily reveal that medium to long-term efficacy of EUS-FNI for insulinoma is good.

To compare the safety and efficacy between endoscopic submucosal dissection (ESD) and radical surgery (RS) for the treatment of large colorectal laterally spreading tumors (LST) larger than 50 mm in diameter. 
 Methods: From January 2011 to January 2016, a total of 82 patients were diagnosed as large LST without deep submucosal invasion (T1 SM2, ≥1 000 µm) in the Second Xiangya Hospital of Central South University. Among them, 52 patients were treated by ESD and the other 30 patients were treated by RS [laparoscopic-assisted colectomy (LAC)/open colectomy (OC)]. The clinic data were retrospectively analyzed and the en-bloc resection rate, en-bloc R0 resection rate, local recurrence, complication, procedure time and hospital stay were collected and analyzed.
 Results: The lesion sizes were (5.80±1.20) cm and (5.53±0.69) cm in diameter for ESD and RS groups, respectively (P>0.05). En-bloc resection rates, en-bloc R0 resection rates and recurrence rates showed no significant difference between the ESD group and RS group (P>0.05). Complication rate of the ESD group (7.69%, 4/52) was much lower than that in the RS group (33.33%, 10/30; P<0.01). The ESD group also had a shorter hospital stay and operation time than the RS group (P<0.05).
 Conclusion: ESD appears to be a safe, minimal invasive and effective strategy for treating large LST and it is obviously better than RS in the aspects of hospital stay, operation time and short-term complication.
Colorectal Neoplasms ; pathology ; surgery ; Dissection ; Endoscopic Mucosal Resection ; standards ; Humans ; Intestinal Mucosa ; pathology ; surgery ; Neoplasm Recurrence, Local ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

Subphrenic splenic implantation is a rare disease, usually occurred followed the splenic trauma and splenectomy. Surgeries are often necessary for diagnosing and treating it. A 46-year-old male post-splenectomy patient, tolerating abdominal bloating and pain for more than 1 year, was admitted to the Second Xiangya Hospital, Central South University. Fundus bulge suggested a possibility of stromal tumors originating from the muscularispropria layer with endoscopic ultrasound. Slightly stomachic thickness was detected using enhanced computed tomography (CT). Without any improvement for symptoms after medication, the patient strongly requested to undergo an endoscopic therapy. Natural orifice transluminal endoscopic surgery (NOTES) result confirmed it as subphrenic splenic implantation with postoperative pathology. In this case, NOTES helped us to confirm the diagnosis, relieve the symptoms, as well as prevent secondary surgery injury, which would be helpful to other clinicians.
Endoscopy ; Gastric Fundus ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Splenectomy/adverse effects* ; Tomography, X-Ray Computed