Objective To investigate the clinical characteristics of gastrointestinal stromal tumor (GIST) of the stomach and to analyze the corresponding prognostic factors. Methods We retrospectively reviewed the clinical data of 121 patients in our hospital from March 1996 to March 2008. Gender、age、tumor size and histological type were analyzed. Results For these 121 cases the median survival time is 73.2 months. The overall 1-、3-、and 5-year survival rates were 82%, 59% and 50% respectively. The tumor-free survival rates for 1-、3-、and 5-yeas were 65%, 46% and 33% respectively. Cox univariale analysis revealed that gender、tumor size、organ involvement and recurrence were factors impacting prognosis. Cox multivariate analysis revealed that gender、tumor size、organ involvement、recurrence were prognostic factors for gastric GIST. Conclusions Male sex、tumor size (> 10 cm) and involvement of organ were independent indicators for a poor prognosis in patients with primary malignant gastric GIST.

Objective To explore the clinical safety of peroral endoscopic cardial constriction for gastro-esophageal reflux.Methods Clinical data of 47 patients with gastro-esophageal reflux who underwent peroral endoscopic cardial constriction in Chinese PLA General Hospital were retrospectively studied from August 2013 to August 2016.Results A total of 47 patients underwent peroral endoscopic cardial constriction successfully with no perforation or fever.Retrostemal vague pain and discomfort occurred in 7 cases,mild dysphagia occurred in 2 cases,and mild hemoptysis occurred in one patient the day after the operation.No special measures were taken and all 10 patients showed symptom remission in less than two days.As for the postoperative treatment,22 (46.8％) patients were given a liquid diet on the day of operation,39(82.9％) patients were given semi-or liquid diet on the first day after the operation,and two days later,43 (91.5％) resumed semi-or liquid diet.Only 9 cases were given antibiotics for prophylaxis for infection.Conclusion Peroral endoscopic cardial constriction is safe and effective for gastro-esophageal reflux.The hospitalizing time is short and postoperative recovery is quick.

Objective To explore the reasons for lateral and basal incomplete resection of precancerous lesions or cancer from upper digestive tract by endoscopic submucosal dissection (ESD).Methods Data of 295 patients undergoing ESD for upper gastrointestinal precancerous lesions or cancer from November 2006 to October 2011 were collected,and reasons of basal or lateral incomplete resectin confirmed by postESD pathology were analyzed.Results The total incomplete resection rate after ESD was 3.05％ ( 9/295 ).Among 95 cases of esophageal ESD,there was 1 case of lateral margin incomplete resection because of the retraction of normal tissue after dissection.Among 200 cases of gastric ESD,there were 5 cases of lateral margin incomplete resection,in which 2 cases were signet ring carcinoma with submucosal infiltration and spreading,2 were due to retraction of normal tissue after dissection,and 1 was due to inaccurate judgment on cancer demarcation.There were 3 cases of basal incomplete resectin in gastric ESD,which was caused by incorrecte invasion depth estimation before ESD.Conclusion The rate of basal or lateral incomplete resection in upper gastrointestinal ESD was low,which is related to pathological type,ESD procedure and estimation of invasion depth before ESD.

OBJECTIVETo compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM.

METHODSPOEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications.

RESULTSAll the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0∓18.0 min vs 74.1∓18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3∓9.0 min vs 45.4∓10.5 min; 10.2∓4.6 min vs 15.5∓5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis- related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula.

CONCLUSIONSPOEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.

Adolescent ; Adult ; Endoscopy ; Esophageal Achalasia ; surgery ; Female ; Humans ; Male ; Middle Aged ; Tendons ; surgery ; Treatment Outcome ; Young Adult

Objective:To analyze the differences in clinical and endoscopic ultrasonography (EUS) findings between diffuse and focal IgG4-related autoimmune pancreatitis (IgG4-AIP).Methods:Data of patients diagnosed as having IgG4-AIP who underwent EUS at Chinese PLA General Hospital from September 2011 to April 2022 were retrospectively collected. General clinical data, EUS features, and postoperative pathology were analyzed for characteristic differences.Results:A total of 40 patients were included in the study, 60.03±10.87 years old, a higher proportion of males (85.0%, 34/40). All patients underwent EUS, and 28 underwent EUS-guided fine-needle aspiration. Among the 40 patients, 29 (72.5%) had diffuse type and 11 (27.5%) had focal type. Abdominal pain [65.5% (19/29) VS 18.2% (2/11), χ2=5.393, P=0.020] and thickening of the bile duct wall [51.7% (15/29) VS 9.1% (1/11), χ2=4.394, P=0.036] were more common in the diffuse type, while main pancreatic duct dilation [45.5% (5/11) VS 10.3% (3/29), χ2=4.146, P=0.042] was more common in the focal type, with the lesion most commonly located in the pancreatic head (90.9%, 10/11). There was no significant difference in the presence of chronic pancreatitis parenchymal changes between the two groups [34.5% (10/29) VS 27.3% (3/11), χ2=0.003, P=0.955]. Conclusion:There are certain differences in abdominal pain and biliary and pancreatic duct lesions between diffuse and focal AIP. The high expression of chronic pancreatitis characteristics is not observed in either group, which provides clues for the classification of AIP in clinical practice.

Objective To compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM. Methods POEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications. Results All the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0±18.0 min vs 74.1±18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3±9.0 min vs 45.4±10.5 min;10.2±4.6 min vs 15.5±5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis-related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula. Conclusions POEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.

Objective To compare the safety and efficiency of transverse-incision peroral endoscopic myotomy (POEM) with longitudinal-incision POEM. Methods POEM, with a transverse or longitudinal entry incision, was performed in 53 consecutive patients with confirmed achalasia (AC) between December 2010 and September 2012. Data of those patients was collected including the time spent for different procedures and complications. Results All the 53 patients underwent POEM successfully, among whom 41 patients had a transverse entry incision and 12 had a longitudinal incision. Treatment success (Eckardt score≤3) with a follow-up for 3-24 months (median 5 month) was achieved in 96.2% of the cases (mean score pre-treatment vs. post-treatment: 7.5 vs 0.6, P<0.001). The whole operation time of transverse-incision group was slightly shorter than that of longitudinal-incision group (65.0±18.0 min vs 74.1±18.2 min, P=0.142), but it took much less time in tunnel built-up and muscle dissection in the transverse-incision group (36.3±9.0 min vs 45.4±10.5 min;10.2±4.6 min vs 15.5±5.5 min, P<0.05). In addition, patients in transverse incision group were much less likely to develop pneumatosis-related complications [9.8% (4/41) vs 41.7% (5/12), P<0.05). No serious complications occurred in these two groups such as pleural effusion, mediastinitis or digestive tract fistula. Conclusions POEM with a transverse entry incision can significantly decrease the operation time and reduce the incidence of pneumatosis-related complications while obviously relieving the symptoms.

OBJECTIVETo compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms.

METHODSA total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis.

RESULTSOf the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4∓5.2 mm(2)/min vs 12.2∓4.0 mm(2)/min, P<0.05). Despite a similar en bloc rate between the two groups (100% [11/11] vs 88.9% [16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8% [9/11] vs 66.7% [12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05).

CONCLUSIONESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.

Aged ; Endoscopy ; Esophageal Neoplasms ; surgery ; Esophagus ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mucous Membrane ; surgery ; Retrospective Studies

Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min, P<0.05). Despite a similar en bloc rate between the two groups (100%[11/11]vs 88.9%[16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8%[9/11]vs 66.7%[12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.

Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min, P<0.05). Despite a similar en bloc rate between the two groups (100%[11/11]vs 88.9%[16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8%[9/11]vs 66.7%[12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.