Objective To compare the clinical efficacy of cold snare endoscopic mucosal resection(CS-EMR)with conventional endoscopic mucosal resection(EMR)in the treatment of＜20 mm colorectal laterally spreading tumor(CLST).Methods A total of 248 CLST patients undergoing endoscopic resection treated in the First People's Hospital of Huzhou from January 2020 to June 2022 were selected and divided into EMR group and CS-EMR group according to random number table method,with 124 cases in each group.The general data,focal features,surgical indicators and complication rate of two groups were statistically compared.Results There were no significant differences in en bloc resection rate,complete resection rate and postoperative recurrence rate between two groups(P＞0.05).The operation time and hospital stay in CS-EMR group were significantly shorter than those in EMR group,the number of titanium clips and hospitalization costs were significantly lower than those in EMR group,and the incidence of intraoperative bleeding,delayed bleeding and delayed perforation were significantly lower than those in EMR group(P＜0.05).Conclusion In treatment of CLST with a maximum diameter of＜20mm,CS-EMR not only retains the advantages of fewer surgery-related complications,but also has similar therapeutic effect as EMR,and reduces the cost burden of patients,which is worthy of clinical reference and promotion.

Objective: To investigate the clinicopathological features and molecular phenotypes of gastric cancer with enteroblastic dif-ferentiation (GCED). Methods: A retrospective analysis of 337 patients with gastric adenocarcinoma diagnosed by the pathology de-partment of the First Affiliated Hospital of Zhejiang University in March 2013-2017 was conducted. Of them, 8 patients were diag-nosed with gastric carcinoma with intestinal blastocyte differentiation. All the patients were elderly, including 6 men and 2 women. The onset age was 68-83 years (mean 76.6 years). Two cases had serum AFP≥200 μg/L before treatment. According to the histopatho-logical morphology, the immunophenotype was analyzed by immunohistochemistry, the SALL4 gene was detected using reverse tran-scription-polymerase chain reaction (RT-PCR), and the relevant literature was reviewed. Results: Microscopically, all cases had primi-tive enteroid structures, consisting of cubic or columnar cells with clear cytoplasm, and immunohistochemical staining showed positivi-ty for either AFP and GPC3 or SALL4. The expression of SALL4 mRNA was significantly increased by RT-PCR. Follow-up from 1 to 5 years showed that 5 patients had liver and other organ metastases, 2 patients died, and 1 patient survived without a tumor. Conclusions:GCED is a rare invasive gastric adenocarcinoma with a worse prognosis than that of normal intestinal adenocarcinoma. The treatment of general intestinal adenocarcinoma has little effect. There are some characteristic changes in histology. It would be helpful for diag-nosis and differential diagnosis if clinicians are familiar with the tumor spectrum and genetic characteristics. Target therapy for an origi-nal marker, such as SALL4, has a bright future.