Objective:To investigate the clinicopathological features of gastric adenocarcinoma of fundic gland type (GA-FG).Methods:A total of 12 patients, including 7 cases treated with endoscopic submucosal dissection (ESD), were diagnosed as having GA-FG in Nanjing Drum Tower Hospital from January 2018 to August 2019. Morphological changes were analyzed by reviewing endoscopic and pathological results. Patients were followed up after definitive diagnosis.Results:The clinical symptoms of patients with GA-FG were nonspecific. No Helicobacter pylori infection was identified. The lesions were found in the non-atrophic gastric mucosa of the upper 1/3 portion in 10 cases and middle 1/3 portion in 2 cases. Endoscopically, the most common features were whitish color (9 cases), and all lesions diameter≤1 cm. Their macroscopic types were classified as 0-Ⅰ (2 cases), 0-Ⅱa (9 cases) and 0-Ⅱc (1 case) respectively. All lesions had sharp boundary, with branching dilated blood vessels on the surface. Five in 7 cases who were treated with ESD showed submucosal invasion. Immunohistochemically, 9 cases were classified as the chief cell type , 3 as the mixed type, 11 MUC6 positive, 4 MUC5AC positive, 2 MUC2 positive, and 3 CD10 positive. P53 was detected in all 12 cases, and 9 cases had low Ki-67 staining index (<10%). The mean time of follow-up was 11 months, and 11 patients survived. Conclusion:GA-FG should be taken into consideration when the polyps are found in the upper part of the stomach, with whitish color, and branch dilated blood vessels on the surface. Excellent clinical outcomes can be achieved for GA-FG patients with ESD.

Objective To evaluate the feasibility and safety of endoscopic ultrasound-guided microwave ablation ( EUS-MWA ) for porcine liver and pancreas by assessing physiological state and pathological changes. Methods EUS-MWA was performed on liver and pancreas of 8 healthy pigs after general anesthesia. The needle size was 1. 9 mm in diameter, and the power of ablation was 65 W, 10 min on liver and 60 W, 5 min on pancreas. The levels of blood amylase and hepatic transaminase were examined before and after the operation. All pigs underwent CT scan on the right postoperative day to assess the extent of ablation and complications. Two pigs were killed 6 hours after operation and 2 others were killed 24 hours after operation to assess structural damage around the puncture path. The remaining 4 pigs were raised to 2 weeks after operation to observe diet, activities and mental state. The ablated areas of liver and pancreas underwent pathological analysis after dissection, and non-ablation regions were treated as the control. Results All 8 pigs underwent EUS-MWA and their vital signs were stable during the operation. Except for the difficulty in locating the pancreas in one case, other surgical procedures were smooth and 18 ablations were performed totally ( 10 in liver and 8 in pancreas) . CT scans showed quasi-circular low density lesions in the liver and pancreas, and the maximum diameter of the ablation area in liver and pancreas was 2. 8 ± 0. 3 cm, 1. 8±0. 2 cm respectively. There was no free intraperitoneal gas, ascites or pleural effusion. The level of blood amylase increased at 6 hours after operation and the peak value occurred within 12-24 hours. The level of hepatic transaminase had a mild elevation. The rearing group showed transient food refusal and activity reduction after the operation, but all returned to normal within 1-2 days. No fever, vomiting or other abnormalities occurred. Puncture path burn, adjacent organ damage and bleeding was not observed except for one case of gastric wall burns during pancreas ablation. Pathology showed massive coagulative necrosis and peripheral bleeding area in the liver ablation center, and diffuse focal necrosis in the tissue of the pancreatic ablation area. Conclusion EUS-MWA is safe and feasible for porcine liver and pancreas, which can be used for the treatment of human liver and pancreatic diseases in the future.

Objective:To compare the efficacy and safety of endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR) for intraluminal gastric stromal tumors.Methods:Data of 441 patients diagnosed as having gastric stromal tumors in Nanjing Drum Tower Hospital from June 2009 to June 2020 were retrospectively analyzed. A total of 241 patients underwent ESE (ESE group) and 200 EFR (EFR group). Epidemiological data (gender, age and body mass index), tumor size, procedure related parameters, complications, hospital stay, cost and follow-up were compared between the two groups.Results:There were no significant differences between the two groups in gender, age, body mass index, tumor size, National Institutes of Health risk grade, complete resection rate, or block resection rate ( P>0.05). Compared with the EFR group, the ESE group required less titanium clips to close defects in the stomach wall [6.0 (4.0, 6.0) VS 6.0 (5.0, 8.0), U=18 424.0. P<0.001], shorter time of first postoperative fluid intake [2.0 (1.0, 2.0) days VS 2.0 (2.0, 3.0) days, U=17 420.0, P<0.001] and hospital stay [6.0 (5.0, 8.0) days VS 7.0 (6.0, 9.0) days, U=18 906.0, P<0.001], and lower total cost [18.9 (16.4, 21.4) thousand yuan VS 20.9 (18.1, 23.8) thousand yuan, U=17 956.0, P<0.001]. Moreover, the total incidence of complications of the ESE group was lower than that of the EFR group [5.8% (14/241) VS 11.5% (23/200), χ2=4.605, P=0.032]. Patients were followed up with the median period of 45.0 months. The disease recurrence rate was 0.45% (2/441), and there were no disease-related deaths. Conclusion:The efficacy is comparable between ESE and EFR for treating intraluminal gastric stromal tumors, but ESE shows a lower incidence of complications, and requires a shorter hospital stay and lower cost.

Objective:To investigate the clinical, endoscopic and pathologic characteristics of gastric hyperplastic polyps coexisting with gastric cancers.Methods:A retrospective study was performed involving 18 patients who were pathologically confirmed with gastric hyperplastic polyps coexisting with gastric cancers. The clinical features, endoscopic findings, pathological characteristics and treatment strategy were analyzed.Results:The age of 18 patients was 67. 2±7. 8 years (ranged 45-79), including 6 males and 12 females. The symptoms included abdominal pain, distention, and some patients were asymptomatic. Multiple polyps (13/18) were common. Single lesions were often located in the gastric corpus (7/18). Endoscopy showed various morphological changes. Pedunculated polyp was the most common type (15/18). All polyps were larger than 10 mm in diameter, and the polyps in 9 patients were larger than 20 mm. Fourteen patients had atrophic gastritis in the background mucosa, and 4 patients had Helicobacter pylori ( HP) infection. Conclusion:Gastric hyperplastic polyps coexisting with gastric cancers shows no specific symptoms. For HP (-) atrophic gastritis patients accompanied with multiple gastric polyps, malignant transformation of those larger and pedunculated polyps is of possibility.

Objective:To evaluate the safety and efficacy of indwelling cutting with guidewire in treatment of difficult pancreatic duct stricture.Methods:A retrospective study was performed on the data of patients with chronic pancreatitis, who failed to implant pancreatic duct stent by endoscopic retrograde cholangiopancreatography (ERCP) and whose narrow pancreatic duct only allowed the guidewire to pass through, in Nanjing Drum Tower Hospital from November 2017 to April 2019. The dilatation effect of guidewire indwelling on difficult pancreatic duct stenosis was studied. The duration of guidewire indwelling, the success rate of stent re-implantation, the level of postoperative amylase, recent complications, and follow-up results were analyzed.Results:A total of five patients received indwelling guidewire after failure of dilation of pancreatic duct stenosis during ERCP. After 2.4 days of mean indwelling time, all patients received re-ERCP. The narrow pancreatic duct was successfully expanded and the stent was placed. In terms of complications, only one patient suffered from acute pancreatitis after the first ERCP, and was improved after medical treatment.Conclusion:Guidewire indwelling is a new simple, safe, and effective method for dilatation of pancreatic duct stenosis, and has important clinical value in the management of difficult intubation of pancreatic duct in chronic pancreatitis.

Objective:To study the different clinical features of early gastric cardia carcinoma (EGCC) patients with synchronous tumor, and identify the risk factors and prognosis of the occurence of synchronous tumor after endoscopic resection.Methods:A retrospective study was made on the data of 499 patients (512 lesions) who underwent cardiac endoscopic submucosal dissection (ESD) and were pathologically confirmed as EGCC in Nanjing Drum Tower Hospital from January 2011 to June 2018. The patients were divided into synchronous tumor group (47 patients with 50 lesions) and non-synchronous tumor group (452 patients with 462 lesions). Univariate and multivariate logistic regression analysis were performed to identify independent risk factors for the occurrence of synchronous tumor. Kaplan-Meier method was conducted to prognosis. Differences between the two groups were analyzed for significance by the log-rank test.Results:Among the 499 patients, the incidence of synchronous tumor was 9.4% (47/499). Logistic regression analysis showed that the lesion size ( P=0.046, OR=0.807, 95% CI: 0.653-0.996), atrophic gastritis and intestinal metaplasia ( P=0.017, OR=3.207, 95% CI: 1.229-8.371), Helicobacter pylori infection ( P=0.046, OR=1.952, 95% CI: 1.013-3.761) were independent risk factors for the occurrence of synchronous tumor after endoscopic resection. A total of 453 (90.8%)patients were successfully followed up. Kaplan-Meier curve showed that the overall survival rate of the synchronous tumor group and the non-synchronous tumor group were 95.2% and 97.6%, respectively ( P=0.72). Conclusion:The incidence of EGCC accompanied with synchronous tumor is not high, but it should not be neglected. For patients with small lesions, it is necessary to consider the possibility of main cancer in other parts. For patients with Helicobacter pylori infection or severe mucosal atrophy and intestinal metaplasia, more attention should be paid to the mucosa around the lesion during endoscopic examination and strict endoscopic follow-up should be carried out.

Objective:To evaluate the long-term efficacy of endoscopic transluminal drainage(ETD) for acute pancreatitis complicated with walled-off necrosis (WON) or pancreatic pseudocyst (PPC).Methods:A total of 79 patients who were diagnosed as having WON or PPC by abdominal CT or ultrasound and treated with ETD in Nanjing Drum Tower Hospital were enrolled. Past medical records and follow-up by phone call after discharge were analyzed for long-term outcomes including endocrine and exocrine functions and long-term quality of life.Results:A total of 50 patients were enrolled, including 31 patients with infected WON/PPC and 19 patients with uninfected WON/PPC. Seventeen patients (54.84%) in the infected WON/PPC group and 11 patients (57.89%) in the uninfected WON/PPC group lost 5% or more of their weight. There were no significant differences in the proportion of cases of weight loss of 5% or more ( P=0.833), or the weight loss between the two groups (12.59±8.89 kg VS 10.91±2.47 kg, P=0.522). Only one patient in the infected WON/PPC group had chronic abdominal pain. There was no significant difference in the Izbicki score between the two groups (23.79±6.74 VS 22.03±3.21, P=0.295). None of the patients developed steatorrhea after discharge. Five patients (16.67%, 5/30) in the infected WON/PPC group and 6 patients (40.00%, 6/15) in the uninfected WON/PPC group developed endocrine insufficiency with no significant difference ( P=0.140). Greater risk of secondary diabetes resulted from higher low-density lipoprotein cholesterol ( HR=1.9, 95% CI: 1.0-3.4, P=0.044)and triglycerides ( HR=1.2, 95% CI: 1.0-1.3, P =0.029). Conclusion:ETD is safe and effective for WON and PPC. But there is possibility that patients develop secondary diabetes. Additionally, greater risk of secondary diabetes results from higher low-density lipoprotein cholesterol and triglycerides.