Objective To evaluate the advantage of using dental floss traction in treating upper gas-trointestinal mucosal tumor by ESD.Methods Data of 10 patients who had upper gastrointestinal mucosal tumor and accepted ESD assisted by dental floss traction during April 2014 to August 2014,were collected retrospectively.The en bloc excision rate,procedure time,complication rate and follow-up were analyzed. Results The median age of patients was 53.5 years old,average tumor size was 3.75 ±0.92 cm.There were 4 tumors located in esophagus and 6 in stomach.The median surgical time was 45 min (ranging 30-100 min)and the median hospital stay was 3.5 days (ranging 3-5 days).There was no bleeding or perforation occurred during or after the procedure.All lesions received en bloc resection and the pathology showed no lymphatic or vascular invasion.After short-time of follow-up (ranging 1 to 4 months),no recurrence or me-tastasis was found.Conclusion Dental floss traction is easy to make,and can provide good vision during the procedure to reduce the operation time and rate of complication.

Objective To analyze the clinicopathological characteristics of upper gastrointestinal submucosal tumors ( SMTs ) . Methods Clinicopathological data of 1 743 patients with 1 775 upper gastrointestinal SMTs in our department from January 2008 to December 2012 were retrospectively analyzed. Results The first finding was that in 702 esophagus cases,leiomyoma(92?59%,650/702) was the most common type of esophageal SMTs. Second, in 1 045 gastric cases, there were 405 lesions at gastric fundus, the most common type of SMTs were 249 ( 61?48%) GISTs and 144 ( 35?56%) leiomyoma. In 307 lesions located at body,the most common type of SMTs were 143( 46?58%) GISTs and 90( 29?32%) leiomyoma. In 191 lesions located at antrum, the most common type of SMTs were 83( 43?46%) heterotopia pancreas and 45(23?56%) hamartoma, followed by 28(14?66%) lipoma and 20(10?47%) GISTs. In 142 lesions located at cardia, the most common type of SMTs was 110 ( 77?46%) leiomyoma. Third, in 28 duodenum cases, there were 19 lesions at duodenal bulb, the most common type of SMTs was 10 heterotopia pancreas, 4 Brunner gland adenoma and 3 GISTs. In 9 lesions located at descending duodenum,the most common type of SMTs was 4 lipomyoma, followed by 2 ectopic pancreas,1 GISTs and 2 others. Conclusion Leiomyoma is the most common type of esophageal SMTs. In gastric fundus and body, the most common type of SMTs are GISTs and leiomyoma. In antrum, the most common type of SMTs are heterotopia pancreas and hamartoma, but in cardia, that is leiomyoma.In duodenal bulb, the most common type of SMTs are heterotopia pancreas, Brunner gland adenoma and GISTs,and in descending duodenum, is lipomyoma.

Objective To improve the detection rate of early esophageal cancer during endoscopy by construction of artificial intelligence assistant diagnosis system. Methods A total of 2400 esophageal images were collected from Zhongshan Hospital of Fudan University from January 2016 to December 2017, including 1200 images of early esophageal cancer and 1200 images of normal esophageal mucosa. The lesions in pictures were marked with rectangular box by using computer program. Among them, 2000 pictures were divided into the training set and 400 pictures into the test set. An assistant diagnostic model of early esophageal cancer was established by back propagation algorithm in computer deep learning. The training model was tested and the sensitivity and specificity of the system at different cut-off points in the test set was calculated. Receiver operating characteristic ( ROC) curve was used to evaluate the performance of the diagnostic model. Results The area under ROC curve ( AUC) of the auxiliary diagnostic model was 0. 9961. The sensitivity and specificity were satisfactory. Conclusion The deep learning model constructed in this study has good specificity, sensitivity and AUC value in the diagnosis of early esophageal cancer, and can assist endoscopists in real-time diagnosis in clinical examination.

OBJECTIVETo determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy.

METHODSClinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated.

RESULTSBoth the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5(range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40(10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation, and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36(6-78) months without discomfort and recurrence under gastroscopy.

CONCLUSIONESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Adenocarcinoma ; Dissection ; Gastrectomy ; Gastric Mucosa ; Gastric Stump ; Gastroscopy ; Hemostasis, Endoscopic ; Humans ; Lymph Node Excision ; Neoplasm Recurrence, Local ; Operative Time ; Retrospective Studies ; Stomach Neoplasms

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD)for colorectal SMTs. Methods In this retrospective study, 412 consecutive patients with colorectal SMTs who underwent ESD at Zhongshan Hospital of Fudan University from January 2008 to July 2014 were enrolled. Tumor histopathology,resection rate and complications were analyzed.Results Complete resection was achieved in 358(86.9%)lesions. Adverse events occurred in 13(3.2%)patients including bleeding and perforation. Multivariate analysis showed that the SMTs in the colon(OR=0.460,95%CI:0.232-0.911, P=0.014)and number of ESD procedures for colorectal SMTs(OR=0.421, 95% CI:0.211-0.837, P=0.026)were independent risk factors for non-complete resection.Moreover,SMTs in the colon(OR=0.253, 95%CI:0.067-0.957,P=0.043),tumors in the muscularis propria(OR=5.459,95%CI:1.162-25.638, P=0.032)and number of ESD procedures for colorectal SMTs(OR=0.198, 95% CI:0.058-0.674, P=0.010)were independent risk factors for adverse events. Conclusion ESD is safe and effective for resection of colorectal SMTs. Tumor location and the experience of endoscopists may influence the complete resection rate and the development of adverse events.

Objective To determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy. Methods Clinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated. Results Both the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5 (range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40 (10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation , and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36 (6-78) months without discomfort and recurrence under gastroscopy. Conclusion ESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Objective To evaluate the safety and efficacy of dental floss traction?assisted endoscopic submucosal dissection (DFS?ESD) for rectal neuroendocrine neoplasm (NEN). Methods A retrospective cohort study was performed. Clinical data of rectal NEN patients undergoing ESD at Endoscopy Center of Zhongshan Hospital ,Fudan University from January 2016 to December 2017 were retrospectively analyzed. Inclusion criteria: 1) age of 18 to 80 years old; 2) maximal diameter of lesions <1.5 cm; 3) tumor locating in the submucosa without invasion into the muscularis propria; 4) no enlarged lymph nodes around bowel and in abdominal cavity; 5) ESD requested actively by patients. A total of 37 patients were enrolled,including 23 male and 14 female cases with mean age of (56.0±11.3) years. All the lesions were single tumor of stage T1,and the mean size was 0.8±0.2(0.5?1.2) cm. Postoperative pathology revealed all samples as neuroendocrine tumors (NET). Seventeen patients received DFS?ESD treatment (DFS?ESD group) and 20 patient received conventional ESD treatment (conventional ESD group). In DFS?ESD group,after the mucosa was partly incised along the marker dots ,the endoscopy was extracted,and the dental floss was tied to one arm of the metallic clip. When the endoscope was reinserted,the hemoclip was attached onto the incised mucosa; another hemoclip was attached onto normal mucosa opposite to the lesion in the same way. The submucosa was clearly exposed with the traction of dental floss and the resection could proceed. The conventional ESD group received the traditional ESD operation procedure. The operation time,modified operation time (remaining time after excluding the assembly time of dental floss traction in DFS?ESD group),en bloc resection rate,R0 resection rate, morbidity of operative complication,recurrence and metastasis were compared between two groups. Results The average tumor size was (0.8±0.2) cm in DFS?ESD group and (0.7±0.2) cm in conventional ESD group (t=0.425,P=0.673). According to postoperative pathological grading of rectal neuroendocrine neoplasm,13 were G1 and 4 were G2 in DFS?ESD group,while 17 cases were G1 and 3 cases were G2 in conventional ESD group without significant difference (P=0.680). There were no significant differences in baseline data between in the two groups (all P>0.05). All the basal resection margins were negative,the en bloc resection rate was 100% and the R0 resection rate was 100%. Pathological results showed tumor tissue close to the burning margin in 5 cases of conventional ESD group and in 2 cases of DFS?ESD group (P=0.416). The operation time was (17.9±6.6) minutes in conventional ESD group and (14.7±3.3) minutes in DFS?ESD group (t=1.776,P=0.084). The modified operation time of DFS?ESD group was (11.9±2.8) minutes,which was significantly shorter than (17.9±6.6) minutes in conventional ESD group (t=3.425, P=0.002). The hospital stay was (2.3 ± 0.6) days and (2.0 ± 0.5) days in conventional ESD group and DFS?ESD group,respectively,without significant difference (t=1.436,P=0.160). No patient was transferred to surgery,and no delayed bleeding or perforation occurred in either group. There was no recurrence or primary tumor?related death,and all the patients recovered well during a follow?up period of 14(1?24) months. Conclusion Dental floss traction?assisted ESD for rectal neuroendocrine neoplasm can simplify operation and ensure negative basal margin.

Objective To determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy. Methods Clinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated. Results Both the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5 (range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40 (10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation , and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36 (6-78) months without discomfort and recurrence under gastroscopy. Conclusion ESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Objective To evaluate the safety and efficacy of dental floss traction?assisted endoscopic submucosal dissection (DFS?ESD) for rectal neuroendocrine neoplasm (NEN). Methods A retrospective cohort study was performed. Clinical data of rectal NEN patients undergoing ESD at Endoscopy Center of Zhongshan Hospital ,Fudan University from January 2016 to December 2017 were retrospectively analyzed. Inclusion criteria: 1) age of 18 to 80 years old; 2) maximal diameter of lesions <1.5 cm; 3) tumor locating in the submucosa without invasion into the muscularis propria; 4) no enlarged lymph nodes around bowel and in abdominal cavity; 5) ESD requested actively by patients. A total of 37 patients were enrolled,including 23 male and 14 female cases with mean age of (56.0±11.3) years. All the lesions were single tumor of stage T1,and the mean size was 0.8±0.2(0.5?1.2) cm. Postoperative pathology revealed all samples as neuroendocrine tumors (NET). Seventeen patients received DFS?ESD treatment (DFS?ESD group) and 20 patient received conventional ESD treatment (conventional ESD group). In DFS?ESD group,after the mucosa was partly incised along the marker dots ,the endoscopy was extracted,and the dental floss was tied to one arm of the metallic clip. When the endoscope was reinserted,the hemoclip was attached onto the incised mucosa; another hemoclip was attached onto normal mucosa opposite to the lesion in the same way. The submucosa was clearly exposed with the traction of dental floss and the resection could proceed. The conventional ESD group received the traditional ESD operation procedure. The operation time,modified operation time (remaining time after excluding the assembly time of dental floss traction in DFS?ESD group),en bloc resection rate,R0 resection rate, morbidity of operative complication,recurrence and metastasis were compared between two groups. Results The average tumor size was (0.8±0.2) cm in DFS?ESD group and (0.7±0.2) cm in conventional ESD group (t=0.425,P=0.673). According to postoperative pathological grading of rectal neuroendocrine neoplasm,13 were G1 and 4 were G2 in DFS?ESD group,while 17 cases were G1 and 3 cases were G2 in conventional ESD group without significant difference (P=0.680). There were no significant differences in baseline data between in the two groups (all P>0.05). All the basal resection margins were negative,the en bloc resection rate was 100% and the R0 resection rate was 100%. Pathological results showed tumor tissue close to the burning margin in 5 cases of conventional ESD group and in 2 cases of DFS?ESD group (P=0.416). The operation time was (17.9±6.6) minutes in conventional ESD group and (14.7±3.3) minutes in DFS?ESD group (t=1.776,P=0.084). The modified operation time of DFS?ESD group was (11.9±2.8) minutes,which was significantly shorter than (17.9±6.6) minutes in conventional ESD group (t=3.425, P=0.002). The hospital stay was (2.3 ± 0.6) days and (2.0 ± 0.5) days in conventional ESD group and DFS?ESD group,respectively,without significant difference (t=1.436,P=0.160). No patient was transferred to surgery,and no delayed bleeding or perforation occurred in either group. There was no recurrence or primary tumor?related death,and all the patients recovered well during a follow?up period of 14(1?24) months. Conclusion Dental floss traction?assisted ESD for rectal neuroendocrine neoplasm can simplify operation and ensure negative basal margin.

Objective To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis.Methods Data of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively.The number of dilation,complications rate,short-term effects and recurrence rate of stenosis were analyzed.Results Thirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months),including 10 (27.8％) patients of grade 1 stenosis,15 (41.7％) of grade 2 stenosis,and 11 (30.5％) of grade 3 stenosis.The anastomotic distance from anus was 3-24 cm (median 6 cm).The 36 patients underwent 80 times of EBD with mean time of 2.22.Among them,69.4％ (25/36) cases received 1-2 times and 30.6％ (11/36) received 3 times or more.During the EBD operation,14 (17.5％) patients had minor bleeding,and intraoperative or postoperative perforation did not appeared.Postoperative obstructive symptoms were relieved in all patients.The anastomotic diameter was greater than 20 mm and EBD treatment was successful.Postoperative follow-up was 22-76 months (median 44 months).Four (11.1％) patients had recurrence of anastomotic benign stenosis at 7,11,18,and 63 months after the last time of EBD,respectively,and the symptoms were improved after the second treatment.Conclusion EBD is safe and effective in treating benign colorectal anastomotic stenosis,with better short-term and long-term outcomes.