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The clinical preliminary study of second generation colon capsule endoscopy

Jun SONG ; Gengchen HU ; Xiaoping XIE ; Jun LIU ; Xiaohua HOU

Chinese Journal of Digestive Endoscopy.2013;30(5):249-252. doi:10.3760/cma.j.issn.1007-5232.2013.05.003

Objective To investigate the diagnositic role of second generation colon capsule endoscopy in colorectal diseases.Methods After colon preparation procedure,fourteen volunteers were observed with second generation colon capsule endoscopy.During the examination,stomach and small bowel transit time,the colorectal examination time and the positive founding were recorded.Capsule excretion rate,the colon cleaning level and rate of adverse events also were assessed.Results Colorectal diseases including colon polyp,colon protrusion lesion and internal hemorrhoid were found in 7 volunteers.Stomach diseases including erosive gastritis and gastric ulcer in 10 volunteers.Small bowel diseases including small bowel polyp,ileum ulcer and small bowel protrusion lesion in 6 volunteers.Thirteen capsule were excreted within 480 minutes.The average colorectal examination time was 310 ± 125 minutes.The average stomach and small bowel transit time were 82 ± 39 minutes and 121 ± 73 minutes,respectively.The overall colon cleanliness was adequate in 7 patients.There are no severe adverse events during the examination.Conclusion The second generation capsule endoscopy can observe the colorectal mucosal changes and it might be considered as an adequate tool for colorectal diseases screening and diagnosis.

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Expression of HSF2 in ulcerative colitis and other intestinal diseases

Jiarong MIAO ; Mingxia TONG ; Yinglei MIAO ; Liping DUAN

Chinese Journal of Digestive Endoscopy.2013;30(5):253-256. doi:10.3760/cma.j.issn.1007-5232.2013.05.004

Objective To investigate the expression of HSF2 in colonic mucosa of patients with ulcerative colitis (UC),Crohn's disease (CD),intestinal tuberculosis (ITB),intestinal lymphoma (IL),infectious enteritis,Behcet's disease and normal control.Methods Intestinal tissue samples were retrieved from 2003-2011 archived specimen at the Department of Pathology,and assigned to UC group (n =38),CD group (n =29),ITB group (n =31),IL group (n =32),infectious enteritis group (n =32) and Behcet's disease group (n =28).10 cases were recruited as normal control group.The expression of HSF2 in colonic mucosa were detected by immunohistochemistry.Positive cells were counted by Image Analysis.Results The expression rate of HSF2 in intestinal mucosa of UC patients (64.64 ± 15.17) was significantly higher than that of CD (32.44 ± 5.94),ITB (36.93 ± 6.32),IL (36.16 ± 6.55),infectious enteritis (37.86 ±7.76),Behcet's disease (34.90 ±5.92) and normal control (35.54 ±6.76) (P ＜0.05),while there was no significant difference among the latter six groups (P ＞ 0.05).Conclusion HSF2 is closely related with UC,and may play an important role in the pathogenesis,diagnosis and differential diagnosis of UC.

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The impact of double-balloon enteroscopy on the evolution of detection and surgical treatment for small bowel stromal tumors

Lifen YU ; Chenying XU ; Jie ZHONG ; Shidan CHENG ; Weiguo HU ; Yonghua TANG

Chinese Journal of Digestive Endoscopy.2013;30(5):257-260. doi:10.3760/cma.j.issn.1007-5232.2013.05.005

Objective To investigate the role of double-balloon enteroscopy (DBE) in the evolution of detection and surgical treatment of small bowel stromal tumors (SBSTs),based on nine years experience.Methods In this retrospective study,193 patients with localized SBSTs were divided into the CT-enterography (CTE) and/or DBE group (n =100) and conventional modalities group (n =93).These patients were further divided into the open surgery group (n =126) and laparoscopy-assisted resection group (n =67).The development of clinical diagnosis and surgical treatment strategies were compared before and after the introduction of DBE.Results The average age and tumor size were significantly smaller in the CTE and/or DBE group than those in the conventional modalities group,respectively (age:50.9 ± 12.1 vs.56.9 ± 11.6 years; tumor size:3.6 ± 1.3 vs.6.1 ± 2.6 cm,P ＜ 0.01).Before the introduction of DBE (from January 2001 to December 2002),all patients underwent conventional modalities,and only 4 cases/year for open surgery.Afterward,from January 2003 to December 2004,84.6％ (11/13) of SBSTs were detected by DBE.From January 2005 to December 2008,50.0％ (23/46) of SBSTs were found by CTE combination with DBE.From January 2009 to December 2011,80.5％ (33/41) of SBSTs were diagnosed by CTE,and the number of patients underwent operation increased up to 25 cases/year,which was nearly 5.3 folds higher than that before the introduction of DBE.Sixty-seven patients were successfully operated by laparoscopy-assisted resection,82.1％ (55/67) of them were detected by CTE ands/or DBE,89.1％ (49/55) of whom had low-or intermediate-risk SBSTs.Conclusion DBE plays an important role in optimizing the algorithm of detection and treatment of SBSTs.

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The diagnostic value of colonoscopy for chronic diarrhea

Hongxiang GU ; Fachao ZHI ; Ying HUANG ; Dan ZHOU ; Yali ZHANG

Chinese Journal of Digestive Endoscopy.2013;30(5):261-264. doi:10.3760/cma.j.issn.1007-5232.2013.05.006

Objective To evaluate the diagnostic value of colonoscopy for patients with chronic diarrhea.Methods Data of 2449 patients with chronic diarrhea who underwent colonoscopy from January,1999 to December,2008 were reviewed.A total of 2110 patients who underwent colonoscopy screening for health checkup during the same period were used as controls.The rates of clinic-relevant abnormal endoscopic findings and negative finding were compared between two groups.Results Lesions with clinic significance were found in 44.1％ of patients with chronic diarrhea (1080/2449) and in 41.7％ of controls (870/2110,x2 =2.756,P =0.097).Compared with controls,incidence of non-IBD and noninfectious colitis (x2 =58.578,P ＜ 0.001),IBD (x2 =59.609,P ＜ 0.001),malignant tumor (x2 =21.649,P ＜0.001),terminal ileitis (x2 =6.275,P =0.012),infectious colitis (x2 =17.019,P ＜0.001),intestinal tuberculosis (x2 =7.021,P =0.008),melanosis coli (x2 =6.040,P =0.014) and parasitic infection (x2 =4.245,P =0.039) were all significantly higher in patients with chronic diarrhea.However,incidences of adenomatous polyps (x2 =14.124,P ＜ 0.001),non-adenomatous polyps (x2 =33.427,P ＜0.001) and diverticular disease (x2 =9.921,P =0.002) were significantly higher in the control group.There was no significant difference in incidences of the benign tumor (x2 =1.627,P =0.202) and angiodysplasia (x2 =0.231,P =0.631) between the two groups.The overall screening rate of colonic polyps,diverticulosis,and vascular lesions was 37.3％ in chronic diarrhea group.Conclusion Colonic polyps,diverticulitis,benign tumors and angiodysplasia may not be the causes of chronic diarrhea.Etiology of more than 1/3 patients with chronic diarrhea remains unknown after colonoscopy.

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Compare the expression of p53, c-myc and Ki-67 in laterally spreading tumor, polypoid adenomas and colorectal cancer

Xiaofeng PENG ; Zhijin YU ; Xuanfang ZHONG ; Angao XU

Chinese Journal of Digestive Endoscopy.2013;30(9):519-521. doi:10.3760/cma.j.issn.1007-5232.2013.09.014

Objective To study the genetic regulation mechanism of colorectal LST,polypoid adenomas and clolrectal cancer by detecting the expression of p53,c-myc and Ki-67 in these three lesions.Methods The expressions of p53,c-myc,Ki-67 were determined via two-step of immunohistochemistry method in LST,polypoid adenomas,invasive colorectal cancer and their significant difference were compared.Statistical analyses were used to analyze the correlation among Ki-67 expression and p53,c-myc expression in these three group lesions.Results Immunohistochemical staining was performed in 38 LST,62polypoid adenomas and 36 colorectal cancer.For p53 and c-myc,the positive rates in LST,polypoid adenomas and colorectal cancer were significantly different from each other.For Ki-67,the positive rates in LST and polypoid adenomas were significantly lower than that in colorectal cancer,but there was no statistical significant difference between LST and polypoid adenomas.The expression of Ki-67 did not correlate with p53and c-myc both in LST and polypoid adenomas.But in colorectal cancer,the expression of Ki-67 was strongly related to p53 and c-myc.Conclusion The expressions of p53,c-myc and Ki-67 were different in LST,polypoid adenomas and colorectal cancer,indicating that their genetic regulation mechanism might be different,and the genetic avenue for LST may be different from polypoid adenomas.

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Endoscopic ultrasound guided fine needle aspiration biopsy of the pelvic lesions

Shan GAO ; Xiangwu DING ; Baoping YU ; Weiguo DONG ; Hesheng LUO

Chinese Journal of Digestive Endoscopy.2013;30(5):265-268. doi:10.3760/cma.j.issn.1007-5232.2013.05.007

Objective Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) was performed for diagnosis and treatment of the pelvic Lesions and safety of this method were evaluated.Methods EUS-FNA was performed in 52 patients with pelvic Lesions selected by EUS,CT or MRI between March 2009 and June 2012.Both 19 and 22 gauge needles were used for EUS-FNA.The tissue specimens were analyzed by cytologic or histologic examination.The pelvic cystic lesions were drained and in which purulent lesions were lavaged with Metronidazole repeatedly.Results All patients recieved fine needle biopsy of the pelvic lesions.Among the 52 lesions,there were 42 solid lesions,10 cystic lesions.In solid lesions,cytology and pathology demonstrated malignant tumors in 28 patients,3 cases of malignant stromal tumors,3 cases of Inflammatory mass cases,2 cases of lymphoma,1 case of dermoid cyst,5 cases of other.In cystic lesions,2 cases of serous cystadenoma,perirectal abscess in 8 cases.6 purulent lesions were lavaged with Metronidazole repeatedly.Diagnosis rates of samples for immunohistology remained similar between 22 gauge and 19 gauge needles (P ＞0.05).During the operation,8 cases of perirectal abscess patients have different degree of pain.There were no other complications after the procedures except one patient suffering from fever.Conclusion EUS-guided FNA is minimaly invasive,a safe and accurate method for diagnosis of pelvic lesions.

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Percutaneous transhepatic variceal embolization with 2-Octyl-Cyanoacrylate versus endoscopic cyanoacrylate injection for treatment of gastric variceal bleeding

Lei WU ; Hua FENG ; Jinhua HU ; Guangchuan WANG ; Yi CUI ; Chunqing ZHANG

Chinese Journal of Digestive Endoscopy.2013;30(5):273-276. doi:10.3760/cma.j.issn.1007-5232.2013.05.009

Objective To compare the efficacy of a modified percutaneous transhepatic variceal embolization (PTVE) with 2-Octyl-Cyanoacrylate (2-OCA) and endoscopic variceal obturation (EVO) in preventing gastric variceal bleeding.Methods Seventy-seven patients with history of gastric variceal bleeding who underwent either EVO or PTVE were retrospectively reviewed.The rebleeding rate,survival rate and complications were compared between the two groups.Results EVO was performed in 45 patients; PTVE was performed in 32 patients.During the follow-up (19.78 ± 7.70 months in EVO group,vs.21.53 ± 8.56 months in PTVE group),rebleeding occurred in 17 patients (37.78％) of EVO group,and in 4 patients (12.5％) of PTVE group (P =0.028).The cumulative rebleeding free rate for EVO was 75％,59％,and 49％ in 1,2,and 3 years,respectively; 93％,84％,84％ for PTVE (P =0.011).There is no significant different in survival rate and the incidence of complications was similar in two groups.Conclusion Compared with EVO,PTVE with 2-OCA demonstrates advantage as an effective and safe method for gastric varices.

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Effects on 125I seeds continuous irradiation in esophagus fibroblast cell of beagle dog

Zhen GAN ; Guangyu ZHU ; Yonglin QIN ; Jian JING ; Gaojun TENG ; Jinhe GUO

Chinese Journal of Digestive Endoscopy.2013;30(5):277-280. doi:10.3760/cma.j.issn.1007-5232.2013.05.010

Objective To evaluate the effects of low-dose 125I seeds to the esophagus fibroblast cell proliferation in vitro.Methods The titanium wire was implanted in the beagle dog's esophagus to induce fibroblast proliferation,and the esophageal tissue was removed after two weeks and cultured in vitro.The 125I seeds with different dose commonly used were chosen to irradiation fibroblast in group B (11.1 MBq × 9)、C (22.2 Mbq ×9) 、D (33.3 MBq ×9) for 72 hours,while in control group no 125I seeds were used.After irradiation,cells were collected.MTT and AnnexinV/PI double staining were performed respectively to evaluate the effects of 125I seeds in cell proliferation and apoptosis.Results The inhibition rate respectively:(26.81 ± 1.96) ％、(34.52 ± 3.21) ％ and (45.33 ± 2.59) ％ ; the apoptosis rate respectively:(6.73 ±0.57)％、(13.11 ± 1.39)％ and (15.23 ± 0.90)％.There were significant differences among the experimental groups and between every experimental group and the control group.Conclusion The three doses of 125I seeds could significantly inhibit the fibroblast proliferation and promote cells apoptosis,of which 33.3 MBq 12sI seed was the most significant.

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Preoperative evaluation of risk factors of complete resection in early gastric cancer with endoscopic submucosal dissection: a prospective study

Xiaolu LIN ; Liping HE ; Wei LIANG ; Wanyin DENG ; Xiaoling ZHENG ; Lizhen WANG ; Liying GAO

Chinese Journal of Digestive Endoscopy.2013;30(9):491-494. doi:10.3760/cma.j.issn.1007-5232.2013.09.006

Objective To prospectively evaluate the risk factors of complete resection in early gastric cancer (EGC) with endoscopic submucosal dissection (ESD),and to guide the choice of treatment methods.Methods This study prospectively evaluated the endoscopic features of 66 EGCs,including the lesion size,presence or absence of ulceration,the extent of differentiation,invasion depth and entire margins of the EGC,then compared them with postoperative pathologic results and analysed these factors.Results The lesion size of the high grade intmepithelial neoplasia (H) group and the intramucosal carcinoma (M) group were mainly less than 30 mm (90.9％ vs.88.5％),but 57.1％ of the submucosal carcinoma (SM) were more than 30 mm.There was a significant difference between any two of three groups (P ＜ 0.05).Fourteen EGCs who got ulceration without invasion beyond mucosal muscularis underwent ESD successfully,and the basal or dissected margin had no residual tumor cells confirmed pathologically.And no tumor cell infiltration or lymph node metastasis was discovered.Of 45 EGCs with ESD,the underestimation rate for horizontal extent determined by white light and chromoendoscopy was higher than that of magnifying endoscopy with narrow-band imaging (ME-NBI) (15.6％ vs.2.2％,P ＜0.05).Diagnostic accuracy for the extent of differenciation by conventional endoscopy was 93.9％ (31/32,P ＞ 0.1),but it's unable to determine the extent of differentiation by ME-NBI.The accuracy of the group H was 84.8％ (28/33),that of M was 57.7％ (15/26),that of SM was 71.4％ (5/7),and there was a significant difference between group H and group M (P ＜ 0.05).Conclusion To achieve complete resection of EGC with ESD,the lesion more than 30 mm,presence of ulceration,undifferentiated type,deep infiltration should be considered as the risk factors,and it's also important to identify the horizontal extent of EGC to avoid unnecessary operation.

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Clinical research to patients with achalasia after peroral endoscopic myotomy therapy by high resolution manometry

Haiying GUO ; Zhongqing ZHENG ; Wei ZHAO ; Bangmao WANG ; Wentian LIU

Chinese Journal of Digestive Endoscopy.2013;30(9):495-498. doi:10.3760/cma.j.issn.1007-5232.2013.09.007

Objective To investigate the effects of peroral endoscopic myotomy (POEM) on esophageal dynamics in patients with achalasia (AC) and appraise the role of high resolution manometry (HRM)in assessment of POEM therapy.Methods From July 2011 to September 2012,20 patients with achalasia underwent POEM in the department of gastroenterology,Tianjin Medical University General Hospital.Preoperation esophageal dynamics of all the patients were evaluated by high resolution manometry (HRM) system and one month after POEM operation the test was repeated.Data of lower esophageal sphincter (LES)and esophageal body were analyzed,with 15 healthy volunteers as a contrast study.Results Mter POEM,the LES pressure (LESP) and 4-second integrated relaxation pressure (4sIRP) significantly decreased:LESP [pre-operation (24.5 ± 13.1) mm Hg vs.post-operation (8.5 ± 3.1) mm Hg,P ＜ 0.05] ; 4sIRP [pre-operation (20.7 ± 6.8) mm Hg vs.post-operation (5.0 ± 3.4) mm Hg,P ＜ 0.05].The LES relax rate (LESRR) significantly elevated [pre-operation (12.7 ± 9.8) ％ vs.post-operation (39.6 ± 18.1) ％,P ＜ 0.05].However,the esophageal aperistalsis remained after POEM.The total of 20 patiems were all type Ⅰ achalasia and responded well to POEM therapy.Post-operation data on the symptom scores markedly decreased and a significant correlation was found between the decreasing level of symptom scores and LESP,as well as the scores 4sIRP in the 20 patients (LESP:r =0.751,P ＜ 0.05 ; 4sIRP:r =0.500,P ＜ 0.05).Conclusion POEM can significantly improve esophageal dynamics in patients with achalasia and the treatment outcome is definite.HRM plays an important role in evaluation of POEM therapy on achalasia.

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