Objective To determine the risk factors related to the occurrence of colorectal adenomatous polyps and provide a basis for early screening, diagnosis, and treatment of colorectal cancer. Methods A total of 1 527 cases of colorectal polyps detected by colonoscopy were selected as the research subjects. Data on sociodemographic information, lifestyle and dietary habits, clinical history, laboratory tests, and endoscopic characteristics were collected. The patients were divided into adenoma and non-adenoma groups based on the pathological type. Multivariate logistic regression analysis was conducted to explore the influence of the above factors on the occurrence of colorectal adenoma. Results Old age (OR: 1.024, 95%CI: 1.001-1.048, P=0.044), high body mass index (OR: 1.046, 95%CI: 1.008-1.087, P=0.020), and a history of smoking (OR: 1.493, 95%CI: 1.035-2.158, P=0.032) were independent risk factors for the occurrence of colorectal adenoma. Patients with better cognitive function had a lower risk of developing colorectal adenoma than those with poorer cognitive function (OR: 0.929, 95%CI: 0.871-0.984, P=0.017). Polyps located in the rectum (OR: 0.396, 95%CI: 0.229-0.677, P=0.001) and those of flat type (OR: 0.531, 95%CI: 0.342-0.810, P=0.004) or laterally spreading type (OR: 0.306, 95%CI: 0.135-0.698, P=0.005) were more likely to be non-adenomatous polyps. The possibility of adenomatous pathological changes increased significantly with an increase in polyp size (OR: 1.063, 95%CI: 1.035-1.095, P<0.001). Conclusion Old age, high body mass index, smoking history, and large polyp diameters are related with a high risk of adenoma in the patients with colorectal polyps. Patients who have satisfactory cognitive function, polyps located in the rectum and polyps of flat type or laterally spreading type are likely to have non-adenoma.

Objective:To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer.Methods:Endoscopic and pathological features of 324 patients diagnosed as having early esophageal cancer from January 2013 to January 2022 in Beijing Friendship Hospital were retrospectively collected. Independent risk factors for early esophageal cancer combined with multiple primary cancer were selected by multivariate logistic regression analysis.Results:Among the 324 patients with early esophageal cancer, 47 (14.51%) patients (29 metachronous and 18 synchronous) had multiple primary cancer. Multivariate logistic regression analysis showed that alcohol drinking ≥5 standard drinks/day ( OR=6.23, 95% CI: 2.49-15.57, P<0.001), submucosal layer invasion ( OR=2.80, 95% CI:1.07-7.30, P=0.036), lesion location at lower esophagus ( OR=4.18, 95% CI: 1.98-8.97, P<0.001) and multiple lesions in esophagus ( OR=3.30, 95% CI:1.57-6.92, P=0.002) were independent risk factors for early esophageal cancer combined with multiple primary cancer. Conclusion:Alcohol drinking ≥5 standard drinks/day, submucosal layer invasion, lower lesions location, and multiple lesions in the esophagus are independent risk factors that are more likely to develop multiple primary cancer in patients with early esophageal cancer. It is recommended to prioritize monitoring patients with these factors, and enhance endoscopic follow-up and assessment.

To explore the clinical characteristics and risk factors of perforation during endoscopic submucosal dissection (ESD) of superficial colorectal tumor in elderly patients, clinical data including patients' medical history, characteristics of colorectal lesions, operation process and prognosis in the elderly patients who underwent colorectal ESD at Beijing Friendship Hospital, Capital Medical University from January 2017 to October 2020 were retrospectively analyzed. A total of 278 patients were collected with the age of 68.62±6.82 years. There were 218 patients aged 60-< 75 years and 60 patients aged 75-< 90 years. There were 32 lesions at the ileocecum, 51 at the ascending colon, 20 at the transverse colon, 12 at the descending colon, 54 at the sigmoid colon, and 109 at the rectum. The long diameter of the lesions was 2.32±1.36 cm with 117 cases <2 cm, 138 cases 2-<5 cm, and 23 cases ≥5 cm. There were 150 adenomas, 23 high grade intraepithelial neoplasms, 65 malignant lesions, 18 neuroendocrine tumors, 3 benign lesions, and 19 inflammatory lesions. Intraoperative perforation occurred in 25 cases and postoperative perforation occurred in 2. The results showed that the incidence of perforation in the right half of the colon was higher than that in the left half. The incidence of perforation was higher in malignant lesions and those with larger long diameter of the lesion. Malignant lesions, long diameter ≥2 cm, and the lesion site are independent risk factors for ESD perforation.

Objective:To identify risk factors associated with endoscopic atrophic progression of gastric mucosa after Helicobacter pylori ( HP) eradication and to develop a risk scoring system for establishing an individualized endoscopic follow-up strategy for patients with chronic gastritis. Methods:This retrospective cohort study included chronic gastritis patients with successful HP eradication at the Department of Gastroenterology, Beijing Friendship Hospital between January 2018 and October 2021. Demographic characteristics, endoscopic findings, and other clinical data were analyzed. Endoscopic outcomes of gastric mucosal atrophy before and after follow-up were compared to classify patients into progression and non-progression groups. Univariate and multivariate analyses were performed to identify independent risk factors for endoscopic atrophic progression. A risk scoring system was then constructed based on these factors. Results:A total of 218 patients with chronic gastritis were included, including 153 in the non-progression group and 65 in the progression group. Multivariate logistic regression analysis showed that gastric ulcer ( P=0.008, OR=4.24, 95% CI: 1.46-12.25), history of proton pump inhibitor use ( P=0.007, OR=4.06, 95% CI: 1.46-11.27), alcohol consumption ( P=0.002, OR=3.77, 95% CI: 1.64-8.67), high-salt diet ( P=0.008, OR=2.90, 95% CI: 1.32-6.41), and high red meat intake ( P=0.025, OR=2.33, 95% CI: 1.11-6.31) were independent risk factors for endoscopic atrophic progression after HP eradication. The predictive model based on these 5 factors demonstrated strong discriminative capacity, with an area under the receiver operating characteristic curve of 0.813 (95% CI: 0.755-0.876, P<0.001). The optimal cut-off value was 1.5 points, stratifying patients into low-risk (0-2 points) and high-risk (3-5 points) groups. Conclusion:Patients with chronic gastritis remain susceptible to progression even after successful HP eradication. Individualized endoscopic follow-up strategies should be considered based on patients' medical history, medication use, lifestyle, and dietary habits.

Objective To investigate the role and molecular mechanism of SOX4 in Helicobacter pylori(H.pylori)-mediated gastric mucosal epithelial dysplasia.Methods The expression of SOX4 in gastric tissues and cells was analyzed with reverse transcription-polymerase chain reaction(RT-PCR),Western blotting,and immunohistochemical staining.The effects of SOX4 on gastric epithelial cell proliferation and colony formation were determined with CCK-8 and colony formation assays.A PCR array was used to screen downstream target genes involved in H.pylori-induced dysplasia mediated by SOX4.The transcriptional regulation and binding sites of the target gene MLH3 by SOX4 were elucidated with luciferase reporter assay,promoter truncation assay,and chromatin immunoprecipitation(ChIP).Results SOX4 expression was significantly increased in H.pylori-infected gastric tissues(P<0.05).Overexpression of SOX4 markedly enhanced the proliferation and colony formation abilities of normal gastric epithelial cells(P<0.05).Elevated SOX4 led to the dysregulation of MLH3 and other DNA damage repair-related molecules after H.pylori infection in gastric epithelial cells(|logFC|>1,P<0.05).H.pylori promoted MLH3 expression in gastric epithelial cells through SOX4.SOX4 transcriptionally activated MLH3 expression by binding to the 5th site of the MLH3 promoter.The increased expression of SOX4 and MLH3 is associated with poor prognosis of gastric cancer patients.Conclusion SOX4 is closely associated with H.pylori-induced dysplasia in gastric epithelial cells.Upregulation of SOX4 promotes H.pylori-related dysplasia by transcriptionally activating MLH3,leading to the imbalance of proliferation and colony formation in gastric epithelial cells.

Objective To analyze the clinical characteristics of esophageal foreign body impaction by gastroscopy intervention in adults.Methods A retrospective analysis was conducted on 470 patients who underwent gastroscopic intervention for esophageal foreign bodies at the Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,from January 2019 to January 2024.The patients' gender,age,underlying esophageal conditions,date of endoscopic examination,type of anesthesia,the type,size,and shape of the foreign bodies,as well as the severity of complications were compared and analyzed in this study.Results The median age of the patients was 62.5,with an equal male-to-female ratio of 1∶1.Totally 63.40％endoscopic examination were performed on weekdays.Local pharyngeal anesthesia was used in 96.17％of patients.The upper esophagus was the most common site of impaction(61.7％).Esophageal strictures were detected in 19.36％of patients during endoscopy.The size of the foreign bodies ranged from 0.4 cm to 13 cm,with an average of(2.44±1.03)cm.The most common foreign bodies were animal bones such as fish,chicken,and duck bones(47.02％),followed by jujube pits(19.36％).Female patients were significantly more likely to have jujube pit impactions(P＜0.001).Two pressure points were identified in 28.94％of the foreign bodies.Mild complications related to foreign body impaction occurred in 416 cases(88.51％),while severe complications occurred in 54 cases(11.49％).Among those with severe complications,a higher proportion were elderly(P=0.009),female(P=0.045),had foreign bodies larger than 2.0 cm(P＜0.05),jujube pits and had foreign bodies with two pressure points(P＜0.001).Swallowing jujube pits and having foreign bodies larger than 3.0 cm were independent risk factors for severe complications.Conclusion Elderly patients,female patients,foreign bodies larger than 2.0 cm,foreign bodies with two pressure points,and jujube pits are more likely to develop severe esophageal complications.Early endoscopic intervention is recommended for patients with these characteristics.

Objective To investigate the role and molecular mechanism of SOX4 in Helicobacter pylori(H.pylori)-mediated gastric mucosal epithelial dysplasia.Methods The expression of SOX4 in gastric tissues and cells was analyzed with reverse transcription-polymerase chain reaction(RT-PCR),Western blotting,and immunohistochemical staining.The effects of SOX4 on gastric epithelial cell proliferation and colony formation were determined with CCK-8 and colony formation assays.A PCR array was used to screen downstream target genes involved in H.pylori-induced dysplasia mediated by SOX4.The transcriptional regulation and binding sites of the target gene MLH3 by SOX4 were elucidated with luciferase reporter assay,promoter truncation assay,and chromatin immunoprecipitation(ChIP).Results SOX4 expression was significantly increased in H.pylori-infected gastric tissues(P<0.05).Overexpression of SOX4 markedly enhanced the proliferation and colony formation abilities of normal gastric epithelial cells(P<0.05).Elevated SOX4 led to the dysregulation of MLH3 and other DNA damage repair-related molecules after H.pylori infection in gastric epithelial cells(|logFC|>1,P<0.05).H.pylori promoted MLH3 expression in gastric epithelial cells through SOX4.SOX4 transcriptionally activated MLH3 expression by binding to the 5th site of the MLH3 promoter.The increased expression of SOX4 and MLH3 is associated with poor prognosis of gastric cancer patients.Conclusion SOX4 is closely associated with H.pylori-induced dysplasia in gastric epithelial cells.Upregulation of SOX4 promotes H.pylori-related dysplasia by transcriptionally activating MLH3,leading to the imbalance of proliferation and colony formation in gastric epithelial cells.

Objective:To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer.Methods:Endoscopic and pathological features of 324 patients diagnosed as having early esophageal cancer from January 2013 to January 2022 in Beijing Friendship Hospital were retrospectively collected. Independent risk factors for early esophageal cancer combined with multiple primary cancer were selected by multivariate logistic regression analysis.Results:Among the 324 patients with early esophageal cancer, 47 (14.51%) patients (29 metachronous and 18 synchronous) had multiple primary cancer. Multivariate logistic regression analysis showed that alcohol drinking ≥5 standard drinks/day ( OR=6.23, 95% CI: 2.49-15.57, P<0.001), submucosal layer invasion ( OR=2.80, 95% CI:1.07-7.30, P=0.036), lesion location at lower esophagus ( OR=4.18, 95% CI: 1.98-8.97, P<0.001) and multiple lesions in esophagus ( OR=3.30, 95% CI:1.57-6.92, P=0.002) were independent risk factors for early esophageal cancer combined with multiple primary cancer. Conclusion:Alcohol drinking ≥5 standard drinks/day, submucosal layer invasion, lower lesions location, and multiple lesions in the esophagus are independent risk factors that are more likely to develop multiple primary cancer in patients with early esophageal cancer. It is recommended to prioritize monitoring patients with these factors, and enhance endoscopic follow-up and assessment.

To explore the clinical characteristics and risk factors of perforation during endoscopic submucosal dissection (ESD) of superficial colorectal tumor in elderly patients, clinical data including patients' medical history, characteristics of colorectal lesions, operation process and prognosis in the elderly patients who underwent colorectal ESD at Beijing Friendship Hospital, Capital Medical University from January 2017 to October 2020 were retrospectively analyzed. A total of 278 patients were collected with the age of 68.62±6.82 years. There were 218 patients aged 60-< 75 years and 60 patients aged 75-< 90 years. There were 32 lesions at the ileocecum, 51 at the ascending colon, 20 at the transverse colon, 12 at the descending colon, 54 at the sigmoid colon, and 109 at the rectum. The long diameter of the lesions was 2.32±1.36 cm with 117 cases <2 cm, 138 cases 2-<5 cm, and 23 cases ≥5 cm. There were 150 adenomas, 23 high grade intraepithelial neoplasms, 65 malignant lesions, 18 neuroendocrine tumors, 3 benign lesions, and 19 inflammatory lesions. Intraoperative perforation occurred in 25 cases and postoperative perforation occurred in 2. The results showed that the incidence of perforation in the right half of the colon was higher than that in the left half. The incidence of perforation was higher in malignant lesions and those with larger long diameter of the lesion. Malignant lesions, long diameter ≥2 cm, and the lesion site are independent risk factors for ESD perforation.

Objective:To identify risk factors associated with endoscopic atrophic progression of gastric mucosa after Helicobacter pylori ( HP) eradication and to develop a risk scoring system for establishing an individualized endoscopic follow-up strategy for patients with chronic gastritis. Methods:This retrospective cohort study included chronic gastritis patients with successful HP eradication at the Department of Gastroenterology, Beijing Friendship Hospital between January 2018 and October 2021. Demographic characteristics, endoscopic findings, and other clinical data were analyzed. Endoscopic outcomes of gastric mucosal atrophy before and after follow-up were compared to classify patients into progression and non-progression groups. Univariate and multivariate analyses were performed to identify independent risk factors for endoscopic atrophic progression. A risk scoring system was then constructed based on these factors. Results:A total of 218 patients with chronic gastritis were included, including 153 in the non-progression group and 65 in the progression group. Multivariate logistic regression analysis showed that gastric ulcer ( P=0.008, OR=4.24, 95% CI: 1.46-12.25), history of proton pump inhibitor use ( P=0.007, OR=4.06, 95% CI: 1.46-11.27), alcohol consumption ( P=0.002, OR=3.77, 95% CI: 1.64-8.67), high-salt diet ( P=0.008, OR=2.90, 95% CI: 1.32-6.41), and high red meat intake ( P=0.025, OR=2.33, 95% CI: 1.11-6.31) were independent risk factors for endoscopic atrophic progression after HP eradication. The predictive model based on these 5 factors demonstrated strong discriminative capacity, with an area under the receiver operating characteristic curve of 0.813 (95% CI: 0.755-0.876, P<0.001). The optimal cut-off value was 1.5 points, stratifying patients into low-risk (0-2 points) and high-risk (3-5 points) groups. Conclusion:Patients with chronic gastritis remain susceptible to progression even after successful HP eradication. Individualized endoscopic follow-up strategies should be considered based on patients' medical history, medication use, lifestyle, and dietary habits.