Objective:To evaluate the adjuvant role of the eCura scoring system in selecting appropriate treatment strategies after non-curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) patients.Methods:The clinicopathological data of 110 EGC patients who underwent non-curative ESD at Fujian Provincial Hospital from January 2015 to June 2019 were retrospectively analyzed. According to the eCura score, patients were divided into three lymph node metastasis (LNM) risk groups: low-risk group (79 cases), middle-risk group (22 cases), and high-risk group (9 cases). The receiver operator characteristic (ROC) curve analysis was used to test the diagnostic efficacy of eCura scoring system in predicting LNM. Logistic regression analysis was used to explore the influence of risk stratification of eCura scoring system on LNM. Kaplan-Meier method was used to evaluate cancer survival rate, which was then compared with log-rank test.Results:Thirty-five patients underwent additional standard surgery after ESD, including 22 in the low-risk group, 8 in the middle-risk group, and 5 in the high-risk group. Among them, 5 cases had LNM, including 1 case in the low-risk group and the middle-risk group respectively and 3 cases in the high-risk group. The area under the ROC curve was 0.857 (95% CI: 0.697-0.952, P=0.001), and when the cut-off value of the eCura score was set at 3, the Yuden index reached the maximum value of 0.7, with the corresponding sensitivity and specificity of 80% and 90%, respectively. Logistic regression analysis showed that the probability of LNM in the middle-risk group was about 3.00 times (95% CI: 0.17-54.57, P=0.458) as high as that in the low-risk group, and the probability of LNM in the high-risk group was about 31.50 times (95% CI: 2.14-463.14, P=0.012) of that in the low-risk group. The follow-up time was 12 to 58 months, and the median follow-up time was 40 months. There were 10 cases of recurrence, including 4 cases in the low-risk group, 3 cases in the middle-risk group and 3 cases in the high-risk group, of which 2 cases in the low-risk group were from those of additional standard surgery after ESD, and the remaining 8 cases were from those who did not receive additional standard surgery after ESD. Kaplan-Meier survival curve analysis showed that the survival rate of patients with additional surgery in the low-risk group was similar to that of patients without ( P=0.319), and the survival rate of patients with additional surgery in the middle-risk group was also similar to that of patients without ( P=0.296). The survival rate of patients with additional surgery in the high-risk group was significantly higher than that of those without ( P=0.013). Conclusion:The eCura scoring system can assist the selection of treatment strategies after non-curative resection of EGC, and can accurately predict the risk of subsequent LNM and recurrence. Close follow-up may be an acceptable option for patients with low risk of LNM, and additional standard surgical treatment may be more conducive to improving the prognosis in patients with high risk of LNM.

Objective To evaluate the clinical efficacy and safety of different stitching methods,over-the-scope-clip (OTSC) and metal clips combined with nylon rope (King closure),for full-layer gastric wall defect.Methods Data of 75 cases,who underwent endoscopic full-thickness resection (EFTR) of gastric SMTs from May 2015 to May 2018 in our endoscopy center were retrospectively analyzed.According to the closure method,the patients were divided into the OTSC group (20 cases) and the King closure group (55 cases).Comparison was made in gender,age,the largest diameter of tumor,the location of tumor,defect surface diameter,total operating time,defect closure time,closure success rate,the length of hospital stays,cost and postoperative complications between the two groups,Results The baseline data were comparable,and there were no significant differences in age,gender,tumor location,tumor diameter,and defect surface diameter between the two groups(all P＞0.05).The success rate of closure was 100％ in both groups.In terms of length of hospital stay,there was no significant difference between the two groups (t =1.13,P=0.268).The total operating time was 63.24±43.22 min in the King closure group versus 47.60± 18.13 min in the OTSC group (t =2.20,P =0.030).The closure time of the defect surface was 20.85 ± 16.35 min in the King closure group versus 10.95±5.20 min in the OTSC group (t =2.65,P=O.010).Hospitalization costs were 24 200±800 yuan in the King closure group versus 36 200±2 350 yuan in the OTSC group (t=6.21,P＜0.001).Postoperative abdominal elevation radiographs in both groups indicated a small amount of subphrenic free gas,and no intervention was given due to the small amount of gas and no obvious symptoms.No late bleeding,recurrent perforation,infection or other complications occurred after operation,and all patients were discharged successfully.Six months after surgery,15 patients (27％) in the King closure group developed metal clips or nylon rope residue,which were successfully removed by endoscopy.The anastomosis clamp of nighteen patients (95％) in the OTSC group were in the original position.None of the patient received open surgery.Conclusion OTSC and King closure are both safe and effective in the treatment of full-thickness defect of gastric wall.OTSC has the advantages of short total operation time and short closure time,but with high cost.

Objective To investigate the endoscopic and clinicopathological features between the young,middle-aged,and elderly patients with advanced gastric cancer in Fuzhou area. Methods The clinical data of 2 357 patients with advanced gastric cancer in digestive endoscopy center of Fujian Provincial Hospital from January 2010 to December 2015 were collected. All cases were divided into two groups, the youth group with age ≤40 years old, and the middle-aged and elderly group with age > 40 years old. The gender, pathological type, cancer position and endoscopic typing of patients were compared between the two groups by using chi-square test. Results In the whole 2 357 patients, the male to female ratio was 2.71:1. The youth group had 120 cases (5.09 %), the male to female ratio was 1:1.07. The middle-aged elderly group had 2 237 cases (94.91 %), the male to female ratio was 2.90:1. The incidence of middle part gastric cancer in youth group was significantly higher than that in middle-aged and elderly group [43.33 % (52/120) vs. 25.75 %(576/2 237),χ2=18.018,P =0.000], however the incidence of upper part gastric cancer in middle-aged and elderly group was significantly higher than that in youth group [27.58 % (617/2 237) vs. 6.67 % (8/120), χ2= 25.568, P = 0.000]. Borrmann Ⅲ type were common in the two groups, but the proportion of Borrmann Ⅰ type in middle-aged and elderly group was significantly higher than that in youth group [20.79 % (465/2 237) vs. 11.67 % (14/120), χ 2= 5.850, P = 0.016], the proportion of Borrmann Ⅳ type in youth group was significantly higher than that in middle-aged and elderly group [23.33 % (28/120) vs. 11.27 %(252/2 237),χ2=15.845,P =0.000].As compared with the middle-aged and elderly patients,youth patients had worse differentiation and growth type (P < 0.01). There were no significant differences in each index between male and female in the youth group (all P > 0.05). In the middle-aged and elderly group, the incidence of upper part gastric cancer in male group was higher than that in female group[29.03 %(483/1 664) vs. 23.39 % (134/573), χ 2= 6.790, P = 0.009], the incidence of middle part gastric cancer in female group was higher than that in male group [31.06 % (178/573) vs. 23.92 % (398/1 664), χ 2= 9.415, P = 0.002]. In the middle-aged and elderly group, the female patients had worse differentiation than the males (P < 0.01). Conclusions There are differences in the endoscopic and clinicopathological features between young, middle-aged, and elderly patients with advanced gastric cancer in Fuzhou area. In young patients, the proportion of patients with middle part gastric cancer is high, while in middle-aged and elderly patients, the proportion of upper part gastric cancer is high.Compared with the middle-aged and elderly patients,the young patients have worse differentiation.

Objective To evaluate the efficacy of testa triticum tricum purif combined with polyethylene glycol electrolyte powder for bowel preparation before colonoscopy in patients with constipation. Methods A total of 190 patients with constipation who underwent colonoscopy were randomized into 2 groups. The study group(n=93)were given testa triticum tricum purif and polyethylene glycol electrolyte powder,whereas the control group(n=97)were given polyethylene glycol electrolyte powder only.The bowel cleanness,adenoma detection rate,and incidence of adverse events during bowel preparation were compared. Results The bowel preparation score(7.31±1.14 VS 6.06±1.22,P=0.000)and effective rate(95.70%VS 69.07%, P=0.000)in the study group was significantly higher than that in the control group. The incidence of adverse events in the study group was lower than that in the control group(5.38% VS 17.53%, P=0.009). There was no significant difference in the adenoma detection rate between the two groups (36.56% VS 26.80%, P=0.148). Conclusion Testa triticum tricum purif combined with polyethylene glycol electrolyte powder is superior to conventional method of polyethylene glycol electrolyte powder alone for colonoscopy bowel preparation in patients with constipation.

Objective To compare the effectiveness and safety of endoscopic submucosal dissection ( ESD) with endoscopic piecemeal mucosal resection ( EPMR) for early esophageal cancer and precancerous lesions with length more than 5 cm. Methods A retrospective analysis was performed on data of 85 patients diagnosed as early esophageal cancer and precancerous lesions with length more than 5 cm in Fujian Medical Association of Early Esophageal Carcinoma from January 2012 to July 2017. The patients were divided into ESD group (52 cases) and EPMR group (33 cases), and the effectiveness and safety between the two groups were compared. Results There was no significant difference on the complete resection rate between the two groups[86. 5％ (45/52) VS 87. 9％ (29/33), P>0. 05]. The operative time (58. 53±30. 50 min VS 32. 06±9. 12 min), postoperative fasting time (4. 18±1. 30 d VS 3. 67±0. 96 d), postoperative hospital-stay time (7. 45±2. 44 d VS 6. 54±1. 73 d), and postoperative antibiotics using time (3. 48±2. 33 d VS 1. 96±2. 20 d) in ESD group were higher than those in EPMR group (all P<0. 05). There were no significant difference in the rate of intraoperative complication and short-term postoperative complication, such as fever, chest pain, and postoperative bleeding, between the two groups ( all P>0. 05 ) . But the postoperative stricture rate of ESD group was higher than that of EPMR group[23. 1％ (12/52) VS 6. 1％(2/33), P<0. 05]. During the follow-up of 3-63 months, 5 cases recurred in ESD group and 1 case in EPMR group, with no significant difference ( P>0. 05). Conclusion ESD and EPMR have equivalent efficacy and safety on the treatment of early esophageal cancer and precancerous lesion. EPMR has a shorter operative time, lower rate of post-operative stricture, and is easier to master.

Objective To explore the value of OTSC( over-the-scope-clip) for upper digestive tract perforation. Methods Thirteen patients with old and fresh upper digestive tract perforation, treated with an OTSC clip at the Department of Digestive Endoscopy from May 2015 to June 2016, were enrolled. All OTSCs were 11/6t, and all procedures were performed by experienced endoscopists. Results Seven cases of fresh perforation were iatrogenic after treatment for gastric submucosal tumor. Six cases of old perforation included 2 cases of spontaneous esophageal rupture, 2 fistula after operations for esophageal foreign body, 1 fistula after the operation for gastric stromal tumor, and 1 anastomotic fistula after esophagectomy. Eight cases of perforation occurred in stomach and 5 in esophageal. Fresh lesion sizes were from 4 to 30 mm ( average 15. 3 mm), old lesion sizes from 5 to 10 mm(average 7. 8 mm). OTSC′s release time in fresh lesions was 6-27 min(average 15. 1 min), that in old 15-80 min(average 42. 3 min) with significant difference. Technical success rate was 100％(13/13),clinical success rate in fresh lesions was 100％(7/7),and 50％ (3/6) in old lesions. No patient had special treatment or complication. Conclusion OTSC is useful and safe for the treatment of upper digestive tract perforation, which is superior for fresh perforation than for the old. The perfect time to release OTSC for old perforation is when there is no obvious fibrosis caused by inflammation. The success rate is higher when the lesion size is smaller than 30 mm. Self-releasing of OTSC is rare. The necessity and the timing to take them out still needs further study.

Objective To evaluate the efficacy of combined application of lactitol oral solution and polyethylene glycol electrolyte (PEG) powder compared with conventional method in bowel preparation before colonoscopy. Methods 205 patients who underwent colonoscopy were randomly divided into experimental group and control group. The experimental group (n = 102) were given lactitol and polyethylene glycol electrolyte powder, whereas the patients in control group (n = 103) were given polyethylene glycol electrolyte powder only. The visibility and adverse effects during colonoscopy were observed. Results The cleaning satisfaction rate was not statistically significant between the two groups. The proportion of cleanliness to grade 1 in experimental group was higher than that in control group. The incidence of adverse effects in experimental group was lower, and there was no effect on sleeping night. The compliance and tolerance of hospitalized patients were significantly improved. Conclusion Lactitol combined with polyethylene glycol electrolyte (peg) powder is safe, effective, with low incidence of adverse effect for bowel preparation in hospitalized patients.

Objective To evaluate the effects and the safety of peroral endoscopic myotomy (POEM) for achalasia (AC).Methods POEM was performed on 7 AC patients from November 2010 to November 2011.Preoperative dysphagia grade,postoperative complications and short-term and long-term efficacy were recorded.Results POEM was performed successfully on all the 7 patients.The operation time were ranging from 46 to 113 minutes,mean 73 ± 20 minutes.Subcutaneous emphysema and mediastinal emphysema occurred in 2 patients,but cured after treatment.The 1-12 month follow-up showed dysphagia of all the patients was obviously improved.Conclusion POEM is efficient and safe to relieve dysphagia of AC patients.

ObjectiveTo investigate the protection effect of bifidobacterial adhesin for intestine ischemia/reperfusion (I/R) injury on gut barrier function in rat.MethodsSeventy-two male SD rats were randomly divided into sham operation group (n =24), I/R model group (n =24) and pretreatment group of bifidobacterial adhesin (pretreatment group, n = 24).Six rats were anatomized at 6 h, 1 d, 4 d and 7d after inducing I/R model in each group, respectively.The pathological changes of the terminal ilea and the blood levels of TNFα, IL-6, IL-10, diamine oxidase (DAO), and the activity and content of D-lactic acid were observed.ResultsThe blood levels of TNFα, IL-6, DAO and D-lactic acid in I/R model group were significantly higher than sham operation group at all time points (P ＜0.05) , while the blood level of IL-10 was no significantly change.The activity of IL-6 and DAO in pretreatment group was significantly lower than I/R model group at all time points (P ＜ 0.05), the blood level of TNFαt in pretreatment group was significantly lower than I/R model group at 1 d, the blood level of D-lactic was significantly lower than I/R model group at 4 d and 7 d (P ＜ 0.05). Intestinal pathological damages were obviously milder in pretreatment group than I/R model group at all time points (Chiu's pathological scores: 6 h, 3.22 ±0.22 vs 3.57 ±0.20;1 d,3.77 ±0.13 vs 3.90 ±0.12;4 d,2.93 ±0.23 vs 3.07 ±0.21;7 d,2.10 ±0.30 vs 2.22 ±0.17,all P ＜ 0.05).ConclusionThe pretreatment of bifidobacterial adhesin could protect the intestinal mucosa from I/R injury, and alleviate intestinal ischemic reperfusion injury.

ObjectiveTo observe the effects of bifidobacterial sectory adhesin on NF-κB DNA binding activity,cytoplasm IκB,nuclei NF-κBp65,TNF-α,IL-1β,and IL-8 expression in intestinal epithelial cell post stress response.MethodsThe cultured intestinal epithelial cell line Lovo cells were divided into 5 groups,which included directly stimulated by lypopolysaccharide (LPS) (100 ng/ml) or H2O2 (200 μmol/L) for 3 hours groups,bifidobacterial sectory adhesin (30μg/ml) pre-incubation for 30 minutes and then treated by LPS (100 ng/ml) or H2O2 (200 μmol/L) for 3 hours groups and control group with no treatment.NF-κB DNA binding activity was evaluated by electrophoretic mobility shift assay (EMSA).The cytoplasm IκB and nuclei NF-κBp65 expression were determined by Western blot.The expressions of TNF-α,IL-1β and IL-8 at mRNA level were detected by semi-quantatitive assay of RT-PCR.ResultsThe expressions of NF-κB DNA binding activity [(6.20±0.35) times and (4.16 ± 0.52) times of that of non treated control group,respectively] and nuclei NF-κBp65 [ (0.64±0.05) and (0.67±0.06)] were higher in cells after LPS or H2()2 stimulated,however the cytoplasm IκB expression [ (0.28 ± 0.10) and (0.39 ± 0.12) respectively] was weaker.After bifidobacterial sectory adhesin pre-incubation,the expressions of NF-κB DNA binding activity and nuclei NF-κBp65decreased obviously,but cytoplasm IκB expression increased.After treated with LPS or H2O2,the mRNA expressions of TNF-α,IL-1β and IL-8 were significantly increased [LPS treated group2 (0.92±0.10)、(0.38±0.03)、(1.44±0.25),H2O2 treated group:(0.89±0.13)、(0.36±0.06)、(1.42±0.18)].After bifidobacterial sectory adhesin pre-incubation,their expressions decreased.The mRNA expressions of TNF-α,IL-1β and IL-8 have significantly positive correlation with NF-κB DNA binding activity.ConclusionsThere is a significant inhibition role of bifidobacterial sectory adhesin in LPS and H2O2 induced NF-κB DNA binding activity in intestinal epithelia cells.The activation of NFκB may associate with the regulation of TNF-α,IL-1β and IL-8 proinflammatory cytokines expression.