Objective: To analyze the clinicopathological characteristics and prognosis of patients with small bowel tumors. Methods: This was a retrospective, observational study. We collected clinicopathological data of patients with primary jejunal or ileal tumors who had undergone small bowel resection in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between January 2012 and September 2017. The inclusion criteria included: (1) older than 18 years; (2) had undergone small bowel resection; (3) primary location at jejunum or ileum; (4) postoperative pathological examination confirmed malignancy or malignant potential; and (5) complete clinicopathological and follow-up data. Patients with a history of previous or other concomitant malignancies and those who had undergone exploratory laparotomy with biopsy but no resection were excluded. The clinicopathological characteristics and prognoses of included patients were analyzed. Results: The study cohort comprised 220 patients with small bowel tumors, 136 of which were classified as gastrointestinal stromal tumors (GISTs), 47 as adenocarcinomas, and 35 as lymphomas. The median follow-up for all patient was 81.0 months (75.9-86.1). GISTs frequently manifested as gastrointestinal bleeding (61.0%, 83/136) and abdominal pain (38.2%, 52/136). In the patients with GISTs, the rates of lymph node and distant metastasis were 0.7% (1/136) and 11.8% (16/136), respectively. The median follow-up time was 81.0 (75.9-86.1) months. The 3-year overall survival (OS) rate was 96.3%. Multivariate Cox regression-analysis results showed that distant metastasis was the only factor associated with OS of patients with GISTs (HR=23.639, 95% CI: 4.564-122.430, P<0.001). The main clinical manifestations of small bowel adenocarcinoma were abdominal pain (85.1%, 40/47), constipation/diarrhea (61.7%, 29/47), and weight loss (61.7%, 29/47). Rates of lymph node and distant metastasis in patients with small bowel adenocarcinoma were 53.2% (25/47) and 23.4% (11/47), respectively. The 3-year OS rate of patients with small bowel adenocarcinoma was 44.7%. Multivariate Cox regression-analysis results showed that distant metastasis (HR=4.018, 95%CI: 2.108-10.331, P<0.001) and adjuvant chemotherapy (HR=0.291, 95% CI: 0.140-0.609, P=0.001) were independently associated with OS of patients with small bowel adenocarcinoma. Small bowel lymphoma frequently manifested as abdominal pain (68.6%, 24/35) and constipation/diarrhea (31.4%, 11/35); 77.1% (27/35) of small bowel lymphomas were of B-cell origin. The 3-year OS rate of patients with small bowel lymphomas was 60.0%. T/NK cell lymphomas (HR= 6.598, 95% CI: 2.172-20.041, P<0.001) and adjuvant chemotherapy (HR=0.119, 95% CI: 0.015-0.925, P=0.042) were independently associated with OS of patients with small bowel lymphoma. Small bowel GISTs have a better prognosis than small intestinal adenocarcinomas (P<0.001) or lymphomas (P<0.001), and small bowel lymphomas have a better prognosis than small bowel adenocarcinomas (P=0.035). Conclusions: The clinical manifestations of small intestinal tumor are non-specific. Small bowel GISTs are relatively indolent and have a good prognosis, whereas adenocarcinomas and lymphomas (especially T/NK-cell lymphomas) are highly malignant and have a poor prognosis. Adjuvant chemotherapy would likely improve the prognosis of patients with small bowel adenocarcinomas or lymphomas.
Humans ; Prognosis ; Intestinal Neoplasms/diagnosis* ; Duodenal Neoplasms ; Gastrointestinal Stromal Tumors ; Lymphoma ; Adenocarcinoma/surgery* ; Constipation ; Abdominal Pain ; Retrospective Studies

Gastric intestinal metaplasia (GIM) is a known premalignant condition of the human stomach along the pathway to gastric cancer (GC). Histologically, GIM represents the replacement of normal gastric mucosa by mucin-secreting intestinal mucosa. Helicobacter pylori infection is the most common etiologic agent of GIM development worldwide. The prevalence of GIM is heterogeneous among different regions of the world and correlates with the population endemicity of H. pylori carriage, among other environmental factors. GC remains the third leading cause of cancer-related mortality globally. GIM is usually diagnosed by upper endoscopy with biopsy, and histologic scoring systems have been developed to risk-stratify patients at highest risk for progression to GC. Several recent endoscopic imaging modalities may improve the optical detection of GIM and early GC. Appropriate surveillance of GIM may be cost effective and represents an opportunity for the early diagnosis and therapy of GC. Certain East Asian nations have established population-level programs for the screening and surveillance of GIM; guidelines regarding GIM surveillance have also recently been published in Europe. By contrast, few data exist regarding the appropriateness of surveillance of GIM in the United States. In this review, we discuss the pathogenesis, epidemiology, diagnosis, and management of GIM with an emphasis on the role of appropriate endoscopic surveillance.
Asian Continental Ancestry Group ; Biopsy ; Diagnosis ; Early Diagnosis ; Endoscopy ; Epidemiology ; Europe ; Gastric Mucosa ; Helicobacter pylori ; Humans ; Intestinal Mucosa ; Mass Screening ; Metaplasia ; Mortality ; Prevalence ; Stomach ; Stomach Neoplasms ; United States

When performing laparoscopic gastrectomy, suturing the intestinal anastomosis presents one of the greatest challenges. The V-Loc unidirectional barbed suture has been introduced to eliminate the need to tie knots during closure. This device offers a fast, secure, and effective alternative to conventional suture repair during laparoscopic surgery. However, there have been reported cases of surgical complications associated with the use of barbed suture devices. We describe here a case of small bowel obstruction resulting from improper use of barbed suture during total laparoscopic distal gastrectomy performed for gastric cancer. Following diagnosis of small bowel obstruction, the patient underwent immediate laparoscopic repair that identified the cause and relieved the small bowel obstruction. This case highlights the need for surgeons to carefully perform proper suturing technique in order to prevent complications. Surgeons should maintain a high index of suspicion for diagnosing and treating potentially severe complications when using barbed sutures.
Diagnosis ; Gastrectomy* ; Humans ; Intestinal Obstruction ; Laparoscopy ; Stomach Neoplasms ; Surgeons ; Suture Techniques ; Sutures*

Primary malignant small bowel tumor as a rare kind of intestinal tumor is associated with a poor prognosis. The pathological types were various and complicated, such as adenocarcinoma, neuroendocrine tumor, malignant lymphoma, and malignant stromal tumor. The atypical early stage symptom resulted in difficult diagnosis at early stage, high misdiagnosis rate and lack of standard therapy schemes and means. In the past, X-ray, CT, MRI, and PET-CT were the main examination methods for primary small bowel tumor. However, with the development of radiology, a series of new diagnosis methods, including electronic enteroscopy, capsule endoscopy, multi-slice spiral CT enteroclysis and so on, promotes the diagnosis accurate rate. Surgery is still the most important method in the small bowel tumor treatment, and the alternative of the surgical method should depend on the tumor location, size and relationship with the adjacent organs. Application of the laparoscopic surgery for the small bowel tumor is still in the initial stage. Besides, some researches have confirmed that chemotherapy, radiotherapy, target therapy and endocrinotherapy have effects on the specific kind of small bowel tumor. Therefore this article will review the epidemiology, pathology, diagnosis and treatment of the primary malignant small bowel tumors.
Adenocarcinoma ; diagnosis ; epidemiology ; pathology ; therapy ; Capsule Endoscopy ; Gastrointestinal Stromal Tumors ; diagnosis ; epidemiology ; pathology ; therapy ; Humans ; Intestinal Neoplasms ; diagnosis ; epidemiology ; pathology ; therapy ; Intestine, Small ; diagnostic imaging ; pathology ; Laparoscopy ; methods ; Lymphoma ; diagnosis ; epidemiology ; pathology ; therapy ; Neuroendocrine Tumors ; diagnosis ; epidemiology ; pathology ; therapy ; Tomography, Spiral Computed

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are neoplasms presenting unpredictable and unusual biologic behavior that causes many clinical challenges. NETs can produce a variety of metabolically active substances (hormones and amines) leading to distinct clinical syndromes. This review will discuss the imaging techniques for the diagnosis of GEP-NETs including ultrasonography, CT, MRI and ultrasound endoscope. In this article, Gallium-68 labeled peptide binding to G protein coupled receptor including SSTR, CCKR1 and GLP1R is addressed, and the application of Gallium-68 labeled somatostin analogues and PET-CT for diagnosis of GEP-NETs is evaluated. In conclusion, Gallium-68 labeled peptide and molecular imaging will play important roles in diagnosis, prognosis and therapeutic strategy development of GEP-NETs.
Diagnostic Imaging ; methods ; Endoscopy ; Gallium Radioisotopes ; chemistry ; Humans ; Intestinal Neoplasms ; diagnosis ; Magnetic Resonance Imaging ; Neuroendocrine Tumors ; diagnosis ; Pancreatic Neoplasms ; diagnosis ; Prognosis ; Receptors, G-Protein-Coupled ; chemistry ; Stomach Neoplasms ; diagnosis ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo evaluate the result of colorectal cancer screening for high-risk groups in Harbin, China from 2012 to 2015.

METHODSAccording to the Project of National Colorectal Cancer Screening in Urban Area, epidemiological investigation and cancer risk evaluation established by National Cancer Center were performed among 40-69 years old residents in Harbin. Questionnaires were issued to assess high-risk groups for clinical screening, including colonoscope examination. The results of colorectal screening were evaluated in detail.

RESULTSProject of Colorectal Cancer Screening in Urban Area was completed successfully from 2012 to 2015 in various districts of Harbin. The accomplishment of high-risk assessment included 3 017 people, while 2 996 people received the clinical screening, including 1 376 males and 1 629 females, from 40 to 69 (53.3±7.1) years old. Among 2 996 people, 1 158 cases of colorectal polyps(38.7%) were screened, including 36.6%(901/2 465) cases of age<60 and 48.4%(257/531) cases of age>60 years old with significant difference (χ=19.19, P<0.01), and 47.6% (651/1 367) cases of male and 31.1%(507/1 629) cases of female with significant difference (χ=85.33, P<0.01). Of 1 158 polyps patients, 141 received the pathological examination and 11 patients were diagnosed as colorectal cancer, accounting for 0.4% of overall screening people (11/2 996). All these 11 patients underwent operation by advice and the postoperative pathology results all indicated early adenocarcinoma. Furthermore, among 141 polyps patients, 97 cases of tubular adenoma were found, which were distributed as follows: 2 cases of cecum (2.1%), 14 cases of ascending colon(14.4%), 12 cases of transverse colon (12.4%), 15 cases of descending colon (15.5%), 35 cases of sigmoid colon (36.1%) and 19 cases of rectum(19.6%).

CONCLUSIONWith the increase in age, the risk of colorectal polyps is significantly elevated. The males have higher incidence of colorectal polyps than the females. Adenoma mainly locates in the distal colon and rectum, especially in the sigmoid colon. Early screening for high-risk group can find out colorectal precancerosis and cancer, so the patients can receive early treatment.

Adenocarcinoma ; diagnosis ; Adenoma ; diagnosis ; Aged ; Cecum ; China ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Colorectal Neoplasms ; diagnosis ; Early Detection of Cancer ; Female ; Humans ; Incidence ; Intestinal Polyps ; Male ; Middle Aged ; Rectum ; Risk ; Surveys and Questionnaires

OBJECTIVETo explore the application of a novel device of collecting large amount of fecal mucosa for detecting the DNA methylation and screening colorectal cancer.

METHODSPreoperative complete fecal sample and surgical specimen of 10 patients with colorectal cancer, and complete fecal sample and normal bowel mucosal samples confirmed by colonoscopy of 6 hospitalization cases at The Third Affiliated Hospital, Nanjing University of TCM from March to April 2014 were collected. A self-made bowel mucosa collector (consisting of upper, middle, lower three containers of 1 000 ml volume, with filter screen in each bottom whose pore diameter is 100, 200 and 300 mesh.) was used to collect mucosal exfoliation cells. Fecal DNA kit was applied to extract DNA of exfoliation cells and the concentration and purity of DNA were measured by UV spectrophotometer (A260/A280), meanwhile DNA methylation of fecal fluid and mucosal tissues was detected by bisulfite sequencing pCR(BSP).

RESULTSDNA methylation sequencing showed that FBN1, SPG20, and SNCA genes presented methylation in CpG island in fecal fluid and cancer tissues from 10 colorectal cancer patients, but did not presented methylation in fecal fluid and mucosa from 6 control cases. When fecal amount was below 100 g, collection rate of fecal fluid was 60% to 80%; when fecal amount was over 100 g, collection rate of fecal fluid was unstable. When fecal amount was 50 to 100 g, DNA A260/A280 value was 1.6 to 1.8, and DNA concentration was 5.0 to 56.1 ng/L.

CONCLUSIONCollection rate of fecal fluid with this self-made fecal mucosa collector is quite stable when managing fecal amount of 50 to 100 g once, and can obtain higher purity and concentration of DNA, meeting the demand of methylation detection for screening colorectal cancer.

Colonoscopy ; Colorectal Neoplasms ; diagnosis ; CpG Islands ; DNA Methylation ; Early Detection of Cancer ; methods ; Feces ; chemistry ; Humans ; Intestinal Mucosa

Carcinoma, Squamous Cell ; diagnosis ; drug therapy ; therapy ; Fatal Outcome ; Humans ; Intestinal Neoplasms ; diagnosis ; drug therapy ; therapy ; Intestine, Small ; pathology ; Male ; Middle Aged

Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.
Abdominal Pain ; Antigens, CD20/metabolism ; Antigens, CD45/metabolism ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Gastrectomy ; Humans ; Intestinal Perforation/diagnostic imaging ; Lymphoma, Large B-Cell, Diffuse/*diagnosis/drug therapy/pathology ; Lymphoma, Non-Hodgkin/*diagnosis/drug therapy/pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Stomach Neoplasms/*diagnosis/drug therapy/pathology ; Tomography, X-Ray Computed

Phaeochromocytomas are rare neuroendocrine tumours with variable clinical signs and symptoms. Hypertension, tachycardia, sweating and headaches are cardinal manifestations. Although nausea and abdominal pain are the more common gastrointestinal features, rare gastrointestinal spectrums have been reported that can mimic abdominal emergencies. Metabolic effects of hypercatecholaminaemia are vast and one such rare presentation is lactic acidosis. We describe a case of phaeochromocytoma presenting with both intestinal pseudo-obstruction as well as lactic acidosis. This case report highlights the importance of having a high index of suspicion for and early recognition of the gastrointestinal and metabolic manifestations of phaeochromocytomas.
Abdominal Pain ; Acidosis, Lactic ; complications ; Adrenal Gland Neoplasms ; complications ; diagnosis ; Diabetes Mellitus, Type 2 ; complications ; Dyslipidemias ; complications ; Female ; Humans ; Hypertension ; complications ; Intestinal Pseudo-Obstruction ; complications ; Middle Aged ; Neuroendocrine Tumors ; complications ; diagnosis ; Pheochromocytoma ; complications ; diagnosis ; Radiography, Abdominal