Evaluation of the short-term efficacy of local analgesic (lidocaine) and opioid analgesic (sufentanil) on patients with centrally mediated abdominal pain syndrome: a randomized controlled trial

BACKGROUND

Centrally mediated abdominal pain syndrome (CAPS) is characterized by continuous or frequently recurring abdominal pain and can result in functional loss across several life domains. The efficacy of the present management methods has not been established yet. We performed a prospective randomized controlled trial to explore the short-term efficacy of local analgesic (lidocaine) and opioid analgesic (sufentanil) in patients with CAPS.

METHODS

We consecutively enrolled 130 patients who met the Rome IV CAPS criteria and divided them into the sufentanil + lidocaine (S + L) group and sufentanil (S) group. Patients completed the pain rating scales, including the numeric rating scale (NRS) and verbal rating scale (VRS), 60 min before colonoscopy. All the patients were initially administered sufentanil. In the S + L group, we sprayed a 5 ml solution of lidocaine on the surface of ascending, transverse, descending, and sigmoid colon during colonoscope withdrawal, while 5 ml saline was sprayed in the S group. Follow up was performed 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months after colonoscopy, to complete the pain scaling.

RESULTS

A comparison of the NRS and VRS showed that there were no significant differences between the S + L and S groups and within each group (p > 0.05).

CONCLUSIONS

Local analgesic lidocaine and opioid analgesic sufentanil showed negative efficacy during short-term observation. The opioid receptor blocker sufentanil did not worsen symptoms in patients with CAPS after colonoscopy under general anesthesia in the short term.[chictr.org.cn, Chinese Clinical Trial Identifier, ChiCTR-IOR-16008187].

New anti-reflux plastic stent to reduce the risk of stent-related cholangitis in the treatment of biliary strictures

BACKGROUND

There is little data available on the role of new anti-reflux plastic stents (ARPSs).

AIM

To compare the use of ARPSs with that of traditional plastic stents (TPSs) for patients with biliary strictures.

METHODS

Consecutive patients with biliary strictures who underwent first endoscopic biliary stenting between February 2016 and May 2019 were included. The onset of stent-related cholangitis, stent patency, clinical success, and other adverse events were evaluated.

RESULTS

Sixty-seven patients in the ARPS group and 66 patients in the TPS group were included in the final analyses. Fewer patients experienced stent-related cholangitis in the ARPS group than that in the TPS group (8 patients vs 18 patients; P = 0.030). The median time till the onset of first stent-related cholangitis was later in the ARPS group than that in the TPS group (128.5 d vs 76 d; P = 0.039). The cumulative median stent patency in the ARPS group was 185 d, which was significantly longer than that in the TPS group (133 d; P = 0.001). The clinical success rates and other adverse events did not significantly differ between both groups.

CONCLUSION

Placement of new ARPS might be a safe and effective optional therapeutic strategy to reduce the risk of stent-related cholangitis and prolong stent patency.

Negative-Pressure Isolation Mask for Endoscopic Examination During the Coronavirus Disease 2019 Pandemic: A Randomized Controlled Trial

INTRODUCTION

During the coronavirus disease 2019 (COVID-19) pandemic, endoscopists have high risks of exposure to exhaled air from patients during gastroscopy. To minimize this risk, we transformed the oxygen mask into a fully closed negative-pressure gastroscope isolation mask. This study aimed to evaluate the effectiveness, safety, and feasibility of use of this mask during gastroscopy.

METHODS

From February 28, 2020, to March 10, 2020, 320 patients undergoing gastroscopy were randomly assigned into the mask group (n = 160) or conventional group (n = 160). Patients in the mask group wore the isolation mask during gastroscopy, whereas patients in the conventional group did not wear the mask. The adenosine triphosphate fluorescence and carbon dioxide (CO2) concentration in patients' exhaled air were measured to reflect the degree of environmental pollution by exhaled air. Patients' vital signs, operation time, and adverse events during endoscopy were also evaluated.

RESULTS

Four patients were excluded because of noncooperation or incomplete data. A total of 316 patients were included in the final analysis. The difference between the highest CO2 concentration around patients' mouth and CO2 concentration in the environment was significantly decreased in the mask group compared with the conventional group. There was no significant difference in the adenosine triphosphate fluorescence, vital signs, and operation time between the 2 groups. No severe adverse events related to the isolation mask, endoscopy failure, or new coronavirus infection during follow-up were recorded.

DISCUSSION

This new isolation mask showed excellent feasibility of use and safety compared with routine gastroscopy during the COVID-19 pandemic.

Clinical research of individualized therapy in advanced esophageal cancer based on the ERCC1 C8092A genotype

The present study aimed to explore the role and clinical value of the detection of Excision repair cross-complementing 1(ERCC1) C8092A polymorphisms in individualized therapy of patients with advanced esophageal cancer. A total of 127 patients with advanced esophageal cancer were enrolled between January 2010 and January 2014 in Anhui Provincial Hospital. Patients were randomly assigned in a 1:2 ratio to a standard treatment group or an individualized treatment group, respectively, prior to ERCC1 C8092A assessment. Patients in the standard treatment group were treated with paclitaxel and cisplatin. The DNA was obtained from the peripheral blood of individualized treatment patients, amplified by PCR and sequenced to determine the ERCC1 C8092A polymorphism prior to the administration of chemotherapies. Patients with the ERCC1 C8092A genotype of A/A or A/C received paclitaxel and cisplatin, and those with the genotype of C/C received paclitaxel and fluorouracil. The primary endpoint was response rate (RR). The secondary endpoints included toxicity of chemotherapy, progression-free survival (PFS) and overall survival (OS) times. Differences between the groups were evaluated by χ2 test. Differences in survival were analyzed by Kaplan-Meier survival curves. The survival rate was analyzed by log-rank test. Follow-up data was obtained until December 2015. The RR was obtained for 15 patients (34.8%) in the standard treatment group and 45 patients (53.6%) in the individualized treatment group (χ2=3.095; P=0.046). For adverse events, nausea and vomiting and anemia were significantly decreased in the individualized treatment group compared with the standard treatment group (P=0.001 and P=0.004, respectively). The median progression free survival time was 4.4 months [95% confidence interval (CI)3.8-5.0 months] in the standard treatment group and 6.6 months (95% CI, 5.8-7.4 months) in the individualized treatment group (P=0.018). The median overall survival time was 11.4 months (95% CI, 10.1-12.7 months) in the standard treatment group and 14.2 months (95% CI, 13.2-15.2 months) in the individualized treatment group (P=0.008). The RR, toxicity of chemotherapy, PFS and OS were significantly improved in the individualized treatment group compared with the standard treatment group. Detection of ERCC1 gene polymorphisms maybe performed for patients with advanced esophageal cancer to improve individualized therapy, which requires additional study.

Per-oral endoscopic dual myotomy for the treatment of achalasia

BACKGROUND

Repeat per-oral endoscopic myotomy is occasionally performed for persistent/recurrent symptoms in patients with achalasia, and yields favorable outcomes. We investigated a novel technique, per-oral endoscopic dual myotomy (dual-POEM), where a second myotomy was performed during a single session to augment the efficacy and avoid repeat interventions. The aim of this study was to evaluate its feasibility, safety and efficacy.

METHODS

Consecutive patients diagnosed with achalasia who underwent dual-POEM (1/2018-5/2019) were prospectively collected and retrospectively analyzed. Patients with baseline Eckardt score ≥ 9, ≥ 10 years of symptoms, and/or having prior interventions other than myotomy received dual-POEM. The primary outcome was clinical success (Eckardt score ≤ 3). Secondary outcomes were procedure-related adverse events, change in lower esophageal sphincter (LES) pressure, and reflux complications.

RESULTS

Seventeen patients received dual-POEM. Procedure-related adverse events were observed in 2 (11.8%) patients (mucosal injury and pneumonitis). Both were minor in severity. During a median follow-up of 33 months (interquartile range, IQR [31,35]; range, 19-36), clinical success was achieved in 16 (94.1%) patients. The median Eckardt score decreased from 9 (IQR [8, 11.5]; range 7-12) to 1 (IQR [1, 2]; range 0-4) (P < 0.001), and LES pressure decreased from 25.8 mmHg (IQR [21.7, 33.5]; range 17.7-46.3) to 7.4 mmHg (IQR [6.3, 10.4]; range 2.2-12.6) (P < 0.001). Seven (41.2%) patients developed postprocedural reflux either by gastroesophageal reflux disease questionnaire or esophagitis endoscopically, all successfully treated with proton pump inhibitors.

CONCLUSION

Dual-POEM preliminarily demonstrated high efficacy with a favorable safety profile in patients with achalasia with predictors of treatment failure.

Aorto-esophageal fistula caused by fishbone ingestion: a case report on staged endovascular and endoscopic treatment

BACKGROUND

Aorto-esophageal fistula (AEF) caused by foreign bodies ingestion is a rare but devastating disorder. Thoracic endovascular aortic repair (TEVAR) has become a widely accepted intervention for treating aorto-esophageal fistulas. As for post-TEVAR esophageal defect, secondary esophagectomy has been the recommended choice for most of the AEFs, but there is no general consensus with regard to the need of secondary surgeries for patients in the absence of clear signs of reinfection or bleeding. We herein presented a case of an AEF caused by fishbone ingestion, after successful TEVAR, the esophageal lesion was closed endoscopically.

CASE PRESENTATION

A 38-year-old male presented with esophageal fistula for 4 months. He was diagnosed with AEF because of Chiari's triad after fishbone ingestion 4 months ago. Emergency thoracic aortic stent implantation was done, and given broad spectrum antibiotics and blood transfusion. His symptoms were improved, and discharged with an esophageal fistula left to heal itself. Nevertheless, after 4 months, re-examination of esophago-gastro-duodenoscopy revealed that the diameter of the fistula was changed from 3 to 6 mm. He was then admitted to our hospital for esophageal fistula repair. Laboratory examinations and chest computed tomography showed no signs of active infection, and endoscopic closure of the fistula was achieved with 4 clips. After that, he was discharged and gradually returned to normal diet.

CONCLUSION

For AEFs in the absence of active infection with repaired aorta but persistent esophageal fistula, endoscopic closure by endoclips might be an effective treatment choice.

Endoscopic partial closure followed by adequate drainage for treating delayed perforation caused by duodenal endoscopic submucosal dissection: A case report

RATIONALE

Delayed perforation of duodenal endoscopic submucosal dissection (ESD) was reported to be up to 14.3%. High invasive surgery remains the main treatment for delayed duodenal perforation.

PATIENT CONCERNS

A 56-year-old woman presented with abdominal pain and fever at 1st day after ESD for treating a large laterally spreading tumor in the second part of duodenum.

DIAGNOSIS

Emergent abdominal computed tomography revealed the presence of duodenal perforation.

INTERVENTIONS

Endoscopic purse-string technique was used to partially close the large mucosal defect. Percutaneous endoscopic gastrostomy was conducted for gastric drainage and proximal drainage of the wound. A nasointestinal decompression tube was placed for distal drainage of the wound.

OUTCOMES

No further symptoms were noted after 5 days. Both upper gastrointestinal series and endoscopy confirmed the healing of the wound.

LESSONS

Partial closure of the mucosal defect followed by adequate drainage can be selected as a preferred choice for management of delayed duodenal perforation. It may also serve as an alternative for prevention of delayed perforation when complete closure of the mucosal defect is technically difficult or impossible.

Multidisciplinary approaches in the management of advanced hepatocellular carcinoma: Exploring future directions

Recently, we read the article "Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy: A case report and review of the literature" published in the World Journal of Gas trointestinal Oncology. The prognosis of advanced hepatocellular carcinoma (HCC) is poor, and multidisciplinary comprehensive treatment is currently the main research direction. This case report demonstrated the efficacy of the combination therapy of transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, epclusa, lenvatinib and sintilimab for a patient with advanced HCC, and the report can serve as a reference for clinical practice. We would also like to share some of our views.

The value of endoscopically-placed metal clips for transcatheter arterial embolization in the treatment of recurrent acute non-variceal upper gastrointestinal bleeding

OBJECTIVE

Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is a common clinical emergency. Transcatheter arterial embolization (TAE) is usually used to locate the bleeding site and provide interventional embolization. During TAE, there is a low positive rate of angiography, and localization of the culprit vessel is difficult. The purpose of this study was to demonstrate the role of preplaced metal clips in TAE for ANVUGIB patients.

MATERIALS AND METHODS

Patients with ANVUGIB in whom bleeding sites were identified endoscopically and treated with TAE from January 1st, 2005 to July 1st, 2021 were retrospectively included. According to the presence or absence of preplaced metal clips, they were divided into two groups. The main outcome measurements included the clinical success rate and rebleeding rate. Secondary outcome measurements included the mortality rate and the need for surgery. Predictors of the clinical success rate were assessed with univariate analysis and multivariate analysis.

RESULTS

A total of 102 patients were included in this study, and all of them had undergone arterial embolization. There were 73 cases in the group with metal clips and 29 cases in the group without metal clips with consistent baseline information. The group with metal clips had a higher clinical success rate (82.2% vs. 45.0%, P < 0.001), lower rebleeding rate (8.2% vs 27.6%, P = 0.039) and additional surgery rate (11.0% vs 20.7%, P < 0.001) than the group without metal clips. In univariate analysis, ROCKALL score and preplaced metal clip marking were shown to affect clinical success rate. In multivariate analysis, metal clip marking was found to facilitate clinical success (OR = 3.750, 95CI = 1.456-9.659, P = 0.004).

CONCLUSION

In ANVUGIB patients, preplaced metal clips could improve the clinical success rate of TAE and reduce the mortality rate and the risk of rebleeding.

Managing crawling-type gastric adenocarcinoma with endoscopic techniques and postoperative monitoring

Crawling-type gastric adenocarcinoma is a rare subtype of gastric cancer with diagnostic and therapeutic challenges due to its flat, ill-defined lesions. Advanced diagnostic techniques, such as narrow-band imaging and linear endoscopic ultrasonography, improve detection, but endoscopic submucosal dissection poses a risk of incomplete resection. Despite negative resection margins, vigilant postoperative monitoring is crucial due to the potential for recurrence. This letter highlights the importance of refined diagnostic criteria, individualized treatment approaches, and continuous follow-up to optimize management of this unique gastric cancer subtype.

Magnet-assisted diverticuloplasty for treating the symptomatic esophageal diverticulum: a case series (with video)

BACKGROUND

The development of the magnetic compression technique (MCT) for the gastrointestinal (GI) tract has been widely applied in the treatment of biliary strictures, esophageal atresia, and GI anastomoses. Our team combined the MCT and minimally invasive endoscopic operation to propose a novel alternative procedure called magnet-assisted diverticuloplasty (MAD) for treating various esophageal diverticula. This case series aimed to report the effectiveness, safety, and our experience of MAD.

METHODS

This retrospective case series included patients with symptomatic esophageal diverticulum (SED) who underwent MAD between November 2017 and June 2022 in West China Hospital, Sichuan University. The patients' symptomatic scores were accessed by Eckardt symptomatic scores. The telephone follow-up period ended in March 2023. The primary outcome of the study was clinical success. Secondary outcomes included the technical success of MAD, procedure time, hospitalization, recurrence, and adverse events.

RESULTS

We reported 6 patients with SED who underwent MAD (3 with Zenker's, 1 with middle, and 2 with lower esophageal diverticulum). The technical success rate was 100% (6/6) and no adverse events were reported. The median procedural duration was 22.5 min (interquartile range (IQR) 18.5). The mean hospitalization was 2 days (range 1-3). The median time of follow-up endoscopy was on postoperative day 18 (IQR 31), revealing a shortened diverticular septum under endoscopic examination. After a median telephone follow-up of 23 months (IQR 36), the median total symptomatic score decreased significantly from 4.00 (IQR 3.25) to 1.00 (IQR 2.00) (P = 0.015). The clinical success rate was 83.3% (5/6), and only one patient had recurrent symptoms two years after MAD.

CONCLUSION

MAD provided a novel method for treating SED. Our limited experience suggested that MAD could be minimally invasive and effective. More extensive, multicenter prospective studies were needed to assess this technique further.

Overexpression of periostin is significantly correlated to the tumor angiogenesis and poor prognosis in patients with esophageal squamous cell carcinoma

Recent studies have found that periostin (PN), as a kind of secreted glycoprotein, is closely related to the metastatic potential and prognosis of many kinds of tumors. This study aimed to examine the expression of PN in patients with esophageal squamous cell carcinoma (ESCC) and explore the relationship of PN expression with clinicopathologic factors, tumor angiogenesis and prognosis. The results showed that increased PN protein expression was prevalent in ESCC and was significantly associated with lymphatic metastasis (P=0.008), tumor differentiation (P=0.04), venous invasion (P=0.014) and TNM stage (P=0.001). Additionally, expression of PN was found to be an independent prognostic factor in ESCC patients. High expression of PN protein is closely correlated to the tumor progression and angiogenesis and poor survival of ESCC. Taken together, PN is a promising biomarker to identify individuals with poor prognostic potential and concludes the possibility of its use as a prognostic marker in patients with ESCC.

A Bio-Adaptive Janus-Adhesive Dressing with Dynamic Lubrication Overlayer for Prevention of Postoperative Infection and Adhesion

Wound postoperative infection and adhesion are prevalent clinical conditions resulting from surgical trauma. However, integrating intraoperative repair and postoperative management into a dressing suitable for wounds with unpredictable surface shapes and surroundings remains a formidable challenge. Here, we attempt to introduce a dynamic antifouling surface as wound protective covering and report an in situ formation of slippery-adhesive Janus gel (SAJG) by assembling hydrogel (N-hydrosuccinimide ester-activated powders) and elastomer (Silicon oil-infused polydimethylsiloxane). First powders can rapidly absorb interfacial water to gel and bond to tissue based on network entanglement, forming a tough adhesive hydrogel. Then precured organosilicon is applied to hydrogel and bonded together, forming a slippery elastomer. Due to the molecular polarity difference between hydrogel and elastomer, SAJG exhibits anisotropic surface behavior as evidenced by liquid repellency (hydrophilic vs. hydrophobic), and adhesion performance (bioadhesion vs. antiadhesion). Further, in vivo models are constructed and results demonstrated that the SAJG can effectively prevent bacterial infection to promote wound healing and avoid postoperative adhesion. Predictably, the morphologically adaptive SAJG with slippery and adhesive properties will have tremendous potential in addressing complex wound infections and postoperative complications.

Multiple endocrine neoplasia type 1: Early diagnosis is very important

In this manuscript, we comment on a recent publication by Yuan et al. This article provides a detailed scientific diagnostic process for a multiple endocrine neoplasia type 1 patient, thus offering strong guidance for clinical practice. However, we believe that the authors should also provide information on the patient's long-term prognosis.

Peroral endoscopic myotomy for management of gastrointestinal motility disorder

Achalasia is a type of esophageal motility disorder, consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis. Related clinical symptoms include dysphagia, regurgitation, chest pain, and weight loss. Traditional treatment options include endoscopic botulinum toxin injection, endoscopic pneumatic dilation, and laparoscopic Heller's myotomy. These therapies mainly relieve symptoms by reducing the pressure on the lower esophageal sphincter and reducing blood flow resistance at the esophagogastric junction. Based on endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery, peroral endoscopic myotomy (POEM) is a purely endoscopic method of myotomy with minimal invasiveness and a low rate of adverse events when performed by experienced operators. Since then, numerous studies have shown the significant clinical efficacy and safety of POEM. The purpose of this article is to introduce different modified POEMs, special indications for different POEMs, and their advantages as well as disadvantages.

Albumin-bilirubin score in non-malignant liver and other diseases

The albumin-bilirubin (ALBI) score is derived from albumin and bilirubin levels. Currently, the ALBI score is widely used in various clinical settings. A recent article in the World Journal of Gastroenterology summarized the application of the ALBI score in various non-malignant liver diseases. The ALBI score has a predictive power that is superior or non-inferior to established numerous measures. This may be related to its contiguity, sensitivity, and inclusion of albumin. While we recognize the good results of the ALBI score in a number of diseases, the ALBI score also has limitations. Variation studies for population characteristics and other factors should be performed to validate the performance of ALBI. Further modifications or optimization of ALBI scores should be taken into account.