Vacuum Evaporation Plating Enabling ≤ 10 µm Ultrathin Lithium Foils for Lithium Metal Batteries.

Lithium (Li) metal is widely recognized as a viable candidate for anode material in future battery technologies due to its exceptional energy density. Nevertheless, the commercial Li foils in common use are too thick (≈100 µm), resulting in a waste of Li resources. Herein, by applying the vacuum evaporation plating technology, the ultra-thin Li foils (VELi) with high purity, strong adhesion, and thickness of less than 10 µm are successfully prepared. The manipulation of evaporation temperature allows for convenient regulation of the thickness of the fabricated Li film. This physical thinning method allows for fast, continuous, and highly accurate mass production. With a current density of 0.5 mA cm-2 for a plating amount of 0.5 mAh cm-2, VELi||VELi cells can stably cycle for 200 h. The maximum utilization of Li is already more than 25%. Furthermore, LiFePO4||VELi full cells present excellent cycling performance at 1 C (1 C = 155 mAh g-1) with a capacity retention rate of 90.56% after 240 cycles. VELi increases the utilization of active Li and significantly reduces the cost of Li usage while ensuring anode cycling and multiplication performance. Vacuum evaporation plating technology provides a feasible strategy for the practical application of ultra-thin Li anodes.

Acute Pancreatitis in Pregnancy: A Propensity Score Matching Analysis and Dynamic Nomogram for Risk Assessment.

BACKGROUND: Acute pancreatitis is easily confused with abdominal pain symptoms, and it could lead to serious complications for pregnant women and fetus, the mortality was as high as 3.3% and 11.6-18.7%, respectively. However, there is still lack of sensitive laboratory markers for early diagnosis of APIP and authoritative guidelines to guide treatment. OBJECTIVE: The purpose of this study was to explore the risk factors of acute pancreatitis in pregnancy, establish, and evaluate the dynamic prediction model of risk factors in acute pancreatitis in pregnancy patients. STUDY DESIGN: Clinical data of APIP patients and non-pregnant acute pancreases patients who underwent regular antenatal check-ups during the same period were collected. The dataset after propensity matching was randomly divided into training set and verification set at a ratio of 7:3. The model was constructed using Logistic regression, least absolute shrinkage and selection operator regression, R language and other methods. The training set model was used to construct the diagnostic nomogram model and the validation set was used to validate the model. Finally, the accuracy and clinical practicability of the model were evaluated. RESULTS: A total of 111 APIP were included. In all APIP patients, hyperlipidemic pancreatitis was the most important reason. The levels of serum amylase, creatinine, albumin, triglyceride, high-density lipoprotein cholesterol, and apolipoprotein A1 were significantly different between the two groups. The propensity matching method was used to match pregnant pancreatitis patients and pregnant non-pancreatic patients 1:1 according to age and gestational age, and the matching tolerance was 0.02. The multivariate logistic regression analysis of training set showed that diabetes, triglyceride, Body Mass Index, white blood cell, and C-reactive protein were identified and entered the dynamic nomogram. The area under the ROC curve of the training set was 0.942 and in validation set was 0.842. The calibration curve showed good predictive in training set, and the calibration performance in the validation set was acceptable. The calibration curve showed the consistency between the nomogram model and the actual probability. CONCLUSION: The dynamic nomogram model we constructed to predict the risk factors of acute pancreatitis in pregnancy has high accuracy, discrimination, and clinical practicability.

Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China.

BACKGROUND: Sleep disturbances are serious public health issues that warrant increased attention, especially in adolescents. The aim of this study was to investigate the prevalence and factors associated with sleep disorders among urban adolescents in China. METHODS: This study utilized an online survey to assess the demographic characteristics and mental health status of secondary school students in Lianyungang City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate sleep disturbances in adolescents. The seven-item Generalized Anxiety Disorder (GAD-7) assessed anxiety symptoms, and the Perceived Social Support Scale (PSSS) was used to measure perceived social support. RESULTS: Among 3443 adolescents, the prevalence of sleep disorders were 10.8%, with significantly higher proportions of sleep disorders (13.7% VS 8.3%, P < 0.001) among female adolescents when compared to males. Binary regression analysis revealed that anxiety symptoms (OR = 1.305, 95% CI: 1.269-1.342, P < 0.001) was risk factor for sleep disturbances, and significant other support (OR = 0.944, 95% CI: 0.896-0.994, P = 0.028) and good annual household income (OR = 0.616, 95% CI: 0.394-0.963, P = 0.034) were protective factors. Furthermore, multinomial logistic regression analysis showed that age, sex, and anxiety symptoms were associated with an elevated risk of experiencing more frequent sleep disturbances (all P < 0.05). CONCLUSIONS: We have found that 10.8% of adolescents experience sleep disorders, and it is evident that various factors can influence healthy sleeping. These results underscore the significance of addressing these factors to enhance sleep health among this population.

Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis.

Peroral endoscopic myotomy (POEM) has revolutionized the therapeutic strategy for achalasia with promising results. We conducted this meta-analysis to compare clinical outcomes between Eastern and Western countries. A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library databases to query for studies that assessed the efficacy of POEM for achalasia. All articles published from inception to December 31, 2021 were included. The primary outcome was the pooled clinical success rate. The secondary outcomes included the pooled technical success rate, incidence of adverse events, procedure time and hospital stay. Eighteen Eastern studies involving 5962 patients and 11 Western studies involving 1651 patients were included. The pooled clinical success rate and technical success rate for POEM was equal in the Eastern studies compared to Western studies. The pooled incidence of procedure adverse events for POEM was a little lower in the Eastern studies compared to Western studies (6.6% vs. 8.7%). Similarly, the incidence of reflux-related adverse events was lower in Eastern studies than that in Western studies. The pooled procedure time of POEM was shorter in Eastern studies compared to Western studies (61 minutes vs. 80 minutes), while the length of hospital stay was longer in Eastern studies compared to Western studies (5.8 days vs. 2.4 days). Overall, Eastern countries have the similar POEM outcomes compared to Western countries. However, Eastern countries still need to do more to reduce the length of hospital stay.

Gender differences of authors of major Hepatology society guidelines during the past 15 years.

BACKGROUND AND OBJECTIVE: Recent studies have shown that women are underrepresented as authors of medical research and clinical practice guidelines. This study aimed to evaluate gender disparities of authors of major hepatology guidelines. METHODS: We reviewed the hepatology guidelines published by the following major gastroenterology societies from January 2008 to September 2022: the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), American Association for the Study of Liver Diseases (AASLD), Asian-Pacific Association for the Study of the Liver (APASL), British Society of Gastroenterology (BSG), European Association for the Study of the Liver (EASL) and Korean Association for the Study of the Liver (KASL). We determined the topic and the gender of all authors of each guideline. The numbers of men authors, women authors and total authors were collected. The trends of women first authors, women senior authors and total women authors were assessed. A logistic regression analysis was performed to analyse the relationship between the gender of the first or senior author and related factors. RESULTS: We identified 103 hepatology guidelines published between January 2008 and September 2022 published by the AGA, ACG, AASLD, APASL, BSG, EASL, and KASL. The gender of 1096 of 1100 (99.6%) authors was determined. Therefore, a total of 1096 authors were included: 223 (20.3%) authors were women and 873 (79.7%) authors were men. Women comprised 14.6% of all first authors, and 20.4% of all senior authors were women. Only the AASLD had writing committees comprising more than 30% total women authors. The proportions of women senior authors and total women authors increased significantly during the study period (p < .05). Women first authors and women senior authors were more likely to publish guidelines with more women authors. Women first authors were less likely to be co-authors with men authors. CONCLUSIONS: Over the course of the past decade, the proportion of women authors of major hepatology guidelines has been low; however, this gender gap appears to be closing.

States and hotspots in Helicobacter pylori research from 2002 to 2021: A bibliometric analysis.

BACKGROUND: Recently, numerous publications on Helicobacter pylori (H. pylori) have been published, but bibliometric analyses on this research field are scarce. To address this gap, we conducted a bibliometric analysis to provide a comprehensive overview and to explore the current research states and hotspots in this field. MATERIALS AND METHODS: Publications on H. pylori from 2002 to 2021 were retrieved from the Web of Science Core Collection database (WoSCC). Trends in publications and citations were analyzed using Excel 2021. VOSviewer and Citespace were used to perform bibliometrics analysis. RESULTS: 36,266 publications on H. pylori were retrieved from the WoSCC database. In general, we observed an increasing trend in the number of publications over the past 20 years. The United States was the most productive and influential country, with the largest proportion of both publications and total citations. Helicobacter, US Department of Veterans Affairs, and Graham, David were the most productive journals, institutions and authors, respectively. Further analysis the co-occurrence and burst detection of keywords revealed that the most common keywords were "Helicobacter pylori," "gastric cancer," and "gastritis," all keywords were divided into eight main clusters, and the most important current research hotspot was the relationship between H. pylori infection and the changes of gut microbiota. CONCLUSIONS: The United States has been the most productive and influential country on H. pylori research, and H. pylori-related research remains an active research field. The relationship between H. pylori infection and the changes of gut microbiota is a research hotspot attracting significant attention.

Prediction of in-hospital Mortality of Intensive Care Unit Patients with Acute Pancreatitis Based on an Explainable Machine Learning Algorithm.

BACKGROUND AND AIM: Acute pancreatitis (AP) is potentially fatal. Therefore, early identification of patients at a high mortality risk and timely intervention are essential. This study aimed to establish an explainable machine-learning model for predicting in-hospital mortality of intensive care unit (ICU) patients with AP. METHODS: Data on patients with AP, including demographics, vital signs, laboratory tests, comorbidities, treatment, complication, and severity scores, were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU collaborative research database (eICU-CRD). Based on the data from MIMIC-IV, we used the least absolute shrinkage and selection operator algorithm to select variables and then established 9 machine-learning models and screened the optimal model. Data from the eICU-CRD were used for external validation. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, decision curve, and calibration plots were used to assess the models' efficacy. Shapley's additive explanation values were used to explain the model. RESULTS: Gaussian naive Bayes (GNB) model had the best performance on the data from MIMIC-IV, with an AUC, accuracy, sensitivity, and specificity of 0.840, 0.787, 0.839, and 0.792, respectively. The GNB model also performed well on the data from the eICU-CRD, with an AUC, accuracy, sensitivity, and specificity of 0.862, 0.833, 0.848, and 0.763, respectively. According to Shapley's additive explanation values, the top 4 predictive factors were maximum red cell distribution width, minimum saturation of blood oxygen, maximum blood urea nitrogen, and the Sequential Organ Failure Assessment score. CONCLUSION: The GNB model demonstrated excellent performance and generalizability in predicting mortality in ICU patients with AP. Therefore, it can identify patients at a high mortality risk.

Application of a Machine Learning Predictive Model for Recurrent Acute Pancreatitis.

BACKGROUND AND AIM: Acute pancreatitis is the main cause of hospitalization for pancreatic disease. Some patients tend to have recurrent episodes after experiencing an episode of acute pancreatitis. This study aimed to construct predictive models for recurrent acute pancreatitis (RAP). METHODS: A total of 531 patients who were hospitalized for the first episode of acute pancreatitis at the Affiliated Hospital of Southwest Medical University from January 2018 to December 2019 were enrolled in the study. We confirmed whether the patients had a second episode until December 31, 2021, through an electronic medical record system and telephone or WeChat follow-up. Clinical and follow-up data of patients were collected and randomly allocated to the training and test sets at a ratio of 7:3. The training set was used to select the best model, and the selected model was tested with the test set. The area under the receiver operating characteristic curves, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, decision curve, and calibration plots were used to assess the efficacy of the models. Shapley additive explanation values were used to explain the model. RESULTS: Considering multiple indices, XGBoost was the best model. The area under the receiver operating characteristic curves, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model in the test set were 0.779, 0.763, 0.883, 0.647, 0.341, and 0.922, respectively. According to the Shapley additive explanation values, drinking, smoking, higher levels of triglyceride, and the occurrence of ANC are associated with RAP. CONCLUSION: The XGBoost model shows good performance in predicting RAP, which may help identify high-risk patients.

Mid-Term and Long-Term Outcomes of Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) achieves a satisfactory short-term clinical response in patients with achalasia. However, data on mid- and long-term clinical outcomes are limited. We aimed to assess the mid- and long-term efficacy and safety of POEM in achalasia patients. METHODS: Using the pre-designed search strategy, we identified relevant studies that evaluated the efficacy and safety of POEM with a minimum of 2-year follow-up in the Embase, Cochrane, and PubMed databases from inception to January 2021. Primary outcome was pooled mid- and long-term clinical success rate based on the Eckardt score. Secondary outcome was pooled long-term reflux-related adverse events. RESULTS: A total of 21 studies involving 2,698 patients were included. Overall, the pooled clinical success rates with 2-, 3-, 4-, and 5-year follow-ups were 91.3% (95% confidence interval [CI] 88.4-93.6%), 90.4% (95% CI 88.1-92.2%), 89.8% (95% CI 83.6-93.9%), and 82.2% (95% CI 76.6-86.7%), respectively. Besides, the pooled long-term clinical success rates for type I, II, and III achalasia were 86.1% (95% CI 80.9-90.1%; I2 = 0%), 87.9% (95% CI 84.2-90.8%; I2 = 48.354%), and 83.9% (95% CI 72.5-91.2%; I2 = 0%), respectively. Moreover, the pooled incidence of symptomatic reflux and reflux esophagitis was 23.9% (95% CI 18.7-29.9%) and 16.7% (95% CI 11.9-23.1%), respectively. CONCLUSIONS: POEM is associated with a long-term clinical success of 82.2% after 5 years of follow-up. Randomized control trials comparing POEM with laparoscopic Heller myotomy or pneumatic dilation with longer follow-up periods are needed to further demonstrate the long-term safety and efficacy of POEM.

A systematic evaluation of methodological and reporting quality of meta-analysis published in the field of gastrointestinal endoscopy.

BACKGROUND: To evaluate the methodological and reporting quality of published meta-analyses (MAs) in four major gastrointestinal endoscopic journals, and identify the predicted factors for high quality. METHODS: A systematic search was performed in PubMed to identify MAs from 1, January, 2016 to 31, December, 2020 in four major gastrointestinal endoscopic journals (including Digestive Endoscopy, Gastrointestinal Endoscopy, Surgical Endoscopy, and Endoscopy). We collected the characteristics of MAs after filtering unqualified articles, and assessed methodological and reporting qualities for eligible articles by AMSTAR tool and PRISMA checklist, respectively. Logistic regression was used for identifying predictive factors for high quality. RESULTS: A total of 289 MAs were identified after screening by predefined inclusion and exclusion criteria. The scores (mean ± SD) of AMSTAR and PRISMA were 7.73 ± 1.11 and 22.90 ± 1.85, respectively. In PRISMA checklist, some items had less than 50% complete adherence, including item 2 (structured summary), items 5 (protocol and registration), items 12 and 19 (risk of bias in studies), item 27 (funding support). Item 1 (a priori design), item 4 (gray literature research), item 5 (list of included and excluded) were inferior to 50% adherence in AMSTAR tool. We found the predictive factors for high quality through logistic regression analysis: a priori design and funding support were associated with methodological quality. Protocol and registration influenced the methodological and reporting quality closely. CONCLUSION: In general, qualities on the methodology and the reporting of MAs published in the gastrointestinal endoscopic journals are good, but both of which still potentially need further improvement.

16S rRNA gene sequencing reveals the effect of fluoxetine on gut microbiota in chronic unpredictable stress-induced depressive-like rats.

OBJECTIVES: Gut microbiota is relevant to the pathogenesis of mental disorders including depression. This study aimed to investigate the influence of fluoxetine (FLX) on the gut microbiota in rats with Chronic Unpredictable Mild Stresses (CUMS)-induced depression. RESULTS: We confirmed that the 28-day CUMS-induced depression rat model. Chronic FLX administration weakly improved depressive-like behaviors in rats. Illumina 16S rRNA gene sequencing on rat feces showed CUMS increased the relative abundance of Firmicutes (60.31% vs. 48.09% in Control, p < 0.05) and Lactobacillus genus (21.06% vs. 6.82% in control, p < 0.05); FLX and CUMS increased Bacilli class (20.00% ~ 24.08% vs. 10.31% in control, p < 0.05). CONCLUSION: Collectively, our study showed that both CUMS and FLX changed the compositions of gut microbiota in rats. FLX and CUMS distinctly regulated the gut microbiota in depressed rats.

Gender differences in the authorship of Global Major Gastroenterology Society Guidelines.

BACKGROUND: Gender differences remain a serious issue in the gastroenterology field, which negatively affect the career success and academic advancement of female gastroenterologists. In this study, we aim to identify gender differences in the authors of global major Gastroenterology Society guidelines. METHODS: We included six associations and collected guidelines published between 2003 and 2022. The genders of authors were determined and recorded for each guideline. Linear by linear association test was used to assess trends every 5 years. RESULTS: We included 210 guidelines and 461 authors. The proportion of female first and senior authors was 11.3% and 9.8%, respectively. The number of female first and senior authors in most societies has improved over the past 20 years, with the largest increase in the AGA. CONCLUSIONS: Women are still underrepresented among the authors of guidelines. Although gender differences have gained more attention in recent years, there are many obstacles to achieving gender equality.

The application of artificial intelligence in improving colonoscopic adenoma detection rate: Where are we and where are we going.

Colorectal cancer (CRC) is one of the common malignant tumors in the world. Colonoscopy is the crucial examination technique in CRC screening programs for the early detection of precursor lesions, and treatment of early colorectal cancer, which can reduce the morbidity and mortality of CRC significantly. However, pooled polyp miss rates during colonoscopic examination are as high as 22%. Artificial intelligence (AI) provides a promising way to improve the colonoscopic adenoma detection rate (ADR). It might assist endoscopists in avoiding missing polyps and offer an accurate optical diagnosis of suspected lesions. Herein, we described some of the milestone studies in using AI for colonoscopy, and the future application directions of AI in improving colonoscopic ADR.

Mixing and Flow Transition in an Optimized Electrokinetic Turbulent Micromixer.

Micromixer is a key element in a lab on a chip for broad applications in the analysis and measurement of chemistry and engineering. Previous investigations reported that electrokinetic (EK) turbulence could be realized in a "Y" type micromixer with a cross-sectional dimension of 100 µm order. Although the ultrafast turbulent mixing can be generated at a bulk flow Reynolds number on the order of unity, the micromixer has not been optimized. In this investigation, we systematically investigated the influence of electric field intensity, AC frequency, electric conductivity ratio, and channel width at the entrance on the mixing effect and transition electric Rayleigh number in the "Y" type electrokinetic turbulent micromixer. It is found that the optimal mixing is realized in a 350 µm wide micromixer, under 100 kHz and 1.14 × 105 V/m AC electric field, with an electric conductivity ratio of 1:3000. Under these conditions, a degree of mixedness of 0.93 can be achieved at 84 µm from the entrance and 100 ms. A further investigation of the critical electric field and the critical electric Rayleigh number indicates that the most unstable condition of EK flow instability is inconsistent with that of the optimal mixing in EK turbulence. To predict the evolution of EK flow under high Raσ and guide the design of EK turbulent micromixers, it is necessary to apply a computational turbulence model instead of linear instability analysis.

Twenty-year span of global acute pancreatitis trends: A bibliometric analysis.

OBJECTIVE: This study aims to investigate the global research routine and trends of acute pancreatitis over the last twenty years based on the production, hotspots, and frontiers of published articles as well as to provide the global health system with a bibliometric reference. METHODS: The Web of Science core collection database was retrieved for acute pancreatitis original articles and review articles published from January 1, 1999 to May 17, 2020. Duplicates and discrete papers were excluded. Articles were evaluated for several characteristics including number of citations, publication time, country of origin, institution, journal and authorship. RESULTS: A total of 7001 articles originated from 94 countries and were published in 1263 journals. The China contributed most articles (1752) followed by USA (1214). The research was major published in specialized journals including the Pancreas (511) and pancreatology (351). Universities were the main institutions of science progress. High-impact articles focused on the fields of clinical medicine. A steady growth was observed in the last 20 years from 1999 to 2020. CONCLUSION: This comprehensive bibliometric study indicates that severe acute pancreatitis and necrotizing pancreatitis are significant topic in the acute pancreatitis research. The structured information may be helpful in understanding research trends, and locating research hot spots and gaps in this domain.

Role of Peroral Endoscopic Myotomy in Geriatric Patients with Achalasia: A Systematic Review and Meta-Analysis.

BACKGROUND: Peroral endoscopic myotomy (POEM) is a particularly attractive intervention for achalasia. Presently, POEM has been reported to be effective and safe for achalasia in geriatric patients. Herein, this systematic review was conducted to explore the role of POEM in geriatric patients with achalasia. METHOD: PubMed, Embase, and Cochrane Library were searched to identify studies evaluating the clinical outcome of POEM in geriatric patients with achalasia during January 2009 to October 2020. The primary outcomes were technical and clinical success. Secondary outcomes included postoperative Eckardt score, lower esophageal sphincter (LES) pressure, adverse events, and clinical reflux. RESULTS: There were 7 studies with a total of 469 geriatric patients, and the pooled technical success of POEM treatment was 98.1% (95% confidence interval [CI], 95.1-99.3%), and the pooled clinical success was 92.5% (95% CI, 89.3-94.8%). After POEM, the Eckardt score significantly decreased by 6.09 points (95% CI, 5.44-6.74, p < 0.00001), and the LES pressure significantly reduced by 13.53 mm Hg (95% CI, 5.14-21.91, p = 0.002). The pooled adverse events rate was 9.0% (95% CI, 4.3-17.9%), and the post-POEM clinical reflux rate was 17.4% (95% CI, 12.9-23.2%). CONCLUSION: Our current study demonstrated that POEM was an effective and safe technique for achalasia in geriatric patients.

The 100 most cited articles on pancreatic neuroendocrine tumors from 2000 to 2020: a bibliometric analysis.

PURPOSE: The present study attempted to identify 100 most cited articles on pancreatic neuroendocrine tumors and characterize them via bibliometric analysis whereby it would provide an insight into the progress and trend in this field. METHODS: Records regarding pancreatic neuroendocrine tumors and published between 2000 and 2020 were retrieved in 2021 through the Web of Science to identify the 100 most cited articles. RESULTS: The 100 articles were screened in 17 434 records. The number of citations of the top-cited articles ranged from 151 to 1867. These articles were published in 47 journals among which the Journal of Clinical Oncology produced the most articles (n = 10). The USA contributed most of the articles (n = 44). Articles enrolled came from 58 institutions; the University of California System of the USA came to the top (n = 7). More than half of the articles were clinical studies (n = 55), basic science research reports accounting for a quarter. In clinical topics (n = 73), treatment issues were the most concerned (n = 21), in which more articles focused on targeted inhibitors. Articles about gene mutation were cited most frequently in basic science topics (n = 27). CONCLUSIONS: This bibliometric analysis reflected the brief the progress and highlighted current trend in pancreatic neuroendocrine tumor research, providing references for further study.

Outcomes of simultaneous endoscopic submucosal dissection for synchronous multiple gastric neoplastic lesions: a retrospective comparative study.

BACKGROUND AND AIMS: Simultaneous endoscopic submucosal dissection (ESD) is occasionally used in synchronous multiple gastric neoplastic lesions (SMGL). Therefore, we aim to evaluate the safety and efficacy of simultaneous ESD for SMGL compared with ESD for single lesions. METHODS: A total of 1058 patients who received ESD from November 2006 to September 2019 were retrospectively evaluated in this study, including 997 single gastric epithelial lesions treated by single ESD (unifocal group) and 125 SMGL from 61 patients treated by simultaneous ESD (multifocal group). RESULTS: The mean procedure time was 49.2 ± 41.30 min and 89.5 ± 66.33 min in unifocal group and multifocal group, respectively (p < 0.001). There was no significant difference in postoperative stenosis rate (1.0% vs. 0.0%, p = 1.000), intraoperative bleeding (endoscopic resection bleeding-c3 grade) rate (0.5% vs. 1.6%, p = 0.696), postoperative bleeding rate (1.3% vs. 0.0%, p = 0.461), and perforation rate (0.9% vs. 1.6%, p = 0.449) between the two groups. In addition, en block resection rate (p = 0.825), complete resection rate (p = 0.856) and curative resection rate (p = 0.709) were comparable between the two groups. During the follow-up, the local recurrence rate per patient: p = 0.363; per lesion: p = 0.235) was not significantly different between the two groups, however, the cumulative incidence of metachronous lesions after treatment was significantly higher in the multifocal group than the other group (10.0% vs. 3.2%, p = 0.004). CONCLUSIONS: Simultaneous ESD is safe and effective in the treatment of SMGL. However, separate ESD is recommended for SMGL with longer procedure time. Besides, the metachronous gastric neoplastic lesions should be paid attention to during follow-up.

The role of peroral endoscopic myotomy for Zenker's diverticulum: a systematic review and meta-analysis.

BACKGROUND: Zenker's peroral endoscopic myotomy (Z-POEM) has revolutionized the therapeutic strategy for Zenker's diverticulum (ZD) with promising results. We conducted this meta-analysis to estimate the safety and efficacy of Z-POEM for ZD and compare the feasibility and effectiveness of Z-POEM with that of flexible endoscopic septotomy (FES). METHODS: A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases to query for studies that assessed the safety and efficacy of Z-POEM for ZD. All articles published from inception to July 31, 2021 were included. The primary outcomes were the overall technical success rate, clinical success rate, incidence of adverse events, and clinical recurrence rate. RESULTS: Eleven studies involving 357 patients undergone Z-POEM were included. Overall, the quality of included studies was above average, with five studies rated as high quality and six ranked as moderate quality. The overall pooled technical success rate for Z-POEM was 96.3% (95% confidence interval [CI] 93.6-97.9%; I2 = 0%). The total pooled clinical success rate for Z-POEM was 93.0% (95% CI 89.4-95.4%; I2 = 0%). The pooled incidence of adverse events for Z-POEM was 12.4% (95% CI 9.1-16.7%; I2 = 0%). The pooled clinical recurrence rate for Z-POEM was 11.2% (95% CI 7.6-16.2%; I2 = 0%). The clinical success for Z-POEM was significantly better than that of FES (relative risk [RR]: 1.11; CI 95% 1.03-1.18; p = 0.004, I2 = 0%), while there were no significant differences in technical success, adverse events, and clinical recurrence between Z-POEM and FES. CONCLUSION: Z-POEM could be an effective and safe therapeutic modality for ZD, and even has a slightly higher clinical success rate than FES. However, comparative studies with long-term follow-up will be needed to further confirm our finding.

Clinical outcomes of endoscopic resection for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria: a 7-year experience from a large tertiary center in China.

BACKGROUND AND AIMS: Few studies have evaluated the value of endoscopic resection (ER) for the treatment of gastric gastrointestinal (GI) stromal tumors (GISTs) originating from the muscularis propria (MP) in a large population, and no studies have evaluated risk factors for piecemeal resection. This study aimed to evaluate the efficacy and safety of ER for gastric GISTs in a real-world setting and to explore factors associated with piecemeal resection. METHODS: From January 2013 to December 2019, 185 patients with gastric GISTs originating from the MP were assessed. Clinicopathological and endoscopic data were collected and analyzed. Baseline characteristics of the en bloc resection and piecemeal resection groups were compared to evaluate predictive factors for piecemeal resection. RESULTS: There were 71 males and 114 females with a mean age of 57.0 ± 9.7 years. The mean size of GISTs was 15 mm (range 4-65 mm). A total of 123 were very low risk, 52 were low risk, and ten were moderate risk. In this study, 103 GISTs were treated with endoscopic submucosal excavation (ESE), 68 GISTs were treated with endoscopic full-thickness resection (EFR), and 14 GISTs were treated with submucosal tunneling ER (STER). Either en bloc resection or complete resection was achieved in 160 (86.5%) patients. No recurrence was noted during follow-up. Only five patients experienced minor complications, with a complication rate of 2.7%. Multivariate analysis demonstrated that size (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.004-1.118; P = 0.035) and shape (OR 5.434, 95% CI 1.638-18.027; P = 0.006) were independent predictors of piecemeal resection. CONCLUSION: ER was effective and safe for the treatment of gastric GISTs originating from the MP. Piecemeal resection did not seem to affect the efficacy of ER, and no recurrence was noted during follow-up. Large size and irregular shape are risk factors related to piecemeal resection of ER.