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@#Objective To systematically evaluate the accuracy of endoscopy-based artificial intelligence (AI)-assisted diagnostic systems in the diagnosis of early-stage esophageal cancer and provide a scientific basis for its diagnostic value. Methods PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database were searched by computer to search for the relevant literature about endoscopy-based AI-assisted diagnostic systems for the diagnosis of early esophageal cancer from inception to March 2022. The QUADAS-2 was used for quality evaluation of included studies. Meta-analysis of the literature was carried out using Stata 16, Meta-Disc 1.4 and RevMan 5.4 softwares. A bivariate mixed effects regression model was utilized to calculate the combined diagnostic efficacy of the AI-assisted system and meta-regression analysis was conducted to explore the sources of heterogeneity. Results A total of 17 articles were included, which consisted of 13 retrospective cohort studies and 4 prospective cohort studies. The results of the quality evaluation using QUADAS-2 showed that all included literature was of high quality. The obtained meta-analysis results revealed that the AI-assisted system in the diagnosis of esophageal cancer presented a combined sensitivity of 0.94 (95%CI 0.91 to 0.96), a specificity of 0.85 (95%CI 0.74 to 0.92), a positive likelihood ratio of 6.28 (95%CI 3.48 to 11.33), a negative likelihood ratio of 0.07 (95%CI 0.05 to 0.11), a diagnostic odds ratio of 89 (95%CI 38 to 208) and an area under the curve of 0.96 (95%CI 0.94 to 0.98). Conclusion The AI-assisted diagnostic system has a high diagnostic value for early stage esophageal cancer. However, most of the included studies were retrospective. Therefore, further high-quality prospective studies are needed for validation.
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Objective:To investigate the characteristics, process, and prognosis of esophageal stricture after circumferential endoscopic submucosal dissection (ESD), and to preliminarily analyze the prevention and treatment effects of simple dilation, stent placement, mucosal transplantation, and glucocorticoid (hereinafter referred to as hormone) application in esophageal stricture.Methods:From August 2017 to March 2022, at the First Affiliated Hospital of Zhengzhou University, the clinical and follow-up data of 55 patients who underwent circumferential ESD for early esophageal cancer and precancerous lesions were retrospectively analyzed. According to the prevention and treatment methods for esophageal stricture, the patients were divided into two groups: simple dilation group (23 cases) and combined dilation group (32 cases). The combined dilation group was divided into mucosal transplantation subgroup (9 cases), stent placement subgroup (14 cases), hormone application subgroup (7 cases), and bleomycin subgroup (2 cases, excluded from comparative analysis due to limited cases). Overall prognosis of patients was observed. Treatment efficacy, prognosis, and adverse events were compared among the simple dilation group, mucosal transplantation subgroup, stent placement subgroup, and hormone application subgroup. Independent samples t-test, chi-square test, and Fisher′s exact test were used for statistical analysis. Results:Among the 55 patients, the follow-up time was (894.1±417.7) days. Refractory esophageal stricture (total dilation times ≥ 5) occurred in 33 patients (60.0%). Fifty-two patients (94.5%) achieved clinical remission of the stricture. The total number of dilations was 5.8±4.0, and the average dysphagia-free period was (52.3±37.1) days. The dysphagia-free period of mucosal transplantation subgroup was longer than that of the simple dilation group, stent placement subgroup, and hormone application subgroup ((114.5±50.0) days vs. (40.9±20.0), (39.7±10.0), and (40.9±25.5) days, respectively), and the differences were statistically significant ( t=4.82, 3.77 and 3.14, P<0.001, =0.011, =0.009). There were no statistically significant differences between the simple dilation group and the mucosal transplantation subgroup, stent placement subgroup, and hormone application subgroup in the total number of dilations (6.8±4.8 vs. 3.0±2.5, 5.8±2.2, and 5.7±5.0), stricture remission rate (95.7%, 22/23 vs. 8/9, 13/14, and 7/7), and incidence of adverse events (17.4%, 4/23 vs. 5/9, 5/14, and 2/7; all P>0.05). Conclusions:Esophageal stricture formed after circumferential ESD shows the characteristics of recurrence and intractability. The over all number of dilations is high, and the average dysphagia-free period is short. Most patients can achieve clinical remission of the stricture after multiple times of endoscopic dilation treatment. However mucosal transplantation, stent placement, and hormone application cannot well intervene the natural process of esophageal stricture.
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Objective To investigate the diagnostic value of blue light imaging-bright (BLI-bright) and linked color imaging (LCI) for early esophageal cancer (EEC).Methods:Data of 63 consecutive patients with EEC who underwent gastroscopy under BLI-bright, LCI and white-light imaging (WLI) and endoscopic submucosal dissection (ESD) from May 2018 to August 2020 at Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine were analyzed retrospectively in the cohort study. Subjective visibility analysis was performed by 6 endoscopists who were divided into 2 groups (expert group and trainee group) with 3 endoscopists in each group. The main observation index was the visibility score (ranking score, RS). The objective color difference (Δ E) between lesions of EEC and surrounding mucosa under 3 modes were analyzed by using the L *a *b * color space. Results:The overall RS of 6 endoscopists under WLI mode (2.57±0.81) was significantly lower than that under LCI (3.25±0.67) ( t=9.71, P<0.001) and BLI-bright (3.18±0.67) ( t=9.31, P<0.001). In the expert group, the RS of WLI (2.71±0.80) was significantly lower than that of LCI (3.33±0.66) ( t=7.16, P<0.001) and BLI-bright (3.42±0.62) ( t=8.09, P<0.001). In the trainee group, the RS of WLI (2.40±0.90) was also significantly lower than that of LCI (3.15±0.83) ( t=9.62, P<0.001) and BLI-bright (2.89±0.92) ( t=5.69, P<0.001), and the RS of LCI was higher than that of BLI-bright ( t=4.07, P<0.001). The Δ E between lesions of EEC and surrounding mucosa under WLI (11.52±3.40) was significantly lower than that under LCI (16.64±4.70) ( t=7.10, P<0.001) and BLI-bright (15.72±3.84) ( t=7.88, P<0.001). Conclusion:BLI-bright and LCI can effectively improve EEC visibility and color difference between EEC and surrounding mucosa. Furthermore, LCI is more conducive to the detection of EEC for the trainees.
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@#Objective To compare the short- and long-term efficacy of surgery and endoscopy in the treatment of early esophageal cancer by a systematic review and meta-analysis. Methods We extracted data independently from The Cochrane Library, PubMed, EMbase, Web of Science for studies comparing surgery with endoscopy from 2010 to 2020. The primary outcomes including R0 resection rate, long-term overall survival (OS), disease-specific survival (DSS), major complications, recurrence, hospital stay and cost. Meta-analysis was performed using RevMan 5.3 and Engauge Digitizer was used to extract survival curves from relevant literature, and relevant data were calculated based on statistical methods. Results A total of 17 studies involving 3 705 patients were included. It was found that patients in the surgery group had a higher R0 resection rate compared with the endoscopic group (OR=0.13, 95%CI 0.07 to 0.27, P<0.001, I2=6%). The total complications rate of resection of esophageal cancer was higher than that of the endoscopic group (OR=0.28, 95%CI 0.16 to 0.50, P<0.001, I2=68%). The length of hospitalization in the endoscopic group was obviously shorter than that in the surgery group (MD=–8.28, 95%CI –12.44 to –4.13, P<0.001, I2=96%). The distant recurrence rate (OR=0.58, 95%CI 0.24 to 1.41, P=0.230, I2=0%) and the local recurrence rate after resection (OR=1.74, 95%CI 0.66 to 4.59, P=0.260, I2=40%) in the endoscopic group was similar to those of the surgery group. There was no significant difference in 5 year-OS rate between the two groups (HR=0.86, 95%CI 0.67 to 1.11, P=0.25, I2=0%), which was subdivided into two groups: adenocarcinoma (HR=0.55, 95%CI 0.15 to 2.05, P=0.37, I2=0%) and squamous cell carcinoma (HR=0.68, 95%CI 0.46 to 1.01, P=0.06, I2=0%), showing that there was no difference between the two subgroups. There was no significant difference in the DSS rate (HR=0.72, 95%CI 0.49 to 1.05, P=0.090, I2=0%) between the two groups. The cost of the surgery group was significantly higher than that of the endoscopic group (MD=–12.97, 95%CI –18.02 to –7.92, P<0.001, I2=93%). Conclusion The evidence shows that endotherapy may be an effective treatment for early esophageal neoplasm when considering the long-term outcomes whether it is squamous or adenocarcinoma, even though it is not as effective as surgery in the short-term efficacy.
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Objective:To investigate the independent risk factors for fever after endoscopic radiofrequency ablation (RFA).Methods:From January 2016 to April 2021, 51 patients with early esophageal cancer, who were treated with RFA in the Department of Gastroenterology, Changhai Hospital and whose lesion range exceeded 3/4 of the circumference of esophagus, were included in the case-control study. Patients were divided into fever group ( n=15) and non-fever group ( n=36) according to whether they had fever after operation. The general condition of patients, family history of gastrointestinal tumors, lesion length, lesion range, ablation energy and ablation times were mainly collected for univariate analysis. The variables with P<0.1 were further included in multivariate logistic regression analysis to explore the independent risk factors for fever after RFA. Results:Univariate analysis showed that the lesion length ( t=-3.89, P<0.001), lesion range ( χ2=11.52, P=0.001) and ablation energy ( P=0.001) were significantly different between the two groups. Pearson correlation showed that there was a significant positive correlation between lesion length and lesion circumference ( r=0.71, P<0.001), and the lesion range was determined by the lesion circumference length. Therefore, the two variables of lesion length and ablation energy were finally included in the logistic regression analysis. Logistic regression analysis showed that the risk of fever after RFA was 1.21 times as high as that before when the length of esophageal lesions increased by 1 centimeter (95% CI: 1.01-1.43, P=0.037). The risk of fever after RFA using 12 J ablation energy was 0.43 times as high as that using 10 J ablation energy (95% CI: 0.22-0.85, P=0.015). Conclusion:Lesion length and ablation energy are independent risk factors for fever after esophageal RFA. Patients with long segment early esophageal cancer and using low ablation energy are more likely to have fever after RFA.
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Objective:To investigate the risk factors of esophageal stenosis after endoscopic submucosal dissection (ESD) of early esophageal cancer and precancerous lesions, and to construct and assess a predictive model for esophageal stenosis.Methods:Data of 421 patients with early esophageal cancer or precancerous lesions who underwent ESD and were confirmed by pathology in the First Affiliated Hospital of Zhengzhou University between January 2015 and April 2020 were retrospectively analyzed.Eighty-nine cases developed postoperative esophageal stenosis (stenosis group) and 332 cases did not (non-stenosis group). Risk factors of esophageal stenosis were investigated by univariate and multivariate logistic regression analysis. Independent risk factors were used as predictors to construct a nomogram model by using the lasso algorithm.The accuracy of the model was evaluated by the consistency index (C-index) and the calibration curve. Bootstrap was applied to internal verification to avoid over-fitting of the model.Results:Univariate analysis showed that postoperative pathology, depth of infiltration, median long and short diameters of the specimen, circumferential resection range, and muscularis propria injury were related to postoperative esophageal stenosis( P<0.05). Further multivariate logistic regression analysis showed that the resection range≥1/2 of the circumference (VS <1/2 circumference: P<0.01, OR=48.453, 95% CI: 11.288-207.983), muscularis propria injury( P<0.01, OR=4.671, 95% CI: 2.283-9.557)and longitudinal length≥50 mm (VS <50 mm: P=0.008, OR=2.741, 95% CI: 1.299-5.785) were independent risk factors for esophageal stenosis after ESD. The nomogram model was constructed through the lasso algorithm by taking the longitudinal length, circumferential resection range, and muscularis propria injury as the predictive factors. The C-index of the nomogram was 0.934 (95% CI: 0.909-0.959)and was 0.931 after 100 times of Bootstrap internal sampling, which meant the prediction probability of the model in the calibration curve was in good agreement with the actual observation probability. Conclusion:Circumferential resection range ≥1/2, muscularis propria injury, and longitudinal length≥50 mm are independent risk factors for post-ESD esophageal stenosis. The nomogram model constructed by the above three indicators as predictors shows an ideal prediction effect on esophageal stenosis after ESD for early esophageal cancer and precancerous lesions, which is helpful to establish a standard plan for early intervention in patients at high risk of stenosis after ESD.
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Objective:To compare the clinicopathological characteristics of main and accessory lesions in patients with synchronous multiple esophageal lesions (SMEL, i. e. early esophageal cancer and intraepithelial neoplasia) and to explore their correlation.Methods:Data of 80 patients with SMEL treated by endoscopic resection in The First Medical Center of Chinese PLA General Hospital from November 2006 to September 2019 were retrospectively analyzed, and the clinicopathological characteristics as well. The lesions were divided into main and accessory lesions, and their correlation in macroscopic type, lesion location, pathological type and invasion depth in 70 patients with double SMEL were investigated.Results:The age of 80 patients with SMEL was 61.3±8.32 years, more common in males (83.8%, 67/80). Fifty-seven patients (71.2%) had a history of smoking and drinking, respectively. There was a positive correlation between the size of main and accessory lesions in the 70 patients with double SMEL ( r=0.464, P<0.001). The macroscopic type ( P=0.115), location ( P=0.340) and depth of invasion ( P=0.555) of the main and accessory lesions were not correlated, but the pathological type had high correlation ( P<0.001). The consistency rate was 50.0% (35/70). Conclusion:Most SMEL patients are elderly males with a history of smoking and drinking. When one lesion is found, there is high possibility of multiple lesions. Physicians should be aware of the correlation between main and accessory lesions to avoid missed diagnosis.
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@#Endoscopic resection and surgical resection are the two major therapeutic methods for early esophageal cancer. Endoscopic resection is safe and minimally invasive, but lymph node dissection can not be performed. Although surgery provides a rather thorough resection of the lesions and affected lymph nodes, surgical trauma brings certain negative impact on patients' long-term life quality. A comprehensive assessment of the patient's general condition, the risk of diseased lymph node metastasis, and the risk of the treatment itself is an important measure to optimize treatment decisions and formulate personalized treatment plans.
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A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o'clock position inside the iodine-unstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o'clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.
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Humans , Middle Aged , Carcinoma, Squamous Cell , Epithelial Cells , Esophageal Neoplasms , Iodine , Methods , Neoplasms, Squamous CellABSTRACT
Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.
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Humans , Chemoradiotherapy , Esophageal Neoplasms , Follow-Up Studies , Lymph Nodes , Neoplasm Metastasis , Prospective Studies , Recurrence , Survival RateABSTRACT
Objective To investigate the risk factors for non-curative resection after endoscopic submucosal dissection ( ESD ) for early esophageal cancer and high-grade intraepithelial neoplasia .Methods The clinicopathological data of 427 cases of early esophageal cancer and high-grade intraepithelial neoplasia who underwent ESD was performed from January 2013 to December 2016 in the Department of Gastroenterology , First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed .According to the results of postoperative pathology and immunohistochemistry ,339 patients were defined as curative resection group and 88 patients were defined as non-curative resection group .Chi-square test , univariate analysis and multivariate logistic regression analysis were used for statistical analysis .Results A total of 427 patients were enrolled in this study, with an average age of (63.2 ±7.7) years, including 96 cases of early esophageal cancer and 331 cases of high-grade intraepithelial neoplasia .The enbloc resection rate of ESD was 94.8％(405/427), 88 of them were non-curative resected, and the non-curative resection rate was 20.6％.Univariate analysis showed that early esophageal cancer (odds ratio (OR)=3.682, 95％confidence interval (CI) 2.216 to 6.118, P<0.01), submucosal infiltration (OR=10.220, 95％CI 4.861 to 21.481, P<0.01), ESD indications (OR=6.005, 95％CI 3.545 to 10.172, P<0.01) and lifting sign after injecting at the base of lesions (OR=2.508, 95％CI 1.005 to 6.255, P=0.042) were statistically significant between non-curative resection group and curative resection group . Multivariate unconditional logistic regression analysis revealed that submucosal infiltration (OR =4.329, 95％CI 1.758 to 10.661,P =0.001), not absolute indications of ESD (OR =6.484, 95％CI 2.205 to 19.068, P=0.001) and negative lifting sign (OR=3.182, 95％CI 1.171 to 8.651, P=0.023) were independent risk factors for non-curative resection.Conclusions Patients with early esophageal cancer , submucosal infiltration , not absolute indications for ESD and negative lifting signs are prone to non-curative resection .Moreover , submucosal infiltration , not absolute indications for ESD , and negative lifting signs are the independent risk factors for non-curative resection .
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Objective To assess the efficacy and safety of autologous skin-grafting surgery ( ASGS) in the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection ( ESTD) for early esophageal cancer. Methods Between January 2018 and March 2018, five patients with early esophageal cancer underwent complete circular ESTD and ASGS in Chinese PLA General Hospital. The skin-graft survival situation, and occurrence of esophageal stenosis and complications were observed by endoscopy follow-up. Results Complete circular ESTD and ASGS were successfully performed in all 5 patients, and no complications including perforation, bleeding, wound infection or stent migration occurred. The mean skin-graft survival rate was 86. 0％. Four patients did not experience esophageal stenosis over the mean follow-up of 9. 5 months. One patient experienced esophageal stenosis after operation, and underwent endoscopic balloon dilatation. No stenosis occurred in 8 months of follow-up. Conclusion ASGS is a safe and effective method to prevent esophageal stenosis after complete circular ESTD.
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Objective To evaluate the clinical value of epithelial vessel branch detected by non-magnifying narrow-band imaging ( NM-NBI ) in diagnosis of early esophageal cancer. Methods A retrospective analysis was performed on data of 59 patients, who underwent endoscopy with NM-NBI and iodine staining to screen early esophageal cancer in PLA General Hospital from January 2013 to May 2015. The final diagnosis for all lesions were determined by pathology. The diagnostic accuracy, sensitivity and specificity of NM-NBI and iodine staining for early esophageal cancer were compared. Results The accuracy, sensitivity and specificity of NM-NBI on the epithelial vessel branch in diagnosis of early esophageal cancer were 83. 1％ (49/59), 91. 3％ (21/23) and 77. 8％ (28/36), respectively, and the corresponding statistical values of iodine staining were 55. 9％ ( 33/59) , 95. 7％ ( 22/23) and 30. 6％ ( 11/36), respectively. The accuracy (χ2=1. 45, P=0. 028) and specificity (χ2=21. 4, P=0. 000) of epithelial vessel branch by NM-NBI were significantly higher than those of iodine staining, and there was no significant difference in the sensitivity between the two methods (χ2=22. 3, P=1. 000) . Conclusion The observation of epithelial vessel branch using NM-NBI was useful and reliable in diagnosis of early esophageal cancer with high accuracy and specificity, and can be possible for application in the clinic.
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Objective To improve the detection rate of early esophageal cancer during endoscopy by construction of artificial intelligence assistant diagnosis system. Methods A total of 2400 esophageal images were collected from Zhongshan Hospital of Fudan University from January 2016 to December 2017, including 1200 images of early esophageal cancer and 1200 images of normal esophageal mucosa. The lesions in pictures were marked with rectangular box by using computer program. Among them, 2000 pictures were divided into the training set and 400 pictures into the test set. An assistant diagnostic model of early esophageal cancer was established by back propagation algorithm in computer deep learning. The training model was tested and the sensitivity and specificity of the system at different cut-off points in the test set was calculated. Receiver operating characteristic ( ROC) curve was used to evaluate the performance of the diagnostic model. Results The area under ROC curve ( AUC) of the auxiliary diagnostic model was 0. 9961. The sensitivity and specificity were satisfactory. Conclusion The deep learning model constructed in this study has good specificity, sensitivity and AUC value in the diagnosis of early esophageal cancer, and can assist endoscopists in real-time diagnosis in clinical examination.
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Objective To explore the feasibility, safety and effectiveness of endoscopic submucosal dissection ( ESD) in the treatment of the synchronous multiple early cancer or precancerous lesions in esophageal and stomach. Methods A retrospective study was conducted on the data of 5 patients with synchronous multiple early cancer or precancerous lesions in esophageal and stomach who were treated by ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013. The characteristics of lesions, and results of therapy and follow-up were analyzed. Results All 5 patients were male with mean age of 67. 8±13. 1 years. The mean size of esophageal lesions was 2. 1±0. 9 cm with 1 lesion located in the upper esophagus and 4 in the middle. The mean size of gastric lesions was 2. 5±1. 5 cm with 2 lesions in the antrum, 2 in the gastric angle and 1 in cardia. Lesions in 4 cases were removed at the same time and 1 at different times. All lesions achieved complete resection. Postoperative pathological results showed that there were 2 cases of esophageal precancerous lesions with gastric precancerous lesions, 2 cases of esophageal precancerous lesions with early gastric cancer, and 1 case of early esophageal cancer with early gastric cancer. The 5 patients with 10 lesions all achieved curative resection. Postoperative esophageal stricture occurred in 1 case, which was improved after dilation. Median follow-up time was 72 months, when 3 patients survived and 2 patients died. However, the cause of death was not associated with the treatment. Conclusion ESD is a minimally invasive endoscopic method for treating synchronous multiple primary early cancers in esophagus and stomach.
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Objective To explore the clinical significance of detection of plasma microRNA-21,-143 in identifying early esophageal cancer and esophageal non-tumor diseases.Methods The expression of plasma microRNA-21,-143 in 27 cases of patients with early esophageal cancer (esophagus cancer group),25 cases of patients with non-esophageal tumor (non-esophageal tumor group)and in the healthy controls were detected by RT-PCR,and detected the levels of plasma CEA and CA72-4 by the electrochemical luminescence technology,which of changes were analysed to observe the relationship between the changes and the esophageal cancer,the benign esophageal diseases for the two markers.Results The expression of plasma microRNA-21,-143 in the esophagus cancer group were 0.93±0.17,0.27±0.05,which of ones in the non-esophagus cancer group were 0.25±0.03,0.99±0.15,and with those in the control group were 0.23±0.03,1.02±0.15.Compared with those in the non-esophagus cancer group,the expression of plasma microRNA-21,-143 were obviously up or down-regulated with significant differences (t=10.87,11.55,P＜0.01).Compared with those in the control group,which of ones were obviously up or down-regulated with significant differences (t=9.20,9.07,P＜0.01),and with no statistical significances in comparison between the esophagus cancer group and the control group (t=1.39,1.19,P＞0.05).The positiverate of plasma microRNA-21,-143 in the esophageal cancer,non-esophagus cancer group and the control group were,81.4 ％ (22/27),4.0 ％(1/25) and 0 (0/24);85.1％ (23/27),4.0％ (1/25),and 0 (0/24),respectively.The positive rate of microRNA-21,-143 in the esophageal group respectively in comparison with those in the non-esophagus cancer group and the control group were significantly higher,the differences had statistical significances (x2 =31.59,34.39,P＜ 0.01;x2 =34.42,37.23,P＜ 0.01).The expression of two markers in the esophagus cancer group were no statistically significant differences compared with control group (x2 =0.980,0.980,P＞0.05).The sensitivity and specificity of microRNA-21,-143 in early diagnosis on the esophageal cancer were 81.4 ％,97.9 ％ and 85.1％,97.9 ％.The sensitivity of microRNA-21,-143 in the esophageal group were significantly higher compared with those of CEA and CA72-4,the differences were statistically significant (x2 =12.79,P＜0.01;x2 =5.33,P＜0.05;x2 =15.03,P＜0.01;x2 =6.95,P＜0.05).The specificity of microRNA-21,-143 in the esophageal cancer group were no statistically significant differences in comparison with those of CEA and CA72-4 (x2 =1.043,0.000,P＞0.05) and (x2=1.043,0.000,P＞0.05),respectively.The analysis results from the spearman correlation test showed that in the esophageal cancer group,the expression of plasma microRNA-21,-143 had a negative correlation (r =0.658,P＜0.01).Which of ones respectively associated with the levels of CEA and CA72-4 (r=0.607,0.623,P＜0.01 and r=0.579,0.610,P＜0.01).Conclution The detection of expression of plasma miRNA-21,miRNA-143 in the patients with the early esophageal cancer and non-esophageal tumor can provide a new train of thought for pathologic diagnosis of early esophageal cancer.
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Objective To analyze the risk factors of refractory postoperative stenosis after large-scale endoscopic submucosal dissection (ESD) for patients with early esophageal cancer.Methods The data of 35 postoperative stenosis patients previously treated by ESD (dissection ≥3/4 circumferential) for early esophageal cancer from January 2011 to September 2016 in Digestive Endoscopy Center, Changhai Hospital were reviewed.According to the number of endoscopic dilation, 35 patients were divided into two groups: refractory stenosis (≥6 endoscopic dilations, n=21) and non-refractory stenosis (≤5 endoscopic dilations, n=14), comparison between the two groups was performed using t test or Fisher exact probability method.Results Muscle layer damage (P=0.018), longitudinal mucosal defect length (P=0.013), tumor infiltrating depth (P=0.031), and the number of hemostatic clips (P=0.031) were significantly different between the two groups.The history of chemotherapy and radiotherapy, the location of tumor, the macroscopic type, and the postoperative administration of oral prednisolone were not significant differences between the two groups (P>0.05).Conclusion Refractory esophageal stenosis commonly occurs in patients undergoing large-scale ESD with tumor depth >M2, muscle layer damage, longitudinal mucosal defect length ≥50 mm and the number of hemostatic clips ≥6.
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Objective To explore the diagnosis value of narrow-band imaging magnifying endoscopy (NBI-ME) in the early esophageal cancer and precancerous lesions while estimating the quality,depth and treatment strategy.Methods One hundred and eleven cases of patients with suspected early esophageal cancer and precancerous lesions,who underwent ESD treatment,were selected as the study subjects.To estimate the diagnosis value of NBI-ME in the quality,depth and treatment strategy with pathological histology as gold standard.Results While estimating quality,there was no low grade intraepithelial neoplasia(LGIN) cases with NBI-ME.A total of 33 cases were diagnosed as high grade intraepithelial neoplasia(HGIN),including 30 cases of HGIN and 3 cases of LGIN after ESD treatment,and the other 78 cases were diagnosed as early esophageal cancer,including 5 cases of LGIN,22 cases of HGIN,and 51 cases of early esophageal cancer.Compared with the pathology results,the quality consistency of NBI-ME is general:K=0.498.While estimating depth,there was no LGIN cases with NBI-ME.A total of 33 cases were diagnosed as HGIN,including 30 cases of HGIN and 3 cases of LGIN after ESD treatment,67 cases were diagnosed as intramucosal carcinoma,including 5 cases of LGIN,22 cases of HGIN,30 cases of intramucosal carcinoma,and 10 cases of submucosal carcinoma after ESD treatment,and 11 cases were diagnosed as submucosal carcinoma.Compared with the pathology results,the depth consistency of NBI-ME is general:K=0.469.Most of the patients shoud be treated by ESD except 8 cases of LGIN.Conclusion The study shows general diagnosis value of NBI-ME in estimating quality,depth and treatment strategy of early esophageal cancer and precancerous lesions.
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Objective To compare the clinical value of different endoscopic methods for infiltration depth of early esophageal cancer. Methods Patients with suspected esophageal cancer, examined in Sichuan Provincial People′s Hospital from August 2013 to February 2016 were enrolled to this study. The patients underwent narrow band imaging( NBI) with magnifying endoscopy( including IPCL?type and B?type methods) and endoscopic ultrasonography(EUS) to estimate infiltration depth and then underwent iodine staining and biopsy. All lesions, which included the identified moderate?severe hyperplasia, high?grade intraepithelial neoplasia and early esophageal cancer and those which were diagnosed as possible cancer by white light and NBI with the negative pathological results, were given endoscopic or surgical procedure depending on patients′ choices. A total of 54 cases were diagnosed as early esophageal cancer, with pathological results as the gold standard. The diagnostic accuracy of invasion depth of these patients was compared by the statistic kappa values. Results Type B of NBI was highly consistent with the final pathological results(Kappa=0?802). White light endoscopy and IPCL type had poorer results(Kappa=0?596, Kappa = 0?601 ) compared with the final pathological results. However, EUS had the lowest consistency with the final pathological results( Kappa=0?132) . For the mucosal layer( M1?M2) infiltration of the esophageal cancer, type B showed the highest accuracy ( 86?7%, 26/30 ) , followed by white light endoscopy(76?7%, 23/30) and IPCL type(73?3%, 22/30). And EUS showed the lowest diagnostic accuracy(30?0%, 9/30) and the highest over?diagnostic rate(70?0%,21/30). For the cancer infiltration depth( M3?SM1 ) , type B also showed slightly higher accuracy rate ( 89?5%, 17/19 ) than IPCL type (78?9%, 15/19) and white light endoscopy (73?7%, 14/19). And EUS still showed the lowest accuracy rate( 42?1%, 8/19 ) and the highest over?diagnostic rate ( 52?6%, 10/19 ) . Conclusion White light endoscopy is still valuable for the invation depth of early esophageal cancer. But B type and IPCL?type of NBI are superior to white light endoscopy. B type presents higher accuracy rate than others, and it seems much easier to operate than IPCL?type for beginners. Accuracy rate of EUS is unsatisfactory, and the over?diagnostic rate is much higher than others. Diagnosis with EUS alone is not recommended.
ABSTRACT
Objective To evaluate the accuracy of magnifying endoscopy with narrow-band imaging (ME-NBI) for detecting early esophageal cancer invasion depth. Methods We searched Embase, Pubmed, Web of Science, Cochrane Library, CBM, CNKI, Wanfang and VIP databases from inception to Feb.2016. Domestic articles related to the accuracy of ME-NBI detecting the early esophageal cancer invasion depth were collected comprehensively. The quality of the papers was evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Data analysis was conducted by Stata 12.0 software. Results Seven group data from six studies including 319 patients with 366 lesions met the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, SROC area under the curve and DOR were 93.8 % (95 % CI: 0.886~0.967), 75.2 % (95 % CI: 0.658~0.827), 3.779 (95 % CI: 2.685 ~ 5.318), 0.083 (95 % CI: 0.044~0.155), 0.80 (95 % CI: 0.770~0.840) and 45.658 (95 % CI:21.006~99.240). Conclusions The results suggest that ME-NBI may be an effective tool for detecting invasion depth of early esophageal cancer, which plays an important role in clinical selection of surgical approach and treatment.