Clinical guideline on magnetically controlled capsule gastroscopy (2021 edition).

With the development and generalization of endoscopic technology and screening, clinical application of magnetically controlled capsule gastroscopy (MCCG) has been increasing. In recent years, various types of MCCG are used globally. Therefore, establishing relevant guidelines on MCCG is of great significance. The current guidelines containing 23 statements were established based on clinical evidence and expert opinions, mainly focus on aspects including definition and diagnostic accuracy, application population, technical optimization, inspection process, and quality control of MCCG. The level of evidence and strength of recommendations were evaluated. The guidelines are expected to guide the standardized application and scientific innovation of MCCG for the reference of clinicians.

Screening for upper gastrointestinal cancers with magnetically controlled capsule gastroscopy: a feasibility study.

BACKGROUND: The medical consortium is an intensive and disease-specific association that integrates tertiary public hospitals and medical examination centers in China. We aimed to evaluate the feasibility of the medical consortium for screening upper gastrointestinal (GI) cancers (MCSC) by magnetically controlled capsule gastroscopy (MCCG). METHODS: 6627 asymptomatic subjects underwent MCCG as part of health check-ups in the MCSC between March and November 2018. Relevant clinical data were collected and analyzed. RESULTS: The MCSC detected 32 patients with upper GI cancer (0.48 %) confirmed by pathology. The detection rate of early gastric cancer was 16.67 % (4 /24). Gastric polyps, ulcers, and submucosal tumors were found in 15.54 %, 3.76 %, and 3.17 % of subjects, respectively. The whole GI preparation and operation process were well tolerated. CONCLUSIONS: The MCSC was a feasible model for upper GI cancer screening, especially for asymptomatic subjects. Further prospective studies with better operational quality control are warranted.

Blocking follistatin-like 1 attenuates liver fibrosis in mice by regulating transforming growth factor-beta signaling.

AIM: To elucidate the effect of inhibiting follistatin-like 1 on liver fibrosis and activation of hepatic stellate cells in mice. METHODS: We generated a follistatin-like 1 neutralizing antibody that can inhibit TGF-ß 1-induced expression of collagen1α1 in primary mouse liver fibroblasts. All of the mice in our study were induced with carbon tetrachloride and thioacetamide. In addition, primary hepatic stellate cells from mice were isolated from fresh livers using density gradient separation. The degree and extent of fibrosis in mouse livers from the different groups were evaluated by Sirius Red and Masson staining. The effect of the follistatin-like 1 neutralizing antibody on proliferation and migration of hepatic stellate cells was detected using CCK-8 and Transwell assays, respectively. RESULTS: Expression of follistatin-like 1 in human cirrhotic liver tissue was higher than that in normal liver tissue. Blocking follistatin-like 1 resulted in a delay of primary hepatic stellate cell activation and down-regulation of the migratory capacity of hepatic stellate cells. Blocking follistatin-like 1 also down-regulated TGF-beta signaling in primary hepatic stellate cells from mice. Finally, inhibition of follistatin-like 1 attenuated liver fibrosis and liver function damage in vivo. CONCLUSIONS: Inhibiting follistatin-like 1 attenuates liver fibrosis and causes a delay in hepatic stellate cell activation. The effect of follistatin-like 1 on liver fibrosis is mainly attributed to its role in regulating TGF-beta signaling.

Meat intake and risk of inflammatory bowel disease: A meta-analysis.

BACKGROUND/AIMS: This meta-analysis is designed to determine the association between meat consumption and the risk of inflammatory bowel disease. MATERIALS AND METHODS: Search relevant literature published in PubMed, Cochrane before July 2015 without restrictions. Studies were included if relative ratios and the corresponding 95% confidence intervals of the risk of inflammatory bowel disease were reported with respect to meat consumption. RESULTS: Nine studies were included in this meta-analysis. Relative to those who did not or seldom eat meat, meat consumers had a significantly greater risk of inflammatory bowel disease (pooled relative ratio: 1.50, 95% confidence interval: 1.15-1.95). The funnel plot revealed no evidence for publication bias. CONCLUSION: Meat consumption may increase the risk of inflammatory bowel disease. Additional large prospective studies are warranted to verify this association.

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis.

AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors. METHODS: Databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 were searched to include eligible articles. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histological resection rate and the local recurrence rate. Meanwhile, we also compared the operation time and the incidence of procedure-related complications. RESULTS: Six trials were identified and a total of 1642 lesions were included. The en bloc resection rate was higher and the local recurrence rate was lower in the ESD group compared with the EMR group (OR = 7.94; 95%CI: 3.96-15.91; OR = 0.09; 95%CI: 0.04-0.19). There was no significant difference in histological resection rate(OR = 1.65; 95%CI: 0.29-9.30) and procedure-related complication rate between the two groups (OR = 1.59; 95%CI: 0.92-2.73). The meta-analysis also showed that ESD was more time consuming than EMR. CONCLUSION: Compared with EMR, ESD results in higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications.

Endoscopic submucosal dissection versus endoscopic mucosal resection for the treatment of early esophageal carcinoma: a meta-analysis.

Endoscopic submucosal dissection (ESD) was originally developed for en bloc resection of large, flat gastrointestinal lesions. Compared with endoscopic mucosal resection (EMR), ESD is considered to be more time consuming and have more complications for treatment of early esophageal carcinoma, such as bleeding, stenosis and perforation. The objective of this study was to compare the efficacy and safety of ESD and EMR for such lesions. We searched databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 for related trials. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histologically resection rate and the local recurrence rate. We also compared the operation time and the incidences of procedure-related complications. Five trials were identified, and a total of 710 patients and 795 lesions were included. The en bloc and histologically complete resection rates were higher in the ESD group compared with the EMR group (odds ratio (OR) 27.3; 95% CI, 11.5-64.8; OR 18.4; 95% CI, 8.82-38.59). The local recurrence rate was lower in the ESD group (OR 0.13, 95 % CI 0.04-0.43). The meta-analysis also showed ESD was more time consuming, but did not increase the complication rate (P=0.76). The results implied that compared with EMR, ESD showed better en bloc and histologically resection rates, and lower local recurrence, without increasing the incidence of procedure-related complications in the treatment of early esophageal carcinoma.

[Transjugular intrahepatic portosystemic shunt plus embolotherapy in the treatment of gastroesophageal varices: a report of 38 patients].

OBJECTIVE: To evaluate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus embolotherapy in the treatment of patients with gastroesophageal varices. METHODS: A total of 36 patients with gastroesophageal varices underwent the therapies of TIPS plus embolotherapy from July 2005 to March 2011 at Provincial Hospital Affiliated to Shandong University. The rechecked items included abdominal ultrasound examination, liver function test and blood routine examination at Day 7 post-operation. All received endoscopic examinations at Month 1. RESULTS: The technical success rate of TIPS plus embolotherapy was 100%. The portal vein pressures declined from (28 ± 8) mm Hg (1 mm Hg = 0.133 kPa) to (14 ± 7) mm Hg at post-operation. Angiography showed gastroesophageal varices disappeared in all patients. Both liver function and gastroesophageal varices markedly improved. During the follow-up period of 3 - 6 months, 4 cases had hepatic encephalopathy and 1 case stent restenosis at post-operation. And most cases were resolved after treatment. No rebleeding occurred during the follow-up period. CONCLUSIONS: The combined modality of TIPS plus embolotherapy can effectively lower portal vein pressure and cure esophageal and gastric varice bleeding. As a safe and excellent interventional procedure with fewer complications and a lower recurrence rate of portal hypertension, it has great clinical values in the treatment of portal hypertension and gastroesophageal varices.

[The therapeutic effects of eliminating allergic foods according to food-specific IgG antibodies in irritable bowel syndrome].

OBJECTIVE: To explore the therapeutic effects on irritable bowel syndrome (IBS) by eliminating the allergic foods according to food-specific IgG antibodies and to clarify the etiopathological role and mechanism of food allergy. METHODS: The food-specific IgG antibodies to a panel of 14 different food antigens in serum were detected with ELISA in fifty five cases with diarrhea-dominant IBS, thirty two with constipation-dominant IBS and eighteen normal controls. The frequency and severity index of symptoms and scores of Irritable Bowel Syndrome Quality of Life (IBS-QOL) in thirty five cases with positive food-specific IgG were observed before and after elimination of allergic foods for two months. RESULTS: The positive rate of serum food-specific IgG antibodies was 63.6 percent in patients with diarrhea-dominant IBS and 43.8 percent in constipation-dominant IBS. Both were higher than that in normal controls. After eliminating allergic foods for four weeks according to the levels of serum food-specific IgG antibodies, the frequency of symptoms decreased from (3.79 +/- 1.58) to (1.67 +/- 0.70) per week and the severity from 3.18 +/- 1.46 to 1.52 +/- 0.67 with significant differences. After eight weeks, the frequency of symptoms decreased from (3.79 +/- 1.58) to (1.53 +/- 0.69) per week and the severity from 3.18 +/- 1.46 to 1.45 +/- 0.66, also with significant differences. After eliminating allergic foods, the overall health score and the eight dimensionality integrals of QOL except avoiding food in patients with IBS increased significantly than those before treatment. At the end of eight weeks, the symptoms relieved completely in 31.4 percent of the cases and remarkably in 34.3 percent. CONCLUSIONS: Abnormal immune reactions mediated by IgG antibodies coexisted in patients with IBS. It is of great significance in treating IBS by eliminating the allergic foods according to the serum level of food-specific IgG antibodies.

Influence of antitumor drugs on the expression of Fas system in SW480 colon cancer cells.

AIMS: To observe the influence of popular antitumor drugs [5-fluorouracil (5-FU), mitomycin (MMC), cisplatin (CP) and all-trans retinoic acid (ATRA)] on the expression of Fas system in SW480 colon cancer cells. METHODS: The expressions of Fas/FasL protein and mRNA in colon cancer line SW480 cells before and after the treatment of the antitumor drugs (5-FU, MMC, CP and ATRA) were detected by immunocytochemistry, flow cytometry and reverse-transcriptase polymerase chain reaction. Coculture assays of colon cancer cells and Jurkat cells (Fas-sensitive cells) were performed to observe the counterattack of colon cancer cells to lymphocytes. Apoptosis of Jurkat cells were detected by flow cytometry and fluorescence microscopy. RESULTS: SW480 expressed high FasL and low Fas without drug treatments. When treated with 5-FU, Fas expression rates in SW480 increased, but FasL remained unchanged. Both Fas and FasL increased significantly when treated with MMC and CP. Most importantly, ATRA could induce SW480 cells to differentiate, increase the expression of Fas and decrease the expression of FasL. The coculture of SW480 cells and Jurkat cells confirmed the function of FasL in the SW480 cells. CONCLUSION: Certain antitumor drugs can change the expression of the Fas system in SW480 cells in different ways. In vitro, MMC and CP can increase the sensitivity of colon cancer cells to apoptosis signals, but they possibly facilitate immune escape of tumor cells. 5-FU results in immune escape of colon cancer cells. ATRA can down-regulate the possibility of counterattack of colon cancer cells.

Mechanism of counterattack of colorectal cancer cell by Fas/Fas ligand system.

AIM: To determine the role of Fas/Fas ligand (FasL) in the immune escape of colon cancer cells. METHODS: Immunohistochemistry was used to observe the expression of Fas and FasL in the tissues of colon cancer patients. In situ hybridization was used to detect the localization of FasL mRNA expression in cancer tissues. Terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL) assay and CD45 staining were performed to detect the apoptosis of tumor-infiltrating lymphocytes (TILs). Co-culture assays of colon cancer cells (SW480) and Jurkat cells (Fas-sensitive cells) were performed to observe the counterattack of colon cancer cells to lymphocytes. RESULTS: Of 53 cases of colon carcinomas, 23 cases (43.4%) expressed Fas which was significantly lower as compared to the normal colonic mucosa (73.3%, P<0.01), and 45 cases (84.9%) of colon carcinomas expressed FasL, whereas only two cases (3.75%) in normal mucosa expressed FasL. FasL expression in the colon cancer cells was found to be associated with increased cell death of TILs. The apoptotic rate of TIL in the FasL-positive staining regions of tumor cells was significantly higher than that in the FasL-negative staining region (54.84+/-2.79% vs 25.73+/-1.98%, P<0.01). The co-culture of SW480 cells and Jurkat cells confirmed the function of FasL on the SW480 cells. The apoptotic rates of Jurkat cells were found to be related with the amount of SW480 cells. CONCLUSION: Colon cancer cells can escape the immune surveillance and killing via decreasing Fas expression, and can counterattack the immune system via increasing FasL expression. Fas/FasL can serve as potential targets for effective antitumor therapy.