[Research Progress in Delayed Bleeding after Endoscopic Submucosal Dissection of Early-Stage Gastrointestinal Cancer].

Endoscopic submucosal dissection (ESD) has been widely used in the clinical treatment of early-stage and precancerous lesions of the digestive tract. Compared with traditional open surgery, the procedure has a number of advantages, including low postprocedural recurrence rate, the location and scope of lesions not posing much restrictions on the procedure, and quick patients recovery afterwards. The procedure has hence become one of the minimally-invasive procedures commonly performed with gastrointestinal endoscope. However, due to the influence of various factors, complications such as intraoperative and postoperative bleeding, perforation, electrocoagulation syndrome and lumen stenosis may occur. Delayed postoperative bleeding, in particular, may induce cardiovascular and other related diseases due to the insidious nature of its onset, resulting in serious consequences. It is critically important for the further development of ESD that we should acquire thorough understanding and mastery of the relevant influencing factors and preventive measures of delayed bleeding after ESD of early-stage gastrointestinal cancer. We herein summarized and discussed the latest research findings in the preventative and treatment measures.

Simethicone administration improves gastric cleanness for esophagogastroduodenoscopy: a randomized clinical trial.

BACKGROUND: Esophagogastroduodenoscopy is very useful in diagnosing and treating upper gastrointestinal mucosal disorders, but too much foam and water in stomach decrease its diagnostic efficiency. Simethicone administration can help remove excessive foam. AIMS: To determine the optimal simethicone administration strategies in a comparative randomized controlled clinical trial. METHODS: Adult outpatients with indications for esophagogastroduodenoscopy were enrolled and randomly divided into group 1 (simethicone solution intake 20-30 min before procedure, n = 110), group 2 (simethicone solution intake 31-60 min before procedure, n = 92), and group 3 (simethicone solution intake > 60 min before procedure). Primary and secondary outcomes were procedure time and the patients' satisfaction after the examination. All symptoms like abdominal pain and distension were recorded. RESULTS: No statistically significant differences were found on the patients' demographic and clinical features and mean examination time (all P values > 0.05). The distribution of patients with different endoscopic and pathological diagnosis was comparable among three groups, respectively (P = 0.607; P = 0.289). However, the proportion of patients with Gastric Cleanness Grade A was most in group 2 (n = 73, 79.3%), and patient proportion with Gastric Cleanness Grade C was most found in group 1 (n = 72, 65.5%), which was greatly different (P < 0.001). There was no statistically significant difference on the satisfaction scores [immediately 6 (3-8) vs. 6 (1-10) vs. 6 (1-9), P = 0.533; 2 h after 10 (8-10) vs. 10 (10-10) vs. 10 (8-10), P = 0.463]. CONCLUSION: Simethicone solution intake 31-60 min before esophagogastroduodenoscopy can help obtain the best gastric cleanness, which is recommended in clinical practice (registered at ClinicalTrials.gov, NCT03776916 on December 13, 2018).

Novel endoscopic findings as visualized by non-magnification endoscopy with linked color imaging are indicative of gastric intestinal metaplasia.

BACKGROUND: Gastric intestinal metaplasia (GIM) is generally considered to be the main mucosal background for the development of gastric adenocarcinomas. Using linked color imaging (LCI), we noticed that the color pattern in areas of GIM was purple mixed with white on the epithelium with signs of mist that were detected by the non-magnifying LCI observation. We have termed this endoscopic finding "Purple in Mist" (PIM). The aim of this study was to investigate whether PIM could be a useful optical sign for predicting GIM. METHODS: We prospectively evaluated consecutive patients undergoing endoscopy for various indications. The endoscopist used the LCI system to carefully observe the gastric antrum, body and angulus. When a PIM was identified in the surface layer, targeted biopsies were subsequently taken from this part. If the suspected area had no PIM on the surface, targeted biopsies were also taken. RESULTS: Sixty-three consecutive patients were included in this study. The prevalence of intestinal metaplasia (IM) was 29/63 (46%). In PIM-positive patients, the prevalence of IM was 23/26 (89%). Of these patients, 146 biopsy specimens were included in this study. For the diagnosis of IM, compared to histological assessment, the LCI finding had an accuracy of 91.1% (95%CI: 86.5%-95.7%), a sensitivity of 89.8% (95%CI: 81.3%-98.3%), a specificity of 91.8% (95%CI: 86.3%-97.2%), a positive predictive value of 84.6% (95%CI: 74.8%-94.4%), and a negative predictive value of 94.7% (95%CI: 90.1%-99.2%). CONCLUSIONS: A positive PIM finding in a suspicious lesion on LCI would complement LCI diagnosis of possible IM because of the positive predictive value of PIM. PIM could be a novel endoscopic marker for IM. TRIAL REGISTRATION: ClinicalTrials.gov, No. NCT03092414; https://clinicaltrials.gov/ct2/show/NCT03092414?id=NCT03092414&rank=1.

Autologous Flap Transfer for Esophageal Stricture Prevention After Endoscopic Submucosal Dissection in a Porcine Model.

BACKGROUND: Esophageal stricture caused by endoscopic submucosal dissection for a mucosal defect that covers more than three quarters of the circumference of the esophagus has a high incidence. To date, no method for preventing such strictures has been widely recognized as effective in clinical practice. AIMS: We examined whether esophageal stricture caused by circumferential endoscopic submucosal dissection could be prevented by autologous flap transfer. METHODS: Six pigs (N = 6) underwent circumferential esophageal endoscopic submucosal dissection under general anesthesia. For animals in the flap group (N = 3), an autologous flap was constructed and then placed at the resection site and secured with metal clips. Animals in the control group (N = 3) underwent endoscopic submucosal dissection only. Endoscopy was performed 3 weeks postoperative to evaluate the effects of flap transfer. RESULTS: Animals in the flap group gained more weight than animals in the control group. At 3 weeks postoperative, animals in the flap group developed clinically slight stricture; in these animals, an endoscope could be passed through the stricture with slight resistance. In contrast, in the control group, significant stricture was observed, and the stricture was difficult to cross with an endoscope. CONCLUSION: Autologous flap transfer after circumferential esophageal endoscopic submucosal dissection is a novel approach that remarkably decreases the degree of esophageal stricture that arises.

In vivo inhibitory activity of andrographolide derivative ADN-9 against liver cancer and its mechanisms involved in inhibition of tumor angiogenesis.

It is well known that liver cancer is a highly aggressive malignancy with poor prognosis. Andrographolide (AD), a major bioactive component of Andrographis paniculata (Burm. F.), is a potential anti-cancer pharmacophore and the synthesis of AD derivatives with better cytotoxicity to cancer cells has attracted considerable attentions. In the present study, we evaluated the in vivo inhibitory effects of ADN-9, a 15-benzylidene substituted derivative of AD, on the growth and metastasis of murine hepatoma H22 using an orthotopic xenograft model and a subcutaneous xenograft model, and we further studied the anti-angiogenic action and the related mechanisms of ADN-9 in vivo and in vitro. Importantly, ADN-9 remarkably suppressed the growth and metastasis of both orthotopic and subcutaneous xenograft tumors, and the serum AFP level in orthotopic hepatoma-bearing mice treated with 100mg/kg ADN-9 (ig.) was decreased to the normal level. We also found that ADN-9 showed stronger abilities than AD in shrinking tumors, suppressing the invasion and metastasis of H22 cells, decreasing the MVD and promoting tumor cell apoptosis in subcutaneous xenograft of mice. Additionally, ADN-9 exhibited stronger inhibitory activity than AD against the migration and VEGF-induced capillary-like tube formation in HUVECs, which was further proved to be associated with attenuating VEGF/VEGFR2/AKT signaling pathway. The present research provides the first evidence that a 15-substituted AD derivative is more promising than the parent compound in therapeutic treatment of liver cancer.

Efficient hydrolysis of corncob residue through cellulolytic enzymes from Trichoderma strain G26 and L-lactic acid preparation with the hydrolysate.

To prepare fermentable hydrolysate from corncob residue (CCR), Trichoderma strain G26 was cultured on medium containing CCR for production of cellulolytic enzymes through solid-state fermentation (SSF), resulting in 71.3 IU/g (FPA), 136.2 IU/g (CMCase), 85.1 IU/g (ß-glucosidase) and 11,344 IU/g (xylanase), respectively. Through a three-stage saccharification strategy, CCR was hydrolyzed by the enzymatic solution (6.5 FPU/ml) into fermentable hydrolysate containing 60.1g/l glucose (81.2% cellulose was converted at solid loading of 12.5%), 21.4% higher than that by the one-stage method. And then the hydrolysate was used to produce L-lactic acid by a previous screened strain Bacillus coagulans ZX25 in the submerged fermentation. 52.0 g/l L-lactic acid was obtained after fermentation for 44 h, with 86.5% glucose being converted to L-lactic acid. The results indicate that the strains and the hydrolysis strategy are promising for commercial production of L-lactic acid from CCR and other biomass.