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OBJECTIVE: To evaluate the safety and effectiveness of transparent cap-assisted blunt dissection (TCABD) in the endoscopic resection of gastric submucosal tumours (G-SMT) smaller than 2cm, as compared with conventional electronic knife dissection. STUDY DESIGN: Randomised controlled analysis. Place and Duration of the Study: Department of Gastrointestinal Surgery, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian City, Putian, China, from July 2020 to 2022. METHODOLOGY: Fifty-eight patients having G-SMT smaller than 2cm were included. They were randomly divided into two groups; undergoing transparent cap-assisted blunt dissection (BD group) and conventional endoscopic submucosal excavation (ESE group). The pathology, lesion size in long diameter (mm), operation time, the number of clips used to close the wounds, the number of snare used to resect the tumour, hospital days, hospitalisation expense, en bloc resection rate, and the complications including perforation, postoperative bleeding, and postoperative infection were compared between the two groups. RESULTS: The mean long diameter in the BD group was 9.6 ± 3.6mm, while the conventional ESE group was 10.7 ± 4.5mm. As compared with the conventional ESE group, the operation time, the number of clips used to close the wounds, the number of snare used to resect the tumours, the hospital days, and the hospitalisation expense were all significantly decreased (p <0.05). The perforation rate was lower in the BD group (p <0.05). CONCLUSION: TCABD was effective and safe in the endoscopic resection of G-SMT smaller than 2cm. TCABD could help to reduce the perforation rate, shorten the operation time and hospital days, and decrease the hospitalisation expense in the endoscopic resection of G-SMT. KEY WORDS: Endoscopic submucosal excavation, Endoscopic full-thickness resection, Endoscopic resection, Submucosal tumour, Transparent cap-assisted blunt dissection.

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Resección Endoscópica de la Mucosa , Tempo Operativo , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Masculino , Femenino , Persona de Mediana Edad , Resección Endoscópica de la Mucosa/métodos , Resección Endoscópica de la Mucosa/instrumentación , Gastroscopía/métodos , Adulto , Disección/métodos , Disección/instrumentación , Mucosa Gástrica/cirugía , Mucosa Gástrica/patología , China , Resultado del Tratamiento , Anciano

RESUMEN

OBJECTIVE: To analyse the clinical spectrum and endoscopic treatment outcome of patients diagnosed with gastrointestinal carcinoid tumours. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The First Hospital of Putian City of Fujian Province, China from 2012 to 2019. METHODOLOGY: Patients with gastrointestinal carcinoid tumours were searched on the gastrointestinal endoscopic database and the hospital medical records database. Patients who were evaluated and treated at other institutions or with insufficient clinical information were excluded. Data were extracted from the databases, including clinical presentation, tumour size and location, treatment, complications of treatment, and clinical and endoscopic follow-up. RESULTS: In 113 cases, 92 tumours were smaller than 1 cm, 16 tumours were between 1-2 cm, and 5 tumours were larger than 2 cm in size. Ninety-five (84.1%) tumours showed as nodules with smooth surface, and 4(3.5%) as neoplasms with malignant performance. The tumours were limited to the mucosa in 14 (12.4%) cases, invaded into the submucosa in 88 (77.9%) cases, and the muscularis propria in 6 cases (5.3%). Most of the tumours (87.6%) were located in the rectum. The Ki-67 index was more than 30% in cases with metastases. One hundred and eight (95.6%) gastrointestinal carcinoid tumour patients were treated with endoscopic resection including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), and 5 (4.4%) patients underwent surgical resection. All 108 patients including the 6 patients with positive margins had no relapse of carcinoid tumour on follow-up. CONCLUSION: The rectum may be the most common location of gastrointestinal carcinoid tumours in Asian people. Most small tumours located in the stomach, colon, and rectum are nonfunctional, especially in rectum. Endoscopic excision including EMR and ESD is effective and safe for the treatment of small-sized gastrointestinal carcinoid tumours. Ki-67 index can be a good predictor for malignant potency of gastrointestinal carcinoid tumours. KEY WORDS: Gastrointestinal carcinoid tumours, Neuroendocrine tumour, Clinical features, Endoscopic treatment.

Asunto(s)

Tumor Carcinoide , Neoplasias Gastrointestinales , Neoplasias del Recto , Tumor Carcinoide/patología , Tumor Carcinoide/cirugía , Endoscopía Gastrointestinal , Neoplasias Gastrointestinales/cirugía , Humanos , Mucosa Intestinal/patología , Antígeno Ki-67 , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Resultado del Tratamiento

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The present study investigated the correlations of the Tspan-1 gene expression with the clinical characteristics and survival prognoses of patients with advanced gastric cancer. A total of 150 patients with advanced gastric cancer were enrolled in the present study, of whom 84 were at stage II and 66 were at stage III according to the tumor node metastasis (TNM) staging; the immunohistochemical staining method and the semi-quantitative PCR method were used to detect the positive expression rates and mRNA relative expression levels of Tspan-1, vascular endothelial growth factor (VEGF), E-cadherin and N-cadherin. The positive expression rates of Tspan-1, VEGF, E-cadherin and N-cadherin were 58.0% (87 patients), 50.0% (75 patients), 28.0% (42 patients) and 53.3% (80 patients), respectively. The positive expressions and mRNA levels of Tspan-1, VEGF, E-cadherin and N-cadherin were not correlated with sex or age (P>0.05), but associated with the cancer state (stage II or stage III) and maximum tumor diameter (P<0.05). With the increase of stage and tumor diameter, the positive rates and mRNA levels of Tspan-1, VEGF and N-cadherin were increased, while those of E-cadherin were decreased. Among patients with stage II/III advanced gastric cancer, those with positive expression of Tspan-1, VEGF and N-cadherin had lower median survival time and survival rates than patients with negative expressions, while patients with positive expression of E-cadherin had higher median survival time and survival rate than those with negative expression (P<0.05). The high expression of Tspan-1 gene is associated with the TNM staging of advanced gastric cancer and the tumor diameter, influences the survival prognosis, and may involve the processes of angiogenesis and epithelial-mesenchymal transition.