Early Gastric Cancer Research Articles

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling

ImportanceRadical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects.ObjectiveTo assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer.Design, Setting, and ParticipantsThis open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024.InterventionsEligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG).Main Outcomes and MeasuresThe primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses.ResultsOf 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (P = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant.Conclusions and RelevanceNeurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life.Trial RegistrationChictr.org.cn Identifier: ChiCTR2200059489

Current status of evaluation and treatment of early-stage remnant gastric cancer

Because of early diagnosis and improved prognosis, patients with gastric cancer are now surviving longer and remnant gastric cancer after gastrectomy is becoming more common. Remnant gastric cancer is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. In recent years, the development of endoscopic therapy has provided us with new therapeutic ideas. Although with some drawbacks, such as limited working space, gastric fibrosis and staples under the suture line, endoscopic management is still an effective treatment option with potential long-term survival advantage. For gastrectomy patients, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the early remnant gastric cancer. This review aims to provide an overview of remnant gastric cancer, especially focusing on its pathogenesis as well as new advances in the diagnosis and endoscopic treatment of early-stage remnant gastric cancer.

Abstract 4120573: Abrupt cardiac rupture of the patient with ATTR amyloidosis

A Japanese male in his 80s was admitted to our emergency department with chest pain. His prior history was syncope and ventricular tachycardia. Transthoracic echocardiography (TTE) revealed thickening of the basal part of the antero-septal wall and thinning of the basal part of the inferior wall. Coronary angiography (CAG), cardiac MRI and blood test revealed no specific abnormalities. The day before his emergency admission, he visited the cardiology outpatient department for a periodic examination of cardiac hypertrophy. ECG, chest X-ray, and TTE were unchanged from his prior examination. However, that night, he experienced chest pain and was transferred to our hospital. On arrival, his vital signs were critical, with a blood pressure of 70/59 mmHg. ECG indicated ST elevation in antero-lateral leads. TTE detected pericardial effusion, and contrast-enhanced CT identified two focal areas of non-enhancement in the myocardium and pericardial effusion without signs of aortic dissection. CAG revealed no significant stenosis or obstructive lesion. During coronary angiography, the patient deteriorated to asystole. Cardiopulmonary resuscitation and percutaneous pericardial drainage were initiated. Hemorrhagic pericardial effusion was aspirated. Immediate surgical hemostasis was undergone, revealing about 2 cm lacerations and hematoma in the anterior and inferior wall. After surgery, he complained of abdominal discomfort. Esophageal gastrointestinal endoscopy was undergone to investigate the abdominal discomfort, and he was diagnosed with early gastric cancer. Endoscopic submucosal dissection (ESD) was undergone, and histopathological examination revealed adenocarcinoma and eosinophilic amorphous materials deposited in the submucosal vessels. Congo red staining of the submucosal vessels revealed orange-red areas. A technetium-99m pyrophosphatase scintigraphy showed Grade 2 uptake in the heart. Transthyretin (TTR) staining was positive in the specimen from ESD, leading to a diagnosis of TTR amyloidosis. Genetic test for TTR was negative, which led to a diagnosis of wild-type TTR amyloidosis and tafamidis was started. In cases of acute pericardial effusion and/or cardiac rupture, it is imperative to consider cardiac amyloidosis as a potential etiology, in addition to myocardial infarction and aortic dissection, especially in patients with left ventricular wall thickening, neuropathy, or abnormal ECG, also known as “red flag”.

Combination of artificial intelligence endoscopic diagnosis and Kimura‐Takemoto classification determined by endoscopic experts may effectively evaluate the stratification of gastric atrophy in post‐eradication status

AbstractBackgroundSince it is difficult for expert endoscopists to diagnose early gastric cancer in post‐eradication status, it may be critical to evaluate the stratification of high‐risk groups using the advance of gastric atrophy or intestinal metaplasia. We tried to determine whether the combination of endoscopic artificial intelligence (AI) diagnosis for the evaluation of gastric atrophy could be a useful tool in both pre‐ and post‐eradication status.Methods270 Helicobacter pylori‐positive outpatients (Study I) were enrolled and Study II was planned to compare patients (n = 72) with pre‐eradication therapy with post‐eradication therapy. Assessment of endoscopic appearance was evaluated by the Kyoto classification and Kimura‐Takemoto classification. The trained neural network generated a continuous number between 0 and 1 for gastric atrophy.ResultsThere were significant associations between the severity of gastric atrophy determined by AI endoscopic diagnosis and not having a regular arrangement of collecting venules in angle, visibility of vascular pattern, and mucus using Kyoto classification in H. pylori‐positive gastritis. There were significant differences (p = 0.037 and p = 0.014) in the severity of gastric atrophy between the high‐risk group and low‐risk group based on the combination of Kimura‐Takemoto classification and endoscopic AI diagnosis in pre‐ and post‐eradication status. The area under the curve values of the severity of gastric atrophy (0.674) determined by the combination of Kimura‐Takemoto classification and gastric atrophy determined by AI diagnosis was higher than that determined by Kimura‐Takemoto classification alone in post‐eradication status.ConclusionA combination of gastric atrophy determined by AI endoscopic diagnosis and Kimura‐Takemoto classification may be a useful tool for the prediction of high‐risk groups in post‐eradication status.

Knowledge and practice of early gastric cancer screening among adults aged ≥ 45 years in China: a cross-sectional study

BackgroundAs the incidence of gastric cancer increases sharply in adults aged over 45 years, a better understanding of gastric cancer screening knowledge and practice is crucial to promote cancer-screening services. This study aimed to evaluate knowledge of early gastric cancer screening, adherence to screening, and perceived barriers hindering screening practices among adults aged ≥ 45 years in China.MethodsA multi-center, face-to-face, cross-sectional study was conducted in community sites in Shijiazhuang, China, through the distribution of structured questionnaires from August to September, 2022.ResultsOf the 1053 respondents, only 13.4% demonstrated a good understanding of early gastric cancer screening. While 64.0% knew that gastroscopy is the gold standard for screening (“how to screen”), only 19.9% were aware of the recommended starting age (“when to screen”). Moreover, less than half could correctly identify high-risk groups (“whom to screen”), with awareness ranging from 20.5% for those infected with H. pylori to 47.8% for those with gastric diseases. Independent factors related to higher screening knowledge included female sex (OR = 1.55, 95% CI = 1.01–2.38), higher education level (OR = 4.03, 95% CI = 2.68–6.06), being with a personal/family experience of gastric diseases (OR = 1.68, 95% CI = 1.12–2.52). In addition, only 23.4% of respondents underwent GC screening. The dominant barrier to early screening was the “absence of symptoms or signs”, followed by “fearing procedural discomfort”.ConclusionThis study highlights significant gaps in early gastric cancer screening knowledge and participation among middle-aged and elderly individuals in China. Addressing these gaps through culturally tailored health education campaigns is a critical strategy for increasing public awareness and participation.

Treatment outcomes of non‐curative endoscopic submucosal dissection for superficial gastric neoplasia: A retrospective study at a tertiary care center in the United States

AbstractObjectivesEndoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer; additional treatment may be recommended for patients in whom resection is not curative per the American Society for Gastrointestinal Endoscopy guidelines. The aim of this study was to assess treatment outcomes of ESD for gastric neoplasia, with a focus on cases of non‐curative resection.MethodsThis was a retrospective study of all individuals undergoing ESD for the treatment of gastric adenocarcinoma or dysplasia in a high‐volume tertiary care center in the United States. Data on patient demographic characteristics, clinical history, lesion characteristics, and procedural and clinical outcomes were collected from the electronic medical record.ResultsAmong 82 cases undergoing ESD for the management of gastric neoplasia, 32 cases resulted in non‐curative resection. 20 of these non‐curative cases did not get additional treatment, among which recurrence occurred in two cases with positive horizontal margins only. These patients did not show lymph node metastasis and underwent further endoscopic or surgical resection. There was no recurrence in 11 cases with undifferentiated carcinomas of ≤2 cm in size.ConclusionsAlthough this study was limited by its retrospective design, small sample size, and follow‐up duration, our findings suggest that a risk‐adapted strategy could be employed for certain patients undergoing non‐curative ESD per American Society for Gastrointestinal Endoscopy guidelines, with close follow‐up instead of routine surgery in select cases with favorable features. Further studies are needed to refine the criteria for additional treatment after non‐curative ESD in Western populations.

Analysis of clinicopathological factors associate with the visibility of early gastric cancer in endoscopic examination and usefulness of linked color imaging: A multicenter prospective study.

This study investigated clinicopathological factors associated with the visibility of early gastric cancer and the efficacy of linked color imaging. Patients with early gastric cancer who underwent endoscopic treatment between April 2021 and July 2022 were enrolled. All cases underwent white light imaging and linked color imaging. Three experts evaluated lesion visibility using a visual analog scale. A mean score ≥3 on white light imaging was defined as "good visibility", and <3 as "poor visibility". We extracted patient information and endoscopic and pathological data for the lesion and background mucosa, analyzed factors associated with the visibility of early gastric cancer, and compared visibility between white light imaging and linked color imaging. Ninety-seven lesions were analyzed, with good visibility in 49 and poor visibility in 48. Multivariate analysis revealed small lesion size (odds ratio 1.89) and presence of endoscopic intestinal metaplasia (odds ratio 0.49) as significantly associated with the poor visibility of early gastric cancer. Mean visibility score was significantly higher for linked color imaging (P<0.001). Mean score for linked color imaging was significantly higher in the poor visibility group (P<0.001), but not significantly different in the good visibility group (P = 0.292). Mean score was significantly higher with linked color imaging in cases with endoscopic intestinal metaplasia (P = 0.0496) and lesions <20 mm in diameter (<10 mm, P = 0.002; 10-20 mm, P = 0.004). Lesion size and endoscopic intestinal metaplasia are associated with the visibility of early gastric cancer in white light imaging. Linked color imaging improves visibility of gastric cancer with these factors.

Morbidity and quality of life of totally laparoscopic versus laparoscopy-assisted distal gastrectomy for early gastric cancer: a multi-center prospective randomized controlled trial (CKLASS01).

There is a paucity of confirmatory randomized controlled trials (RCTs) comparing the effectiveness of totally laparoscopic distal gastrectomy (TLDG) vs laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC). A phase III, prospective, multi-center RCT was conducted, wherein patients (n = 442) with clinical stage I gastric cancer eligible for laparoscopic distal gastrectomy were randomized 1:1 to the TLDG or the LADG group. Postoperative morbidity and quality of life (QoL) were compared. In total, 422 patients were assessed (TLDG, 216; LADG, 206) in the modified intention-to-treat (mITT) analysis. The morbidity rate did not differ significantly between the two groups (TLDG, 6.0%; LADG, 5.8%; P = 0.93). The 90-day mortality rate was comparable between the groups (TLDG, 0.5%; LADG, 0.0%; P > 0.99). TLDG was significantly associated with a lower pain score compared with LADG in patients with a BMI of ≥ 25 kg/m2 (P = 0.002) at 24 h postoperatively. Moreover, TLDG significantly improved QoL in terms of C30 social functioning at 3 and 6 months (P = 0.03 and P = 0.04), C30 global health status at 3 months (P = 0.02), and STO22 body image at 3 months (P = 0.01), with differences dissipating at 12 months. TLDG is not superior to LADG in terms of postoperative morbidity and mortality, but it provides better C30 social functioning at 3 and 6 months, C30 global health status and STO22 body image at 3 months, and reduces early postoperative pain for patients with a BMI of ≥ 25 kg/m2. ClinicalTrials.gov: NCT03393182.

A deep learning approach for gastroscopic manifestation recognition based on Kyoto Gastritis Score.

The risk of gastric cancer can be predicted by gastroscopic manifestation recognition and the Kyoto Gastritis Score. This study aims to validate the applicability of AI approaches for recognizing gastroscopic manifestations according to the definition of Kyoto Gastritis Score, with the goal of improving early gastric cancer detection and reducing gastric cancer mortality. In this retrospective study, 29013 gastric endoscopy images were collected and carefully annotated into five categories according to the Kyoto Gastritis Score, i.e. atrophy (A), diffuse redness (DR), enlarged folds (H), intestinal metaplasia (IM), and nodularity (N). As a multi-label recognition task, we propose a deep learning approach composed of five GAM-EfficientNet models, each performing a multiple classification to quantify gastroscopic manifestations, i.e. no presentation or the severity score 0-2. This approach was compared with endoscopists of varying years of experience in terms of accuracy, specificity, precision, recall, and F1 score. The approach demonstrated good performance in identifying the five manifestations of the Kyoto Gastritis Score, with an average accuracy, specificity, precision, recall, and F1 score of 78.70%, 91.92%, 80.23%, 78.70%, and 0.78, respectively. The average performance of five experienced endoscopists was 72.63%, 90.00%, 77.68%, 72.63%, and 0.73, while that of five less experienced endoscopists was 66.60%, 87.44%, 70.88%, 66.60%, and 0.66, respectively. The sample t-test indicates that the approach's average accuracy, specificity, precision, recall, and F1 score for identifying the five manifestations were significantly higher than those of less experienced endoscopists, experienced endoscopists, and all endoscopists on average (p < 0.05). Our study demonstrates the potential of deep learning approaches on gastric manifestation recognition over junior, even senior endoscopists. Thus, the deep learning approach holds potential as an auxiliary tool, although prospective validation is still needed to assess its clinical applicability.

Association Between Changes in Skeletal Muscle Quality and Prognosis in Postoperative Patients with Early Gastric Cancer.

Identifying accurate prognostic factors is crucial for postoperative management of early gastric cancer (EGC) patients. Skeletal muscle quality (SMQ), defined by muscle density on computed tomography (CT) images, has been proposed as a novel prognostic factor. This study compared the prognostic significance of SMQ changes with the well-established factor of body weight (BW) loss in the postoperative EGC setting. This single-center retrospective study included 297 postoperative EGC patients (median age 69 years, 68.4% male) who had preoperative and 1-year-postoperative gastrectomy CT images. SMQ was defined as the modified intramuscular adipose tissue content (mIMAC = skeletal muscle density-subcutaneous fat density on CT images) and the change as ΔmIMAC. Log-rank test, Kaplan-Meier survival, and Cox proportional hazards regression analyses were used to assess the associations between prognosis and either ΔmIMAC or BW change (ΔBW). Prognosis prediction by ΔmIMAC and ΔBW was compared by using the area under the curve (AUC) of the receiver operating characteristic curve. ΔmIMAC was significantly associated with prognosis (log-rank test; P = 0.037), but ΔBW was not (P = 0.243). Prognosis was significantly poorer in the severely decreased mIMAC group than in the preserved group (multivariate Cox proportional hazards regression analysis; P = 0.030) but was unaffected by BW changes (P = 0.697). The AUC indicated a higher prognostic value for ΔmIMAC than ΔBW (ΔmIMAC: AUC = 0.697, ΔBW: AUC = 0.542). One-year post-gastrectomy SMQ changes may be better prognostic EGC predictors than BW changes.

Utility of near-infrared fluorescent clip for the robot-assisted gastrectomy: Report of 2 cases (case series)

Introduction and importanceThe importance of preoperative tumor site marking has increased over the years, as the method of intraoperative primary lesion identification and determination of resection margins is one factor determining whether oncological safety and function-preserving gastrectomy are possible during surgery. We hypothesize that preoperative placement of the near-infrared fluorescent (NIRF) clip, ZEOCLIP FS, near the oral incision line of the gastric tumor will allow for Firefly recognition of the NIRF clip on da Vinci during surgery and easy determination of the tumor location and incision line. Hence, we report on two cases in which the procedure was performed. Case presentationCase 1: A 62-year-old woman was diagnosed with early gastric cancer of 35 mm in size located in the greater curvature of the gastric angle and underwent robot-assisted distal gastrectomy. NIRF clips were placed around the negative biopsy-confirmed area on the tumor's oral side by endoscopy on the day before surgery. The clips were identified intraoperatively in Firefly mode, and we performed gastrectomy without using an intraoperative endoscope. Case 2: A 60-year-old man was diagnosed with early gastric cancer 40 mm in size on the anterior wall of the gastric angle and underwent robot-assisted distal gastrectomy. Similarly, NIRF clips were placed around the site of negative biopsy confirmation the day before surgery. NIRF clips were identified, and we performed gastrectomy. Clinical discussionThe time taken to mark the gastric resection line after activating the Firefly imaging system was 120 and 154 s, respectively, and intraoperative endoscopy was not required. The advantage of our two-step method is that a surgeon can mark the clips the day before the surgery, even if they are not endoscopists. Increasing the recognition rate of fluorescent clips and preventing their remains are future issues. ConclusionBased on the results of the above two cases, ZEOCLIP FS is influential in determining the tumor's location and the resection line.

Modified Double-Tract Reconstruction in Gastrointestinal Reconstruction after Proximal Gastrectomy.

To determine the clinical efficacy and safety of modified double-channel anastomosis for digestive tract reconstruction in proximal gastrectomy for early gastric cancer (EGC). Case series. Place and Duration of the Study: Department of Gastrointestinal Surgery, Heji Hospital, Changzhi Medical College, Shanxi, China, from January to November 2022. Based on inclusion and exclusion criteria, this study included a total of 21 patients with oesophagogastric junction cancer or proximal gastric cancer who underwent laparoscopic proximal gastrectomy with modified double-channel anastomosis. After resection of the proximal stomach, the remaining stomach was shaped into a tube. The distal end of the oesophagus was anastomosed to the jejunum. The jejunum was anastomosed 10-15 cm from the oesophagojejunostomy site laterally to the anterior wall of the stomach 3 cm from the gastric remnant. General data including operative time, anastomosis time, intraoperative blood loss, time to oral intake, length of hospital stay, and postoperative complications were evaluated. Postoperative gastroscopy and gastrointestinal imaging were performed to assess the residual stomach motility and anti-reflux effect. All twenty-one patients underwent modified double-channel anastomosis. The mean operation time was 254 (211 - 297) minutes. Mean reconstruction time was 65 (60 - 70) minutes. A mean of 19 (15 - 29) lymph nodes were cleared. Mean intraoperative blood loss was 86 (78.5-105ml). Mean time to oral intake was 6 (5 - 6.5) days. Postoperatively, there were two cases of pulmonary infection. There was no occurrence of anastomotic stenosis, anastomotic bleeding, or leakage. Gastrointestinal contrast study at 6 months postoperatively revealed reduced gastrointestinal motility in three cases and good residual gastric motility observed in the remaining patients. Gastroscopic examination at 6 months postoperatively revealed only one case of reflux oesophagitis. Modified double-channel anastomosis for proximal gastrectomy is safe and feasible. It provides a good anti-reflux effect and gastric emptying function without increasing the risk of postoperative complications. Adenocarcinoma of the oesophagogastric junction, Upper gastric carcinoma, Proximal gastrectomy, Double-tract reconstruction.

Modified Double-Tract Reconstruction in Gastrointestinal Reconstruction after Proximal Gastrectomy.

To determine the clinical efficacy and safety of modified double-channel anastomosis for digestive tract reconstruction in proximal gastrectomy for early gastric cancer (EGC). Case series. Place and Duration of the Study: Department of Gastrointestinal Surgery, Heji Hospital, Changzhi Medical College, Shanxi, China, from January to November 2022. Based on inclusion and exclusion criteria, this study included a total of 21 patients with oesophagogastric junction cancer or proximal gastric cancer who underwent laparoscopic proximal gastrectomy with modified double-channel anastomosis. After resection of the proximal stomach, the remaining stomach was shaped into a tube. The distal end of the oesophagus was anastomosed to the jejunum. The jejunum was anastomosed 10-15 cm from the oesophagojejunostomy site laterally to the anterior wall of the stomach 3 cm from the gastric remnant. General data including operative time, anastomosis time, intraoperative blood loss, time to oral intake, length of hospital stay, and postoperative complications were evaluated. Postoperative gastroscopy and gastrointestinal imaging were performed to assess the residual stomach motility and anti-reflux effect. All twenty-one patients underwent modified double-channel anastomosis. The mean operation time was 254 (211 - 297) minutes. Mean reconstruction time was 65 (60 - 70) minutes. A mean of 19 (15 - 29) lymph nodes were cleared. Mean intraoperative blood loss was 86 (78.5-105ml). Mean time to oral intake was 6 (5 - 6.5) days. Postoperatively, there were two cases of pulmonary infection. There was no occurrence of anastomotic stenosis, anastomotic bleeding, or leakage. Gastrointestinal contrast study at 6 months postoperatively revealed reduced gastrointestinal motility in three cases and good residual gastric motility observed in the remaining patients. Gastroscopic examination at 6 months postoperatively revealed only one case of reflux oesophagitis. Modified double-channel anastomosis for proximal gastrectomy is safe and feasible. It provides a good anti-reflux effect and gastric emptying function without increasing the risk of postoperative complications. Adenocarcinoma of the oesophagogastric junction, Upper gastric carcinoma, Proximal gastrectomy, Double-tract reconstruction.

Helicobacter pylori prevalence and its spontaneous eradication rate after distal or proximal gastrectomy for gastric cancer: A multicenter prospective cohort study

AbstractBackgroundHelicobacter pylori (H. pylori) eradication is recommended in patients undergoing endoscopic resection for early gastric cancer to reduce recurrence. However, due to the possibility of spontaneous regression secondary to dynamic changes in the remnant stomach, the immediate eradication after gastrectomy for H. pylori carriers remains unclear. This study aimed to investigate the prevalence of H. pylori in Japanese patients with gastric cancer and the spontaneous eradication rate after distal or proximal gastrectomy.MethodsThis multicenter prospective cohort study was conducted at 22 institutions. Eligibility criteria was patients over 20 years planned to undergo R0 gastrectomy for gastric cancer. The primary endpoint was spontaneous eradication rate 1 year after distal or proximal gastrectomy. The prevalence of H. pylori infection before surgery and clinical features related to spontaneous eradication were examined.ResultsA total of 1247 patients were included in this study. The preoperative H. pylori status was positive in 756 patients and negative in 491. Seventy‐nine of the negative patients had an eradication history, totaling 835 (67%) patients preoperatively infected with H. pylori. The infection status of 541 patients was examined 1 year postoperatively; 285 were negative, with a 52.7% spontaneous eradication rate. Spontaneous eradication was significantly higher in male and older patients (&gt;70 years); other factors, such as histological type, gastrectomy method and adjuvant chemotherapy presence, did not affect the rate.ConclusionsAs spontaneous H. pylori eradication occurred in more than half of the analyzed patients, retesting for H. pylori. should be considered before postoperative eradication therapy (UMIN000020280).

Closure of gastric mucosal defects using the reopenable-clip over the line method to decrease the risk of bleeding after endoscopic submucosal dissection: a multicenter propensity score-matched case-control study (with video)

Background and AimsEndoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer. However, post-ESD bleeding presents significant risks. Closing mucosal defects following ESD may reduce the incidence of post-ESD bleeding. Currently, no optimal closure method exists. Therefore, we invented clip-line closure using the reopenable-clip over the line method (ROLM) and evaluated its efficacy in preventing post-ESD bleeding. MethodsWe retrospectively reviewed data from patients who underwent gastric ESD between January 2012–March 2024. Patients were categorized into two groups: the non-closure group (mucosal defect remained unclosed) and the ROLM group (defect was closed using ROLM). Baseline characteristics of patients, distribution of bleeding risk factors, and incidence and timing of post-ESD bleeding were compared between the groups. Propensity score matching was employed to minimize potential bias. ResultsFollowing propensity score-matching, 162 ESDs were performed for 168 lesions in the non-closure group, whereas 160 ESDs were performed for 168 lesions in the ROLM group. The mean long diameter of the mucosal defects, procedure time for ROLM, and number of clips required for ROLM were 45.9 mm, 35.6 min, and 33.2, respectively. All mucosal defects resulting from the ESD were fully closed using ROLM. The post-ESD bleeding rate in the ROLM group was significantly lower (1.8%, 3/168 lesions) than in the non-closure group (7.7%, 13/168 lesions, p = 0.02). ConclusionsROLM is feasible for mucosal defect closure following gastric ESD and effectively prevents post-ESD bleeding in high-risk patients, addressing a significant gap in existing methods.

Endoscopic morphology of gastric MALT lymphoma correlate with API2/MALT1 fusion and predict treatment response after helicobacter pylori eradication

BackgroundThe presence of API2/MALT1 fusion in gastric mucosa-associated lymphoid tissue (MALT) lymphoma predicts poor response to Helicobacter pylori (Hp) eradication therapy. This study aimed to assess the correlation between endoscopic morphology of MALT lymphoma and API2/MALT1 fusion and evaluate treatment response to Hp eradication based on morphological subtypes.MethodsA retrospective review was conducted on patients diagnosed with gastric MALT lymphoma between January 2011 and December 2022. Endoscopic morphology was categorized as superficial, non-superficial, or mixed type. The superficial type was further classified into gastritis superficial lesion and localized superficial lesion based on border clarity. Logistic regression models evaluated the impact of clinical and endoscopic characteristics on anti-Hp therapy effectiveness.ResultsAmong the 114 patients included, 93 (81.6%) were Hp-positive, and API2/MALT1 fusion was detected in 58 (50.9%) cases, The superficial type was the predominate morphology (73/114, 64%). The regular arrangement of collecting venules (RAC) sign was noted in 21 (18.4%) cases. In superficial subtypes, the RAC signs were more frequently observed in localized lesion than gastritis lesion (35.6% vs. 7.1%, p = 0.01). and the superficial localized lesion was more common in individuals with positive API/MALT1 fusion than negative ones (76.9% vs. 44.1%, p = 0.01). Following Hp eradication, the remission rate for localized lesion was 34.3%, significantly lower than for gastritis lesion (66.7%, p = 0.01). Both endoscopic morphology (OR = 0.26, 95% CI 0.09–0.75) and API2-MALT1 fusion (OR = 14.29, 95% CI 4.19–48.67) impacted the efficacy of anti-Hp therapy. However, multivariate analysis identified API2-MALT1 fusion as the only independent predictor of treatment outcome (OR = 12.18, 95% CI 3.49–42.55, p < 0.001).ConclusionGastric MALT lymphomas with superficial-type morphology, particularly those with defined borders resembling early gastric cancer, were associated with API2/MALT1 fusion and a lower remission rate after Hp eradication therapy. This suggests that endoscopic morphology, along with API2/MALT1 fusion status, could help predict the therapeutic response, with API2/MALT1 fusion serving as a critical indicator of treatment resistance.

Gastric neoplasm detection of computer-aided detection-assisted esophagogastroduodenoscopy changes with implement scenarios: a real-world study.

The implementation of computer-aided detection (CAD) devices in esophagogastroduodenoscopy (EGD) could autonomously identify gastric precancerous lesions and neoplasms and reduce the miss rate of gastric neoplasms in prospective trials. However, there is still insufficient evidence of their use in real-life clinical practice. A real-world, two-center study was conducted at Wenzhou Central Hospital (WCH) and Renmin Hospital of Wuhan University (RHWU). High biopsy rate and low biopsy rate strategies were adopted, and CAD devices were applied in 2019 and 2021 at WCH and RHWU, respectively. We compared differences in gastric precancerous and neoplasm detection of EGD before and after the use of CAD devices in the first half of the year. A total of 33 885 patients were included and 32 886 patients were ultimately analyzed. In WCH of which biopsy rate >95%, with the implementation of CAD, more the number of early gastric cancer divided by all gastric neoplasm (EGC/GN) (0.35% vs 0.59%, P=0.028, OR [95% CI]=1.65 [1.0-2.60]) was found, while gastric neoplasm detection rate (1.39% vs 1.36%, P=0.897, OR [95% CI]=0.98 [0.76-1.26]) remained stable. In RHWU of which biopsy rate <20%, the gastric neoplasm detection rate (1.78% vs 3.23%, P<0.001, OR [95% CI]=1.84 [1.33-2.54]) nearly doubled after the implementation of CAD, while there was no significant change in the EGC/GN. The application of CAD devices devoted to distinct increases in gastric neoplasm detection according to different biopsy strategies, which implied that CAD devices demonstrated assistance on gastric neoplasm detection while varied effectiveness according to different implementation scenarios.

Water pressure method endoscopic submucosal dissection with clip traction for early gastric cancer with submucosal fibrosis.

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Preparation and identification of a fluorescent probe with CsPbBr3perovskite quantum dots and CD44v6 specific peptide for gastric cancer imaging.

Since the sensitivity and accuracy of traditional detection for early gastric cancer diagnosis are still insufficient, it is significant to continuously optimize the optical molecular imaging detection technology based on an endoscopic platform. The signal intensity and stability of traditional chemical fluorescent dyes are low, which hinders the clinical application of molecular imaging detection technology. This work developed a probe based on perovskite quantum dots (PQDs) and peptide ligands. By utilizing CsPbBr3perovskite PQDs modified by azithromycin (AZI), combined with the specific polypeptide ligand of CD44v6, a gastric cancer biomarker, the perovskite-based probe (AZI-PQDs probe) which can specifically identify gastric cancer tumor was prepared. Owing to the high photoluminescence quantum yield of CsPbBr3PQDs, the naked eye can observe the imaging under the excitation of the hand-held ultraviolet light source. AZI-PQDs probe can accurately identify gastric cancer cells, tissues, and xenograft models with experiments ofex vivoandin vivofluorescence imaging detection. It also exhibited low toxicity and immunogenicity, indicating the safety of the probe. This work provides a probe combined with cancer specificity and a reliable fluorescent signal that has the potential for application in gastric cancer optical molecular imaging.