A 43-year-old woman was referred for endoscopic resection after detection of a giant subepithelial lesion (SEL) during routine physical assessment. The lesion was approximately 50 × 25 mm in size and was located in the posterior wall of the gastric fundus ([Fig. 1]). A comprehensive assessment of the origin and characteristics of the lesion was performed via a dual-frequency ultrasonic miniprobe (InnerMedical Co., Ltd., Shenzhen, China) ([Fig. 2], [Video 1]).
A 55-year-old man, during a routine screening gastroscopic examination, was found to be harboring an incipient neoplasm on the horizontal part of the duodenum. The lesion measured approximately 40×35 mm. Its surface morphology exhibited irregularity and a villous-like appearance under linked color imaging or blue light imaging, with uneven distribution and marginalization of white opaque substance. Abdominal enhanced computed tomography showed no lymphatic or organ metastasis ([Fig. 1]). The patient was admitted as an inpatient and underwent endoscopic submucosal dissection (ESD) under general anesthesia ([Video 1]). Significant challenges were encountered during this procedure, specifically during the circumferential mucosal incision, and particularly on the anal side of the lesion. To overcome the difficulty, we employed a colonoscope (EC-L600ZP7; Fujifilm, Tokyo, Japan) and applied abdominal pressure, which enhanced endoscope stability and allowed the circumferential incision to be successfully completed. We then used clips and dental floss for traction on the oral side of the lesion. This improved visualization of the submucosal layer and facilitated continuous pulling towards the oral side, aiding the approach of the endoscope's tip. We transitioned to a gastroscope (EG-601WR; Fujifilm, Tokyo, Japan) to complete dissection in the submucosal layer. The procedure was completed in 285 minutes ([Fig. 2]). After surgery, no complications such as perforation, hemorrhage, or pyrexia occurred. Histopathological analysis showed complete excision of the villous tubular adenoma, with R0 resection achieved ([Fig. 3]).
A 72-year-old man underwent a gastroscopy that revealed a 13 × 11-mm lesion within the left pyriform sinus (0-IIb). The lesion displayed a reddish hue under white light, with well-defined borders ([Fig. 1]a). Its tea-colored appearance under blue-laser imaging (BLI) classified it as type B1, indicative of an early pharyngeal tumor ([Fig. 1]b).
A 59-year-old woman was admitted to our hospital for the management of refractory gastroesophageal reflux disease (GERD). Gastroscopy, ascertaining the presence of GERD, revealed a manifestation classified as LA-C, accompanied by a conspicuous abnormality in the gastroesophageal flap valve, graded as Type III ([Fig. 1]). Dynamic reflux monitoring unveiled an acid exposure time of 32%, accompanied by a DeMeester score of 144.9.
A 49-year-old man was admitted to our hospital for endoscopic resection of a subepithelial lesion located in the lower rectum ([Fig. 1 a]). The lesion was incidentally discovered during routine screening colonoscopy. Endoscopic ultrasound confirmed that the lesion originated from the submucosal layer ([Fig. 1 b]). Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose/computed tomography + speckle reduction imaging (18F-FDG PET/CT + SRI) suggested that the lesion was a neuroendocrine tumor (NET) with high expression of growth inhibitor receptors, without evidence of lymphatic or organ metastasis ([Fig. 2]). The possibility of endoscopic resection was discussed with the patient, and subsequently, endoscopic intermuscular dissection (EID) was performed ([Video 1]).
This study aims to explore the expression and significance of feces cyclooxygensae-2 (COX-2) mRNA in colorectal cancer and colorectal adenomas.The expression of feces COX-2 mRNA in colorectal cancer (n = 28), colorectal adenomas (n = 54), and normal control group (n = 11) were examined by reverse transcriptase polymerase chain reaction (RT-PCR). The positive rate of fecal occult blood test (FOBT) were detected in colorectal cancer (n = 30), colorectal adenomas (n = 56), and normal control group (n = 11); the sensitivity of the two methods was also compared.The positive rate of feces COX-2 mRNA in colorectal cancer was 82.1% (25/28), which was significantly higher than colorectal adenomas 59.3% (32/54), and normal tissues 18.2% (2/11), the difference being significant between the three groups (χ2= 13.842,P= 0.001). The positive rate of FOBT in colorectal cancer was 73.3% (10/30), which was significantly higher than colorectal adenomas 10.7% (6/56) and normal tissues 9.1% (1/11), the difference being significant between these three groups (χ2= 7.525,P= 0.023). There was no significant association between feces COX-2 expression and various clinical pathological features of colorectal cancer and colorectal adenomas (P > 0.05). The sensitivity of the RT-PCR method is higher than FOBT, however, the specificity of FOBT is slightly higher than RT-PCR.High expression of feces COX-2 mRNA in colorectal adenomas and colorectal cancer is a common event; it is an early event in the development of colorectal adenomas to colorectal cancer. Feces COX-2 mRNA has a high sensitivity for detect colorectal cancer; combination with FOBT will be the best alternative. Feces COX-2 can be potentially used in the early diagnosis and screening of colorectal cancer.
Acute appendicitis and cecal diverticulitis are both common causes of acute right-sided abdominal pain, but it is extremely rare for both to be found in one patient. Acute appendicitis and diverticulitis are mainly treated through medication and surgical intervention [1] [2]. Digital single-operator cholangioscopy (dSOC) has proven effective for managing inflammation in natural conduits such as the bile duct, pancreatic duct, and appendix [3] [4]. Herein, we present endoscopic direct therapy for appendicitis and diverticulitis in a man with right-sided abdominal pain ([Video 1]).
Appendiceal lesions are predominantly discovered incidentally during appendectomy for other indications. Single-use cholangioscopes, used in the management of appendicitis and diverticulitis, facilitate direct visualization of the appendix and diverticula [1] [2]. We present a case of a large appendiceal lesion, adeptly diagnosed via direct visualization with a 9-Fr single-use cholangioscope (EyeMax, Micro-Tech, Nanjing, China) ([Video 1]).
A 44-year-old man presented with symptoms of gastroesophageal reflux disease and dysphagia. Gastroscopy revealed a 3-cm, half-circumferential, bluish-purple esophageal mass located in the mid-esophageal region ([Fig. 1] a). Computed tomography revealed a soft tissue nodule causing significant stenosis of the esophageal lumen. Endoscopic ultrasound confirmed a well-demarcated, moderately hyperechoic submucosal lesion, characteristic of an esophageal cavernous hemangioma ([Fig. 1] b). Subsequent to a detailed consultation, endoscopic submucosal tunnel dissection (ESTD) was undertaken ([Video 1]).
Research had shown that subtilisin-like protease gene had important physiological functions,and it had involved in phenotypic stability,pathogenicity and autophagy.The important physiological functions of subtilisin-like protease and the prospects in disease control in agriculture and animal husbandry were reviewed.
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