简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：Pancreaticcysticlesions(PCLs)areincreasinglybeingidentifiedbecauseofthewidespreaduseofhighresolutionabdominalimaging.Thesecystsencompassaspectrumfrommalignantdiseasetobenignlesions,andtherefore,accuratediagnosisiscrucialtodeterminethebestmanagementstrategy,eithersurgicalresectionorsurveillance.However,thecurrentstandardofdiagnosisisnotaccurateenoughduetolimitationsofimagingandtissuesamplingtechniques,whichentailtheriskofunnecessaryburdensomesurgeryforbenignlesionsormissedopportunitiesofprophylacticsurgeryforpotentiallymalignantPCLs.Inthelastdecade,endoscopicinnovationsbasedonendoscopicultrasonography(EUS)imaginghaveemerged,aimingtoovercomethepresentlimitations.ThesenewEUS-basedtechnologiesarecontrastharmonicEUS,needle-basedconfocalendomicroscopy,through-the-needlecystoscopyandthrough-theneedleintracysticbiopsy.Here,wepresentacomprehensiveandcriticalreviewoftheseemergingendoscopictoolsforthediagnosisofPCLs,withaspecialemphasisonfeasibility,safetyanddiagnosticperformance.

简介：AIM:Toinvestigatethefactorsinfluencingtheoccurrenceofgastricvarioliformlesions(GVLs)andtheirpossiblelinkwithgastriccancer.METHODS:A1:1matchedcase-controlstudywasperformedtoretrospectivelyanalyzedatafrom1638chronicgastritispatientswhohadundergonegastroscopyatoneoftwoChinesehospitalsbetween2009and2014.PatientswithGVLs(cases)werecomparedtothosewithoutsuchlesions(controls).Endoscopicandpathologicalfindingswererecorded,alongwithinterviewinformationonHelicobacterpylori(H.pylori)infection,medical,drugandfamilyhistories,lifestyleandeatinghabits.TheassociationbetweeneachfactorandtheoccurrenceofGVLswasestimated,andthenmultivariateconditionallogisticregressionwasusedtoevaluatetheindependentfactors.RESULTS:Thefrequencyandseverityofglandularatrophy,intestinalmetaplasia(IM)andlow-gradeintraepithelialneoplasiaweresignificantlyincreasedintheGVLgroup(P<0.01).OverallanalysisshowedthatH.pyloriinfection[3.051(2.157,4.317),P<0.001],allergicrespiratorydiseases[3.636(2.183,6.055),P<0.001],work-relatedstress[2.019(1.568,2.600),P<0.001],irregularmeals[2.300(1.462,3.619),P<0.001],highintakeofspicyfood[1.754(1.227,2.507),P=0.002]andhighintakeoffreshfruit[0.231(0.101,0.529),P=0.001]weresignificantlycorrelatedwiththeoccurrenceofGVLs(positively,exceptforthelatter).Stratifiedanalysesindicatedthatpickledfoodconsumptioninpatientsover50yearsold[7.224(2.360,22.115),P=0.001]andexcessivesmokinginmen[2.013(1.282,3.163),P=0.002]werealsopositivelycorrelated,andthat,forantralGVLs,vegetableconsumption[0.491(0.311,0.776),P=0.002]wasnegativelycorrelated.CONCLUSION:SevenriskfactorsandtwoprotectivefactorsaredeterminedforGVLs,whichwerefoundtobeassociatedwithpremalignantabnormalities.

简介：AIMToevaluatetheclinicaloutcomesofpatientswhounderwentendoscopicsubmucosaltunneldissection(ESTD)foresophagealsquamouscellcarcinoma(ESCC)andprecancerouslesions.METHODSESTDwasperformedin289patients.Theclinicaloutcomesofthepatientsandpathologicalfeaturesofthelesionswereretrospectivelyreviewed.RESULTSAtotalof311lesionswereincludedintheanalysis.Theenblocrate,completeresectionrate,andcurativeresectionratewere99.04%,81.28%,and78.46%,respectively.TheESTDproceduretimewas102.4±35.1min,themeanhospitalizationtimewas10.3±2.8d,andtheaverageexpenditurewas3766.5±846.5dollars.Theintraoperativebleedingratewas6.43%,thepostoperativebleedingratewas1.61%,theperforationratewas1.93%,andthepostoperativeinfectionratewas9.65%.Esophagealstrictureandpositivemarginweresevereadverseevents,withanincidencerateof14.79%and15.76%,respectively.Notumorrecurrenceoccurredduringthefollow-upperiod.CONCLUSIONESTDforESCCandprecancerouslesionsisfeasibleandrelativelysafe,butforlargemucosallesions,therateofesophagealstrictureandpositivemarginishigh.

简介：Endoscopicultrasonography-guidedfine-needleaspiration（EUS-FNA）hasbeenappliedtopancreaticobiliarylesionssincethe1990sandisinwidespreadusethroughouttheworldtoday.Weusedthismethodtoconfirmthepathologicalevidenceofthepancreaticobiliarylesionsandtoperformsuitabletherapies.ComplicationsofEUS-FNAarequiterare,butsomeofthemaresevere.OperatorsshouldmasterconventionalEUSobservationandexperienceaminimumof20-30casesofsupervisedEUS-FNAonnon-pancreaticandpancreaticlesionsbeforeattemptingsoloEUSFNA.StudiesconductedonpancreaticobiliaryEUSFNAhavefocusedonselectionofsuitableinstruments（e.g.,needleselection）andsamplingtechniques（e.g.,fanningmethod,suctionlevel,withorwithoutastylet,optimumnumberofpasses）.Today,thediagnosticabilityofEUS-FNAisstillimproving;thedetectionofpancreaticcancer（PC）currentlyhasasensitivityof90%-95%andspecificityof95%-100%.InadditiontoPC,avarietyofrarepancreatictumorscanbediscriminatedbyconductingimmunohistochemistryontheFNAmaterials.Aflexible,largecaliberneedlehasbeenusedtoobtainalargepieceoftissue,whichcanprovidesufficienthistologicalinformationtobehelpfulinclassifyingbenignpancreaticlesions.EUSFNAcansupplyhighdiagnosticyieldsevenforbiliarylesionsorperi-pancreaticobiliarylymphnodes.ThisreviewfocusesontheclinicalaspectsofEUS-FNAinthepancreaticobiliaryfield,withtheaimofprovidinginformationthatcanenablemoreaccurateandefficientdiagnosis.