Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
Objective To review the relationship between histone modifications and gastrointestinal cancer. Methods Literatures on histone modifications and the relationship between histone modifications and gastrointestinal cancer were collected and reviewed. Results Histone modifications played an important role in the establishment of gene silencing during tumorgenesis. DNA methylation and histone modifications might interact with each other and form a complex network to establish and maintain gene silencing. Restoring gene function silenced by epigenetic changes in cancer had the potential of ‘normalizing’ cancer cells, which was named epigenetic therapy. Epigenetic therapy was very promising in prevention and treatment of gastrointestinal cancer, but many unsolved issues remain which need to be addressed in future studies. Conclusion Histone modifications are associated with the pathogenesis of gastrointestinal cancer. Restoring gene function silenced by epigenetic changes may have a great role in the prevention and treatment of gastrointestinal cancer.
The 2024 American Society of Clinical Oncology Gastrointestinal Cancers Symposium (ASCO-GI) was held in San Francisco, the USA from January 18th to 20th, 2024 (local time). The multiple studies presented in this symposium will have a significant impact on the clinical practice of esophageal cancer. This article will focus on the surgical methods of esophageal cancer, perioperative immunotherapy, drug therapy for advanced esophageal cancer, rescue treatment after immunotherapy resistance, and other relevant aspects. It aims to summarize and interpret the significant advancements in the field of esophageal cancer presented in this symposium.
ObjectiveTo study the imaging manifestation and clinicopathologic characteristics of rectal stromal tumors. MethodsThe CT and MRI data of 8 patients with pathology proved rectal stromal tumors were retrospectively analyzed, and the correlation between the imaging features and pathological results were analyzed. ResultsAll of 8 cases were malignant. One case was submucosal. It showed irregular thickening of the rectal wall with a diameter of about 2.6 cm, and small ulcers with low-risk could be seen. Three cases were intramural with diameters of about 0.7－10.0 cm. Small lesion located in rectum, and the larger lesions showed internal and external growth across the rectal wall and the main part of the mass was outside the rectum. They were heterogeneous enhancement. One case accompanied with adenocarcinoma. One case was extremely low-risk, two cases were high-risk. Four cases were subserous. The diameter was about 4.2－16.5 cm. CT showed round or lobular, well-circumscribed, exophytic, hypervascular, and heterogeneous masses with cystic necrosis and hemorrhage. They displaced rectum occasionally. Lymphadenopathy in the left groin was developed in one case. Two cases were highrisk, two cases were intermediated-risk. No cases developed intestinal obstruction. Results of immunohistochemistry: CD117 was positive in 7 cases, CD34 positive in five cases, CD117 and CD34 positive in four cases, CD117 negative but CD34 positive in one case, CD117 positive but CD34 negative in three cases. Five cases were followed up, among whom 3 cases recurred. ConclusionsRectal stromal tumor is rare. Imaging appearances of rectal stromal tumors are specific. Its final diagnosis depends on immunohistochemistry examination. It has generally higher degree of malignancy and the prognosis is relatively poor.
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
ObjectiveTo systematically evaluate short-term efficacy of omega-3(ω-3) polyunsaturated fatty acidsupplemented parenteral nutrition in postoperative gastrointestinal malignancy. MethodsThe literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes ofω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. All the relevant studies were screened and the data were extracted before January 2015. The quality of included literatures was assessed by the risk of bias table provided on Cochrane Library. Statistical analysis was performed by Revman 5.3 software. ResultsSixteen RCTs involving 1019 patients (511 in the study group, 508 in the control group) were enrolled into the analysis. The results of meta analysis:①In the cell immunity:The proportions of CD3, CD4, CD4/CD8 in the study group were significantly higher than those in the control group[CD3:WMD=6.09, 95% CI (2.40, 9.77), P=0.001; CD4:WMD=5.25, 95% CI (3.30, 7.20), P < 0.00001; CD4/CD8:WMD=0.40, 95% CI (0.22, 0.58), P < 0.0001].②In the humoral immunity:The levels of IgA and IgG in the study group were significantly higher than those in the control group[IgA:WMD=0.56, 95% CI (0.36, 0.77), P < 0.00001; IgG:WMD=2.88, 95% CI (0.63, 5.13), P=0.01].③The count of lymphocyte in the study group was significantly higher than that in the control group[WMD=0.27, 95% CI (0.10, 0.43), P=0.002].④In the cytokines:The levels of interleukin-6 and tumor necrosis factor (TNF)-αin the study group were significantly lower than those in the control group[interleukin-6:WMD=-16.75, 95% CI (-25.00, -8.50), P < 0.0001; TNF-α:WMD=-6.25, 95% CI (-10.55, -1.95), P=0.004].⑤The rate of postoperative infective complications in the study group was significantly lower than that in the control group[OR=0.36, 95% CI (0.20, 0.66), P=0.0008]. ConclusionFor postoperative patients with gastrointestinal malignancy, ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition could improve immune function, decrease postoperative inflammatory reaction, and reduce rate of infective complications.
Objective To evaluate the role of apparent diffusion coefficients (ADC) in assesment of response to chemotherapy in patients with gastrointestinal liver metastasis. MethodsTen patients with liver metastasis （8 from colorectal cancer， 1 from gastric cancer， 1 from esophageal cancer） at Peking University People’s Hospital from April 2006 to April 2007 were included. All of them received chemotherapy （FOLFOX6： 4 cases， XELOX： 3 cases, and FOLFIRI： 1 case in 8 cases of colorectal liver metastases; ECF: 1 case of gastric liver metastases; DCF: 1 case of esophageal liver metastasis）. ADC were calculated after MR duffusionweight imaging exmination (GE MEDICAL SYSTEMS HD EXCITE 1.5 T) 1 month pre-and post-chemotherapy, respectively. Tumour response to chemotherapy was assessed by RECIST criteria. ResultsTumors with low pretreatment ADC (lt;9.04×10－4 mm2/s) responded better to chemotherapy than that with high ADC (gt;9.04×10－4 mm2/s); pretreatment ADC of cases (6/10) were remarkable lower than those of cases (4/10)， P＝0.033. Increased ADC after onemonth chemotherapy in patients with liver metastasis predicted a better response. ConclusionsLow pretreatment ADC is predictive of better response to chemotherapy. An increased ADC after treatment predicts a better response to chemotherapy.
Objective To investigate the mechanism of gastrointestinal motility disorder of severe acute pancreatitis （SAP） in rats. Methods SD rats were randomly divided into 2 groups：sham operation （SO） group （n=16） and SAP group （n=16）. The gastric antrum interdigestive myoelectric complex （IMC） of rat was recorded by using bipolar silver electrode recording， the concentration of serum motilin （MTL） and vasoactive intestinal peptide （VIP） were detected by enzyme-linked immunosorbent assay （ELISA） method， and determined the pancreatic pathology score. Results Compared with SO group， the concentration of serum MTL obvious decreased and the concentration of VIP obvious rised in SAP group （P＜0.01）. Compared with SO group， the time of IMC cycle， andⅠand Ⅱ phase were extended， and time of Ⅲ phase was shortened， also the amplitude and frequency of peak electric of Ⅲ phase were declined in SAP group （P＜0.01）. And the concentration of MTL in SAP group showed positive correlation with the time of Ⅲ phase of IMC （r=0.967， P＜0.01）， the concentration of VIP in SAP group showed negative correlation with the time of Ⅲ phase of IMC （r=-0.592， P＜0.05）. The pancreatic organization pathological score in SAP group was higher than that in SO group （P＜0.01）. Conclusion There is gastrointestinal motility disorder in SAP rats， furthermore， it may induce gastrointestinal motility disorder through effecting the gastrointestinal smooth muscle electrical activity.
【Abstract】ObjectiveTo study the diagnosis and the treatment of gastrointestinal stromal tumor (GIST). Methods In this retrospective study, tissue slices, including immunohistochemical examinations, of 48 patients with GIST from January 1999 to December 2004 were collected. All of their clinical symptoms, pathologic characters, and surgical treatment and other information were also analyzed. ResultsTwenty-seven males and 21 females with a mean age of 68 were included in this report. All patients received tumor resections. Tumors were located in the stomach in the 29 cases (60.4%), and 11 cases (22.9%) were in the small intestine. The main clinical manifestations were alimentary tract hemorrhage (52.1%) and abdominal mass (35.4%). Immunohistochemical examination showed the positive rate of CD117 was 83.3%(40/48), and CD34 was 77.1%(37/48). Conclusion GIST mostly occurs at stomach and small intestine in aged people with clinical manifestations of alimentary tract hemorrhage and abdominal mass. The diameter of the mass is an important clinical index to distinguish malignant and benign tumors. The diagnosis of GIST depends on the combination of pathological and immunohistochemistry examinations. Complete regional resection of the tumor may be the most effective treatment.