1.Endoscopic Diagnosis Of Helicobacter Pylori Infection 2.Traditional And Novel Strategy For Endoscopic Submucosal Dissection In Treatment Of Giant Subcardiac Submucosal Tumors

Background Helicobacter pylori is a kind of micro aerobic bacteria.Hp infection is the main pathogenic factor of peptic ulcer,chronic active gastritis,gastric mucosa associated lymphoma and gastric cancer.It was designated as class I carcinogen by WHO/IARC in 1994.In recent years,epidemiological studies have found that Hp infects half of the world’s population,and the infection rates vary among different regions.The detection rate of Hp in gastric mucosa biopsy specimens of patients with chronic gastritis can reach 80%to 90%,and the infection rate of gastric ulcer and duodenal ulcer is higher,reaching more than 90%-95%.At present,there are two main diagnostic methods for Hp infection,invasive examination and non-invasive examination,respectively.Invasive examinations include rapid urease test,mucosa smear staining,histological examination and Hp training.Non intrusive inspections mainly include urea breath test(13C-UBT or 14C-UBT)and serological test.In recent years,with the development of endoscopic technology and endoscopic examination means,scholars at home and abroad have begun to study the relationship between endoscopic manifestations and Hp infection,and have made some progress,but the accuracy is not high,and there are many contradictions between the studies.This study aims to solve the above problems and find a simpler and more accurate method for the diagnosis of Hp infection.Methods We analyzed the endoscopic image features of 298 patients,analyze the relationship between endoscopic findings and Helicobacter pylori infection,calculation of the characteristics of Hp infection diagnosis sensitivity and specificity,and summarizes the performance and Hp infection was related to the correct diagnosis rate of endoscopy.We biopsied the most accurate part where Hp infection was most indicated,to determine whether there was Hp infection.Results Gastric cardia gland body distribution of gastric area edema,redness,gastric canaliculus deepened,or rough mucosa,hyperplasia,grainy,suggest Hp infection.The sensitivity,specificity,positive predictive value,negative predictive value,and the total diagnostic accuracy was 69.6%,90%,85.7%,77.4%,and 80.5%respectively.The endoscopic findings were not correlated with age,bile reflux,and so on.Giemsa staining was negative in most of the 12 biopsy lesions.The accuracy of other endoscopic manifestations in diagnosis of Hp infection is lower.Conclusions The area gastrica edema,redness,gastric canaliculus deepened,or rough mucosa,hyperplasia,mucosal granular sensation,indicated Hp infection.Both sensitivity and specificity are high.The endoscopic features are not interfered by bile reflux,but this is not the manifestation of Hp colonization.It may be the effect of Helicobacter pylori toxin secretion on gastric mucosa.In distribution area of gastric cardia gland,area gastrica edema,redness,gastric canaliculus deepened,or rough mucosa,hyperplasia,grain increased,indicated Hp infection,with a high sensitivity and specificity.These resutls were not affected by bile reflux and other interfering factors,and were not the performance of Hp colonization in the stomach.All of these endoscopic findings may be the results of the effects of HP on the gastric mucosa.OBJECTIVE:Subcardiac submucosal tumors(SCSMTs)in the cardia region are among the most technically difficult lesions for endoscopic submucosal dissection(ESD).Little studies currently exists regarding the safety and efficacy of ESD on the GSMTs in the cardia region,and some complications remain existing,such as cardiac obstruction and perforation.So we developed a novel ESD strategy"mucosa-reserved aproach method"(MRAM)to deal with these problems.The aim of the study was to assess the safety and efficacy of normal ESD and MRAM in SCSMTs resection.METHODS:A retrospective observational study was conducted,investigating the clinical records of 23 patients with submucosal tumors in the subcardiac region,who underwent ESD between March 2012 and March 2016.Patients were categorized into two groups,group A were treated by conventional ESD procedure,group B by a novel improved ESD procedure,which was conducted by preserving the overlying mucosa Giant tumor was defined as tumor with a maximal diameter of at least 3 cm.The clinicopathological data,therapeutic outcomes,en bloc rates and procedure-related complications were further analyzed.RESULTS:Out of the 91 patients,84 patients underwent endoscopic submucosal dissection,The operative time ranged from 10 to 250 min(mean,56.6 minutes).Two cases were transferred to surgical operation,one for uncontrollable hemorrhage,another for unsuccessful resection.The maximum length of lesion ranged from 0,6 to 7 cm(mean,2.1 cm).In the giant tumor group,the age ranged from 29 to 67 years(mean,54.1 years),The maximum length of the lesions ranged from 3 to 7 mm(mean,4.8 cm).The operative time ranged from 15 to 90 min(mean,47.8 minutes).The en bloc resection rate was 100%.No pneumoperitoneum occurred,or no case transferred to surgical operation.All the patients underwent operation successfully and postoperative rehabilitation satisfactorily.The mean operation time of group B(96.7min)was longer than group A(73.5min).Leiomyomas of the two group were both in the majority.Nine of ten cases in group B had wounds sutured,meanwhile only 46.2%wounds in group A were sutured.So the average number of clips used during the operation in group B was 10,more than that in group A(2.5).One patient in group A had postoperative stenosis,and no serious complications occurred in group B.The en bloc resection rates were similar in two groups(84.6%VS 80%).CONCLUSION:ESD is a safe and effective procedure for gastric tumors in the cardia region.The improved ESD procedure by preserving the overlying mucosa will benefit patients with giant gastric cardia tumors for reduced wound areas and less procedure-related complications.Our study demonstrated that ESD,no matter novel improved ESD or not,is a safe and effective method for subcardiac submucosal tumors.ESD has a high en bloc resection rate.The improved ESD procedure by preserving the overlying mucosa can reserved the overlying mucosa of SCSMTs,so it is a time-consuming but also a more safe and effective process.