Study Of Premedication During Upper Gastrointestinal Endoscopy?Study Of Endoscopic Treatment For Early Gastric Cancer

Part ? Effect of premedication on lesion detection rate and visualization and other observation indexes of the mucosa during upper gastrointestinal endoscopy:a prospective,multicenter,large-sample-size,randomized,controlled,double-blind studyIntroduction:Mucus and foam can reduce the mucosal visibility and may increase the frequency of missing clinically important lesions.Therefore,a premedication that reduces mucus and foam may be an effective strategy to improve the visibility and possibly diagnostic performance of minimal lesions,such as early cancer or precancerous lesions.The effect of premedication on the detection rate and the mucosal visibility of upper gastrointestinal early cancer or precancerous lesions and other observation indexes were never investigated earlier.This study aimed to explore whether premedication could improve the detection rate of early cancer or precancerous lesions and the mucosal visibility and other observation indexes.Materials and Methods:During July 2015 to December 2015,7200 participants from six centers received endoscopy with 1 of the 4 following premedications randomly:(1)water(group D);(2)pronase(group A);(3)simethicone(group B);(4)pronase and simethicone(group C).The effects of premedications on the detection of early cancer and precancerous lesions of upper gastrointestinal tract and the efficacy of mucosal visibility and other observation indexes after premedications were evaluated.Results:The upper gastrointestinal overall precancerous lesion detection rate among four groups were 8.7%,8.4%,10.0%and 10.3%,the overall early cancer detection rate were 1.3%,and 1.4%,1.5%and 1.6%,both didn't have significant difference(p=0.138 and 0.878).While the visibility score distributions were statistically significant,with all positions' p values<0.001,group C has the best visibility score.For the examination time,group D(10.3±4.8)<group A(9.8±4.8)<group B(9.0±4.9)<group C(8.9±4.9),p =0.000.For the flushing water volume,group D(170.9±101.2)<group A(131.0±090.1)<group B(63.4±62.7)<group C(43.2±54.2),p = 0.000.Subgroup analyses combining data form Linqu and Hebi also showed significant difference in esophageal(3.9%,3.3%,4.5%and 8.4%with p=0.004)and overall(7.0%,5.5%,7.3%and 12.0%with p=0.004)precancerous lesion detection rate.The movement of appropriate rolling after premedications had a better visibility scores than moving around in esophagus and gastric body.Conclusions:To achieve the best upper gastrointestinal(UGI)mucosal visibility and detect more early cancer or precancerous lesions,pronase combined with simethicone was the best option.Moreover,appropriate rolling after premedications was more efficient.Part ? A retrospective study comparing endoscopic submucosal dissection(ESD)with surgery in the treatment of early gastric cancer(EGC)Introduction With the development of endoscopic treatment technology,in selected cases who have a negligible risk of lymph node metastasis,ESD is widely accepted as a standard treatment.Few studies on comparison of efficacy and adverse events between endoscopic submucosal dissection(ESD)and surgery for early gastric cancer(EGC)have been reported in China.The aim of this retrospective study is to compare ESD with surgery on the safety and effectiveness for EGC.Materials and Methods:460 cases of early gastric cancer who received endoscopic therapy or surgical treatment from October 2009 to January 2015 in the Cancer Hospital,Chinese Academy of Medical Sciences were collected.Retrospectively analyzed the clinical efficacy and quality of life of ESD and surgical treatment for EGC.Results:For the short-term clinical outcomes,hospitalization time,average cost and complications were statistically significant(p<0.001,p<0.001,P=0.075)compared the ESD group with the surgery group.For the long term clinical outcomes,there was no statistical significance(P=0.622)between the two groups.The cumulative multiple hazard probability curve showed that the ESD group had a significantly higher risk of multiple primary lesions than the surgery group(P=0.004)after the same follow-up period.In order to exclude the influence of confounding factors,Cox regression model was used to control the age and other factors,multiple primary risk of the two groups was also statistically significant(P=0.013).The scores of two groups were statistically significant(P<0.001)compared the ESD group and the surgery group.Conclusions:For the short-term clinical outcomes,including hospitalization time,costs and complications,ESD group were better than surgery group.For the long term clinical outcomes,multiple primary risk was higher in the ESD group than in the surgery 1 group,but most of the multiple primary cases were successfully treated with additional ESD.The scores of self health and quality of life were better in group ESD than the patients in the surgery group.