Esophageal leiomyomas, the most common benign primary tumors of the esophagus, are esophageal subepithelial lesions treated by surgery traditionally. In recent years, endoscopic submucosal dissection and related endoscopic treatment techniques are adopted by endoscopists to resect gastrointestinal submucosal tumors. But if a giant esophageal leiomyoma approaches the esophagus entrance and originates from the deep layer of muscularis propria, it will be difficult for both endoscopic resection and surgical treatment. Especially, endoscopic resection has a high risk of huge perforation difficult to be sutured. A 72-year-old man with dysphagia underwent gastroscopy examination which indicated a large submucous eminence lesion, about 18–24 cm from the incisors. Endoscopic ultrasonography revealed the lesion was hypoechoic and originated from the muscularis propria with a clear boundary. The patient refused invasive surgical resection. Then, an en bloc endoscopic full-thickness resection was performed, which perforation was successfully closed with purse-string sutures using a novel endoloop device through standard single-channel endoscopy. Histopathologic examination showed an esophageal leiomyoma. This endoscopic procedure may be an alternative to avoid surgery for the removal of a giant upper esophagus tumor from muscularis propria layer.

Background: Refractory esophageal anastomotic strictures are difficult to treat. Current treatments include esophageal stent placement (ESP) and the endoscopic incision method (EIM). This study was conducted to determine which treatment is better for patients with refractory esophageal anastomotic stricture. Methods: This study retrospectively collected data of patients with refractory esophageal anastomotic stricture who underwent ESP or EIM between January 2012 and June 2018. Dysphagia scores before and after the procedure were recorded in both groups. The duration of relief during the follow-up period was recorded. Results: Fifty patients were enrolled in this study, including 32 patients who underwent ESP and 18 who underwent EIM. Patients in the ESP group had a markedly larger diameter of dilatation than those in the EIM group (19.9±1.8 versus 11.0±1.9 mm, respectively; P<0.001). However, the dysphagia score improved by 1.0±0.0 point in the ESP group and by 1.4±0.5 points in the EIM group (P<0.001). Nearly 70% of patients in the ESP group maintained lumen patency at 12 months. In contrast, only 50% of patients in the EIM group had persistent relief of stricture symptoms at 6 months and only 20% had relief at 12 months. Five patients had slight bleeding; none required blood transfusion. Thirteen patients in the ESP group had slight chest pain; seven of these required administration of a painkiller. Conclusions: EIM can rapidly relieve the symptoms of esophageal anastomotic stricture but ESP provides longer duration of relief. Both procedures are safe for patients with refractory esophageal anastomotic stricture.

Background: Hepatocellular carcinoma (HCC) is male-predominant cancer, but the underlying mechanism remains unclear. This study aimed to investigate the expression of the age-suppressing gene klotho and estrogen receptors (ERs) in HCC patients and analyze their association with clinicopathological variables and their effects on prognosis. Methods: The expression patterns of klotho, ERα, and ERβ were determined by tissue microarray and immunohistochemical technique, and their correlations with clinicopathological characteristics were investigated using univariate and multivariate analysis. Results: Klotho expression was significantly lower in HCC than in the adjacent noncancerous tissues (52.7% (49/93) vs. 90.8% (79/87), P = .000), and its protein level in HCC tissue was negatively correlated with clinical staging, histological grade, and stage of the primary tumor (T) (P < .05). Whereas the expression of nuclear ERα and ERβ was higher in HCC than their corresponding non-neoplastic tissues (55.9% (52/93) vs. 35.6% (31/87), P = .006; 59.1% (55/93) vs. 43.7% (38/87), P = .038), and the level of nuclear ERα and ERβ in HCC tissue was inversely correlated with T stage, tumor size, and clinical staging (P < .05). Correlation analysis showed the expression level of klotho, which is positively correlated with that of nuclear ERα (r = 0.243, P = .019). Patients with klotho-positive tumors had longer survival than those with klotho-negative tumors (P = .002). Cox proportional hazards model analysis demonstrated that positive expression of klotho was an important factor indicating good prognosis (P = .003). Conclusion: Klotho, partially regulated by ERα-mediated estrogen pathway, acts as a tumor suppressor and might be a novel biomarker candidate for predicting progression and prognosis in HCC patients.

Background: Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) is a well-established technique for diagnosing pancreatic malignancy. In general, tissue of pancreatic head and uncinate process lesions is obtained via a transduodenal approach. However, this tissue-acquisition modality is not applicable in cases of pyloric obstruction and duodenal bulb ulceration. The aim of this study is to determine the feasibility and safety of a novel EUS-guided transgastric trans-portal system FNA in the diagnosis of pancreatic head and uncinate process cancer. Methods: This study retrospectively analyzed 26 consecutive inpatient patients who had undergone EUS-FNA for highly suspected malignancy of pancreatic head or uncinate process between December 2013 and December 2018. EUS-guided transgastric trans-portal vein (trans-PV, n=2) or trans-superior mesenteric vein (trans-SMV, n=24) FNA was performed in the patients under conscious sedation. Feasibility, diagnostic yield and complication rates of the technique were evaluated. Results: Specimens obtained by EUS-guided transgastric trans-portal system FNA were adequate for cytological evaluation in all 26 patients. Cytological diagnosis of adenocarcinoma was established in 22 patients, while the remaining 4 patients were negative. The diagnostic accuracy, sensitivity and specificity were 92.3%, 91.7% and 100% respectively. No immediate or delayed procedure-related complications were observed. Conclusions: EUS-guided transgastric trans-portal system FNA is a feasible and probably safe method for diagnosing pancreatic head and uncinate process malignancy. Careful selection of the potential candidates and close periprocedural observation are mandatory.

Objective: To investigate the feasibility and accuracy of esophageal sponge cytology in screening esophageal squamous cell carcinoma (ESCC).Methods: From May 2021 to June 2022, an opportunistic screening was performed in people aged 40–75 from a high‐risk region for ESCC. Using an esophageal cell collector that was independently developed in China for esophageal sponge cytology, a positive cytology was determined as detection of atypical squamous cells or more severe lesions. The safety, tolerability, and accuracy of esophageal sponge cytology were compared with those of pathological examination after endoscopy and biopsy.Results: A total of 1581 eligible participants were involved in the screening program, including 61 (3.86%) with high‐grade lesions pathologically confirmed by endoscopic biopsy. No serious adverse events were reported during sampling. Major adverse events included vomiting during sampling (n = 2, 0.13%) and sore throat after sampling (n = 36, 2.27%). The majority of participants showed good tolerability and accessibility (n = 1568, 98.80%) accessed by the visual analogue scale (VAS). Esophageal sponge cytology offered a satisfactory diagnostic accuracy in screening advanced esophageal epithelial lesions, with a sensitivity of 98.36% (95%CI: 90.02%–99.91%) and a specificity of 91.15% (95%CI: 89.97%–92.84%), and a negative predictive value up to 99. 92% (95%CI: 99.53%–99.99%).Conclusion: Esophageal sponge cytology is a highly feasible, safe, and accurate screening method for ESCC in a high‐risk region of China.Trial Registration: First Affiliated Hospital of Naval Medical University: NCT04609813