Background. Gastric low-grade intraepithelial neoplasia (LGIN) is a precancerous lesion of gastric cancer. Endoscopic therapies represented by radiofrequency ablation (RFA) and argon plasma coagulation (APC) have been applied to treat gastric LGIN in recent years. However, no comparative study examining the effectiveness and safety profiles of RFA and APC has been reported. Methods. A single-center, large-scale, retrospective study, including 73 and 50 patients treated with RFA and APC, respectively, was conducted in the First Medical Center of Chinese PLA General Hospital from October 2015 to October 2020, with a two-year follow-up. Effectiveness, complications, operative factors, and other data were assessed. Results. At 2 years of follow-up, cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively, with no statistically significant differences between the two groups (all ). However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) ( ); there was also a significant difference in the composition ratio of large lesions between the two groups ( ). No serious postoperative complications showed in either group, and the abdominal pain was the most common symptom in the short term after surgery. Conclusions. RFA and APC are both safe and effective destructive therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. An intraoperative submucosal injection is expected to be an effective method for relieving postoperative abdominal pain.

Endoscopic submucosal tunnel dissection (ESTD) was first introduced by us as a new strategy for rapid resection of large esophageal neoplasms [1]. However, for circumferential superficial esophageal neoplasms (CSENs), an obscured view and poor submucosal lifting have been experienced during lateral resection of the final one-third of the circumference. In our early experience using single-tunnel ESTD to treat four patients with CSENs, the mean operation time was 382.5 minutes and one patient experienced a perforation. To counteract the problems with this technique, we have now successfully performed a double-tunnel ESTD procedure on a patient with an 8-cm CSEN. A 66-year-old man was referred for resection of an 8-cm CSEN, at about 28 cm to 36 cm from the incisors ([Fig. 1]; [Video 1]). After marking the margin of the lesion, successive circular incisions were made at the anal and oral margins using a dual knife (KD-650L; Olympus, Tokyo, Japan) and an insulated-tip knife (KD-611L; Olympus) ([Fig. 2 a]). The first submucosal tunnel was created in the oral to anal direction using a triangular knife (KD-640L; Olympus), with endoscopic hemostasis of visible vessels or active bleeding being actively performed, either with a knife or with a hot forceps. A second tunnel was then created, running in the opposite direction to the first, using the same technique ([Fig. 2 b]). Finally, the narrow borders between the two tunnels were easily resected ([Fig. 2 c]), which allowed for complete removal of the lesion ([Fig. 3]). To prevent postoperative stricture, a 14-cm retrievable, fully-covered esophageal stent (CZES-II; Sigma, Huaian, China) was placed after preventive coagulation of the artificial ulcer had been performed ([Fig. 4]). Fig. 2 Endoscopic view showing: a circular incisions at the anal and oral margins of the lesion that were made with a dual knife and an insulated-tip knife; b the two submucosal tunnels that were created by submucosal dissection with a triangular knife; c the narrow borders left following completion of the two tunnels, which could then be easily resected. The whole operation took 97 minutes and the patient’s recovery was uneventful. Histopathological examination revealed a micro-invasive squamous carcinoma limited to the lamina propria mucosae without vascular invasion, and the resection margins were free of cancer. Recently, there have been an increasing number of reports on the use of ESTD for large esophageal neoplasms [2] [3], which have also described the advantage this technique has over endoscopic submucosal dissection (ESD), namely improved speed of dissection [4]. Compared with the single-tunnel procedure, the double-tunnel ESTD procedure made it easier to dissect most of the esophageal circumference and offered significant improvements in the endoscopic view and the ease of submucosal lifting. This is the first report of the use of double-tunnel ESTD for a CSEN, which appears to be not only safe and feasible, but also more efficient. Endoscopy_UCTN_Code_TTT_1AO_2AG

Pancreatic cystic neoplasms (PCNs) are being increasingly detected because of rapid advances in radiologic technology and an increased imaging demand. The management of PCNs is challenging as most of these neoplasms are asymptomatic, but have malignant potential, and surgical resection has substantial perioperative morbidity and mortality. Endoscopic ultrasonography (EUS)-guided ablation, as a minimally invasive treatment, has received increasing attention in the past few years. However, the resolution after EUS-guided ablative therapy still needs to be improved. In this case report, EUS-guided radiofrequency ablation combined with lauromacrogol ablation was applied for the first time in the treatment of PCN, and it showed complete resolution at a 3-month follow-up. Cite this article as: Feng X, Linghu E, Chai N, Li H. New treatment of the pancreatic cystic neoplasm: Endoscopic ultrasonography-guided radiofrequency ablation combined with lauromacrogol ablation. Turk J Gastroenterol 2018; 29: 97-100.

Background and Objectives: An accurate diagnosis is crucial for the clinical management of pancreatic cystic neoplasm (PCN). EUS-guided through-the-needle biopsy (EUS-TTNB) is a novel technique for improving the accuracy of PCN diagnosis. There is insufficient evidence about the efficacy of EUS-TTNB. This study aims to evaluate the feasibility and diagnostic performance of EUS-TTNB for PCN. Methods: Between June 2015 and July 2023, we prospectively enrolled 454 patients with a clinical concern for PCN in our database. After excluding those diagnosed with pancreatic cancer, pseudocysts, or other no-neoplasms, we assessed 326 patients with 329 cysts undergoing EUS-guided fine-needle-aspiration (EUS-FNA) or EUS-TTNB for evaluation. The primary indicators were tissue acquisition yield and diagnostic yield. The cyst characteristics (size, location, the presence of septation, mural nodule, and solid mass) and the number of biopsy samples were chosen for the analysis of factors associated with diagnostic performance. Results: There were 220 (67.5%) females and 106 (32.5%) males, and the median patient age was 50 years (range, 18–88). There were 329 cysts sampled by FNA and 143 by TTNB. The median cyst size was 31.5 mm (range, 6.9–114.0). The diagnostic yields of FNA and TTNB were 35.7% (112/314) and 57.5% (73/127), respectively (P < 0.001). Special cyst types were diagnosed by TTNB in 58 (45.7%, 58/127) cysts, 19 of which had surgical pathology. Fifteen of 19 TTNB diagnoses were concordant with the surgical pathology. Conclusion: EUS-TTNB is an option to improve the diagnosis of PCN. Standardized procedures and appropriate indications for TTNB need to be studied.

Objectives: To explore the safety and efficacy of injections of 1%, 2%, or 3% lauromacrogol during EUS–guided lauromacrogol ablation (EUS-LA) for the treatment of pancreatic cystic neoplasms (PCNs) and to determine the optimal concentration of lauromacrogol for use in EUS-LA therapeutic regimens. Methods: From May 2021 to January 2023, patients who met the indications for EUS-LA were randomly divided into 3 groups: A, B, and C; the patients in these groups were injected with 1%, 2%, and 3% lauromacrogol during EUS-LA, respectively. Safety was evaluated based on the incidence of postoperative complications. Efficacy was comprehensively evaluated by assessing the ablation rate and ablation effect. Results: Forty-two patients underwent EUS-LA, and 31 patients completed at least 1 postoperative re-examination. No acute pancreatitis was observed in the 1% and 2% lauromacrogol groups, and 1 case of acute pancreatitis occurred in the 3% lauromacrogol group. The total complication rate was 2.4%. The median ablation rates of the groups were 94.1%, 82.0%, and 100.0%, respectively. There were statistically significant differences in the EUS-LA ablation rate between the 1% and 3% lauromacrogol groups and between the 2% and 3% lauromacrogol groups. There was a statistically significant difference in complete disappearance between the 1% and 3% lauromacrogol groups as well as between the 2% and 3% lauromacrogol groups. Conclusion: The short-term outcomes showed that injections of 1%, 2%, and 3% lauromacrogol were safe for use in EUS-LA, and injection of 3% lauromacrogol was the most effective for EUS-LA.

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