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世界胃肠病学杂志（英文版）
世界胃肠病学杂志（英文版）

潘伯荣

周刊

1007-9327

wjg@wjgnet.com

010-85381901-628

100025

北京市朝阳区东四环中路62号楼远洋国际中心D座903室

世界胃肠病学杂志（英文版）/Journal World Journal of GastroenterologyCSCDCSTPCDSCI
查看更多>>主要报道和刊登国内外、特别是我国消化病学者具有创造性的、有较高学术水平的基础和临床研究论文、研究快报等. 对具有中国特色的研究论文, 如食管癌、胃癌、肝癌、大肠癌、病毒性肝炎、幽门螺杆菌、中医中药、中西医结合和基于作者自己研究工作为主的综述性论文, 将优先发表. 读者对象为基础研究或临床研究的消化专业工作者。
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    Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy

    Shinji NishiwakiHiroshi ArakiMotoshi HayashiJun Takada...
    3565-3570页
    查看更多>>摘要：AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were undergoing PEG were enrolled in our study.After eliminating 13 patients who fitted our exclusion criteria,60 patients were randomly assigned to either CO2 (30patients) or air insufflation (30 patients) groups.PEG was performed by pull-through technique after three-point fixation of the gastric wall to the abdominal wall using a gastropexy device.Arterial blood gas analysis was performed immediately before and after the procedure.Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension.Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum.The outcomes of PEG for 7 d post-procedure were also investigated.RESULTS:Among 30 patients each for the air and the CO2 groups,PEG could not be conducted in 2 patients of the CO2 group,thus they were excluded.Analyses of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two groups.The elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg,respectively (P =0.408).The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P ＜ 0.001) at 10 min and 24 h after PEG,whereas there was no significant difference in large bowel distension between the two groups.Pneumoperitoneum was observed only in the air group but not in the CO2 group (P =0.003).There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.CONCLUSION:There was no adverse event associated with CO2 insufflation.CO2 insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability

    Jaehoon JahngYoung Hoon YounKwang Hyun KimJunghwan Yu...
    3571-3577页
    查看更多>>摘要：AIM:To investigate endoscopic and clinicopathologic characteristics of early gastric cancer (EGC) according to microsatellite instability phenotype.METHODS:Data were retrospectively collected from a single tertiary referral center.Of 981 EGC patients surgically treated between December 2003 and October 2007,73 consecutive EGC patients with two or more microsatellite instability (MSI) mutation [high MSI (MSI-H)] and 146 consecutive EGC patients with one or no MSI mutation (non-MSI-H) were selected.The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC groups.RESULTS:In terms of endoscopic characteristics,MSI-H EGCs more frequently presented with elevated pattern (OR 4.38,95％ CI:2.40-8.01,P ＜ 0.001),moderate-to-severe atrophy in the surrounding mucosa (OR 1.91,95％ CI:1.05-3.47,P =0.033),antral location (OR 3.99,95％ CI:2.12-7.52,P ＜ 0.001) and synchronous lesions,compared to non-MSI-H EGCs (OR 2.65,95％ CI:1.16-6.07,P =0.021).Other significant clinicopathologic characteristics of MSI-H EGC included predominance of female sex (OR 2.77,95％ CI:1.53-4.99,P ＜ 0.001),older age (＞ 70 years) (OR 3.30,95％ CI:1.57-6.92,P =0.002),better histologic differentiation (OR 2.35,95％ CI:1.27-4.34,P =0.007),intestinal type by Lauren classification (OR 2.34,95％ CI:1.15-4.76,P =0.019),absence of a signet ring cell component (OR2.44,95％ CI:1.02-5.86,P =0.046),presence of mucinous component (OR 5.06,95％ CI:1.27-20.17,P =0.022),moderate-to-severe lymphoid stromal reaction (OR 3.95,95％ CI:1.59-9.80,P =0.003),and co-existing underlying adenoma (OR 2.66,95％ CI:1.43-4.95,P =0.002).CONCLUSION:MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics including frequent presentation in protruded type,co-existing underlying adenoma,and synchronous lesions.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Weekend and nighttime effect on the prognosis of peptic ulcer bleeding

    Young Hoon YounYong Jin ParkJae Hak KimTae Joo Jeon...
    3578-3584页
    查看更多>>摘要：AIM:To evaluate whether weekend or nighttime admission affects prognosis of peptic ulcer bleeding despite early endoscopy.METHODS:Retrospective data collection from four referral centers,all of which had a formal out-of-hours emergency endoscopy service,even at weekends.A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between January 2007 and December 2009 were enrolled.Analyzed parameters included time from patients' arrival until endoscopy,mortality,rebleeding,need for surgery and length of hospital stay.RESULTS:The weekday and weekend admission groups comprised 326 and 62 patients,respectively.There were no significant differences in baseline characteristics between the two groups,except for younger age in the weekend group.Most patients (97％) had undergone early endoscopy,which resulted in a low mortality rate regardless of point of presentation (1.8％ overallvs 1.6％ on the weekend).The only outcome that was worse in the weekend group was a higher rate of rebleeding (12％ vs 21％,P =0.030).However,multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding,rather than weekend admission.CONCLUSION:Early endoscopy for peptic ulcer bleeding can prevent the weekend effect,and nighttime admission was identified as a novel risk factor for rebleeding,namely the nighttime effect.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients

    Muhsin KayaRemzi BestasFatma BacalanFerhat Bacakslz...
    3585-3589页
    查看更多>>摘要：AIM:To identify the frequency of bacterial growth,the most commonly grown bacteria and their antibiotic susceptibility,and risk factors for bacterial colonization in bile collected from patients with different biliary diseases.METHODS:This prospective study was conducted between April 2010 and August 2011.Patients with various biliary disorders were included.Bile was aspirated by placing a single-use,5F,standard sphincterotome catheter into the bile duct before the injection of contrast agent during endoscopic retrograde cholangiopancreaticography (ERCP).Bile specimens were transported to the microbiology laboratory in blood culture bottles within an anaerobic transport system.Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory.The susceptibilities of the organisms recovered were identified using antimicrobial disks,chosen according to the initial gram stain of the positive cultures.RESULTS:Ninety-one patients (27％ male,mean age 53.7 ± 17.5 years,range:17-86 years) were included in the study.The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients.The bile culture was positive for bacterial growth in 46 out of 91 (50.5％) patients.The most frequently encountered organisms were Gram-negative bacteria including Escherichia coli (28.2％),Pseudomonas (17.3％) and Stenotrophomonas maltophilia (15.2％).There were no significant differences between patients with malignant and benign disease (58％ vs 49％,P =0.474),patients with acute cholangitis and without acute cholangitis (52.9％ vs 50％,P =0.827),patients who were empirically administered antibiotics before intervention and not administered (51.4％ vs 60.7％,P =0.384),with regard to the bacteriobilia.We observed a large covering spectrum or low resistance to meropenem,amikacin and imipenem.CONCLUSION:We did not find a significant risk factor for bacteriobilia in patients with biliary obstruction.A bile sample for microbiological analysis may become a valuable diagnostic tool as it leads to more accurate selection of antibiotics for the treatment of cholangitis.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Gender preference and implications for screening colonoscopy: Impact of endoscopy nurses

    Vui Heng Chong
    3590-3594页
    查看更多>>摘要：AIM:To assess the gender preferences,specifically the gender of the nursing staff (endoscopy assistants) and the impact on acceptance for screening colonoscopy (SC).METHODS:Patients or relatives attending the clinics or health care workers working in a tertiarycenter were invited to participate in this questionnaire study.The questionnaire enquired on the general demographics (1) age,gender,ethnicity,education level,and employment status,previous history of colonoscopy,family or personal history of colonic pathologies,personal and family history of any cancers; (2) subjects were asked if they would go for an SC if they had appropriate indications (age over 50 years,family history of colorectal cancer (CRC),fecal occult blood positive,anemia especially iron deficiency anemia,bleeding per rectum with or without loss of appetite,weight loss and abdominal pain) with and without symptoms attributable to CRC;and (3) preferences for the gender of the endoscopists and assistants and whether they would still undergo SC even if their preferences were not met.RESULTS:Eighty-four point seven percent (470/550)completed questionnaire were analysed.More female subjects expressed gender preferences for the endoscopists [overall 70％; female (67.7％) and male (2.3％)]compared to male subjects [overall 62.8％; male (56％)and female (6.8％),P =0.102].Similarly,more female subjects expressed gender preferences for the assistants [overall 74.5％; female (73.4％) and male (1.1％)]compared to male subjects [overall 58％,male (49.3％)and female (8.7％),P ＜ 0.001].Overall,a third would decline an SC,despite having appropriate indications,if their preferences were not met.On univariate analysis,male gender,non-Malay ethnicity (Chinese and others)and previous colonoscopy experience were more likely to undergo an SC,even if their preferences were not met (all P ＜ 0.05).Gender and previous experience [odds ratio (OR) 1.68,95％ confidence interval (CI) 1.00-2.82,P ＜ 0.05] with colonoscopy (OR 4.70,95％CI 1.41-15.66,P ＜ 0.05) remained significant on multivariate analysis.CONCLUSION:Genders preference for the endoscopy nurses/assistants is more common than for the endoscopist among women and has implications for the success of a screening colonoscopy program.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

    Chien Cheng LiuCheng Yuan LuChih Fang ChangchienPing Hsin Liu...
    3595-3601页
    查看更多>>摘要：AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy; BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHtODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A)and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5％ and 5.1％,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P ＜ 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4％).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P =0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P =0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

    Yi-Fen ZhangJiong ShiHui-Ping YuAn-Ning Feng...
    3602-3609页
    查看更多>>摘要：AIM:To investigate the clinicopathologic features which predict surgical overall survival in patients with proximal gastric carcinoma involving the esophagus (PGCE).METHODS:Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009.Each retrieved pathology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were selected as PGCE.Each tumor was re-staged,following the guidelines on esophageal adenocarcinoma,according to the 7th edition of the American Joint Commission on Cancer Staging Manual.All histology slides were studied along with the pathology report for a retrospective analysis of 13 clinicopathologic features,i.e.,age,gender,Helicobacter pylori (H.pylori) infection,surgical modality,Siewert type,tumor Bormann's type,size,differentiation,histology type,surgical margin,lymphovascular and perineural invasion,and pathologic stage in relation to survival after surgical resection.Prognostic factors for overall survival were assessed with uniand multi-variate analyses.RESULTS:Patients' mean age was 65 years (range:47-90 years).The male:female ratio was 3.3.The 1-,3-and 5-year overall survival rates were 87％,61％ and 32％,respectively.By univariate analysis,age,male gender,H,pylori,tumor Bormann's type,size,histology type,surgical modality,positive surgical margin,lymphovascular invasion,and pT stage were not predictivefor overall survival; in contrast,perineural invasion (P =0.003),poor differentiation (P =0.0003),＞ 15 total lymph nodes retrieved (P =0.008),positive lymphnodes (P =0.001),and distant metastasis (P =0.005)predicted poor post-operative overall survival.Celiac axis nodal metastasis was associated with significantly worse overall survival (P =0.007).By multivariate analysis,≥ 16 positive nodes (P =0.018),lymph node ratio ＞ 0.2 (P =0.003),and overall pathologic stage (P =0.002) were independent predictors for poor overall survival after resection.CONCLUSION:Patients with PGCE showed worse overall survival in elderly,high nodal burden and advanced pathologic stage.This cancer may be more accurately staged as gastric,than esophageal,cancer.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Impact of lymphatic and/or blood vessel invasion in stage Ⅱ gastric cancer

    Chun-Yan DUJing-Gui ChenYe ZhouGuang-Fa Zhao...
    3610-3616页
    查看更多>>摘要：AIM:To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage Ⅱ gastric cancer.METHODS:From January 2001 to December 2006,487 patients with histologically confirmed primary gastric adenocarcinoma were diagnosed with stage Ⅱ gastric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery,Fudan University Shanghai Cancer Center.All patients underwent curative gastrectomy with standard lymph node (LN) dissection.Fifty-one patients who died in the postoperative period,due to various complications or other conditions,were excluded.Clinicopathological findings and clinical outcomes were analyzed.Patients were subdivided into four groups according to the status of LBVI and LN metastases.These four patient groups were characterized with regard to age,sex,tumor site,pT category,tumor grading and surgical procedure (subtotal resection vs total resection),and compared for 5-year overall survival by univariate and multivariate analysis.RESULTS:The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years (range:23-88years).The 5-year overall survival rates were 50.7％and the median survival time was 62 mo.Stage Ⅱa cancer was observed in 334 patients,including 268T3N0,63 T2N1,and three T1N2,and stage Ⅱb wasobserved in 102 patients,including 49 patients T3N1,51 T2N2,one T1N3,and one T4aN0.The incidence of LBVI was 28.0％ in stage Ⅱ gastric cancer with 19.0％(51/269) and 42.5％ (71/167) in LN-negative and LN-positive patients,respectively.In 218 patients (50.0％),there was neither a histopathologically detectable LBVI nor LN metastases (LBVI-/LN-,group Ⅰ); in 51patients (11.7％),LBVI with no evidence of LN metastases was detected (LBVI+/LN-,group Ⅱ).In 167patients (38.3％),LN metastases were found.Among those patients,LBVI was not determined in 96 patients (22.0％) (LBVI-/LN+,group Ⅲ),and was determined in 71 patients (16.3％) (LBVI+/LN+,group Ⅳ).Correlation analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI (P ＜ 0.001).The overall 5-year survival was significantly longer in LN-negative patients compared with LN-positive patients (56.1％ vs 42.3％,P =0.015).There was a significant difference in the overall 5-year survival between LBVI-positive and LBVInegative tumors (39.6％ vs 54.8％,P =0.006).Overall 5-year survival rates in each group were 58.8％ (Ⅰ),45.8％ (Ⅱ),45.7％ (Ⅲ) and 36.9％ (Ⅳ),and there was a significant difference in overall survival between the four groups (P =0.009).Multivariate analysis in stage Ⅱ gastric cancer patients revealed that LBVI independently affected patient prognosis in LN-negativeCONCLUSION:In LN-negative stage Ⅱ gastric cancer patients,LBVI is an additional independent prognostic marker,and may provide useful information to identify patients with poorer prognosis.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Effect of interferon-γ and tumor necrosis factor-α on hepatitis B virus following lamivudine treatment

    Hong ShiLu LuNing-Ping ZhangShun-Cai Zhang...
    3617-3622页
    查看更多>>摘要：AIM:To evaluate anti-hepatitis B virus (HBV) activity and cytotoxicity of interferon-γ (IFN-γ) and tumor necrosis factor-cα (TNF-α) following lamivudine treatment of HepG2.2.15 cells.METHODS:HepG2.2.15 cells were treated with 2 μmol/L lamivudine for 16 d (lamivudine group),cultured for 10d,followed by 5 ng/mL TNF-cα and 1000 U/mL IFN-γfor 6 d (cytokine group),or treated with 2 iμmol/L lamivudine for 10 d followed by 5 ng/mL TNF-cα and 1000 U/mL IFN-γ,for 6 d (sequential group),or cultured without additions for 16 d (control group).Intracellular DNA was extracted from 3 x 105 HepG2.2.15 cells from each group.The extracted DNA was further purified with mung bean nuclease to remove HBV relaxed circular DNA that may have remained.Both HBV covalently closed circular DNA (cccDNA) and HBV DNA were examined with real-time polymerase chain reaction.The titers of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were quantified with enzyme-linked immunosorbent assay.Cell viability was measured with the cell counting kit-8 assay.RESULTS:Compared to lamivudine alone (22.63％ ±-0.12％),both sequential (51.50％ ± 0.17％,P =0.034)and cytokine treatment (49.66％ ± 0.06％,P =0.041)showed a stronger inhibition of HBV cccDNA; the difference between the sequential and cytokine groups was not statistically significant (51.50％ ± 0.17％ vs 49.66％ ± 0.06％,P =0.88).The sequential groupshowed less inhibition of HBV DNA replication than the lamivudine group (67.47％ ± 0.02％ vs 82.48％ ±0.05％,P =0.014); the difference between the sequential and cytokine groups was not statistically significant (67.47％ ± 0.02％ vs 57.45％ ± 0.07％,P =0.071).The levels of HBsAg and HBeAg were significantly decreased in the sequential treatment group compared to the other groups [HBsAg:3.48 ± 0.04 (control),3.09±t 0.08 (lamivudine),2.55 ± 0.13 (cytokine),2.32 ±0.08 (sequential),P =0.042 for each between-group comparison; HBeAg:3.48 ± 0.01 (control),3.08 ± 0.08 (lamivudine),2.57 ± 0.15 (cytokine),2.34 ± 0.12 (sequential),P =0.048 for each between-group comparison].Cell viability in the cytokine group was reduced to 58.03％ ± 8.03％ compared with control cells (58.03％ ± 8.03％ vs 100％,P =0.000).Lamivudine pretreatment significantly reduced IFN-γ,+ TNF-α-mediated toxicity of HepG2.2.15 cells [85.82％ ± 5.43％ (sequential) vs 58.03％ ± 8.03％ (cytokine),P =0.002].CONCLUSION:Sequential treatment overcame the lower ability of lamivudine alone to inhibit cccDNA and precluded the aggressive cytotoxicity involving IFN-γ and TNF-α by decreasing the viral load.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普

    Difficulty in differentiating two cases of sigmoid stenosis by diverticulitis from cancer

    Noriko NishiyamaHirohito MoriHideki KobaraKazi Rafiq...
    3623-3626页
    查看更多>>摘要：The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging.The rate of diverticulitis in colon diverticulosis ranges from 8.1％ to 9.6％.However,few cases of stenosis due to diverticulitis have been reported.These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult.This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer.Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS).CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon.Barium enema revealed a marked,hourglassshaped,2-cm circumferential stenosis in the sigmoid colon.Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon.Sigmoid colon cancer was suspected,and laparoscopic sigmoidectomy was performed.Pathological examination demonstrated active inflammation with no evidence of malignancy.Case 2 was a 50-year-old man who presented to a nearby clinic with reduced stool output despite the urge to defecate.CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line.Contrast-enhanced abdominal CT revealed multiple diverticula,wall thickening,and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery.A partial sigmoidectomy was performed.Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface,but a marked infiltration of inflammatory cells was observed.
      原文链接:
    • NETL
    • NSTL
    • 万方数据
    • 维普