An update in the endoscopic management of gastric cancer

Efficacy, safety, and impact on procedural outcomes of local anesthesia in endoscopic submucosal dissection: a systematic review and meta-analysis

Background

Endoscopic submucosal dissection (ESD) has revolutionized the treatment of early stage gastrointestinal cancers. However, ESD can be associated with increased postprocedural pain and higher complication rates. This systematic review and meta-analysis evaluated the efficacy and safety of local anesthesia.

Methods

A comprehensive search was conducted to identify relevant randomized controlled trials investigating the effect of local anesthesia in ESD procedures. The Cochrane risk of bias tool for randomized trials was used to assess study quality. A meta-analysis was performed using Review Manager 5.4, with summary measures expressed as pooled odds ratios (OR) or mean differences with corresponding 95% confidence intervals (CI).

Results

Four randomized controlled trials with 296 patients undergoing ESD procedures were included. The use of local anesthesia did not significantly impact procedural time (mean difference = -2.05, 95% CI = -9.29, 5.18, I2 = 30%, P = 0.58). Lastly, the use of local anesthesia did not increase the risk of bleeding or other adverse events (P > 0.05) and decreased the incidence of bradycardia (OR = 0.16, 95% CI = 0.03, 0.95; I2 = 0%; P = 0.04).

Conclusion

Our study found that the use of local anesthesia did not significantly affect the procedural time of ESD. However, it effectively reduced postoperative pain in some trials with no risk of increased incidence of adverse events.

KIF23 Promotes Gastric Cancer by Stimulating Cell Proliferation

Gastric cancer (GC) is one of the most aggressive malignant tumors with low early diagnosis and high metastasis. Despite progress in treatment, to combat this disease, a better understanding of the underlying mechanisms and novel therapeutic targets is needed. KIF23, which belongs to the KIF family, plays a vital role in various cell processes, such as cytoplasm separation and axon elongation. Nowadays, KIF23 has been found to be highly expressed in multiple tumor tissues and cells, suggesting a potential link between KIF23 and tumorigenesis. Herein, we reported that KIF23 expression was correlated with poor prognosis of gastric cancer and found an association between KIF23 and pTNM stage. An in vitro assay proved that the proliferation of gastric cancer cells was significantly inhibited, which is caused by KIF23 depletion. Additionally, knockdown of KIF23 resulted in a marked inhibition of cell proliferation of gastric cancer in mice, with significant downregulation of Ki67 and PCNA expression. In conclusion, these data indicate that KIF23 is a potential therapeutic target for gastric cancer treatment.

Stomach wall structure and vessels imaging by acoustic resolution photoacoustic microscopy

AIM

To image stomach wall blood vessels and tissue, layer-by-layer.

METHODS

We built up the acoustic resolution photoacoustic microscopy (AR-PAM) system for imaging layered tissues, such as the stomach wall. A tunable dye laser system was coupled to a fiber bundle. The fibers of the bundle were placed in nine directions with an incident angle of 45° around a high-frequency ultrasound transducer attached to the acoustic lens. This structure formed a dark field on the tissue surface under the acoustic lens and the nine light beams from the fibers to be combined near the focal point of the acoustic lens. The sample piece was cut from a part of the porcine stomach into a petri dish. In order to realize photoacoustic depth imaging of tumor, we designed a tumor model based on indocyanine green (ICG) dye. The ICG solution (concentration of 129 μM/mL) was mixed into molten gel, and then a gel mixture of ICG (concentration of 12.9 μM/mL) was injected into the stomach submucosa. The injection quantity was controlled by 0.1 mL to make a small tumor model.

RESULTS

An acoustic resolution photoacoustic microscopy based on fiber illumination was established and an axial resolution of 25 μm and a lateral resolution of 50 μm in its focal zone range of 500 μm has been accomplished. We tuned the laser wavelength to 600 nm. The photoacoustic probe was driven to do B-scan imaging in tissue thickness of 200 μm. The photoacoustic micro-image of mucosa and submucosa of the tissue have been obtained and compared with a pathological photograph of the tissue stained by hematoxylin-eosin staining. We have observed more detailed internal structure of the tissue. We also utilized this photoacoustic microscopy to image blood vessels inside the submucosa. High contrast imaging of the submucosa tumor model was obtained using ICG dye.

CONCLUSION

This AR-PAM is able to image layer-by-layer construction and some blood vessels under mucosa in the stomach wall without any contrast agents.