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Gastrointestinal endoscopic surgery (GES) has high requirements for instruments' size and distal dexterity, because of the narrow endoscopic channel and long, tortuous human gastrointestinal tract. This paper utilized Nickel-Titanium (NiTi) wires to develop a miniature 3-DoF (pitch-yaw-translation) flexible parallel robotic wrist (FPRW). Additionally, we assembled an electric knife on the wrist's connection interface and then teleoperated it to perform an endoscopic submucosal dissection (ESD) on porcine stomachs. The effective performance in each ESD workflow proves that the designed FPRW has sufficient workspace, high distal dexterity, and high positioning accuracy., IEEE International Conference on Robotics and Automation (ICRA) 2022 workshop: Frontiers of Endoluminal Intervention: Clinical opportunities and technical challenges

Additional file 1. Figure S1. Age-specific rates for incidence, death, and DALY increased with age in China, Japan, South Korea, Mongolia, East Asia and Pacific, and the world in 2019, by sexes. DALY, disability-adjusted life-year. Figure S2. The absolute burden of gastric cancer in China, Japan, South Korea, Mongolia, East Asia and Pacific, and the world in 2019, by sexes and age groups. (A) Number of incident cases; (B) Number of incident deaths; (C) Number of DALYs. DALY, disability-adjusted life-year. Figure S3. Trends for incidence rate of gastric cancer in China, Japan, South Korea, Mongolia, East Asia and Pacific, and the world from 1990 to 2019 by age groups. (A) Age-specific incidence rate, both; (B) The AAPC in age-specific incidence rate by sexes. AAPC, average annual percentage change. Figure S4. Trends for mortality rate of gastric cancer in China, Japan, South Korea, Mongolia, East Asia and Pacific, and the world from 1990 to 2019 by age groups. (A) Age-specific mortality rate, both; (B) The AAPC in age-specific mortality rate by sexes. AAPC, average annual percentage change. Figure S5. Trends for DALY rate of gastric cancer in China, Japan, South Korea, Mongolia, East Asia and Pacific, and the world from 1990 to 2019 by age groups. (A) Age-specific DALY rate, both; (B) The AAPC in age-specific DALY rate by sexes. DALY, disability-adjusted life-year, AAPC, average annual percentage change. Table S1. DALYs and age-standardized DALY rate from 1990 to 2017 for gastric cancer in the 34 provinces of China.

Background Adiponectin, a protein hormone produced by adipose tissues, exhibits anti-inflammatory functions in various models. This study was investigated the effects of adiponectin on dextran sodium sulfate (DSS)-colonic injury, inflammation, apoptosis, and intestinal barrier dysfunction in Caco-2 cell and mice. Materials and methods The results showed that DSS caused inflammatory response and intestinal barrier dysfunction in vitro and in vivo. Adiponectin injection alleviated colonic injury and rectal bleeding in mice. Meanwhile, adiponectin downregulated colonic IL-1β and TNF-α expressions and regulated apoptosis relative genes to attenuate DSS-induced colonic inflammation and apoptosis. Adiponectin markedly reduced serum lipopolysaccharide concentration, a biomarker for intestinal integrity, and enhanced colonic expression of tight junctions (ZO-1 and occludin). The in vitro data further demonstrated that adiponectin alleviated DSS-induced proinflammatory cytokines production and the increased permeability in Caco-2 cells. Conclusion Adiponectin plays a beneficial role in DSS-induced inflammation via alleviating apoptosis and improving intestinal barrier integrity.

Helicobacter pylori (H. pylori) recurrence remains a significant public health concern. The study aimed to assess H. pylori reinfection rate and identify its risk factors in China. This prospective open cohort, observational study was performed at 18 hospitals across 15 provinces in China. Consecutive patients who received the successful initial eradication during 1 January 2012 and 31 December 2018 were eligible for enrolment. H. pylori recurrence was defined as reinfection that occurred at more than the 12-month interval after successful initial eradication. Surveyed risk factors that might be associated with reinfection were preliminarily estimated by log-rank test and further determined by Cox regression model to calculate the hazard ratio (HR) and 95% confidence interval (CI). A total of 5193 subjects enrolled in the study. The follow-up intervals varied from 6 to 84 months with a general follow-up rate of 67.9%. Annual reinfection rate was 1.5% (95% CI: 1.2–1.8) per person-year. H. pylori reinfection was independently associated with the following five risk factors: minority groups (HR = 4.7, 95% CI: 1.6–13.9), the education at lower levels (HR = 1.7, 95% CI: 1.1–2.6), a family history of gastric cancer (HR = 9.9, 95% CI: 6.6–14.7), and the residence located in Western China (HR = 5.5, 95% CI: 2.6–11.5) following by in Central China (HR = 4.9, 95% CI: 3–8.1) (all P < 0.05). Reinfection rate of H. pylori in China is relatively low. Patients with specific properties of ethnic groups, education level, family history, or residence location appear to be at higher risk for reinfection.

Background and study aims Owing to the indistinctive endoscopic appearance of gastric intestinal metaplasia (GIM), gastric intraepithelial neoplasia (GIN), and early gastric cancer (EGC), a significant number of such lesions may be missed during surveillance endoscopy. The aim of this clinical trial was to assess the value of combined computed virtual chromoendoscopy (flexible spectral imaging color enhancement [FICE]) and probe-based confocal laser endomicroscopy (pCLE) for in vivo detection of GIM, GIN, and EGC. Patients and methods This was a multicenter, randomized controlled trial performed in 238 patients at four tertiary centers. Patients were randomized to FICE-guided pCLE with targeted biopsies (group A) or FICE with standard biopsies (group B). The diagnostic yield of GIM, GIN, or EGC was compared between the two groups. Results On a per-patient assessment, the diagnostic yield for GIM/GIN/EGC was 73.3 % (88/120) in group A and 63.6 % (75/118) in group B (P = 0.09). On a per-biopsy analysis, FICE-guided pCLE with targeted biopsies significantly increased the diagnostic yield of GIM/GIN/EGC vs. FICE with standard biopsies, from 31.5 % (252/800) to 75.1 % (313/417) (P Conclusions Real-time pCLE and targeted biopsies after FICE improved the diagnostic yield for the detection of GIM, GIN, and EGC, and only required about half the number of biopsies vs. FICE with standard biopsies. This may allow a better regimen for endoscopic surveillance and subsequent treatment of patients with premalignant and malignant gastric abnormalities.Trial registered at ClinicalTrials.gov (NCT02515721).

Goals To propose a new probe-based confocal laser endomicroscopy (pCLE) classification of gastric pit patterns and vessel architecture, and to assess the accuracy and interobserver agreement. Background pCLE is a newly developed endoscopic device that allows the application of laser microscopy with any conventional endoscope and mosaic imaging. Study A total of 291 pCLE videos from 32 patients were recruited in phase I to establish the new pCLE image classification in the stomach. Eligible patients were then prospectively investigated by pCLE using the newly established classification system. All patients were examined first with high-definition endoscopy followed by pCLE at 7 standardized locations and endoscopic-suspected lesions. Targeted biopsies were performed with precise matching of pCLE recordings. Results The sensitivity and specificity of type 2b pit pattern for predicting atrophic gastritis were 88.51% and 99.19%, respectively. The sensitivity and specificity of type 2c pit pattern for predicting intestinal metaplasia were 92.34% and 99.34%, respectively. The overall sensitivity and specificity of type 3 pit pattern or vessel architecture for predicting neoplasia were 89.89% and 99.44%, respectively. The interobserver agreement was "substantial" (kappa=0.70) for the differentiation of neoplasia versus non-neoplasia. Conclusions The new pCLE classification system in the stomach correlates well with specific pathologic conditions and is reproducible by multiple investigators. Multicenter researches are warranted to further validate its value in clinical practice.

Background and study aims: In vivo molecular imaging represents a powerful tool for the immediate diagnosis of gastric cancer. In this study, the monoclonal antibody MG7, which is a specific molecular marker against gastric cancer, was labeled with fluorescent agents to enable in vivo real-time imaging by confocal laser endomicroscopy (CLE). Patients and methods: In vivo molecular imaging was performed in tumor-bearing mice from two kinds of human gastric cancer cell lines. Xenograft tumors were visualized in vivo first with a whole-body fluorescent imaging device and then by CLE using fluorescently labeled MG7 antibody. Gastric cancerous tissue and noncancerous mucosa from human biopsies or surgical specimens were also examined ex vivo by CLE. Results: Intravital imaging of xenograft tumors revealed a specific cellular signal, whereas no specific signal was observed in control tissue or in mice injected with irrelevant antibodies. An ex vivo experiment on human specimens using a rigid confocal probe showed positive fluorescent staining in 22 /23 samples diagnosed as gastric cancer and weak signals in 5 /23 noncancerous tissue samples. CLE evaluation correlated well with immunohistochemical findings. Conclusions: Screening tumors in vivo by CLE may help to detect MG7-Ag-positive tissues, decrease the sampling error by screening the large tumor surface not routinely screened by biopsy or conventional immunohistochemistry, and facilitate early detection of gastric carcinoma.

BACKGROUND AND STUDY AIM The real-time identification and removal of adenomas is a cost-effective strategy to improve the prognosis of colorectal cancer. Confocal laser endomicroscopy (CLE) could provide real-time histological-level observation. We aimed to evaluate the efficacy of CLE diagnosis using a simple classification system that differentiates adenomas from non-neoplastic polyps with intravenous fluorescein staining alone. PATIENTS AND METHODS An endoscope integrated confocal laser microscopy system was used in this study. CLE images of 35 colonic polyps, including 15 hyperplastic polyps and 20 adenomas confirmed by histology, were first evaluated to develop criteria for diagnosis of neoplastic and non-neoplastic polyps. The diagnostic criteria included goblet cell depletion, villous architecture, and microvascular alterations. We then performed a prospective study of colonic polyps found during CLE and classified them according to the established criteria. A total of 115 patients with 115 colonic polyps were included. The real-time CLE diagnosis was compared with that from histology. The stored CLE images were evaluated later by a blinded observer. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of real-time CLE in identifying colonic adenomas were 93.9 % (95 % confidence interval [CI] 85.4 - 97.6), 95.9 % (95 % CI 86.2 - 98.9), 96.9 % (95 % CI 89 - 99), and 92.2 % (95 % CI 81 - 97), respectively, compared with histological results. Interobserver agreement between real-time and post-CLE still-image evaluation was excellent (kappa = 0.929). Goblet cell depletion alone had a sensitivity of 84.9 % (95 % CI 73 - 92) and a specificity of 87.8 % (95 % CI 75 - 95), as well as excellent interobserver agreement (kappa = 0.824). CONCLUSIONS Endoscope integrated CLE with fluorescein staining may reliably assist in the real-time identification of colonic adenomas. Among three diagnostic categories, goblet cell depletion can be used to distinguish adenomas and hyperplastic polyps.