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Zhuang XY, Wu C, Wu JW, Yang XF, Liu ZH. Transgastric single-incision laparoscopic resection for a recurrent gastric adenoma at the prepyloric antrum: A case report. Int J Surg Case Rep 2025; 127:110940. [PMID: 39862665 PMCID: PMC11803858 DOI: 10.1016/j.ijscr.2025.110940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/22/2025] [Accepted: 01/22/2025] [Indexed: 01/27/2025] Open
Abstract
INTRODUCTION Endoscopic resection is suitable for most benign gastric or early stage cancerous polyps. Laparoscopic local resection is performed only for gastric polyps that are difficult to treat with endoscopic resection, such as recurrent or large polyps. However, when polyps are located in difficult regions, such as the gastric cardia and prepyloric antrum, wedge resection may damage the sphincter around the cardia or pylorus, resulting in postoperative deformity or stenosis. PRESENTATION OF CASE A 66-year-old gentleman found a 2.5 cm recurrent adenoma at pre-pyloric antrum when he repeated a esophagogastoscopy 1 year after a 2 cm polyp removed by endoscopic mucosal resection (EMR) at the same site. Owing to submucosal fibrosis, neither EMR nor endoscopic submucosal dissection is considered suitable for recurrent adenoma because of the increased risk of perforation. Pyloric stenosis or deformity was expected with traditional laparoscopic wedge resection for such a lesion located at the pre-pyloric antrum. Instead, we successfully performed a transgastric single-incision laparoscopic en bloc resection of the adenoma. Precise dissection was performed during surgery. The patient's postoperative recovery was uneventful. A repeated esophagogasroscopy one year later showed no recurrence. DISCUSSION Transgastric single-incision laparoscopic resection for recurrent gastric mucosal lesions after previous endoscopic resection is technically feasible and safe. CONCLUSION This procedure can be an alternative choice for local resection of recurrent benign gastric mucosal lesions, especially for those located in special regions such as the prepyloric antrum or gastric cardia.
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Affiliation(s)
- Xin Yu Zhuang
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Can Wu
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Jun Wen Wu
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Xue Fei Yang
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Zhong Hui Liu
- Department of Surgery, The University of Hong Kong, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
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He S, Zhang Z, Song G, Wang Z, Dai C, Yan S, Jiang K, Song B, Li H, Cao M, Sun D, Yang F, Yan X, Zhang S, Teng Y, Li Q, Xia C, Chen W. Can patients with mild non-neoplastic lesions diagnosed at baseline screening be safely exempt from surveillance: evidence from multicenter community-based cohorts. SCIENCE CHINA. LIFE SCIENCES 2025; 68:263-271. [PMID: 39254888 DOI: 10.1007/s11427-023-2558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/25/2024] [Indexed: 09/11/2024]
Abstract
Surveillance recommendations for gastric cancer (GC) in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions. We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool, and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance. In the multicenter community-based cohort, 75,051 participants receiving baseline endoscopy were enrolled during 2015-2017 and followed-up until 2021. Cumulative incidence rates (CIRs) of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests. Mixed-effects Cox regression models were used to detect potential factors for progression towards GC. A risk score was calculated as counts of selected factors. An independent cohort, including 26,586 participants was used for external validation. During a median follow-up of 6.25 years, CIRs of GC were 0.302%, 0.436%, and 4.756% for normal group, non-neoplastic (atrophic gastritis/intestinal metaplasia) and neoplastic lesions (low-grade/high-grade dysplasia), respectively (Ptrend<0.001). Four predictors, including male, ⩾60 years, smoking, and limited vegetable consumption, were selected for risk-stratification. High-risk patients (⩾3 risk factors) with non-neoplastic lesions showed higher GC risks (adjusted HR=7.73, 95%CI: 4.29-13.92), and their four-year CIR reached the one-year CIR of neoplastic lesions. Further categorizing non-neoplastic lesions by histological grade, both patients with moderate-to-severe lesions (aHR=3.07, 95%CI: 1.67-5.64) and high-risk patients with mild lesions (aHR=7.29, 95%CI: 3.58-14.86) showed higher risks. Consistent trends were observed in validation cohort. High-risk mild-precursor-lesion patients should receive surveillance within 3-5 years after baseline screening. Our study provides evidence on supplementing current guideline recommendations.
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Affiliation(s)
- Siyi He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhiyi Zhang
- Department of Gastroenterology, Gansu Wuwei Tumor Hospital, Wuwei, 730000, China
| | - Guohui Song
- Cixian Cancer Institute, Handan, 056500, China
| | | | - Chunyun Dai
- Center for Disease Control and Prevention of Sheyang County, Yancheng, 224499, China
| | - Shipeng Yan
- Department of Cancer Prevention and Control, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410029, China
| | - Kun Jiang
- Luoshan Center for Disease Control and Prevention, Xinyang, 464299, China
| | - Bingbing Song
- Office for Cancer Control and Research, Affiliated Cancer Hospital of Harbin Medical University, Harbin, 150081, China
| | - He Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Maomao Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dianqin Sun
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fan Yang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xinxin Yan
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shaoli Zhang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi Teng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qianru Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Xue J, Lyu G, Li S. The diagnostic value of two-dimensional ultrasound Su-RADS combined with shear wave elastography for benign and malignant lesions of the gastric wall. BMC Med Imaging 2024; 24:352. [PMID: 39731044 DOI: 10.1186/s12880-024-01530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/16/2024] [Indexed: 12/29/2024] Open
Abstract
OBJECTIVE This study explored the value of stomach ultrasound reporting and data system (Su-RADS) and two-dimensional shear wave elastography (2D-SWE) in the diagnosis of benign and malignant lesions of the gastric wall, evaluating the feasibility of combining the two methods for the diagnosis of gastric wall lesions. METHODS 113 patients with gastric wall lesions were examined after oral gastric ultrasound contrast agent, and the grades of the gastric wall lesions were classified according to Su-RADS. Moreover, 2D-SWE was performed to measure the E value of the lesions. ROC curves were constructed to evaluate the diagnostic efficacy of Su-RADS, 2D-SWE and their combination for gastric wall lesions. RESULTS The cutoff values for Emean and Emax were 8.01 kPa and 11.08 kPa, respectively. The sensitivity and specificity of 2D-SWE were 70.59%, 93.67% and 85.69%, 88.61%, respectively. The diagnostic sensitivity and specificity of Su-RADS were 91.18% and 82.28%, respectively. The AUC of combination of two methods was 0.951, which was greater than that of Su-RADS (0.940) or 2D-SWE alone (0.853, 0.903), and the sensitivity and specificity were 82.35% and 94.94%. The sensitivity and specificity of the combination of the two methods for the diagnosis of malignant gastric lesions were 82.35% and 94.94%, respectively. The AUC was 0.951, and the Youden index was 0.8064. The DeLong test was used to determine the AUC between the combination of two methods and 2D-SWE was P < 0.05. CONCLUSION Compared with Su-RADS or 2D-SWE alone, the combination of the two methods is more effective at diagnosing of gastric wall.And improved the specificity in the diagnosis of gastric wall lesions.
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Affiliation(s)
- Jingjing Xue
- Department of Ultrasound, The Fujian Medical University Union Hospital, Fuzhou, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
- Quanzhou Medical College, Quanzhou, China.
- Department of Clinical Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
| | - Shaohui Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
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Ogata Y, Hatta W, Koike T, Takahashi S, Matsuhashi T, Iwai W, Asonuma S, Okata H, Ohyauchi M, Ito H, Abe Y, Sasaki Y, Kawamura M, Saito M, Uno K, Fujishima F, Nakamura T, Nakaya N, Iijima K, Masamune A. Is blue light imaging without magnification satisfactory as screening for esophageal squamous cell carcinoma? Post-hoc analysis of multicenter randomized controlled trial. Dig Endosc 2024; 36:1118-1126. [PMID: 38494659 DOI: 10.1111/den.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Narrow light observation is currently recommended as an alternative to Lugol chromoendoscopy (LCE) to detect esophageal squamous cell carcinoma (ESCC). Studies revealed little difference in sensitivity between the two modalities in expert settings; however, these included small numbers of cases. We aimed to determine whether blue light imaging (BLI) without magnification is satisfactory for preventing misses of ESCC. METHODS This was a post-hoc analysis of a multicenter randomized controlled trial targeting patients at high risk of ESCC in expert settings. In this study, BLI without magnification followed by LCE was performed. The evaluation parameters included: (i) the diagnostic abilities of ESCC; (ii) the endoscopic characteristics of lesions with diagnostic differences between the two modalities; and (iii) the color difference between cancerous and noncancerous areas in BLI and LCE. RESULTS This study identified ESCC in 49 of 699 cases. Of these cases, nine (18.4%) were missed by BLI but detected by LCE. In per-patient analysis, the sensitivity of BLI was lower than that of LCE following BLI (83.7% vs. 100.0%; P = 0.013), whereas the specificity and accuracy of BLI were higher (88.2% vs. 81.2%; P < 0.001 and 87.8% vs. 82.5%; P < 0.001, respectively). No significant endoscopic characteristics were identified, but the color difference was lower in BLI than in LCE (21.4 vs. 25.1; P = 0.003). CONCLUSION LCE following BLI outperformed BLI in terms of sensitivity in patients with high-risk ESCC. Therefore, LCE, in addition to BLI, would still be required in screening esophagogastroduodenoscopy even by expert endoscopists.
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Affiliation(s)
- Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - So Takahashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Wataru Iwai
- Department of Gastroenterology, Miyagi Cancer Center, Miyagi, Japan
| | - Sho Asonuma
- Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan
| | - Hideki Okata
- Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan
| | - Motoki Ohyauchi
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Hirotaka Ito
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Yasuhiko Abe
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masashi Kawamura
- Department of Gastroenterology, Sendai City Hospital, Miyagi, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | | | | | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Fukushima N, Masuda T, Tsuboi K, Watanabe J, Yano F. Long-term outcomes of treatment for achalasia: Laparoscopic Heller myotomy versus POEM. Ann Gastroenterol Surg 2024; 8:750-760. [PMID: 39229567 PMCID: PMC11368501 DOI: 10.1002/ags3.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 09/05/2024] Open
Abstract
Achalasia is a rare esophageal motility disorder characterized by nonrelaxation of the lower esophageal sphincter. Laparoscopic Heller myotomy (LHM) is the gold standard treatment for achalasia. Peroral endoscopic myotomy (POEM), a less invasive treatment, is performed extensively, and the selection of the intervention method remains debatable to date. In addition to the availability of extensive studies on short-term outcomes, recent studies on the long-term outcomes of LHM and POEM have shown similar clinical success after 5 y of follow-up. However, gastroesophageal reflux disease (GERD) was more common in patients who had undergone POEM than in those who had undergone LHM. Moreover, existing studies have compared treatment outcomes in various disease states. Some studies have suggested that POEM is superior to LHM for patients with type III achalasia because POEM allows for a longer myotomy. Research on treatment for sigmoid types is currently in progress. However, the long-term results comparing LHD and POEM are insufficient, and the best treatment remains controversial. Further research is needed, and treatment options should be discussed with patients and tailored to their individual needs and pathologies.
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Affiliation(s)
- Naoko Fukushima
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Takahiro Masuda
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Kazuto Tsuboi
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Jun Watanabe
- Division of Gastroenterological, General and Transplant Surgery, Department of SurgeryJichi Medical UniversityShimotsukeTochigiJapan
| | - Fumiaki Yano
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
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Lewis D, Jimenez L, Mansour MH, Horton S, Wong WWL. A Systematic Review of Cost-Effectiveness Studies on Gastric Cancer Screening. Cancers (Basel) 2024; 16:2353. [PMID: 39001415 PMCID: PMC11240801 DOI: 10.3390/cancers16132353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Gastric cancer (GC) poses notable economic and health burdens in settings where the incidence of disease is prevalent. Some countries have established early screening and treatment programs to address these challenges. The objectives of this systematic review were to summarize the cost-effectiveness of gastric cancer screening presented in the literature and to identify the critical factors that influence the cost-effectiveness of screening. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluation studies of gastric cancer screening were reviewed from SCOPUS and PubMed. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) was used to assess the quality of reporting presented in the selected articles. Only primary economic evaluation studies addressing the cost-effectiveness, cost-utility, and cost-benefit of gastric cancer screening were selected. Two reviewers scrutinized the selected articles (title, abstract, and full text) to determine suitability for the systematic review based on inclusion and exclusion criteria. Authors' consensus was relied on where disagreements arose. The main outcome measures of concern in the systematic review were cost, effectiveness (as measured by either quality-adjusted life years (QALY) or life-years saved (LYS)), and incremental cost-effectiveness ratio (ICER) of screening versus either no screening or an alternative screening method. Thirty-one studies were selected for the final review. These studies investigated the cost-effectiveness of GC screening based on either primary, secondary, or a combination of primary and secondary interventions. The main primary intervention was Helicobacter pylori (Hp) screening with eradication, while the main secondary intervention was endoscopic screening. Cost-effectiveness was evaluated against no screening or screening using an alternative method in both observational and model-based studies. Screening was mainly cost-effective in Asian countries or their diasporas where the prevalence of GC was high. GC screening was generally not cost-effective among Western countries. GC screening can be cost-effective, but cost-effectiveness is dependent on context-specific factors, including geographical location, the prevalence of GC in the local population, and the screening tool adopted. However, there is benefit in targeting high-risk population groups in Asian countries and their diaspora for GC screening.
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Affiliation(s)
- Diedron Lewis
- School of Pharmacy, University of Waterloo, Waterloo, ON N2G 1C5, Canada
| | - Laura Jimenez
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Manel Haj Mansour
- Department of Haematology and Oncology, Aga Khan University Hospital, Nairobi P.O. Box 30270-00100, Kenya
| | - Susan Horton
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G5, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON N2G 1C5, Canada
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Jacob J, Millien V, Berger S, Hernaez R, Ketwaroo GA, Flores AG, Hou JK, Jarbrink-Sehgal ME, Khalaf NI, Rosen DG, El-Serag HB, Tan MC. Improving Adherence to Clinical Practice Guidelines for Managing Gastric Intestinal Metaplasia Among Gastroenterologists at a US Academic Institution. J Clin Gastroenterol 2024; 58:432-439. [PMID: 37436841 PMCID: PMC10787041 DOI: 10.1097/mcg.0000000000001890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Clinical guidelines reserve endoscopic surveillance after a gastric intestinal metaplasia (GIM) diagnosis for high-risk patients. However, it is unclear how closely guidelines are followed in clinical practice. We examined the effectiveness of a standardized protocol for the management of GIM among gastroenterologists at a US hospital. METHODS This was a preintervention and postintervention study, which included developing a protocol and education of gastroenterologists on GIM management. For the preintervention study, 50 patients with GIM were randomly selected from a histopathology database at the Houston VA Hospital between January 2016 and December 2019. For the postintervention study, we assessed change in GIM management in a cohort of 50 patients with GIM between April 2020 and January 2021 and surveyed 10 gastroenterologists. The durability of the intervention was assessed in a cohort of 50 GIM patients diagnosed between April 2021 and July 2021. RESULTS In the preintervention cohort, GIM location was specified (antrum and corpus separated) in 11 patients (22%), and Helicobacter pylori testing was recommended in 11 of 26 patients (42%) without previous testing. Gastric mapping biopsies were recommended in 14% and surveillance endoscopy in 2%. In the postintervention cohort, gastric biopsy location was specified in 45 patients (90%, P <0.001) and H. pylori testing was recommended in 26 of 27 patients without prior testing (96%, P <0.001). Because gastric biopsy location was known in 90% of patients ( P <0.001), gastric mapping was not necessary, and surveillance endoscopy was recommended in 42% ( P <0.001). One year after the intervention, all metrics remained elevated compared with the preintervention cohort. CONCLUSIONS GIM management guidelines are not consistently followed. A protocol for GIM management and education of gastroenterologists increased adherence to H. pylori testing and GIM surveillance recommendations.
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Affiliation(s)
- Jake Jacob
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Scott Berger
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Gastroenterology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Gyanprakash A. Ketwaroo
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Avegail G. Flores
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Department of Gastroenterology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Jason K. Hou
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Gastroenterology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Natalia I. Khalaf
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Gastroenterology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Daniel G. Rosen
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Hashem B. El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Mimi C. Tan
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Department of Gastroenterology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Plotnikova EY. Autoimmune gastritis. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2024:157-167. [DOI: 10.21518/ms2023-467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Diagnosis of autoimmune gastritis (AIG) is often challenging because of the absence of typical symptoms. Clinical guidelines are lacking, which results in inadequate treatment and poor cancer screening. This work presents an overview of current management options and aims at raising awareness for this disease. The paper also describes a clinical case of the full-scale course of AIG with all its complications. Autoimmune gastritis is mostly considered as a disease of elderly with vitamin B12 deficiency and pernicious anaemia. Today it is recognized that AIG is found with a similar prevalence in all age groups, with iron deficiency being a frequent symptom. Conventional therapy consists of adequate iron and vitamin B12 supplementation, as well as symptomatic approaches. The associated risk for gastric adenocarcinoma and gastric neuroendocrine tumours requires regular endoscopic follow-up. New treatments aiming to reduce gastric atrophy and cancer risk are currently under development. Thus, treatment of autoimmune gastritis should focus on optimizing supplementation of vitamin and macronutrient deficiencies, symptomatic therapy that improves quality of life, and include cancer prevention measures. Clinical studies should address the possibility to arrest the inflammation process and to prevent progression of AIG. The author of the article suggests that itopride hydrochloride and rebamipide will be used for symptomatic and pathogenetic therapy. The problem facing gastroenterologists today is to develop domestic guidelines for the management and screening endoscopic intervals of patients with AIG.
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Ogata Y, Hatta W, Koike T, Takahashi S, Matsuhashi T, Oikawa T, Iwai W, Asonuma S, Okata H, Ohyauchi M, Ito H, Abe Y, Sasaki Y, Kawamura M, Saito M, Uno K, Fujishima F, Nakamura T, Nakaya N, Iijima K, Masamune A. Blue light imaging and linked color imaging as a screening mode for esophageal squamous cell carcinoma in high-risk patients: Multicenter randomized trial. Dig Endosc 2023; 35:835-844. [PMID: 36802097 DOI: 10.1111/den.14538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Blue light imaging (BLI) and linked color imaging (LCI) are superior to conventional white light imaging for detecting esophageal squamous cell carcinoma (ESCC). Hence, we compared their diagnostic performances in ESCC screening. METHODS This open-labeled, randomized controlled trial was performed at seven hospitals. Patients with a high risk of ESCC were randomly assigned to the BLI group (BLI followed by LCI) and LCI group (LCI followed by BLI). The primary end-point was the detection rate of ESCC in the primary mode. The main secondary end-point was its miss rate in the primary mode. RESULTS In total, 699 patients were enrolled. The detection rate of ESCC did not significantly differ between the BLI and LCI groups (4.0% [14/351] vs. 4.9% [17/348]; P = 0.565); however, the number of patients with ESCC tended to be smaller in the BLI group (19 vs. 30). Notably, the miss rate of ESCC was lower in the BLI group (26.3% [5/19] vs. 63.3% [19/30]; P = 0.012) and LCI detected no ESCCs missed by BLI. The sensitivity was higher in BLI (75.0% vs. 47.6%; P = 0.042); on the other hand, the positive predictive value in BLI tended to be lower (28.8% vs. 45.5%; P = 0.092). CONCLUSIONS The detection rates of ESCC did not significantly differ between BLI and LCI. Although BLI may have the potential to be advantageous over LCI for the diagnosis of ESCC, it is still unclear whether BLI is superior to LCI, and a further large-scale study is needed. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT1022190018-1).
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Affiliation(s)
- Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - So Takahashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomoyuki Oikawa
- Department of Gastroenterology, Miyagi Cancer Center, Miyagi, Japan
| | - Wataru Iwai
- Department of Gastroenterology, Miyagi Cancer Center, Miyagi, Japan
| | - Sho Asonuma
- Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan
| | - Hideki Okata
- Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan
| | - Motoki Ohyauchi
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Hirotaka Ito
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Yasuhiko Abe
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masashi Kawamura
- Department of Gastroenterology, Sendai City Hospital, Miyagi, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tomohiro Nakamura
- Departments of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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10
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Wang Y, Zhang X, Yang Z, Wang T, Zhu D, Gao J, Zhang PP, Wang P, Shi X. Long-term follow-up of endoscopic papillectomy and the value of preventive pancreatic stent placement (with videos). Gastroenterol Rep (Oxf) 2023; 11:goad050. [PMID: 37867926 PMCID: PMC10585593 DOI: 10.1093/gastro/goad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023] Open
Abstract
Background Early-stage ampullary adenomas have only been reported in a small case series on endoscopic management. Hence, this study aimed to evaluate the long-term outcomes of early ampullary adenoma with endoscopic management and identify the risk factors for acute pancreatitis after endoscopic papillectomy (EP). Methods In this study, 115 patients who underwent EP at Changhai Hospital (Shanghai, China) between January 2012 and December 2018 were retrospectively analysed. Endoscopy was performed at 1, 3, 6, and 12 months after EP. Data were statistically analysed using the t-test or the Mann-Whitney U test. Results A total of 107 patients were included in this study and the follow-up period was 75 ± 43 months. The average age of the 107 patients was 54.6 years and the average tumor size was 17 mm. The average age of the patients (53.7 ± 10.7 years vs 55.2 ± 10.5 years, P = 0.482), minimum tumor size (13 vs 19 mm, P = 0.063), and complete resection rate (84.78% vs 85.25%, P = 0.947) did not differ significantly between the stent placement and non-stent placement groups. Post-EP acute pancreatitis rates in the non-stent placement and stent placement groups were 11.48% and 4.35%, respectively. The risk of post-EP acute pancreatitis was significantly associated with the preoperative carcinoembryonic antigen level in univariate analysis, but not in multivariate analysis. The risk of post-EP acute pancreatitis was not significantly associated with the placement of the pancreatic stent in either univariate or multivariate analysis. Moreover, delayed proximal pancreatic duct stenosis was not noted in either group during long-term follow-up. Conclusions EP is a satisfactory option for treating adenomas of the ampulla of the duodenum.
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Affiliation(s)
- Yuling Wang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Xiaoqing Zhang
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Zhenhua Yang
- Department of Nephrology, Gongli Hospital, Pudong New Area, Shanghai, P. R. China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Dongqing Zhu
- Department of Radiology, Changzheng Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Jie Gao
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Ping-Ping Zhang
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Peiqin Wang
- Department of Gastroenterology, Changzheng Hospital, Naval Military Medical University, Shanghai, P. R. China
| | - Xingang Shi
- Department of Gastroenterology, Changhai Hospital, Naval Military Medical University, Shanghai, P. R. China
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11
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Mansuri I, Goldsmith JD, Liu E, Bonilla S. Gastric Intestinal Metaplasia in Children: Natural History and Clinicopathological Correlation. J Pediatr Gastroenterol Nutr 2023; 77:332-338. [PMID: 37319118 DOI: 10.1097/mpg.0000000000003862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Gastric intestinal metaplasia (GIM) is defined as the replacement of the normal gastric epithelium by intestinal-type epithelium. GIM is considered a preneoplastic lesion for gastric adenocarcinoma in adults and is found in 25% of Helicobacter pylori ( H pylori ) exposed adults. However, the significance of GIM in pediatric gastric biopsies is still unknown. METHODS We conducted a retrospective study of children with GIM on gastric biopsies at Boston Children's Hospital between January 2013 and July 2019. Demographic, clinical, endoscopic, and histologic data were collected and compared to age and sex-matched cohort without GIM. Gastric biopsies were reviewed by the study pathologist. GIM was classified as complete/incomplete based on Paneth cell presence or absence and limited/extensive based on its distribution in the antrum or both antrum and corpus. RESULTS Of 38 patients with GIM, 18 were male (47%), mean age of detection was 12.5 ± 5.05 years (range, 1-18 years). The most common histologic was chronic gastritis (47%). Complete GIM was present in 50% (19/38) and limited GIM was present in 92% (22/24). H pylori was positive in 2 patients. Two patients had persistent GIM on repeat esophagogastroduodenoscopy (2/12). No dysplasia or carcinoma was identified. Proton-pump inhibitor use and chronic gastritis were more common in GIM patients compared to control ( P = 0.02). CONCLUSION Most children with GIM had low-risk histologic subtype (complete/limited) for gastric cancer; GIM was rarely associated with H pylori gastritis in our cohort. Larger multicenter studies are needed to better understand outcomes and risk factors in children with GIM.
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Affiliation(s)
- Ishrat Mansuri
- From the Division of Gastroenterology, Boston Children's Hospital, Boston, MA
| | | | - Enju Liu
- the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Silvana Bonilla
- From the Division of Gastroenterology, Boston Children's Hospital, Boston, MA
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12
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Meyers TM, Reeves PT, Lombardo JL, Anisowicz SK, Larson NS, Rogers PL. Autoimmune gastritis as an unexpected cause of diarrhea in a young adult with type I diabetes: a case report. J Med Case Rep 2023; 17:342. [PMID: 37507704 PMCID: PMC10386669 DOI: 10.1186/s13256-023-04039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is a lifelong diagnosis that involves immune-mediated damage of pancreatic beta cells and subsequent hyperglycemia, manifesting as: polyuria, polydipsia, polyphagia, and weight loss. Treatment of type 1 diabetes centers on insulin administration to replace or supplement the body's own insulin with the goal of achieving euglycemia and preventing or minimizing complications. Patients with T1DM are at risk for developing other autoimmune conditions, most commonly thyroid or celiac disease. CASE PRESENTATION A 20-year-old African American female with T1DM was referred by her endocrinologist to pediatric gastroenterology for 2 months of nocturnal, non-bloody diarrhea, left lower quadrant pain, and nausea; she was also being followed by neurology for complaints of lower extremity paresthesias and pain. The patient's initial lab-workup was remarkable for a low total Immunoglobulin A (IgA) level of < 6.7 mg/dL. As IgA deficiency is associated with an increased risk of celiac disease, the patient underwent upper and lower endoscopy, which was grossly unremarkable; however, histology revealed a pattern consistent with autoimmune gastritis. Subsequent serum evaluation was remarkable for an elevated fasting gastrin level and an elevated parietal cell antibody level without macrocytic anemia, iron deficiency, or vitamin B12 depletion. The patient was diagnosed with autoimmune gastritis (AIG) and subsequently initiated on parenteral B12 supplementation therapy with improvement in her neurologic and gastrointestinal symptoms. CONCLUSION This case illustrates the importance of recognition of red flag findings in a patient with known autoimmune disease. Following well-established health maintenance recommendations for individuals with T1DM ensures that common comorbidities will be detected. Autoimmune gastritis, while a rarer pathology in the pediatric population, deserves consideration in patients with pre-existing autoimmune conditions and new gastrointestinal or neurologic symptoms, as AIG can be associated with poor outcomes and risk of malignancy. Initial lab findings associated with an eventual diagnosis of AIG typically include anemia, iron deficiency, or Vitamin B12 deficiency. However, as demonstrated in this case, symptoms of AIG can rarely present before anemia or Vitamin B12 deficiency develops. To prevent permanent neurological damage, parenteral Vitamin B12 therapy must be considered even in the absence of Vitamin B12 deficiency, especially in those patients already experiencing neurological symptoms.
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Affiliation(s)
- Taylor M Meyers
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA.
| | - Patrick T Reeves
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jamie L Lombardo
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sarah K Anisowicz
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Noelle S Larson
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Philip L Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD, 20814, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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13
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Sinonquel P, Vermeire S, Maes F, Bisschops R. Advanced Imaging in Gastrointestinal Endoscopy: A Literature Review of the Current State of the Art. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:175-191. [PMID: 37387720 PMCID: PMC10305270 DOI: 10.1159/000527083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/11/2022] [Indexed: 01/03/2025]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) endoscopy has known a great evolution in the last decades. Imaging techniques evolved from imaging with only standard white light endoscopes toward high-definition resolution endoscopes and the use of multiple color enhancement techniques, over to automated endoscopic assessment systems based on artificial intelligence. This narrative literature review aimed to provide a detailed overview on the latest evolutions within the field of advanced GI endoscopy, mainly focusing on the screening, diagnosis, and surveillance of common upper and lower GI pathology. METHODS This review comprises only literature about screening, diagnosis, and surveillance strategies using advanced endoscopic imaging techniques published in (inter)national peer-reviewed journals and written in English. Studies with only adult patients included were selected. A search was performed using MESH terms: dye-based chromoendoscopy, virtual chromoendoscopy, video enhancement technique, upper GI tract, lower GI tract, Barrett's esophagus, esophageal squamous cell carcinoma, gastric cancer, colorectal polyps, inflammatory bowel disease, artificial intelligence. This review does not elaborate on the therapeutic application or impact of advanced GI endoscopy. CONCLUSIONS Focusing on current and future applications and evolutions in the field of both upper and lower GI advanced endoscopy, this overview is a practical but detailed projection of the latest developments. Within this review, an active leap toward artificial intelligence and its recent developments in GI endoscopy was made. Additionally, the literature is weighted against the current international guidelines and assessed for its potential positive future impact.
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Affiliation(s)
- Pieter Sinonquel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Frederik Maes
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
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14
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Garg R, Thind K, Bhalla J, Simonson MT, Simons-Linares CR, Singh A, Joyce D, Chahal P. Long-term recurrence after endoscopic versus surgical ampullectomy of sporadic ampullary adenomas: a systematic review and meta-analysis. Surg Endosc 2023:10.1007/s00464-023-10083-0. [PMID: 37221416 DOI: 10.1007/s00464-023-10083-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND AIMS Ampullary adenomas are treated both surgically and endoscopically, however, data comparing both techniques are lacking. We aimed to compare long-term recurrence of benign sporadic adenomas after endoscopic (EA) and surgical ampullectomy (SA). METHODS A comprehensive literature search of multiple databases (until December 29, 2020) was performed to identify studies reporting outcomes of EA or SA of benign sporadic ampullary adenomas. The outcome was recurrence rate at 1 year, 2-year, 3 year and 5 years after EA and SA. RESULTS A total of 39 studies with 1753 patients (1468 EA [age 61.1 ± 4.0 years, size 16.1 ± 4.0 mm], 285 SA [mean age 61.6 ± 4.48 years, size 22.7 ± 5.4 mm]) were included in the analysis. At year 1, pooled recurrence rate of EA was 13.0% (95% confidence interval [CI] 10.5-15.9], I2 = 31%) as compared to SA 14.1% (95% CI 9.5-20.3 I2 = 15.8%) (p = 0.82). Two (12.5%, [95% CI, 8.9-17.2] vs. 14.3 [95% CI, 9.1-21.6], p = 0.63), three (13.3%, [95% CI, 7.3-21.6] vs. 12.9 [95% CI, 7.3-21.6], p = 0.94) and 5 years (15.7%, [95% CI, 7.8-29.1] vs. 17.6% [95% CI, 6.2-40.8], p = 0.85) recurrence rate were comparable after EA and SA. On meta-regression, age, size of lesion or enbloc and complete resection were not significant predictors of recurrence. CONCLUSION EA and SA of sporadic adenomas have similar recurrence rates at 1, 2, 3 and 5 years of follow up.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Komal Thind
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaideep Bhalla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marian T Simonson
- Cleveland Clinic Alumni Library, Cleveland Clinic, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Joyce
- Department of Hepatopancreaticobiliary Surgery, Digestive Diseases and Surgery Institute Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA.
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15
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Cheema HI, Tharian B, Inamdar S, Garcia-Saenz-de-Sicilia M, Cengiz C. Recent advances in endoscopic management of gastric neoplasms. World J Gastrointest Endosc 2023; 15:319-337. [PMID: 37274561 PMCID: PMC10236974 DOI: 10.4253/wjge.v15.i5.319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/12/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy, magnification endoscopy, and narrow-band imaging, more recently supplemented by artificial intelligence, have enabled wider recognition and detection of various gastric neoplasms including early gastric cancer (EGC) and subepithelial tumors, such as gastrointestinal stromal tumors and neuroendocrine tumors. Over the last decade, the evolution of novel advanced therapeutic endoscopic techniques, such as endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection, along with the advent of a broad array of endoscopic accessories, has provided a promising and yet less invasive strategy for treating gastric neoplasms with the advantage of a reduced need for gastric surgery. Thus, the management algorithms of various gastric tumors in a defined subset of the patient population at low risk of lymph node metastasis and amenable to endoscopic resection, may require revision considering upcoming data given the high success rate of en bloc resection by experienced endoscopists. Moreover, endoscopic surveillance protocols for precancerous gastric lesions will continue to be refined by systematic reviews and meta-analyses of further research. However, the lack of familiarity with subtle endoscopic changes associated with EGC, as well as longer procedural time, evolving resection techniques and tools, a steep learning curve of such high-risk procedures, and lack of coding are issues that do not appeal to many gastroenterologists in the field. This review summarizes recent advances in the endoscopic management of gastric neoplasms, with special emphasis on diagnostic and therapeutic methods and their future prospects.
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Affiliation(s)
- Hira Imad Cheema
- Department of Internal Medicine, Baptist Health Medical Center, Little Rock, AR 72205, United States
| | - Benjamin Tharian
- Department of Interventional Endoscopy/Gastroenterology, Bayfront Health, Digestive Health Institute, St. Petersberg, FL 33701, United States
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Mauricio Garcia-Saenz-de-Sicilia
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Cem Cengiz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, United States
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, TOBB University of Economics and Technology, Ankara 06510, Turkey
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16
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Erdoğan Ç, Arı D, Yeşil B, Koşar K, Coşkun O, Tenlik İ, Köseoğlu HT, Yüksel M. Evaluation of non-gastric upper gastrointestinal system polyps: an epidemiological assessment. Sci Rep 2023; 13:6168. [PMID: 37061587 PMCID: PMC10105756 DOI: 10.1038/s41598-023-33451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/13/2023] [Indexed: 04/17/2023] Open
Abstract
Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.
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Affiliation(s)
- Çağdaş Erdoğan
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey.
| | - Derya Arı
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
| | - Bayram Yeşil
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
| | - Kenan Koşar
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
| | - Orhan Coşkun
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
| | - İlyas Tenlik
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
| | - Hasan Tankut Köseoğlu
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
| | - Mahmut Yüksel
- Department of Gastroenterology, Ankara City Hospital, University of Health Sciences, Bilkent Avenue, Çankaya, 06800, Ankara, Turkey
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17
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Feng Y, Zhang Y, Wang F, Liang Y, Liu Y, Ren L. Radiation-free endoscopic papillectomy for ampullary adenoma: experience from a Chinese tertiary hospital. Surg Endosc 2023; 37:4097-4103. [PMID: 37024584 DOI: 10.1007/s00464-023-10038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/12/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Conventional endoscopic papillectomy (ESP) for ampullary adenoma is performed as a hybrid endoscopy and fluoroscopy guided procedure. In this study, we report our preliminary experience of non-radiation ESP. METHODS The present method includes endoscopic snare resection, non-radiation endoscopic biliary and pancreatic stenting and endoclipping. Data from ten patients who underwent non-radiation ESP due to ampullary adenoma were collected. Procedure details, adverse events and follow-up were analyzed. RESULTS Complete resection was accomplished in all patients, with en bloc resection and piecemeal resection in nine and one patient(s), respectively. Both biliary and pancreatic stenting and biliary stenting alone were achieved in eight and two patients, respectively. Endoclipping was performed in all patients. Hyperleukocytosis and hyperamylasemia occurred in two and one patient(s), respectively. No other complications occurred. No lesion residual or recurrence occurred during follow-up. CONCLUSIONS Radiation-free ESP can be technically feasible and safely executed by experienced endoscopists. Our study provides a novel strategy for endoscopic resection of major papilla adenoma.
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Affiliation(s)
- Yadong Feng
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
| | - Yinqiu Zhang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Fangjun Wang
- Department of Gastroenterology, Jiangyin Hospital Affiliated to Nantong University, No. 3 Yingrui Road, Jiangyin, 214400, China
| | - Yan Liang
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Yang Liu
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Lihua Ren
- Department of Gastroenterology, School of Medicine, Zhongda Hospital Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
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18
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Wang ZX, Li LS, Su S, Li JP, Zhang B, Wang NJ, Liu SZ, Wang SS, Zhang S, Bi YW, Gao F, Shao Q, Xu N, Shao BZ, Yao Y, Liu F, Linghu EQ, Chai NL. Linked color imaging vs Lugol chromoendoscopy for esophageal squamous cell cancer and precancerous lesion screening: A noninferiority study. World J Gastroenterol 2023; 29:1899-1910. [PMID: 37032726 PMCID: PMC10080703 DOI: 10.3748/wjg.v29.i12.1899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/29/2022] [Accepted: 03/13/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND Lugol chromoendoscopy (LCE) has served as a standard screening technique in high-risk patients with esophageal cancer. Nevertheless, LCE is not suitable for general population screening given its side effects. Linked color imaging (LCI) is a novel image-enhanced endoscopic technique that can distinguish subtle diff-erences in mucosal color.
AIM To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions.
METHODS In this prospective study, we enrolled 543 patients who underwent white light imaging (WLI), LCI and LCE successively. We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions. Clinicopathological features and color analysis of lesions were assessed.
RESULTS In total, 43 patients (45 neoplastic lesions) were analyzed. Among them, 36 patients (38 neoplastic lesions) were diagnosed with LCI, and 39 patients (41 neoplastic lesions) were diagnosed with LCE. The sensitivity of LCI was similar to that of LCE (83.7% vs 90.7%, P = 0.520), whereas the specificity of LCI was greater than that of LCE (92.4% vs 87.0%, P = 0.007). The LCI procedure time in the esophageal examination was significantly shorter than that of LCE [42 (34, 50) s vs 160 (130, 189) s, P < 0.001]. The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI. However, the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer.
CONCLUSION LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions, and LCI represents a promising screening strategy for general populations.
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Affiliation(s)
- Zi-Xin Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Long-Song Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Song Su
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jin-Ping Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Nan-Jun Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Sheng-Zhen Liu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Sha-Sha Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Shuai Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ya-Wei Bi
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Fei Gao
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Qun Shao
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ning Xu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Bo-Zong Shao
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yi Yao
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Fang Liu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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19
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Ramai D, Facciorusso A, Singh J, Brooks OW, Mirtorabi H, Barakat M, Ofosu A, Mcdonough S, Adler DG. Endoscopic Management of Ampullary Adenomas in Familial Adenomatous Polyposis Syndrome: A Systematic Review with Pooled Analysis. Dig Dis Sci 2022; 67:3220-3227. [PMID: 34251561 DOI: 10.1007/s10620-021-07132-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic papillectomy is a viable therapy in ampullary lesions. Prior studies have reported on outcomes of sporadic ampullary lesions, and only small cohort studies have reported outcomes associated with familial adenomatous polyposis (FAP) syndrome. AIMS We performed a systematic review with pooled analysis to assess the safety and efficacy of EP for treating ampullary adenomas in FAP. METHODS We performed a comprehensive literature search of major databases from inception to May 2020. Studies that included patients with endoscopically resected ampullary lesions and FAP were eligible. The rate of technical success, en bloc resection, piecemeal resection, recurrence, and adverse events was pooled by means of a random-effects model to obtain a proportion with a 95% confidence interval (CI). RESULTS Six studies, including a total of 99 patients, were included in our final analysis. Patient age ranged from 28 to 91 years. Pooled technical success was 90.3% (CI 76.9-96.3%, I2 = 31%). Rate of en bloc resection was 60.6% (CI 47.9-72.0%, I2 = 0%). Recurrence rate was 25.4% (5.7-65.9%, I2 = 82%). The post-procedural pancreatitis rate was 14.7% of which 68% (51 of 75) utilized prophylactic pancreatic stenting. Other adverse events included bleeding (9.2%) and perforation (4%). CONCLUSION Endoscopic papillectomy offers high technical success but remains challenging in patients with FAP, particularly due to high recurrence rates.
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Affiliation(s)
- Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Port Jefferson, NY, USA
| | - Olivia W Brooks
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Houman Mirtorabi
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Andrew Ofosu
- Division of Gastroenterology, Stanford University, Stanford, CA, USA
| | | | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, CO, USA.
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20
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Sato H, Nishikawa Y, Abe H, Shiwaku H, Shiota J, Sato C, Sakae H, Ominami M, Hata Y, Fukuda H, Ogawa R, Nakamura J, Tatsuta T, Ikebuchi Y, Yokomichi H, Terai S, Inoue H. Esophageal carcinoma in achalasia patients managed with endoscopic submucosal dissection and peroral endoscopic myotomy: Japan Achalasia Multicenter Study. Dig Endosc 2022; 34:965-973. [PMID: 34787940 DOI: 10.1111/den.14197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Indications for peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD) in patients with achalasia concomitant with esophageal carcinoma (EC) are unclear. This study aimed to clarify the role of POEM in cases of achalasia concomitant with EC and to elucidate the indications for ESD and efficient surveillance for EC. METHODS We conducted a multicenter cohort study at 14 hospitals in Japan, including 3707 cases of achalasia-related esophageal motility disorders (EMDs). Factors contributing to EC risk, the characteristics of EC, and clinical outcomes of POEM/ESD were analyzed. RESULTS In patients undergoing POEM, screening and surveillance endoscopy throughout a 1-year period resulted in diagnosis of 72.1% new EC cases. Of 62 patients with 123 ECs, 40.3% had multiple or metachronous lesions within 37.5 months. EC was predominantly observed in the middle thoracic esophagus (58.5%) and posteriorly (73.2%). POEM had comparable safety and efficacy in cases of concomitant EC even after ESD. Endoscopic en bloc resection was performed in 95.8% and 89.3% of ECs diagnosed before and after POEM, respectively (P = 0.351); however, ESD on the POEM-line was impaired by fibrosis. Multivariate analysis revealed risk factors for EC, including regular alcohol consumption, a history of smoking, advanced age, and extended disease duration. Alcohol intake and smoking had a synergistic effect on EC development. CONCLUSIONS Screening and surveillance of POEM help in detecting EC. ESD is feasible in achalasia, although on the POEM-line is challenging. Surveillance endoscopy for EC is recommended for cases with specific risks and a history of ECs.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - Yohei Nishikawa
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
| | - Hirofumi Abe
- Department of Gastroenterology, Kobe University Hospital, Hyogo, Japan
| | - Hironari Shiwaku
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Junya Shiota
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroyuki Sakae
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshitaka Hata
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisashi Fukuda
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryo Ogawa
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yuichiro Ikebuchi
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Yamanashi, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
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21
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Joo JS, Park JH, Kim JS, Kang SH, Moon HS, Sung JK, Jeong HY. Risk factors for the histologic discrepancy of gastric adenomatous lesions and long-term outcome. Medicine (Baltimore) 2021; 100:e27827. [PMID: 34766597 PMCID: PMC8589245 DOI: 10.1097/md.0000000000027827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
Although endoscopic forceps biopsies (EFB) have a significant role in diagnosing gastric adenoma, there are still discrepancies between EFBs and finalized pathology results.Therefore, the objective of this study was to find the risk factors that cause this discrepancy and to analyze the effects of this discrepancy on the long-term outcome.In this study patients that had received endoscopic resection due to low-grade gastric adenoma diagnosis from EFB between January of 2011 and January of 2018 at the Chungnam National University Hospital were retrospectively analyzed. According to whether there was histological discrepancy the cumulative incidence of the metachronous lesions were analyzed.A total of 745 lesions diagnosed as low-grade gastric adenoma at EFB were enrolled, and the final pathology results were confirmed to be non-neoplastic (n = 19), low-grade adenoma (n = 614), High-grade adenoma (n = 63), and carcinoma (n = 49), and with the exception of non-neoplastic lesion, the results confirmed 84.6% (n = 614) for the concordant group and 15.4% (n = 112) for the discordant. The results of the multivariate analysis confirmed that depressed lesion (odds ratio [OR]: 2.056; 95% confidence interval [CI]: 1.130-3.451; P = .011), erythema (OR: 2.546; 95% CI: 1.604-4.030; P = .004), and a size >1.5 cm (OR: 1.903; 95% CI: 1.102-3.172; P = .018) were risk factors for discrepancy. The results also confirmed that for the average observation period of (SD) 39.12 (12.31) months, the cumulative incidence of metachronous neoplasm had a higher significance (P = 0.001) in the discordant group when compared to that of the concordant group.The factors related to the histologic discrepancy of low-grade gastric adenoma were depressed lesion, erythema and size >1.5 cm. In the groups with histological discrepancy, the cumulative incidence of the metachronous neoplasm was significantly higher and therefore closer observation of such patients after performing endoscopic resection is necessary.
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22
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Tseng J, Miller JP, Johnson J, Waters K, Gangi A, Gong J, Burch M. Disparities and survival in newly diagnosed gastric cancer in Hispanic patients in the United States: a propensity score matched analysis. J Gastrointest Oncol 2021; 12:1308-1325. [PMID: 34532090 DOI: 10.21037/jgo-21-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Background The burden of gastric cancer involving Hispanic patients in the United States is growing as both the population and the incidence of gastric cancer in this group increases. This burden is compounded by presentation with advanced disease and socioeconomic challenges shaping cancer care. We sought to describe the demographics, socioeconomic factors, treatment, and survival experience of Hispanic patients with gastric adenocarcinoma. Methods Patients with gastric adenocarcinoma diagnosed between 2004 and 2015 (n=90,737) in the National Cancer Database were retrospectively identified. Patients of Hispanic ethnicity were compared against non-Hispanic white patients. Surgical cohort was further analyzed, and 1:1 propensity score matching was used to balance covariates between Hispanic and non-Hispanic white surgical patients. Survival was compared using Kaplan-Meier method. Cox regression was used to determine prognostic factors for survival. Results Compared to non-Hispanic white patients, Hispanic patients are more likely to be younger, female, and healthier. They were more likely to be uninsured, reside in poorer neighborhoods and reside in areas with lower rates of education. Hispanic patients were more likely to live in a metropolitan area, travel shorter distances for healthcare, and receive treatment at an academic and high volume centers. Hispanic patients were more likely to have higher stage disease presentation, higher grade tumors, lymphovascular invasion, and poorly cohesive adenocarcinoma. Hispanic patients were more likely to receive surgery, but less likely to receive adjuvant therapy. In Cox regression of all patients, unmatched surgical patients, and matched surgical patients, Hispanic ethnicity was an independent prognostic factor of improved survival. Conclusions Hispanic patients with gastric adenocarcinoma present with several unfavorable clinicopathologic and socioeconomic factors. Paradoxically, these patients demonstrate improved survival. Further study is warranted to characterize disease biology in this population.
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Affiliation(s)
- Joshua Tseng
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James P Miller
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey Johnson
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin Waters
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexandra Gangi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jun Gong
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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23
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Belkovets AV, Ozhiganova NV. Are all the polyps in the stomach the same? EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021; 1:134-139. [DOI: 10.31146/1682-8658-ecg-190-6-134-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
The article presents a clinical case of a 38-year-old patient with revealed polyps of the stomach body and iron deficiency anemia on the background of chronic atrophic gastritis. On the example of this observation, variants of the course were demonstrated, including endoscopic and histological manifestations of autoimmune (atrophic corpus) gastritis (AIG). In parallel, the issues of diagnosis and management of patients with the most common polyps in the stomach are discussed. The problem of timely diagnosis of AIG and the advantages of non-invasive methods for assessing the functional state of the stomach is also being actualized.
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Affiliation(s)
- A. V. Belkovets
- IIPM — Branch of the Federal State Budget Scientifi c Institution “The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences”; Federal State Budget Educational Institution of Higher Education “Novosibirsk State Medical University” Ministry of Health of the Russian Federation
| | - N. V. Ozhiganova
- IIPM — Branch of the Federal State Budget Scientifi c Institution “The Federal Research Center Institute of Cytology and Genetics of Siberian Branch of the Russian Academy of Sciences”
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24
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Xia R, Zeng H, Liu W, Xie L, Shen M, Li P, Li H, Wei W, Chen W, Zhuang G. Estimated Cost-effectiveness of Endoscopic Screening for Upper Gastrointestinal Tract Cancer in High-Risk Areas in China. JAMA Netw Open 2021; 4:e2121403. [PMID: 34402889 PMCID: PMC8371571 DOI: 10.1001/jamanetworkopen.2021.21403] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
IMPORTANCE Upper gastrointestinal tract cancer, including esophageal and gastric cancers, in China accounts for 50% of the global burden. Endoscopic screening may be associated with a decreased incidence of and mortality from upper gastrointestinal tract cancer. OBJECTIVE To evaluate the cost-effectiveness of endoscopic screening for esophageal and gastric cancers among people aged 40 to 69 years in areas of China where the risk of these cancers is high. DESIGN, SETTING, AND PARTICIPANTS For this economic evaluation, a Markov model was constructed for initial screening at different ages from a health care system perspective, and 5 endoscopic screening strategies with different frequencies (once per lifetime and every 10 years, 5 years, 3 years, and 2 years) were evaluated. The study was conducted between January 1, 2019, and October 31, 2020. Model parameters were estimated based on this project, government documents, and published literature. For each initial screening age (40-44, 45-49, 50-54, 55-59, 60-64, and 65-69 years), a closed cohort of 100 000 participants was assumed to enter the model and follow the alternative strategies. MAIN OUTCOMES AND MEASURES Cost-effectiveness was measured by calculating the incremental cost-effectiveness ratio (ICER), and the willingness-to-pay threshold was assumed to be 3 times the per capita gross domestic product in China (US $10 276). Univariate and probabilistic sensitivity analyses were conducted to assess the robustness of model findings. RESULTS The study included a hypothetical cohort of 100 000 individuals aged 40 to 69 years. All 5 screening strategies were associated with improved effectiveness by 1087 to 10 362 quality-adjusted life-years (QALYs) and increased costs by US $3 299 000 to $22 826 000 compared with no screening over a lifetime, leading to ICERs of US $1343 to $3035 per QALY. Screening at a higher frequency was associated with an increase in QALYs and costs; ICERs for higher frequency screening compared with the next-lower frequency screening were between US $1087 and $4511 per QALY. Screening every 2 years would be the most cost-effective strategy, with probabilities of 90% to 98% at 3 times the per capita gross domestic product of China. The model was the most sensitive to utility scores of esophageal cancer- or gastric cancer-related health states and compliance with screening. CONCLUSIONS AND RELEVANCE The findings suggest that combined endoscopic screening for esophageal and gastric cancers may be cost-effective in areas of China where the risk of these cancers is high; screening every 2 years would be the optimal strategy. These data may be useful for development of policies targeting the prevention and control of upper gastrointestinal tract cancer in China.
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Affiliation(s)
- Ruyi Xia
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Hongmei Zeng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Li Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Mingwang Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Peng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - He Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqiang Wei
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
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25
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Gruner M, Denis A, Masliah C, Amil M, Metivier-Cesbron E, Luet D, Kaasis M, Coron E, Le Rhun M, Lecleire S, Antonietti M, Legoux JL, Lefrou L, Renkes P, Tarreirias AL, Balian P, Rey P, Prost B, Cellier C, Rahmi G, Samaha E, Fratte S, Guerrier B, Landel V, Touzet S, Ponchon T, Pioche M. Narrow-band imaging versus Lugol chromoendoscopy for esophageal squamous cell cancer screening in normal endoscopic practice: randomized controlled trial. Endoscopy 2021; 53:674-682. [PMID: 32698233 DOI: 10.1055/a-1224-6822] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics). METHODS This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. RESULTS 334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015. In per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100 %, 66.0 %, 21.2 %, and 100 %, respectively, for Lugol chromoendoscopy vs. 100 %, 79.9 %, 37.5 %, and 100 %, respectively, for NBI. Specificity was greater with NBI than with Lugol (P = 0.002). CONCLUSIONS As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia.
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Affiliation(s)
- Mélissa Gruner
- Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Angélique Denis
- Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France
| | - Claude Masliah
- Gastroenterology Division, Clinique Mutualiste de l'Estuaire, Saint Nazaire, France
| | - Morgane Amil
- Gastroenterology Division, Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | - Dominique Luet
- Gastroenterology Division, Centre Hospitalo-Universitaire Larrey, Angers, France
| | - Medhi Kaasis
- Gastroenterology Division, Centre Hospitalier de Cholet, Cholet, France
| | - Emmanuel Coron
- Hepatogastroenterology Department, Hotel Dieu, Nantes, France
| | - Marc Le Rhun
- Hepatogastroenterology Department, Hotel Dieu, Nantes, France
| | - Stéphane Lecleire
- Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France
| | - Michel Antonietti
- Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France
| | - Jean-Louis Legoux
- Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France
| | - Laurent Lefrou
- Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France
| | - Pascal Renkes
- Gastroenterology Division, Hôpital Clinique Claude Bernard, Metz, France
| | | | | | - Philippe Rey
- Gastroenterology Division, Hôpital d'Instruction des Armées, Legouest, Metz, France
| | - Bénédicte Prost
- Gastroenterology Division, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Christophe Cellier
- Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
| | - Gabriel Rahmi
- Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
| | - Elia Samaha
- Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
| | - Serge Fratte
- Gastroenterology Division, Centre Hospitalier Régional, Belfort, France
| | - Béatrice Guerrier
- Gastroenterology Division, Centre Hospitalier Bourg en Bresse, Bourg en Bresse, France
| | - Verena Landel
- Direction Recherche Clinique et Innovations, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Touzet
- Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France.,INSERM U1032, LabTAU, Lyon, France
| | - Mathieu Pioche
- Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University Claude Bernard, Lyon, France.,INSERM U1032, LabTAU, Lyon, France
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26
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Trivanovic D, Plestina S, Honovic L, Dobrila-Dintinjana R, Vlasic Tanaskovic J, Vrbanec D. Gastric cancer detection using the serum pepsinogen test method. TUMORI JOURNAL 2021; 108:386-391. [PMID: 33993805 DOI: 10.1177/03008916211014961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastric cancer (GC) is the eighth most common cause of cancer deaths in Croatia and one of the most common causes of cancer deaths worldwide. A reliable diagnostic tool for the early detection of GC is essential. OBJECTIVE We previously suggested a pepsinogen test method to reduce the mortality from GC by allowing early detection. Here, we report an updated analysis from a prospective single-center clinical study to evaluate the sensitivity and specificity of the pepsinogen test method and to determine whether this test can be used as a part of routine laboratory assessment of high-risk patients. METHODS We present mature data of the pepsinogen test method in the Croatian population after a median follow-up of 36 months. Statistical analyses were performed using a Mann-Whitney U test, multiple logistic regression, and receiver operating characteristics (ROC) to evaluate the predictive power of the assayed biomarkers. RESULTS Of the 116 patients, 25 patients had GC and 91 demonstrated a nonmalignant pathology based on tissue biopsy. Cutoff values were pepsinogen I ⩽70 and pepsinogen I/II ratio ⩽3.0. Using ROC curve analysis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were determined to be 87.22%, 78.12%, 90.10%, 71.43%, and 92.86%, respectively, for the diagnosis of GC. The area under the curve was 0.700 (95% confidence interval 0.57-0.83). CONCLUSION Pepsinogen tests are valuable for screening a population in need of further diagnosis and could help to avoid unnecessary invasive endoscopic procedures.
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Affiliation(s)
- Dragan Trivanovic
- Department of Oncology and Medical Faculty, General Hospital Pula, Pula, Croatia
| | - Stjepko Plestina
- Department of Oncology and Radiotherapy, Clinical Hospital Zagreb, Zagreb, Croatia
| | - Lorena Honovic
- Department of Clinical Chemistry and Medical Faculty, General Hospital Pula, Pula, Croatia
| | | | | | - Damir Vrbanec
- Department of Oncology and Medical Faculty, General Hospital Pula, Pula, Croatia
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Achalasia and esophageal cancer: a large database analysis in Japan. J Gastroenterol 2021; 56:360-370. [PMID: 33538893 DOI: 10.1007/s00535-021-01763-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achalasia has been reported to be associated with esophageal cancers (ECs). However, owing to the rarity of achalasia, details of achalasia-related ECs are not well investigated. METHOD The incidence of ECs in Japanese patients with achalasia and achalasia-related esophageal motility disorders (EMDs) was estimated, and risk factors for achalasia-related ECs were determined. Characteristics of ECs and treatment courses were also analyzed. RESULTS Between 2010 and 2019, 2714 Japanese patients with achalasia and achalasia-related EMDs were recorded in 7 high-volume centers; 24 patients (21 men, 3 women) developed ECs. The incidence of ECs was estimated at 0.078 and 0.28 per 100 person-years from the onset and the diagnosis of disease, respectively. Kaplan-Meier estimate suggested that, in addition to a long history of achalasia, advanced age, male sex, and regular alcohol consumption were statistically significant risk factors for EC development. A prevalence of 40 ECs (12.5% multiple lesions, and 22.7% metachronal lesions) was also noted, predominantly distributed over the thoracic esophagus. All were histologically diagnosed as squamous cell carcinoma. Superficial ECs were successfully treated with endoscopic treatment in all cases, except one. Achalasia-related Barret esophagus was extremely rare, and Barret adenocarcinoma was not detected in our cohort. CONCLUSION The high relative risk of ECs was clarified in Japanese achalasia patients, although the absolute risk remained low. Therefore, surveillance endoscopy may be recommended in limited patients with several aforementioned risk factors determined. Superficial cancer can be treated with endoscopic treatment. Multiple and metachronal ECs should be screened.
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Cecinato P, Parmeggiani F, Braglia L, Carlinfante G, Zecchini R, Decembrino F, Iori V, Sereni G, Tioli C, Cavina M, Camellini L, Azzolini F, Ponz de Leon M, Sassatelli R. Endoscopic Papillectomy for Ampullary Adenomas: Different Outcomes in Sporadic Tumors and Those Associated with Familial Adenomatous Polyposis. J Gastrointest Surg 2021; 25:457-466. [PMID: 31898110 DOI: 10.1007/s11605-019-04500-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ampullary adenomas are rare and potentially malignant. Surgery was the standard treatment but endoscopic papillectomy (EP) is a possible alternative. AIM We retrospectively evaluated the principal clinical outcomes of EP in all patients referred to our unit also dividing sporadic ampullary adenoma (SAA) from familial adenomatous polyposis (FAP)-associated adenomas. METHODS All consecutive patients who underwent endoscopic papillectomy because of ampullary adenoma were considered. The primary outcome was the technical success of EP. Secondary outcomes included the number of procedures, the adverse event rate, the recurrence rate, the concordance of histology pre- and post-EP, and the evaluation of factors related to technical success. RESULTS Between January 2001 and December 2015, sixty-two patients were included (21 FAP and 41 SAA). Technical success was achieved in 75.8% and was different in the two groups (FAP 95.2%, SAA 65.8%, p 0.025). Intraductal invasion was negatively associated with technical success (41.7% vs. 84.0%; p 0.005). The intestinal subtype was predictive of success (79.7% vs. 0%; p 0.012) as well as en bloc resection (90.3% vs. 61.3%; p 0.016). Adverse events were reported in 14 patients (22.6%). CONCLUSIONS EP is an effective and safe procedure and is a viable alternative to surgery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03494543.
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Affiliation(s)
- Paolo Cecinato
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy.
| | - Francesca Parmeggiani
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Luca Braglia
- Research and Statistics Infrastructure, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Ramona Zecchini
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Francesco Decembrino
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Veronica Iori
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Giuliana Sereni
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Cristiana Tioli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Maurizio Cavina
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | | | - Francesco Azzolini
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy
| | - Maurizio Ponz de Leon
- Diagnostic Medicine Department, Clinic and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
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Pereira D, Kővári B, Brown I, Chaves P, Choi WT, Clauditz T, Ghayouri M, Jiang K, Miller GC, Nakanishi Y, Kim KM, Kim BH, Kumarasinghe MP, Kushima R, Ushiku T, Yozu M, Srivastava A, Goldblum JR, Pai RK, Lauwers GY. Non-conventional dysplasias of the tubular gut: a review and illustration of their histomorphological spectrum. Histopathology 2021; 78:658-675. [PMID: 33124049 DOI: 10.1111/his.14294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The increasing use of gastrointestinal endoscopic procedures has led to the recognition by histopathologists of non-conventional (or special-type) dysplasias of the gastrointestinal tract. These lesions can be recognised in association with prevalent underlying gastrointestinal conditions, such as Barrett oesophagus, chronic atrophic gastritis, and inflammatory bowel disease. The diagnosis of these special types can be challenging, and their biological behaviours are not fully characterised. The aim of this review is to provide a global view of non-conventional dysplastic lesions observed in the various segments of the tubular gastrointestinal tract and describe their salient features. Furthermore, as the clinical implications of these various subtypes have not been broadly tested in practice and are not represented in most management guidelines, we offer guidance on the best management practices for these lesions.
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Affiliation(s)
- Daniela Pereira
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa de Francisco Gentil-EPE (IPOLFG EPE), Lisboa, Portugal.,Faculdade de Ciências da Saúde, Universidade da Beira Interior (FCS UBI), Covilhã, Portugal
| | - Bence Kővári
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology, University of Szeged, Szeged, Hungary.,Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - Ian Brown
- Envoi Specialist Pathologists, Brisbane, Qld, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Paula Chaves
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa de Francisco Gentil-EPE (IPOLFG EPE), Lisboa, Portugal.,Faculdade de Ciências da Saúde, Universidade da Beira Interior (FCS UBI), Covilhã, Portugal
| | - Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Till Clauditz
- Department of Pathology, University-Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Masoumeh Ghayouri
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Kun Jiang
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Gregory C Miller
- Envoi Specialist Pathologists, Brisbane, Qld, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Yukihiro Nakanishi
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Kyoung M Kim
- Department of Pathology, Samsung Medical Centre, Seoul, Korea
| | - Baek H Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | | | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Masato Yozu
- Histopathology Department, Middlemore Hospital, Auckland, New Zealand
| | | | - John R Goldblum
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
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Transduodenal surgical ampullectomy: a procedure that requires a multidisciplinary approach. Updates Surg 2021; 73:2215-2223. [PMID: 33387169 DOI: 10.1007/s13304-020-00951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
Trans-duodenal surgical ampullectomy (TSA) was first described in 1899. Nowadays its role in ampullary tumor surgery is still a matter of debate and requires a multidisciplinary approach. The aim of this study is to evaluate the results of TSA as a curative treatment for benign and selected malignant tumors arising from the ampulla in a single-institution experience. Sixteen patients with periampullary tumors that underwent TSA in our surgical units between January 2012 and January 2017 were included in the study. Patient demographic characteristics, pre or postoperative endoscopic interventions, operative procedures, postoperative morbidity and mortality, hospitalization, follow-up time, and quality of life questionnaire were analyzed. Mean operative time was 238.5 min (range 180-390), mean tumor size was 2.3 cm (range 1.5-3.9). The microscopic surgical outcome was R0 for 14 patients. The most frequent findings in terms of histological type were high-grade dysplasia/pTis (43.7%), low-grade dysplasia in 37.5% patients, invasive adenocarcinoma in 2 cases (12.5%), chronic inflammation in 1 case (6.3%). The readmission rate was 18.8% (3/16) and in 2 cases (12.5%) relaparotomy was required. The cumulative median duration of follow-up was 50 months (range 1-96). 90-days mortality was 6.2%. Mean hospital stay was 12 days (range 8-60). Our results confirm that TSA offers good results in terms of morbidity and mortality; still, it remains a challenging procedure that requires particular surgical experience and operative skills. A pre-operative planning in a multidisciplinary board should be carried out prior to the procedure.
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31
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Beştaş R, Ekin N. Is gastric intestinal metaplasia a risk factor for colorectal neoplasms? BIOTECHNOL BIOTEC EQ 2021. [DOI: 10.1080/13102818.2021.1974945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Remzi Beştaş
- Gastroenterology Department, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Nazım Ekin
- Gastroenterology Department, Diyarbakır Gazi Yaşargil Training and Research Hospital, Health Sciences University, Diyarbakır, Turkey
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Macdonald EJ, Lerner BA, Lerner MZ. Incidental Otolaryngologic Pathology Noted Upon Esophagogastroduodenoscopy: Case Series and Review of Literature. Cureus 2020; 12:e11866. [PMID: 33409100 PMCID: PMC7781552 DOI: 10.7759/cureus.11866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES We report and analyze eight cases in which patients were referred from gastroenterology (GI) to otolaryngology following esophagogastroduodenoscopy (EGD). We aim to provide specific examples of head and neck pathology encountered by gastroenterologists during upper endoscopy. METHODS A series of eight cases between 2016 and 2019 were analyzed by chart review. In each case, otolaryngology consultation was requested after an abnormality was noticed by a gastroenterologist during EGD. Subsequent laryngoscopy or bronchoscopy was performed in all cases allowing for image comparison. Select images comparing EGD to laryngoscopy findings are included as well as a literature review concerning the nature of communication between the two specialties. RESULTS Eight adult patients were referred to otolaryngology for abnormalities noted by a gastroenterologist during EGD at the following anatomic sites: soft palate (n=1), base of tongue (n=2), glottis (n=3), and interarytenoid mucosa (n=1). Additionally, a potential airway foreign body was noted on EGD which was ultimately determined to represent normal subglottic anatomy by bronchoscopy. Some 5/8 (63%) cases were considered true pathology while 3/8 (37%) represented normal anatomy or anatomic variants upon subsequent otolaryngologic evaluation. CONCLUSIONS There is minimal literature regarding the nature of referrals from GI to otolaryngology following EGD. Our findings suggest that EGD offers a unique opportunity for early detection of otolaryngologic pathology. However, certain inter-specialty anatomic knowledge gaps were noted which contributed to occasional unnecessary referrals, procedures, and associated patient anxiety. We hope that the results of this study can inform future research aimed at improving communication and collaboration between the two specialties.
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Affiliation(s)
| | - Benjamin A Lerner
- Medicine, Section of Digestive Disease, Yale School of Medicine, New Haven, USA
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Technical feasibility of a newly designed bendable forceps for difficult endoscopic tissue samplings (with video). Surg Endosc 2020; 34:4692-4701. [PMID: 32661712 DOI: 10.1007/s00464-020-07784-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Biopsies with conventional forceps beyond the operating range are difficult and cumbersome. Thus, we developed a new bendable forceps for improved access to gastrointestinal lesions and evaluated its technical feasibility. METHODS A bendable forceps was constructed with two channels and a two-stage knob. The bending motion-related structures were designed to improve the range of motion. For the evaluation of the forceps, we used 2 gastrointestinal simulators: an ex vivo porcine model, and an in vivo porcine model with some difficult endoscopic biopsy cases. All evaluations were performed by 5 expert endoscopists and an expert pathologist. RESULTS Compared with the conventional forceps, the bendable forceps had greater efficacy in the simulator (6.2 ± 0.4 vs. 1.96 ± 0.2, p < 0.001), ex vivo porcine model (6.33 ± 0.52 vs. 4.25 ± 0.89, p < 0.001), and in vivo porcine model (6.33 ± 0.52 vs. 4.25 ± 0.89, p < 0.001); greater safety in the simulator (1.92 ± 0.13 s vs. 4.88 ± 0.50 s, p < 0.001), ex vivo porcine model (2.02 ± 0.15 s vs 4.66 ± 0.27 s, p < 0.001), and in vivo porcine model (2.02 ± 0.15 s vs. 4.08 ± 0.70 s, p = 0.002); and larger specimens in the ex vivo porcine model (3.92 ± 0.03 mm vs. 3.85 ± 0.07 mm, p = 0.020). CONCLUSIONS This study showed that compared with the conventional forceps, the bendable forceps was effective and safe to use for accessing difficult lesions in the three models. We believe that the bendable forceps serves as a useful supplementary diagnostic tool for accessing difficult lesions. However, further validation of its usefulness in the human body is needed.
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Endoscopic snare papillectomy for adenoma of the ampulla of vater: Long-term results in 135 consecutive patients. Dig Liver Dis 2020; 52:1033-1038. [PMID: 32532606 DOI: 10.1016/j.dld.2020.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The premalignant nature of ampullary adenomas justifies their radical excision. AIMS Aim of this study is to evaluate the long-term results of endoscopic snare papillectomy in a consecutive series of patients with ampullary adenomas. METHODS Patients who underwent endoscopic snare papillectomy between October 1999 and October 2017 were identified from an electronic database. Endoscopic snare papillectomy was performed en bloc, when possible; a pancreatic stent or a nasopancreatic drainage were inserted. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly. RESULTS Endoscopic snare papillectomy was performed in 135 patients (70 M, mean age 60.5 years) by en bloc (83%) or piecemeal (17%) resection. Delayed bleeding occurred in 16 patients (11.8%), infected retroperitoneal collections in 6 patients (4.4%), pancreatitis in 4 patients (3%). One patient died (0.7%). Follow-up was available in 103/114 (90.3%) patients. In case of residual (24.3%) and recurrent (23.3%), adenomas endoscopic retreatment was successful in 42/49 cases (85.7%). After a mean follow-up of 40 months, 93.2% (96/103) of the patients were disease free CONCLUSION: Endoscopic snare papillectomy of ampullary adenomas is effective with favorable long-term outcomes. Compliance to the scheduled follow-up is important for the early detection and re-treatment of recurrences.
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Sayar S, Ayranci G, Kürbüz K, Ak Ç, Tarikçi Kiliç E, Kahraman R, Atalay R, Öztürk O, Çalişkan Z, Adali G, Doganay L, Özdil K. High frequency of gastric cancer precursor lesions in patients with gastric xanthelasma: a prospective case-control study. Eur J Gastroenterol Hepatol 2020; 32:1130-1134. [PMID: 32732810 DOI: 10.1097/meg.0000000000001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE An association of gastric cancer and precursor lesions with gastric xanthelasma has frequently been reported. However, the incidence of both gastric xanthelasma and gastric cancer precursor lesions increases with age. The aim of this study was to evaluate the frequency and characteristics of atrophic gastritis, intestinal metaplasia and dysplasia in patients with gastric xanthelasma compared to controls. MATERIAL AND METHODS Cases with gastric xanthelasma endoscopically and histopathologically were included in this prospective study. The patients included in the study were compared with age- and sex-matched controls in terms of the frequency and characteristics of atrophic gastritis, intestinal metaplasia, dysplasia and cancer. RESULTS In a series of 1892 upper endoscopies, 108 patients (5.7%) were found to have gastric xanthelasma. The average age of the patients was 61.41 ± 11.43 years. Among the patients, 58 (53.7%) were male. The frequencies of atrophic gastritis, intestinal metaplasia, dysplasia and gastric cancer in the xanthelasma group (n = 108) were 31.5, 68.5, 3.7 and 2.8%, respectively. The frequencies of atrophic gastritis, intestinal metaplasia, dysplasia and gastric cancer in the control group (n = 183) were 11.5, 31.7, 0.5 and 0.5%, respectively. Compared to the control group, the frequency of these cancer precursor lesions and the prevalence of advanced stage based on operative link on gastritis intestinal metaplasia assessment were found to be higher in the xanthelasma group (P < 0.05). CONCLUSION Gastric xanthelasma is associated with an increased frequency of gastric precancerous lesions and should be considered an important marker.
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Affiliation(s)
| | | | | | | | - Ebru Tarikçi Kiliç
- Anesthesiology, Saglik Bilimleri University Ümraniye Training and Research Hospital, İstanbul, Turkey
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Angsuwatcharakon P, Ahmed O, Lynch PM, Lum P, Gonzalez GN, Weston B, Coronel E, Katz MHG, Folloder J, Lee JH. Management of ampullary adenomas in familial adenomatous polyposis syndrome: 16 years of experience from a tertiary cancer center. Gastrointest Endosc 2020; 92:323-330. [PMID: 32145286 DOI: 10.1016/j.gie.2020.02.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The management of ampullary adenomas in familial adenomatous polyposis (FAP) is challenging due to multiple adenomas in the duodenum, history of previous major abdominal surgery, and desmoid lesions. In this study, we aim to define the optimum management for ampullary adenomas, particularly in FAP. METHODS This is a retrospective study of all patients with pathology-confirmed ampullary adenomas in M.D. Anderson Cancer Center from 2002 to 2018. Relevant data were extracted, including patient demographics, treatments, outcomes, and adverse events. RESULTS There were 137 patients with ampullary adenomas who underwent 159 procedures; 95 of the 137 patients had FAP and were placed under close observation, 29 underwent endoscopic ampullectomy, 4 underwent surgical ampullectomy, and 31 underwent panreaticoduodenectomy (PD). In the close observation group, 12.6% progressed to advanced adenoma and subsequently underwent resection. There was no ampullary cancer detected in this group. The endoscopic ampullectomy group had a postprocedure adverse event rate of 10.2%. Eleven patients had residual/recurrent disease after endoscopic ampullectomy, 3 of whom needed surgery. Four patients underwent initial surgical ampullectomy and 2 subsequently needed PD. Patients who underwent PD had an adverse event rate of 29%. In this group, there were no cases of residual disease or recurrence. CONCLUSIONS The management of ampullary adenomas in FAP should be carefully considered for the best outcome. Although these patients can be managed by endoscopic ampullectomy, careful surveillance for recurrence should be followed along with prompt management of the recurrence when detected. Although PD provides a definitive treatment, it is limited by the patient's comorbid conditions and high adverse event rates.
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Affiliation(s)
- Phonthep Angsuwatcharakon
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Osman Ahmed
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick M Lynch
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phillip Lum
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Graciella N Gonzalez
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brian Weston
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emmanuel Coronel
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Justin Folloder
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Silva LC, Arruda RM, Botelho PFR, Taveira LN, Giardina KM, de Oliveira MA, Dias J, Oliveira CZ, Fava G, Guimarães DP. Cap-assisted endoscopy increases ampulla of Vater visualization in high-risk patients. BMC Gastroenterol 2020; 20:214. [PMID: 32646369 PMCID: PMC7346639 DOI: 10.1186/s12876-020-01361-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background Periampullary adenocarcinoma is a major clinical problem in high-risk patients including FAP population. A recent modification for visualizing the ampulla of Vater (AV) involves attaching a cap to the tip of the forward-viewing endoscope. Our aim was to compare the rates of complete visualization of AV using this cap-assisted endoscopy (CAE) approach to standard forward-viewing endoscopy (FVE). We also determined: (i) the rates of complications and additional sedation; (ii) the mean time required for duodenal examination; and (iii) the reproducibility among endoscopists performing this procedure. Methods We performed esophagogastroduodenoscopy for AV visualization in 102 > 18 years old using FVE followed by CAE. Video recordings were blinded and randomly selected for independent expert endoscopic evaluation. Results The complete visualization rate for AV was higher in CAE (97.0%) compared to FVE (51.0%) (p < 0.001). The additional doses of fentanyl, midazolam, and propofol required for CAE were 0.05, 1.9 and 36.3 mg. in 0.9, 24.5, and 77.5% patients, respectively. The mean time of duodenal examination for AV visualization was lower on CAE compared to FVE (1.41 vs. 1.95 min, p < 0.001). Scopolamine was used in 34 FVE and 24 CAE, with no association to AV complete visualization rates (p = 0.30 and p = 0.14). Three more ampullary adenomas were detected using CAE compared to FVE. Cap displacement occurred in one patient, and there was no observed adverse effect of the additional sedatives used. Kappa values for agreement between endoscopists ranged from 0.60 to 0.85. Conclusions CAE is feasible, reproducible and safe, with a higher success rate for complete visualization compared to FVE. Trial registration: ClinicalTrials.gov, NCT02867826, 16 August 2016.
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Affiliation(s)
- Leonardo Correa Silva
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | - Rondinelle Martins Arruda
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | - Paula Fortuci Resende Botelho
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | - Leonardo Nogueira Taveira
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | - Kelly Menezio Giardina
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | | | - Julia Dias
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | | | - Gilberto Fava
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil
| | - Denise Peixoto Guimarães
- Department of Endoscopy, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Zip Code: 14784 400, Barretos, São Paulo, Brazil. .,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.
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Rubenstein JH, McConnell D, Waljee AK, Metko V, Nofz K, Khodadost M, Jiang L, Raghunathan T. Validation and Comparison of Tools for Selecting Individuals to Screen for Barrett's Esophagus and Early Neoplasia. Gastroenterology 2020; 158:2082-2092. [PMID: 32119928 PMCID: PMC7282990 DOI: 10.1053/j.gastro.2020.02.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines suggest endoscopic screening of individuals who are at increased risk for Barrett's esophagus (BE) and esophageal adenocarcinoma. Tools based on clinical factors are available for identifying patients at risk, but only some have been validated. We aimed to compare and validate available tools. METHODS We performed a prospective study of 1241 patients, ages 40 to 79 years, presenting either for their first esophagogastroduodenoscopy (EGD) or their first endoscopic therapy of early neoplastic BE, from April 2015 through June 2018. We calculated risk scores for 6 previously published tools (the Gerson, Locke, Thrift, Michigan BE pREdiction Tool [M-BERET], Nord-Trøndelag Health Study [HUNT], and Kunzmann tools). We also investigated the accuracy of frequency and duration of gastroesophageal reflux disease (GERD), using data from a randomly selected 50% of patients undergoing their first EGD. We compared the ability of all these tools to discriminate patients with BE and early neoplasia from patients without BE, using findings from endoscopy as the reference standard. RESULTS BE was detected in 81 of 1152 patients during their first EGD (7.0%). GERD symptoms alone identified patients with BE with an area under the receiver operating characteristic curve (AuROC) of 0.579. All of the tools were more accurate in identifying patients with BE than the frequency and duration of GERD (AuROC for GERD, 0.579 vs range for other tools, 0.660-0.695), and predicted risk correlated well with observed risk (calibration). The AUROCs of the HUNT tool (0.796), the M-BERET (0.773), and the Kunzmann tool (0.763) were comparable in discriminating between patients with early neoplasia (n = 94) vs no BE. Each tool was more accurate in discriminating BE with early neoplasia than GERD frequency and duration alone (AuROC, 0.667; P < .01). CONCLUSIONS The HUNT, M-BERET, and Kunzmann tools identify patients with BE with AuROC values ranging from 0.665 to 0.695, and discriminate patients with early neoplasia from patients without BE with AuROC values ranging from 0.763 to 0.796. These tools are more accurate than frequency and duration of GERD in identifying individuals at risk for neoplastic BE.
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Affiliation(s)
- Joel H. Rubenstein
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI,Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Daniel McConnell
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Akbar K. Waljee
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI,Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Valbona Metko
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Kimberly Nofz
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI
| | | | - Li Jiang
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Trivellore Raghunathan
- Institute for Social Research, University of Michigan, Ann Arbor, MI,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
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Lü S, Jiang M, Liu F, Tang H, Yang Y, Zhang W, Zhang M, Jin Z, Li Z. Endoscopic papillectomy of benign papillary tumors: A single-center experience. Medicine (Baltimore) 2020; 99:e20414. [PMID: 32481436 DOI: 10.1097/md.0000000000020414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through comparisons between endoscopic snare papillectomy (ESP) and endoscopic mucosal resection (EMR).Between May 2010 and December 2017, 72 patients were enrolled. Diagnosis and treatment procedures were ESP and EMR. Endoscopic follow-up evaluation was done periodically as a surveillance measurement for recurrence.Seventy-two patients with ampullary tumors were enrolled, of which 66 had adenomas including 9 high-grade intraepithelial neoplasias and 2 carcinomas in adenoma. Complete resections with tumor-free lateral and basal margins were achieved in all patients. Postoperative complications were bleeding (9.5% in EMR vs 10% in ESP) and pancreatitis (2.4% in EMR and 3.3% in ESP), with no occurrence of perforation, cholangitis or papillary stenosis. Adenoma recurrence was found in 7 patients (14.3% in EMR vs 3.3% in ESP) at 1 year.The ESP procedure is safe and effective for benign ampullary adenoma, high-grade intraepithelial neoplasias, and noninvasive cancer without intraductal tumor growth, which has a shorter procedural duration, as well as lower complication, recurrence rates and hospitalization costs.
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Affiliation(s)
- Shunli Lü
- Department of Gastroenterology, Changhai Hospital, Changhai Road 168, Shanghai
| | - Mengni Jiang
- Department of Gastroenterology, Changhai Hospital, Changhai Road 168, Shanghai
| | - Feng Liu
- Department of Gastroenterology, Changhai Hospital, Changhai Road 168, Shanghai
| | - Hailing Tang
- Department of Gastroenterology, Xi'an Central Hospital, Xi'
| | - Yuan Yang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical College, Zunyi, P.R. China
| | | | - Minmin Zhang
- Department of Gastroenterology, Changhai Hospital, Changhai Road 168, Shanghai
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Changhai Road 168, Shanghai
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Changhai Road 168, Shanghai
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40
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Hamel C, Ahmadzai N, Beck A, Thuku M, Skidmore B, Pussegoda K, Bjerre L, Chatterjee A, Dennis K, Ferri L, Maziak DE, Shea BJ, Hutton B, Little J, Moher D, Stevens A. Screening for esophageal adenocarcinoma and precancerous conditions (dysplasia and Barrett's esophagus) in patients with chronic gastroesophageal reflux disease with or without other risk factors: two systematic reviews and one overview of reviews to inform a guideline of the Canadian Task Force on Preventive Health Care (CTFPHC). Syst Rev 2020; 9:20. [PMID: 31996261 PMCID: PMC6990541 DOI: 10.1186/s13643-020-1275-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Two reviews and an overview were produced for the Canadian Task Force on Preventive Health Care guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease (GERD) without alarm symptoms. The goal was to systematically review three key questions (KQs): (1) The effectiveness of screening for these conditions; (2) How adults with chronic GERD weigh the benefits and harms of screening, and what factors contribute to their preferences and decision to undergo screening; and (3) Treatment options for Barrett's esophagus (BE), dysplasia or stage 1 EAC (overview of reviews). METHODS Bibliographic databases (e.g. Ovid MEDLINE®) were searched for each review in October 2018. We also searched for unpublished literature (e.g. relevant websites). The liberal accelerated approach was used for title and abstract screening. Two reviewers independently screened full-text articles. Data extraction and risk of bias assessments were completed by one reviewer and verified by another reviewer (KQ1 and 2). Quality assessments were completed by two reviewers independently in duplicate (KQ3). Disagreements were resolved through discussion. We used various risk of bias tools suitable for study design. The GRADE framework was used for rating the certainty of the evidence. RESULTS Ten studies evaluated the effectiveness of screening. One retrospective study reported no difference in long-term survival (approximately 6 to 12 years) between those who had a prior esophagogastroduodenoscopy and those who had not (adjusted HR 0.93, 95% confidence interval (CI) 0.58-1.50). Though there may be higher odds of a stage 1 diagnosis than a more advanced diagnosis (stage 2-4) if an EGD had been performed in the previous 5 years (OR 2.27, 95% CI 1.00-7.67). Seven studies compared different screening modalities, and showed little difference between modalities. Three studies reported on patients' unwillingness to be screened (e.g. due to anxiety, fear of gagging). Eleven systematic reviews evaluated treatment modalities, providing some evidence of early treatment effect for some outcomes. CONCLUSIONS Little evidence exists on the effectiveness of screening and values and preferences to screening. Many treatment modalities have been evaluated, but studies are small. Overall, there is uncertainty in understanding the effectiveness of screening and early treatments. SYSTEMATIC REVIEW REGISTRATIONS PROSPERO (CRD42017049993 [KQ1], CRD42017050014 [KQ2], CRD42018084825 [KQ3]).
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Affiliation(s)
- Candyce Hamel
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.
| | - Nadera Ahmadzai
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Andrew Beck
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Micere Thuku
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Becky Skidmore
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Kusala Pussegoda
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Lise Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Avijit Chatterjee
- Gastroenterology Department, Faculty of Medicine, Unveristy of Ottawa, Ottawa, ON, Canada
| | - Kristopher Dennis
- Ottawa Hospital Research Institute, Cancer Therapeutics Program, Ottawa, ON, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University, Montreal, QC, Canada
| | - Donna E Maziak
- Department of Surgery and The Ottawa Hospital, Department of Thoracic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Beverley J Shea
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David Moher
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Adrienne Stevens
- Ottawa Hospital Research Institute, Knowledge Synthesis Group, 501 Smyth Road, Ottawa, ON, Canada
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41
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Argon Plasma Coagulation With Cholangioscopy as Additional Treatment for Residual Ampullary Tumor in a Young Familial Adenomatous Polyposis Patient. ACG Case Rep J 2019; 6:e00202. [PMID: 31737730 PMCID: PMC6791631 DOI: 10.14309/crj.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022] Open
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42
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Incidence Rate of Gastric Cancer Adenocarcinoma in Patients With Gastric Dysplasia: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2019; 53:703-710. [PMID: 31415022 DOI: 10.1097/mcg.0000000000001257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several studies have reported the risk of progression to gastric adenocarcinoma (GAC) in patients with gastric dysplasia (GD); however, the findings are controversial. We performed a systematic review and meta-analysis to study the incidence rate of GAC among patients with GD. Using a comprehensive search strategy, we systematically searched online databases including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science databases for identifying all relevant original articles through inception until July 2018. Cochran Q and I tests were used to assess heterogeneities between included studies. The incidence rates of GAC and their corresponding 95% confidence intervals (CIs) were pooled using random-effect or fixed-effect models. Of the 1980 retrieved records, 30 eligible articles (61 studies) were included. The overall pooled incidence rate of GAC was 40.36 (95% CI, 27.08-55.71; I, 96.0%) cases per 1000 person-years in patients with GD. Subgroup analysis according to the type of GD indicated the highest incidence rate of GAC was 186.40 (95% CI, 106.63-285.60; I, 94.6%) per 1000 person-years among patients with high-grade dysplasia (HGD) lesions. Although the incidence rates of GAC in low-grade dysplasia (LGD) lesions and in nonclassified lesions were 11.25 (95% CI, 3.91-21.22; I, 89.3%), and 1.40 (95% CI, 0.00-9.71; I, 78.8%), respectively. Compared with patients with LGD lesions, progression rate from GD to GAC was roughly 16 times greater in patients with HGD lesions. As the majority of patients with GAC are diagnosed in an advanced stage our study suggests strict management of HGD lesions to prevent GAC.
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43
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Evaluation and Management of Premalignant Conditions of the Esophagus: A Systematic Survey of International Guidelines. J Clin Gastroenterol 2019; 53:627-634. [PMID: 31403982 DOI: 10.1097/mcg.0000000000001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal cancer represents one of the most lethal forms of malignancy. The growing incidence of esophageal adenocarcinoma represents an emerging public health concern. This review article summarizes current diagnostic, management, and therapeutic practices of premalignant conditions of the esophagus including Barrett's esophagus, tylosis, granular cell tumors, achalasia, and the ingestion of caustic substances. Our report provides clinicians and academics with a global clinical perspective regarding presentation, surveillance guidelines, and therapeutic management of these esophageal conditions.
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44
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Labib PL, Goodchild G, Turbett JP, Skipworth J, Shankar A, Johnson G, Clark S, Latchford A, Pereira SP. Endoscopic ultrasound in the assessment of advanced duodenal adenomatosis in familial adenomatous polyposis. BMJ Open Gastroenterol 2019; 6:e000336. [PMID: 31645990 PMCID: PMC6781957 DOI: 10.1136/bmjgast-2019-000336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 01/28/2023] Open
Abstract
Objective Current surveillance strategies for duodenal adenomatosis in familial adenomatous polyposis (FAP) miss malignancies and underestimate cancer risk in ampullary disease. This study aimed to evaluate the utility of endoscopic ultrasound (EUS) in the assessment of FAP patients with duodenal and/or ampullary polyposis referred for surgical intervention. Design A retrospective analysis of FAP patients undergoing index EUS between December 2006 and May 2015 was performed. Follow-up was completed in January 2018, including review of all EUS procedures and surgical interventions (median follow-up 6 years). Results Fifty-five patients underwent 188 EUS procedures. Six patients (11%) developed malignancy (three duodenal, three ampullary). Ampullary cancer risk was underestimated by Spigelman stage and overestimated by Kashiwagi classification. Ultrasound findings were poor predictors of malignancy, with common bile duct dilatation being the only finding present in one EUS prior to a diagnosis of ampullary cancer. The best predictors of ampullary malignancy were an ampullary polyp size >3 cm and an increase >1 cm in ampullary polyp size. Ampullary polyp size >3 cm provided the best predictive value, correctly identifying two of the three cases of ampullary cancer and both patients with high-grade dysplasia. EUS biopsy failed to detect malignancy later confirmed by surgical histology in two patients. Conclusion EUS surveillance confers little additional benefit to standard endoscopic surveillance in FAP patients. The best predictor of ampullary malignancy is an ampullary polyp >3 cm; this could be regarded as a relative indication for surgery.
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Affiliation(s)
- Peter L Labib
- Institute for Liver & Digestive Health, University College London, London, UK
| | - George Goodchild
- Institute for Liver & Digestive Health, University College London, London, UK.,Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - James P Turbett
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - James Skipworth
- Hepatopancreaticobiliary Surgery, Royal Free Hospital, London, UK
| | - Arjun Shankar
- Hepatopancreaticobiliary Surgery, Royal Free Hospital, London, UK
| | - Gavin Johnson
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sue Clark
- St Mark's Hospital, London, UK.,Surgery and Cancer, Imperial College London, London, UK
| | - Andrew Latchford
- St Mark's Hospital, London, UK.,Surgery and Cancer, Imperial College London, London, UK
| | - Stephen P Pereira
- Institute for Liver & Digestive Health, University College London, London, UK.,Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
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Diagnosis, risk stratification, and management of ampullary dysplasia by DNA flow cytometric analysis of paraffin-embedded tissue. Mod Pathol 2019; 32:1291-1302. [PMID: 30976103 PMCID: PMC8549479 DOI: 10.1038/s41379-019-0272-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
The limited accuracy of endoscopic biopsy in detecting high-grade dysplasia or adenocarcinoma within ampullary adenoma or dysplasia has been reported. The natural history of ampullary dysplasia is also unclear, and there are no established guidelines to determine which patients with ampullary dysplasia require resection versus surveillance endoscopy. DNA flow cytometry was performed on 47 ampullary biopsies with low-grade dysplasia, 18 high-grade dysplasia, and 23 negative for dysplasia, as well as 11 cases of ampullary adenocarcinoma. Abnormal DNA content (aneuploidy or elevated 4N fraction > 6%) was identified in 9 (82%) of adenocarcinoma, 13 (72%) of high-grade dysplasia, 7 (15%) of low-grade dysplasia, and none (0%) of non-dysplastic mucosa. One-, 2-, and 7-year detection rates of high-grade dysplasia or adenocarcinoma in low-grade dysplasia patients with abnormal DNA content were 57%, 86%, and 88%, respectively, whereas low-grade dysplasia patients in the setting of normal DNA content had 1-, 2-, and 7-year detection rates of 10%, 10%, and 10%, respectively. The univariate and multivariate hazard ratios (HRs) for subsequent detection of high-grade dysplasia or adenocarcinoma in low-grade dysplasia patients with DNA content abnormality were 16.8 (p = <0.01) and 9.8 (p = <0.01), respectively. Among the 13 high-grade dysplasia patients with DNA content abnormality, 5 patients (38%) were subsequently found to have adenocarcinoma within a mean follow-up time of 3 months, whereas only 1 (20%) of the remaining 5 patients in the setting of normal DNA content developed adenocarcinoma in a month (HR = 2.6, p = 0.39). The overall 1- and 2-year detection rates of adenocarcinoma in all high-grade dysplasia patients (regardless of flow cytometric results) were 34% (95% confidence interval = 16-63%) and 47% (95% confidence interval = 23-79%), respectively. In conclusion, the majority of low-grade dysplasia patients (86%) in the setting of abnormal DNA content developed high-grade dysplasia or adenocarcinoma within 2 years and thus may benefit from resection, whereas those with normal DNA content may be followed with surveillance endoscopy. The presence of DNA content abnormality can also confirm a morphologic suspicion of high-grade dysplasia, which should be managed with resection, as nearly 50% of the high-grade dysplasia patients were found to have adenocarcinoma within 2 years.
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46
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Holmberg D, Ness-Jensen E, Mattsson F, Lagergren J. Adherence to clinical guidelines for Barrett's esophagus. Scand J Gastroenterol 2019; 54:945-952. [PMID: 31314608 DOI: 10.1080/00365521.2019.1641740] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aim: Clinical guidelines recommend endoscopy surveillance at given intervals or endoscopic therapy for Barrett's esophagus with low-grade dysplasia (LGD) and high-grade dysplasia (HGD). Whether these guidelines are followed in clinical practice is unknown and was assessed in this study. Methods: This nationwide Swedish cohort study included patients with Barrett's esophagus with histologically verified LGD or HGD from 50 centers in 2006-2013. These patients were followed up using nationwide registers. Adherence to clinical guidelines was explored. Eight potential risk factors for deviation from guidelines were assessed using multivariable logistic regression, providing adjusted odds ratios (OR) with 95% confidence intervals (95%CI). Results: Among 211 patients with Barrett's esophagus (mean age 67.0 years, standard deviation 9.7 years, 81% male), 71% had LGD and 29% had HGD. During median 3.9 years of follow-up, 84% underwent a follow-up endoscopy, 17% received endoscopic therapy and 8% underwent esophagectomy. The clinical management deviated from guidelines in 60% of all patients (69% in LGD and 39% in HGD), which was mainly due to under-surveillance (86%). Risk factors for deviation from guidelines were LGD compared to HGD (OR 3.4, 95%CI 1.7-6.8), longer Barrett's segment length (OR 2.0, 95%CI 1.0-3.9, comparing ≥3 cm with <3 cm), and treatment at gastroenterology compared to surgery departments (OR 2.3, 95%CI 1.2-4.4). Age, sex, calendar period and university hospital status were not associated with deviation from surveillance guidelines. Conclusions: Adherence to guidelines for dysplastic Barrett's esophagus is poor, particularly for LGD. Efforts to implement clinical guideline recommendations are needed.
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Affiliation(s)
- Dag Holmberg
- Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Eivind Ness-Jensen
- Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.,Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology , Levanger , Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust , Levanger , Norway
| | - Fredrik Mattsson
- Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London , London , UK
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Gonzalez HH, Acosta M, Yazji G, Bromer MQ. Type 1 Gastric Neuroendocrine Tumor Found on Endoscopic Polypectomy. Cureus 2019; 11:e4193. [PMID: 31106093 PMCID: PMC6504030 DOI: 10.7759/cureus.4193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 12/13/2022] Open
Abstract
Gastric neuroendocrine tumors (GNET) are rare gastric neoplasms accounting for <1% of all gastric neoplasms. The World Health Organization (WHO) categorized these neoplasms as types 1-3 to help predict malignant potential and long-term survival and guide management. Improved outcomes have been shown with endoscopic resections, but further studies are needed to confirm the best approach. We present a case of a 56-year-old woman who demonstrated the classic features of type one GNET with mucosal and submucosal involvement in the setting of primary atrophic gastritis, secondary hypergastrinemia, and underlying pernicious anemia. In general, standardizing treatment has been difficult due to a variable presentation.
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Affiliation(s)
- Hector H Gonzalez
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Mary Acosta
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - George Yazji
- Family Medicine, North Florida Regional Medical Center/ University of Central Florida College of Medicine, Gainesville, USA
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Kim MS, Kim SG, Chung H, Kim J, Hong H, Lee HJ, Kim HJ, Kim MA, Kim WH, Jung HC. Clinical Implication and Risk Factors for Malignancy of Atypical Gastric Gland during Forceps Biopsy. Gut Liver 2019; 12:523-529. [PMID: 29938460 PMCID: PMC6143445 DOI: 10.5009/gnl18006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/08/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Although forceps biopsy is performed for suspicious gastric tumors during endoscopy, it is difficult to determine treatment strategies for atypical gastric glands due to uncertainty of the diagnosis. The aim of this study was to investigate clinical implications and risk factors for predicting malignancy in atypical gastric glands during forceps biopsy. Methods We retrospectively reviewed medical records of 252 patients with a diagnosis of atypical gastric gland during forceps biopsy. Predictors of malignancy were analyzed using initial endoscopic findings and clinical data. Results The final diagnosis for 252 consecutive patients was gastric cancer in 189 (75%), adenoma in 26 (10.3%), and gastritis in 37 (14.7%). In the multivariate analysis, lesion sizes of more than 10 mm (odds ratio [OR], 3.021; 95% confidence interval [CI], 1.480 to 6.165; p=0.002), depressed morphology (OR, 3.181; 95% CI, 1.579 to 6.406, p=0.001), and surface nodularity (OR, 3.432; 95% CI, 1.667 to 7.064, p=0.001) were significant risk factors for malignancy. Conclusions Further evaluation and treatment should be considered for atypical gastric gland during forceps biopsy if there is a large-sized (>10 mm) lesion, depressed morphology, or surface nodularity.
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Affiliation(s)
- Min Seong Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoungju Hong
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jong Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Ju Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Min A Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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49
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Da B, Jani N, Gupta N, Jayaram P, Kankotia R, Yao Yu C, Dinis-Ribeiro M, Buxbaum J. High-risk symptoms do not predict gastric cancer precursors. Helicobacter 2019; 24:e12548. [PMID: 30412322 DOI: 10.1111/hel.12548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/06/2018] [Accepted: 09/07/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND & STUDY AIMS Gastric intestinal metaplasia (GIM) is the most common precursor of gastric cancer. Our aim is to determine if presenting symptoms predict gastric cancer precursor lesions in a high-risk population. PATIENT AND METHODS Consecutive unique patients evaluated by endoscopy for upper gastrointestinal symptoms at the Los Angeles County Hospital between 2010 and 2014 were evaluated. Presenting symptoms were classified as low- or high-risk depending on the procedure indication as coded using the Clinical Outcomes Research Initiative (CORI) system. Endoscopy and histology results were used to classify findings as benign, GIM, high-risk GIM, or malignant. The primary outcome was the proportion of patients with premalignant or malignant gastric findings who had high-risk clinical indications for endoscopy relative to those with benign results. RESULTS A total of 3699 patients underwent endoscopy to evaluate upper gastrointestinal symptoms. There were 373 (10.1%) patients with GIM of which 278 had high-risk GIM. One hundred and sixty (4.3%) patients were diagnosed with gastric cancer. High-risk indications for upper endoscopy predicted gastric cancer (OR 1.8 [95% CI 1.3-2.6]) but not GIM (OR 1.0 [0.8-1.3]) or high-risk GIM (OR 0.9 [0.7-1.2]). Hispanic or Asian patients and patients >50 years old were more likely to have GIM, high-risk GIM, and cancer. CONCLUSIONS Performance of upper endoscopy for high-risk indications is inadequate to detect GIM and marginal for malignancy. At risk patients should undergo upper endoscopy for both low- and high-risk symptoms. Screening certain populations deserve additional study and may, in fact, be cost-effective.
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Affiliation(s)
- Ben Da
- Digestive Disease Branch, National Institutes of Health, Bethesda, Maryland
| | - Niraj Jani
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nikhil Gupta
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Preeth Jayaram
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ravi Kankotia
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Chung Yao Yu
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal
| | - James Buxbaum
- Division of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Emura F, Gomez-Esquivel R, Rodriguez-Reyes C, Benias P, Preciado J, Wallace M, Giraldo-Cadavid L. Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location. World J Gastroenterol 2019; 25:498-508. [PMID: 30700945 PMCID: PMC6350169 DOI: 10.3748/wjg.v25.i4.498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/03/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.
METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound (EUS) in 25 consecutive patients to confirm the findings. The scope orientation throughout the exam was maintained at the natural axis, where the left esophageal quadrant corresponds to the area between 6 and 9 o’clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients’ air expiration.
RESULTS The left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm (SD 2.3), and 31.4 cm (SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the sub-study, the left main bronchus was identified in 24 (92%) patients at 25.4 cm (SD 2.1) and 26.7 cm (SD 1.9) from the incisors, by white light and EUS, respectively. The left atrium was recognized in all patients at 30.5 cm (SD 1.9), and 31.6 cm (SD 2.3) from the incisors, by both white light and EUS, respectively. EUS confirmed that the landmarks corresponded to these two structures, respectively, and that they were located on the anterior esophageal wall. The Bland-Altman plot demonstrated high agreement between the white light and EUS measurements.
CONCLUSION This study provides an endoscopic characterization of esophageal landmarks corresponding to the left main bronchus and left atrium, to permit radial and longitudinal orientation and accurate lesion location.
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Affiliation(s)
- Fabian Emura
- Division of Gastroenterology, Universidad de La Sabana, Bogotá DC 140013, Colombia
- Advanced Gastrointestinal Endoscopy, EmuraCenter LatinoAmerica, Bogotá DC 110121, Colombia
- Emura Foundation for the Promotion of Cancer Research, Bogotá DC 110121, Colombia
- Unidad de Endoscopia Digestiva, Clínica Pediátrica Colsanitas, Bogotá DC 110121, Colombia
| | - Rene Gomez-Esquivel
- Division of Digestive Diseases and Nutrition, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
| | | | - Petros Benias
- Division of Gastroenterology, North Shore-Long Island Jewish Medical Center. New York, NY 11030, United States
| | - Javier Preciado
- Unidad de Exploraciones Digestivas, Clinica Universitaria Colombia, Bogotá DC 110121, Colombia
| | - Michael Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Luis Giraldo-Cadavid
- Department of Internal Medicine. Universidad de La Sabana, Bogotá DC 140013, Colombia
- Division of Interventional Pulmonology, Fundacion Neumologica Colombiana, Bogota DC, 110131, Colombia
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