Assuntos
Adenocarcinoma , Neoplasias Gástricas , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Cor , Fundo Gástrico/diagnóstico por imagem , Fundo Gástrico/patologia , Aumento da Imagem/métodos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: Many micro-RNAs (miRNAs) are differentially expressed in Helicobacter pylori-infected gastric mucosa and in gastric cancer tissue and previous reports have suggested the possibility of serum miRNAs as complementary tumour markers. The aim of the study was to investigate serum miRNAs and pepsinogen levels in individuals at high risk for gastric cancer both before and after H. pylori eradication. METHODS: Patients with recent history of endoscopic resection for early gastric cancer and the sex- and age-matched controls were enrolled. Serum was collected from subjects before or after eradication and total RNA was extracted to analyse serum levels of 24 miRNAs. Serum pepsinogen (PG) I and II levels were measured using enzyme-linked immunosorbent assay kits. RESULTS: Using miR-16 as an endogenous control, the relative levels of miR-106 and let-7d before and after H. pylori eradication and miR-21 after eradication were significantly higher in the high-risk group than in the controls. H. pylori eradication significantly decreased miR-106b levels and increased let-7d only in the control group. After eradication, the combination MiR-106b with miR-21 was superior to serum pepsinogen and the most valuable biomarker for the differentiating high-risk group from controls. CONCLUSION: Serum miR-106b and miR-21 may provide a novel and stable marker of increased risk for early gastric cancer after H. pylori eradication.
Assuntos
Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/genética , MicroRNAs/sangue , Neoplasias Gástricas/sangue , Neoplasias Gástricas/genética , Idoso , Estudos de Casos e Controles , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Infecções por Helicobacter/sangue , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pepsinogênio A/sangue , Pepsinogênio C/sangue , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND AND STUDY AIMS: The frequency of stricture after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma with a mucosal defect involving more than three-quarters of the circumference is 70% - 90%. Stricture decreases quality of life and requires multiple endoscopic balloon dilation (EBD) sessions. We investigated the efficacy and safety of a single session of intralesional steroid injections to prevent post-ESD stricture. PATIENTS AND METHODS: We conducted a prospective study on 30 patients with esophageal squamous cell carcinoma treated by ESD, who had a more than three-quarter but less than whole circumferential defect. A single session of intralesional steroid injections was undertaken immediately after ESD. Esophagogastroduodenoscopy was performed whenever patients reported dysphagia and 2 months after ESD in patients without dysphagia. Results were compared with a historical control group of 29 patients who underwent ESD without intralesional steroid injection. The primary endpoint was the post-ESD stricture rate. Secondary endpoints were the number of EBD sessions and the complication rate. RESULTS: Compared with the historical control group, the study group had a significantly lower stricture rate (10%, 3/30 patients vs. 66%, 19/29 patients; P < 0.0001) and a lower number of EBD sessions (median 0, range 0 - 2 vs. median 2, range 0 - 15; P < 0.0001). The study group had a complication rate of 7 % (2 /30 patients), comprising a submucosal tear in one patient and bleeding in another, which were not a direct result of EBD. CONCLUSIONS: A single session of intralesional steroid injections showed promising results for the prevention of stricture after ESD for esophageal cancer.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Endoscopia Gastrointestinal , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/prevenção & controle , Triancinolona Acetonida/administração & dosagem , Idoso , Endoscopia do Sistema Digestório , Endoscopia Gastrointestinal/métodos , Feminino , Humanos , Injeções Intralesionais , Masculino , Complicações Pós-Operatórias/prevenção & controle , Estudos ProspectivosAssuntos
Cicatriz/etiologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Mucosa Gástrica/cirurgia , Complicações Pós-Operatórias , Antro Pilórico/cirurgia , Cicatriz/diagnóstico , Cicatriz/patologia , Mucosa Gástrica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Antro Pilórico/patologiaRESUMO
Perforation is a major complication of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). However, there have been no reports on delayed perforation after ESD for EGC. We aimed to elucidate the incidence and outcomes of delayed perforation after ESD. Clinical courses in 1159 consecutive patients with 1329 EGCs who underwent ESD were investigated. Delayed perforation occurred in six patients (0.45â%). All these patients had complete en bloc resection without intraoperative perforation during ESD. Five of six perforations were located in the upper third of the stomach, while one lesion was found in the middle third. Symptoms of peritoneal irritation with rebound tenderness presented within 24 h after ESD in all cases. One patient did not require surgery because the symptoms were localized, and recovered with conservative antibiotic therapy by nasogastric tube placement. The remaining five patients required emergency surgery. There was no mortality in this case series.
Assuntos
Dissecação/efeitos adversos , Mucosa Gástrica/cirurgia , Gastroscopia/efeitos adversos , Peritonite/diagnóstico , Neoplasias Gástricas/cirurgia , Estômago/lesões , Idoso , Antibacterianos/uso terapêutico , Feminino , Gastroscopia/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Peritonite/epidemiologia , Peritonite/cirurgia , Estômago/cirurgiaRESUMO
BACKGROUND AND AIM: Endoscopic submucosal dissection (ESD) is feasible as a treatment for early gastric cancer (EGC) when it is performed by an experienced endoscopist. We investigated whether it was feasible for novice endoscopists to perform ESD for EGC, and how difficult it was to learn the procedure. METHODS: This case series study was performed in a cancer referral center. Three resident endoscopists, who had already learned basic procedures, performed ESD under supervision for 30 consecutive lesions, and their procedures were analyzed. The procedure was divided for assessment into (i) mucosal incision and (ii) submucosal dissection by completion of the circumferential mucosal cut. An insulated-tip knife was used for mucosal incision and submucosal dissection. A total of 90 mucosal EGCs (< or = 2 cm) without ulcers or scars in 87 patients were included. Outcomes were: rates of complete resection, complications, and self-completion; operation time; learning curve; and reasons for change of supervisor as an indicator of difficulty. RESULTS: Among the 90 procedures, there was a good overall complete resection rate of 93 %, with an acceptable complication rate of 4.4 %; the complications were delayed hemorrhage in two patients, and perforations in another two patients that were repaired successfully by endoscopic clipping. The self-completion rate and operation time were significantly worse for submucosal dissection than for mucosal incision. Two of the three operators showed a flat learning curve for submucosal dissection. Difficulty with the procedure was related mainly to uncontrollable hemorrhage. CONCLUSIONS: With appropriate supervision, gastric ESD by residents is feasible, with equivalent complete resection rates and acceptable complication rates compared with those of experienced endoscopists, although there was difficulty in achieving sufficient self-completion rates in submucosal dissection. Better control of bleeding during submucosal dissection may be a key to improving the procedure.
Assuntos
Dissecação/métodos , Mucosa Gástrica/cirurgia , Internato e Residência , Neoplasias Gástricas/cirurgia , Idoso , Estudos de Viabilidade , Gastroscopia , Humanos , MasculinoAssuntos
Anti-Inflamatórios/efeitos adversos , Carcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Perfuração Esofágica/etiologia , Estenose Esofágica/terapia , Triancinolona/efeitos adversos , Dilatação , Dissecação/efeitos adversos , Perfuração Esofágica/cirurgia , Estenose Esofágica/etiologia , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , MucosaRESUMO
INTRODUCTION AND OBJECTIVE: Atrophy and intestinal metaplasia are early phenotypic markers in gastric carcinogenesis. White light endoscopy does not allow direct biopsy of intestinal metaplasia due to a lack of contrast of the mucosa. Narrow-band imaging is known to enhance the visibility of intestinal metaplasia, to reduce sampling error, and to increase the diagnostic yield of endoscopy for intestinal metaplasia in Asian patients. The aim of our study was to validate the diagnostic performance of narrow-band imaging using 1.5× electronic zoom endoscopy (with no high magnification) to diagnose intestinal metaplasia in Mexican patients. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive patients with dyspeptic symptoms at a private endoscopy center within the time frame of January 2015 to December 2016. RESULTS: A total of 338 patients (63±8.4 years of age, 40% women) were enrolled. The prevalence of H. pylori infection was 10.9% and the incidence of intestinal metaplasia in the gastric antrum and corpus was 23.9 and 5.9%, respectively. Among the patients with intestinal metaplasia, 65.3% had the incomplete type, 42.7% had multifocal disease, and one third had extension to the gastric corpus. Two patients had low-grade dysplasia. The sensitivity of white light endoscopy was 71.2%, with a false negative rate of 9.9%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of narrow-band imaging (with a positive light blue crest) were 85, 98, 86.8, 97.7, and 87.2%, respectively. CONCLUSION: The prevalence of H. pylori infection and intestinal metaplasia in dyspeptic Mexican patients was not high. Through the assessment of the microsurface structure and light blue crest sign, non-optical zoom narrow-band imaging had high predictive values for detecting intestinal metaplasia in patients from a general Western setting.
Assuntos
Dispepsia/diagnóstico por imagem , Dispepsia/etiologia , Intestinos/diagnóstico por imagem , Intestinos/patologia , Imagem de Banda Estreita/métodos , Idoso , Estudos de Coortes , Dispepsia/patologia , Reações Falso-Negativas , Feminino , Humanos , Masculino , Metaplasia/diagnóstico por imagem , Pessoa de Meia-Idade , Imagem de Banda Estreita/instrumentação , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: Vonoprazan is a new potassium-competitive acid blocker for treatment of acid-related diseases. AIM: To conduct two randomised-controlled trials, to evaluate the non-inferiority of vonoprazan vs. lansoprazole, a proton pump inhibitor, for treatment of gastric ulcer (GU) or duodenal ulcer (DU). METHODS: Patients aged ≥20 years with ≥1 endoscopically-confirmed GU or DU (≥5 mm white coating) were randomised 1:1 using double-dummy blinding to receive lansoprazole (30 mg) or vonoprazan (20 mg) for 8 (GU study) or 6 (DU study) weeks. The primary endpoint was the proportion of patients with endoscopically confirmed healed GU or DU. RESULTS: For GU, 93.5% (216/231) of vonoprazan-treated patients and 93.8% (211/225) of lansoprazole-treated patients achieved healed GU; non-inferiority of vonoprazan to lansoprazole was confirmed [difference = -0.3% (95% CI -4.750, 4.208); P = 0.0011]. For DU, 95.5% (170/178) of vonoprazan-treated patients and 98.3% (177/180) of lansoprazole-treated patients achieved healed DU; non-inferiority to lansoprazole was not confirmed [difference = -2.8% (95% CI -6.400, 0.745); P = 0.0654]. The incidences of treatment-emergent adverse events were slightly lower for GU and slightly higher for DU with vonoprazan than with lansoprazole. There was one death (subarachnoid haemorrhage) in the vonoprazan group (DU). The possibility of a relationship between this unexpected patient death and the study drug could not be ruled out. In both studies, increases in serum gastrin levels were greater in vonoprazan-treated vs. lansoprazole-treated patients; levels returned to baseline after treatment in both groups. CONCLUSIONS: Vonoprazan 20 mg has a similar tolerability profile to lansoprazole 30 mg and is non-inferior with respect to GU healing and has similar efficacy for DU healing.
Assuntos
Antiulcerosos/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Lansoprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Pirróis/uso terapêutico , Úlcera Gástrica/tratamento farmacológico , Sulfonamidas/uso terapêutico , Adulto , Idoso , Antiulcerosos/efeitos adversos , Método Duplo-Cego , Úlcera Duodenal/diagnóstico , Endoscopia , Feminino , Humanos , Lansoprazol/efeitos adversos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/efeitos adversos , Pirróis/efeitos adversos , Úlcera Gástrica/diagnóstico , Sulfonamidas/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Whether proton pump inhibitors (PPIs) relieve heartburn or precordial pain after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this study was to investigate the efficacy of PPI therapy for these symptoms after ER for ESCC. METHODS: We conducted a multicenter prospective randomized controlled trial among 15 hospitals in Japan. In total, 229 patients with cT1a ESCC were randomly assigned to receive PPI therapy for 5 weeks after ER (the PPI group, n = 115) or follow-up without PPI therapy (the non-PPI group, n = 114). The primary end point was the incidence of gastroesophageal reflux disease (GERD)-like symptoms after ER from a self-reported questionnaire (Frequency Scale for Symptoms of GERD). Secondary end points were ulcer healing rate at 5 weeks, incidence of pain, improvement rate of symptoms in those who started PPI therapy because of GERD-like symptoms in the non-PPI group, and adverse events. RESULTS: No significant difference was observed in the incidence of GERD-like symptoms after ER between the non-PPI and PPI groups (30 % vs 34 %, respectively). No significant differences were observed in the ulcer healing rate at 5 weeks (84 % vs 85 %) and incidence of pain within 1 week (36 % vs 45 %). In nine of ten patients (90 %) who started PPI therapy because of GERD-like symptoms in the non-PPI group, PPI administration relieved GERD-like symptoms. No adverse events related to PPI administration were observed. CONCLUSION: PPI therapy is not efficacious in reducing symptoms and did not promote healing of ulcers in patients undergoing ER for ESCC.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagoscopia/efeitos adversos , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Doenças do Esôfago/tratamento farmacológico , Doenças do Esôfago/etiologia , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago , Esofagoscopia/métodos , Feminino , Refluxo Gastroesofágico/etiologia , Azia/tratamento farmacológico , Azia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Úlcera/tratamento farmacológico , Úlcera/etiologiaRESUMO
BACKGROUND: In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness. METHODS: The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results. FINDINGS: 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P<0·001). INTERPRETATION: This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).
Assuntos
Gastroenterologistas/educação , Desenvolvimento de Programas , Neoplasias Gástricas/diagnóstico , Detecção Precoce de Câncer , Gastroenterologistas/psicologia , Gastroscopia , Humanos , Internet , Aprendizagem , Avaliação de Programas e Projetos de SaúdeRESUMO
The effect of prolonged oral administration of D-limonene on gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) and on the labeling and apoptotic indices of gastric cancers were investigated in Wistar rats. After 25 weeks of the carcinogen treatment, rats were given chow pellets containing 1% or 2% limonene. In week 52, long-term oral administration of 2%, but not 1%, limonene significantly decreased the incidence of gastric cancers. Limonene also significantly decreased the labeling index and significantly increased the apoptotic index of gastric cancers. No K-ras mutations were detected in gastric cancers induced by MNNG in either group. These findings indicate that limonene inhibits the development of gastric cancers through increased apoptosis and decreased DNA synthesis of gastric cancers, but not through ras oncoprotein plasma membrane association.
Assuntos
Adenocarcinoma/prevenção & controle , Anticarcinógenos/uso terapêutico , Neoplasias Gástricas/prevenção & controle , Terpenos/uso terapêutico , Adenocarcinoma/induzido quimicamente , Adenocarcinoma/genética , Adenocarcinoma/patologia , Animais , Apoptose , Testes de Carcinogenicidade , Cicloexenos , Relação Dose-Resposta a Droga , Genes ras/efeitos dos fármacos , Genes ras/genética , Limoneno , Masculino , Metilnitronitrosoguanidina , Mutação Puntual/efeitos dos fármacos , Mutação Puntual/genética , Ratos , Ratos Wistar , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologiaRESUMO
The effects of combined administration of a reactive oxidant, monochloramine, and a mucoregulatory agent, ambroxol, on the development of gastric cancers induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) were investigated in inbred Wistar rats. After receiving oral MNNG and regular chow pellets for 25 weeks, rats received regular chow pellets or chow pellets containing 20% ammonium acetate, and normal tap water or water containing 30 mM sodium hypochlorite, with or without subcutaneous injection of ambroxol at high or low doses, until the end of the experiment at week 52. Treatment with both ammonium acetate and sodium hypochlorite, which produce monochloramine, significantly increased the incidence of gastric cancers at week 52, whereas concomitant administration of ambroxol with ammonium acetate and sodium hypochlorite significantly attenuated this enhanced gastric carcinogenesis. Results also revealed that ambroxol scavenged monochloramine. Because monochloramine is closely related to Helicobacter pylori-associated gastric carcinogenesis, these findings suggest that ambroxol may prevent H. pylori-associated gastric carcinogenesis.
Assuntos
Ambroxol/farmacologia , Anticarcinógenos/farmacologia , Cloraminas/toxicidade , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/prevenção & controle , Animais , Apoptose/efeitos dos fármacos , Carcinógenos/toxicidade , Cloraminas/antagonistas & inibidores , Interações Medicamentosas , Sequestradores de Radicais Livres/farmacologia , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/metabolismo , Helicobacter pylori/metabolismo , Masculino , Metilnitronitrosoguanidina/toxicidade , Ratos , Ratos Wistar , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: In patients with Helicobacter pylori infection, the concentration of nitrite in gastric juice is elevated. The degree of elevation correlates with that of inflammation and H. pylori density. AIM: The aim of this study was to examine hypoacidity and high nitrite levels related to H. pylori infection in patients with gastric cancer. METHODS: We studied 88 patients with more than one history of endoscopic mucosal resection (EMR) for early gastric cancer and 88 age-matched controls. Concentration of nitrite in gastric juice was measured by Griess reaction, and serum pepsinogen levels were measured by RIA. RESULTS: Multiple malignant lesions were found in 20 of the 88 patients. Serum gastrin, gastric juice pH and nitrite levels in patients with gastric cancer were significantly higher and pepsinogen I and pepsinogen I/II significantly lower than in control subjects. Pepsinogen I level and I/II ratio were lower and gastric juice pH was higher in the protruded-type group than in the depressed-type group. Pepsinogen I and pepsinogen I/II were lower and gastric juice pH was higher in multiple than in single cases. CONCLUSIONS: Hypoacidity combined with high gastric juice nitrite induced by H. pylori infection is associated with the intestinal type of gastric cancer, especially protruded lesions.
Assuntos
Suco Gástrico/química , Infecções por Helicobacter/complicações , Helicobacter pylori , Nitritos/metabolismo , Neoplasias Gástricas/etiologia , Idoso , Estudos de Casos e Controles , Feminino , Ácido Gástrico , Determinação da Acidez Gástrica , Gastrinas/sangue , Infecções por Helicobacter/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pepsinogênios/sangue , Estudos Prospectivos , Neoplasias Gástricas/sangueRESUMO
BACKGROUND/AIMS: Endoscopic resection has been used to treat hypergastrinemia-associated early carcinoid tumors of the stomach. However, indications for endoscopic treatment of these tumors have not been established. Moreover, endoscopic resection of these tumors is often difficult with conventional polypectomy, because these tumors are often located in the submucosal layer. To completely remove these tumors, we used a two-channel videoendoscope with which both grasping forceps and a polypectomy snare could be used simultaneously. METHODOLOGY: At Osaka Medical Center for Cancer and Cardiovascular Diseases, eight carcinoid tumors in six patients were removed with a two-channel videoendoscope. Reports of early carcinoid tumor in Japanese literature were reviewed to analyze the relationship between lymph node metastasis and the size and depth of involvement of these tumors. RESULTS: Six carcinoid tumors were completely removed "en bloc", but two tumors were incompletely removed. In these two patients, submucosal tumor invasion was observed on the excision line. To completely remove these tumors, the oral side, but not the top, of the tumor should be strongly grasped and pulled toward the center of the lumen as far as possible by the grasping forceps, which had been passed through the snare loop. Endoscopic follow-up studies showed no local recurrence in any patients with and without complete tumor resection during the average observation period of 30 months. A review of histological reports in Japanese literature showed that lymph node metastasis did not occur when the tumors were less than 10 mm in diameter, and could be completely removed by an endoscope. CONCLUSIONS: Endoscopic resection with a two-channel videoendoscope is a useful and safe method for resection of small carcinoid tumors of the stomach.
Assuntos
Tumor Carcinoide/cirurgia , Gastroscópios , Gastroscopia , Neoplasias Gástricas/cirurgia , Idoso , Tumor Carcinoide/patologia , Feminino , Gastrinas/sangue , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND/AIMS: Cytological examination of pancreatic juice is useful in the diagnosis of an occult cancer of the pancreas. The early diagnosis of pancreatic carcinoma using traditional radiographic or ultrasonographic methods is extremely difficult. METHODOLOGY: In order to detect an early pancreatic cancer, cytological examination, measurement of tumor marker, and detection of K-ras point mutation were performed using the samples of pure pancreatic juice aspirated endoscopically in patients who had symptoms or findings that suggested pancreatic disease. RESULTS: By routine ERP-cytology, positive cytologic results were obtained in 15 (4%) out of 359 patients without a mass. With the aid of intra-operative cytodiagnosis, all 15 occult neoplasms of the pancreas were successfully resected. One patient died from another disease without evidence of recurrence. However, the other patients were alive with no evidence of recurrence for an average of 5.5 years following surgery. The patients who had negative ERP-cytology results were observed, but no further cases of pancreatic cancer were found. The CEA levels in the pure pancreatic juice were significantly higher in patients with pancreatic cancer than in those with pancreatitis. K-ras point mutation at codon 12 was detected not only in cases of pancreatic cancer, but also in cases of chronic pancreatitis as well as control subjects. CONCLUSIONS: Cytological examination of pancreatic juice is useful in the diagnosis of an early and potentially curable in situ cancer of the pancreas. The CEA levels in the pure pancreatic juice provided useful information for differentiating the pancreatic cancer from chronic pancreatitis. K-ras point mutation at codon 12 in pancreatic juice was considered to be useful in identifying patients at high risk for the development of pancreatic cancer.
Assuntos
Neoplasias Primárias Desconhecidas/diagnóstico , Suco Pancreático/química , Suco Pancreático/citologia , Neoplasias Pancreáticas/diagnóstico , Idoso , Antígeno CA-19-9/análise , Antígeno Carcinoembrionário/análise , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Genes ras , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/genética , Neoplasias Pancreáticas/genética , Mutação Puntual , Estudos ProspectivosAssuntos
Adenocarcinoma/patologia , Mucosa Gástrica/patologia , Gastroscópios , Processamento de Imagem Assistida por Computador/instrumentação , Microscopia de Fluorescência/instrumentação , Neoplasias Gástricas/patologia , Cirurgia Vídeoassistida/instrumentação , Adenocarcinoma/cirurgia , Idoso , Desenho de Equipamento , Mucosa Gástrica/cirurgia , Humanos , Masculino , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND: The loss of sonic hedgehog is an early change that occurs in the mucosa prior to neoplastic transformation and correlates with the type of intestinal metaplasia. Aberrant expression of CDX has also been shown to correlate with the development of intestinal metaplasia. AIM: To examine CDX2 expression in the non-cancerous mucosa of patients with gastric cancer and compared it to CDX2 expression in controls with intestinal metaplasia. METHODS: Sixty patients who had undergone endoscopic mucosal resection for early gastric cancer and 60 gender- and age-matched controls were studied. Two specimens each were obtained from the greater and lesser curves of the corpus and from the greater curve of the antrum. Expression of CDX2 and sonic hedgehog were evaluated by immunostaining. RESULTS: Gastric cancer was associated with a higher frequency of incomplete intestinal metaplasia (OR = 8.3; 95%CI, 3.7-18.9, P < 0.001). CDX2 negatively correlated with sonic hedgehog expression, however, multivariate analysis revealed that CDX2 correlated with the intestinal metaplasia scores. Sonic hedgehog indices were lower and CDX2 staining in the corpus lesser curve was higher in the cancer group than in the controls. Sonic hedgehog indices in the corpus decreased and CDX2 indices in both areas increased in patients in the ascending order of those without intestinal metaplasia, those with complete intestinal metaplasia and those with incomplete intestinal metaplasia (P < 0.001). CONCLUSIONS: Loss of sonic hedgehog expression and aberrant expression of CDX2 correlates with the type of intestinal metaplasia and may play a role in carcinogenesis.