Clinical significance of minimal change lesions of the esophagus in a healthy Korean population: a nationwide multi-center prospective study.

BACKGROUND AND AIM: At least half of the patients with typical reflux symptoms have non-erosive reflux disease (NERD). Minimal change lesions are commonly seen in the screening endoscopic examinations for individuals without clinically significant symptoms. We evaluated the correlation between minimal changes and symptoms in individuals visiting the hospital for routine health check-up by a nationwide survey in 2006. METHODS: Upper gastrointestinal endoscopic examinations as a health check-up were performed for 25,536 patients. Among them, symptom questionnaires were given in 23,350 patients without mucosal break or Barrett's esophagus. Endoscopic findings of the lower esophagus were divided into normal or minimal changes. Minimal changes in the present study included white turbid discoloration and Z-line blurring. RESULTS: Among a total of 25,536 subjects, reflux esophagitis was found in 2019 subjects (7.91%) and 3043 patients (11.9%) were classified as having minimal changes. History of gastroesophageal reflux disease (GERD) was more commonly found in individuals with minimal changes. Among the reflux-related symptoms, heartburn, acid regurgitation, globus sensation, and epigastric soreness were related to the minimal changes of the esophagus. Especially, individuals with globus sensation or epigastric soreness were more likely to have minimal changes compared to individuals without respective symptoms. Male gender, current smoker, history of H. pylori eradication, frequent stooping at work, hiatal hernia, and atrophic/metaplastic gastritis were found to be risk factors for minimal changes. CONCLUSION: The minimal changes were closely related with upper gastrointestinal symptoms and had similar risk factors for GERD, suggesting that minimal changes could be considered as early endoscopic findings of GERD.

[A case of sarcomatoid combined hepatocellular-cholangiocarcinoma].

Combined hepatocellular-cholangiocarcinoma (HCC-CC) with sarcomatoid features is an extremely rare primary liver cancer, of which only four cases have been reported. We report a case of sarcomatoid combined HCC-CC in a 60-year-old woman who complained of right upper quadrant pain and presented with a 7 cm mass in the S4 region of the liver in abdominal CT. Ultrasonography-guided needle biopsy diagnosed it as HCC, and left lobectomy of the liver followed. Microscopically, the tumor consisted of two portions: HCC portion showing trabecular pattern, which had partially sarcomatous area with spindle-shaped tumor cells, and CC portion with glandular pattern. Immunohistochemically, HCC portion reacted positively with alpha-fetoprotein while CC portion demonstrated positive reactivity with carcinoembryonic antigen and mucicarmine. Sarcomatoid cells reacted positively for cytokeratin. She died of tumor recurrence and hepatic failure 12 months after the operation. Combined HCC-CC has poor prognosis, and sarcomatoid HCC has high metastatic potential and poor prognosis compared with ordinary HCC.

[Usefulness of endoscopic mucosal resection for curative treatment of early gastric cancer].

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been widely accepted as a curative treatment of early gastric cancer (EGC). The aim of this study was to determine the usefulness and limitations of EMR for treatment of EGC by analyzing our own experience. METHODS: We retrospectively evaluated 51 EGC lesions (45 mucosal and 6 submucosal cancers) from 49 patients who had undergone EMR between Oct. 1997 and Aug. 2002 at Inha Universtiy Hospital. RESULTS: Among 45 lesions of mucosal cancer, enbloc resection was performed in 13 lesions and piecemeal resection in 32 lesions. Complete resection rates of enbloc and piecemeal resection were 84.6% and 43.8%, respectively (p=0.012). Complete resection rate of the lesions smaller than 1 cm in size was 71.4%, 1 to 2 cm in size 52%, and greazter than 2 cm in size 37.5%. Complete resection rates of well, moderately, and poorly differentiated EGC were 59.4%, 71.4%, and 16.7%, respectively (p=0.048). Thirty-three patients underwent a follow-up endoscopy at I month after EMR and two were found to have residual cancers. One patient who had a piecemeal EMR showed cerical and abdominal lymph node metastasis 10 months after EMR. CONCLUSIONS: In selected patients with EGC, EMR can be a curative treatment modality. However, complete resection rate is low in large sized and poorly differentiated EGCs and when piecemeal resection is performed.