Phytochemical, Antioxidant Activity, and Toxicity of Wild Medicinal Plant of Melitotus albus Extracts, In Vitro and In Silico Approaches.

Morocco is known for its high plant biodiversity, but many plants are poorly valorized. For this reason, this study aims to valorize the methanolic and aqueous extracts of Melitotus albus leaves by studying their antioxidant activity and toxicity. The extracts' antioxidant activity is assessed using the FRAP, DPPH, CAT, and ABTS methods. The chemical composition was determined using LC-MS analysis and evaluated using in silico studies. The results revealed that the total polyphenol content of the aqueous extract, 259.26 ± 7.79 (mg GAE/g), is higher than that of the methanolic extract, 131.41 ± 12.64 (mg GAE/g). The antioxidant activity by the methods of DPPH, ABTS, and phosphor molybdenum of aqueous extracts (0.087 ± 0.015, 0.014 ± 0.001 and 6.157 ± 1.050 mg eq vit C/g, respectively) is greater than that of methanolic extracts (0.107 ± 0.02, 0.167 ± 0.03, and 0.453 ± 0.014 mg eq vit C/g, respectively). The reducing power of iron (FRAP) shows that the methanolic extract has a greater reducing power than that of the aqueous extract with a low IC50 (0.011 ± 0.003 and 0.199 ± 0.016 mg/mL, respectively). The study of acute and subacute toxicity shows that the administration of the aqueous extract of M. albus at different doses increases the body weight of rats without modifying their general behavior. The M. albus extract had a 99.99% total phenolic content, as determined by LC-MS, consisting of 12 different components. The primary constituents of the extract are chlorogenic acid (43.68%), catechin/epicatechin (24.82%), quercetin-3-O-glucuronic acid (9.91%), naringin (7.64%), and p-hydroxybenzoic/salicylic acid (2.95%). The in-silico study showed that these compounds can passively permeate through the blood and have a beneficial effect on various organs of the body. Based on these results, M. albus can be used as a medicinal plant in phytotherapy, cosmetics, or as a dietary supplement. The bioactive compounds of these plants will require a lot of further effort in terms of isolation and characterization.

Exploring the Bioactive Compounds in Some Apple Vinegar Samples and Their Biological Activities.

Apple vinegar is highly recommended for nutrition due to its health benefits and bioactive components. However, the apple cultivar greatly influences the quality of the vinegar. In this research, our focus was on examining the impact of four different apple cultivars on the physicochemical attributes, chemical composition, as well as biological properties-including antidepressant and anti-inflammatory activities-of vinegar. Interestingly, the physicochemical properties of vinegar and the contents of acetic acid and polyphenols depend on the apple cultivars. HPLC chromatographic analysis showed that citric acid (820.62-193.63 mg/100 g) and gallic acid (285.70-54.40 µg/g) were mostly abundant in the vinegar samples. The in vivo results showed that administration of Golden Delicious apple vinegar (10 mL/kg) to adult Wistar rats reduced carrageenan-induced inflammation by 37.50%. The same vinegar sample exhibited a significant antidepressant effect by reducing the rats' immobility time by 31.07% in the forced swimming test. Due to its high acidity, Golden Delicious vinegar was found to be more effective against bacteria, particularly Bacillus subtilis and Candida albicans, resulting in a MIC value of 31.81 mg/mL. Furthermore, the antioxidant activity of various vinegar samples was found to be powerful, displaying optimal values of IC50 = 65.20 mg/mL, 85.83%, and 26.45 AAE/g in the DPPH, ß-carotene decolorization and TAC assays, respectively. In conclusion, the apple cultivars used in this study impact the chemical composition and biological activities of vinegar, which may help demonstrate the importance of raw material selection for the production of vinegar.

Papaver rhoeas L. stem and flower extracts: Anti-struvite, anti-inflammatory, analgesic, and antidepressant activities.

The Papaver rhoeas L. (P. rhoeas) plant, which belongs to the Papaveraceae family, is also used as food and is exploited to treat several health problems. The purpose of this research is to determine the anti-struvite, anti-inflammatory, analgesic, and antidepressant effects of the stem extract (SE) and flower extract (FE) of the plant P. rhoeas. We used polarizing microscopy and Fourier transform infrared spectrometry (FT-IR) to evaluate the anti-struvite effect of our plant. The edema approach induced by the carrageenan molecule was used to study the anti-inflammatory impact of our extracts. The analgesic test was determined by calculating the number of abdominal contractions induced by the intraperitoneal (IP) administration of acetic acid. To evaluate the antidepressant effect of our extracts, we used the forced swimming test (FST). According to the results of the secondary metabolite extraction, both extracts contained high contents of secondary metabolites, while the results of the screening test showed that flavonoids, alkaloids, phenols, tannins, coumarins, saponins, and terpenoids were present. The result of struvite crystallization inhibition observed by polarizing microscopy and FT-IR shows the inhibition of struvite crystal aggregation by SE by decreasing the amount and size of crystals in a manner similar to cystone. The results of anti-inflammatory activity show maximum inhibition of edema after six hours of carrageenan injection in rats (T6) for all extracts, with a maximum value of 86.36% for SE at the dose of 200 mg/kg. Regarding the analgesic effect of our plant, the lowest number of abdominal contractions was observed in rats treated with SE at a dose of 400 mg/kg. The FST results show that the lowest immobilization time was observed in rats treated with FE at a dose of 400 mg/kg. The results obtained show that the flowers and stems of P. rhoeas can constitute a rich source of bioactive molecules with potential pharmaceutical applications.

When to discharge patients following a neuronavigation-assisted brain biopsy for supratentorial lesion? A single-center experience.

OBJECTIVE: Most brain biopsies are performed using the frame-based stereotactic technique and several studies describe the time taken and rate of complications, often allowing an early discharge. In comparison, neuronavigation-assisted biopsies are performed under general anesthesia and their complications have been poorly described. We examined the complication rate and determined which patients will worsen clinically. METHODS: All adults who underwent a neuronavigation-assisted brain biopsy for a supratentorial lesion from Jan, 2015, to Jan, 2021, in the Neurosurgical Department of the University Hospital Center of Bordeaux, France, were analyzed retrospectively in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. The primary outcome of interest was short-term (7 days) clinical deterioration. The secondary outcome of interest was the complication rate. RESULTS: The study included 240 patients. The median postoperative Glasgow score was 15. Thirty patients (12.6 %) showed acute postoperative clinical worsening, including 14 (5.8 %) with permanent neurological worsening. The median delay was 22 h after the intervention. We examined several clinical combinations that allowed early postoperative discharge. A preoperative Glasgow prognostic score of 15, Charlson Comorbidity Index ≤ 3, preoperative World Health Organization Performance Status ≤ 1, and no preoperative anticoagulation or antiplatelet treatment predicted postoperative worsening (negative predictive value, 96.3 %). CONCLUSION: Optical neuronavigation-assisted brain biopsies might require longer postoperative observation than frame-based biopsies. Based on strict preoperative clinical criteria, we consider to plan postoperative observation for 24 h a sufficient hospital stay for patients who undergo these brain biopsies.

Optimization of a New Antioxidant Formulation Using a Simplex Lattice Mixture Design of Apium graveolens L., Coriandrum sativum L., and Petroselinum crispum M. Grown in Northern Morocco.

A statistical Simplex Lattice Mixture design was applied to develop a new formulation based on a combination of three plants grown in northern Morocco: Apium graveolens L., Coriandrum sativum L., and Petroselinum crispum M. We examined the extraction yield, total polyphenol content (TPC), 2'2-diphenyl-l-picrylhydrazyl (DPPH) radical scavenging activity, and total antioxidant capacity (TAC). The results of this screening study showed that C. sativum L. had the highest content of DPPH (53.22%) and TAC (37.46 ± 0.29 mg Eq AA/g DW) compared to the other two plants, while P. crispum M. showed the highest TPC (18.52 ± 0.32 mg Eq GA/g DW). Furthermore, the ANOVA analysis of the mixture design showed that all three responses (DPPH, TAC, and TPC) were statistically significant, with determination coefficients of 97%, 93%, and 91%, respectively, and fit the cubic model. Moreover, the diagnostic plots showed good correlation between the experimental and predicted values. Therefore, the best combination obtained under optimal conditions (P1 = 0.611, P2 = 0.289, P3 = 0.100) was characterized by DPPH, TAC, and TPC of 56.21%, 72.74 mg Eq AA/g DW, and 21.98 mg Eq GA/g DW, respectively. The results of this study reinforce the view of stimulating the effect of plant combinations to achieve better antioxidant activities, thus providing a better formulation using designs of mixtures for the food industry and in cosmetic and pharmaceutical applications. Moreover, our findings support the traditional use of the Apiaceae plant species in managing many disorders cited in the Moroccan pharmacopeia.

Total Polyphenols Content, Antioxidant and Antimicrobial Activities of Leaves of Solanum elaeagnifolium Cav. from Morocco.

Solanum elaeagnifolium is among the invasive plants of Morocco; studies on its chemical composition and biological activities are few in number in Morocco. S. elaeagnifolium has shown molluscicidal and nematicidal and cancer-inhibitory effects, anti-inflammatory, analgesic activity, and antibacterial activity. The objective of this research is to improve this plant and assess its antibacterial and antioxidant properties as well as its total polyphenolic content (TPC) and total flavonoid content (TFC). The Folin-Ciocalteu method and the aluminium-trichloride method were used to determine TPC and TFC in hydro-ethanolic (HEE) and hydro-acetonic (HAE) leaf extract. Three assays were performed to determine the antioxidant activity: the DPPH test (radical 2,2'-diphenyl-1-picrylhydrazyl), the FRAP test (Ferric Reducing Antioxidant Power), and the TAC test. Disk diffusion and microdilution were used to test antibacterial activity against four pathogenic bacteria and Candida albicans. The hydro-ethanolic extract 2.54 ± 0.4 mg EAG/g has a greater polyphenol concentration than the hydro-acetonic extract 1.58 ± 0.03 mg EAG/g. Although the flavonoid content of the hydro-acetonic extract (0.067 ± 0.001 mg EQ/g) is larger than that of the hydro-ethanolic extract (0.012 ± 0.001 mg EQ/g), the flavonoid content of the hydro-ethanolic extract (0.012 ± 0.001 mg EQ/g). The DPPH values were IC-50 = 0.081 ± 0.004 mg/mL for hydro-ethanoic extract and 0.198 ± 0.019 mg/mL for hydro-acetonic extract, both extracts superior to BHT (0.122 ± 0.021 g/mL). While the FRAP assay showed a low iron-reducing power values for both extracts compared to BHT), the overall antioxidant activity of the two extracts was found to be considerable. The overall antioxidant activity of the hydro-ethanolic extract was 8.95 ± 0.42 mg EAA/g, whereas the total antioxidant activity of the hydro-acetonic extract was 6.44 ± 0.61 mg EAA/g. In comparison with the antibiotic Erythromycin, HAE and HEE from S. elaeagnifolium leaves demonstrated significant antibacterial action. HAE had the best inhibitory efficacy against Bacillus subtilis DSM 6333, with an inhibition diameter of 10.5 ± 0.50 mm and a MIC of 7.5 ± 0.00 mg/mL, as well as against Proteus mirabilis ATCC 29906, with an inhibitory diameter of 8.25 ± 0.75 mm and a MIC of 15 ± 0.00 mg/mL.

In Vitro Studies on the Antimicrobial and Antioxidant Activities of Total Polyphenol Content of Cynara humilis from Moulay Yacoub Area (Morocco).

In Morocco, Cynara humilis L. is used in traditional medicine. The objective of this research was to research the antioxidant and antimicrobial properties of hydroethanolic extracts from the C. humilis plant's leaves and roots. The content of polyphenols and flavonoids was evaluated using Folin-Ciocalteu's and aluminum chloride assays. Two techniques were used to evaluate antioxidant properties: antioxidant capacity in total (TAC) and 2,2-diphenyl-1-picrylhdrazyl (DPPH). In antimicrobial assays, five pathogenic microbial strains were studied including two Escherichia coli, one coagulase-negative Staphylococcus and Klebsiella pneumoniae, and one Candida albicans, by two techniques: agar disk diffusion and microdilution. Leaves had a greater content of flavonoids 27.07 mg QE/g of extract and the polyphenols 38.84 mg GAE/g of extract than root 24.39 mg QE/g of extract and 29.39 mg GAE/g of extract, respectively. The TAC test value of the 0.77 mg AAE/g extract in the leaf extract was found to be significantly greater than that of the 0.60 mg EAA/g extract in the root extract. The DPPH antioxidant assay IC50 values of the root and leaf extract were 0.23 and 0.93 µg/mL, respectively. C. humilis extracts showed an antimicrobial effect against all tested strains, the inhibitory zone (DIZ) have values in the range between 12 and 15 mm. Moreover, the root extract showed the lowest minimum inhibitory concentration (MIC) against coagulase-negative Staphylococcus with an IC50 value of 6.25 mg/mL. The higher content of flavonoids and polyphenols in the hydroethanolic extracts of C. humilis leaves and roots demonstrates that they have a significant antimicrobial and antioxidant effect, as found in this study.

Chemical Composition and Antimicrobial Activity of Essential Oil of Fruits from Vitex agnus-castus L., Growing in Two Regions in Bulgaria.

The chemical composition of Vitex agnus-castus L. (Verbenaceae family) fruits, collected from two regions in Bulgaria (south-central and north-east Bulgaria), was investigated. The content of proteins (5.3-7.4%), carbohydrates (73.9-78.8%), fiber (47.2-49.9%), ash (2.5-3.0%), essential oils (0.5%), and vegetable oil (3.8-5.0%) were identified in the fruits. The composition of the essential oils (EOs) of Vitex fruits from both regions was determined; the main compounds were 1,8-cineole (16.9-18.8%), α-pinene (7.2-16.6%), sabinene (6.7-14.5%), and bicyclogermacrene (7.3-9.0%), but significant differences in the quantitative and qualitative composition of EOs between the regions were found. The EOs of plants from north-east Bulgaria demonstrated antimicrobial activity against the pathogenic species Salmonella abony, Staphylococcus aureus, and Bacillus subtilis, but the Gram-negative bacteria Esсherichia coli and Pseudomonas aeruginosa exhibited resistance to the oil. Linoleic acid predominated in vegetable oil from both regions, followed by oleic acid. ß-sitosterol and γ-tocopherol were the main components in the sterol and tocopherol fraction of the lipids. Phosphatidic acids were the main components in the vegetable oil from north-east Bulgaria, while in the vegetable oil from south-central Bulgaria, all phospholipids were found in almost the same quantity. Overall, significant differences were observed in the chemical composition (proteins, carbohydrates, ash and moisture) of the fruits from the two regions of Bulgaria, as well as in the content of the main components of their essential and vegetable oils.

Contribution to the Evaluation of Physicochemical Properties, Total Phenolic Content, Antioxidant Potential, and Antimicrobial Activity of Vinegar Commercialized in Morocco.

Vinegar is a natural product widely used in food and traditional medicine thanks to its physicochemical properties and its richness in bioactive molecules. However, its direct use by consumers can have complications and undesirable effects. Therefore, this study contributes to investigating the physicochemical and biological properties of eleven vinegars marketed in Morocco. Determination of pH, acetic acid, conductivity, total soluble solids and alcohol content in vinegar was carried out. The polyphenols (TP), flavonoids (TF), and condensed tannins (CT) content was determined, and their antioxidant activities were evaluated using 2,2-diphenyl-1-picryl Hydrazyl (DPPH), Ferric Reducing Antioxidant Power (FRAP) and Phosphomolybdenum Reduction Assay (TAC). Then, the antimicrobial activity was studied against four pathogenic bacteria and two fungal strains, using the disk diffusion and the microdilution method. This study showed a wide range of acetic acid values from 0.65 ± 0.29 to 5.15 ± 0.20%. The high value of TP, TF, and CT in our samples V10, V9, and V4 was 655.00 ± 22.2 µgGAE/mL, 244.53 ± 11.32 µgQE/mL and 84.63 ± 1.00 µgTAE/mL, respectively. The tested strains showed variable sensitivities to the different samples with inhibition zones ranging from 6.33 ± 2.08 to 34.33 ± 0.58 mm. The lowest minimum inhibition concentrations were recorded against Staphylococcus aureus ATCC29213 ranging from 1.95 to 7.81 µL/mL. While Aspergillus niger ATCC16404 showed resistance against all of the analyzed samples. In general, vinegar commercialized in Morocco presents a variable range of products with variable properties. Indeed, must take into account this diversity when using it. A future study is needed to identify the phytochemical composition that will further the comprehension of this variability and contribute to its valorization.

Total Phenolic Content and Antioxidant and Antimicrobial Activities of Papaver rhoeas L. Organ Extracts Growing in Taounate Region, Morocco.

The objective of this study is to valorize Papaver rhoeas L. from the Taounate region of Morocco by determining the total polyphenol content (TPC), the total flavonoid content (TFC) and the antioxidant and antimicrobial activities of four organs. The quantification of TPC and TFC in root, stem, leaf and flower extracts (RE, SE, LE and FE, respectively) was estimated by the Folin-Ciocalteu reaction and the aluminum trichloride method, respectively. Two tests were used to assess antioxidant power: the DPPH test and TAC assay. The antimicrobial activity was studied against five pathogenic bacteria and yeast, using two methods: disk diffusion and microdilution. The TPC in LE and LF was twice as high as that in RE and SE (24.24 and 22.10 mg GAE/g, respectively). The TFC values in the four extracts were very close and varied between 4.50 mg QE/g in the FE and 4.38 mg QE/g in the RE. The LE and FE showed low DPPH values with IC50 = 0.50 and 0.52 mg/mL, respectively. The TAC measurement revealed the presence of a significant amount of antioxidants in the studied extracts, mainly in LE and FE (6.60 and 5.53 mg AAE/g, respectively). The antimicrobial activity results revealed significant activity on almost all of the tested strains. The MIC of FE and SE against E. coli 57 was 1.56 and 0.78 mg/mL, respectively, while against the S. aureus it was 50 and 25 mg/mL, respectively. The low MLC value (1.56 mg/mL) was recorded against E. coli 57 by RE and SE.

Antimicrobial and Antioxidant Properties of Total Polyphenols of Anchusa italica Retz.

Anchusa italica Retz has been used for a long time in phytotherapy. The aim of the present study was to determine the antioxidant and antibacterial activities of extracts from the leaves and roots of Anchusa italica Retz. We first determined the content of phenolic compounds and flavonoids using Folin-Ciocalteu reagents and aluminum chloride (AlCl3). The antioxidant activity was determined using three methods: reducing power (FRAP), 2.2-diphenyl-1-picrylhydrazyl (DPPH), total antioxidant capacity (TAC). The antimicrobial activity was investigated against four strains of Escherichia coli, two strains of Klebsiella pneumoniae and coagulase-negative Staphylococcus, and one fungal strain of Candida albicans. The results showed that the root extract was rich in polyphenols (43.29 mg GAE/g extract), while the leave extract was rich in flavonoids (28.88 mg QE/g extract). The FRAP assay showed a strong iron reduction capacity for the root extract (IC50 of 0.11 µg/mL) in comparison to ascorbic acid (IC50 of 0.121 µg/mL). The DPPH test determined an IC50 of 0.11 µg/mL for the root extract and an IC50 of 0.14 µg/mL for the leaf extract. These values are low compared to those for ascorbic acid (IC50 of 0.16 µg/mL) and BHT (IC50 0.20 µg/mL). The TAC values of the leaf and root extracts were 0.51 and 0.98 mg AAE/g extract, respectively. In vitro, the extract showed inhibitory activity against all strains studied, with diameters of zones of inhibition in the range of 11.00-16.00 mm for the root extract and 11.67-14.33 mm for the leaf extract. The minimum inhibitory concentration was recorded for the leaf extract against E. coli (ATB:57), corresponding to 5 mg/mL. Overall, this research indicates that the extracts of Anchusa italica Retz roots and leaves exert significant antioxidant and antibacterial activities, probably because of the high content of flavonoids and polyphenols.

The vanishing duodenal polyp: mesenteric invagination presenting as duodenal pseudopolyp.

Duodenal polypoid masses are an uncommon finding mainly diagnosed incidentally at endoscopy or surgery. We report a 39-year-old female patient with symptoms of intermittent stabbing pain in the upper right abdominal quadrant and an iron deficiency anaemia, without complaints of weight loss, haematemesis or melaena. A duodenal polyp and acute duodenitis have been described during endoscopic examinations and CT and ultrasound. Surgical excision of the polyp was advised. Intraoperatively, an elongated duodenum was remarkable; however, at duodenotomy, no polyp was found, nor during intraoperative endoscopy. Looking back at the endoscopy and imaging results, it was noted that the polyp varied in size and location. It was therefore concluded that we dealt with the pseudopolyp phenomenon, caused by invagination of the duodenal wall and its mesentery into the duodenum, presenting as a lipomatous pseudopolyp. Telescopic invagination of the duodenal wall was facilitated by the elongated hypermobile duodenum.

Narrow band imaging does not reliably predict residual intestinal metaplasia after radiofrequency ablation at the neo-squamo columnar junction.

BACKGROUND AND STUDY AIMS: After radiofrequency ablation (RFA) of Barrett's esophagus, it may be difficult to determine whether complete eradication of intestinal metaplasia at the neosquamocolumnar junction (neo-SCJ) in the cardia has been achieved. It is claimed that narrow band imaging (NBI) may predict the presence of intestinal metaplasia, which would enable immediate treatment. The aim of the current study was to evaluate whether inspection of the neo-SCJ with NBI after RFA results in reliable detection of intestinal metaplasia. PATIENTS AND METHODS: Patients with a normal-appearing neo-SCJ who were scheduled for RFA were included in the study. Two expert endoscopists obtained images from the neo-SCJ in overview (high resolution white light and NBI mode) and from four areas using NBI zoom, followed by corresponding biopsies. Four other blinded expert endoscopists evaluated the images for the presence of intestinal metaplasia and type of mucosal pattern (round, small tubular, large tubular, villous). Endpoints were sensitivity and specificity for identifying patients and areas with intestinal metaplasia. RESULTS: From 21 patients overview images from 21 neo-SCJs and NBI zoom images from 83 neo-SCJ areas were obtained. Intestinal metaplasia was present in five overview images (24 %) and nine zoom images (11 %). Using the overview images, sensitivity and specificity for identifying patients with intestinal metaplasia were 65 % (95 % confidence interval [CI] 38 - 86) and 46 % (95 %CI 33 - 60), respectively. For individual zoom images, sensitivity was 71 % (95 %CI 54 - 85) and specificity was 37 % (95 %CI 32 - 43). CONCLUSIONS: After RFA, endoscopic inspection of the neo-SCJ with NBI in overview or zoom does not reliably predict presence or absence of intestinal metaplasia.

Effects of autofluorescence imaging on detection and treatment of early neoplasia in patients with Barrett's esophagus.

BACKGROUND & AIMS: Studies have reported that autofluorescence imaging (AFI) increases targeted detection of high-grade intraepithelial neoplasia (HGIN) and intramucosal cancer (IMC) in patients with Barrett's esophagus (BE). We analyzed data from trials to assess the clinical relevance of AFI-detected lesions. METHODS: We collected information on 371 patients with BE, along with endoscopy and histology findings, from databases of 5 prospective studies of AFI (mean age, 65 years; 305 male). We compared these data with outcomes of treatment and follow-up. Study end points included the diagnostic value of AFI (proportion of surveillance patients with HGIN or IMC detected only by AFI-targeted biopsies) and value of AFI in selection of therapy (the proportion of patients for which detection of an HGIN or IMC lesion by AFI changed the treatment strategy based on white-light endoscopy or random biopsy analysis). RESULTS: Of study participants, 211 were referred for surveillance and 160 were referred for early stage neoplasia; HGIN or IMC were diagnosed in 147 patients. In 211 patients undergoing surveillance, 39 had HGIN or IMC (23 detected by white-light endoscopy, 11 detected by random biopsies, 5 detected by AFI). So, the diagnostic value of AFI was 5 (2%) of 211. In 24 patients, HGIN or IMC was diagnosed using only AFI. In 33 patients, AFI detected additional HGINs or IMCs next to lesions detected by primary white-light endoscopy. Lesions detected by AFI were treated in 57 patients: 26 patients underwent radiofrequency ablation and showed full remission of neoplasia, whereas 31 underwent endoscopic resection and 6 were found to have IMC. The value of AFI in selection of therapy was 6 (2%) of 371. CONCLUSIONS: Based on an analysis of data from clinical trials of patients with BE, detection of lesions by AFI has little effect on the diagnosis of early stage neoplasia or therapeutic decision making. AFI therefore has a limited role in routine surveillance or management of patients with BE.

Zooming in on Barrett oesophagus using narrow-band imaging: an international observer agreement study.

BACKGROUND: Several classifications of mucosal morphology have been proposed in Barrett oesophagus using narrow-band imaging (NBI). We evaluated a simplified classification in which only the regularity of mucosal and vascular patterns were evaluated. AIM: To assess the inter and intraobserver agreement and the correlation with histology of a simplified NBI classification of mucosal morphology in Barrett oesophagus combining the experience of two referral centres. METHODS: Two hundred NBI images [57 high-grade intraepithelial neoplasia (HGIN)/early cancer (EC)] were evaluated twice by four NBI-experienced and four nonexperienced endoscopists in the field of NBI. Endoscopists assessed each image for: quality, suspicion for dysplasia, and regularity of mucosal and vascular patterns. Observer agreement was assessed using kappa statistics. RESULTS: Overall interobserver agreement for the items evaluated was 'moderate' and varied between 0.42 and 0.44. Overall intraobserver agreement was 'moderate' to 'substantial' (kappa 0.60-0.62). There were no significant differences in agreement between expert and nonexpert endoscopists. Endoscopist correctly identified 71% of the images containing HGIN/EC. Of the areas without HGIN/EC, 68% were correctly identified as not suspicious. Again, there were no significant differences between experts and nonexperts. CONCLUSION: Our proposed, simplified classification for Barrett mucosal morphology has a moderate interobserver and a moderate to substantial intraobserver agreement. The lack of differences in agreements between expert and nonexpert endoscopists suggests a short learning curve. The disappointing rate for correctly indentifying HGIN/EC, questions, however, whether detailed inspection of Barrett oesophagus with NBI can replace histological sampling.

Clinical evaluation of endoscopic trimodal imaging for the detection and differentiation of colonic polyps.

BACKGROUND & AIMS: Endoscopic trimodal imaging (ETMI) incorporates high-resolution endoscopy (HRE) and autofluorescence imaging (AFI) for adenoma detection, and narrow-band imaging (NBI) for differentiation of adenomas from nonneoplastic polyps. The aim of this study was to compare AFI with HRE for adenoma detection and to assess the diagnostic accuracy of NBI for differentiation of polyps. This was a randomized trial of tandem colonoscopies. The study was performed at the Academic Medical Center in Amsterdam. METHODS: One hundred patients underwent colonoscopy with ETMI. Each colonic segment was examined twice for polyps, once with HRE and once with AFI, in random order per patient. All detected polyps were assessed with NBI for pit pattern and with AFI for color, and subsequently removed. Histopathology served as the gold standard for diagnosis. The main outcome measures of this study were adenoma miss-rates of AFI and HRE, and diagnostic accuracy of NBI and AFI for differentiating adenomas from nonneoplastic polyps. RESULTS: Among 50 patients examined with AFI first, 32 adenomas were detected initially. Subsequent inspection with HRE identified 8 additional adenomas. Among 50 patients examined with HRE first, 35 adenomas were detected initially. Successive AFI yielded 14 additional adenomas. The adenoma miss-rates of AFI and HRE therefore were 20% and 29%, respectively (P = .351). The sensitivity, specificity, and overall accuracy of NBI for differentiation were 90%, 70%, and 79%, respectively; corresponding figures for AFI were 99%, 35%, and 63%, respectively. CONCLUSIONS: The overall adenoma miss-rate was 25%; AFI did not significantly reduce the adenoma miss-rate compared with HRE. Both NBI and AFI had a disappointing diagnostic accuracy for polyp differentiation, although AFI had a high sensitivity.

Multiband mucosectomy for endoscopic resection of Barrett's esophagus: feasibility study with matched historical controls.

BACKGROUND AND AIMS: Piece-meal endoscopic resection of early neoplastic lesions larger than 15-20 mm is a laborious procedure with the cap technique. Multiband mucosectomy is a new technique using a modified variceal band ligator. Submucosal lifting and prelooping of the snare in the cap is not necessary and multiple resections can be performed with a single snare. We prospectively evaluated the feasibility of multiband mucosectomy for widespread endoscopic resection in patients with a Barrett's esophagus with early neoplasia and compared results retrospectively with prospectively registered endoscopic cap resection procedures. RESULTS: Eighty multiband mucosectomy procedures were performed in 40 patients and 86 endoscopic cap resection procedures in 53 patients. Median duration of the multiband mucosectomy procedures was 37 vs. 50 min for endoscopic cap resection procedures (P=0.06); median duration per resection was 6 vs. 12 min, respectively (P<0.001). Mean diameter of the specimens was 17 vs. 21 mm (P<0.001). One perforation in the endoscopic cap resection group was successfully treated conservatively. Mild bleeding occurred in 6% of multiband mucosectomy and 20% of endoscopic cap resection procedures (P=0.012). Technical difficulties during multiband mucosectomy procedures included a decreased visibility owing to the black bands and the releasing wires. CONCLUSIONS: Multiband mucosectomy allows safe and easy widespread piece-meal resections in Barrett's esophagus. Time and costs appear to be saved compared with the cap technique, and multiband mucosectomy appears to cause less bleeding during the endoscopic resection procedure. Multiband mucosectomy, however, results in smaller specimens and is, therefore, most suited for en-bloc resection of lesions smaller than 10 mm or for widespread resection of flat mucosa.

Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett's esophagus by using narrow band imaging.

BACKGROUND: The detection of the mucosal morphology (ie, mucosal and vascular patterns) in Barrett's esophagus (BE) by magnifying (chromo)endoscopy may improve the distinction of high-grade intraepithelial neoplasia (HGIN) from nondysplastic specialized intestinal metaplasia (SIM). Narrow band imaging (NBI) is a new technique that uses optical filters to enhance the mucosal contrast without the need for chromoendoscopy. OBJECTIVE: To use NBI for the characterization and the classification of the mucosal morphology in nondysplastic BE and in BE with HGIN. DESIGN: Descriptive study. SETTING: Single-center study in a tertiary referral center for the diagnosis and treatment of patients with BE. PATIENTS: We used NBI with magnifying endoscopy to image and biopsy randomly selected areas in 63 patients with BE. A systematic image and a biopsy specimen evaluation process was followed, including unblinded assessment of an exploratory set of images and biopsy specimens, and blinded evaluation of learning and validation sets. MAIN OUTCOME MEASUREMENTS: The relationship between the mucosal morphology and the presence of SIM and HGIN. RESULTS: SIM was characterized by either villous/gyrus-forming patterns (80%), which were mostly regular and had regular vascular patterns, or a flat mucosa with regular normal-appearing long branching vessels (20%). HGIN was characterized by 3 abnormalities: irregular/disrupted mucosal patterns, irregular vascular patterns, and abnormal blood vessels. All areas with HGIN had at least 1 abnormality, and 85% had 2 or more abnormalities. The frequency of abnormalities showed a significant rise with increasing grades of dysplasia. The magnified NBI images had a sensitivity of 94%, a specificity of 76%, a positive predictive value of 64%, and a negative predictive value of 98% for HGIN. LIMITATIONS: No data on observer agreement. CONCLUSIONS: NBI with magnification reveals the mucosal morphology characteristics of nondysplastic BE and HGIN, without the need for staining and has a relatively high diagnostic value for HGIN when used for targeted detailed examination of areas of interest.

Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus.

BACKGROUND: Video-autofluorescence imaging (AFI) and narrow band imaging (NBI) are new endoscopic techniques that may improve the detection of high-grade intraepithelial neoplasia (HGIN) in Barrett's esophagus (BE). AFI improves the detection of lesions but may give false-positive findings. NBI allows for detailed inspection of the mucosal and (micro)vascular patterns, which are related to HGIN. OBJECTIVE: A proof-of-principle study to combine AFI and NBI to improve the detection of HGIN and to reduce false-positive findings. DESIGN: Cross-sectional study of consecutive eligible patients. SETTING: Single-center. PATIENTS: Twenty patients with BE with suspected or endoscopically treated HGIN were investigated with 2 prototype imaging systems: AFI (inspection with high-resolution videoendoscopy and autofluorescence imaging for detection of lesions) and NBI (for detailed inspection of mucosal and vascular patterns of identified lesions). Lesions were sampled for histopathologic evaluation. MAIN OUTCOME MEASUREMENTS: The positive predictive value of AFI alone and of AFI-NBI for detecting HGIN and the reduction of false-positive findings because of the use of NBI. RESULTS: All of the 28 lesions with HGIN were identified with AFI. Seventeen were identified with white light (61%). Forty-seven suspicious lesions were detected with AFI: 28 contained HGIN (60%) and 19 were false positive (40%). With NBI, 25 of the true-positive lesions had definitely suspicious patterns, and 3 had dubiously suspicious patterns. Of the 19 false positives, 14 were not suspicious on NBI. The false-positive rate, therefore, was reduced from 40% to 10%. Low-grade dysplasia was found in 4 of the remaining 5 false positives. All of the 14 patients with HGIN were identified by AFI-NBI (sensitivity 100%). LIMITATIONS: Uncontrolled study in high-risk patients. CONCLUSIONS: This proof-of-principle study confirms that AFI can be used as a red-flag technique to detect suspicious lesions. With NBI, detailed inspection of the surface patterns can be performed. This combination may increase the accuracy of detecting HGIN in BE.

Stepwise radical endoscopic resection is effective for complete removal of Barrett's esophagus with early neoplasia: a prospective study.

OBJECTIVES: Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving rapidly. Aim of this study was to prospectively evaluate safety and efficacy of stepwise radical endoscopic resection (ER) of BE containing early neoplasia. METHODS: Patients with early neoplasia (i.e., high-grade intraepithelial neoplasia or early cancer) in BE < or = 5 cm, without signs of submucosal infiltration or lymph node/distant metastases, were included. Patients underwent resection sessions (cap technique after submucosal lifting) with intervals of 6 wk. RESULTS: Between January 2003 and December 2004, 39 consecutive patients were included. Therapy was discontinued in two patients due to unrelated comorbidity. Complete eradication of early neoplasia was achieved in all 37 treated patients in a median number of three sessions. Complete removal of all Barrett's mucosa was achieved in 33 (89%) patients: 4 patients (all had undergone APC [argon plasma coagulation]) were found to have small isles of Barrett's mucosa underneath neosquamous mucosa. Complications occurred in two out of 88 (2%) ER procedures: one asymptomatic perforation, one delayed bleeding. Symptomatic stenosis occurred in 10 of 39 (26%) patients and was effectively treated by endoscopic bougienage. During a median follow-up of 11 months, no patients died and none had recurrence of neoplasia or Barrett's mucosa. CONCLUSIONS: Stepwise radical ER is effective for selected patients with early neoplasia in BE; provides optimal histopathological diagnosis; and may reduce recurrence rate, since all mucosa at risk is effectively removed. Use of APC should be limited to prevent buried Barrett's mucosa. Methods for prevention of stenosis should be developed.