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INTRODUCTION: We investigated the factors associated with synchronous multiple early gastric cancers and determined their localization. METHODS: We analyzed 8,191 patients who underwent endoscopic submucosal dissection for early gastric cancers at 33 hospitals in Japan from November 2013 to October 2016. Background factors were compared between single-lesion (n = 7,221) and synchronous multi-lesion cases (n = 970) using univariate and multivariate analyses. We extracted cases with two synchronous lesions (n = 832) and evaluated their localization. RESULTS: Significant independent risk factors for synchronous multiple early gastric cancer were older age (≥75 years old) (odds ratio [OR] = 1.257), male sex (OR = 1.385), severe mucosal atrophy (OR = 1.400), tumor localization in the middle (OR = 1.362) or lower region (OR = 1.404), and submucosal invasion (OR = 1.528 [SM1], 1.488 [SM2]). Depressed macroscopic type (OR = 0.679) and pure undifferentiated histology OR = 0.334) were more common in single early gastric cancers. When one lesion was in the upper region, the other was more frequently located in the lesser curvature of the middle region. When one lesion was in the middle region, the other was more frequently located in the middle region or the lesser curvature of the lower region. When one lesion was in the lower region, the other was more frequently located in the lesser curvature of the middle region or the lower region. CONCLUSION: Factors associated with synchronous multiple early gastric cancer included older age, male sex, severe mucosal atrophy, tumor localization in the middle or lower region, and tumor submucosal invasion. Our findings provide useful information regarding specific areas that should be examined carefully when one lesion is detected.
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Resección Endoscópica de la Mucosa , Mucosa Gástrica , Gastroscopía , Neoplasias Primarias Múltiples , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/epidemiología , Masculino , Femenino , Anciano , Japón/epidemiología , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias Múltiples/epidemiología , Persona de Mediana Edad , Resección Endoscópica de la Mucosa/métodos , Mucosa Gástrica/patología , Mucosa Gástrica/cirugía , Factores de Riesgo , Gastroscopía/métodos , Gastroscopía/estadística & datos numéricos , Estudios Retrospectivos , Anciano de 80 o más Años , Factores de Edad , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/estadística & datos numéricos , Invasividad Neoplásica , Atrofia , Factores SexualesRESUMEN
OBJECTIVE: This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. DESIGN: A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett's oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS: 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. CONCLUSIONS: Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.
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Esófago de Barrett , Bases de Datos Factuales , Gastroscopía , Humanos , Femenino , Masculino , Reino Unido/epidemiología , Gastroscopía/estadística & datos numéricos , Persona de Mediana Edad , Estudios Transversales , Esófago de Barrett/diagnóstico , Anciano , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiología , Adulto , Valor Predictivo de las Pruebas , Gastroenterología/estadística & datos numéricos , Trastornos de Deglución/diagnósticoRESUMEN
Hiatus hernia (HH) is a prevalent endoscopic finding in clinical practice, frequently co-occurring with esophageal disorders, yet the prevalence and degree of association remain uncertain. We aim to investigate HH's frequency and its suspected association with esophageal disorders. We reviewed endoscopic reports of over 75,000 consecutive patients who underwent gastroscopy over 12 years in two referral centers. HH was endoscopically diagnosed. We derived data on clinical presentation and a comprehensive assessment of benign and malignant esophageal pathologies. We performed multiple regression models to identify esophageal sequela associated with HH. The overall frequency of HH was (16.8%); the majority (89.5%) had small HHs (<3 cm). Female predominance was documented in HH patients, who were significantly older than controls (61.1±16.5 vs. 52.7±20.0; P < 0.001). The outcome analysis of esophageal pathology revealed an independent association between HH, regardless of its size, and erosive reflux esophagitis (25.7% vs. 6.2%; OR = 3.8; P < 0.001) and Barrett's esophagus (3.8% vs. 0.7%; OR = 4.7, P < 0.001). Furthermore, following rigorous age and sex matching, in conjunction with additional multivariable analyses, large HHs were associated with higher rates of benign esophageal strictures (3.6% vs. 0.3%; P < 0.001), Mallory Weiss syndrome (3.6% vs. 2.1%; P = 0.01), and incidents of food impactions (0.9% vs. 0.2%; P = 0.014). In contrast, a lower rate of achalasia was noted among this cohort (0.55% vs. 0%; P = 0.046). Besides reflux-related esophageal disorders, we outlined an association with multiple benign esophageal disorders, particularly in patients with large HHs.
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Hernia Hiatal , Humanos , Hernia Hiatal/complicaciones , Hernia Hiatal/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Anciano , Macrodatos , Adulto , Prevalencia , Enfermedades del Esófago/epidemiología , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/etiología , Esófago de Barrett/complicaciones , Esófago de Barrett/epidemiología , Gastroscopía/estadística & datos numéricos , Estudios Retrospectivos , Esofagitis Péptica/epidemiología , Esofagitis Péptica/complicaciones , Esofagitis Péptica/diagnóstico , Análisis de DatosRESUMEN
BACKGROUND: It remains open whether gastric precancerous lesions are associated with an elevated risk of pancreatic cancer. Our aim was to investigate the association between gastric mucosal status and pancreatic cancer risk. METHODS: Patients with gastric biopsies [normal, minor changes, superficial gastritis, and atrophic gastritis/intestinal metaplasia/dysplasia (AG/IM/Dys)] from the Swedish histopathology registers during 1979 to 2011 were included. Cross-linkages with several nationwide registries allowed complete follow-up and identification of pancreatic cancer cases until 2014. Standardized incidence ratios (SIR) and HRs were estimated. RESULTS: During 3,438,248 person-years of follow-up with 318,653 participants, 3,540 cases of pancreatic cancer were identified. The same pattern of excess risk of pancreatic cancer compared with the general population was observed across all groups: a peak of 12- to 21-fold excess risk in the first year after biopsy [e.g., normal: SIR = 17.4; 95% confidence interval (CI), 15.7-19.3; AG/IM/Dys: SIR = 11.5; 95% CI, 9.9-13.4], which dropped dramatically during the second and third years, followed by 20% to 30% increased risk after the third year (e.g., normal: SIR = 1.2; 95% CI, 1.1-1.4; AG/IM/Dys: SIR = 1.3; 95% CI, 1.1-1.5). However, no significant excess risk was observed with the normal gastric mucosa as reference. CONCLUSIONS: This unique, large pathologic cohort study did not find evidence that abnormal gastric mucosal status is causally associated with a long-term pancreatic cancer risk. However, a highly increased short-term risk was observed for people undergoing gastroscopy with biopsy sampling compared with the general population. IMPACT: Further studies for a long-term risk of pancreatic cancer in patients with gastric biopsies are needed, with further adjustments.
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Mucosa Gástrica/patología , Neoplasias Pancreáticas/epidemiología , Lesiones Precancerosas/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Gastroscopía/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Suecia/epidemiologíaRESUMEN
ABSTRACT: Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0-4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0-5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0-8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25-11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0-10.75] vs 3.5 [IQR: 2.0-4.0], Pâ<â.05). The risk of intestinal perforation was significantly higher in symptomatic patients (Pâ<â.05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6âdays. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.
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Abdomen , Tratamiento Conservador/estadística & datos numéricos , Tratamiento de Urgencia/estadística & datos numéricos , Cuerpos Extraños/terapia , Gastroscopía/estadística & datos numéricos , Imanes , Niño , Preescolar , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In our study, we evaluated the effectiveness of upper gastrointestinal (GI) endoscopy as an instrument for early gastric cancer (GC) detection in Lynch syndrome (LS) patients by analyzing data from the registry of the German Consortium for Familial Intestinal Cancer. In a prospective, multicenter cohort study, 1128 out of 2009 registered individuals with confirmed LS underwent 5176 upper GI endoscopies. Compliance was good since 77.6% of upper GI endoscopies were completed within the recommended interval of 1 to 3 years. Forty-nine GC events were observed in 47 patients. MLH1 (n = 21) and MSH2 (n = 24) mutations were the most prevalent. GCs in patients undergoing regular surveillance were diagnosed significantly more often in an early-stage disease (UICC I) than GCs detected through symptoms (83% vs 25%; P = .0231). Thirty-two (68%) patients had a negative family history of GC. The median age at diagnosis was 51 years (range 28-66). Of all GC patients, 13 were diagnosed at an age younger than 45. Our study supports the recommendation of regular upper GI endoscopy surveillance for LS patients beginning no later than at the age of 30.
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Neoplasias Colorrectales Hereditarias sin Poliposis/complicaciones , Detección Precoz del Cáncer/métodos , Gastroscopía/estadística & datos numéricos , Neoplasias Gástricas/diagnóstico , Adulto , Factores de Edad , Anciano , Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Detección Precoz del Cáncer/normas , Detección Precoz del Cáncer/estadística & datos numéricos , Estudios de Evaluación como Asunto , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/patología , Gastroscopía/normas , Predisposición Genética a la Enfermedad , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Homólogo 1 de la Proteína MutL/genética , Proteína 2 Homóloga a MutS/genética , Mutación , Estadificación de Neoplasias , Cooperación del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologíaRESUMEN
PURPOSE: Gastric schwannomas (GSs) are rare mesenchymal neoplasms of the gastrointestinal tract. Diagnosis is often achieved postoperatively, based on pathology reports of retrieved specimens. The aim of the present study is to follow up all patients with gastric schwannoma (Gs) undergoing endoscopic, partial, or more extended surgery and to evaluate the appearance of local or distant recurrence. METHODS: A PubMed, Cochrane, and Embase systematic review of the literature has been performed. Original papers, review articles, and case reports published between 1988 and 2019 were considered eligible. All the studies who met the inclusion criteria were analyzed. Statistical analysis of data has been performed using GraphPad Prism 7 software. RESULTS: Three hundred twenty-eight articles were found, and a total of 102 were included and analyzed in depth. Fifty-three papers reported the follow-up information, ranging from 1 to 417 months across different studies. Among them, 31 patients underwent endoscopic removal of the gastric lesions; 140 patients underwent local surgery, including wedge resection or partial gastrectomy; and 148 patients underwent subtotal or total gastrectomy. The median follow-up was of 27-38-33 months, respectively. No recurrence or distant metastasis was detected in the endoscopy group. Among local surgery group, liver metastasis was reported in one case; in extended surgery group, one patient died for multiple liver metastases. CONCLUSIONS: Local or more extended surgery involved a larger cohort of patients and reported satisfactory long-term results compared with endoscopy group. Surgery in absence of a definite preoperative diagnosis is considered the gold standard treatment for resectable Gs.
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Gastrectomía/métodos , Neoplasias Hepáticas/epidemiología , Recurrencia Local de Neoplasia/epidemiología , Neurilemoma/cirugía , Neoplasias Gástricas/cirugía , Estudios de Seguimiento , Gastrectomía/estadística & datos numéricos , Gastroscopía/métodos , Gastroscopía/estadística & datos numéricos , Humanos , Hallazgos Incidentales , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/prevención & control , Neoplasias Hepáticas/secundario , Recurrencia Local de Neoplasia/prevención & control , Neurilemoma/diagnóstico , Neurilemoma/epidemiología , Neurilemoma/secundario , Estómago/inervación , Estómago/patología , Estómago/cirugía , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
PURPOSE: Gastric cancer remains the leading cause of cancer-related deaths in Northeast Asia. Population-based endoscopic screenings in the region have yielded successful results in early detection of gastric tumors. Endoscopic screening rates are continuously increasing, and there is a need for an automatic computerized diagnostic system to reduce the diagnostic burden. In this study, we developed an algorithm to classify gastric epithelial tumors automatically and assessed its performance in a large series of gastric biopsies and its benefits as an assistance tool. EXPERIMENTAL DESIGN: Using 2,434 whole-slide images, we developed an algorithm based on convolutional neural networks to classify a gastric biopsy image into one of three categories: negative for dysplasia (NFD), tubular adenoma, or carcinoma. The performance of the algorithm was evaluated by using 7,440 biopsy specimens collected prospectively. The impact of algorithm-assisted diagnosis was assessed by six pathologists using 150 gastric biopsy cases. RESULTS: Diagnostic performance evaluated by the AUROC curve in the prospective study was 0.9790 for two-tier classification: negative (NFD) versus positive (all cases except NFD). When limited to epithelial tumors, the sensitivity and specificity were 1.000 and 0.9749. Algorithm-assisted digital image viewer (DV) resulted in 47% reduction in review time per image compared with DV only and 58% decrease to microscopy. CONCLUSIONS: Our algorithm has demonstrated high accuracy in classifying epithelial tumors and its benefits as an assistance tool, which can serve as a potential screening aid system in diagnosing gastric biopsy specimens.
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Aprendizaje Profundo , Mucosa Gástrica/patología , Interpretación de Imagen Asistida por Computador/métodos , Patólogos/estadística & datos numéricos , Neoplasias Gástricas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Mucosa Gástrica/diagnóstico por imagen , Gastroscopía/estadística & datos numéricos , Humanos , Interpretación de Imagen Asistida por Computador/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias Gástricas/patologíaRESUMEN
BACKGROUND & AIMS: Helicobacter pylori eradication and endoscopic surveillance of gastric precancerous lesions are strategies to reduce gastric cancer (GC) risk. To our knowledge, this study is the longest prospective cohort of an H pylori eradication trial in a Hispanic population. METHODS: A total of 800 adults with precancerous lesions were randomized to anti-H pylori treatment or placebo. Gastric biopsy samples taken at baseline and 3, 6, 12, 16, and 20 years were assessed by our Correa histopathology score. A generalized linear mixed model with a participant-level random intercept was used to estimate the effect of H pylori status on the score over time. Logistic regression models were used to estimate progression by baseline diagnosis and to estimate GC risk by intestinal metaplasia (IM) subtype and anatomic location. RESULTS: Overall, 356 individuals completed 20 years of follow-up. Anti-H pylori therapy (intention-to-treat) reduced progression of the Correa score (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.38-0.93). H pylori-negative status had a beneficial effect on the score over time (P = .036). Among individuals with IM (including indefinite for dysplasia) at baseline, incidence rates per 100 person-years were 1.09 (95% CI, 0.85-1.33) for low-grade/high-grade dysplasia and 0.14 (95% CI, 0.06-0.22) for GC. Incomplete-type (vs complete-type) IM at baseline presented higher GC risk (OR, 13.4; 95% CI, 1.8-103.8). Individuals with corpus (vs antrum-restricted) IM showed an OR of 2.1 (95% CI, 0.7-6.6) for GC. CONCLUSIONS: In a high-GC-risk Hispanic population, anti-H pylori therapy had a long-term beneficial effect against histologic progression. Incomplete IM is a strong predictor of GC risk.
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Antibacterianos/uso terapéutico , Mucosa Gástrica/patología , Infecciones por Helicobacter/tratamiento farmacológico , Lesiones Precancerosas/epidemiología , Neoplasias Gástricas/prevención & control , Adulto , Anciano , Biopsia , Colombia/epidemiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/microbiología , Gastroscopía/estadística & datos numéricos , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Incidencia , Masculino , Metaplasia/diagnóstico , Metaplasia/epidemiología , Metaplasia/microbiología , Metaplasia/patología , Persona de Mediana Edad , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/microbiología , Lesiones Precancerosas/patología , Estudios Prospectivos , Factores de Riesgo , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
PURPOSE: To determine whether the use of salicylates is a predictive factor for detecting explanatory pathology during gastroscopy or colonoscopy procedures in patients with iron deficiency anaemia (IDA). METHODS: This retrospective study included patients who underwent a gastroscopy and/or a colonoscopyto determine the cause of IDA at Treant Healthcare, hospital location Scheper in Emmen, the Netherlands, between 2010 and 2016. The study compared two groups. The first group consisted of patients who were not taking antithrombotics at the time of, and during the last six months prior to, the endoscopy. The second group consisted of patients who used salicylates at the time of, and during the last six months prior, to the endoscopy. Data were collected on whether and which explanatory pathology was found in the endoscopic evaluation. RESULTS: In total, 464 patients were included, of whom, 174 were using a salicylate and 290 were not. In 41.2% of the patients, explanatory pathology was found, which was not significantly different between the two groups with univariate analysis (p = 0.207). However, the patients in the group of salicylate users were significantly older and more often male. When correcting for these differences in group characteristics during multivariate analysis, the use of salicylates was found to be a negative predictive factor for finding explanatory pathology (p < 0.001; OR 2.307). CONCLUSION: When determining the chance of finding explanatory pathology during endoscopic evaluation in patients with IDA, the use of salicylates should be taken into account as a negative predictive factor for finding explanatory pathology during endoscopic evaluation.
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Anemia Ferropénica/diagnóstico , Colonoscopía/estadística & datos numéricos , Fibrinolíticos/uso terapéutico , Gastroscopía/estadística & datos numéricos , Salicilatos/uso terapéutico , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores SexualesAsunto(s)
Infecciones por Coronavirus/epidemiología , Duodenoscopía/estadística & datos numéricos , Esofagoscopía/estadística & datos numéricos , Neoplasias Gastrointestinales/diagnóstico , Gastroscopía/estadística & datos numéricos , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina , Betacoronavirus , COVID-19 , Diagnóstico Tardío , Inglaterra/epidemiología , Humanos , Pandemias , SARS-CoV-2RESUMEN
INTRODUCTION: In a previous study we demonstrated that a simple training programme improved quality indicators of Oesophagogastroduodenoscopy (OGD) achieving the recommended benchmarks. However, the long-term effect of this intervention is unknown. The aim of this study was to assess the quality of OGDs performed 3 years after of having completed a training programme. MATERIAL AND METHODS: A comparative study of 2 cohorts was designed as follows: Group A included OGDs performed in 2016 promptly after a training programme and Group B with OGDs performed from January to March 2019, this group was also divided into 2 subgroups: subgroup B1 of Endoscopists who had participated in the previous training programme and subgroup B2 of Endoscopists who had not. The intra-procedure quality indicators proposed by ASGE-ACG were used. RESULTS: A total of 1236 OGDs were analysed, 600 from Group A and 636 from Group B (439 subgroup B1 and 197 subgroup B2). The number of complete examinations was lower in Group B (566 [94.3%] vs. 551 [86.6%]; p<0.001). A significant decrease was observed in nearly all quality indicators and they did not reach the recommended benchmarks: retroflexion in the stomach (96% vs. 81%; p<0.001); Seattle biopsy protocol (86% vs. 50%; p=0.03), description of the upper GI bleeding lesion (100% vs. 62%; p<0.01), sufficient intestinal biopsy specimens (at least 4) in suspected coeliac disease (92.5% vs. 18%; p<0.001), photo documentation of the lesion (94% vs. 90%; p<0.05). Regarding the overall assessment of the procedure (including correct performance and adequate photo documentation), a significant decrease was also observed (90.5% vs. 62%; p<0.001). There were no differences between subgroups B1 and B2. CONCLUSIONS: The improvement observed in 2016 after a training programme did not prevail after 3 years. In order to keep the quality of OGDs above the recommended benchmarks, it is necessary to implement continuous training programmes.
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Benchmarking , Duodenoscopía/normas , Esofagoscopía/normas , Gastroscopía/normas , Indicadores de Calidad de la Atención de Salud/normas , Biopsia/normas , Enfermedad Celíaca/patología , Estudios de Cohortes , Duodenoscopía/educación , Duodenoscopía/estadística & datos numéricos , Esofagoscopía/educación , Esofagoscopía/estadística & datos numéricos , Hemorragia Gastrointestinal/diagnóstico por imagen , Gastroscopía/educación , Gastroscopía/estadística & datos numéricos , Humanos , Intestinos/patología , Fotograbar , Desarrollo de Programa , Estándares de Referencia , Sociedades Médicas , Factores de TiempoRESUMEN
BACKGROUND: Persistent Helicobacter pylori (H. pylori) infection causes chronic inflammation, atrophy of the gastric mucosa, and a high risk of developing gastric cancer. In recent years, awareness of eradication therapy has increased in Japan. As H. pylori infections decrease, the proportion of gastric cancers arising from H. pylori uninfected gastric mucosa will increase. The emergence of gastric cancer arising in H. pylori uninfected patients though rarely reported, is a concern to be addressed and needs elucidation of its clinicopathological features. AIM: To evaluate the clinicopathological features of early gastric cancer in H. pylori-uninfected patients. METHODS: A total of 2462 patients with 3375 instances of early gastric cancers that were treated by endoscopic submucosal dissection were enrolled in our study between May 2000 and September 2019. Of these, 30 lesions in 30 patients were diagnosed as H. pylori-uninfected gastric cancer (HpUIGC). We defined a patient as H. pylori-uninfected using the following three criteria: (1) The patient did not receive treatment for H. pylori, which was determined by investigating medical records and conducting patient interviews; (2) Lack of endoscopic atrophy; and (3) The patient was negative for H. pylori after being tested at least twice using various diagnostic methods, including serum anti-H. pylori-IgG antibody, urease breath test, rapid urease test, and microscopic examination. RESULTS: The frequency of HpUIGC was 1.2% (30/2462) for the patients in our study. The study included 19 males and 11 females with a mean age of 59 years. The location of the stomach lesions was divided into three sections; upper third (U), middle third (M), lower third (L). Of the 30 lesions, 15 were U, 1 was M, and 14 were L. Morphologically, 17 lesions were protruded and flat elevated type (0-I, 0-IIa, 0-IIa + IIc), and 13 lesions were flat and depressed type (0-IIb, 0-IIc). The median tumor diameter was 8 mm (range 2-98 mm). Histological analysis revealed that 22 lesions (73.3%) were differentiated type.The HpUIGC lesions were classified into fundic gland type adenocarcinoma (7 cases), foveolar type well-differentiated adenocarcinoma (8 cases), intestinal phenotype adenocarcinoma (7 cases), and pure signet-ring cell carcinoma (8 cases). Among 30 HpUIGCs, 24 lesions (80%) were limited to the mucosa; wherein, the remaining 6 lesions showed submucosal invasion. One of the submucosal invasive lesions showed more than 500 µm invasion. The mucin phenotype analysis identified 7 HpUIGC with intestinal phenotype and 23 with gastric phenotype. CONCLUSION: We elucidated the clinicopathological characteristics of HpUIGC, revealing recognition not only undifferentiated-type but also differentiated-type. In addition, intestinal phenotype tumors were also observed and could be an important tip.
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Adenocarcinoma/epidemiología , Carcinoma de Células en Anillo de Sello/epidemiología , Mucosa Gástrica/patología , Neoplasias Gástricas/epidemiología , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Carcinoma de Células en Anillo de Sello/diagnóstico , Carcinoma de Células en Anillo de Sello/patología , Carcinoma de Células en Anillo de Sello/cirugía , Resección Endoscópica de la Mucosa/estadística & datos numéricos , Femenino , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/cirugía , Gastroscopía/estadística & datos numéricos , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Carga TumoralRESUMEN
Gastric carcinoma (GC) disproportionately affects Asian Americans. We examined whether history of upper gastrointestinal (GI) endoscopy was associated with lower stage at GC diagnosis among Asian Americans and whether origin of providers influenced referral for endoscopy. We employed Surveillance Epidemiology and End Results-Medicare data on Asian Americans diagnosed with GC in 2004-2013 (n = 1,554). Stage distribution, GI conditions at diagnosis, and history of endoscopy were compared between Asian ethnic groups. Multivariate logistic regression adjusting for age, sex, poverty level, tumor location, and histology was used to examine the association of ethnicity and endoscopic history with stage I disease at diagnosis of GC. Koreans were more likely to be diagnosed with stage I, T1a GC and have prior history of endoscopy, compared with other Asian ethnicities (24% vs. 8% for stage I, T1a; 40% vs. 15% for endoscopy). Patients with primary care providers of concordant ethnic origin were more likely to have history of endoscopy. Asian American patients with GC with history of endoscopy were more likely to be diagnosed with GC at stage I disease (adjusted OR, 3.07; 95% confidence interval, 2.34-4.02). Compared with other Asian Americans, Koreans were diagnosed with GC at earlier stages owing to common history of endoscopy, which was more often undergone by patients with primary care providers of concordant ethnic origin. Overall, upper GI endoscopy was associated with early detection of GC in Asian Americans. Novelty and Impact. It is well-established that Asian Americans in the United States are disproportionately affected by gastric cancer. In our study we found that Asian American patients treated by physicians of similar ethnic background are more likely to undergo upper GI endoscopy in the United States, leading to early detection of gastric cancer and longer survival. Given this, targeted endoscopic screening in Asian Americans should be considered for early detection of GC.
Asunto(s)
Carcinoma/mortalidad , Gastroscopía/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Neoplasias Gástricas/mortalidad , Anciano , Anciano de 80 o más Años , Asiático/estadística & datos numéricos , Carcinoma/diagnóstico , Carcinoma/economía , Femenino , Disparidades en Atención de Salud/economía , Humanos , Masculino , Tamizaje Masivo/economía , Medicare/economía , Medicare/estadística & datos numéricos , Estadificación de Neoplasias , Médicos de Atención Primaria/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Derivación y Consulta/economía , Derivación y Consulta/estadística & datos numéricos , Programa de VERF/estadística & datos numéricos , Estómago/diagnóstico por imagen , Estómago/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/economía , Neoplasias Gástricas/terapia , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: The prognosis of Cronkhite-Canada syndrome (CCS) is considered poor. Despite the recent therapeutic improvements, the survival outcomes and prognostic factors have been less studied. This study aimed to investigate the long-term clinical and endoscopic outcomes of CCS. METHODS: Thirty-one patients diagnosed since 1999 and followed up for over 6 months were included. Data regarding survival outcomes, clinical symptoms, endoscopic findings, and treatment were collected and analyzed. R (version 3.6.1) was used to perform the survival analyses. RESULTS: The median (interquartile range) follow-up time was 42.5 (19.5-85.8) months. The 5-year overall survival (OS) was 87.4%. The maximum gastric polyp size over 2 cm was associated with worse OS (Hazard ratio [HR]: 18, 95% confidence interval [CI]: 1.6-210, P = 0.021). The 3-year relapse-free survival (RFS) after corticosteroid treatment was 66.8%. Age older than 60 years (HR: 7.0, 95% CI: 1.5-33.0, P = 0.015) and maximum gastric polyp size over 2 cm (HR: 6.0, 95% CI: 1.6-23.0, P = 0.009) were associated with worse RFS. Twenty-three patients received follow-up endoscopic examinations, with a median (interquartile range) follow-up time of 29.0 (14.0-53.5) months. Eight (34.8%) and 12 (52.2%) patients achieved complete remission under gastroscopy and colonoscopy, respectively. Colonic lesions showed a tendency of earlier responses compared with gastric lesions (25.0 [11.3-39.8] months vs 31.0 [21.0-39.8] months). DISCUSSION: Patients with CCS usually responded well to glucocorticoids with a fairly good 5-year survival rate. Large gastric polyp was associated with worse OS and RFS, whereas age older than 60 years was another predictor for worse RFS. Diffuse gastrointestinal lesions partly or completely resolved after treatment, and colonic lesions showed a better response than gastric lesions.
Asunto(s)
Pólipos Adenomatosos/mortalidad , Colonoscopía/estadística & datos numéricos , Gastroscopía/estadística & datos numéricos , Glucocorticoides/uso terapéutico , Poliposis Intestinal/mortalidad , Neoplasias Gástricas/mortalidad , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/tratamiento farmacológico , Pólipos Adenomatosos/patología , Factores de Edad , Colon/diagnóstico por imagen , Colon/patología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/patología , Humanos , Mucosa Intestinal/diagnóstico por imagen , Mucosa Intestinal/patología , Poliposis Intestinal/diagnóstico , Poliposis Intestinal/tratamiento farmacológico , Poliposis Intestinal/patología , Masculino , Persona de Mediana Edad , Pronóstico , Recurrencia , Estudios Retrospectivos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Estómago/diagnóstico por imagen , Estómago/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patología , Tasa de SupervivenciaRESUMEN
INTRODUCTION: This nationwide study assessed the impact of Lynch syndrome-related risk management guidelines on clinicians' recommendations of risk management strategies to carriers of pathogenic variants in mismatch repair genes and the extent to which carriers took up strategies in concordance with guidelines. MATERIALS AND METHODS: Clinic files of 464 carriers (with and without colorectal cancer) were audited for carriers who received their genetic testing results in July 2008-July 2009 (i.e. before guideline release), July 2010-July 2011 and July 2012-July 2013 (both after guideline release) at 12 familial cancer clinics (FCCs) to ascertain the extent to which carriers were informed about risk management in accordance with guidelines. All carriers captured by the audit were invited to participate in interviews; 215 were interviewed to assess adherence to recommended risk management guidelines. RESULTS: The rates of documentation in clinic files increased significantly from pre- to post-guideline for only two out of eight risk management strategies. The strategies with the highest compliance of carriers post-guidelines were: uptake of one or two-yearly colonoscopy (87%), followed by hysterectomy to prevent endometrial cancer (68%), aspirin as risk-reducing medication (67%) and risk-reducing salpingo-oophorectomy (63%). Interrater reliability check for all guidelines showed excellent agreement (k statistics = 0.89). CONCLUSION: These results indicate that there is scope to further increase provision of advice at FCCs to ensure that all carriers receive recommendations about evidence-based risk management. A multi-pronged behaviour change and implementation science approach tailored to specific barriers is likely to be needed to achieve optimal clinician behaviours and outcomes for carriers.
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Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Reparación de la Incompatibilidad de ADN/genética , Adhesión a Directriz/estadística & datos numéricos , Heterocigoto , Medición de Riesgo , Adulto , Anticarcinógenos/administración & dosificación , Aspirina/administración & dosificación , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/prevención & control , Neoplasias Endometriales/prevención & control , Femenino , Gastroscopía/estadística & datos numéricos , Pruebas Genéticas/normas , Humanos , Histerectomía/estadística & datos numéricos , Masculino , Auditoría Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias Ováricas/prevención & control , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Reproducibilidad de los Resultados , Salpingooforectomía/estadística & datos numéricos , Neoplasias Gástricas/prevención & controlRESUMEN
BACKGROUND AND AIM: Helicobacter pylori infection is very common worldwide, and it is associated with an important gastric pathology. Treatment of this infection is difficult and consists of the combination of two or three antibiotics. However, the rate of resistance to treatment is high. Antimicrobial resistance of Helicobacter pylori is based on its cultivation in the laboratory and testing of phenotypic susceptibility, a time-consuming, laborious method. This study aimed to detect the genetic resistance to antibiotics of Helicobacter pylori in the south-eastern region of Romania. METHODS: Ninety patients with positive rapid urease test gastric biopsy samples were tested. Genetic resistance to antibiotics (fluoroquinolone and clarithromycin) was tested by GenoType HelicoDR kit (Hain Lifescience GmbH, Germany). RESULTS: Clarithromycin resistance mutations were detected in 20% of patients, the commonest mutation in our study beeing A2147G (associated with high level of clarithromycin resistance and lower cure rates). Fluoroquinolones resistance mutations were detected in 30% of patients, and the most common mutations were D91N, D91G, and N87K. There was no correlation with patients gender or age, with the exception of fluoroquinolone resistance, which was detected more frequently in females. Conclusions. Clarithromycin and fluoroquinolone resistance of Helicobacter pylori is moderately high in our study. There is a need for monitoring Helicobacter resistance patterns in Romania to provide data that can guide empirical treatment. This is the first published study on the genetic resistance of Helicobacter pylori in Romania.
Asunto(s)
Claritromicina/farmacología , Farmacorresistencia Bacteriana/genética , Fluoroquinolonas/farmacología , Infecciones por Helicobacter , Helicobacter pylori , Estómago , Antibacterianos/farmacología , Biopsia/métodos , Femenino , Gastroscopía/métodos , Gastroscopía/estadística & datos numéricos , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/fisiopatología , Helicobacter pylori/efectos de los fármacos , Helicobacter pylori/genética , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mutación Puntual , Rumanía/epidemiología , Estómago/microbiología , Estómago/patologíaRESUMEN
OBJECTIVES: To assess the value of endoscopic grading of gastric intestinal metaplasia (EGGIM), operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric neoplasia (EGN) and to investigate other factors possibly associated with its development. DESIGN: Single centre, case-control study including 187 patients with EGN treated endoscopically and 187 age-matched and sex-matched control subjects. Individuals were classified according to EGGIM, OLGA and OLGIM systems. EGN risk according to gastritis stages and other clinical parameters was further evaluated. RESULTS: More patients with EGN had EGGIM of ≥5 than control subjects (68.6% vs 13.3%, p<0.001). OLGA and OLGIM stages III/IV were more prevalent in patients with EGN than in control subjects (68% vs 11%, p<0.001, and 61% vs 3%, p<0.001, respectively). The three systems were the only parameters significantly related to the risk of EGN in multivariate analysis: for EGGIM 1-4 (adjusted OR (AOR) 12.9, 95% CI 1.4 to 118.6) and EGGIM 5-10 (AOR 21.2, 95% CI 5.0 to 90.2); for OLGA I/II (AOR 5.0, 95% CI 0.56 to 44.5) and OLGA III/IV (AOR 11.1, 95% CI 3.7 to 33.1); for OLGIM I/II (AOR 11.5, 95% CI 4.1 to 32.3) and OLGIM III/IV (AOR 16.0, 95% CI 7.6 to 33.4). CONCLUSION: This study confirms the role of histological assessment as an independent risk factor for gastric cancer (GC), but it is the first study to show that an endoscopic classification of gastric intestinal metaplasia is highly associated with that outcome. After further prospective validation, this classification may be appropriate for GC risk stratification and may simplify every day practice by reducing the need for biopsies.
Asunto(s)
Detección Precoz del Cáncer , Gastroscopía , Medición de Riesgo , Neoplasias Gástricas , Biopsia/métodos , Estudios de Casos y Controles , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Gastroscopía/métodos , Gastroscopía/estadística & datos numéricos , Humanos , Masculino , Metaplasia/clasificación , Metaplasia/diagnóstico , Metaplasia/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Portugal , Mejoramiento de la Calidad , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologíaRESUMEN
A majority of gastric cancer cases in China are diagnosed at advanced stages, chiefly due to lack of an established routine nationwide screening program. This study evaluated the effectiveness of a novel screening program for gastric cancer. Seven geographic communities were randomly selected, and residents ages 40-69 years were screened. Serologic tests of Helicobacter pylori antibodies and pepsinogens, and positive family history of gastric cancer in first-degree relatives (FDR), were used to differentiate individuals for further gastroscopic examination and gastric mucosal biopsies. Among 7,773 individuals who underwent examination of serum markers, gastric cancer was detected in 14 (1.8%; 10 men). The rate in terms of gastric cancer cases per 100 gastroendoscopies was 1.6% (14/872), which was greater than 0.87% previously reported. Eleven of 14 patients with gastric cancer (78.6%) were FDRs of patients with gastric cancer. Two-thirds of the subjects with cardia gastric cancer were FDRs of individuals with gastric cancer rather than cardia gastric cancer. Comparative analysis indicated that the gastric cancer subjects were significantly more likely to be FDRs of patients with gastric cancer, in contrast to those without gastric cancer. All the individuals with gastric cancer were aged ≥50 years. After conducting a reverse analysis, we propose a novel screening program for gastric cancer. In conclusions, the populations most vulnerable to gastric cancer are those with positive family history of gastric cancer in FDRs, male gender, and aged 50 years or older. This screening program using fewer serum markers combined individual risk factors, mainly FDRs, is novel for identification of high-risk individuals for further gastroscopy in detecting early gastric cancer.
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Servicios de Salud Comunitaria/organización & administración , Infecciones por Helicobacter/diagnóstico , Tamizaje Masivo/organización & administración , Lesiones Precancerosas/diagnóstico , Neoplasias Gástricas/epidemiología , Adulto , Factores de Edad , Anciano , Biopsia , China/epidemiología , Servicios de Salud Comunitaria/normas , Servicios de Salud Comunitaria/estadística & datos numéricos , Detección Precoz del Cáncer/normas , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastroscopía/estadística & datos numéricos , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Tamizaje Masivo/normas , Tamizaje Masivo/estadística & datos numéricos , Anamnesis , Persona de Mediana Edad , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas/microbiología , Lesiones Precancerosas/patología , Evaluación de Programas y Proyectos de Salud , Factores Sexuales , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/prevención & controlRESUMEN
BACKGROUND/AIMS: To compare white light imaging (WLI) with linked color imaging (LCI) and blue LASER imaging (BLI) in endoscopic findings of Helicobacter pylori presently infected, previously infected, and uninfected gastric mucosae for visibility and inter-rater reliability. METHODS: WLI, LCI and BLI bright mode (BLI-bright) were used to obtain 1,092 endoscopic images from 261 patients according to the Kyoto Classification of Gastritis. Images were evaluated retrospectively by 10 experts and 10 trainee endoscopists and included diffuse redness, spotty redness, map-like redness, patchy redness, red streaks, intestinal metaplasia, and an atrophic border (52 cases for each finding, respectively). Physicians assessed visibility as follows: 5 (improved), 4 (somewhat improved), 3 (equivalent), 2 (somewhat decreased), and 1 (decreased). Visibility was assessed from totaled scores. The inter-rater reliability (intraclass correlation coefficient) was also evaluated. RESULTS: Compared with WLI, all endoscopists reported improved visibility with LCI: 55.8% for diffuse redness; LCI: 38.5% for spotty redness; LCI: 57.7% for map-like redness; LCI: 40.4% for patchy redness; LCI: 53.8% for red streaks; LCI: 42.3% and BLI-bright: 80.8% for intestinal metaplasia; LCI: 46.2% for an atrophic border. For all endoscopists, the inter-rater reliabilities of LCI compared to WLI were 0.73-0.87. CONCLUSION: The visibility of each endoscopic finding was improved by LCI while that of intestinal metaplasia was improved by BLI-bright.