The role of magnification endoscopy in the early diagnosis of gastric signet ring cell carcinoma.

We present the case of a 67-year-old woman referred to our outpatient clinic presenting dyspepsia. Gastroscopy was performed, showing antral gastritis. Random biopsies were taken, being positive for poorly differentiated Lauren's diffuse gastric adenocarcinoma. Narrow-band imaging gastroscopy was performed, combining random and targeted biopsies, with negative results. The study was completed with echoendoscopy and thoraco-abdominal-pelvic CT scan, showing no relevant pathological findings. Control endoscopic was performed after 12 months, showing no macroscopic lesions. Random biopsies were repeated, being positive for diffuse gastric adenocarcinoma. Gastroscopy with conventional chromoendoscopy was performed, showing a completely flat area of approximately 2cm of diameter in the body-antrum junction, in the greater curvature; it was well delimited and no indigo carmine staining was observed (Figure 1). Electronic magnification was performed, showing disruption of the crypt pattern and aberrant neovessels (Figures 2 and 3). Targeted biopsies were taken, being positive for poorly differentiated gastric adenocarcinoma. The case was discussed in a multidisciplinary session and subtotal gastrectomy was performed. Magnification endoscopy offers a better performance diagnosing early gastric cancer than white light endoscopy. [1] It allows the identification of patterns that can predict malignancy, such as distortion of the mucosal glandular pattern or aberrant proliferation of neovessels. [2] Once the diagnosis has been established, assessing the depth of invasion has great clinical relevance, as it guides therapeutic decisions. Works such as that of Zhou et al. [3] underline the usefulness of linear echoendoscopy in this process.

Impact of the SARS-CoV-2 pandemic on pancreatic cancer: diagnosis and short-term survival.

INTRODUCTION: The COVID-19 pandemic has delayed medical consultation, possibly leading to the diagnosis of gastrointestinal cancer. The aim of the study was to analyze the impact of SARS-Cov-2 pandemic on new diagnosis and short-term survival of patients with pancreatic cancer (PC). METHODS: All consecutive patients who had a suspected diagnosis of pancreatic lesion before (from March to September 2019) and during COVID 19 pandemic (from March to September 2020). Demographics, clinical and treatment were collected and compared. Short-term survival was assessed. RESULTS: A total of 25 patients (n=13 men) with diagnosis of adenocarcinoma of the pancreas and a median age of 70 years (IQR 62-74) were included. An increase was observed in the number of patients with newly diagnosed PC (n= 12 [19.1%] versus n=13 [20.9%]; P= 0.603). The subgroup analysis revealed a tendency toward a longer diagnosis (11 versus 12 days; P= 0.219) and treatment (28 versus 44; P= 0.375) delay for patients with PC during COVID-19 pandemic. A significant increase was observed for number of cases of advanced stage III and IV (n=4 [30.8%] versus n=7 [53.8%]; P= 0.006). Palliative treatment was the most frequent approach during COVID-19 period. During 1-year follow-up, 6 (50%) and 7 (61.5%) deaths were observed among patients diagnosed before and after COVID-19 (P= 0.449), respectively. CONCLUSIONS: The COVID-19 pandemic has led to delays in diagnosis and treatment in PC, which translates into an advanced staging and a worse prognosis. These data should stimulate health care provider to facilitate procedures for detection pancreatic cancer.