Evaluation of Barrett's esophagus with CK7, CK20, p53, Ki67, and COX2 expressions using chromoendoscopical examination.

Barrett's esophagus (BE) is a complication of chronic gastroesophageal reflux disease and can be diagnosed when there is an endoscopically irregular Z-line and intestinal metaplasia (IM) in a biopsy obtained lower esophagus. It is still not clear whether IM in the gastric cardia or columnar mucosa without IM in the lower esophagus have any significance as BE, which is considered as preneoplastic. The aim of the study was to determine the immunohistochemical features of BE and columnar mucosa in the distal esophagus and also to evaluate the value of chromoendoscopy in the diagnosis of BE in a prospective manner. A total of 12 chromoendoscopic biopsies (six from normal-looking unstained esophagus and six from esophageal mucosa stained with methyl blue suspicious of BE) were taken from 111 cases who underwent endoscopy because of a variety of upper gastrointestinal symptoms. Immunohistochemical analysis was performed using CK7, CK20, p53, Ki67, and cyclooxygenase 2 (COX2). Of the 111 cases, 19 cases with carcinoma (nine adeno, six squamous, four undifferentiated carcinomas) and 17 cases with normal squamous epithelium were excluded, while 75 cases showing columnar epithelium, including 46 (61.3%) with IM and 29 (38,7%) without IM, were further evaluated immunohistochemically. CK7 was observed in surface, crypt, and glandular epithelium, whereas CK20 was expressed in surface and superficial crypt epithelium. No significant difference was observed between the Barrett and non-Barrett type of CK7/20 staining pattern (P > 0,05). Expression of p53 did not show any difference between BE and columnar mucosa without IM, whereas COX2 expression was significantly increased in BE (P < 0.05) in comparison with columnar mucosa without IM. Ki67 expression was significiantly higher both in upper and lower crypts in BE (P < 0.05). The present study showed that a Barrett pattern does not seem to exist; however, the analysis of COX2 expression and the Ki67 proliferation fraction by immunohistochemistry can be used to separate BE from non-Barrett's metaplasia of the distal esophagus. In our point of view, the immunohistochemical detection of p53 expression in Barrett's metaplasia stage is useless as a marker for early detection of high-risk patients.

The usefulness of chromoendoscopy with methylene blue in Barrett's metaplasia and early esophageal carcinoma.

BACKGROUND: Barrett's esophagus is a condition that is premalignant for adenocarcinoma of the esophagus and the esophagogastric junction. Early detection of Barrett's metaplasia and dysplasia is very important to decrease the mortality and morbidity from esophageal adenocarcinoma cancer. This study aimed to evaluate the effectiveness of methylene blue-targeted biopsies in the differential diagnosis of intestinal metaplasia, dysplasia, and superficial esophageal carcinoma. METHODS: A total of 109 patients (43 women and 66 men; average age, 62.32 +/- 10.61 years; range, 33-82 years) were enrolled for the study. Four groups were designed before endoscopic examinations. The patients for these groups were selected at the conventional endoscopy, and then chromoendoscopy was performed. The esophagus was stained with methylene blue, after which six biopsies were taken from stained and unstained areas. RESULTS: Conventional and chromoendoscopic assessments were compared with histopathologic examination. The sensitivity of chromoendoscopy for Barrett's epithelium was superior to that of conventional endoscopy (p < 0.05). However, there was no statistical difference between the two methods in the diagnosis of esophagitis or esophageal carcinoma (p > 0.05). Stained biopsies were superior to unstained biopsies in terms of sensitivity for Barrett's epithelium and esophageal carcinoma (p < 0.001). CONCLUSION: Chromoendoscopy is useful for delineating Barrett's epithelium and for indicating the correct location for securing biopsies where dysplasia or early esophageal cancer is suspected.

A new percutaneous approach for the treatment of hydatid cysts of the liver.

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.

Induction of remission by interferon-alpha in patients with chronic active ulcerative colitis.

OBJECTIVE: To ascertain whether treatment with interferon-alpha 2a (IFN-alpha 2a) can induce remission in patients with chronic active ulcerative colitis. STUDY DESIGN: Prospective, open-label study. SETTING: The gastroenterology section of Ankara University School of Medicine, which is the regional referral centre for the city of Ankara. STUDY POPULATION: The study included 28 in-patients with established ulcerative colitis and lacking known pathogens. The diagnosis was confirmed using endoscopic, radiological and histological techniques. Patients enrolled in the study had previously shown resistance to 5-aminosalicylic acid and steroids. MEASUREMENTS: Disease activity was evaluated clinically and endoscopically. Laboratory parameters (erythrocyte sedimentation rate, haematocrit, and serum albumin levels) were used as indirect markers of inflammatory status. After a 10 day washout period, patients were treated with IFN-alpha 2a. INTERVENTION: IFN-alpha 2a therapy started with 3 MIU (one subcutaneous injection) and was increased to 6 MIU (one subcutaneous injection) and then 9 MIU three times a week (three subcutaneous injections every second day for 1 week) to habituate the patients and ensure early onset of action. The dose was then decreased to 6 MIU (three injections every second day for 1 week) and maintained at 3 MIU (three times a week) for 6-12 months. RESULTS: Clinically, 71% per cent of the patients had severe and 29% moderate ulcerative colitis activity before the treatment. Five patients (18%) did not respond to IFN-alpha 2a therapy within the first 2 months; two of them underwent total colectomy and the remaining three (11%) achieved late remission after prolonged IFN-alpha 2a therapy. Twenty-three (82%) patients responded to therapy with a fast improvement (within 15 days) and were in complete clinical and endoscopic remission after 6 months of therapy. During the treatment period, four (14.2%) patients with pre-existing small haemorrhoids suffered from enlarged ulcerated and bleeding external haemorrhoids, and flu-like symptoms were a common side effect. No adverse effects serious enough to necessitate discontinuation of the therapy were observed. Twenty-six (93%) patients were observed for more than 2 years without being given therapy and remained in full clinical and endoscopic remission during this period. CONCLUSION: In our opinion, IFN-alpha 2a is a well-tolerated, non-toxic, easily applicable and outstanding drug, which could become the treatment of choice for first-line therapy of chronic active ulcerative colitis, especially in patients who show resistance to other drugs.