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3.
Cancer Invest ; 37(9): 417-426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31483161

RESUMO

To investigate the molecular mechanisms of gastric carcinogenesis after Helicobacter pylori (H. pylori) eradication, expression of miR-124a, miR-34b, and miR-34c was examined in nonneoplastic gastric specimens after successful H. pylori eradication. The magnifying narrow-band imaging (NBI) endoscopic features of gastric mucosa were also examined. The atrophic type, an informative endoscopic feature for histological intestinal metaplasia, showed lower expression of miR-124a. Lower expression of miR-124a correlated with hypermethylation of the miR-124a3 locus. The atrophic type represents gastric microarchitectures associated with irreversibility with H. pylori eradication and downregulation of miR-124a.


Assuntos
Regulação para Baixo , Mucosa Gástrica/diagnóstico por imagem , Infecções por Helicobacter/prevenção & controle , MicroRNAs/genética , Imagem de Banda Estreita/métodos , Neoplasias Gástricas/genética , Idoso , Idoso de 80 Anos ou mais , Metilação de DNA , Erradicação de Doenças , Epigênese Genética , Feminino , Mucosa Gástrica/patologia , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/diagnóstico por imagem
4.
World J Gastroenterol ; 25(27): 3546-3562, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31367156

RESUMO

Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer (GC) development. There are several approaches to identifying these subjects, including noninvasive methods, esophagogastroduodenoscopy and histology. The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate- and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient's risk level. In addition, imaging enhanced endoscopy (IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However, resource limitations are an important barrier in many regions worldwide. Thus, for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resource-sensitive approach.


Assuntos
Detecção Precoce de Câncer/métodos , Endoscopia do Sistema Digestório/métodos , Programas de Rastreamento/métodos , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Biópsia , Comparação Transcultural , Prestação Integrada de Cuidados de Saúde/métodos , Progressão da Doença , Medicina Baseada em Evidências/métodos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Carga Global da Doença , Humanos , Incidência , Imagem Multimodal/métodos , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Medição de Risco/métodos , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia
5.
World J Gastroenterol ; 25(29): 3996-4006, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31413533

RESUMO

BACKGROUND: The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial. AIM: To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD. METHODS: We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January 2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients' clinicopathological data and identified the predictors of residual cancer (RC) and lymph node metastasis (LNM). RESULTS: Surgical specimens showed RC in ten (22.2%) patients and LNM in five (11.1%). Multivariate analysis revealed that positive horizontal margin [odds ratio (OR) = 13.393, 95% confidence interval (CI): 1.435-125, P = 0.023] and neural invasion (OR = 14.714, 95%CI: 1.087-199, P = 0.043) were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM (OR = 12.000, 95%CI: 1.197-120, P = 0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 µm. Postoperative complications after additional laparoscopic gastrectomy occurred in five (11.1%) patients, and no deaths occurred among patients with complications. CONCLUSION: Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Gastrectomia/métodos , Laparoscopia/métodos , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Gástricas/cirurgia , Idoso , Ressecção Endoscópica de Mucosa/estatística & dados numéricos , Endossonografia , Estudos de Viabilidade , Feminino , Seguimentos , Gastrectomia/estatística & dados numéricos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Humanos , Laparoscopia/estatística & dados numéricos , Metástase Linfática/patologia , Metástase Linfática/prevenção & controle , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasia Residual , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
World J Gastroenterol ; 25(26): 3344-3358, 2019 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-31341360

RESUMO

Gastroduodenal disease (GDD) was initially thought to be uncommon in Africa. Amongst others, lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world. Following the increasing availability of flexible upper gastro-intestinal endoscopy, it has now become apparent that GDD, especially peptic ulcer disease (PUD), is prevalent across the continent of Africa. Recognised risk factors for gastric cancer (GCA) include Helicobater pylori (H. pylori), diet, Epstein-Barr virus infection and industrial chemical exposure, while those for PUD are H. pylori, non-steroidal anti-inflammatory drug (NSAID)-use, smoking and alcohol consumption. Of these, H. pylori is generally accepted to be causally related to the development of atrophic gastritis (AG), intestinal metaplasia (IM), PUD and distal GCA. Here, we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy, and complement the analysis with new data obtained on pre-malignant gastric his-topathological lesions in Accra, Ghana which was compared with previous data from Maputo, Mozambique. As there is a general lack of structured cohort studies in Africa, we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals. In Africa, there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns. Furthermore, there are differences in PUD within-country despite universally endemic H. pylori infection. PUD is not uncommon in Africa. Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries. An additional intriguing observation is a recent, ongoing decline in PUD in some African countries where H. pylori infection is still high. One possible reason for the high, sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations. The prevalence of AG and IM, were similar or modestly higher over rates in western countries but lower than those seen in Asia. . In our new data, sampling of 136 patients in Accra detected evidence of pre-malignant lesions (AG and/or IM) in 20 individuals (14.7%). Likewise, the prevalence of pre-malignant lesions, in a sample of 109 patients from Maputo, were 8.3% AG and 8.3% IM. While H. pylori is endemic in Africa, the observed prevalence for GCA is rather low. However, cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems, diagnostic health facilities and expertise. Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of GCA on the continent. We conclude that evidence is still lacking to support (or not) the African enigma theory due to inconsistencies in the data that indicate a particularly low incidence of GDD in African countries.


Assuntos
Gastrite Atrófica/epidemiologia , Infecções por Helicobacter/epidemiologia , Úlcera Péptica/epidemiologia , Neoplasias Gástricas/epidemiologia , Endoscopia Gastrointestinal , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastrite Atrófica/diagnóstico , Gastrite Atrófica/etiologia , Gana/epidemiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/etiologia , Helicobacter pylori/isolamento & purificação , Humanos , Incidência , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Metaplasia , Úlcera Péptica/diagnóstico , Úlcera Péptica/etiologia , Prevalência , Fatores de Risco , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiologia
8.
Surgery ; 166(5): 886-894, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31227185

RESUMO

INTRODUCTION: Laparoscopic Nissen fundoplication is the preferred operative treatment for patients with gastroesophageal reflux disease. The most recent published results only refer to clinical evaluations and few discuss objective measurements. Our purpose was to determine the late results of laparoscopic Nissen fundoplication, performing clinical, endoscopic, histologic, and functional studies. MATERIAL AND METHODS: A total of 179 patients were included in a prospective study. All had gastroesophageal reflux disease symptoms of at least 5-year duration, daily dependence on proton pump inhibitors, and a type I hiatal hernia less than 5 cm. Exclusion criteria included Barrett's esophagus, hiatal hernia >5 cm, failed antireflux surgery, and obesity (body mass index >30). We performed a radiologic study, 3 or more endoscopic procedures with biopsy samples of the antrum and esophagogastric junction, esophageal manometry, and 24-hour pH monitoring. RESULTS: We found that 4 patients (2.2%) died 3-4 years after operation from nonoperatiove reasons. A total of 25 patients (14%) were lost to follow-up, and 150 patients (83.8%) submitted to late objective evaluations (15 years). Visick I-II symptoms were observed in 79.3% and III-IV (failures) in 20.7%. Endoscopy showed a normal positioning of the esophagogastric junction in the Visick I-II patients and a type III cardia or hiatal hernia with erosive esophagitis in Visick III-IV patients. Short-segment Barrett's esophagus developed in 5.3% of patients. Lower esophageal sphincter pressure remained increased over the preoperative value in all groups. The 24-hour pH monitoring also was decreased over the preoperative value in Visick I-II patients but showed no significant change in Visick III-IV patients. Carditis at the esophagogastric junction regressed to fundic mucosa in 50% of Visick I-II patients. CONCLUSION: Laparoscopic Nissen fundoplication produces control of symptoms in 80% of patients late (up to 15 years) after surgeries corroborated by endoscopic, histologic examinations, and functional studies. It is essential to perform these objective evaluations to demonstrate the "antireflux effect" after laparoscopic Nissen fundoplication.


Assuntos
Esôfago de Barrett/epidemiologia , Esofagite Péptica/epidemiologia , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/terapia , Laparoscopia/efeitos adversos , Adulto , Idoso , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/etiologia , Biópsia , Endoscopia Gastrointestinal , Esofagite Péptica/diagnóstico , Esofagite Péptica/etiologia , Junção Esofagogástrica/diagnóstico por imagem , Junção Esofagogástrica/patologia , Feminino , Seguimentos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
World J Gastroenterol ; 25(16): 1928-1935, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31086461

RESUMO

Upper gastrointestinal (UGI) tract involvement of inflammatory bowel disease (IBD) is commonly seen in pediatric patients. Upper endoscopy is included in the routine workup of children with suspected IBD to enhance the diagnosis and management of these patients. Currently, childhood IBD is classified into ulcerative colitis (UC), atypical UC, Crohn's disease (CD) and IBD unclassified. Histologic confirmation of UGI tract involvement, in particular the presence of epithelioid (non-caseating) granulomas, is helpful in confirming the diagnosis of IBD and its classification. Herein, we reviewed selected IBD-associated UGI tract manifestations in children. Lymphocytic esophagitis, seen predominantly in CD, is histologically characterized by increased intraepithelial lymphocytes (> 20 in one high-power field) in a background of mucosal injury with absence of granulocytes. Focally enhanced gastritis is a form of gastric inflammation in pediatric IBD marked by a focal lymphohistiocytic pit inflammation with or without granulocytes and plasma cells in a relatively normal background gastric mucosa. Duodenal inflammation seen in children with IBD includes cryptitis, villous flattening, increased intraepithelial lymphocytes, and lamina propria eosinophilia. Finally, epithelioid granulomas not associated with ruptured gland/crypt are a diagnostic feature of CD. The clinicopathologic correlation and differential diagnosis of each microscopic finding are discussed. Clinicians and pathologists should be cognizant of the utility and limitations of these histologic features.


Assuntos
Duodenite/diagnóstico , Esofagite/diagnóstico , Gastrite/diagnóstico , Doenças Inflamatórias Intestinais/diagnóstico , Trato Gastrointestinal Superior/patologia , Criança , Diagnóstico Diferencial , Duodenite/imunologia , Duodenite/patologia , Endoscopia Gastrointestinal , Esofagite/imunologia , Esofagite/patologia , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/imunologia , Mucosa Gástrica/patologia , Gastrite/imunologia , Gastrite/patologia , Humanos , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/imunologia , Mucosa Intestinal/patologia , Linfócitos Intraepiteliais/imunologia , Trato Gastrointestinal Superior/diagnóstico por imagem , Trato Gastrointestinal Superior/imunologia
10.
J BUON ; 24(2): 679-685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31128023

RESUMO

PURPOSE: To analyze the prognostic factors of gastric mucosal dysplasia after endoscopic resection. METHODS: 362 patients with gastric mucosal dysplasia diagnosed by endoscopic biopsy and undergoing endoscopic resection from March 2012 to March 2016 were enrolled. Follow-up was longer than 30 months. Basic characteristics of enrolled patients were recorded, including age, gender, surgical procedures, lesion location, pathological type, lesion size, Helicobacter pylori (HP) infection, operation time and wound area. The relationship between the above factors and postoperative residual lesions and recurrence after endoscopic resection of gastric mucosal dysplasia was analyzed. RESULTS: Included were 200 males and 162 females, aged 28-78 years, (mean 59.3±11.5). Operation time and wound area were not correlated with postoperative recurrence of gastric mucosal dysplasia resected by endoscopic mucosal resection (EMR) (p>0.05). Operation time in patients undergoing endoscopic submucosal dissection (ESD) was longer compared with those of controls (p=0.032). Additionally, wound area was smaller in patients with postoperative residual disease (p=0.003) and postoperative recurrence (p=0.048) after ESD compared with controls. Intestinal metaplasia was a common risk factor for postoperative residual disease and postoperative recurrence of gastric mucosal dysplasia. Lesion location and complete resection were independent risk factors for postoperative recurrence of gastric mucosal dysplasia. Also, pathological findings and HP infection were independent risk factors for recurrence of gastric mucosal dysplasia after endoscopic resection. CONCLUSIONS: In patients undergoing ESD of gastric mucosal dysplasia, prolonged operation time may increase the possibility of postoperative residual disease. Complete resection may reduce the possibility for recurrence. Intestinal metaplasia may serve as a common independent risk factor for postoperative residual disease and recurrence of gastric mucosal dysplasia after endoscopic resection.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma in Situ/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Idoso , Biópsia , Carcinoma in Situ/diagnóstico por imagem , Carcinoma in Situ/patologia , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/diagnóstico , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Período Pós-Operatório , Fatores de Risco , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 98(20): e15710, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096520

RESUMO

BACKGROUND: To systematically evaluate efficacy of traditional Chinese medicine (TCM) in treating chronic gastritis (CG). METHODS: Data sources from PubMed, Embase, Springer Link, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese Biomedicine Database, and Wan-fang database were searched up to July 5, 2018. Review Manager software version 5.3, the Cochrane Collaboration's risk of bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation profiler software were conducted for this meta-analysis. RESULTS: Sixteen studies involving 1673 participants (906 vs 767) were included in this study. Pooled data showed significant statistical differences between TCM groups and current routine pharmacotherapy (RP) groups in overall clinical efficacy (odds ratio [OR] 4.65; 95% confidence interval [CI] 3.29, 6.56; P < .00001), efficacy under endoscopy (OR 2.46; 95% CI 1.12, 5.43; P = .03), stomach distension (mean difference [MD] -0.37; 95% CI -0.56, -0.19; P < .0001), stomachache (standardized MD [SMD] -0.80; 95% CI -1.45, -0.14; P = .02), and belching (SMD -2.00; 95% CI -3.80, -0.20; P = .03). However, acid regurgitation (SMD -0.71; 95% CI -1.69, 0.28; P = .16) and anorexia (SMD -0.75; 95% CI -2.30, 0.80; P = .35) showed no significant statistical differences between 2 groups. In addition, incidence of adverse reactions of TCM groups was lower than that of RP groups. CONCLUSION: Evidence from this meta-analysis suggests that TCM could be more efficacious than current RP in treating CG. But further standardized research of rigorous design should be needed to further validate its efficacy.


Assuntos
Mucosa Gástrica/efeitos dos fármacos , Gastrite/tratamento farmacológico , Medicina Tradicional Chinesa/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Doença Crônica , Endoscopia do Sistema Digestório/métodos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Gastrite/diagnóstico por imagem , Gastrite/patologia , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
13.
World J Gastroenterol ; 25(10): 1248-1258, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30886507

RESUMO

BACKGROUND: Linked color imaging (LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal color. AIM: To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological findings. METHODS: Endoscopic images were obtained for 39 patients (43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging (WLI) and LCI. Color values in Commission Internationale de l'Eclairage (CIE) 1976 L*a*b* color space were used to calculate the color difference (ΔE) between cancer lesions and non-cancer areas. After endoscopic submucosal dissection, blood vessel density in the surface layer of the gastric epithelium was evaluated pathologically. The identical region of interest was selected for analyses of endoscopic images (WLI and LCI) and pathological analyses. RESULTS: LCI was superior for lesion recognition (P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI (29.4 vs 18.6, P < 0.0001). Blood vessel density was significantly higher in cancer lesions (5.96% vs 4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%. CONCLUSION: LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.


Assuntos
Detecção Precoce de Câncer/métodos , Mucosa Gástrica/diagnóstico por imagem , Gastroscopia/métodos , Imagem de Banda Estreita/métodos , Neoplasias Gástricas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Cor , Ressecção Endoscópica de Mucosa , Feminino , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Humanos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Software , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
14.
Lasers Med Sci ; 34(9): 1791-1797, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30903528

RESUMO

We aimed to investigate the ability of linked color imaging (LCI) versus white light endoscopy (WLE) to detect gastric intestinal metaplasia (GIM). One hundred and seven participants who underwent upper gastrointestinal endoscopy were included. Under WLE endoscopy, biopsies were performed on any suspected abnormal mucosal changes. Under LCI endoscopy, we tested whether the specific color feature of patchy lavender color (PLC) pathologically indicated GIM. Biopsies were randomly performed in participants who had neither PLC nor suspected lesions. The detection abilities of LCI and WLE were assessed by comparison of histological and endoscopic findings. A total of 41 participants had histological GIM. The total diagnostic accuracy rate for GIM by LCI was 79.44%, higher than that of WLE (40.19%) (P < 0.001). Moreover, LCI with targeted biopsies showed a significantly increased ability to detect GIM (P < 0.001). PLC observed in the gastric mucosa on LCI can guide endoscopic biopsies and increase the detection rate of GIM. Thus, LCI could be a good tool for detecting GIM. ClinicalTrials.gov Identifier: ChiCTR-DDD-17011326).


Assuntos
Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Gastroscopia , Intestinos/diagnóstico por imagem , Intestinos/patologia , Adulto , Idoso , Cor , Feminino , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/patologia
15.
Chin Med J (Engl) ; 132(7): 782-788, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30896610

RESUMO

BACKGROUND: Gastric intestinal metaplasia (GIM) is generally considered to be the main mucosal background for the development of gastric adenocarcinomas. Using linked color imaging (LCI), we noticed that the color pattern in areas of GIM was purple mixed with white on the epithelium with signs of mist that were detected by the non-magnifying LCI observation. We have termed this endoscopic finding "Purple in Mist" (PIM). The aim of this study was to investigate whether PIM could be a useful optical sign for predicting GIM. METHODS: We prospectively evaluated consecutive patients undergoing endoscopy for various indications. The endoscopist used the LCI system to carefully observe the gastric antrum, body and angulus. When a PIM was identified in the surface layer, targeted biopsies were subsequently taken from this part. If the suspected area had no PIM on the surface, targeted biopsies were also taken. RESULTS: Sixty-three consecutive patients were included in this study. The prevalence of intestinal metaplasia (IM) was 29/63 (46%). In PIM-positive patients, the prevalence of IM was 23/26 (89%). Of these patients, 146 biopsy specimens were included in this study. For the diagnosis of IM, compared to histological assessment, the LCI finding had an accuracy of 91.1% (95%CI: 86.5%-95.7%), a sensitivity of 89.8% (95%CI: 81.3%-98.3%), a specificity of 91.8% (95%CI: 86.3%-97.2%), a positive predictive value of 84.6% (95%CI: 74.8%-94.4%), and a negative predictive value of 94.7% (95%CI: 90.1%-99.2%). CONCLUSIONS: A positive PIM finding in a suspicious lesion on LCI would complement LCI diagnosis of possible IM because of the positive predictive value of PIM. PIM could be a novel endoscopic marker for IM. TRIAL REGISTRATION: ClinicalTrials.gov, No. NCT03092414; https://clinicaltrials.gov/ct2/show/NCT03092414?id=NCT03092414&rank=1.


Assuntos
Mucosa Gástrica/diagnóstico por imagem , Gastroscopia/métodos , Metaplasia/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
Digestion ; 99(3): 219-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30799389

RESUMO

BACKGROUND/AIMS: The mucosal healing process after endoscopic submucosal dissection (ESD) is mostly scarring change (flat type), but a protruded lesion is occasionally found. We investigated the factors influencing the mucosal healing process, such as the flat and protruded types. METHODS: A total of 2,096 ESD cases were performed from February 2005 to December 2013, and 1,757 underwent follow-up endoscopy after 3 months to check the healing type of the ulceration. We retrospectively reviewed the medical charts to analyze demographic, endoscopic, and pathological findings between the 2 groups. RESULTS: Forty-eight cases were of the protruded type and 1,709 were of the flat type. In univariate analysis, the protruded type was found more in the antrum, anterior wall, and greater curvature (p < 0.001). In protruded types, the Helicobacter pylori (H. pylori) infection rate was lower (p < 0.017), the mean length of ESD specimen was shorter (p < 0.012), the fibrosis rate was lower (p < 0.033), and the mean number of hot biopsy and clips during ESD were less (p < 0.008 and p < 0.001 respectively). CONCLUSIONS: The healing type of mucosal ulceration after ESD seemed to be influenced by location, specimen size, and the presence of an H. pylori infection.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Mucosa Gástrica/patologia , Gastroscopia/efeitos adversos , Complicações Pós-Operatórias/patologia , Neoplasias Gástricas/cirurgia , Úlcera/patologia , Idoso , Ressecção Endoscópica de Mucosa/métodos , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/microbiologia , Mucosa Gástrica/cirurgia , Gastroscopia/métodos , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Úlcera/diagnóstico por imagem , Úlcera/etiologia , Cicatrização
17.
World J Surg Oncol ; 17(1): 32, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760272

RESUMO

BACKGROUND: Endoscopic resection (ER) has come to be recognized as a standard treatment for early gastric cancer (EGC). While its adoption is expanding, ER remains restricted to cases of EGC without lymph node metastasis for the treatment of local resection. On the other hand, histopathological analyses of surgically resected specimens of EGC have revealed the presence of lymph node (LN) metastasis in some cases of mucosal gastric cancer (MGC) and undifferentiated MGC (UD-MGC) is considered to have higher risk of nodal metastases than differentiated MGC (D-MGC). To evaluate the risk factors for LN metastasis in MGC, we investigated the characteristics of UD-MGC associated with LN metastasis. METHODS: Among all UD-MGC patients who underwent surgery as initial treatment, between January 2000 and March 2016, we reviewed the clinicopathological data, including the preoperative endoscopic findings and histopathological findings in the resected specimens, of the 11 UD-MGC patients who were identified as having lymph node metastasis. Furthermore, in comparison with cases without lymph node metastasis, we examined the possibility of expansion of the indication for local treatment. RESULTS: In most of the cases of UD-MGC with LN metastasis, the lesions were relatively large (> 20 mm in diameter) and of the clearly depressed type with faded color and apparent border, and histopathology revealed a high percentage of cases with lymphatic invasion and a predominance of signet ring cell carcinomas. No cases with LN metastasis without depressed macroscopic type nor signet ring cell carcinoma component existed. A degree of invasion of lamina propria (LP) or muscularis mucosae (MM) had same relation to the risk of LN metastasis. CONCLUSIONS: In this study, none of the cases of undifferentiated-type mucosal cancer (UD-MGC) with LN metastasis satisfied the current adoption criteria for ER. We suggested significant risk factors for LN metastasis in UD-MGC cases as depressed tumor type, presence of a signet ring cell carcinoma component, presence of lymphatic tumor invasion, and a large tumor size. More detailed analyses of the endoscopic and histopathological findings may allow further risk classification for LN metastasis in cases of UD-MGC.


Assuntos
Carcinoma de Células em Anel de Sinete/patologia , Ressecção Endoscópica de Mucosa/métodos , Gastrectomia/métodos , Gastroscopia/métodos , Metástase Linfática/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/cirurgia , Diferenciação Celular , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Medição de Risco , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia
18.
Clin Transl Gastroenterol ; 10(1): e00008, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30702488

RESUMO

OBJECTIVES: To evaluate the healing efficacy of rebamipide and lansoprazole combination therapy with lansoprazole alone for endoscopic submucosal dissection (ESD)-induced ulcers and clarify the ulcer healing-associated factors. METHODS: Three hundred patients were randomized into control and experimental groups after they underwent ESD. The patients received intravenous pantoprazole (30 mg) every 12 hours and oral rebamipide (100 mg, experimental group) or placebo (control group) 3 times daily on days 1-3. On days 4-56, patients received oral lansoprazole (30 mg daily) and rebamipide (100 mg) or placebo 3 times daily. Endoscopic evaluations were performed at postoperative weeks 4 and 8. RESULTS: At week 4, the ulcer reduction rate was significantly higher in the experimental than in the control group (0.97 ± 0.034 vs. 0.94 ± 0.078; P < 0.001). The ulcer healing (18.2% vs 20.3%; P = 0.669) and ulcer improvement rates (94.2% vs 88.7%; P = 0.109) in the 2 groups were not significantly different. At week 8, the ulcer healing and ulcer improvement rates were 90.6% and 100%, respectively, in both groups. Multivariate analysis showed that the combination treatment was an independent factor associated with ulcer area reduction after ESD. The maximum diameter of the initial ulcer (≥35.5 mm vs <35.5 mm) was an independent factor associated with the ulcer improvement rate after ESD. CONCLUSIONS: The rebamipide and lansoprazole combination therapy can help accelerate the reduction rate of post-ESD ulcer compared with the lansoprazole monotherapy at 4 weeks of therapy.


Assuntos
Alanina/análogos & derivados , Antiulcerosos/administração & dosagem , Ressecção Endoscópica de Mucosa/efeitos adversos , Lansoprazol/administração & dosagem , Quinolonas/administração & dosagem , Úlcera Gástrica/tratamento farmacológico , Administração Oral , Idoso , Alanina/administração & dosagem , Biópsia , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/etiologia , Fatores de Tempo , Resultado do Tratamento
19.
World J Gastroenterol ; 25(4): 469-484, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30700943

RESUMO

BACKGROUND: Gastric 'indefinite for neoplasm/dysplasia' (IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal management. AIM: To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND lesions. METHODS: In total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection (n = 134), surgery (n = 22), and follow-up endoscopic biopsy (n = 305) were performed to confirm the diagnosis. The time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia (60%) or atypical epithelia (40%) at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the cases. RESULTS: Four clinical factors [age ≥ 60 years (2.445, 95%CI: 1.305-4.580, P = 0.005), endoscopic size ≥ 10 mm (3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion (5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding (4.056, 95%CI: 1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium (25.575, 95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI: 1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were 91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change (5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeated IFND cases and resulted in low diagnostic accuracy even on retrospective blinded review. CONCLUSION: More than two clinical and pathologic factors each had significant cut-off values for gastric carcinoma diagnosis; in such cases, endoscopic resection should be considered.


Assuntos
Adenocarcinoma/diagnóstico , Mucosa Gástrica/patologia , Gastrite/cirurgia , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Tardio , Diagnóstico Diferencial , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/cirurgia , Gastrite/diagnóstico , Gastrite/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto Jovem
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