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Di Maio S, Biswas A, Vézina JL, Hardy J, Mohr G. Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications. Surg Neurol Int 2012; 3:67. [PMID: 22754732 PMCID: PMC3385069 DOI: 10.4103/2152-7806.97534] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/10/2012] [Indexed: 11/21/2022] Open
Abstract
Background: To assess the relationship between the preoperative magnetic resonance imaging (MRI) appearance of the normal residual pituitary gland (NRPG) and pituitary functional outcome following transsphenoidal resection of pituitary macroadenomas. Methods: We retrospectively reviewed the medical records of 100 consecutive patients with a pituitary macroadenoma, who underwent transsphenoidal resection. The preoperative configuration of the displaced NRPG was stratified as superior, superolateral or lateral. The extent of postoperative restitution of the NRPG was divided into four groups: Group 1 — normal residual gland or almost normal; Group 2 — more than 50% restitution; Group 3 — less than 50% of the normal residual gland; and Group 4 — barely visible or absent residual gland. The pre- and postoperative NRPG appearance was correlated with pituitary functional status. Results: Preoperatively, the NRPG was identifiable in 79 patients, with extrasellar displacement in 53%. The displacement pattern was superior in 8%, superolateral in 32%, and lateral in 58% of the patients. If the NRPG was displaced laterally, the ipsilateral cavernous sinus was not invaded by the pituitary macroadenoma. Partial or complete pituitary function was lost in 6 / 23 (26.1%) patients with superior or superolateral displacement of the NRPG, compared to only 1 / 36 (2.8%) patients without superior displacement of the NRPG (P = 0.025). Progressive postoperative reconstitution of the NRPG was related to the preservation of the pituitary hormonal axis (Pearson Chi-Square P < 0.001). Conclusions: Progressive displacement of the NRPG preoperatively, and lack of restitution of the NRPG on postoperative MRI appeared to correlate with the postoperative pituitary functional loss.
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Takeda Y, Yashima K, Hayashi A, Sasaki S, Kawaguchi K, Harada K, Murawaki Y, Ito H. Expression of AID, P53, and Mlh1 proteins in endoscopically resected differentiated-type early gastric cancer. World J Gastrointest Oncol 2012; 4:131-7. [PMID: 22737274 PMCID: PMC3382659 DOI: 10.4251/wjgo.v4.i6.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/14/2012] [Accepted: 03/20/2012] [Indexed: 02/05/2023] Open
Abstract
AIM To analyze the expression of the tumor-related proteins in differentiated-type early gastric carcinoma (DEGC) samples. METHODS Tumor specimens were obtained from 102 patients (75 males and 27 females) who had received an endoscopic tumor resection at Tottori University Hospital between 2007 and 2009. Ninety-one cancer samples corresponded to noninvasive or intramucosal carcinoma according to the Vienna classification system, and 11 samples were submucosal invasive carcinomas. All of the EGCs were histologically differentiated carcinomas. All patients were classified as having Helicobacter pylori (H. pylori) infections by endoscopic atrophic changes or by testing seropositive for H. pylori IgG. All of the samples were histopathologically classified as either tubular or papillary adenocarcinoma according to their structure. The immunohistochemical staining was performed in a blinded manner with respect to the clinical information. Two independent observers evaluated protein expression. All data were statistically analyzed then. RESULTS The rates of aberrant activation-induced cytidine deaminase (AID) expression and P53 overexpression were both 34.3% in DEGCs. The expression of Mlh1 was lost in 18.6% of DEGCs. Aberrant AID expression was not significantly associated with P53 overexpression in DEGCs. However, AID expression was associated with the severity of mononuclear cell activity in the non-cancerous mucosa adjacent to the tumor (P = 0.064). The rate of P53 expression was significantly greater in flat or depressed tumors than in elevated tumors. The frequency of Mlh1 loss was significantly increased in distal tumors, elevated gross-type tumors, papillary histological-type tumors, and tumors with a severe degree of endoscopic atrophic gastritis (P < 0.05). CONCLUSION Aberrant AID expression, P53 overexpression, and the loss of Mlh1 were all associated with clinicopathological features and gastric mucosal alterations in DEGCs. The aberrant expression of AID protein may partly contribute to the induction of nuclear P53 expression.
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Kim HH, Park SJ, Park MI, Moon W. Clinical impact of second-look endoscopy after endoscopic submucosal dissection of gastric neoplasms. Gut Liver 2012; 6:316-20. [PMID: 22844558 PMCID: PMC3404167 DOI: 10.5009/gnl.2012.6.3.316] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/09/2011] [Accepted: 11/02/2011] [Indexed: 02/06/2023] Open
Abstract
Background/Aims One major complication of endoscopic submucosal dissection (ESD) is delayed bleeding. Most hospitals routinely perform second-look endoscopy to reduce the chances of delayed bleeding without solid evidence supporting the practice. The aim of this study was to evaluate whether second-look endoscopy prevents delayed bleeding and to verify the clinicopathological features of delayed bleeding to determine how to identify lesions that may require second-look endoscopy. Methods We investigated 440 lesions in 397 patients who underwent ESD for gastric neoplasm from January 2008 to June 2010. Two-thirds of the enrolled cases were adenomas, and 290 lesions were located in the lower portion of the stomach. Clinically evident bleeding from mucosal defects 24 hours after ESD was considered as delayed bleeding. We reviewed the data, including the characteristics of patients, lesions, and procedures. Furthermore, the rate of delayed bleeding before and after second-look endoscopy, performed within three days of ESD, was investigated to determine the utility of second-look endoscopy. Results Delayed bleeding was evident in 9 of 440 lesions (2.0%), all of which underwent endoscopic hemostasis. The only significant factor predicting delayed bleeding was resected specimen over 40 mm in size (p=0.003). Delayed bleeding occurred in 8 of 9 cases (89%) before the second-look endoscopy, which was performed within 72 hours after ESD. Conclusions In this study, second-look endoscopy may be useful for preventing post-ESD bleeding, especially when resected specimens are over 40 mm in size.
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Nishida T, Tsutsui S, Kato M, Inoue T, Yamamoto S, Hayashi Y, Akasaka T, Yamada T, Shinzaki S, Iijima H, Tsujii M, Takehara T. Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy. World J Gastrointest Pathophysiol 2011; 2:93-9. [PMID: 22180842 PMCID: PMC3240908 DOI: 10.4291/wjgp.v2.i6.93] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/26/2011] [Accepted: 10/03/2011] [Indexed: 02/06/2023] Open
Abstract
Treatment strategies, whether as follow-up or “total incisional biopsy” for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen, are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment. Based on the histological findings of the biopsy specimen, it is difficult to differentiate between reactive or regenerative changes, inflammation and neoplastic changes, intraepithelial and invasive tumors. Therefore, gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and high-frequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection (ESD), a therapeutic option for gastric intraepithelial neoplasia, including low-grade neoplasms. Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.
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455
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Senadhi V, Jani N. Hypergastrinemia and recurrent type 1 gastric carcinoid in a young Indian male: Necessity for antrectomy? World J Gastroenterol 2011; 17:4052-4. [PMID: 22046097 PMCID: PMC3199567 DOI: 10.3748/wjg.v17.i35.4052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 05/21/2011] [Accepted: 05/28/2011] [Indexed: 02/06/2023] Open
Abstract
Carcinoid tumors are the most common neuroendocrine tumors. Gastric carcinoids represent 2% of all carcinoids and 1% of all gastric masses. Due to the widespread use of Esophagogastroduodenoscopy for evaluating a variety of upper gastrointestinal symptoms, the detection of early gastric carcinoids has increased. We highlight an alternative management of a young patient with recurrent type 1 gastric carcinoids with greater than 5 lesions, as well as lesions intermittently greater than 1 cm. Gastric carcinoids have a variable presentation and clinical course that is highly dependent on type. Type 1 gastric carcinoids are usually indolent and have a metastasis rate of less than 2%, even with tumors larger than 2 cm. There are a number of experts as well as organizations that recommend endoscopic resection for all type 1 gastric carcinoid lesions less than 1 cm, with a follow-up every 6-12 mo. They also recommend antrectomy for type 1 gastric carcinoids with greater than 5 lesions, lesions 1 cm or greater, or refractory anemia. However, the American Society of Gastrointestinal Endoscopy guidelines state that type 1 gastric carcinoid surveillance is controversial based on the evidence and could not make an evidence-based position statement on the best treatment modality. Our report illustrates a rare cause of iron deficiency anemia in a young male (without any medical history) due to multiple recurrent gastric carcinoid type 1 lesions in the setting of atrophic gastritis causing hypergastrinemia, and in the absence of a vitamin B12 deficiency. Gastric carcinoid type 1 can present in young males without an autoimmune history, despite the known predilection for women aged 50 to 70 years. Type 1 gastric carcinoids can be managed by endoscopic resection in patients with greater than 5 lesions, even with lesions larger than 1 cm. This course of treatment enabled the avoidance of early antrectomy in our patient, who expressed a preference against more invasive measures at his young age.
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Lee SH, Huh GY, Cheong YS. A case of endoscopic resection of a colonic semipedunculated leiomyoma. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:215-9. [PMID: 21980593 PMCID: PMC3180603 DOI: 10.3393/jksc.2011.27.4.215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 05/17/2011] [Indexed: 02/07/2023]
Abstract
During colonoscopic examination, epithelial lesions, such as adenomatous polyps, are frequently encountered, unlike subepithelial lesions, such as leiomyomas, which are uncommon. A colonic leiomyoma is a rare tumor, originating either from the mucularis mucosa or from the proper muscle, and accounts for only 3% of all gastrointestinal leiomyomas. Colonic leiomyomas are usually benign and asymptomatic. However, they can sometimes cause symptoms, ie, abdominal pain, intestinal obstruction, hemorrhage, and perforation. The traditional management option for a colonic leiomyoma is surgical resection. Recently, with the development of endoscopy devices and techniques, the endoscopic resection has been considered as an alternative treatment option. We experienced a patient with a leiomyoma that was diagnosed during colonoscopy. The leiomyoma was resected endoscopically without complication. We report this case with a review of the literature.
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457
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Won CS, Cho MY, Kim HS, Kim HJ, Suk KT, Kim MY, Kim JW, Baik SK, Kwon SO. Upgrade of Lesions Initially Diagnosed as Low-Grade Gastric Dysplasia upon Forceps Biopsy Following Endoscopic Resection. Gut Liver 2011; 5:187-93. [PMID: 21814599 PMCID: PMC3140664 DOI: 10.5009/gnl.2011.5.2.187] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 01/09/2011] [Indexed: 01/15/2023] Open
Abstract
Background/Aims Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25% to 35% of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy. Methods To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated. Results Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8%) changed following the ER; 56 of 251 LGDs (22.3%) were diagnosed as HGD, 39 (15.5%) as adenocarcinoma, and 5 (2.0%) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95% CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER. Conclusions Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.
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Locatelli M, Carrabba G, Guastella C, Gaini SM, Spagnoli D. Endoscopic endonasal removal of a cavernous hemangioma of the orbital apex. Surg Neurol Int 2011; 2:58. [PMID: 21697974 PMCID: PMC3114373 DOI: 10.4103/2152-7806.80123] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/18/2011] [Indexed: 11/24/2022] Open
Abstract
Background: Cavernous hemangioma are the most common benign lesions of the orbit. Their surgical resection is still challenging and several surgical approaches have been proposed. Case Description: We present the case of a 59-year-old woman with a cavernous hemangioma of the orbital apex, which was diagnosed incidentally. The hemangioma was extraconal and involved mainly the medial orbital apex; it also extended to the pterygoid fossa, to the middle fossa, to the maxillary and sphenoid sinuses. The surgical resection was performed by a pure endoscopic transphenoidal, transmaxillary, transethmoidal approach, achieving a total removal. The patient had a transient and incomplete paresis of the VI cranial nerve on the left side and did not experience other postoperative complications. Conclusion: The endoscopic endonasal approach proved successful in the management of this case and it should be considered in the surgical management of extraconal orbital apex lesions with medial or inferior extension.
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Lee JH, Kim JH, Kim DH, Jeon TY, Kim DH, Kim GH, Park DY. Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer? J Gastric Cancer 2010; 10:182-7. [PMID: 22076184 PMCID: PMC3204500 DOI: 10.5230/jgc.2010.10.4.182] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 10/12/2010] [Indexed: 01/03/2023] Open
Abstract
Purpose Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. Materials and Methods A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. Results Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). Conclusions We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.
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Kim SG, Song HJ, Choi IJ, Cho JY, Jung HY, Keum B, Cheon JH, Lee YC, Kim JG, Park SK, Park BJ, Jung HC. A Planned Prospective, Randomized, Placebo-Controlled Multicenter Trial Assessing the Effect of Helicobacter pylori Eradication on the Healing of Iatrogenic Ulcer after Endoscopic Resection of Gastric Neoplasm. Gut Liver 2010; 4:514-7. [PMID: 21253301 DOI: 10.5009/gnl.2010.4.4.514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 11/08/2010] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Helicobacter pylori eradication may facilitate the healing of iatrogenic ulcer after endoscopic resection of gastric neoplasm. This study involved designing a randomized, double-blinded, placebo-controlled, multicenter trial, performed by the Korean College of Helicobacter and Upper Gastrointestinal Research and the Medical Research Collaboration Center, Seoul National University Hospital. METHODS We intend to enroll up to 232 patients H.-pylori-positive patients who have gastric adenoma or early gastric cancer after endoscopic resection. The enrolled patients are being randomly allocated to the H.-pylori-eradication-plus-proton-pump-inhibitor group or the placebo-plus-proton-pump-inhibitor group based on their histology results and the size of the resected specimen. After random allocation, the iatrogenic ulcer size and stage are evaluated at 4- and 8-week follow-ups (with a window of ±7 days). The primary end point is the healing rate of the ulcer by stage, and the secondary end point is the rate of ulcer size reduction, relief rate from ulcer-related symptoms, and adverse-event rates. RESULTS More than 90% of the target subjects have already been enrolled into the study and are receiving ongoing periodic monitoring by the Medical Research Collaboration Center. CONCLUSIONS Completion of the study should reveal whether H. pylori eradication can facilitate the healing of ulcer after endoscopic resection in Korea.
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461
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Ishido K, Tanabe S, Higuchi K, Sasaki T, Katada C, Azuma M, Naruke A, Koizumi W, Mikami T. Clinicopathological evaluation of duodenal well-differentiated endocrine tumors. World J Gastroenterol 2010; 16:4583-8. [PMID: 20857530 PMCID: PMC2945491 DOI: 10.3748/wjg.v16.i36.4583] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinicopathological characteristics of duodenal well-differentiated endocrine tumors.
METHODS: We examined clinicopathological characteristics in 11 consecutive patients with duodenal well-differentiated endocrine tumors treated by endoscopic therapy or surgery in our hospital from 1992 through 2007. Patients with well-differentiated endocrine tumors of the papilla of Vater or with gastrinoma were excluded.
RESULTS: Three patients received endoscopic treatment, and 8 underwent surgery. In patients who received endoscopic treatment, the tumor diameter was less than 1.0 cm, with no histopathological evidence of lymphovascular invasion or invasion of the muscularis. There were no complications such as late bleeding or perforation after treatment. Among 8 patients with tumors less than 1.0 cm in diameter, 3 underwent partial resection, and 2 underwent radical surgery. Three patients had lymphovascular invasion, 1 had invasion of the muscularis, and 1 had proximal lymph node metastasis. Among 3 patients with tumors 1.0 cm or more in diameter, 1 underwent partial resection, and 2 underwent radical surgery. One patient had lymphovascular invasion, with no lymph node metastasis. After treatment, all patients are alive and have remained free of metastasis and recurrence.
CONCLUSION: Duodenal well-differentiated endocrine tumors less than 1.0 cm in diameter have a risk of lymphovascular invasion, invasion of the muscularis, and lymph node metastasis, irrespective of procedural problems.
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462
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Ryu DY, Kim GH, Park DY, Lee BE, Cheong JH, Kim DU, Woo HY, Heo J, Song GA. Endoscopic removal of gastric ectopic pancreas: An initial experience with endoscopic submucosal dissection. World J Gastroenterol 2010; 16:4589-93. [PMID: 20857531 PMCID: PMC2945492 DOI: 10.3748/wjg.v16.i36.4589] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.
METHODS: A total of eight patients with ectopic pancreas were included. All of them underwent endoscopic ultrasonography before endoscopic resection. Endoscopic resection was performed by two methods: endoscopic mucosal resection (EMR) by the injection-and-cut technique or endoscopic mucosal dissection (ESD).
RESULTS: We planned to perform EMR in all eight cases but EMR was successful in only four cases. In the other four cases, saline spread into surrounding normal tissues and the lesions became flattened, which made it impossible to remove them by EMR. In those four cases, we performed ESD and removed the lesions without any complications.
CONCLUSION: If conventional EMR is difficult to remove gastric ectopic pancreas, ESD is a feasible alternative method for successful removal.
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463
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Jeon SW. Endoscopic management of gastric dysplasia: Cutting edge technology needs a new paradigm. World J Gastrointest Endosc 2010; 2:301-4. [PMID: 21160760 PMCID: PMC2999034 DOI: 10.4253/wjge.v2.i9.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 06/04/2010] [Accepted: 06/11/2010] [Indexed: 02/05/2023] Open
Abstract
There has been tremendous progress in endoscopic techniques for the management of premalignant or malignant gastric lesions. Gastric cancer remains the second most common cause of cancer related mortality worldwide. This means that there is a need for early detection and diagnosis of premalignant lesions or early cancer in clinical practice. Despite substantial development of endoscopic resection techniques, the management of gastric premalignant lesions is controversial because of the lack of consensus and accurate risk stratification. Future study of various aspects would clarify these issues but in the meantime we should reconsider the current algorithm approach for the management of gastric low grade dysplasia.
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Lee SH, Jeon SW, Jung MK, Kim SK, Choi GS. A comparison of transanal excision and endoscopic resection for early rectal cancer. World J Gastrointest Endosc 2009; 1:56-60. [PMID: 21160652 PMCID: PMC2999074 DOI: 10.4253/wjge.v1.i1.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 08/26/2009] [Accepted: 09/15/2009] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare the outcomes of endoscopic resection with transanal excision in patients with early rectal cancer.
METHODS: Thirty-two patients with early rectal cancer were treated by transanal excision or endoscopic resection between May 1999 and December 2007. The patients were regularly re-examined by means of colonoscopy and abdominal computed tomography after resection of the early rectal cancer. Complications, length of hospital-stay, disease recurrence and follow up outcomes were assessed.
RESULTS: Sixteen patients were treated by endoscopic resection and 16 patients were treated by transanal excision. No significant differences were present in the baseline characteristics. The rate of complete resection in the endoscopic resection group was 93.8%, compared to 87.5% in the transanal excision group (P = 0.544). The mean length of hospital-stay in the endoscopic resection group was 2.7 ± 1.1 d, compared to 8.9 ± 2.7 d in the transanal excision group (P = 0.001). The median follow up was 15.0 mo (range 6-99). During the follow up period, there was no case of recurrent disease in either group.
CONCLUSION: Endoscopic resection was a safe and effective method for the treatment of early rectal cancers and its outcomes were comparable to those of transanal excision procedures.
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Miura A, Momma K, Yoshida M. Endoscopic resection for T1a-MM and T1b-SM1 squamous cell carcinoma of the esophagus. Clin J Gastroenterol 2009; 2:252-256. [PMID: 26192419 DOI: 10.1007/s12328-009-0098-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 06/15/2009] [Indexed: 11/26/2022]
Abstract
In Japan, the first paper on endoscopic resection (ER) for squamous cell carcinoma (SCC) of the esophagus confined to the mucosa was reported as endoscopic mucosal resection (EMR) in 1988. Since publication of that article, ER has been recommended as the standard treatment for squamous and mucosal cancer of the esophagus. T1a-EP and T1a-LPM esophageal cancer seldom involves lymph node metastasis. However, in cases of T1a-MM and T1b-SM1 esophageal cancer with lymph node metastasis (10% to 30%), the indication of ER is limited. The risk factors for lymph node metastasis in T1a-MM and T1b-SM1 esophageal cancer were cleared by clinical and pathological studies. Endoscopic findings such as type 0-I or type 0-III, size of 50 mm or more, and pathological findings such as lymphatic permeation, venous permeation, poorly differentiated SCC and INFb or INFc were suggestive of high risk for lymph node metastasis. In addition, histopathological findings of small cancer nests, defined as "budding" or "droplet infiltration," suggest frequent lymph node metastasis. In cases of T1a-MM and T1b-SM1 esophageal cancer with high risk of lymph node metastasis, adjuvant therapy including chemoradiotherapy and radical esophagectomy are recommended after ER. A recent advance in ER for esophageal cancer is the establishment of endoscopic submucosal dissection (ESD). It has allowed us to perform an en-block resection of a large mucosal lesion of the esophagus and detailed histopathological examination. However, ESD requires more difficult manipulation than EMR. The indication of EMR or ESD is sought.
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Consolo P, Luigiano C, Strangio G, Scaffidi MG, Giacobbe G, Giuseppe GD, Zirilli A, Familiari L. Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center. World J Gastroenterol 2008; 14:2364-9. [PMID: 18416463 PMCID: PMC2705091 DOI: 10.3748/wjg.14.2364] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions.
METHODS: We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a ten-year period. One hundred and sixty of these were performed for large polyps, those measuring ≥ 20 mm. Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption and associated intestinal or extra intestinal diseases were analyzed. For statistical analysis, the Pearson χ2 test, NPC test and a Binary Logistic Regression were used.
RESULTS: The mean patient age was 65.9 ± 12.4 years, with 671 men and 367 women. The mean size of polyps removed was 9.45 ± 9.56 mm while the size of large polyps was 31.5 ± 10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon (41.3%). The most frequent histology was tubular adenoma (55.9%) while for the large polyps was villous (92/160 -57.5%). Coexistent malignancy was observed in 28 polyps (2.1%) and of these, 20 were large polyps. There were 17 procedural bleeding (1.3%) and one perforation. The statistical analysis showed that cancer is correlated to polyp size (P < 0.0001); sessile shape (P < 0.0001) and bleeding are correlated to cardiac disease (P = 0.034), tubular adenoma (P = 0.016) and polyp size.
CONCLUSION: The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an important risk factor for malignancy and for bleeding.
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467
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Coda S, Lee SY, Gotoda T. Endoscopic mucosal resection and endoscopic submucosal dissection as treatments for early gastrointestinal cancers in Western countries. Gut Liver 2007; 1:12-21. [PMID: 20485653 DOI: 10.5009/gnl.2007.1.1.12] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 06/07/2007] [Indexed: 12/27/2022] Open
Abstract
Early gastrointestinal cancers are defined as lesions limited to the mucosa or submucosa without invading the muscularis propria, regardless of the presence of lymph node metastases. Although the natural history of these diseases is basically alike worldwide, its management is quite different between the East and West; aggressive surgery is frequently adopted by Western surgeons, while less invasive techniques are adopted by Asian colleagues. These techniques include endoscopic mucosal resection and endoscopic submucosal dissection which are now accepted as treatments for early gastrointestinal cancers in selected cases. Recent advances in endoscopic detection and treatment techniques, especially in Japan and Korea, have prompted Western endoscopists to learn these techniques. This review addresses recent advances regarding endoscopic resections of early gastrointestinal cancers, which promoted its use in Western countries. In addition, prospective studies on endoscopic resection in Western countries are also described.
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468
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Eun SH, Cho JY, Jung IS, Ko BM, Hong SJ, Ryu CB, Kim JO, Jin SY, Lee JS, Lee MS, Shim CS, Kim BS. Effectiveness of sodium alginate as a submucosal injection material for endoscopic mucosal resection in animal. Gut Liver 2007; 1:27-32. [PMID: 20485655 DOI: 10.5009/gnl.2007.1.1.27] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 06/16/2007] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/AIMS Although various solutions are being tested for submucosal injection during endoscopic resection, ideal solution has not been established yet. We performed an animal study to evaluate the possibility of sodium alginate as an ideal submucosal injection solution for endoscopic mucosal resection (EMR). METHODS To compare the lesion-lifting properties of different solutions, injection was done to the submucosal layer of porcine stomach. Then the height of mucosal elevation was measured. In addition, EMR was performed after submucosal injection of sodium alginate solution in six dogs. Two were euthanized after 30 minutes of endoscopic observation while the others were euthanized after 1-4 weeks. Retrieved stomachs were examined microscopically. RESULTS Sodium alginate and sodium hyaluronate solutions maintained longer elevation of the submucosal layer than other solutions. There was no significant difference in the height between two solutions. A clear separation of the mucosal layer from the proper muscle layer was achieved by injecting sodium alginate solution. Histological examination of EMR-induced artificial ulcers revealed no apparent tissue damage and showed normal healing process. CONCLUSIONS Sodium alginate solution creates a sufficient submucosal fluid cushion without apparent tissue damage. It can be considered as an effective submucosal injection material.
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469
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Kwon TH, Park DH, Shim KY, Cho HD, Park JH, Lee SH, Chung IK, Kim HS, Park SH, Kim SJ. Ampullary adenomyoma presenting as acute recurrent pancreatitis. World J Gastroenterol 2007; 13:2892-4. [PMID: 17569131 PMCID: PMC4395647 DOI: 10.3748/wjg.v13.i20.2892] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adenomyoma is a term generally applied to nodular lesions showing proliferation of both epithelial and smooth muscle components. Despite its benign nature, ampullary adenomyoma is usually presented as biliary obstruction. Most cases are misdiagnosed as carcinoma or adenoma by preoperative endoscopic or radiologic procedure. Therefore, it is frequently treated with extensive surgery. To our knowledge, this is the first reported case in English literature of adenomyoma located in the peripancreatic orifice resulting in intermittent pancreatic duct obstruction and recurrent pancreatitis diagnosed by the endoscopic piecemeal resection.
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470
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Rocco A, Borriello P, Compare D, De Colibus P, Pica L, Iacono A, Nardone G. Large Brunner’s gland adenoma: Case report and literature review. World J Gastroenterol 2006; 12:1966-8. [PMID: 16610009 PMCID: PMC4087528 DOI: 10.3748/wjg.v12.i12.1966] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Brunner’s gland adenoma (BGA)is a very rare benign tumour of the duodenum, which is usually asymptomatic and discovered incidentally at endoscopy. Occasionally, this lesion may be large, causing upper gastrointestinal haemorrhage or intestinal obstruction. The case had a large Brunner’s gland adenoma, presenting melena that was managed by endoscopic excision.
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