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Kimura-Takemoto Classification: A Tool to Predict Gastric Intestinal Metaplasia Progression to Advanced Gastric Neoplasia. Dig Dis Sci 2022; 67:4092-4099. [PMID: 34406583 DOI: 10.1007/s10620-021-07212-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Gastric cancer is a leading cause of morbidity and mortality worldwide. Gastric intestinal metaplasia (GIM) has been described as a key histologic step in the development of gastric adenocarcinoma. However, not all people with GIM develop malignancy. We studied the factors associated with progression to dysplasia and advanced gastric neoplasia (aGN) in patients with baseline GIM. METHODS Retrospective cohort analysis of patients with baseline GIM and subsequent endoscopic evaluation at Cleveland Clinic Florida and Ohio Main Campus between 2005 and 2017. Demographic and exposure risk factors, as well as Kimura-Takemoto classification (KTc), were used as variables for hazards ratio (HR) and Kaplan-Meier survival-free analysis for aGN and any form of dysplasia progression. RESULTS There were 708 patients identified with GIM; 29 patients (4.1%) progressed to any degree of dysplasia. From these, LGD was present in 12 cases (1.7%), HGD in 4 cases (0.6%), and gastric cancer in 13 cases (1.8%), for a total of 17 aGN cases. KTc was associated with dysplasia and aGN progression (p < 0.001), and no cases progressed if KTc findings were absent. Open-type KTc was associated with aGN (HR 6.36, p < 0.001) and any dysplasia progression (HR 13.34, p < 0.001) compared to closed-type or absent KTc features. No other factors were associated with aGN or dysplasia progression. Open-type KTc was also associated with shorter cancer survival-free progression. CONCLUSION Patients with baseline GIM present a higher progression risk to aGN, dysplasia, or cancer if concomitant KTc findings are present, particularly an open-type KTc pattern.
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Instant diagnosis of gastroscopic biopsy via deep-learned single-shot femtosecond stimulated Raman histology. Nat Commun 2022; 13:4050. [PMID: 35831299 PMCID: PMC9279377 DOI: 10.1038/s41467-022-31339-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/15/2022] [Indexed: 12/18/2022] Open
Abstract
Gastroscopic biopsy provides the only effective method for gastric cancer diagnosis, but the gold standard histopathology is time-consuming and incompatible with gastroscopy. Conventional stimulated Raman scattering (SRS) microscopy has shown promise in label-free diagnosis on human tissues, yet it requires the tuning of picosecond lasers to achieve chemical specificity at the cost of time and complexity. Here, we demonstrate that single-shot femtosecond SRS (femto-SRS) reaches the maximum speed and sensitivity with preserved chemical resolution by integrating with U-Net. Fresh gastroscopic biopsy is imaged in <60 s, revealing essential histoarchitectural hallmarks perfectly agreed with standard histopathology. Moreover, a diagnostic neural network (CNN) is constructed based on images from 279 patients that predicts gastric cancer with accuracy >96%. We further demonstrate semantic segmentation of intratumor heterogeneity and evaluation of resection margins of endoscopic submucosal dissection (ESD) tissues to simulate rapid and automated intraoperative diagnosis. Our method holds potential for synchronizing gastroscopy and histopathological diagnosis. Diagnosis of gastric cancer currently requires gastroscopic biopsy, which requires time and expertize to perform. Here, the authors demonstrate a femto-SRS imaging method which showed high accuracy in diagnosing gastric cancer without the need for pathologistbased diagnosis.
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Gonzalez‐Pons M, Torres‐Cintrón CR, Soto‐Salgado M, Vargas‐Ramos Y, Perez‐Portocarrero L, Morgan DR, Cruz‐Correa M. Racial/ethnic disparities in gastric cancer: A 15-year population-based analysis. Cancer Med 2022; 12:1860-1868. [PMID: 35785449 PMCID: PMC9883558 DOI: 10.1002/cam4.4997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND AIMS Disparities in gastric cancer incidence and mortality have been reported among ethnic/racial groups. While gastric cancer is not common in the U.S., it is among the top 10 causes of cancer-related death among Hispanics living in Puerto Rico (PRH). This study compared gastric cancer incidence rates during a 15-year period (2002-2006, 2007-2011, and 2012-2016) between PRH and racial/ethnic groups in the mainland U.S., including Non-Hispanic Whites (NHW), Non-Hispanics Blacks (NHB), Hispanics (USH), and Non-Hispanic Asian or Pacific Islanders (NHAPI). METHODS Primary gastric cancer cases (ICD-O-3 codes C16.0 to C16.9) from the Puerto Rico Central Cancer Registry and SEER diagnosed from January 1, 2002 to December 31, 2016 were included in the analysis. The Joinpoint Regression Program and standardized rate ratios were used to estimate Annual Percent Changes (APC) and differences in gastric cancer incidence among racial/ethnic groups, respectively. RESULTS Our analysis included 83,369 gastric cancer cases (PRH n = 4202; NHW n = 43,164; NHB n = 10,414; NHAPI n = 11,548; USH n = 14,041). USH had the highest number of cases among individuals <50 years, whereas NHW and PRH had the highest percentage among individuals ≥50 years. PRH and USH were the only groups with increasing APCs among individuals <50 years. CONCLUSIONS Gastric cancer continues to be a common cancer among PRH, despite the overall decrease in incidence among other racial/ethnic groups. Studies evaluating the gastric cancer risk factors among high-risk groups are necessary to establish health policy and modify gastric cancer screening algorithms among Hispanics.
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Affiliation(s)
- Maria Gonzalez‐Pons
- Division of Cancer BiologyUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | - Carlos R. Torres‐Cintrón
- Analysis and Epidemiology Unit Coordinator / Biostatistician, Puerto Rico Central Cancer Registry, Division of Cancer Control and Population SciencesUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | - Marievelisse Soto‐Salgado
- Division of Cancer Control and Population SciencesUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | - Yimari Vargas‐Ramos
- Division of Cancer BiologyUniversity of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA
| | | | - Douglas R. Morgan
- Director of Division of Gastroenterology and HepatologyUniversity of Alabama, BirminghamBirminghamAlabamaUSA
| | - Marcia Cruz‐Correa
- University of Puerto Rico Comprehensive Cancer CenterSan JuanPuerto RicoUSA,Department of Medicine and BiochemistryUniversity of Puerto Medical Sciences CampusSan JuanPuerto RicoUSA
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Metastasis Prevalence and Survival of Patients with T1-2 Gastric Neuroendocrine Tumor Treated with Endoscopic Therapy and Surgery. Dig Dis Sci 2022; 67:3228-3238. [PMID: 34272627 DOI: 10.1007/s10620-021-07143-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM The selection criteria and long-term outcomes of endoscopic therapy (ET) for gastric neuroendocrine tumors (G-NETs) remain controversial. METHODS Using Surveillance, Epidemiology, and End Results (SEER) Program database, we assessed the prevalence of metastasis of early G-NETs and long-term outcomes of ET in G-NET patients with good/moderate differentiation and no muscularis propria (MP) involvement. RESULTS A total of 2207 patients with stage T1 and T2 G-NETs were included. The depth of invasion into MP [odds ratio (OR) 4.581, 95% confidence interval (CI) 2.571-8.162; P < 0.001] and size of > 20 mm (OR 5.656, 95% CI 2.002-15.975; P = 0.001) were significantly associated with metastasis. The 5-year overall survival (OS) and cancer-specific survival (CSS) of the ET group were similar to the surgery group (91.11% vs. 91.09%, P = 0.750; 99.26% vs. 99.01%, P = 0.173). In the multivariable Cox proportional hazards regression models adjusting for age, gender, race, year of diagnosis, SEER region, depth of tumor invasion, site of cancer, tumor size, and chemotherapy, procedures employed (ET or surgery) had no significant impact on the OS [hazard ratio (HR) 1.189; 95%CI 0.721-1.961; P = 0.498] and CSS (HR 0.684; 95% CI 0.021-22.727; P = 0.832). CONCLUSIONS The long-term outcome of survival did not appear to differ between ET and surgery in G-NETs with good/moderate differentiation, ≤ 20 mm size, and no MP involvement.
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Comparison of Endoscopic Radiofrequency Ablation and Argon Plasma Coagulation in Patients with Gastric Low-Grade Intraepithelial Neoplasia: A Large-Scale Retrospective Study. Can J Gastroenterol Hepatol 2022; 2022:2349940. [PMID: 35782636 PMCID: PMC9242788 DOI: 10.1155/2022/2349940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/30/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gastric low-grade intraepithelial neoplasia (LGIN) is a precancerous lesion of gastric cancer. Endoscopic therapies represented by radiofrequency ablation (RFA) and argon plasma coagulation (APC) have been applied to treat gastric LGIN in recent years. However, no comparative study examining the effectiveness and safety profiles of RFA and APC has been reported. METHODS A single-center, large-scale, retrospective study, including 73 and 50 patients treated with RFA and APC, respectively, was conducted in the First Medical Center of Chinese PLA General Hospital from October 2015 to October 2020, with a two-year follow-up. Effectiveness, complications, operative factors, and other data were assessed. RESULTS At 2 years of follow-up, cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively, with no statistically significant differences between the two groups (all p > 0.05). However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) (p < 0.001); there was also a significant difference in the composition ratio of large lesions between the two groups (p < 0.001). No serious postoperative complications showed in either group, and the abdominal pain was the most common symptom in the short term after surgery. CONCLUSIONS RFA and APC are both safe and effective destructive therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. An intraoperative submucosal injection is expected to be an effective method for relieving postoperative abdominal pain.
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Cho JH, Shin CM, Yoon H, Park YS, Kim N, Lee DH. Comparison of endoscopic treatments for small gastric adenomas. Surg Endosc 2022; 36:3920-3931. [PMID: 34480218 DOI: 10.1007/s00464-021-08710-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/25/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Gastric adenomas can be successfully treated with endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). The aim of this study was to evaluate and compare the efficacy of ESD and EMR with circumferential precutting (EMR-P) in the treatment of small gastric adenomas. METHODS This study included 1014 gastric adenomas ≤ 15 mm in diameter treated with ESD or EMR-P from 2012 to 2019, retrospectively. Propensity score matching between the ESD and EMR-P groups (1:1 to 3:1) was performed according to age, sex, tumor size, tumor location (upper, middle, and lower thirds), morphology, and preprocedural histology. The procedure time and the rates of en bloc resection, complete resection, adverse events, and local recurrence were compared between the two groups. RESULTS After propensity score matching, 478 lesions (ESD: 295, EMR-P: 183) were analyzed. The rates of en bloc resection (94.9% vs. 93.4%, p = 0.498), complete resection (93.6% vs. 90.2%, p = 0.177), bleeding (8.1% vs. 3.8%, p = 0.063), and local recurrence (0.0% vs. 1.4%, p = 0.185) did not significantly differ between the two groups. The procedure time was significantly longer for ESD than for EMR-P (p < 0.001). In the EMR-P group, the complete resection rate was significantly lower in the upper third than in the middle and lower thirds (p < 0.001). CONCLUSION EMR-P is as effective as ESD for the treatment of small gastric adenomas. However, the efficacy of EMR-P is lower for gastric adenomas in the proximal stomach.
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Affiliation(s)
- Jae Ho Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
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Castaño-Llano R, Piñeres A, Jaramillo R, Molina S, Aristizábal F, Puerta JE. Interval gastric cancer: A call to attentiveness and action. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2022; 88:91-99. [PMID: 35659441 DOI: 10.1016/j.rgmxen.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND AIMS Endoscopy is the most effective method for identifying gastric adenocarcinoma (GAC). Interval gastric cancer (IGC) is GAC that is diagnosed 2-3 years after a normal endoscopy. Its characteristics are unknown in the Colombian environment. The clinical, histopathologic, and endoscopic characteristics were evaluated, along with the presentation rate, proton pump inhibitor (PPI) use, and IGC survival rate, and compared with other types of GAC. METHODS A retrospective, analytic study was conducted on a prospective cohort. It evaluated 513 patients with GAC treated at our institution, within the time frame of January 2012 and June 2018. The patients had endoscopic diagnosis of GAC and endoscopy within the past three years that was negative for tumor. RESULTS A total of 513 patients diagnosed with GAC were evaluated. Forty-two of the patients had IGC (8.2%): 9 early lesions and 33 advanced lesions (79%). The IGCs were smaller (31 vs. 41 mm; P < .01), as well as flatter and more depressed (P < .01). There was no association with PPI use, but there was an association with a history of gastrectomy and anastomosis (P = .02), as well as the absence of red flags (P < .003). The most frequent locations were the gastric body (52%) and the antrum (26%). Overall two-year survival was similar between IGC and GAC (37.1 vs. 39.3%, P = .72). CONCLUSION A total of 8.2% of recently diagnosed GAC were cases of IGC. The presence of anastomosis and the absence of red flags were related to IGC. Overall survival was poor and there were no differences from the other types of GAC detected.
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Affiliation(s)
- R Castaño-Llano
- Cirugía Gastrointestinal y Endoscopia Clínica las Américas, Medellín, Antioquía, Colombia; Grupo de Gastro-Hepatología, Universidad de Antioquia, Medellín, Antioquía, Colombia; Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia.
| | - A Piñeres
- Cirugía Gastrointestinal y Endoscopia Clínica las Américas, Medellín, Antioquía, Colombia; Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia
| | - R Jaramillo
- Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia; Clínica las Américas, Medellín, Antioquía, Colombia
| | - S Molina
- Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia; Clínica las Américas, Medellín, Antioquía, Colombia
| | - F Aristizábal
- Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia; Clínica las Américas, Medellín, Antioquía, Colombia
| | - J E Puerta
- Universidad CES, Medellín, Antioquía, Colombia
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Arai J, Aoki T, Sato M, Niikura R, Suzuki N, Ishibashi R, Tsuji Y, Yamada A, Hirata Y, Ushiku T, Hayakawa Y, Fujishiro M. Machine learning-based personalized prediction of gastric cancer incidence using the endoscopic and histologic findings at the initial endoscopy. Gastrointest Endosc 2022; 95:864-872. [PMID: 34998795 DOI: 10.1016/j.gie.2021.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Accurate risk stratification for gastric cancer is required for optimal endoscopic surveillance in patients with chronic gastritis. We aimed to develop a machine learning (ML) model that incorporates endoscopic and histologic findings for an individualized prediction of gastric cancer incidence. METHODS We retrospectively evaluated 1099 patients with chronic gastritis who underwent EGD and biopsy sampling of the gastric mucosa. Patients were randomly divided into training and test sets (4:1). We constructed a conventional Cox proportional hazard model and 3 ML models. Baseline characteristics, endoscopic atrophy, and Operative Link on Gastritis-Intestinal Metaplasia Assessment (OLGIM)/Operative Link on Gastritis Assessment (OLGA) stage at initial EGD were comprehensively assessed. Model performance was evaluated using Harrel's c-index. RESULTS During a mean follow-up of 5.63 years, 94 patients (8.55%) developed gastric cancer. The gradient-boosting decision tree (GBDT) model achieved the best performance (c-index from the test set, .84) and showed high discriminative ability in stratifying the test set into 3 risk categories (P < .001). Age, OLGIM/OLGA stage, endoscopic atrophy, and history of malignant tumors other than gastric cancer were important predictors of gastric cancer incidence in the GBDT model. Furthermore, the proposed GBDT model enabled the generation of a personalized cumulative incidence prediction curve for each patient. CONCLUSIONS We developed a novel ML model that incorporates endoscopic and histologic findings at initial EGD for personalized risk prediction of gastric cancer. This model may lead to the development of effective and personalized follow-up strategies after initial EGD.
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Affiliation(s)
- Junya Arai
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Nobumi Suzuki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Rei Ishibashi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Hirata
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Kakushima N, Fujishiro M, Chan SM, Cortas GA, Dinis‐Ribeiro M, Gonzalez R, Kodashima S, Lee S, Linghu E, Mabe K, Pan W, Parra‐Blanco A, Pioche M, Rollan A, Sumiyama K, Tanimoto M. Proposal of minimum elements for screening and diagnosis of gastric cancer by an international Delphi consensus. DEN OPEN 2022; 2:e97. [PMID: 35873520 PMCID: PMC9302051 DOI: 10.1002/deo2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Naomi Kakushima
- Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Aichi Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Aichi Japan
| | - Shannon Melissa Chan
- Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong
| | - George Adel Cortas
- Saint George Hospital University Medical Center Faculty of Medicine University of Balamand Beirut Lebanon
| | - Mario Dinis‐Ribeiro
- Department of Gastroenterology Portuguese Oncology Institute of Porto Porto Portugal
| | | | - Shinya Kodashima
- Department of Medicine Division of Gastroenterology School of Medicine, Teikyo University Tokyo Japan
| | - Sun‐Young Lee
- Department of Internal Medicine School of Medicine Konkuk University Seoul Korea
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Katsuhiro Mabe
- Junpukai Health Maintenance Center Kurashiki Okayama Japan
| | - Wensheng Pan
- Department of Gastroenterology Zhejiang Provincial People's Hospital People's Hospital of Hangzhou Medical College Hangzhou China
| | - Adolfo Parra‐Blanco
- NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK
| | - Mathieu Pioche
- Department of Gastroenterology and Endoscopy Edouard Herriot Hospital Lyon France
| | - Antonio Rollan
- Unidad de Gastroenterología Facultad de Medicina Clinica Alemana Universidad del Desarrollo Santiago Chile
| | - Kazuki Sumiyama
- Department of Endoscopy School of Medicine, The Jikei University Tokyo Japan
| | - Miguel Tanimoto
- Ancillary and Diagnosis Services National Institute of Medical Sciences and Nutrition Salvador Zubiran Mexico City Mexico
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Wang NJ, Chai NL, Tang XW, Li LS, Zhang WG, Linghu EQ. Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia. World J Gastrointest Oncol 2022; 14:724-733. [PMID: 35321273 PMCID: PMC8919015 DOI: 10.4251/wjgo.v14.i3.724] [Citation(s) in RCA: 1] [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: 11/01/2021] [Revised: 12/15/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of radiofrequency ablation (RFA) has been reported in the treatment of gastric low-grade intraepithelial neoplasia (LGIN). However, its efficacy and prognostic risk factors have not been well analyzed.
AIM To explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large, long-term follow-up clinical study.
METHODS The clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective study. Data on operative parameters, complications, and follow-up outcomes including curative rates were recorded and analyzed.
RESULTS The curative rates of endoscopic RFA for gastric LGIN at 3 mo, 6 mo, and 1-5 years after the operation were 93.3%, 92.8%, 91.5%, 90.3%, 88.5%, 85.7%, and 83.3%, respectively. Multivariate analyses revealed that Helicobacter pylori (H. pylori) infection and disease duration > 1 year had a significant effect on the curative rate (P < 0.001 and P = 0.013, respectively). None of patients had bleeding, perforation, infection, or other serious complications after RFA, and the main discomfort was postoperative abdominal pain.
CONCLUSION RFA was safe and effective for gastric LGIN during long-term follow-up. H. pylori infection and disease course > 1 year may be the main risk factors for relapse of LGIN after RFA.
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Affiliation(s)
- Nan-Jun Wang
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao-Wei Tang
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Long-Song Li
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Gang Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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61
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Huh CW, Lee SK. Intestinal Type Gastric Cancer and Gastric Adenoma. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2022. [DOI: 10.7704/kjhugr.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Héroin L, Saviano A, Fenouil T, Sosa-Valencia L, Baumert TF, Habersetzer F, Mayer P. Differences between sporadic hyperplastic gastric polyps and portal hypertensive gastric polyps: a review. Eur J Gastroenterol Hepatol 2022; 34:260-266. [PMID: 34432677 DOI: 10.1097/meg.0000000000002278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Portal hypertension (PH) is one of the most severe complications of chronic liver diseases. It is defined as an increase in pressure in the portal venous system which results in a portosystemic gradient >5 mmHg. In the western world, cirrhosis is the most frequent cause of PH, mainly due to nonalcoholic fatty liver disease and alcoholic liver disease. Patients with PH have esophageal varices in 68-73% of cases, portal hypertensive gastropathy in 51-73% and hyperplastic polyps (HPs) in 0.9-2%. Recent studies have shown that HPs found in PH patients are different from classical HPs. They constitute a new entity called portal hypertensive polyps (PHPs). The main difference between sporadic HPs and PHP is the presence of larger and more numerous vascular capillaries in the lamina propria. The clinical course of PHPs is unknown. Their physiopathology seems different from HPs: the increased congestion caused by higher portal pressure in the stomach may induce capillaries proliferation and neoangiogenesis. PHPs may be responsible for symptoms, such as pyloric obstruction, iron deficiency and anemia. Their prevalence in portal hypertensive and cirrhotic patients is from 1% to 8%. PHPs can be single or numerous, in the antrum or the gastric corpus. Their size ranges from 2 to 3 cm. PHPs seem to disappear or shrink with the treatment of PH. They should be resected in case of symptom and if >10 mm, after Helicobacter pylori eradication if present. However, their recurrence is frequent (40-79%), thus surveillance endoscopy is mandatory, at the same time as esophageal varices.
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Affiliation(s)
- Lucile Héroin
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
| | - Antonio Saviano
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg
| | - Tanguy Fenouil
- Institute of Pathology Est, Hospices Civils de Lyon, Lyon
| | | | - Thomas F Baumert
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg
| | - François Habersetzer
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg
| | - Pierre Mayer
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
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Yacoub H, Bibani N, Sabbah M, Bellil N, Ouakaa A, Trad D, Gargouri D. Gastric polyps: a 10-year analysis of 18,496 upper endoscopies. BMC Gastroenterol 2022; 22:70. [PMID: 35183117 PMCID: PMC8857847 DOI: 10.1186/s12876-022-02154-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/07/2022] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background/aims
Gastric polyps (GPs) are usually asymptomatic lesions of the upper gastrointestinal tract observed in 1–3% of esophagogastroduodenoscopies (EGD). Most GPs are benign. The aim of this study was to precise the frequency of different types of gastric polyps in our population, and to analyze their possible association with other factors.
Materials and methods
A total of 18,496 consecutive patients undergoing EGD over a 10-year period (between 2007 and 2018) in a tertiary hospital were retrospectively reviewed. Eighty-six patients diagnosed with gastric polyps were analysed. Demographics, medical history of the patients, and indication for gastroscopy were collected. Morphological, histological characteristics of polyps, and therapeutic management data were also collected.
Results
GPs were found in 86 out of 18,496 (0.46%) reviewed EGD, corresponding to a total of 141 polyps. There were 64 female (74.4%) and 22 male patients (25.6%) with a sex ratio (M/F) of 0.34. The average age was 58.1 years. One hundred and forty one polyps were included, and histopathology was obtained on 127 GPs. The most common location was the fundus (59.6%) and 48.9% were smaller than 5 mm. The polyp was unique in 75.6% of cases. According to Paris classification, 80% of the polyps were sessile (Is). Hyperplastic polyps were the most common (55.9%), followed by sporadic fundic gland polyps observed in 23 patients (18.1%), 7 (5.5%) were adenomas and 4 (3.1%) were neuroendocrine tumors type 1. The following factors were associated with hyperplastic polyps: anemia (p = 0.022), single polyp (p = 0.025) and size ≥ 5 mm (p = 0.048). Comparing hyperplastic polyps’ biopsies to resected polyps, no difference was found in the evolutionary profile of the 2 groups. A size less than 10 mm (p = 0.013) was associated with fundic gland polyps. Sixty polyps (47.2%) were treated by cold forceps, 19 (15%) treated by a mucosal resection and 15 (11.8%) with diathermic snare. Five procedural bleeding incidents were observed (3.9%). Only the use of anticoagulant treatment was associated with a high bleeding risk (p = 0.005). The comparative histological study between specimens of biopsied GPs and endoscopic polypectomy led to an overall agreement of 95.3%.
Conclusion
In our study, the GPs frequency was 0.36%. Hyperplastic polyps and fundic gland are the most common in our country. The high frequency of Helicobacter pylori infection in our patients and in our area may explain the high frequency of HP.
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Apolinario M, Brussels A, Cook CB, Yang S. Autoimmune polyglandular syndrome type 3: A case report of an unusual presentation and literature review. Clin Case Rep 2022; 10:e05391. [PMID: 35140971 PMCID: PMC8815091 DOI: 10.1002/ccr3.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/20/2021] [Accepted: 01/14/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michael Apolinario
- Department of Internal Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
| | - Aaron Brussels
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
| | - Curtiss B. Cook
- Division of Endocrinology Department of Internal Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
| | - Shaun Yang
- Division of Hospital Internal Medicine Department of Internal Medicine Mayo Clinic College of Medicine and Science Scottsdale Arizona USA
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Toyoshima O, Nishizawa T, Yoshida S, Matsuno T, Odawara N, Toyoshima A, Sakitani K, Watanabe H, Fujishiro M, Suzuki H. Consistency between the endoscopic Kyoto classification and pathological updated Sydney system for gastritis: A cross-sectional study. J Gastroenterol Hepatol 2022; 37:291-300. [PMID: 34569096 PMCID: PMC9292659 DOI: 10.1111/jgh.15693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Two methods are used to evaluate gastritis: the updated Sydney system (USS) with pathology and Kyoto classification, a new endoscopy-based diagnostic criterion for which evidence is accumulating. However, the consistency of their results is unclear. This study investigated the consistency of their results. METHODS Patients who underwent esophagogastroduodenoscopy and were evaluated for Helicobacter pylori infection for the first time were eligible. The association between corpus and antral USS scores (neutrophil activity, chronic inflammation, atrophy, and intestinal metaplasia) and Kyoto classification scores (atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness) was assessed. RESULTS Seven-hundred-seventeen patients (mean age, 49.2 years; female sex, 57.9%; 450 H. pylori-positive and 267 H. pylori-negative patients) were enrolled. All endoscopic gastritis cases in the Kyoto classification were associated with high corpus and antral USS scores for neutrophil activity and chronic inflammation. A subanalysis was performed for H. pylori-positive patients. Regarding atrophy and intestinal metaplasia, endoscopic findings were associated with USS scores. Enlarged folds, nodularity, and diffuse redness were associated with high corpus USS scores for neutrophil activity and chronic inflammation, but with low antral USS scores for atrophy and intestinal metaplasia. The Kyoto classification scores were also associated with the pathological topographic distribution of neutrophil activity and intestinal metaplasia. CONCLUSIONS Among H. pylori-positive individuals, endoscopic and pathological diagnoses were consistent with atrophy and intestinal metaplasia. Enlarged folds, nodularity, and diffuse redness were associated with pathological inflammation (neutrophil activity and chronic inflammation) of the corpus; however, they were inversely associated with pathological atrophy and intestinal metaplasia. The endoscopy-based Kyoto classification of gastritis partially reflects pathology.
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Affiliation(s)
- Osamu Toyoshima
- Department of GastroenterologyToyoshima Endoscopy ClinicTokyoJapan
| | - Toshihiro Nishizawa
- Department of GastroenterologyToyoshima Endoscopy ClinicTokyoJapan,Department of Gastroenterology and HepatologyInternational University of Health and Welfare, Narita HospitalNaritaJapan
| | - Shuntaro Yoshida
- Department of GastroenterologyToyoshima Endoscopy ClinicTokyoJapan
| | - Tatsuya Matsuno
- Department of GastroenterologyToyoshima Endoscopy ClinicTokyoJapan,Department of Gastroenterology, Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Nariaki Odawara
- Department of GastroenterologyToyoshima Endoscopy ClinicTokyoJapan,Department of Gastroenterology, Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Akira Toyoshima
- Department of Colorectal SurgeryJapanese Red Cross Medical CenterTokyoJapan
| | - Kosuke Sakitani
- Department of GastroenterologyToyoshima Endoscopy ClinicTokyoJapan,Department of GastroenterologySakiatani Endoscopy ClinicNarashinoJapan
| | - Hidenobu Watanabe
- Department of PathologyPathology and Cytology Laboratory JapanTokyoJapan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan,Department of Gastroenterology and HepatologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Hidekazu Suzuki
- Department of Gastroenterology and HepatologyTokai University School of MedicineIseharaJapan
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Real-time artificial intelligence for detecting focal lesions and diagnosing neoplasms of the stomach by white-light endoscopy (with videos). Gastrointest Endosc 2022; 95:269-280.e6. [PMID: 34547254 DOI: 10.1016/j.gie.2021.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 09/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS White-light endoscopy (WLE) is the most pivotal tool to detect gastric cancer in an early stage. However, the skill among endoscopists varies greatly. Here, we aim to develop a deep learning-based system named ENDOANGEL-LD (lesion detection) to assist in detecting all focal gastric lesions and predicting neoplasms by WLE. METHODS Endoscopic images were retrospectively obtained from Renmin Hospital of Wuhan University (RHWU) for the development, validation, and internal test of the system. Additional external tests were conducted in 5 other hospitals to evaluate the robustness. Stored videos from RHWU were used for assessing and comparing the performance of ENDOANGEL-LD with that of experts. Prospective consecutive patients undergoing upper endoscopy were enrolled from May 6, 2021 to August 2, 2021 in RHWU to assess clinical practice applicability. RESULTS Over 10,000 patients undergoing upper endoscopy were enrolled in this study. The sensitivities were 96.9% and 95.6% for detecting gastric lesions and 92.9% and 91.7% for diagnosing neoplasms in internal and external patients, respectively. In 100 videos, ENDOANGEL-LD achieved superior sensitivity and negative predictive value for detecting gastric neoplasms from that of experts (100% vs 85.5% ± 3.4% [P = .003] and 100% vs 86.4% ± 2.8% [P = .002], respectively). In 2010 prospective consecutive patients, ENDOANGEL-LD achieved a sensitivity of 92.8% for detecting gastric lesions with 3.04 ± 3.04 false positives per gastroscopy and a sensitivity of 91.8% and specificity of 92.4% for diagnosing neoplasms. CONCLUSIONS Our results show that ENDOANGEL-LD has great potential for assisting endoscopists in screening gastric lesions and suspicious neoplasms in clinical work. (Clinical trial registration number: ChiCTR2100045963.).
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Siddique SM, May FP. Race-Based Clinical Recommendations in Gastroenterology. Gastroenterology 2022; 162:408-414.e2. [PMID: 34890599 PMCID: PMC10115149 DOI: 10.1053/j.gastro.2021.12.234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, Leonard Davis Institute for Health Economics, University of Pennsylvania, Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Folasade P May
- Vatche & Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, UCLA Kaiser Permanente Center for Health Equity, Division of Gastroenterology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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Clinically actionable findings on surveillance EGD in asymptomatic patients with Lynch syndrome. Gastrointest Endosc 2022; 95:105-114. [PMID: 34252420 DOI: 10.1016/j.gie.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Lynch syndrome (LS) predisposes patients to multiple cancers including of the gastric and small bowel. Data supporting EGD surveillance in LS are limited. Our aim is to describe upper GI (UGI) findings in asymptomatic LS patients undergoing EGD surveillance within a hereditary colorectal cancer registry. METHODS Asymptomatic patients with LS who underwent ≥1 surveillance EGD were included. Demographics, genotype, and EGD findings were reviewed. The frequency of clinically actionable findings including neoplasia (cancer, adenomas), Barrett's esophagus (BE), Helicobacter pylori, and hyperplastic polyps >5 mm were assessed. RESULTS Three hundred twenty-three patients underwent 717 EGDs starting at a median age of 49.5 years. On average, each patient had 2 EGDs with an interval of 2.3 years between examinations. Clinically actionable findings were identified in 57 patients (17.6%). On baseline EGD 27.7% of findings were identified, with the remainder on surveillance EGD over an average of 3.5 years. Five asymptomatic patients (1.5%) had an UGI cancer detected during surveillance, all at early stage, including 1 patient each with BE-related esophageal adenocarcinoma, gastric neuroendocrine tumor, and gastric adenocarcinoma and 2 patients with duodenal adenocarcinoma. Two cancers were found on baseline EGD and 3 on follow-up EGD. CONCLUSIONS Clinically actionable findings were found in approximately 1 in 6 asymptomatic patients with LS undergoing EGD surveillance. Five patients (1.5%) were diagnosed with cancer, all detected at an early stage. These data suggest that both baseline and follow-up EGD surveillance are effective in detecting early-stage UGI cancers in asymptomatic patients with LS.
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Ishibashi F, Kobayashi K, Kawakami T, Tanaka R, Sugihara K, Baba S. Quality management system for screening esophagogastroduodenoscopy improves detection of Helicobacter pylori -negative interval gastric cancer. Endosc Int Open 2021; 9:E1900-E1908. [PMID: 34917459 PMCID: PMC8671005 DOI: 10.1055/a-1594-1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/13/2021] [Indexed: 11/01/2022] Open
Abstract
Background and study aims Double-checking the findings of examinations is necessary for endoscopy quality control in gastric cancer screening; however, there have been no reports showing its effectiveness. We prospectively analyzed the effectiveness of a quality management system (QMS) in endoscopy for gastric cancer screening. Patients and methods QMS was defined as having images and reports checked by a second endoscopist on the same day and reporting inconsistencies to the examining endoscopist. Patients diagnosed with early gastric cancer (EGC) in the 2 years before and after the introduction of QMS were divided into two groups: the interval cancer group, which included those for whom cancer was detected within 1 year of the last endoscopy and the noninterval cancer group. Changes in detection rates were compared. Results Before the introduction of QMS, 11 interval EGC cases were diagnosed among 36,189 endoscopies, whereas after the introduction, 32 interval ECG cases were diagnosed among 38,290 endoscopies ( P = 0.004). Fifteen noninterval EGC cases were diagnosed before the introduction, while 12 noninterval EGC cases were diagnosed after the introduction; no significant difference was observed. Subanalyses by Helicobacter pylori (HP) infection status revealed no difference in the detection rate among HP-positive EGC patients, but the detection rates among HP-eradicated and HP-naïve EGC patients were improved ( P = 0.005 and P = 0.011). Logistic regression analysis showed that QMS was an independent predictor for detection of HP-negative interval EGC ( P = 0.017, OR = 4.4, 95 % CI: 2.0-9.7). Conclusions QMS improved the detection rate for HP-negative interval early gastric cancer. (UMIN000042991).
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Affiliation(s)
- Fumiaki Ishibashi
- Koganei Tsurukame Clinic, Endoscopy Center, Tokyo, Japan,Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan
| | | | | | - Ryu Tanaka
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan
| | - Kazuaki Sugihara
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan,Mirraza Shinjuku Tsurukame Clinic, Tokyo, Japan
| | - Satoshi Baba
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan,Yotsuya Medical Cube, Endoscopy Center, Tokyo, Japan
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Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer. Cancers (Basel) 2021; 13:cancers13246242. [PMID: 34944861 PMCID: PMC8699285 DOI: 10.3390/cancers13246242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Gastric adenocarcinoma has remained a highly lethal disease. Awareness and recognition of preneoplastic conditions (including gastric atrophy and intestinal metaplasia) using high-resolution white-light endoscopy as well as chromoendoscopy is therefore essential. Helicobacter pylori, a class I carcinogen, remains the main contributor to the development of sporadic distal gastric neoplasia. Management of early gastric neoplasia with endoscopic resections should be in line with standard indications. A multidisciplinary approach to any case of an early gastric neoplasia is imperative. Hereditary forms of gastric cancer require a tailored approach and individua-lized surveillance. Abstract The mortality rates of gastric carcinoma remain high, despite the progress in research and development in disease mechanisms and treatment. Therefore, recognition of gastric precancerous lesions and early neoplasia is crucial. Two subtypes of sporadic gastric cancer have been recognized: cardia subtype and non-cardia (distal) subtype, the latter being more frequent and largely associated with infection of Helicobacter pylori, a class I carcinogen. Helicobacter pylori initiates the widely accepted Correa cascade, describing a stepwise progression through precursor lesions from chronic inflammation to gastric atrophy, gastric intestinal metaplasia and neoplasia. Our knowledge on He-licobacter pylori is still limited, and multiple questions in the context of its contribution to the pathogenesis of gastric neoplasia are yet to be answered. Awareness and recognition of gastric atrophy and intestinal metaplasia on high-definition white-light endoscopy, image-enhanced endoscopy and magnification endoscopy, in combination with histology from the biopsies taken accurately according to the protocol, are crucial to guiding the management. Standard indications for endoscopic resections (endoscopic mucosal resection and endoscopic submucosal dissection) of gastric dysplasia and intestinal type of gastric carcinoma have been recommended by multiple societies. Endoscopic evaluation and surveillance should be offered to individuals with an inherited predisposition to gastric carcinoma.
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Luu MN, Quach DT, Hiyama T. Screening and surveillance for gastric cancer: Does family history play an important role in shaping our strategy? Asia Pac J Clin Oncol 2021; 18:353-362. [PMID: 34811928 DOI: 10.1111/ajco.13704] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/23/2021] [Indexed: 12/24/2022]
Abstract
Family history is an important risk factor of gastric cancer. No guidelines have been developed that target gastric cancer with a family history; only hereditary familial gastric cancer is targeted. We review the available evidence regarding the familial aggregation mechanisms of gastric cancer and a strategy of screening and surveillance for gastric cancer in individuals with a positive family history of the disease. As there is a synergic effect of Helicobacter pylori infection and family history on the increased risk of gastric cancer, Helicobacter pylori eradication should be considered in all infected individuals with a family history of gastric cancer. Currently, there is weak evidence indicating that suitable timing to initiate eradication therapy is at the age of 20, when precancerous lesions, including significant gastric atrophy and intestinal metaplasia, have not been established. Reasonable timing to initiate screening for gastric cancer in individuals with a family history of gastric cancer is 10 years prior to the age of onset of gastric cancer in affected relatives. A 2-year surveillance interval, instead of the 3-year interval recommended in the present guidelines, may be better to detect early gastric cancer in those individuals who have already developed precancerous gastric lesions.
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Affiliation(s)
- Mai Ngoc Luu
- Department of Internal Medicine, University of Medicine and Pharmacy, at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy, at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
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Low Risk of Neoplasia and Intraprocedural Adverse Events in Gastric Hyperplastic Polypectomy. J Clin Gastroenterol 2021; 55:851-855. [PMID: 33060440 DOI: 10.1097/mcg.0000000000001446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022]
Abstract
GOALS Assess neoplasia and polypectomy-related adverse event (AE) rates in gastric hyperplastic polyps (GHPs). BACKGROUND GHPs carry a risk of neoplastic transformation. The rate of neoplastic transformation and the risk of polypectomy-related bleeding are unclear in the West, as data are derived from Asian or small studies. The authors aimed to determine the rate of dysplasia and intraprocedural AEs in GHP polypectomies in a western cohort. STUDY A retrospective study of 591 GHPs >1 cm resected in 491 patients in a single referral center on the occurrence of neoplasia and intraprocedural AEs. RESULTS The mean age was 74.9±11.1 years, 57% female individuals. The mean polyp size was 2±0.8 cm. There were 11 neoplastic polyps (1.9%) with low-grade dysplasia, high-grade dysplasia, and cancer in 7 (1.3%), 2 (0.3%), and 2 (0.3%), respectively. Neoplasia was associated with age [9 (3.2%) for more than 75 years vs. 2 (0.7%) for less than 75 years; P=0.035], but not with polyp size or gender. Fifty patients (8.5%) had intraprocedural bleeding (IPB) requiring endoscopic intervention, with 3 hospitalizations. There were no perforations or procedure-related deaths. IPB was associated with polyp size and neoplasia. The adjusted odds ratio (95% confidence interval) for IPB was 1.63 (1.2-2.2) for a 1 cm increase in polyp size, and 7.4 (1.9-29.6) for the presence of neoplasia. CONCLUSIONS The neoplasia rate in GHPs was 1.9%, lower than most previous reports, with no major intraprocedural AEs. Physicians may consider biopsy and follow-up in frail elderly patients, but the safety of this strategy needs further confirmation.
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Risk of Progression of Gastric Intestinal Metaplasia Is Significantly Greater When Detected in Both Antrum and Body. Dig Dis Sci 2021; 66:3470-3475. [PMID: 33094451 DOI: 10.1007/s10620-020-06659-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastric cancer (GC) is the fifth leading cause of cancer-related death worldwide. GC is usually preceded by a cascade of well-defined precursor lesions, set in place by an environmental trigger (H. pylori) including intestinal metaplasia (GIM) and dysplasia. AIMS To investigate the rates of progression of GIM to dysplasia and GC in a region of low gastric cancer incidence. METHODS We identified all patients diagnosed with GIM between January 1, 2008, and June 30, 2012. Any repeat upper endoscopy more than 1 year after index diagnosis and before December 31, 2018, was considered follow-up. Carcinomas the bulk of which were macroscopically located below the OGJ were considered primary gastric cancer. RESULTS Progression to more advanced lesions was observed in six patients (0.6%). Four patients (three male) developed GC at median age 74 years (SD 6). Two patients progressed to dysplasia (one male) at median age 71 years (SD 4). Patients with GIM in both gastric antrum and body were significantly more likely to progress than those with GIM in only one location (3.1% vs. 0.4%) (p value 0.017). Fifty-eight patients who had H. pylori eradicated were followed up. No progression to dysplasia or GC was noted in this group, with 28 patients having persistent GIM at follow-up. CONCLUSION Patients with GIM in both antrum and body had a significantly increased risk of progression and warrant close attention. This is comparable to routinely followed premalignant conditions such as Barrett's esophagus and Colonic Polyps, and appropriate surveillance protocols should be followed in this group.
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Tang Y, Anandasabapathy S, Richards‐Kortum R. Advances in optical gastrointestinal endoscopy: a technical review. Mol Oncol 2021; 15:2580-2599. [PMID: 32915503 PMCID: PMC8486567 DOI: 10.1002/1878-0261.12792] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/23/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Optical endoscopy is the primary diagnostic and therapeutic tool for management of gastrointestinal (GI) malignancies. Most GI neoplasms arise from precancerous lesions; thus, technical innovations to improve detection and diagnosis of precancerous lesions and early cancers play a pivotal role in improving outcomes. Over the last few decades, the field of GI endoscopy has witnessed enormous and focused efforts to develop and translate accurate, user-friendly, and minimally invasive optical imaging modalities. From a technical point of view, a wide range of novel optical techniques is now available to probe different aspects of light-tissue interaction at macroscopic and microscopic scales, complementing white light endoscopy. Most of these new modalities have been successfully validated and translated to routine clinical practice. Herein, we provide a technical review of the current status of existing and promising new optical endoscopic imaging technologies for GI cancer screening and surveillance. We summarize the underlying principles of light-tissue interaction, the imaging performance at different scales, and highlight what is known about clinical applicability and effectiveness. Furthermore, we discuss recent discovery and translation of novel molecular probes that have shown promise to augment endoscopists' ability to diagnose GI lesions with high specificity. We also review and discuss the role and potential clinical integration of artificial intelligence-based algorithms to provide decision support in real time. Finally, we provide perspectives on future technology development and its potential to transform endoscopic GI cancer detection and diagnosis.
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Affiliation(s)
- Yubo Tang
- Department of BioengineeringRice UniversityHoustonTXUSA
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Shah SC, Piazuelo MB, Kuipers EJ, Li D. AGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review. Gastroenterology 2021; 161:1325-1332.e7. [PMID: 34454714 PMCID: PMC8740554 DOI: 10.1053/j.gastro.2021.06.078] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
DESCRIPTION The purpose of this Clinical Practice Update Expert Review is to provide clinicians with guidance on the diagnosis and management of atrophic gastritis, a common preneoplastic condition of the stomach, with a primary focus on atrophic gastritis due to chronic Helicobacter pylori infection-the most common etiology-or due to autoimmunity. To date, clinical guidance for best practices related to the diagnosis and management of atrophic gastritis remains very limited in the United States, which leads to poor recognition of this preneoplastic condition and suboptimal risk stratification. In addition, there is heterogeneity in the definitions of atrophic gastritis, autoimmune gastritis, pernicious anemia, and gastric neoplasia in the literature, which has led to confusion in clinical practice and research. Accordingly, the primary objective of this Clinical Practice Update is to provide clinicians with a framework for the diagnosis and management of atrophic gastritis. By focusing on atrophic gastritis, this Clinical Practice Update is intended to complement the 2020 American Gastroenterological Association Institute guidelines on the management of gastric intestinal metaplasia. These recent guidelines did not specifically discuss the diagnosis and management of atrophic gastritis. Providers should recognize, however, that a diagnosis of intestinal metaplasia on gastric histopathology implies the diagnosis of atrophic gastritis because intestinal metaplasia occurs in underlying atrophic mucosa, although this is often not distinctly noted on histopathologic reports. Nevertheless, atrophic gastritis represents an important stage with distinct histopathologic alterations in the multistep cascade of gastric cancer pathogenesis. METHODS The Best Practice Advice statements presented herein were developed from a combination of available evidence from published literature and consensus-based expert opinion. No formal rating of the strength or quality of the evidence was carried out. These statements are meant to provide practical advice to clinicians practicing in the United States. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Atrophic gastritis is defined as the loss of gastric glands, with or without metaplasia, in the setting of chronic inflammation mainly due to Helicobacter pylori infection or autoimmunity. Regardless of the etiology, the diagnosis of atrophic gastritis should be confirmed by histopathology. BEST PRACTICE ADVICE 2: Providers should be aware that the presence of intestinal metaplasia on gastric histology almost invariably implies the diagnosis of atrophic gastritis. There should be a coordinated effort between gastroenterologists and pathologists to improve the consistency of documenting the extent and severity of atrophic gastritis, particularly if marked atrophy is present. BEST PRACTICE ADVICE 3: Providers should recognize typical endoscopic features of atrophic gastritis, which include pale appearance of gastric mucosa, increased visibility of vasculature due to thinning of the gastric mucosa, and loss of gastric folds, and, if with concomitant intestinal metaplasia, light blue crests and white opaque fields. Because these mucosal changes are often subtle, techniques to optimize evaluation of the gastric mucosa should be performed. BEST PRACTICE ADVICE 4: When endoscopic features of atrophic gastritis are present, providers should assess the extent endoscopically. Providers should obtain biopsies from the suspected atrophic/metaplastic areas for histopathological confirmation and risk stratification; at a minimum, biopsies from the body and antrum/incisura should be obtained and placed in separately labeled jars. Targeted biopsies should additionally be obtained from any other mucosal abnormalities. BEST PRACTICE ADVICE 5: In patients with histology compatible with autoimmune gastritis, providers should consider checking antiparietal cell antibodies and anti-intrinsic factor antibodies to assist with the diagnosis. Providers should also evaluate for anemia due to vitamin B-12 and iron deficiencies. BEST PRACTICE ADVICE 6: All individuals with atrophic gastritis should be assessed for H pylori infection. If positive, treatment of H pylori should be administered and successful eradication should be confirmed using nonserological testing modalities. BEST PRACTICE ADVICE 7: The optimal endoscopic surveillance interval for patients with atrophic gastritis is not well-defined and should be decided based on individual risk assessment and shared decision making. A surveillance endoscopy every 3 years should be considered in individuals with advanced atrophic gastritis, defined based on anatomic extent and histologic grade. BEST PRACTICE ADVICE 8: The optimal surveillance interval for individuals with autoimmune gastritis is unclear. Interval endoscopic surveillance should be considered based on individualized assessment and shared decision making. BEST PRACTICE ADVICE 9: Providers should recognize pernicious anemia as a late-stage manifestation of autoimmune gastritis that is characterized by vitamin B-12 deficiency and macrocytic anemia. Patients with a new diagnosis of pernicious anemia who have not had a recent endoscopy should undergo endoscopy with topographical biopsies to confirm corpus-predominant atrophic gastritis for risk stratification and to rule out prevalent gastric neoplasia, including neuroendocrine tumors. BEST PRACTICE ADVICE 10: Individuals with autoimmune gastritis should be screened for type 1 gastric neuroendocrine tumors with upper endoscopy. Small neuroendocrine tumors should be removed endoscopically, followed by surveillance endoscopy every 1-2 years, depending on the burden of neuroendocrine tumors. BEST PRACTICE ADVICE 11: Providers should evaluate for iron and vitamin B-12 deficiencies in patients with atrophic gastritis irrespective of etiology, especially if corpus-predominant. Likewise, in patients with unexplained iron or vitamin B-12 deficiency, atrophic gastritis should be considered in the differential diagnosis and appropriate diagnostic evaluation pursued. BEST PRACTICE ADVICE 12: In patients with autoimmune gastritis, providers should recognize that concomitant autoimmune disorders, particularly autoimmune thyroid disease, are common. Screening for autoimmune thyroid disease should be performed.
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Affiliation(s)
- Shailja C. Shah
- Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - M. Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dan Li
- Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California,Division of Research, Kaiser Permanente Northern California, Oakland, California
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76
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Carvão J, Dinis-Ribeiro M, Pimentel-Nunes P, Libânio D. Neuroendocrine Tumors of the Gastrointestinal Tract: A Focused Review and Practical Approach for Gastroenterologists. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:336-348. [PMID: 34604465 PMCID: PMC8443956 DOI: 10.1159/000512089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023]
Abstract
Neuroendocrine tumors (NETs) are rare tumors derived from the neuroendocrine cell system, and more commonly found in the gastrointestinal (GI) tract. Over the last decades, the incidence of GI-NETs has been steadily increasing, partly due to the expanding indications for endoscopy. Most patients with NETs are asymptomatic, and their NETs are noticed during screening examinations; thus, endoscopists are on the frontline of the diagnosis of GI-NETs. Since GI-NETs are less frequent than other malignancies, the natural history, diagnosis, and management of these tumors may not be fully understood. In this review, we aim to update the endoscopist on key clinical features and management of patients with gastric, duodenal, and rectal NETs.
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Affiliation(s)
- Joana Carvão
- Gastroenterology Department, Hospital Central do Funchal, Funchal, Portugal
- *Joana Isabel Jardim Carvão, Department of Gastroenterology, Hospital Central do Funchal, Avenida Luís de Camões nº 57, PT–9004-514 Funchal (Portugal),
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS − Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS − Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libânio
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
- MEDCIDS − Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
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77
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Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management. Therap Adv Gastroenterol 2021; 14:17562848211038771. [PMID: 34484423 PMCID: PMC8414617 DOI: 10.1177/17562848211038771] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 02/04/2023] Open
Abstract
Autoimmune gastritis (AIG) is a chronic immune-mediated, inflammatory condition that involves the destruction of the gastric oxyntic mucosa through the autoimmune-mediated loss of parietal cells, with replacement by atrophic and metaplastic tissue. Diagnosing AIG is important, given the need for ongoing clinical management and vigilance with respect to downstream complications, the most serious of which is gastric adenocarcinoma. Other clinical consequences include gastric neuroendocrine tumors, consequences related to decreased gastric acid and decreased intrinsic factor due to parietal cell destruction and antibodies against intrinsic factor (e.g. micronutrient deficiencies), as well as concomitant autoimmune disorders. Considering the prevalence of AIG and the potential for severe clinical outcomes, it is important to engage in efforts to reduce practice pattern variability related to diagnosis and management. Accordingly, herein, we review of the epidemiology, pathogenesis, clinical presentation of AIG, including both gastric and extragastric manifestations, and provide an overview of clinical management.
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Affiliation(s)
- Sheila D Rustgi
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Priyesha Bijlani
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Shailja C Shah
- Section of Gastroenterology, VA San Diego Healthcare System, 3350 La Jolla Villa Drive, San Diego, CA 92161, USA
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78
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Odisho T, Shi D, Aburashed A. Successful endoscopic resection of an unusually enlarged and pedunculated type I gastric carcinoid tumour. BMJ Case Rep 2021; 14:e244292. [PMID: 34413045 PMCID: PMC8378368 DOI: 10.1136/bcr-2021-244292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
Three distinct gastric carcinoid (GC) tumour types have been described based on differing biological behaviour and prognoses. Type I GC tumours account for the vast majority (70%-80%), are associated with chronic atrophic gastritis and have a low metastatic potential. Type II carcinoid tumours are the least common (5%-10%), are related to Zollinger-Ellison syndrome and occur in relation to multiple neoplasia type I. Sporadic type III tumours (15%-25%) are the most aggressive type, are unrelated to gastrin over secretion and carry the worst prognosis. In this case report, we present a patient with longstanding gastroesophageal reflux disease (GERD) who presented with epigastric abdominal pain and tarry stools and was found to have a large gastric polyp on endoscopy. Despite current literature recommending surgical resection for larger GC tumours, endoscopic resection was successfully used to excise the tumour with pathology demonstrating complete resection with negative margins.
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Affiliation(s)
- Tanya Odisho
- Department of Surgery, Detroit Medical Center, Detroit, Michigan, USA
| | - Dongping Shi
- Department of Pathology, Detroit Medical Center, Detroit, Michigan, USA
| | - Ahmad Aburashed
- Department of Gastroenterology, Detroit Medical Center, Detroit, Michigan, USA
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79
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Then EO, Grantham T, Deda X, Ramachandran R, Gaduputi V. Metastatic Gastric Cancer to the Colon. World J Oncol 2021; 12:127-131. [PMID: 34349858 PMCID: PMC8297054 DOI: 10.14740/wjon1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/29/2021] [Indexed: 12/09/2022] Open
Abstract
Gastric cancer is one of the most common and deadly cancers worldwide, especially amongst older males. Current data suggest gastric cancer is the fifth most common neoplasm and the third most deadly cancer, with an estimated 783,000 deaths in 2018. Risk factors associated with the development of gastric cancer include obesity, gastroesophageal reflux disease, Helicobacter pylori infection, and low socioeconomic status. Diagnosis of gastric cancer can be accomplished by endoscopy, which allows the clinician to obtain a biopsy specimen. Endoscopic ultrasound is also an important modality that is helpful in assessing tumor invasion. The most common sites of metastatic gastric cancer in descending order are the liver, peritoneum, lung and bone. Rarely will gastric cancer metastasize to the colon. Here we present a rare case of colonic metastasis of a primary gastric adenocarcinoma.
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Affiliation(s)
- Eric Omar Then
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA.,Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA
| | - Tyler Grantham
- Department of Internal Medicine, St. George's University School of Medicine, Grenada, West Indies
| | - Xheni Deda
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA
| | - Rajarajeshwari Ramachandran
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA
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80
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Abstract
Gastric cancer (GC) remains a leading cause of cancer morbidity and mortality worldwide. Outcomes from GC remain poor, especially in Western nations where cancer diagnosis is usually at advanced stages where curative resection is not possible. By contrast, nations of East Asia have adopted methods of population-level screening with improvements in stage of diagnosis and survival. In this review, the authors discuss the epidemiology of GC in Western populations, highlight at-risk populations who may benefit from screening, overview screening modalities, and discuss promising approaches to early GC detection.
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Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University, 300 Pasteur Drive, Alway Building M211, Stanford, CA 94305, USA.
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, 300 Pasteur Drive, Alway Building M211, Stanford, CA 94305, USA
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81
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Gastritis, Gastric Polyps and Gastric Cancer. Int J Mol Sci 2021; 22:ijms22126548. [PMID: 34207192 PMCID: PMC8234857 DOI: 10.3390/ijms22126548] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Gastric cancer is still an important disease causing many deaths worldwide, although there has been a marked reduction in prevalence during the last few decades. The decline in gastric cancer prevalence is due to a reduction in Helicobacter pylori infection which has occurred for at least 50 years. The most probable mechanism for the carcinogenic effect of H. pylori is hypergastrinemia since H. pylori infected individuals do not have increased risk of gastric cancer before the development of oxyntic atrophy. When atrophy has developed, the carcinogenic process continues independent of H. pylori. Autoimmune gastritis also induces oxyntic atrophy leading to marked hypergastrinemia and development of ECL cell neoplasia as well as adenocarcinoma. Similarly, long-term treatment with efficient inhibitors of acid secretion like the proton pump inhibitors (PPIs) predisposes to ECL cell neoplasia of a different degree of malignancy. Contrasting the colon where most cancers develop from polyps, most polyps in the stomach have a low malignant potential. Nevertheless, gastric polyps may also give rise to cancer and have some risk factors and mechanisms in common with gastric cancer. In this overview the most common gastric polyps, i.e., hyperplastic polyps, adenomatous polyps and fundic gland polyps will be discussed with respect to etiology and particularly use of PPIs and relation to gastric carcinogenesis.
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82
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Chen ZM, Peng MS, Wang LS, Xu ZL. Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review. World J Gastrointest Oncol 2021; 13:462-471. [PMID: 34163567 PMCID: PMC8204354 DOI: 10.4251/wjgo.v13.i6.462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/04/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e., those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?
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Affiliation(s)
- Ze-Ming Chen
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Min-Si Peng
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
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83
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Kang S, Lu J, Zhou HM. Anesthetic strategy for obese patients during gastroscopy: deep sedation or conscious sedation? A prospective randomized controlled trial. J Anesth 2021; 35:555-562. [PMID: 34052943 DOI: 10.1007/s00540-021-02951-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This paper aims to compare the incidence of SpO2 values < 95% and < 90% of the obese patients between conscious sedation and deep sedation and whether conscious sedation was superior to the deep sedation for obese patients during diagnostic gastroscopy. METHODS Obese patients undergoing diagnostic gastroscopy were randomly assigned to two different intervention groups: group CS (conscious sedation) or group DS (deep sedation). Group CS patients were managed by conscious sedation [Modified Observer Assessment of Alertness/Sedation (MOAA/S) at 4-5] protocol, and group DS patients were managed by deep sedation (MOAA/S at ≤ 2) protocol. Propofol and sufentanil (0.1 and 0.05 mg/kg) were, respectively, infused for sedation and analgesia in CS and DS protocols. The primary endpoints were to compare the incidence of SpO2 values < 95% and < 90% of the patients between the two groups. The incidence of successful sedation, satisfaction scores of patients and endoscopist were assessed as secondary endpoints. RESULTS 115 obese patients (59 in group CS and 56 in group DS) were enrolled in this study. The incidences of SpO2 < 95% and < 90% in group CS (42.4% and 6.8%) were significantly lower than those in group DS (69.6% and 19.6%, with P = 0.003 and 0.041, respectively). The incidence of successful sedation was similar between groups (86.4% vs 89.3%, P = 0.641). Patient satisfaction scores and endoscopist satisfaction scores were both similar between groups (P = 0.548 and 0.171). CONCLUSION Conscious sedation with propofol and sufentanil (0.1 mg/kg) reduced the incidence of hypoxic events without affecting gastroscopy procedure and satisfaction compared with the deep sedation for obese patients during diagnostic gastroscopy. TRIAL REGISTRATION ChiCTR-1900024894; registration date, July 31, 2019. http://www.chictr.org.cn .
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Affiliation(s)
- Shuai Kang
- Department of Anesthesiology, Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang Province, China
| | - Jian Lu
- Department of Anesthesiology, Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang Province, China
| | - Hong-Mei Zhou
- Department of Anesthesiology, Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang Province, China.
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84
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Li T, Liu G, Li J, Cui J, Wang X, Li W, Zhao Z, Zhang K, Liu T. Gastric tumorigenesis after radical resection combined with adjuvant chemotherapy for colorectal cancer: two case reports and a literature review. J Int Med Res 2021; 49:3000605211007050. [PMID: 33858250 PMCID: PMC8059046 DOI: 10.1177/03000605211007050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Radical resection with or without adjuvant chemotherapy is a common option for stage II and III colorectal cancer. Few reports exist regarding gastric tumorigenesis, including gastric cancer, gastric intraepithelial neoplasia, and gastric stromal tumor, in patients who received this protocol as the standard treatment for colorectal cancer. We present two cases of gastric tumorigenesis in patients with colorectal cancer following radical resection combined with adjuvant chemotherapy. Both patients underwent gastrectomy and D2 lymphadenectomy for their gastric tumors; neither patient developed recurrence up to 2 years after treatment. These cases indicate that patients should be monitored closely for gastric tumorigenesis after treatment for colorectal cancer. Early detection and active surgical treatment can provide satisfactory results for colorectal cancer followed by gastric tumorigenesis. Long-term follow-up and regular examinations, especially gastroscopy, are necessary to detect gastric tumorigenesis after colorectal cancer. The focus on monitoring colorectal cancer alone in colorectal cancer patients should be changed to include a broader range of cancers in addition to precancers and other tumors, such as gastric stromal tumor.
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Affiliation(s)
- Tao Li
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Guoliang Liu
- Operating Theater and Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jiannan Li
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jian Cui
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Xinyu Wang
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zeyun Zhao
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Zhang
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Tongjun Liu
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
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85
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Lee SW, Lee T, Sul HJ, Park KC, Park J. Differences in Somatic Mutation Profiles between Korean Gastric Cancer and Gastric Adenoma Patients. J Clin Med 2021; 10:jcm10092038. [PMID: 34068652 PMCID: PMC8126162 DOI: 10.3390/jcm10092038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed to investigate molecular factors potentially related to the progression of gastric adenoma (GA) to gastric cancer (GC) and compare the mutation characteristics between GC and GA. METHODS We conducted custom gene panel sequencing for 135 GC-related genes and estimated the difference in somatic mutation profiles between 20 GC and 20 GA cases. RESULTS A total of 31 somatic mutations, including 22 missense, 3 nonsense, and 6 frameshift mutations, were detected in 17 samples. We estimated an average of 1.8 mutations per sample (range, 1 to 3 mutations), with 12 in GC and 5 in GA. GC tended to have one or more mutated genes (p = 0.0217), as well as higher allele frequencies of mutated genes (p = 0.0003), compared to GA. Likewise, known driver mutations associated with GC tumorigenesis (TP53, ERBB2, PIK3CA, and RNF43) were identified in half of the GC cases (50%, 10/20; p = 0.0002). Only the mutant burden, regardless of gene type, was retained, with an odds ratio of 1.8392 (95% confidence interval (CI), 1.0071 to 3.3588; p = 0.0474). CONCLUSION Our study demonstrates that the accumulation of mutant burden contributes to tumorigenesis progression from GA to GC in Korean patients, regardless of the kind of genes. These findings may elucidate the molecular pathogenesis of gastric carcinogenesis and malignant progression.
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Affiliation(s)
- Seung Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Taekyu Lee
- Thermo Fisher Scientific Solutions, Seoul 06349, Korea;
| | - Hae Jung Sul
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Ki Cheol Park
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea;
| | - Joonhong Park
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-63-250-1218
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86
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Yang Y, Yang Y, Yan S. Risk and survival of second primary malignancies following diagnosis of gastric mucosa-associated lymphoid tissue lymphomas: A population-based study. Curr Probl Cancer 2021; 45:100735. [PMID: 33867153 DOI: 10.1016/j.currproblcancer.2021.100735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
Whether gastric mucosa-associated lymphoid tissue lymphoma (GML) is associated with a higher risk of second primary malignancy (SPM) remains controversial. This study aimed to evaluate the detailed risk of SPM and its prognosis in patients with GML based on a large population-based cohort. The Surveillance, Epidemiology, and End Results database was searched to identify patients who were diagnosed with GML during 2000-2014. The standardized incidence ratio was used to estimate the relative risk of developing SPM. Overall survival was evaluated using the Kaplan-Meier method with the log-rank test, as well as Cox regression analysis. Among 3,379 patients with GML, 416 patients (12.31%) developed SPMs. Compared to the general US population, GML patients had a significantly increased risk of developing SPM (standardized incidence ratio: 1.46, 95% CI: 1.33-1.61). The SPM sites were stomach, lung and bronchus, small intestine, thyroid, mouth, and non-Hodgkin's lymphoma. The risk of developing SPM in GML patients varied according to clinical and demographic characteristics. Patients with younger age (<50 year), chemotherapy use and radiotherapy use had the higher risk of developing SPMs. Relative to patients with only GML, GML patients who developed the SPMs had significantly poorer overall survival (P < 0.001). Among GML patients with SPMs, poor overall survival was independently associated with non-localized SPM disease, shorter latency period (<60 months), chemotherapy use and older age (≥70 year). Patients with GML had an elevated risk of developing SPM, which was associated with a poor prognosis. These findings may be useful for improving follow-up surveillance for patients with GML.
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Affiliation(s)
- Yi Yang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Yuqiong Yang
- Department of Hematology, Yijishan Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, 241001, Anhui, China
| | - Su Yan
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
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Nieuwenburg SAV, Mommersteeg MC, Eikenboom EL, Yu B, den Hollander WJ, Holster IL, den Hoed CM, Capelle LG, Tang TJ, Anten MP, Prytz-Berset I, Witteman EM, ter Borg F, Burger JPW, Bruno MJ, Fuhler GM, Peppelenbosch MP, Doukas M, Kuipers EJ, Spaander MC. Factors associated with the progression of gastric intestinal metaplasia: a multicenter, prospective cohort study. Endosc Int Open 2021; 9:E297-E305. [PMID: 33655025 PMCID: PMC7892268 DOI: 10.1055/a-1314-6626] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Gastric cancer (GC) is usually preceded by premalignant gastric lesions (GPLs) such as gastric intestinal metaplasia (GIM). Information on risk factors associated with neoplastic progression of GIM are scarce. This study aimed to identify predictors for progression of GIM in areas with low GC incidence. Patients and methods The Progression and Regression of Precancerous Gastric Lesions (PROREGAL) study includes patients with GPL. Patients underwent at least two upper endoscopies with random biopsy sampling. Progression of GIM means an increase in severity according to OLGIM (operative link on gastric intestinal metaplasia) during follow-up (FU). Family history and lifestyle factors were determined through questionnaires. Serum Helicobacter pylori infection, pepsinogens (PG), gastrin-17 and GC-associated single nucleotide polymorphisms (SNPs) were determined. Cox regression was performed for risk analysis and a chi-squared test for analysis of single nucleotide polymorphisms. Results Three hundred and eight patients (median age at inclusion 61 years, interquartile range (IQR: 17; male 48.4 %; median FU 48 months, IQR: 24) were included. During FU, 116 patients (37.7 %) showed progression of IM and six patients (1.9 %) developed high-grade dysplasia or GC. The minor allele (C) on TLR4 (rs11536889) was inversely associated with progression of GIM (OR 0.6; 95 %CI 0.4-1.0). Family history (HR 1.5; 95 %CI 0.9-2.4) and smoking (HR 1.6; 95 %CI 0.9-2.7) showed trends towards progression of GIM. Alcohol use, body mass index, history of H. pylori infection, and serological markers were not associated with progression. Conclusions Family history and smoking appear to be related to an increased risk of GIM progression in low GC incidence countries. TLR4 (rs11536889) showed a significant inverse association, suggesting that genetic information may play a role in GIM progression.
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Affiliation(s)
- S. A. V. Nieuwenburg
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M. C. Mommersteeg
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E. L. Eikenboom
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B. Yu
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - I. Lisanne Holster
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Caroline M. den Hoed
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - L. G Capelle
- Meander Medical Centre, Amersfoort, the Netherlands
| | - Thjon J. Tang
- IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | | | | | | | - F. ter Borg
- Deventer Hospital, Deventer, The Netherlands
| | - Jordy P. W. Burger
- Department of Gastroenterology and Hepatology, Rijnstate, Arnhem, The Netherlands
| | - Marco J. Bruno
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - G. M. Fuhler
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Maikel P. Peppelenbosch
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michael Doukas
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ernst J. Kuipers
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Manon C.W. Spaander
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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88
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Orr J, Lockwood R, Gamboa A, Slaughter JC, Obstein KL, Yachimski P. Enteral Stents for Malignant Gastric Outlet Obstruction: Low Reintervention Rates for Obstruction due to Pancreatic Adenocarcinoma Versus Other Etiologies. J Gastrointest Surg 2021; 25:720-727. [PMID: 32077045 DOI: 10.1007/s11605-019-04512-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Enteral stents (ES) have emerged as first-line therapy for the treatment of malignant gastric outlet obstruction (GOO). Stent occlusion arising from tissue ingrowth may require endoscopic or surgical reintervention. The objective of this study was to compare rates of reintervention following palliative ES for patients with GOO due to pancreatic adenocarcinoma (PDAC) versus other malignant etiologies. METHODS Patients who had undergone ES for palliation of malignant GOO between 2009 and 2018 were retrospectively identified and demographic, clinical, and procedural data were collected. Primary outcome was procedural reintervention for recurrent symptomatic GOO following ES placement. RESULTS Forty-three patients were included in the study cohort. 62.8% (27/43) of patients had PDAC while 37.2% (16/43) of patients had other malignant etiologies. 11.6% (5/43) of patients were alive at follow-up. Thirty-day and 90-day mortality rates were 22.8% and 70.7% for PDAC and 25% and 56.3% for other malignant etiologies, respectively. Seven patients required reintervention for symptomatic GOO: 14.3% (1/7) had PDAC and 85.7% (6/7) had GOO due to other malignancy (P < .01). Ninety-six percent (26/27) of patients with PDAC required no further intervention for GOO prior to death or end of follow-up. On multivariate analysis, patients with PDAC were significantly less likely to require reintervention than patients with other malignant etiologies (OR 0.064, 95% CI 0.01-0.60). CONCLUSION ES offer durable symptom palliation without requirement for reintervention for the overwhelming majority of patients with malignant GOO due to PDAC. Reintervention rates are higher following ES placement for GOO due to other malignant etiologies and future study may be needed to define the optimal palliative intervention for this group of patients.
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Affiliation(s)
- Jordan Orr
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 The Vanderbilt Clinic, 1301 Medical Center Drive, Nashville, TN, 37232-5280, USA.
| | - Robert Lockwood
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 The Vanderbilt Clinic, 1301 Medical Center Drive, Nashville, TN, 37232-5280, USA
| | - Anthony Gamboa
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 The Vanderbilt Clinic, 1301 Medical Center Drive, Nashville, TN, 37232-5280, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37232-5280, USA
| | - Keith L Obstein
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 The Vanderbilt Clinic, 1301 Medical Center Drive, Nashville, TN, 37232-5280, USA
| | - Patrick Yachimski
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 The Vanderbilt Clinic, 1301 Medical Center Drive, Nashville, TN, 37232-5280, USA
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89
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Lam SK, Lau GKK. Idiopathic multitudinous fundic gland polyposis: A new disease and a management dilemma. JGH OPEN 2021; 5:525-527. [PMID: 33860106 PMCID: PMC8035449 DOI: 10.1002/jgh3.12496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 11/23/2022]
Abstract
Two patients with idiopathic multitudinous fundic gland polyposis, a hitherto undescribed condition, were reported. They presented incidentally with a multitude of fundic gland polyps, 52 and 147, without a family history of polyposis, and these polyps were not attributable to the chronic use of proton pump inhibitors. All polyps were removed by hot‐biopsy polypectomy, and each was individually subjected to pathological examination, which showed no evidence of dysplasia. When confronted with gastric polyps of clinically undetermined origin, endoscopists would, to exclude dysplasia, usually resect all if they are few and sample some and survey the others periodically if they are numerous. The condition reported presents a management dilemma: Because the number of the polyps is such that they are manageable by total polypectomy, should this be carried out, despite the labor intensiveness involved, to exclude dysplasia, and are the polyps a variant of syndromic polyposis and therefore carry a malignant potential and inform the need for periodic surveillance and to investigate the patient's kindred? The frequency of this condition and whether it is truly not associated with dysplasia require further studies.
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Affiliation(s)
- Shiu Kum Lam
- The Humanity & Health GI & Liver Centre Hong Kong China.,The University of Hong Kong, Hong Kong Hong Kong China
| | - George K K Lau
- The Humanity & Health Medical Centre Hong Kong China.,The Liver Diseases & Transplant Centre The Fifth Medical Centre of Chinese PLA General Hospital Beijing China.,Steering Committee of the Asian Pacific Association for the Study of the Liver Tokyo Japan.,The Asian Pacific Digestive Week Federation Kuala Lumpur Malaysia
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90
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Cummings D, Wong J, Palm R, Hoffe S, Almhanna K, Vignesh S. Epidemiology, Diagnosis, Staging and Multimodal Therapy of Esophageal and Gastric Tumors. Cancers (Basel) 2021; 13:582. [PMID: 33540736 PMCID: PMC7867245 DOI: 10.3390/cancers13030582] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric and esophageal tumors are diverse neoplasms that involve mucosal and submucosal tissue layers and include squamous cell carcinomas, adenocarcinomas, spindle cell neoplasms, neuroendocrine tumors, marginal B cell lymphomas, along with less common tumors. The worldwide burden of esophageal and gastric malignancies is significant, with esophageal and gastric cancer representing the ninth and fifth most common cancers, respectively. The approach to diagnosis and staging of these lesions is multimodal and includes a combination of gastrointestinal endoscopy, endoscopic ultrasound, and cross-sectional imaging. Likewise, therapy is multidisciplinary and combines therapeutic endoscopy, surgery, radiotherapy, and systemic chemotherapeutic tools. Future directions for diagnosis of esophageal and gastric malignancies are evolving rapidly and will involve advances in endoscopic and endosonographic techniques including tethered capsules, optical coherence tomography, along with targeted cytologic and serological analyses.
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Affiliation(s)
- Donelle Cummings
- Division of Gastroenterology and Hepatology, Department of Medicine, New York Medical College, New York City Health and Hospitals Corporation-Metropolitan Hospital Center, 1901 First Avenue, New York, NY 10029, USA;
| | - Joyce Wong
- Division of Surgery, Mid Atlantic Kaiser Permanente, 700 2nd St. NE, 6th Floor, Washington, DC 20002, USA;
| | - Russell Palm
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (R.P.); (S.H.)
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (R.P.); (S.H.)
| | - Khaldoun Almhanna
- Division of Hematology/Oncology, Lifespan Cancer Institute, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy St, George 312, Providence, RI 02903, USA;
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, Department of Medicine, SUNY Downstate Health Sciences University, MSC 1196, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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91
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Kamarajah SK, Markar SR, Phillips AW, Salti GI, Dahdaleh FS. Local Endoscopic Resection is Inferior to Gastrectomy for Early Clinical Stage T1a and T1b Gastric Adenocarcinoma: A Propensity-Matched Study. Ann Surg Oncol 2021; 28:2992-2998. [PMID: 33452601 DOI: 10.1245/s10434-020-09485-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of endoscopic resection (ER) in the management of subsets of clinical T1N0 gastric adenocarcinoma remains controversial. The aim of this study was to evaluate the outcome of ER versus gastrectomy in node-negative cT1a and cT1b gastric adenocarcinoma. METHODS Data from the National Cancer Database (2010-2015) were used to identify patients with clinical T1aN0 (n = 2927; ER: n = 1157, gastrectomy: n = 1770) and T1bN0 (n = 2915; ER: n = 474, gastrectomy: n = 2441) gastric adenocarcinoma. Propensity score matching and Cox multivariable analyses were used to account for treatment selection bias. RESULTS ER for cT1a and cT1b cancers was performed more frequently over time. The rates of node-positive disease in patients with cT1a and cT1b gastric adenocarcinoma were 5% and 18%, respectively. In the matched cohort, gastrectomy was associated with increased survival compared with ER for cT1a cancers (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66-0.95; p = 0.013), and corresponding 5-year survival for gastrectomy and ER was 72% and 66%, respectively (p = 0.013). For cT1b cancers, gastrectomy had a significantly longer survival compared with ER (HR 0.77, 95% CI 0.63-0.93; p = 0.008), and the corresponding 5-year survival for gastrectomy and ER was 60% and 50%, respectively (p = 0.013). CONCLUSION This study demonstrates ER is inferior in terms of long-term survival for clinical T1aN0 and T1bN0 gastric adenocarcinoma, despite current recommendations for ER in cT1 gastric cancers. Future research should seek to identify the subset of T1a and T1b cancers at low risk of nodal metastasis, and would thus maximally benefit from ER.
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Affiliation(s)
- Sivesh K Kamarajah
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle-upon-Tyne, UK.,Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alexander W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle-upon-Tyne, UK.,School of Medical Education, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - George I Salti
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA
| | - Fadi S Dahdaleh
- Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, IL, USA.
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92
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Xiao S, Fan Y, Yin Z, Zhou L. Endoscopic grading of gastric atrophy on risk assessment of gastric neoplasia: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:55-63. [PMID: 32656803 DOI: 10.1111/jgh.15177] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Endoscopic examination of gastric atrophy has been developed to determine the extent of atrophy by identifying the atrophic border of gastric mucosa, but its value in predicting the risk of developing gastric neoplasms is not quantified. Thus, this systematic review and meta-analysis aim to assess the incidence risk of gastric neoplasms on the basis of endoscopic grading of gastric atrophy. METHODS Two authors independently searched the electronic databases (PubMed, Embase, and the Cochrane Library) from inception through December 31, 2019, without language restriction. The effect size on study outcomes is calculated using random-effects model and presented as risk ratio (RR) with 95% confidence interval (CI). Heterogeneity, publication bias, and quality of included studies were also assessed. RESULTS Fourteen retrospective studies are identified to perform systematic review and meta-analysis, 11 were cohort studies, and three were cross-sectional research. The pooled RR for developing gastric neoplasms is 3.89 (95% CI 2.92-5.17) among general patients with severe endoscopic atrophy. For patients who underwent endoscopic resection for early gastric neoplasms, nearly two times increased risk of synchronous or metachronous neoplasms is pooled (RR = 1.96, 95% CI 1.39-2.75). In terms of the type of endoscopic atrophy, patients with open-type endoscopic atrophy have a higher risk of gastric cancer development (RR 8.02; 95% CI 2.39-26.88) than those with close type. [Correction added on 22 December 2020, after first online publication: '(RR = 7.27; 95% CI 1.64-32.33)' has been corrected to '(RR 8.02; 95% CI 2.39-26.88)'] CONCLUSIONS: Grading endoscopic atrophy according to the Kimura-Takemoto classification can assess the risk of gastric neoplasia development. Patients with severe or open-type endoscopic gastric atrophy at baseline should undergo rigorous surveillance to early detect premalignant lesions and cancer.
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Affiliation(s)
- Shiyu Xiao
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
| | - Yihan Fan
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
| | - Zhihao Yin
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
| | - Liya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
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93
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Loughrey MB, Shepherd NA. The indications for biopsy in routine upper gastrointestinal endoscopy. Histopathology 2020; 78:215-227. [PMID: 33382487 DOI: 10.1111/his.14213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
This review describes the indications and contraindications for endoscopic biopsy, in routine practice, of the upper gastrointestinal (GI) tract. We accept that this review provides grounds for controversy, as our stance in certain situations is counter to some national guidelines. Nevertheless, we provide evidence to support our viewpoints, especially on efficiency and economic grounds. We describe the particular controversies concerning the biopsy assessment of Barrett's oesophagus, chronic gastritis and the duodenum in the investigation of coeliac disease. We accept that there are indications for more extensive upper GI biopsy protocols in children than in adults; the latter constitute our main focus in this article. We would encourage detailed discussion between pathologists and their endoscopy colleagues about the indications, or lack of them, for routine upper GI endoscopic biopsy, as studies have shown that adherence to agreed guidelines has resulted in a very considerable diminution in the biopsy workload without compromising patient management. Furthermore, where biopsy is indicated, we emphasise the importance of accompanying clinical information provided to the pathologist, in particular regarding biopsy site(s), and regular feedback to endoscopists to improve and maintain the quality of such information. Finally, local dialogue is also advised, when necessary, to indicate to endoscopists the need to appropriately segregate biopsies into separate, individually labelled specimens, to maximise the information that can be derived by pathological evaluation and thereby improve the quality of the final pathology report.
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Affiliation(s)
- Maurice B Loughrey
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, UK
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94
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Asztalos IB, Colling CA, Buchner AM, Chandrasekhara V. Development of a narrow-band imaging classification to reduce the need for routine biopsies of gastric polyps. Gastroenterol Rep (Oxf) 2020; 9:219-225. [PMID: 34316371 PMCID: PMC8309680 DOI: 10.1093/gastro/goaa080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/05/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
Background Most incidental gastric polyps identified during upper endoscopy are considered low-risk. However, current guidelines recommend sampling all gastric polyps for histopathologic analysis. We aimed to devise a simple narrow-band imaging (NBI) classification to reduce the need for routine biopsies of low-risk gastric polyps. Methods Pairs of NBI and white-light images were collected from 73 gastric polyps for which concurrent histopathologic diagnosis was available. A diagnostic accuracy cohort study was performed. Two blinded endoscopists independently analysed NBI features of each polyp for color, vessel pattern, surface pattern, and any combinations thereof to develop a classification scheme to differentiate low-risk polyps (fundic-gland or hyperplastic) from high-risk polyps (adenomatous or adenocarcinoma) and fundic-gland polyps (FGPs) from non-FGPs. Results An isolated lacy vessel pattern and a homogenous absence of surface pattern successfully differentiated low-risk from high-risk gastric polyps. Combining both descriptors into a single algorithm resulted in a negative predictive value (NPV) of 100% [95% confidence interval (CI): 100%–100%], positive predictive value (PPV) of 13.7% (95% CI: 2.6–24.8), sensitivity of 100% (95% CI: 100%–100%), and specificity of 53.7% (95% CI: 45.3%–62.0%) for high-risk polyps. This would reduce the number of polyps requiring biopsy by 50%, while still capturing all high-risk polyps. Regarding FGPs, using a rule not to biopsy polyps with isolated lacy vessels resulted in a 94.9% NPV (95% CI: 89.2%–100%), 63.2% PPV (95% CI: 47.2%–79.2%), 94.8% sensitivity (95% CI: 89.5%–100%), and 63.6% specificity (95% CI: 51.3%–76.0%) for non-FGPs. Conclusion In this derivation cohort study, NBI is helpful for differentiating between high-risk and low-risk gastric polyps, thereby reducing the need for routine sampling of low-risk polyps. These results need to be validated in a separate test population.
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Affiliation(s)
- Ivor B Asztalos
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Caitlin A Colling
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anna M Buchner
- Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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95
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[Endoscopic diagnosis, treatment, and follow-up of polyps of the upper gastrointestinal tract]. Internist (Berl) 2020; 62:145-150. [PMID: 33219394 DOI: 10.1007/s00108-020-00901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Polyps occur significantly less frequently in the upper gastrointestinal tract compared to the lower gastrointestinal tract. They are usually incidental findings at esophagogastroduodenoscopy. A distinction is made between epithelial lesions and subepithelial tumors. Endoscopic screening is not recommended in Germany (exception: hereditary risk groups). Polyps are sometimes symptomatic, generally in the case of advanced tumor size. In this case, or in the case of potential for malignant transformation, resection is necessary and can usually be performed endoscopically. Surgical resections are rarely necessary. Epithelial lesions are removed by means of endoscopic mucosal resection (EMR). For subepithelial tumors, advanced procedures such as endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER), or endoscopic full-thickness resection are available. These procedures should primarily be performed at centers with appropriate expertise. Endoscopic follow-up is primarily determined by the tumor entity and the resection status.
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96
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Abstract
Polyps in the upper and lower gastrointestinal tract can be premalignant or malignant lesions that can be treated endoscopically in early stages to prevent morbidity and more invasive procedures. This article critically reviews the techniques available and provides recommendations for endoscopic polypectomy.
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Affiliation(s)
- Kelly T Wagner
- Department of Surgery, University at Buffalo, 100 High Street D350, Buffalo, NY 14203, USA.
| | - Eleanor Fung
- Department of Surgery, University at Buffalo, 462 Grider Street, DK Miller Building, 3rd Floor, Buffalo, NY 14215, USA
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97
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Yang XM, Xu H. Clinical features of fundic gland polyps and their correlation with colorectal tumors. Shijie Huaren Xiaohua Zazhi 2020; 28:1036-1041. [DOI: 10.11569/wcjd.v28.i20.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps (FGPs) are multiple, sessile polypoid bumps formed by the gastric mucosa of the fundus and body, which are the most common type of gastric polyps and generally tend to be benign. Studies have shown that patients with FGPs have a higher risk of developing colorectal tumors (adenoma and cancer) than the general population, but their correlation is still controversial. This article is aimed to review the clinical features of FGPs and their correlation with colorectal tumors.
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Affiliation(s)
- Xue-Mei Yang
- Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hong Xu
- Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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98
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Hajifathalian K, Ichkhanian Y, Dawod Q, Meining A, Schmidt A, Glaser N, Vosoughi K, Diehl DL, Grimm IS, James T, Templeton AW, Samarasena JB, Chehade NEH, Lee JG, Chang KJ, Mizrahi M, Barawi M, Irani S, Friedland S, Korc P, Aadam AA, Al-Haddad M, Kowalski TE, Smallfield G, Ginsberg GG, Fukami N, Lajin M, Kumta NA, Tang SJ, Naga Y, Amateau SK, Kasmin F, Goetz M, Seewald S, Kumbhari V, Ngamruengphong S, Mahdev S, Mukewar S, Sampath K, Carr-Locke DL, Khashab MA, Sharaiha RZ. Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience. Endosc Int Open 2020; 8:E1291-E1301. [PMID: 33015330 PMCID: PMC7508667 DOI: 10.1055/a-1216-1439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68-138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.
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Affiliation(s)
- Kaveh Hajifathalian
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Yervant Ichkhanian
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Qais Dawod
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Alexander Meining
- Interventional and Experimental Endoscopy, Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nicholas Glaser
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Kia Vosoughi
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - David L. Diehl
- Interventional and Experimental Endoscopy, Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Ian S. Grimm
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Theodore James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Adam W. Templeton
- Department of Gastroenterology, University of Washington, Seattle, Washington, United States
| | - Jason B. Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Nabil El Hage Chehade
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - John G. Lee
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Kenneth J. Chang
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Meir Mizrahi
- Department of Internal Medicine, Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, Alabama, United States
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John hospital, Detroit, Michigan, United States
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United Stats
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
| | - Paul Korc
- Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, California, United States
| | - Abdul Aziz Aadam
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, United States
| | - Mohammad Al-Haddad
- Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology, Indianapolis, Indiana, United States
| | | | - George Smallfield
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia United States
| | - Gregory G. Ginsberg
- Gastroenterology Division, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - Michael Lajin
- SHARP Grossmont Hospital, La Mesa, California, United States
| | - Nikhil A. Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Yehia Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Stuart K. Amateau
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Franklin Kasmin
- Division of Gastroenterology, Lenox Hill Hospital, Northwell Health, New York, New York, United States
| | - Martin Goetz
- Innere Medizin I, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Stefan Seewald
- Centre of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Srihari Mahdev
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Saurabh Mukewar
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Kartik Sampath
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - David L. Carr-Locke
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Mouen A. Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Reem Z. Sharaiha
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
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Novel Pathologic Factors for Risk Stratification of Gastric "Indefinite for Dysplasia" Lesions. Gastroenterol Res Pract 2020; 2020:9460681. [PMID: 33061961 PMCID: PMC7542492 DOI: 10.1155/2020/9460681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
Methods In total, 123 IND cases with final diagnoses of cancer (29.3%), high-grade dysplasia (6.5%), low-grade dysplasia (11.4%), and nonneoplasm (52.8%) were randomly divided into test set (n = 27) and validation set (n = 96). By the image analysis, size, pleomorphism, hyperchromasia, irregularity of nuclei, and ratios of structural atypia area (SAA) to total IND area were measured in the test set. Using the validation set, consensus meetings were held for the evaluation of pathologic factors that predict the final diagnosis. Results By image analysis, the only ratio of SAA to total IND area was associated with the final diagnosis (p < 0.001). In the consensus meeting for validation, the nuclear factors, except loss of nuclear polarity (p = 0.004–0.026), could not predict the final diagnosis. Conversely, most structural factors could predict the final diagnosis. In particular, SAA > 25% was the most powerful predictive factor. We proposed criteria of risk stratification by using SAA > 25%, loss of surface maturation (LOSM), and loss of nuclear polarity (LONP) (Malignancy rate; Category 0: SAA ≤ 25% without LOSM and LONP; 0%, Category 1: SAA ≤ 25% with any of LOSM or LONP; 15.2%–16.7%, Category 2: SAA > 25% without LOSM and LONP; 44.4%–50.0%, Category 3: SAA > 25% with any of LOSM or LONP 54.5%–55.6%). Conclusions Structural atypia was more helpful than nuclear atypia and SAA > 25% was the most powerful predictor for the diagnosis of INDs of the stomach. We propose shortening the follow-up period to six months for Category 1, endoscopic resection for Category 2 and 3, postresection follow-up periods of one year for Category 2, and six months for Category 3.
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100
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Long-term natural history after endoscopic resection for gastric dysplasia. Surg Endosc 2020; 35:5247-5255. [PMID: 32989550 DOI: 10.1007/s00464-020-08023-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Natural history after endoscopic resection (ER) for gastric dysplasia is still unclear. The aim of this study was to evaluate the long-term clinical outcomes and risk factors after ER for gastric dysplasia between control and cases with synchronous or metachronous gastric neoplasm. METHODS A total of 1090 patients who had undergone ER for gastric dysplasia and been followed up for at least one year from December 2002 to December 2013 were finally analyzed. Risk factors affecting the development of synchronous or metachronous neoplasm (SMN) and long-term clinical outcomes after ER for gastric dysplasia were evaluated. RESULTS Synchronous and metachronous neoplasms had developed in 126 (11.6%) and 133 patients (12.2%) during the mean follow-up duration of 63.6 months, respectively. Five-year and 10-year risk of metachronous neoplasm were 9.8% and 27.2%, respectively. Median duration to the development of metachronous neoplasm was 103.1 months. While age (P < 0.001) and mucosal atrophy (P = 0.09) of index cases were associated with the development of synchronous neoplasm, age (P = 0.017), incomplete resection (P = 0.025), and intestinal metaplasia (P = 0.017) of background mucosa of index cases were significantly related to the development of metachronous neoplasm in multivariate analysis. Cumulative incidence of SMN was not significantly different among H. pylori negative, eradicated, and persistent group. CONCLUSIONS Age, incomplete ER, and background intestinal metaplasia of index gastric dysplasia were significantly associated with metachronous recurrence. Endoscopic surveillance for metachronous recurrence after ER for gastric dysplasia is mandatory for longer than 10 years.
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