Coexpression of two distinct muscle acetylcholine receptor alpha-subunits during development

Value of EUS in determining infiltration depth of early carcinoma and associated precancerous lesions in the upper gastrointestinal tract

Objective

The objective is to evaluate the value of EUS in the determination of infiltration depth of early carcinoma and precancerous lesions in the upper gastrointestinal tract and to analyze the various factors affecting the accuracy of EUS.

Methods

One hundred and sixty-three patients diagnosed with early gastric cancer or early esophageal cancer, and associated precancerous lesions, who were seen in our hospital in the recent 10 years were selected. These patients received EUS before endoscopic submucosal dissection or surgery. With a pathological diagnosis as the gold standard, the accuracy, sensitivity, specificity, and misjudgment rate of EUS in determining the invasion depth were evaluated using the pathological stratification (mucosa, M1/2; muscularis mucosa, M3; submucosa, [SM]; and muscularis propria) or TN stratification (mucosa, T1a; SM, T1b), and the possible causes of miscalculation were analyzed.

Results

Based on the pathological stratification, the overall accuracy of EUS was 78.5%, and the overestimation and underestimation rates were 17.8% and 3.7%, respectively. Based on the TN stratification, the overall accuracy of EUS was 81%, and the overestimation and underestimation rates were 16.6% and 2.5%, respectively. There was a significant difference between the groups in terms of overestimation and underestimation rates (P < 0.05), indicating that EUS was more likely to overestimate the depth. Univariate analysis showed that the factors affecting accuracy included lesion size, macroscopic features, sunken mucosa, mucosa with granular and nodular changes, and ulceration. Multivariate logistic regression analysis revealed that larger lesions, mucosa with granular and nodular changes, and ulceration were independent risk factors for the overestimation of infiltration depth by EUS.

Conclusion

EUS is highly accurate in determining the infiltration depth of early cancer and precancerous lesions in the upper gastrointestinal tract. It also has a good reference value for treatment selection and prognostication. However, attention should be paid to its overestimation, especially accompanied by the aforementioned factors.

[Analysis of endoscopic and pathological features of gastric adenomatous polyps and risk factors for canceration]

OBJECTIVE

To investigate the endoscopic and pathological characteristics of gastric adenomatous polyps and to assess the potential risk factors for canceration of gastric adenomatous polyps.

METHODS

The endoscopic and pathological characteristics of the patients with gastric adenomatous polyps from January 1, 2005 to December 31, 2019 were summarized retrospectively, and the risk factors of canceration were analyzed.

RESULTS

A total of 125 patients with gastric adenomatous polyps were included, 51.20% of whom were females. The average age was (66.7±12.3) years. 64.80% of patients with gastric adenomatous polyps equal or more than 65 years old, and only 5.60% of the patients less than 45 years old. Adenomatous polyps were mostly distributed in the corpus and antrum with 40.80% and 32.80%, respectively. The majority of them were single (90.40%) and sessile (76.81%). 65.4% of adenomatous polyps were no more than 1.0 cm in diameter, and 23.20% of patients with adenomatous polyps were combined with hyperplastic polyps and/or fundus glandular polyps, and 1.60% had both pathological types of polyps. 58.62% (17/29) patients with hyperplastic polyps and/or fundus glandular polyps had multiple polyps. 1.60% (2/125) of the patients had gastric neuroendocrine tumor of G1 stage. Synchronous gastric cancer was detected in 13.60% (17/125) of the patients with adenomatous polyps, and the proportion of low-grade intraepithelial neoplasia was 18.40% (23/125). The main types of synchronous gastric cancer were progressive (70.59%) and undifferentiated (66.67%). Chronic atrophic gastritis with intestinal metaplasia was found in 52.80% of the patients, and autoimmune gastritis accounted for 11.20%. The positive rate of Helicobacter pylori was 21.60%. The canceration rate of gastric adenomatous polyps was 20.80%. The cancer was mainly differentiated, but there was sigmoid ring cell carcinoma as well. Diameter of >1.0 cm (OR=5.092, 95%CI: 1.447-17.923, P=0.011), uneven surface morphology and erosion (OR=13.749, 95%CI: 1.072-176.339, P=0.044) were independent risk factors of adenomatous polyps.

CONCLUSION

The synchronous gastric cancer is common and the canceration of gastric adenomatous polyps is high with diameter and surface morphology as independent risk factors. We should pay attention to the identification of the pathological types of polyps and the evaluation of the whole gastric mucosa during the endoscopic examination.

Development of a narrow-band imaging classification to reduce the need for routine biopsies of gastric polyps

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.

Endoscopic diode laser therapy for gastric hyperplastic polyps in cirrhotic patients

Purpose Endoscopic polypectomy to remove gastric hyperplastic polyps in cirrhotic patients is associated to a high risk of postprocedural bleeding. The current study set out to examine the effect of diode laser therapy used to treat this type of polyps in cirrhotic patients. Methods This single-center study retrospectively examined the data of cirrhotic patients with macroscopic bleeding or anemia who underwent diode laser therapy (940 nm wave length, 30-W power setting in continuous mode) to remove histology-confirmed hyperplastic gastric polyps. Results A total of 222 polyps (mean diameter 10 ± 8 mm) were treated in 55 patients who were included in the study. No complications such as bleeding or perforations were reported. After a mean of 5 ± 4 sessions, 31 patients (56%) were completely healed. In 16 patients (29%), there was only a partial response (mean polyp reduction diameter of 64 ± 15%), while 8 (15%) patients did not respond to treatment. Statistically significant better results were noted in the patients who underwent ≥ 2 laser sessions. Hemoglobin levels and number of blood transfusions required were not statistically different after treatment. After a mean study period of 21 ± 17 months, polyp recurrences were noted in 11 patients (20%), but none of the polyps had degenerated. Conclusion Diode laser therapy was found to be a safe treatment for hyperplastic polyps in cirrhotic patients. Due to the presence of others bleeding lesions in cirrhotic patients, this treatment did not have an impact on anemia and transfusion requirements.

The use of endoscopic ultrasonography in the detection and differentiation of pathology in the wall of the upper gastrointestinal tract

Introduction

The growing incidence of gastrointestinal diseases forces to improve imaging techniques. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography.

Aim

To assess the usefulness of endosonography (EUS) in the differentiation between compression from the outside and intramural lesions of the upper gastrointestinal tract.

Material and methods

For 4 years 20,012 patients with performed gastroscopies were enrolled in the study. One hundred and ninety-nine patients (96 females, 103 males; age 62.2 ±14.1 years) with pathology of the wall of the upper gastrointestinal tract qualified for further diagnosis. Endosonography and computed tomography (CT) were performed in each patient. A chest CT was performed in patients with a lesion in the oesophagus. An abdomen CT was performed in patients with pathology in the stomach or duodenum. Based on the results of EUS, histopathology, and imaging, each patient qualified for treatment, endoscopic observation, surgery, or cancer treatment.

Results

In EUS 129 (64.8%) intramural lesions were identified. Five (2.5%) diagnoses were false negative. In 62 (31.2%) patients no intramural changes were recognised and three (1.5%) results were false positive. The sensitivity and specificity of EUS was 96.3% and 95.4%, respectively, with positive predictive value 90.7%, negative predictive value 97.8%, and overall accuracy 95% (p < 0.05). Endoscopic therapy was performed in 31 (15.6%) patients, and 99 (49.8%) were classified for endoscopic observation. Surgery was performed in 50 (25.1%) patients, and 19 (9.5%) patients required oncologic treatment.

Conclusions

Endosonography exceeds computed tomography in differentiating compression from the outside and intramural lesions of the upper gastrointestinal tract.

The impact of age and sex on the occurrence of pathology in the wall of the upper gastrointestinal tract

Introduction

The growing incidence of gastrointestinal diseases forces to improve both imaging techniques and the identification of the population with a greater risk of a disease. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography.

Aim

The study was a retrospective evaluation of the occurrence of submucosal lesions (SML) and thickened wall (TW) of the upper gastrointestinal tract (UGIT) depending on age and sex.

Material and methods

Out of 20012 gastroscopies during the 4-year follow-up study, we enrolled 199 patients with pathological lesions in the wall of the UGIT. All patients underwent computed tomography and endoscopic ultrasound (EUS).

Results

We analysed a total of 122 (78 males, 44 females, age: 64.0 ±12.9 years) out of 187 patients. 23.91% of SML in the oesophagus, 56.52% in the stomach, and 19.57% in the duodenum. A higher number of SMLs was found in men than in women (57.14% vs. 40.45%, p = 0.023), and the difference was greater over 50 years of age (85.71% vs. 40.00%, p = 0.031). We found less malignant SMLs compared to benign (35.87% vs. 64.13%, p = 0.026), especially in women (22.86% vs. 47.46%, p = 0.006). 26.67% of TW were in the oesophagus, 66.67% in the stomach, and 6.67% in the duodenum. There was a tendency towards increased incidence of TW over 50 years of age (8.58% vs. 18.30%, p = 0.074), which concerned men in particular (24.10% vs. 11.43%, p = 0.043). Until 65 years of age, these differences were significant for the oesophagus (27.27% vs. 0.00%, p = 0.044) and the stomach (25.93% vs. 4.00%, p = 0.029). As many as 70% of TW pathologies were malignant.

Conclusions

Submucosal lesions and TW of the upper gastrointestinal tract account for 0.61% of performed gastroscopies. They occur in men and usually over 50 years of age.

Endoscopic management of mucosal lesions in the gastrointestinal tract

With the increasing role of endoscopy in patient evaluation, more mucosal lesions, including gastric, duodenal and colonic polyps, are encountered during routine examinations. It is imperative for gastroenterologists to become familiar with the endoscopic management of these various gastrointestinal lesions. In this article, various resection techniques will be discussed, including hot/cold forceps polypectomy, hot/cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The article will also discuss the evidence regarding the efficacy and safety of these techniques and the future direction of endoscopic management of mucosal lesions in the gastrointestinal tract.

Endoscopic resection is effective for the treatment of bleeding gastric hyperplastic polyps in patients with and without cirrhosis

BACKGROUND AND STUDY AIMS

Gastric hyperplastic polyps (GHP) have been identified as a cause of transfusion-dependent iron-deficiency anemia (tIDA) and transfusion-dependent gastrointestinal bleeding and are commonly identified in the setting of cirrhosis. The aim of this study was to assess the effectiveness of endoscopic resection (ER) for the treatment of tIDA or gastrointestinal bleeding due to GHP in patients with and without liver disease.

PATIENTS AND METHODS

This was a single-center retrospective review. The primary outcome was clinical success of ER (no transfusion or repeat ER in the following 6 months after first ER). Secondary outcomes included technical success, recurrence of GHP with tIDA or gastrointestinal bleeding, and adverse events (AEs).

RESULTS

Sixty-three patients with GHP were included of whom 20 (31 %) had cirrhosis. The majority with cirrhosis presented with gastrointestinal bleeding (n = 13, 65 %, P = 0.52), whereas the majority of non-cirrhotics presented with tIDA (n = 30, 70 %, P = 0.01). Technical success was 100 % with no AEs. The clinical success rate was 94 % (95 % in cirrhotics, 93 % in non-cirrhotics, P = 0.46). The recurrence rate was 32 % (40 % in cirrhotics and 28 % in non-cirrhotics, P = 0.35) with mean time to recurrence of 17.3 ± 13.9 months (P = 0.22). Of those with recurrence, 75 % had no further tIDA or gastrointestinal bleeding after repeat ER (mean follow-up 20 ±11 months).

CONCLUSIONS

ER is an effective treatment for GHP that causes tIDA or gastrointestinal bleeding. Patients with GHP and cirrhosis tend to present with bleeding rather than anemia and have more frequent recurrence. Symptomatic recurrence of GHP is common and should be recognized early as repeat ER appears to be effective.

Gastric Hamartomatous Polyps-Review and Update

Gastric polyps are frequently encountered on endoscopic examinations. While many of these represent true epithelial lesions, some of the polyps may result from underlying stromal or lymphoid proliferations or even heterotopic tissue. Histologic examination is essential for accurate typing of the polyps to predict malignant potential and underlying possible genetic abnormalities. The focus of this review is on gastric hamartomatous polyps, which are relatively rare and diagnostically challenging. Though most of the gastric hamartomatous polyps are benign, certain types are associated with increased malignant potential. These include certain polyps associated with specific genetic familial polyposis syndromes and gastric inverted hamartomatous polyps. Identification of these polyps can result in the prevention or early diagnosis of gastric carcinoma and also help in the identification of family members with polyposis syndromes. The aim of this review is to categorize gastric hamartomatous polyps and aid in the identification of high-risk categories.

Vanek’s tumor of the small bowel in adults

Inflammatory fibroid polyps (IFPs), or Vanek’s tumor, are one of the least common benign small bowel tumors. IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades. They can be found throughout the gastrointestinal tract but most commonly in the gastric antrum or ileum. The underlying cause of IFPs is still unknown. Genetic study of IFP showed mutations in platelet derived growth factor alpha in some cases. At the time of diagnosis most IFPs have a diameter of 3 to 4 cm. The lesions have always been recorded as solitary polyps. Symptoms depend on the location and the size of the lesion, including abdominal pain, vomiting, altered small bowel movements, gastrointestinal bleeding and loss of weight. IFPs arising below the Treitz ligament can present with an acute abdomen, usually due to intussusceptions. Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm intussusceptions. Most inflammatory fibroid polyps can be removed by endoscopy. Surgery is rarely needed. Exploratory laparoscopy or laparotomy is frequently recommended as the best treatment for intussusceptions caused by IFP. The operation should be performed as early as possible in order to prevent the intussusceptions from leading to ischemia, necrosis and subsequent perforation of the invaginated bowel segment. This report aims at reviewing the diagnosis, etiology, genetics, clinical presentation, endoscopy, radiology, and best treatment of IFP.

Preoperative predicting score of lymph node metastasis for gastric cancer

The aim of our study was to develop a new score system that might predict the probability of lymph node of gastric carcinoma. We studied the clinicopathological variables of 932 patients with gastric carcinoma admitted to the Department of Surgical Oncology at the First Hospital of China Medical University. Logistic analysis was performed to identify predictors. The hazard risk (HR) of variables obtained from logistic regression was used to construct a simple scoring system determined by an aggregate of the points assigned for each selected variable. Receiver operator characteristic (ROC) curve was created to analyze the specificity. Lymph node metastases were found in 644 (69.1 %) of 932 patients. After multivariate logistic regression analysis, tumor size, depth of invasion, and macroscopic types (P < 0.001) were selected as viable predictors to establish the scoring system. ROC curves were plotted to verify the accuracy of predicting score and other variables for both Lymph node stage (N stage) prediction. It showed that the predicting score system had a better specificity and sensitivity (65.71 % and 83.54 %, respectively). The current study suggests that a preoperative prediction system to identify the risk of lymph node metastasis is feasible. This model may be useful in preoperative counseling about the cost and benefit of systemic lymph node dissection.