Advanced endoscopic imaging for gastric cancer assessment: new insights with new optics?

One piece biopsy for both rapid urease test and cultivation of Helicobacter pylori

BACKGROUND & AIMS

Increasing antibiotic resistance among Helicobacter pylori isolates and the unsuccessful attempts at eradication can impose many costs to both healthcare systems and patients. The present study intended to find a way from which H. pylori could be isolated from biopsies with less invasive procedures undertaken on infected patients.

METHODS

A biopsy specimen from each patient with gastric disorders was put into urea-containing agar. After two hours, the specimens were removed from agar and placed into tubes containing 1 ml 20% glucose solution. Then, the specimens were inoculated onto the Columbia agar and incubated under microaerophilic conditions. The grown colonies were identified as H.pylori based on the microbiology tests and PCR.

RESULTS

Overall, 449 biopsy specimens were collected from the patients. Of all biopsies, 219 (48.8%) revealed positive results in the rapid urease test. Using the aforementioned method, 158 (35.2%) culture positive biopsy specimens were obtained.

CONCLUSION

The researchers attempted to use one biopsy specimen for both rapid urease and culture tests. This method causes fewer injuries of gastric tissue and allows antimicrobial susceptibility testing and characterization in detail of the isolated organism.

Gastric and duodenal polyps in familial adenomatous polyposis patients: Conventional endoscopy vs virtual chromoendoscopy (fujinon intelligent color enhancement) in dysplasia evaluation

AIM

To test the fujinon intelligent color enhancement (FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis (FAP) patients.

METHODS

Seventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope (for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps < 6 mm. Formalin-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAP-associated fundic gland polyps.

RESULTS

Sixty-nine (90.8%) patients had gastric polyps (34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52 (68.4%) in duodenum (7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the II/III portion.

CONCLUSION

FICE significantly increases adenoma detection rate in FAP patients but does not change any Spigelman stage and thus does not modify patient’s prognosis and treatment strategies.

Gastric carcinoma in canines and humans, a review

Gastric carcinoma (GC) is the most common neoplasm in the stomach of dogs. Although incidence in the general population is reported to be low, breed-specific GC has a high incidence. Median age at presentation ranges from 8 to approximately 10 years. The disease is mostly located in the lesser curvature and antropyloric region of the stomach. Unfortunately, diagnosis is usually made when the disease is at an advanced stage and, therefore, prognosis is poor. Due to similarities in clinical presentation, diagnosis, histology and prognosis, canine GC may serve as a valuable model for human GC. Extensive pedigrees of canine gastric carcinoma cases could reveal insights for human gastric carcinoma. Putative species differences include the role of Helicobacter in pathogenesis, the wide array of genetic data and screening available for humans, and treatment protocols that are available for human GC.