Volume 70 - 2007 - Fasc.4 - Original articles
Endoscopic submucosal dissection is useful and safe for intramucosal gastric neoplasms in the elderly
Background and study aims : Endoscopic submucosal dissection (ESD) has recently gained popularity for use against intramucosal gastric neoplasms in Japan, but few studies have examined whether ESD is feasible for elderly patients. This study aims are to evaluate the efficacy and safety of ESD according to age in con- secutive elderly patients treated with ESD.
Patients and methods : Subjects comprised 116 patients (90 men, 26 women) with 125 lesions treated using ESD from November 2002 to March 2006 at Nagoya City University Hospital and Iwata Municipal Hospital, Japan. Patients were categorized into : Group A, < 65-years-old (n = 34) ; Group B, ?? 65-years-old but < 75- years-old (n = 41) ; and Group C, ?? 75-years-old (n = 41). En bloc resection rate and treatment time were examined according to age, tumour size and location, and frequency of complications was examined according to age.
Results : Rate of concomitant disease was significantly higher in Group C than in the other groups. En bloc resection rates and median treatment times were 91.4% and 80 min in Group A, 91.1% and 97 min in Group B and 86.7% and 110 min in Group C, respectively. No significant differences were noted between groups, or for en bloc resection rate and treatment time according to tumour size and location, or between groups for frequency of complications.
Conclusions : ESD for gastric neoplasms is effective and safe in elderly patients, and may be positively recommended to elderly patients with intramucosal gastric neoplasms. (Acta gastroenterol. belg., 2007, 70, 323-330).Background and study aims : Endoscopic submucosal dissection (ESD) has recently gained popularity for use against intramucosal gastric neoplasms in Japan, but few studies have examined whether ESD is feasible for elderly patients. This study aims are to evaluate the efficacy and safety of ESD according to age in con- secutive elderly patients treated with ESD.
Patients and methods : Subjects comprised 116 patients (90 men, 26 women) with 125 lesions treated using ESD from November 2002 to March 2006 at Nagoya City University Hospital and Iwata Municipal Hospital, Japan. Patients were categorized into : Group A, < 65-years-old (n = 34) ; Group B, ?? 65-years-old but < 75- years-old (n = 41) ; and Group C, ?? 75-years-old (n = 41). En bloc resection rate and treatment time were examined according to age, tumour size and location, and frequency of complications was examined according to age.
Results : Rate of concomitant disease was significantly higher in Group C than in the other groups. En bloc resection rates and median treatment times were 91.4% and 80 min in Group A, 91.1% and 97 min in Group B and 86.7% and 110 min in Group C, respectively. No significant differences were noted between groups, or for en bloc resection rate and treatment time according to tumour size and location, or between groups for frequency of complications.
Conclusions : ESD for gastric neoplasms is effective and safe in elderly patients, and may be positively recommended to elderly patients with intramucosal gastric neoplasms. (Acta gastroenterol. belg., 2007, 70, 323-330).
Is combined 18F-Fluorodeoxyglucose-Positron Emission Tomography-Computed Tomography superior to Positron Emission Tomography or Computed Tomography alone for diagnosis, staging and restaging of pancreatic lesions ?
Background and study aims : To evaluate whether combined 18F- FDG PET/CT has an additive value over 18F-FDG-PET or CT alone for diagnosis, staging and restaging of pancreatic lesions.
Patients and methods : Forty-six consecutive patients (23 women, 23 men; median age 62.5 years) underwent FDG-PET/CT. Analysis of PET, CT and fused PET/CT images was performed by 2 readers. Patients were divided into 2 groups : diagnosis and staging of pri- mary tumours (n = 34) and restaging : screening for recurrent or progressive pancreatic cancer (n = 12). Accuracy analysis was per- formed lesion-by-lesion and patient-by-patient. Results were corre- lated with histopathology or clinical follow-up.
Results : Ninety-five foci were identified on PET, 140 lesions on CT and 119 on PET/CT. Thirty-four lesions were defined as 'defi- nitely pathologic' and localised in pancreas, liver, lung or bone by all 3 techniques with equal certainty. In 11 patients malignancy was ruled out with the highest certainty by PET/CT. All 3 modal- ities made 2 false positive diagnoses of malignancy and missed metastases or vascular ingrowth in 7 patients. The accuracy rate of PET/CT (91.2%) for diagnosis of primary pancreatic lesions is higher compared to CT (88.2%) and PET alone (82.3%). Also for locoregional staging PET/CT has a higher accuracy rate (85.3%) compared to CT (83.8%) and PET (79.4%). When used for restag- ing, sensitivity (90.0%) and accuracy rate (91.6%) were highest for PET and PET/CT. CT had a lower sensitivity (80.0%).
Conclusions : Topographical assignment of 'spots' with high FDG uptake is superior with PET/CT compared to PET alone. Fused PET/CT has a slightly higher sensitivity and accuracy rate for diagnosis and locoregional staging of primary pancreatic lesions compared to CT alone. PET and PET/CT perform equally well in screening for recurrent or progressive pancreatic cancer, with high accuracy. Due to its unlimited access, lower radiation exposure and cost, multidetector row CT remains the imaging technique of choice for diagnosis, staging and screening for recur- rent pancreatic cancer. (Acta gastroenterol. belg., 2007, 70, 330- 338).
The significance of beta-catenin, E-cadherin, and P-cadherin expressions in neoplastic progression of colorectal mucosa : an immunohistochemical study
Background and study aims : The purpose of the current study was to investigate the role of b-catenin, E-cadherin and P-cadherin in colorectal carcinogenesis using tissue array method.
Patients and methods : Core tissue biopsies were taken from paraffin-embedded tissue blocks of 167 cases including 26 normal mucosae (NM), 99 colorectal polyps (10 hyperplastic polyps (HP), 8 traditional serrated (TSA), 17 tubular (TA), 37 tubulovillous (TVA), and 27 villous adenomas (VA)), 14 adenomas with intra- mucosal carcinoma (ACA), and 28 colorectal cancers (CCA). Immunohistochemistry was performed using antibodies to b- catenin, E-cadherin, and P-cadherin. Distribution of positivity was assessed using percentage expression while an arbitrary grading scale was used for staining intensity.
Results : b-catenin expression was cytoplasmic, membranous, and nuclear. Both E-cadherin and P-cadherin expressions were confined to cytoplasmic-membranous compartments. Membranous expression of b-catenin significantly decreased in CCA (p < 0.01). Nuclear b-catenin expression significantly increased in close correlation with neoplastic sequence reaching its highest expression in ACA and CCA (p < 0.001). Polyps with intraepithelial neoplasia (IEN) showed significantly higher nuclear b-catenin expression in parallel with increasing grades of IEN (p < 0.001). E-cadherin and P-cadherin expression increased in polyps, whereas a significant decrease in their expression was observed in CCA (p < 0.001) while E-cadherin expression signifi- cantly increased in CCA compared to NM (p < 0.001), no such difference was observed in P-cadherin expression.
Conclusions : Nuclear b-catenin expression correlating with the grade of IEN in polyps and carcinomas supports its role in colo- rectal carcinogenesis. E-cadherin and P-cadherin expressions in adenomas suggest that these molecules might have role in adeno- ma formation though not necessarily be involved in neoplastic progression. (Acta gastroenterol. belg., 2007, 70, 339-344).
Regulation of hepatic microcirculation in stepwise liver resection
Background : After liver resection a small-for-size syndrome may result from the reduction of liver volume and additional liver damage caused by hepatic hyperperfusion. Therefore the influence of the extent of liver resection on liver perfusion is investigated.
Material and methods : A stepwise liver resection (removal of 30%, 70%, 90%, 95% and 97% of the liver) was performed under inhalation anaesthesia with isoflurane in 6male Lewis rats. Besides systemic arterial and venous blood pressure the portal pressure and flow was measured and the sinusoidal perfusion was visualized. Sinusoidal diameter, intersinusoidal diameter and functional capillary density were determined.
Results and conclusions : A decrease in the portal flow but an increase in the portal pressure was observed. Sinusoidal diameter showed a steady but low increase when up to 70% of the liver was removed but a high increase after 90% or more of the liver was resected. This indicates a decompensation of a regulatory mecha- nism of sinusoidal perfusion. (Acta gastroenterol. belg., 2007, 70, 345-351).
The tissue effect of second generation argon plasma coagulation (VIO APC) in comparison to standard APC and Nd:YAG laser in vitro
Background : The aim of this study was to evaluate the effect of 2nd generation argon plasma coagulation (VIO APC) with respect to the tissue destruction capacity, and to compare it with standard APC and Nd:YAG laser.
Methods : 2nd generation APC (VIO APC2, Erbe, Germany), standard APC (APC 300/Erbotom ICC 200, Erbe) and Nd:YAG laser (KTP/YAG XP 800 ; Laserscope, San Jose, California) were applied in 35 porcine livers. Using APC, power settings (30- 120 W), application time (2 and 5 sec) and gas flow (1 and 2 l/min) were varied. Using Nd:YAG laser, 30-60 W were applied (flow 2 l/min). Diameter and depth of tissue coagulation were evaluated.
Results : Using VIO APC, maximum coagulation depth was 6mm (maximum diameter 15 mm). In comparison to standard APC, the coagulation effect was significantly higher (p < 0.001). There was no significant difference in the mean depth achieved by VIO APC and Nd:YAG laser using 30- 60 W and an application time of 2 sec (p < 0.05). Using maximum energy available for the 2 systems, maximum depth achieved by VIO APC (6 mm) was higher than the one caused by Nd:YAG laser (4 mm).
Conclusions : VIO APC was more effective than standard APC. Using medium power and a limited application time, it was as effective as Nd:YAG laser. The high effectiveness of VIO APC should be a topic of clinical education. (Acta gastroenterol. belg., 2007, 70, 352-356).
