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7061 Acquired hyperplastic gastric polyps in posttransplant patients.
7059 IMPACT OF ENDOSONOGRAPHY GUIDED FINE NEEDLE ASPIRATION BIOPSY (EUS FNA) ON LYMPH NODE (LN) STAGING IN PATIENTS WITH ESOPHAGEAL CARCINOMA. E. Vazquez-Sequeiros, I. D. Norton, J. E. Clain, K. K. Wang, A. Affi, M. Allen, C. Deschamps, D. Miller, V. Trastek, P. Pairolero, M. J. Wiersema, Mayo Clin, Rochester, MN. Background: Recognition of lymph node metastases in esophageal cancer may influence treatment decisions. regarding preoperative adjuvant therapy (N1) and/or surgical resection (M1a: celiac LN). EUS is the most accurate method for locoregional staging of these tumors, clearly superior to CT. To date, the role of EUS FNA in these patients has not been defined. Purpose: Determine if EUS FNA can improve the N staging accuracy of EUS in esophageal carcinoma. Methods: From May 1996 to May 1999, 74 consecutive patients with histologically proven esophageal carcinoma underwent preoperative EUS examination. The mean age was 64 years (range 43-84), male/female 68/6, and adeno/squamous cell carcinoma 65/9. After October 1998 EUS FNA was routinely performed on non-peritumoral lymph nodes > 5 mm in width (31 patients sampled). Final diagnosis was made based on surgical results or EUS FNA malignant cytology. 8 patients were excluded from analysis due to unresectable disease. 29 patients did not proceed directly to surgery after EUS: T4 (2), N1 (15) or M1a (12) and adjuvant or palliative treatment was employed. 9 patients underwent dilatation: 2 were non-traversable after dilatation (both T3N1M0). 1 of 9 patients (11%) developed complications related to dilatation (self limited bleeding). No complications related with the EUS procedure or FNA registered. Results: N stage was obtained in 47 patients (EUS alone: 30 vs EUS FNA: 17). M1a stage was obtained in 51 patients (EUS: 37 vs EUS FNA: 14). CT staging accuracy for N stage was 40% and M stage 15%. EUS T stage global accuracy was 82% (95%CI: 76-88%). (See Table) Conclusions: 1) EUS FNA is more accurate and sensitive than EUS alone for preoperative, evaluation of periesophageal, perigastric and celiac LN when staging esophageal carcinoma. 2) EUS FNA of LN in patients with esophageal carcinoma is a safe method, and should be routinely performed when treatment decisions will be affected by nodal stage.
Sensitivity Specificity Accuracy
EUS EUS FNA EUS EUS FNA EUS EUS FNA
N stage
M1 astage (celiac LN)
12/16:75%* 15/16:93%* 12/14:85% 1/1:100% 24/30:80%§ 16/17:94%§
3/9:33† 13/14:93%† 28/28:100% — 31/37:83% 13/14:93%
N& celiac LN combined 14/22:63%‡ 28/30:93%‡ 9/11:81% 1/1:100% 23/33:70%¶ 29/31:93%¶
(*,†,‡,§,¶: p < 0.05)
7060 CAUSITIVE LESIONS AND LONG TERM OUTCOME IN PATIENTS WITH ESOPHAGEAL FOOD IMPACTION. AN URBAN HOSPITAL EXPERIENCE. Abdolrezah Abassi, Louis R. Lambiase, Univ of Florida Health Sci Center/Jacksonville, Jacksonville, FL. Food impaction in the esophagus is a common problem faced by gastrointestinal endoscopists. While much has been written regarding management of these patients there has been little study of the underlying lesion causing the impaction and the long-term outcome in these patients. In attempt to study these issues we reviewed our recent experience with patients presenting with esophageal foreign body impaction. Methods: The computerized records of upper endoscopies performed during the last 2 years at University Medical center were searched for esophageal food impaction or foreign body in either the indication or findings field. Once records were found charts were reviewed to determine age, gender, findings at endoscopy and follow-up care. An attempt was made to reach the patients via telephone to assess any recurrent symptoms and further endoscopy. Results: There were 1435 endoscopic records searched. 17 individuals were identified as having esophageal foreign bodies. Age range 22-85 Male:Female ratio 8:9. The findings were as follows: Schatzki Ring 2 pts Normal 4 pts Esophagitis 11 pts. 8/11 esophagitis patients were re-endoscoped within one week and 6 demonstrated complete resolution of esophagitis. 13 patients were available for f/u <6 months from the procedure. Only 2 were still symptomatic with esophagitis. There were no recurrent food impactions. Conclusions: Food impaction in the esophagus is more often associated with esophagitis than a shatzki ring or stricture. The esophagitis seen at initial endoscopy is usually short lived suggesting the possibility of its presence being an epiphenomenon rather than a cause of the
VOLUME 51, NO. 4, PART 2, 2000
food impaction. Only a small number of patients were still symptomatic with dysphagia or esophagitis after 6 months. There was no recurrence within the 2 years studied. 7061 ACQUIRED HYPERPLASTIC GASTRIC POLYPS IN POSTTRANSPLANT PATIENTS. Rafael Amaro, Jeffrey B. Raskin, Guy W. Neff, Univ of Miami, Miami, FL. Background: Gastric polyps are usually an incidental finding during endoscopic examination. The significance of gastric polyps depends on their histology, with adenomatous polyps having a high risk for malignant degeneration. Even though hyperplastic polyps have a low risk for malignant degeneration, if multiple they are considered a precancerous lesion. The association between the use of immunosuppressive agents and the formation of multiple gastric polyps has not been previously reported. Methods: We reviewed all transplanted patients found to have gastric polyps on endoscopy and collected demographic data, polyp characteristics (endoscopic and histologic), and treatment regimens at the time of the endoscopy. Results: Ten (7 males; 3 females) transplanted patients (six cardiac, three liver and one kidney) with gastric polyps were identified. Median age at the time of the transplant was 61 years (27-71 years). Gastric polyps were found on endoscopy a median of 11 months post-transplant (3-28 months). Eight patients had endoscopy prior or soon after transplant with no evidence of polyps. All ten patients developed hyperplastic polyps. Nine patients had multiple polyps (≥3) and one had a solitary polyp (large pedunculated polyp). In eight patients the polyps were confined to the antrum; one patient had polyps in the antrum and body; and one patient had polyps in the fundus. There was no evidence of adenomatous or malignant changes in any of the polyps removed or biopsied. All patients were on at least one immunosuppressive agent including: prednisone/methylprednisolone (8), tacrolimus (5), azathioprine (5), cyclosporine (5), mycophenolate mofetil (1). Other common medications included bactrim (7) and omeprazole/lansoprazole (6). Conclusion: The development of gastric polyps after organ transplantation has not been previously reported. The nature of these polyps (hyperplastic and multiple in our series) is concerning as a malignant potential has been recognized in patients harboring multiple hyperplastic gastric polyps. The possible etiopathogenic relation with immunosuppressive therapy as well as the natural history of these acquired hyperplastic gastric polyps needs further investigation. 7062 A CLINICAL STUDY ON PROTRUDING LESIONS THAT ARISE AT THE SCAR OF ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CARCINOMA AND GASTRIC FLAT ADENOMA. Young Koog Cheon, Chang Beom Ryu, Bong Min Ko, Su Jin Hong, Jin Oh Kim, Joo Young Cho, Moon Sung Lee, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Background:Several studies of EMR have been reported, but reports about benign protrudinglesions that arise at the scar of EMR for early gastric cancer (EGC) or gastric adenoma are rare. Aim: To elucidate endoscopic and histologicalcharacteristics of benign protruding lesions which arise at the scar of EMR for EGC and gastric flat adenoma. Methods and Materials: In 101 lesions (73 gastric flat adenoma, 28 EGC) in 96 cases which were completely resected by endoscopy and which could be followed-up, we analyzed endoscopic findings which included initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and Proton pump inhibitor (PPI) or H2-blocker use). We analyzed, retrospectively, 16 lesions that arose at the scar of EMR. Results: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~). 1 of 28 EGC (3.6%), and 15 of 73 gastric flatadenoma (20.5%) arose at the scar of EMR. All of the patients were men (mean age 53 years). 2. With respect to the endoscopic findings, the shapes of protruding lesions were as follows; 10 Yamada(Y) I, 4 Y-II, 1 Y-III, 1 flat lesion. Histologicalexamination of protruding lesion revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6, respectively. With respect to the location of primary lesion, 18.2 % of the protruding lesions developed in the antrum, 19.2% in thelower body, and 20% in the midbody, respectively (p>0.05). 3. There was no difference incidence of developingprotruding lesion in size, depth of invasion and resection method of primary lesion. However, incidence of those lesions was higher in cases of tubular adenoma with focal high grade dysplasia than tubular adenoma without dysplasia (p<0.05). 4. The incidence of H. pyloriinfection was higher in patients (81.7%) who developed a protruding lesion than (51.8%) who did not developed (p=0.029), and also higher incidence of use of PPI in those patients (p=0.045). But, eradication therapy of H. pylori, duration of use of PPI or H2-blocker showed no difference in between groups. Conclusions: It may be possible that the potential hyperplasia thatmay reside in normal mucosa surrounding EGC or gastric adenoma might wake up during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pyloriand PPI might be also related to develop the protruding lesions.
GASTROINTESTINAL ENDOSCOPY
AB257
Sensitivity Specificity Accuracy
EUS EUS FNA EUS EUS FNA EUS EUS FNA
N stage
M1 astage (celiac LN)
12/16:75%* 15/16:93%* 12/14:85% 1/1:100% 24/30:80%§ 16/17:94%§
3/9:33† 13/14:93%† 28/28:100% — 31/37:83% 13/14:93%
N& celiac LN combined 14/22:63%‡ 28/30:93%‡ 9/11:81% 1/1:100% 23/33:70%¶ 29/31:93%¶
(*,†,‡,§,¶: p < 0.05)
7060 CAUSITIVE LESIONS AND LONG TERM OUTCOME IN PATIENTS WITH ESOPHAGEAL FOOD IMPACTION. AN URBAN HOSPITAL EXPERIENCE. Abdolrezah Abassi, Louis R. Lambiase, Univ of Florida Health Sci Center/Jacksonville, Jacksonville, FL. Food impaction in the esophagus is a common problem faced by gastrointestinal endoscopists. While much has been written regarding management of these patients there has been little study of the underlying lesion causing the impaction and the long-term outcome in these patients. In attempt to study these issues we reviewed our recent experience with patients presenting with esophageal foreign body impaction. Methods: The computerized records of upper endoscopies performed during the last 2 years at University Medical center were searched for esophageal food impaction or foreign body in either the indication or findings field. Once records were found charts were reviewed to determine age, gender, findings at endoscopy and follow-up care. An attempt was made to reach the patients via telephone to assess any recurrent symptoms and further endoscopy. Results: There were 1435 endoscopic records searched. 17 individuals were identified as having esophageal foreign bodies. Age range 22-85 Male:Female ratio 8:9. The findings were as follows: Schatzki Ring 2 pts Normal 4 pts Esophagitis 11 pts. 8/11 esophagitis patients were re-endoscoped within one week and 6 demonstrated complete resolution of esophagitis. 13 patients were available for f/u <6 months from the procedure. Only 2 were still symptomatic with esophagitis. There were no recurrent food impactions. Conclusions: Food impaction in the esophagus is more often associated with esophagitis than a shatzki ring or stricture. The esophagitis seen at initial endoscopy is usually short lived suggesting the possibility of its presence being an epiphenomenon rather than a cause of the
VOLUME 51, NO. 4, PART 2, 2000
food impaction. Only a small number of patients were still symptomatic with dysphagia or esophagitis after 6 months. There was no recurrence within the 2 years studied. 7061 ACQUIRED HYPERPLASTIC GASTRIC POLYPS IN POSTTRANSPLANT PATIENTS. Rafael Amaro, Jeffrey B. Raskin, Guy W. Neff, Univ of Miami, Miami, FL. Background: Gastric polyps are usually an incidental finding during endoscopic examination. The significance of gastric polyps depends on their histology, with adenomatous polyps having a high risk for malignant degeneration. Even though hyperplastic polyps have a low risk for malignant degeneration, if multiple they are considered a precancerous lesion. The association between the use of immunosuppressive agents and the formation of multiple gastric polyps has not been previously reported. Methods: We reviewed all transplanted patients found to have gastric polyps on endoscopy and collected demographic data, polyp characteristics (endoscopic and histologic), and treatment regimens at the time of the endoscopy. Results: Ten (7 males; 3 females) transplanted patients (six cardiac, three liver and one kidney) with gastric polyps were identified. Median age at the time of the transplant was 61 years (27-71 years). Gastric polyps were found on endoscopy a median of 11 months post-transplant (3-28 months). Eight patients had endoscopy prior or soon after transplant with no evidence of polyps. All ten patients developed hyperplastic polyps. Nine patients had multiple polyps (≥3) and one had a solitary polyp (large pedunculated polyp). In eight patients the polyps were confined to the antrum; one patient had polyps in the antrum and body; and one patient had polyps in the fundus. There was no evidence of adenomatous or malignant changes in any of the polyps removed or biopsied. All patients were on at least one immunosuppressive agent including: prednisone/methylprednisolone (8), tacrolimus (5), azathioprine (5), cyclosporine (5), mycophenolate mofetil (1). Other common medications included bactrim (7) and omeprazole/lansoprazole (6). Conclusion: The development of gastric polyps after organ transplantation has not been previously reported. The nature of these polyps (hyperplastic and multiple in our series) is concerning as a malignant potential has been recognized in patients harboring multiple hyperplastic gastric polyps. The possible etiopathogenic relation with immunosuppressive therapy as well as the natural history of these acquired hyperplastic gastric polyps needs further investigation. 7062 A CLINICAL STUDY ON PROTRUDING LESIONS THAT ARISE AT THE SCAR OF ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CARCINOMA AND GASTRIC FLAT ADENOMA. Young Koog Cheon, Chang Beom Ryu, Bong Min Ko, Su Jin Hong, Jin Oh Kim, Joo Young Cho, Moon Sung Lee, Chan Sup Shim, Institute for Digest Research, Soon Chun Hyang Univ, Seoul, South Korea. Background:Several studies of EMR have been reported, but reports about benign protrudinglesions that arise at the scar of EMR for early gastric cancer (EGC) or gastric adenoma are rare. Aim: To elucidate endoscopic and histologicalcharacteristics of benign protruding lesions which arise at the scar of EMR for EGC and gastric flat adenoma. Methods and Materials: In 101 lesions (73 gastric flat adenoma, 28 EGC) in 96 cases which were completely resected by endoscopy and which could be followed-up, we analyzed endoscopic findings which included initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and Proton pump inhibitor (PPI) or H2-blocker use). We analyzed, retrospectively, 16 lesions that arose at the scar of EMR. Results: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~). 1 of 28 EGC (3.6%), and 15 of 73 gastric flatadenoma (20.5%) arose at the scar of EMR. All of the patients were men (mean age 53 years). 2. With respect to the endoscopic findings, the shapes of protruding lesions were as follows; 10 Yamada(Y) I, 4 Y-II, 1 Y-III, 1 flat lesion. Histologicalexamination of protruding lesion revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6, respectively. With respect to the location of primary lesion, 18.2 % of the protruding lesions developed in the antrum, 19.2% in thelower body, and 20% in the midbody, respectively (p>0.05). 3. There was no difference incidence of developingprotruding lesion in size, depth of invasion and resection method of primary lesion. However, incidence of those lesions was higher in cases of tubular adenoma with focal high grade dysplasia than tubular adenoma without dysplasia (p<0.05). 4. The incidence of H. pyloriinfection was higher in patients (81.7%) who developed a protruding lesion than (51.8%) who did not developed (p=0.029), and also higher incidence of use of PPI in those patients (p=0.045). But, eradication therapy of H. pylori, duration of use of PPI or H2-blocker showed no difference in between groups. Conclusions: It may be possible that the potential hyperplasia thatmay reside in normal mucosa surrounding EGC or gastric adenoma might wake up during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pyloriand PPI might be also related to develop the protruding lesions.
GASTROINTESTINAL ENDOSCOPY
AB257