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7126 Light-induced autofluorescence spectroscopy for the diagnosis of esophageal cancer.
7123 INTESTINAL METAPLASIA OF THE GASTRIC CARDIA: A PROSPECTIVE STUDY WITH ENHANCED MAGNIFICATION ENDOSCOPY. Moises Guelrud, Idamys Herrera, Julio Castro, Harold Essenfeld, Policlinica Metropolitana, Caracas, Venezuela. Intestinal Metaplasia of the Gastric Cardia (IMC) is a frequent finding in patients undergoing upper endoscopy (UE). However, IMC is usually identify by biopsy of normal-appearing mucosa and its prevalence may be underestimated because of sampling error. Enhanced magnification endoscopy (EME),which combines the use of magnification endoscopy (ME) and acetic acid (AA) instillation, has been shown to improve surface mucosal visualization in Barrett´s esophagus. Aim: To evaluate the potential utility of EME to diagnose IMC. Methods: 72 patients undergoing elective UE underwent EME with an Olympus GIF-200Z (zoom 35X) and 1.5% AA instillation. Patients were included if the squamocolumnar junction and the esophagogastric junction were judged to be at the same level. AA surface patterns were characterized prior to AA-directed biopsy of suspected areas and correlated with histology. A pathologist blinded to the biopsy methods read each biopsy. Logistic regression was performed to determine if targeted biopsies of surface patterns could predict IMC. Results: EME detected 4 different endoscopic patterns. Pattern I: round pits, II: reticular, III: villous, and IV: ridged. Overall, EME identified IMC in 44 of the 72 patients, a prevalence of 61.1%. The sensitivity of detecting IMC by targeted biopsy in patterns I, II, III, and IV were 0/12 (0%), 8/58 (13.8%) odds ratio 2.16 (p=0.41), 72/78 (92.3%) odds ratio 12 (p=0.05), and 12/12 (100%) respectively. Conclusions: EME is an accurate method to detect intestinal metaplasia in the gastric cardia. EME is useful to target biopsies and thus avoid sampling error. IMC is a more frequent lesion than previously reported. Its clinical significance is uncertain and has to be established.
7124 IMPROVED DETECTION AND DIFFERENTIATION OF COLORECTAL NEOPLASIAS WITH HIGH-RESOLUTION CHROMOENDOSCOPY, A PROSPECTIVE STUDY. Ralf Kiesslich, Martin Hahn, Guenter Herrmann, Michael Jung, St Hildegardis Krankenhaus, Mainz, Germany; Pathology, Ludwigsburg, Germany. Introduction: Chromoendoscopy allows more detailed inspection of superficial mucosal changes during colonoscopy. The aim of our prospective study was to look for such changes after intravital staining with indigocarmine (IC) and correlate staining patterns with histology. Methods: Since 5/99 60 unselected patients underwent high-resolution colonoscopy (CF 140, Olympus Co.). Visible lesions OR the distal rectosigmoid (in patients without visible lesions) were stained with 0.4% IC (1-15 ml) with a spraying catheter (Olympus PW-5L). The stained lesions were analyzed according to the Pit-Pattern (PP) Classification (Kudo et al., 1996). All stained lesions were biopsied or removed. Results: see table 45 patients had 79 lesions visible without chromoendoscopy (3-80 mm). After staining and biopsy/removal the incidence of dysplasia/carcinoma was: PPII 0%, PPIIIS 18%, PP IIIL 13%, PPIV 75%, PPV 83%. In 12 of 15 patients without lesions before staining, chromoendoscopy revealed 71 flat lesions (1-3 mm). 4 of these were adenomas with low grade dysplasia. Discussion: Chromoendoscopy with indigocarmine allows classification of mucosal changes according to the staining pattern (PP). Certain staining patterns (PPIV, PPV) seem to correlate with advanced neoplastic changes in histology. In addition, chromoendoscopy makes previously undetectable, small, flat adenomas visible. The clinical significance of the latter finding is the subject of ongoing studies.
PP
n†
Histology†
n*
Histology*
II IIIS IIIL IV V
5 22 38 8 6
Hyperplasia Adenomas, 4 LGD Adenomas, 5 LGD Adenomas, 3 LGD, 3 Ca 5 Ca, 1 Inflammation
34 10 25 2 0
Hyperplasia Adenomas, 2 LGD Adenomas, 2 LGD Adenomas -
7125 HOW BEST TO DIAGNOSE IPMT. Jeffrey H. Lee, Richard S. Johannes, Jacques Van Dam, Francis Farraye, David L. Carr-Locke, Brigham & Women’s Hosp, Harvard Med Sch, Boston, MA; Brigham & Women’s Hosp, Boston, MA. The purpose of the study was to review a single institutional experience of intraductal papillary mucinous tumors (IPMT) and compare different diagnostic modalities. Background: IPMT or mucinous ductal ectasia is a rare neoplasm of the pancreas. It is characterized by extensive intraductal growth with slow invasion and metastasis having a much better prognosis. Diagnosis is usually made by ERCP showing dilated main and side branches with multiple filling defects that represent mucus and often mucus extruding from the papilla. The value of brush cytology and biopsy is unknown. Methods: The medical records, endoscopic findings, brushing results, surgical findings and surgical pathology of 22 patients over a 6 year period were reviewed. Results: The mean age at presentation was 63.1 years. There were 15 females and 7 males. The prevalence of abdominal pain was 86%, h/o pancreatitis 64%, wt loss 23%, diabetes 18%, cholangitis 9%, steatorrhea 5%. CT scan was done in 11 (50 %) and showed cystic dilation in 1, cystic mass in 5, solid mass in 3, and was negative in 2. Three (14%) were found to have pancreas divisum with mucus in the dilated dorsal duct. Nineteen (86%) had tumor involvement in the head of the pancreas and 3 (14%) in the tail. Brushing of the pancreatic duct was performed in 17, biopsy in 8 with only 2 positive for mucinous neoplasm in each (using strict criteria). Pancreatoscopy was performed in 2 patients and revealed the intraductal papillary growth and white gelatinous mucus in both patients. Endoscopic ultrasound was performed on one patient and showed hyperechogenic collection in the dilated pancreatic duct. Eight patients underwent surgery; 4 pancreaticoduodenectomy, 2 pylorus preserving pancreaticoduodenectomy, 1 distal pancreatectomy and 1 total pancreatectomy. Invasive carcinoma was present in 2 (25%). Conclusion: IPMT which has malignant potential, presents with nonspecific symptoms. Non-invasive imaging may be misleading. ERCP is the procedure of choice in making the diagnosis. Brushings or biopsies of the pancreatic duct are insensitive. Pancreatoscopy is useful in determining the extent of the lesion to help guide surgical resection. 7126 LIGHT-INDUCED AUTOFLUORESCENCE SPECTROSCOPY FOR THE DIAGNOSIS OF ESOPHAGEAL CANCER. Brigitte Mayinger, Peter Horner, Christof Gerlach, Martin Jordan, Eckhart Georg Hahn, Medicine Clin I, Erlangen, Germany; Lehrstuhl A fuer Thermodynamik, Munich, Germany. Introduction: Autofluorescence spectroscopy using violet-blue excitation light is being investigated for in-vivo diagnosis of esophageal cancer during routine-endoscopy. Methods: Fluorescence spectra were collected from squamous cell cancer (N = 7 patients) and adenocarcinoma of the esophagus (N = 3 patients) and compared with collected spectra of the corresponding healthy esophageal mucosa. Following the spectrographic measurements biopsies were taken to get a definitive classification of histopathological status. A special light source capable of delivering either white or violet-blue light was used for the excitation of tissue autofluorescence via the endoscope. Endogenous fluorescence spectra emitted by the tissue were collected with a fiberoptic probe and analyzed with a spectrograph. Results: Over 100 spectra of cancerous and benign esophageal mucosa were evaluated. As compared with normal mucosa esophageal squamous cell cancer and adenocarcinoma of the esophagus were associated with special changes in the emitted fluorescence spectra. Discussion: Fluorescence spectroscopy with a slightly modified conventional light source might be useful for the endoscopic in-vivo detection of esophageal cancer. Further series trials need to be done to investigate the sensitivity and specificity of this new method.
† Colonoscopy with visible lesions (45 patients); *Inconspicious colonoscopy: lesions visible after staining (12 of 15 patients)
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB273
7124 IMPROVED DETECTION AND DIFFERENTIATION OF COLORECTAL NEOPLASIAS WITH HIGH-RESOLUTION CHROMOENDOSCOPY, A PROSPECTIVE STUDY. Ralf Kiesslich, Martin Hahn, Guenter Herrmann, Michael Jung, St Hildegardis Krankenhaus, Mainz, Germany; Pathology, Ludwigsburg, Germany. Introduction: Chromoendoscopy allows more detailed inspection of superficial mucosal changes during colonoscopy. The aim of our prospective study was to look for such changes after intravital staining with indigocarmine (IC) and correlate staining patterns with histology. Methods: Since 5/99 60 unselected patients underwent high-resolution colonoscopy (CF 140, Olympus Co.). Visible lesions OR the distal rectosigmoid (in patients without visible lesions) were stained with 0.4% IC (1-15 ml) with a spraying catheter (Olympus PW-5L). The stained lesions were analyzed according to the Pit-Pattern (PP) Classification (Kudo et al., 1996). All stained lesions were biopsied or removed. Results: see table 45 patients had 79 lesions visible without chromoendoscopy (3-80 mm). After staining and biopsy/removal the incidence of dysplasia/carcinoma was: PPII 0%, PPIIIS 18%, PP IIIL 13%, PPIV 75%, PPV 83%. In 12 of 15 patients without lesions before staining, chromoendoscopy revealed 71 flat lesions (1-3 mm). 4 of these were adenomas with low grade dysplasia. Discussion: Chromoendoscopy with indigocarmine allows classification of mucosal changes according to the staining pattern (PP). Certain staining patterns (PPIV, PPV) seem to correlate with advanced neoplastic changes in histology. In addition, chromoendoscopy makes previously undetectable, small, flat adenomas visible. The clinical significance of the latter finding is the subject of ongoing studies.
PP
n†
Histology†
n*
Histology*
II IIIS IIIL IV V
5 22 38 8 6
Hyperplasia Adenomas, 4 LGD Adenomas, 5 LGD Adenomas, 3 LGD, 3 Ca 5 Ca, 1 Inflammation
34 10 25 2 0
Hyperplasia Adenomas, 2 LGD Adenomas, 2 LGD Adenomas -
7125 HOW BEST TO DIAGNOSE IPMT. Jeffrey H. Lee, Richard S. Johannes, Jacques Van Dam, Francis Farraye, David L. Carr-Locke, Brigham & Women’s Hosp, Harvard Med Sch, Boston, MA; Brigham & Women’s Hosp, Boston, MA. The purpose of the study was to review a single institutional experience of intraductal papillary mucinous tumors (IPMT) and compare different diagnostic modalities. Background: IPMT or mucinous ductal ectasia is a rare neoplasm of the pancreas. It is characterized by extensive intraductal growth with slow invasion and metastasis having a much better prognosis. Diagnosis is usually made by ERCP showing dilated main and side branches with multiple filling defects that represent mucus and often mucus extruding from the papilla. The value of brush cytology and biopsy is unknown. Methods: The medical records, endoscopic findings, brushing results, surgical findings and surgical pathology of 22 patients over a 6 year period were reviewed. Results: The mean age at presentation was 63.1 years. There were 15 females and 7 males. The prevalence of abdominal pain was 86%, h/o pancreatitis 64%, wt loss 23%, diabetes 18%, cholangitis 9%, steatorrhea 5%. CT scan was done in 11 (50 %) and showed cystic dilation in 1, cystic mass in 5, solid mass in 3, and was negative in 2. Three (14%) were found to have pancreas divisum with mucus in the dilated dorsal duct. Nineteen (86%) had tumor involvement in the head of the pancreas and 3 (14%) in the tail. Brushing of the pancreatic duct was performed in 17, biopsy in 8 with only 2 positive for mucinous neoplasm in each (using strict criteria). Pancreatoscopy was performed in 2 patients and revealed the intraductal papillary growth and white gelatinous mucus in both patients. Endoscopic ultrasound was performed on one patient and showed hyperechogenic collection in the dilated pancreatic duct. Eight patients underwent surgery; 4 pancreaticoduodenectomy, 2 pylorus preserving pancreaticoduodenectomy, 1 distal pancreatectomy and 1 total pancreatectomy. Invasive carcinoma was present in 2 (25%). Conclusion: IPMT which has malignant potential, presents with nonspecific symptoms. Non-invasive imaging may be misleading. ERCP is the procedure of choice in making the diagnosis. Brushings or biopsies of the pancreatic duct are insensitive. Pancreatoscopy is useful in determining the extent of the lesion to help guide surgical resection. 7126 LIGHT-INDUCED AUTOFLUORESCENCE SPECTROSCOPY FOR THE DIAGNOSIS OF ESOPHAGEAL CANCER. Brigitte Mayinger, Peter Horner, Christof Gerlach, Martin Jordan, Eckhart Georg Hahn, Medicine Clin I, Erlangen, Germany; Lehrstuhl A fuer Thermodynamik, Munich, Germany. Introduction: Autofluorescence spectroscopy using violet-blue excitation light is being investigated for in-vivo diagnosis of esophageal cancer during routine-endoscopy. Methods: Fluorescence spectra were collected from squamous cell cancer (N = 7 patients) and adenocarcinoma of the esophagus (N = 3 patients) and compared with collected spectra of the corresponding healthy esophageal mucosa. Following the spectrographic measurements biopsies were taken to get a definitive classification of histopathological status. A special light source capable of delivering either white or violet-blue light was used for the excitation of tissue autofluorescence via the endoscope. Endogenous fluorescence spectra emitted by the tissue were collected with a fiberoptic probe and analyzed with a spectrograph. Results: Over 100 spectra of cancerous and benign esophageal mucosa were evaluated. As compared with normal mucosa esophageal squamous cell cancer and adenocarcinoma of the esophagus were associated with special changes in the emitted fluorescence spectra. Discussion: Fluorescence spectroscopy with a slightly modified conventional light source might be useful for the endoscopic in-vivo detection of esophageal cancer. Further series trials need to be done to investigate the sensitivity and specificity of this new method.
† Colonoscopy with visible lesions (45 patients); *Inconspicious colonoscopy: lesions visible after staining (12 of 15 patients)
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB273