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Accurate diagnosis of gastrointestinal (GI) submucosal (SM) lesions with endoscopic ultrasound (EUS) and histology
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Abstracts
campaign, the number of inappropriate prescriptions written by attending physicians and residents decreased while those written by Nurse Practitioners did not change. Conclusions: More than half of Prevacid prescriptions that were written at our teaching hospital were inappropriate. Education of health care providers can have a significant impact on prescribing practices and may result in considerable cost savings.
798 The celecoxib long-term safety study (CLASS): Cardiovascular (CV) safety of celecoxib is equivalent to NSAIDs Whelton A. on behalf of the CLASS investigators. Universal Clinical Research Center, Inc., Hunt Valley, MD 21030, United States; and Department of Medicine, Johns Hopkins Medical School, Baltimore, MD; and Clinical Research and Development, G.D. Searle, Skokie, IL 60077. Objective: It has been hypothesized that inhibition of vascular prostacyclin synthesis with corresponding lack of inhibition of platelet thromboxane production by cycloxygenase-2 specific inhibitors might result in an increased risk of CV events. Methods: In a randomized, double-blind, trial, 7968 patients with osteoarthritis (OA) or rheumatoid arthritis (RA) were randomized to receive celecoxib 400 mg bid or a conventional NSAID (ibuprofen 800 mg tid or diclofenac 75 mg bid) for up to 15 months. Approximately 22% (n ⫽ 1739) of patients were taking low-dose aspirin (ASA). ⱕ325 mg/day). Results: The incidence of thromboembolic CV events were similar between the celecoxib and NSAID groups for the entire patient cohort (2.5% vs 2.1%) and for patients who were not taking low-dose ASA (1.5% vs 1.2%). Conclusions: No evidence was found to suggest that celecoxib at supratherapeutic doses was associated with increased incidence of thromboembolic CV events. Sponsored by GD Searle & Co.
AJG – Vol. 95, No. 9, 2000
Previous reports suggest EUS makes an accurate diagnosis in only 2/3 of malignant GI stromal tumors. Adding fine needle aspiration provides tissue only for cytology, but histology is usually necessary for accurate diagnosis. Purpose: To prospectively evaluate effectiveness of EUS and histology from endoscopically obtained tissue (H-ET) in guiding management of SM tumors. Methods: 130 patients with SM lesions were evaluated by EUS (129); tissue was obtained from gut wall abnormalities by snare (5), forceps (11), and/or guillotine deep biopsy needle (73) depending on the layer of the lesion. Results: Sex: 63 female, 67 male. Lesion location: esophagus 37, stomach 87, duodenum 4, colon 2. EUS diagnosed extraluminal lesions in 19 (15%), vascular structures in the gut wall in 6 (5%), thick gastric folds in 11 (8%), and solitary SM lesions in 94 (72%), all of which had previous nondiagnostic standard biopsies. EUS or histology diagnosed a neoplasm in 27, of which two were false positive (1 leiomyoma, 1 inflammatory ulcer). Of the 25 (19%) true positive neoplasms, 18 were solitary lesions: adenocarcinoma 2, squamous carcinoma 2, sarcoma 4, neurosarcoma 1, rhabdomyosarcoma 1, schwannoma 1, leiomyoblastoma 3, lymphoma 1, granular cell tumor 1, carcinoma-in-situ 1, adenoma 1. Five thick folds were lymphoma. Two extraluminal neoplasms included 1 splenic metastasis and 1 pancreatic cystadenocarcinoma. There were no false negatives. True negatives included all other patients (103). Neoplasms were ⬍1 cm in 1, ⬍2 cm in 3, ⬍3 cm in 3, ⱖ 3 cm in 18. Ten of 74 (13%) histologically benign lesions were ⱖ3 cm. Extraluminal growth pattern, involvement of longitudinal muscularis propria, and abnormal 5-layer architecture at the margin of the lesion correlated highly with neoplasia. Size, echogenicity, and ulceration were criteria that required further evaluation with biopsy. 100% of patients with neoplasia received appropriate therapy, either resection (16) or only chemoradiation (9). Only 5 of 105 (5%) of nonneoplastic SM lesions were resected, including the 2 false positives. Conclusions: Up to 1 of 5 GI SM lesions are neoplastic. EUS plus H-ET can be used to direct further management since all neoplasms were diagnosed without false negatives. Moreover, neoplastic potential cannot be inferred by size.
799 The celecoxib long-term safety study (CLASS): Celecoxib is associated with less renal toxicity compared to conventional NSAIDs Whalton A. on behalf of the CLASS investigators. Universal Clinic Research Center Inc., Hunt Valley, MD 21030, United States; and Department of Medicine, Johns Hopkins Medical School, Baltimore, MD; and Clinical Research and Development, GD Searle, Skokie, IL 60077. Conventional NSAIDs, which nonselectively inhibit cyclooxygenase (COX)-1 and COX-2, are associated with deleterious effects on renal function. Celecoxib specifically inhibits COX-2. Such specific inhibition may result in the reduced incidence of renal toxicity. In a randomized, double-blind trial with exposures up to 15 months, 7968 patients with osteoarthritis (OA) or rheumatoid arthritis (RA) received supratherapeutic doses of celecoxib (400 mg bid) vs therapeutic doses of conventional NSAIDs: ibuprofen (800 mg tid) or diclofenec (75 mg bid). Fewer celecoxib-treated patients experienced renal toxicity compared to patients treated with diclofenec or ibuprofen. Creatinine and/or BUN elevations were reported in 1.3%, 2.1%, and 1.4% of the respective groups. Conclusions: Celecoxib at supratherapeutic doses was associated with a lower incidence of renal toxicity compared to conventional NSAIDs at ordinary therapeutic doses. Sponsored by GD Searle & Co.
800 Accurate diagnosis of gastrointestinal (GI) submucosal (SM) lesions with endoscopic ultrasound (EUS) and histology Zakai David M., M.D., Snady Harry, M.D., FACG, Paradiso Harriette, B.S., Agarwal Banke, M.D. New York, NY.
801 Reduced expression of serotonin receptor (SR) in the left colon of patients with colonic inertia (CI) Zhao Rong Hua MD, Baig Khurrum M. MD, Thaler Klaus J. MD, Mack Judith# PhD, Abramson Susan# PhD., Woodhouse Sherry MD, Tamir Hadassah* MD, Weiss Eric G. MD, Nogueras Juan J. MD, Wexner Steven D. MD. Depts. of Colorectal Surgery, #Research Laboratory and Pathology, Cleveland Clinic Florida, Fort Lauderdale, Florida and *Division of Neuroscience, New York State Psychiatric Institute, New York, NY. Aim: To investigate the expression of SR in the left colon of patients with CI as compared to controls. Methods: 16 patients who underwent subtotal colectomy for CI were assessed. Colonic transit time was measured with a radiopaque marker technique and presented as the number of retained markers in the colon on day 5. The control group consisted of 18 patients who underwent left hemicolectomy for colonic carcinoma. Formalin-fixed, paraffin-embedded, histologically normal tissues from the left colon were used. Immunohistochemical staining of SR was performed on 4m tissue sections with rabbit anti-idiotypic antibodies to SRs, biotinylated secondary antibody and enzyme-labeled-streptavidin. The average positive area (square pixel) in mucosa (MU), muscular propria (MM), submucosa (SM), circular and longitudinal muscles (CM and LM) per microscopic field (63⫻) was calculated based on measuring the positively stained area in 15–20 randomly chosen microscopic fields in each related structure. A computer image analysis system (Scion Image) was used for analysis. Results: SR protein was mainly detected in the MM, CM, and LM, rarely in MU and SM. In MM and CM, the positive areas were significantly lower
Abstracts
campaign, the number of inappropriate prescriptions written by attending physicians and residents decreased while those written by Nurse Practitioners did not change. Conclusions: More than half of Prevacid prescriptions that were written at our teaching hospital were inappropriate. Education of health care providers can have a significant impact on prescribing practices and may result in considerable cost savings.
798 The celecoxib long-term safety study (CLASS): Cardiovascular (CV) safety of celecoxib is equivalent to NSAIDs Whelton A. on behalf of the CLASS investigators. Universal Clinical Research Center, Inc., Hunt Valley, MD 21030, United States; and Department of Medicine, Johns Hopkins Medical School, Baltimore, MD; and Clinical Research and Development, G.D. Searle, Skokie, IL 60077. Objective: It has been hypothesized that inhibition of vascular prostacyclin synthesis with corresponding lack of inhibition of platelet thromboxane production by cycloxygenase-2 specific inhibitors might result in an increased risk of CV events. Methods: In a randomized, double-blind, trial, 7968 patients with osteoarthritis (OA) or rheumatoid arthritis (RA) were randomized to receive celecoxib 400 mg bid or a conventional NSAID (ibuprofen 800 mg tid or diclofenac 75 mg bid) for up to 15 months. Approximately 22% (n ⫽ 1739) of patients were taking low-dose aspirin (ASA). ⱕ325 mg/day). Results: The incidence of thromboembolic CV events were similar between the celecoxib and NSAID groups for the entire patient cohort (2.5% vs 2.1%) and for patients who were not taking low-dose ASA (1.5% vs 1.2%). Conclusions: No evidence was found to suggest that celecoxib at supratherapeutic doses was associated with increased incidence of thromboembolic CV events. Sponsored by GD Searle & Co.
AJG – Vol. 95, No. 9, 2000
Previous reports suggest EUS makes an accurate diagnosis in only 2/3 of malignant GI stromal tumors. Adding fine needle aspiration provides tissue only for cytology, but histology is usually necessary for accurate diagnosis. Purpose: To prospectively evaluate effectiveness of EUS and histology from endoscopically obtained tissue (H-ET) in guiding management of SM tumors. Methods: 130 patients with SM lesions were evaluated by EUS (129); tissue was obtained from gut wall abnormalities by snare (5), forceps (11), and/or guillotine deep biopsy needle (73) depending on the layer of the lesion. Results: Sex: 63 female, 67 male. Lesion location: esophagus 37, stomach 87, duodenum 4, colon 2. EUS diagnosed extraluminal lesions in 19 (15%), vascular structures in the gut wall in 6 (5%), thick gastric folds in 11 (8%), and solitary SM lesions in 94 (72%), all of which had previous nondiagnostic standard biopsies. EUS or histology diagnosed a neoplasm in 27, of which two were false positive (1 leiomyoma, 1 inflammatory ulcer). Of the 25 (19%) true positive neoplasms, 18 were solitary lesions: adenocarcinoma 2, squamous carcinoma 2, sarcoma 4, neurosarcoma 1, rhabdomyosarcoma 1, schwannoma 1, leiomyoblastoma 3, lymphoma 1, granular cell tumor 1, carcinoma-in-situ 1, adenoma 1. Five thick folds were lymphoma. Two extraluminal neoplasms included 1 splenic metastasis and 1 pancreatic cystadenocarcinoma. There were no false negatives. True negatives included all other patients (103). Neoplasms were ⬍1 cm in 1, ⬍2 cm in 3, ⬍3 cm in 3, ⱖ 3 cm in 18. Ten of 74 (13%) histologically benign lesions were ⱖ3 cm. Extraluminal growth pattern, involvement of longitudinal muscularis propria, and abnormal 5-layer architecture at the margin of the lesion correlated highly with neoplasia. Size, echogenicity, and ulceration were criteria that required further evaluation with biopsy. 100% of patients with neoplasia received appropriate therapy, either resection (16) or only chemoradiation (9). Only 5 of 105 (5%) of nonneoplastic SM lesions were resected, including the 2 false positives. Conclusions: Up to 1 of 5 GI SM lesions are neoplastic. EUS plus H-ET can be used to direct further management since all neoplasms were diagnosed without false negatives. Moreover, neoplastic potential cannot be inferred by size.
799 The celecoxib long-term safety study (CLASS): Celecoxib is associated with less renal toxicity compared to conventional NSAIDs Whalton A. on behalf of the CLASS investigators. Universal Clinic Research Center Inc., Hunt Valley, MD 21030, United States; and Department of Medicine, Johns Hopkins Medical School, Baltimore, MD; and Clinical Research and Development, GD Searle, Skokie, IL 60077. Conventional NSAIDs, which nonselectively inhibit cyclooxygenase (COX)-1 and COX-2, are associated with deleterious effects on renal function. Celecoxib specifically inhibits COX-2. Such specific inhibition may result in the reduced incidence of renal toxicity. In a randomized, double-blind trial with exposures up to 15 months, 7968 patients with osteoarthritis (OA) or rheumatoid arthritis (RA) received supratherapeutic doses of celecoxib (400 mg bid) vs therapeutic doses of conventional NSAIDs: ibuprofen (800 mg tid) or diclofenec (75 mg bid). Fewer celecoxib-treated patients experienced renal toxicity compared to patients treated with diclofenec or ibuprofen. Creatinine and/or BUN elevations were reported in 1.3%, 2.1%, and 1.4% of the respective groups. Conclusions: Celecoxib at supratherapeutic doses was associated with a lower incidence of renal toxicity compared to conventional NSAIDs at ordinary therapeutic doses. Sponsored by GD Searle & Co.
800 Accurate diagnosis of gastrointestinal (GI) submucosal (SM) lesions with endoscopic ultrasound (EUS) and histology Zakai David M., M.D., Snady Harry, M.D., FACG, Paradiso Harriette, B.S., Agarwal Banke, M.D. New York, NY.
801 Reduced expression of serotonin receptor (SR) in the left colon of patients with colonic inertia (CI) Zhao Rong Hua MD, Baig Khurrum M. MD, Thaler Klaus J. MD, Mack Judith# PhD, Abramson Susan# PhD., Woodhouse Sherry MD, Tamir Hadassah* MD, Weiss Eric G. MD, Nogueras Juan J. MD, Wexner Steven D. MD. Depts. of Colorectal Surgery, #Research Laboratory and Pathology, Cleveland Clinic Florida, Fort Lauderdale, Florida and *Division of Neuroscience, New York State Psychiatric Institute, New York, NY. Aim: To investigate the expression of SR in the left colon of patients with CI as compared to controls. Methods: 16 patients who underwent subtotal colectomy for CI were assessed. Colonic transit time was measured with a radiopaque marker technique and presented as the number of retained markers in the colon on day 5. The control group consisted of 18 patients who underwent left hemicolectomy for colonic carcinoma. Formalin-fixed, paraffin-embedded, histologically normal tissues from the left colon were used. Immunohistochemical staining of SR was performed on 4m tissue sections with rabbit anti-idiotypic antibodies to SRs, biotinylated secondary antibody and enzyme-labeled-streptavidin. The average positive area (square pixel) in mucosa (MU), muscular propria (MM), submucosa (SM), circular and longitudinal muscles (CM and LM) per microscopic field (63⫻) was calculated based on measuring the positively stained area in 15–20 randomly chosen microscopic fields in each related structure. A computer image analysis system (Scion Image) was used for analysis. Results: SR protein was mainly detected in the MM, CM, and LM, rarely in MU and SM. In MM and CM, the positive areas were significantly lower