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Autofluorescence Endoscopy (AF) and Narrow Band Imaging (NBI) in Gastric Ulcers - Is Prediction of Malignancy Possible?
Abstracts
M1312 The Effect of Helicobacter Pylori Eradication in Benign Gastric Polyps Seung Hyun Jung, Euyi Hyeog Im, Yong Moon Kim, Sun Moon Kim, Tae Hee Lee, Kyu Chan Huh, Young Woo Choi, Young Woo Kang
M1314 Predictive Factors for Lymph Node Metastasis and Endoscopic Treatment Strategy for Undifferentiated Early Gastric Cancer Byong Duk Ye, Sang Gyun Kim, Joo Sung Kim, Han-Kwang Yang, Woo Ho Kim, Hyun Chae Jung, Kuhn Uk Lee, in Sung Song
Background/Aims: Evidences indicate that eradication of Helicobacter pylori leads to the disappearance of hyperplastic polyps in the stomach. However, there are limited data on efficacy for H. pylori eradication for benign gastric polyps in Korea. Methods: We prospectively studied 66 patients with benign gastric polyps. 22 patients have H. pylori infection and endoscopic follow up. 11 Patients with H. pylori infection received a 7 days regimen of proton pump inhibitor, amoxacillin and clarithromycin. Other 11 patients did not take a medication. In both groups, we underwent follow up endoscopy at 3, 6 and 12 month and estimated the size of gastric polyps and serum gastrin level. Results: After H. pylori eradicatrion, gastric polyps were regressed in 90.9%. In regular follow up group, gastric polyps were regressed in 54.5%. The average size of gastric polyps was decreased from 4.18 mm to 1.59 mm (p ! 0.05) in H.pylori eradication group. In regular follow group, it were decreased from 5.77 mm to 4.22 mm, but these results didn’t have significance statistically. The mean serum gastrin level were 126 pg/ml in H. pylori eradication group and 61 pg/ml in regular follow group. In both groups, the mean serum gastrin level were decreased. But, there was no significance statistically. H. pylori was successfully eradicated in 9 of 11 patients (82%). In successful H. pylori eradicated patients, the regression rate of gastric polyps was 100% and the patients failed eradication of H. pylori had low regression rate (50%). But, there was no significance statistically. Conclusions: Many benign gastric polyps disappeared or regressed after eradication of H. pylori.
Background and Aims: Although more than 80% of undifferentiated early gastric cancer (EGC) i.e., poorly differentiated adenocarcinoma, signet ring cell carcinoma and mucinous adenocarcinoma are not associated with lymph node metastasis, endoscopic mucosal resection (EMR) has not been generally accepted as the means of curative treatment for this histologic type because of much conflicting clinicopathological characteristics and prognosis. The aim of this study was to define the subgroup of undifferentiated EGC that could be cured by endoscopic treatment without the risk of lymph node metastasis. Patients and Methods: A total of 591 patients surgically resected for undifferentiated EGC at Seoul National University Hospital between January 1999 and March 2005 were retrospectively reviewed. Clinicopathological factors were analyzed to identify predictive factors for lymph node metastasis.Results: Lymph node metastasis was found in 79 patients (13.4%). In multivariate logistic regression analysis, tumor diameter 2.5 cm or larger, invasion to middle third of submucosal layer (sm2) or deeper and lymphatic involvement were independent risk factors for lymph node metastasis (p ! 0.001, respectively). Lymph node metastasis was not found in any patients with undifferentiated EGC of small size (!2.5 cm) which was confined to mucosa or upper third of submucosal layer (sm1) without lymphatic involvement. Conclusion: Small undifferentiated EGC less than 2.5 cm which was confined to mucosa or sm1 without lymphatic involvement was not associated with lymph node metastasis, and EMR could be considered as a definite treatment without compromising the possibility of cure. Further investigations are also needed for long-term prognosis and survival after endoscopic treatment compared with surgical resection.
M1313 Autofluorescence Endoscopy (AF) and Narrow Band Imaging (NBI) in Gastric Ulcers - Is Prediction of Malignancy Possible? Andreas Probst, Maximilian Bittinger, Thomas Eberl, Gertrud Jechart, Reinhard Scheubel, Helmut Messmann Despite benign endoscopic appearance up to 5% of gastric ulcers are shown to be malignant in histology. Recently autofluorescence and narrow band imaging have been developed as new endoscopic techniques to differentiate benign from malignant lesions in vivo (‘‘virtual biopsy’’). Aim: To evaluate the diagnostic value of AF and NBI in the differentiation of benign and malignant gastric ulcers. Methods: We examined 25 ulcers of unknown histology in 23 patients prospectively with AF and NBI (XGIF-Q240FZ; prototype, Olympus); additionally biopsies were taken. Images were recorded and evaluated by an experienced endoscopist at the end of the study. AF images were classified as ‘‘normal AF’’ (green appearance) or ‘‘abnormal AF’’ (violet appearance) for the base and margin of the ulcer. NBI patterns were classified as ‘‘regular’’ and ‘‘irregular’’ for the base and margin of the ulcer. The findings were correlated with histology. Results: Histologic examination revealed peptic ulcers (n Z 20), adenocarcinoma (n Z 3), signet ring cell carcinoma (n Z 1) and lymphoma (n Z 1). AF was found to be ‘‘abnormal’’ in each ulcer base but only in the ulcer margin of the ulcers showing adenocarcinoma. A ‘‘regular’’ NBI pattern could be seen in the margin of all benign ulcers but also in the signet ring cell carcinoma an the lymphoma. NBI findings were classified ‘‘irregular’’ in the ulcer base of all adenocarcinomas and also in the signet ring cell carcinoma. Benign ulcers but also the lymphoma showed ‘‘regular’’ NBI patterns in the base. Conclusions: AF and NBI findings can be helpful in the differentiation of benign and malignant gastric ulcers in vivo. Abnormal autofluoresecence in the ulcer margin and irregular NBI patterns in the ulcer ground are highly suggestive of malignancy. The sensitivity of such findings is limited.
Prediction of malignancy of gastric ulcers abnormal AF in ulcer margin irregular NBI in ulcer base abnormal AF in margin and irregular NBI in base
www.giejournal.org
Sensitivity
Specificity
positive predictive value
60% 80% 60%
100% 100% 100%
100% 100% 100%
negative predictive value 90,9% 95,2% 90,9%
M1315 Comparison of the Hemostatic Effect of Argon Plasma Coagulation and Heat Probe Coagulation for Peptic Ulcer Bleeding: A Prospective Randomized Trial Song Sung Wook, Baik Gwang Ho, Kim Jin Bong, Kim Dong Joon, Kim Tae Hoon Bleeding is a serious complication of peptic ulcer. Emergency endoscopy is the most effective diagnostic and therapeutic method in peptic hemorrhage. Endoscopic heat probe coagulation and argon plasma coagulation are considered to be safe and effective in the treatment of bleeding peptic ulcer. The aim of this study was to evaluate the efficacy and safety of argon plasma coagulation and heater probe coagulation in bleeding peptic ulcer. Method: From May 2004 to October 2005 we conducted a prospective randomized trial in 48 patients with peptic ulcer bleeding, in whom a visible vessel or active bleeding was identified. Patients were randomized into two groups, an APC group comprising 24 patients who received argon plasma coagulation (ERBEÒ, SoeringÒ) and an HP group, comprising 24 patients who received heat probe coagulation(Injection gold probeTM Bipola hemostasis catheters). The bleeding activity was determined according to the Forrest classification. Result: There were no significant differences between the study groups in terms of age, risk factors, initial hemoglobin values, number of patients showing signs of hemodynamic impairment, ulcer location, or bleeding activity. The initial hemostatic rate was 91.7% in the APC group, and 100% in the heat probe group (P Z 0.149). After successful initial endoscopic treatment, rebleeding was observed in 2 cases of APC group and 2 cases of heat probe coagulation group, respectively (not significant). Both rebleeding cases were controlled successfully by endoscopic treatment modality. Mean number of hospital days and percentage needing surgery were comparable in both groups. Conclusions: Argon plasma coagulation and heat probe coagulation are equally effective in control of bleeding from peptic ulcer.
Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB169
M1312 The Effect of Helicobacter Pylori Eradication in Benign Gastric Polyps Seung Hyun Jung, Euyi Hyeog Im, Yong Moon Kim, Sun Moon Kim, Tae Hee Lee, Kyu Chan Huh, Young Woo Choi, Young Woo Kang
M1314 Predictive Factors for Lymph Node Metastasis and Endoscopic Treatment Strategy for Undifferentiated Early Gastric Cancer Byong Duk Ye, Sang Gyun Kim, Joo Sung Kim, Han-Kwang Yang, Woo Ho Kim, Hyun Chae Jung, Kuhn Uk Lee, in Sung Song
Background/Aims: Evidences indicate that eradication of Helicobacter pylori leads to the disappearance of hyperplastic polyps in the stomach. However, there are limited data on efficacy for H. pylori eradication for benign gastric polyps in Korea. Methods: We prospectively studied 66 patients with benign gastric polyps. 22 patients have H. pylori infection and endoscopic follow up. 11 Patients with H. pylori infection received a 7 days regimen of proton pump inhibitor, amoxacillin and clarithromycin. Other 11 patients did not take a medication. In both groups, we underwent follow up endoscopy at 3, 6 and 12 month and estimated the size of gastric polyps and serum gastrin level. Results: After H. pylori eradicatrion, gastric polyps were regressed in 90.9%. In regular follow up group, gastric polyps were regressed in 54.5%. The average size of gastric polyps was decreased from 4.18 mm to 1.59 mm (p ! 0.05) in H.pylori eradication group. In regular follow group, it were decreased from 5.77 mm to 4.22 mm, but these results didn’t have significance statistically. The mean serum gastrin level were 126 pg/ml in H. pylori eradication group and 61 pg/ml in regular follow group. In both groups, the mean serum gastrin level were decreased. But, there was no significance statistically. H. pylori was successfully eradicated in 9 of 11 patients (82%). In successful H. pylori eradicated patients, the regression rate of gastric polyps was 100% and the patients failed eradication of H. pylori had low regression rate (50%). But, there was no significance statistically. Conclusions: Many benign gastric polyps disappeared or regressed after eradication of H. pylori.
Background and Aims: Although more than 80% of undifferentiated early gastric cancer (EGC) i.e., poorly differentiated adenocarcinoma, signet ring cell carcinoma and mucinous adenocarcinoma are not associated with lymph node metastasis, endoscopic mucosal resection (EMR) has not been generally accepted as the means of curative treatment for this histologic type because of much conflicting clinicopathological characteristics and prognosis. The aim of this study was to define the subgroup of undifferentiated EGC that could be cured by endoscopic treatment without the risk of lymph node metastasis. Patients and Methods: A total of 591 patients surgically resected for undifferentiated EGC at Seoul National University Hospital between January 1999 and March 2005 were retrospectively reviewed. Clinicopathological factors were analyzed to identify predictive factors for lymph node metastasis.Results: Lymph node metastasis was found in 79 patients (13.4%). In multivariate logistic regression analysis, tumor diameter 2.5 cm or larger, invasion to middle third of submucosal layer (sm2) or deeper and lymphatic involvement were independent risk factors for lymph node metastasis (p ! 0.001, respectively). Lymph node metastasis was not found in any patients with undifferentiated EGC of small size (!2.5 cm) which was confined to mucosa or upper third of submucosal layer (sm1) without lymphatic involvement. Conclusion: Small undifferentiated EGC less than 2.5 cm which was confined to mucosa or sm1 without lymphatic involvement was not associated with lymph node metastasis, and EMR could be considered as a definite treatment without compromising the possibility of cure. Further investigations are also needed for long-term prognosis and survival after endoscopic treatment compared with surgical resection.
M1313 Autofluorescence Endoscopy (AF) and Narrow Band Imaging (NBI) in Gastric Ulcers - Is Prediction of Malignancy Possible? Andreas Probst, Maximilian Bittinger, Thomas Eberl, Gertrud Jechart, Reinhard Scheubel, Helmut Messmann Despite benign endoscopic appearance up to 5% of gastric ulcers are shown to be malignant in histology. Recently autofluorescence and narrow band imaging have been developed as new endoscopic techniques to differentiate benign from malignant lesions in vivo (‘‘virtual biopsy’’). Aim: To evaluate the diagnostic value of AF and NBI in the differentiation of benign and malignant gastric ulcers. Methods: We examined 25 ulcers of unknown histology in 23 patients prospectively with AF and NBI (XGIF-Q240FZ; prototype, Olympus); additionally biopsies were taken. Images were recorded and evaluated by an experienced endoscopist at the end of the study. AF images were classified as ‘‘normal AF’’ (green appearance) or ‘‘abnormal AF’’ (violet appearance) for the base and margin of the ulcer. NBI patterns were classified as ‘‘regular’’ and ‘‘irregular’’ for the base and margin of the ulcer. The findings were correlated with histology. Results: Histologic examination revealed peptic ulcers (n Z 20), adenocarcinoma (n Z 3), signet ring cell carcinoma (n Z 1) and lymphoma (n Z 1). AF was found to be ‘‘abnormal’’ in each ulcer base but only in the ulcer margin of the ulcers showing adenocarcinoma. A ‘‘regular’’ NBI pattern could be seen in the margin of all benign ulcers but also in the signet ring cell carcinoma an the lymphoma. NBI findings were classified ‘‘irregular’’ in the ulcer base of all adenocarcinomas and also in the signet ring cell carcinoma. Benign ulcers but also the lymphoma showed ‘‘regular’’ NBI patterns in the base. Conclusions: AF and NBI findings can be helpful in the differentiation of benign and malignant gastric ulcers in vivo. Abnormal autofluoresecence in the ulcer margin and irregular NBI patterns in the ulcer ground are highly suggestive of malignancy. The sensitivity of such findings is limited.
Prediction of malignancy of gastric ulcers abnormal AF in ulcer margin irregular NBI in ulcer base abnormal AF in margin and irregular NBI in base
www.giejournal.org
Sensitivity
Specificity
positive predictive value
60% 80% 60%
100% 100% 100%
100% 100% 100%
negative predictive value 90,9% 95,2% 90,9%
M1315 Comparison of the Hemostatic Effect of Argon Plasma Coagulation and Heat Probe Coagulation for Peptic Ulcer Bleeding: A Prospective Randomized Trial Song Sung Wook, Baik Gwang Ho, Kim Jin Bong, Kim Dong Joon, Kim Tae Hoon Bleeding is a serious complication of peptic ulcer. Emergency endoscopy is the most effective diagnostic and therapeutic method in peptic hemorrhage. Endoscopic heat probe coagulation and argon plasma coagulation are considered to be safe and effective in the treatment of bleeding peptic ulcer. The aim of this study was to evaluate the efficacy and safety of argon plasma coagulation and heater probe coagulation in bleeding peptic ulcer. Method: From May 2004 to October 2005 we conducted a prospective randomized trial in 48 patients with peptic ulcer bleeding, in whom a visible vessel or active bleeding was identified. Patients were randomized into two groups, an APC group comprising 24 patients who received argon plasma coagulation (ERBEÒ, SoeringÒ) and an HP group, comprising 24 patients who received heat probe coagulation(Injection gold probeTM Bipola hemostasis catheters). The bleeding activity was determined according to the Forrest classification. Result: There were no significant differences between the study groups in terms of age, risk factors, initial hemoglobin values, number of patients showing signs of hemodynamic impairment, ulcer location, or bleeding activity. The initial hemostatic rate was 91.7% in the APC group, and 100% in the heat probe group (P Z 0.149). After successful initial endoscopic treatment, rebleeding was observed in 2 cases of APC group and 2 cases of heat probe coagulation group, respectively (not significant). Both rebleeding cases were controlled successfully by endoscopic treatment modality. Mean number of hospital days and percentage needing surgery were comparable in both groups. Conclusions: Argon plasma coagulation and heat probe coagulation are equally effective in control of bleeding from peptic ulcer.
Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB169