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Endoscopic balloon dilation for benign esophageal anastomotic stricture
Gastrointestinal Oncology A657
April 1998 G2707
MUTATIONS OF p53 T U M O R SUPPRESSOR GENE OF GASTRIC TISSUE IN HELICOBACTER PYLORI LONG-TERM INFECTED JAPANESE MONKEYS. T.Oda 1), A.Nishizono:), R.Kodama1), K.Kohno2), K.Mifune2), T.Fujioka l), M.NasuU, 1)Second Department of Internal Medicine and 2)Department of Microbiology, Oita Medical University, Oita; Japan Background:Although it has been demonstrated that long-term Helicobacter pylori (H.pylori) infection may increase the risk of developing gastric carcinoma, there is no direct evidence of this phenomenon. In this study, we examined the presence of p53 tumor suppressor gene mutation in gastric tissue of H.pylori -infected Japanese monkeys and aimed to investigate the relationship between long-term infection of H.pylori and gastric carcinogenesis. Materials and Methods: In the present study, we analysed the mutation of p53 gene in 3 Japanese monkeys which infected with H.pylori persistently over 6 years. Original p53 sequences were determined by the amplification of p53 exon 5 to 8 region using 2 uninfected monkeys. DNAs were obtained from gastric biopsy specimens. Determination of nucleotide sequence of exon 5 to 8 were performed by PCR and the amplified products were subclonal into PGEM-Tvector. DNA sequencing were performed by dideoxy termination method using DNA sequencer(ABI-373A). Results: At six years after inoculation of H.pylori, number of nucleotide(amino-acid)substitutions, degree of atrophy in gastric mucosa, and intensity of p53 immunostaining were summarized as follows: Exp. number of monkey 1 2 3 control (2)
Number of nucleotide (aminoacid) substitution in p53 Atrophy p53 immunostaining EX5 Ex6 Ex7 Ex8 5 (1) 3 (2) 0 1 (1) severe + 1 (0) 0 1 (1) 0 moderate + 0 0 0 0 mild + non
Conclusion: It demonstrated that several point mutations increased as the degree of atrophy in gastric mucosa. Analysis of sequential mutation in p53 gene in experimental Japanese monkey might be useful for the details of gastric carcinogenesis. G2708
ENDOSCOPIC BALLOON DILATION FOR BENIGN ESOPHAGEAL ANASTOMOTIC STRICTURE, T. Oeawa. S. Ohwada, I. Takeyoshi, Y. Tanahashi, Y. Kawashima, T. Ohya, K. Kawashima, S. Kawate, T. Yamada, Y. Nakasone, M. Aiba, T. Koyama, Y. Morishita. Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan Object: Anastomotic stricture is a serious and troublesome complication following gastrointestinal surgery. We have chosen balloon dilation for benign anastomotic stricture. The purpose of this study is to describe our experience and decide indication of balloon dilation for stricture. Materials and Methods: From 1981 to 1996, esophageal anastomoses were performed in 510 patients at our hospital. During the period, 35 (6.9%) patients were enrolled for the treatment of stricture with endoscopic balloon dilation. Follow-up period ranged from 15 to 130 months (mean, 51). Anastomotic stricture had developed between 3-57 weeks (median, 8) after operation. Rigiflex balloon and TI'S balloon (Microvasive, MA) were applied. Results: A total of 245 dilations were performed in these 35 patients and it was effective in 29 (83%). The balloon dilation was effective in all 17 patients with lower esophageal stricture and in 12 (67%) of 18 patients with cervical stricture. The balloon dilation was effective in all 21 patients constructed with stapler and in 8 (57%) of 14 patients with hand-sewn. The balloon dilation was effective in 24 (92%) of 26 patients without preceding leakage and in 5 (56%) of 9 patients with preceding leakage. The mean length of stricture in effective patients was 5.4 mm (range, 3~12), and was 30.8 mm (15-50) in non effective patients. There was a significant difference (p<0.01) in the length of stricture between the two groups. On the other hand, there's no significant difference in the diameter of stricture between the two groups. The mean length of stricture in cervical stricture was significantly (p<0.01) longer than that in lower stricture. The mean length of stricture constructed with handsewn was significantly (p<0.01) longer than that with stapler. The mean length of stricture with preceding leakage was significantly (p<0.01) longer than that without preceding leakage. The average dilation time was 4.4 (range, 1~11) in effective patients. Balloon dilation times correlated significantly (r=0.59, p<0.05) with the length, but not with the diameter of stricture. No serious complications such as massive bleeding or perforation were encountered. Conclusion: Balloon dilation is a safe, effective and easy therapeutic procedure for esophageal anastomotic stricture. The effectiveness is concerned in the length, but not in the diameter of stricture. Balloon dilation may successfully perform for stricture of less than 12 mm in length.
• G2709 JEJUNAL POUCH INTERPOSITION AFTER PYLORUS-PRF~ERVING GASTRECTOMY WITH VAGUS NERVE PRESERVATION. T. Ohya, S. Ohwada, H. Iesato*, L Takeyoshi, Y. Kawashima, T. Ogawa, I. Kobayashi, K. Kawashima, T. Ynkomori* and Y. Morishita. Second Department of Surgery, Gunma University School of Medicine, Department of Surgery, Ojiya General Hospital* Objective: In order to improve the quality of life of patients undergoing
gastrectomy for early gastric cancer, pylorus-preserving gastrectomy with nerve preservation and jejunal pouch interposition was performed in 11 patients. We report the operative technique in detail and outcomes. Methods: Pylorus-preserving gastrectomy with lymph node dissection was performed with preservation of the hepatic branch, pyloric branch and celiac branch of the vagus nerve. The jejunum was cut approximately 20cm distal to the ligament of Treitz. Marginal vessels were not divided to preserve the nerves in 44cm of the distal jujunum that would be used for pouch construction. A linear stapler (Endo GIA®, United States Surgical Corp., Norwalk., Conn.) was used to perform side-to,side jejunojejunostomy. With two firings of the stapler, a 12cm-long pouch was formed. The pouch was interposed between the residual stomachs with twoqayers of suture. Intestinal continuity was re-established with an end-to-end jejunojejunostomy Results: None of patients encountered postoperative complications due to pouch construction. No discomforts such as dumping, stagnation or reflux esophagitis were also observed. Six months after surgery, the average diet volume and body weight of patients had gradually increased to 75% and 89% preoperative levels, respectively. A dual phase, dual isotope radionucleid pouch emptying study was performed six months after surgery. RI retention rate combined with the intrapouch and residual stomach was 47% for liquid food and 77% for solid food 120min after intake. The emptying rate was slower in both solid and liquid foods compared with healthy individuals. Conclusions: The pouch emptying test demonstrated a satisfactory retention capacity and an acceptable emptying time as a gastric substitute. A reasonably good quality of life may be obtained in patients undergoing pyloruspreserving gastrectomy with nerve preservation and jejunal pouch interposition. G2710
CLINICAL FEATURES OF LARGE SESSILE COLORECTAL POLYPS WITH A NODULE-AGGREGATED APPEARANCE. M Okamoto. Y Yamaji, J Kato, T Ikenoue, M Takahashi, H Yoshida, T Kawabe, Y Shiratori and M Omata. Second Department of Internal Medicine, University of Tokyo BACKGROUND: Some of large sessile colorectal polyps appear to consist of aggregated small nodules, often called a lateral spreading tumor (LST) in Japan. This type of polyps is relatively rare and little is known about their clinical features. In the present study, we investigated them in the consecutive patients undergoing total colonoscopy. PATIENTS AND METHODS: From September 1995 to October 1997, we have performed total colonoscopy in 2228 patients consecutively (1554 males and 674 females, mean age 62 years old(range 11 to 93)). Polys smaller than 1 cm in diameter or protruding polyps were excluded from LST. RESULTS: Fouty-five LSTs were found in 41 patients (1.8%). They were pathologilcally tubular adenomas in 23, tubulovillus adenomas in 15 and adenomas contaning focal cancer in 7. Seven of LSTs were located at the rectum (16%), 5 at the sigmoid colon (11%), 4 at the descending colon (9%), 5 at the transverse colon (11%), 10 at the ascending colon (22%), and 14 at the ceacum (31%). Among the 528 patients of the age older than 70 years (the older group), LSTs were found in 3.2% (17 patients). Among the remaining 1700 patients younger than 69 years old (the younger group), they were found in 1.4% (24 patients). LSTs in the older group was multiple in 23% (4/17), in contrast to 0% in the younger group.In the older group, LSTs contained focal cancer in 24% (5/21), in contrast to 8% (2•24) in the younger group (p<0.05). CONCLUSION: LSTs were more frequently found in the older patients, and located at the ascending colon and the cecum. And LSTs in the older patients showed a tendency to be multiple and contain focal cancer.
April 1998 G2707
MUTATIONS OF p53 T U M O R SUPPRESSOR GENE OF GASTRIC TISSUE IN HELICOBACTER PYLORI LONG-TERM INFECTED JAPANESE MONKEYS. T.Oda 1), A.Nishizono:), R.Kodama1), K.Kohno2), K.Mifune2), T.Fujioka l), M.NasuU, 1)Second Department of Internal Medicine and 2)Department of Microbiology, Oita Medical University, Oita; Japan Background:Although it has been demonstrated that long-term Helicobacter pylori (H.pylori) infection may increase the risk of developing gastric carcinoma, there is no direct evidence of this phenomenon. In this study, we examined the presence of p53 tumor suppressor gene mutation in gastric tissue of H.pylori -infected Japanese monkeys and aimed to investigate the relationship between long-term infection of H.pylori and gastric carcinogenesis. Materials and Methods: In the present study, we analysed the mutation of p53 gene in 3 Japanese monkeys which infected with H.pylori persistently over 6 years. Original p53 sequences were determined by the amplification of p53 exon 5 to 8 region using 2 uninfected monkeys. DNAs were obtained from gastric biopsy specimens. Determination of nucleotide sequence of exon 5 to 8 were performed by PCR and the amplified products were subclonal into PGEM-Tvector. DNA sequencing were performed by dideoxy termination method using DNA sequencer(ABI-373A). Results: At six years after inoculation of H.pylori, number of nucleotide(amino-acid)substitutions, degree of atrophy in gastric mucosa, and intensity of p53 immunostaining were summarized as follows: Exp. number of monkey 1 2 3 control (2)
Number of nucleotide (aminoacid) substitution in p53 Atrophy p53 immunostaining EX5 Ex6 Ex7 Ex8 5 (1) 3 (2) 0 1 (1) severe + 1 (0) 0 1 (1) 0 moderate + 0 0 0 0 mild + non
Conclusion: It demonstrated that several point mutations increased as the degree of atrophy in gastric mucosa. Analysis of sequential mutation in p53 gene in experimental Japanese monkey might be useful for the details of gastric carcinogenesis. G2708
ENDOSCOPIC BALLOON DILATION FOR BENIGN ESOPHAGEAL ANASTOMOTIC STRICTURE, T. Oeawa. S. Ohwada, I. Takeyoshi, Y. Tanahashi, Y. Kawashima, T. Ohya, K. Kawashima, S. Kawate, T. Yamada, Y. Nakasone, M. Aiba, T. Koyama, Y. Morishita. Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan Object: Anastomotic stricture is a serious and troublesome complication following gastrointestinal surgery. We have chosen balloon dilation for benign anastomotic stricture. The purpose of this study is to describe our experience and decide indication of balloon dilation for stricture. Materials and Methods: From 1981 to 1996, esophageal anastomoses were performed in 510 patients at our hospital. During the period, 35 (6.9%) patients were enrolled for the treatment of stricture with endoscopic balloon dilation. Follow-up period ranged from 15 to 130 months (mean, 51). Anastomotic stricture had developed between 3-57 weeks (median, 8) after operation. Rigiflex balloon and TI'S balloon (Microvasive, MA) were applied. Results: A total of 245 dilations were performed in these 35 patients and it was effective in 29 (83%). The balloon dilation was effective in all 17 patients with lower esophageal stricture and in 12 (67%) of 18 patients with cervical stricture. The balloon dilation was effective in all 21 patients constructed with stapler and in 8 (57%) of 14 patients with hand-sewn. The balloon dilation was effective in 24 (92%) of 26 patients without preceding leakage and in 5 (56%) of 9 patients with preceding leakage. The mean length of stricture in effective patients was 5.4 mm (range, 3~12), and was 30.8 mm (15-50) in non effective patients. There was a significant difference (p<0.01) in the length of stricture between the two groups. On the other hand, there's no significant difference in the diameter of stricture between the two groups. The mean length of stricture in cervical stricture was significantly (p<0.01) longer than that in lower stricture. The mean length of stricture constructed with handsewn was significantly (p<0.01) longer than that with stapler. The mean length of stricture with preceding leakage was significantly (p<0.01) longer than that without preceding leakage. The average dilation time was 4.4 (range, 1~11) in effective patients. Balloon dilation times correlated significantly (r=0.59, p<0.05) with the length, but not with the diameter of stricture. No serious complications such as massive bleeding or perforation were encountered. Conclusion: Balloon dilation is a safe, effective and easy therapeutic procedure for esophageal anastomotic stricture. The effectiveness is concerned in the length, but not in the diameter of stricture. Balloon dilation may successfully perform for stricture of less than 12 mm in length.
• G2709 JEJUNAL POUCH INTERPOSITION AFTER PYLORUS-PRF~ERVING GASTRECTOMY WITH VAGUS NERVE PRESERVATION. T. Ohya, S. Ohwada, H. Iesato*, L Takeyoshi, Y. Kawashima, T. Ogawa, I. Kobayashi, K. Kawashima, T. Ynkomori* and Y. Morishita. Second Department of Surgery, Gunma University School of Medicine, Department of Surgery, Ojiya General Hospital* Objective: In order to improve the quality of life of patients undergoing
gastrectomy for early gastric cancer, pylorus-preserving gastrectomy with nerve preservation and jejunal pouch interposition was performed in 11 patients. We report the operative technique in detail and outcomes. Methods: Pylorus-preserving gastrectomy with lymph node dissection was performed with preservation of the hepatic branch, pyloric branch and celiac branch of the vagus nerve. The jejunum was cut approximately 20cm distal to the ligament of Treitz. Marginal vessels were not divided to preserve the nerves in 44cm of the distal jujunum that would be used for pouch construction. A linear stapler (Endo GIA®, United States Surgical Corp., Norwalk., Conn.) was used to perform side-to,side jejunojejunostomy. With two firings of the stapler, a 12cm-long pouch was formed. The pouch was interposed between the residual stomachs with twoqayers of suture. Intestinal continuity was re-established with an end-to-end jejunojejunostomy Results: None of patients encountered postoperative complications due to pouch construction. No discomforts such as dumping, stagnation or reflux esophagitis were also observed. Six months after surgery, the average diet volume and body weight of patients had gradually increased to 75% and 89% preoperative levels, respectively. A dual phase, dual isotope radionucleid pouch emptying study was performed six months after surgery. RI retention rate combined with the intrapouch and residual stomach was 47% for liquid food and 77% for solid food 120min after intake. The emptying rate was slower in both solid and liquid foods compared with healthy individuals. Conclusions: The pouch emptying test demonstrated a satisfactory retention capacity and an acceptable emptying time as a gastric substitute. A reasonably good quality of life may be obtained in patients undergoing pyloruspreserving gastrectomy with nerve preservation and jejunal pouch interposition. G2710
CLINICAL FEATURES OF LARGE SESSILE COLORECTAL POLYPS WITH A NODULE-AGGREGATED APPEARANCE. M Okamoto. Y Yamaji, J Kato, T Ikenoue, M Takahashi, H Yoshida, T Kawabe, Y Shiratori and M Omata. Second Department of Internal Medicine, University of Tokyo BACKGROUND: Some of large sessile colorectal polyps appear to consist of aggregated small nodules, often called a lateral spreading tumor (LST) in Japan. This type of polyps is relatively rare and little is known about their clinical features. In the present study, we investigated them in the consecutive patients undergoing total colonoscopy. PATIENTS AND METHODS: From September 1995 to October 1997, we have performed total colonoscopy in 2228 patients consecutively (1554 males and 674 females, mean age 62 years old(range 11 to 93)). Polys smaller than 1 cm in diameter or protruding polyps were excluded from LST. RESULTS: Fouty-five LSTs were found in 41 patients (1.8%). They were pathologilcally tubular adenomas in 23, tubulovillus adenomas in 15 and adenomas contaning focal cancer in 7. Seven of LSTs were located at the rectum (16%), 5 at the sigmoid colon (11%), 4 at the descending colon (9%), 5 at the transverse colon (11%), 10 at the ascending colon (22%), and 14 at the ceacum (31%). Among the 528 patients of the age older than 70 years (the older group), LSTs were found in 3.2% (17 patients). Among the remaining 1700 patients younger than 69 years old (the younger group), they were found in 1.4% (24 patients). LSTs in the older group was multiple in 23% (4/17), in contrast to 0% in the younger group.In the older group, LSTs contained focal cancer in 24% (5/21), in contrast to 8% (2•24) in the younger group (p<0.05). CONCLUSION: LSTs were more frequently found in the older patients, and located at the ascending colon and the cecum. And LSTs in the older patients showed a tendency to be multiple and contain focal cancer.