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Genotypical variation of H. pylori isolated from gastric antrum and body
AGAA457
April 2000
2500 RESULTS OF ENDOSCOPIC VERSUS OPERATIVE MANAGEMENT OF BENIGN TUMORS OF THE AMPULLA OF VATER. Christina Schleicher, Mario Colombo-Benkmann, Heiner Wolters, Dirk Tuebergen, Josef Konturek, Norbert Senninger, Dept of Gen Surg, Muenster, Germany; Dept of Medicine B, Muenster, Germany. Introduction: Since adenomas of the ampulla of Vater are regarded as premalignant lesions, complete removal of these tumors is recommended. The different therapeutic options of ampullary tumors include endoscopic excision (EE) and transduodenal resection of the papilla (TRP). The application of both is discussed controversially. The objective of this study was the evaluation of EE and TRP regarding postinterventional morbidity and recurrences. Patients and Methods: From 1993 until 1998, 36 patients with ampullary tumors were analysed retrospectively. Nineteen patients (12 female! 7 male, mean age 61:±: 11,8 [38-82)) were treated by EE (group A), 17 patients (9 female! 8 male; mean age 55:±: 13,3 [30-73)) underwent TRP (group B). In group B, prior to the transduodenal excision of the papilla, endoscopic biopsy revealed mild to moderate dysplasia (n = 10), severe dysplasia (n=3) and chronic papillitis (n=4). The patients were followed for a mean of 15,8:±:20 and 14:±:11,3 months (pO.05), respectively. Results: The histology of specimens from group A showed mild to moderate dysplasia (n= 12), severe dysplasia (n=5), adenomyoma (n=2) and carcinoma of the papilla (n= 1). Besides post-papillectomy bleeding in two patients, no other complications occurred. The resulting morbidity was 10,5 %. Nine patients (47,4 %) had recurrences, in one patient histology showed incomplete resection of the adenoma. Further management of the recurrences included repeated EE (n=3), TRP (n= 1), Whipple s procedure (n=2) and endoscopic controls including biopsy (n=3). Histologic examination in group B revealed mild to moderate dysplasia (n=7), papillitis (n=5), adenomyoma (n=2) and fibrosis of the papilla (n=3). One patient developed incisional hernia one and stenosis of the neo-papilla. The morbidity was 11,7 %. Recurrences did not occur after TRP, thus the recurrence rate in group B was significantly lower than in group A (p<0,05). Conclusion: The results indicate that tumors of the ampulla of Vater should preferably be treated by TRP, since morbidity of the procedure is comparable to that of EE, while recurrences and consecutive reinterventions are significantly less after operative treatment of the premalignant lesions. Thus TRP is more effective regarding cure of ampullary tumors than EE.
2501 GENOTYPICAL VARIATION OF H. PYLORI ISOLATED FROM GASTRIC ANTRUM AND BODY. Bo R. Son, Kyeong S. Shin, Won C. Woo, Seok-Yong Kim, Chungbuk National Univ, Cheongju, South Korea. Background: Although most infected persons harbor a single H. pylori strain, 0-20% of persons have multiple strains in western countries. The prevalence of different strain colonization has been rarely reported in regions of prevalent H. pylori infection like Korea. The aims of this study were to determine the prevalence of different strain colonization and to detect cagA, iceAl, and babA2 status of H. pylori, isolated from antrum and body biopsy specimens, in Korea. Materials and Methods: Isolation of H. pylori from stomach antrum and body, was obtained from thirty-five patients (24 males, 11 females; median age 52 years, ranging from 20 84 y). None had taken bismuth, antibiotics, or omeprazole with the previous 6 weeks. DNA patterns of H. pylori were determined by random amplification of polymorphic DNA (RAPD) using 1254 and 1281 primers. The status of cagA, iceAl, and babA2 genes of H. pylori was assessed with polymerase chain reaction. Results: Clearly different DNA patterns were identified among the isolates from 35 individual patients. Nineteen (54.3%) patients had single strain of H. pylori in their stomach. Seven (20.0%) and nine (25.7%) patients have subtypical and typical different strains of H. pylori, respectively. Among the 70 isolates of H. pylori from 35 patients, the positive rates of cagA, iceAl, and babA2 genes 95.7% (67170), 80.0% (56170), and 31.4% (22/66), respectively. In 6 out of 19 patients with single strain, the genetic status of cagA, iceAl, and babA2 varied between isolates of antrum and body. The putative cytotoxic genetic status varied in 6 out of 16 patients with subtypical or typical different strains. Conclusion: The prevalence of coco1onization with typical or subtypical different strains is high in Korea. Also, subclones with differing putative cytotoxic genetic status exist within the strains presenting identical banding patterns.
2502 RESULTS OF CONVENTIONAL ENDOSCOPIC DIAGNOSTICS IN TUMOURS OF VATER'S PAPILLA. A mSTOPATHOLOGI· CAL CONTROLLED STUDY WITH 43 PATIENTS. Michael Vogt, Ralf Jakobs, Claus Benz, Juergen Ferdinand Riemann, Clin Ludwigshafen/Rhein, Acad teaching Hosp, Ludwigshafen, Germany; Clin Ludwigshafen/Rhein, Acad teaching Hosp, Ludwigshafen/Rh, Germany. Background: In suspected tumours of Vater's papilla a correct endoscopicbioptic diagnosis is difficult to obtain because of occult carcinoma in deeper layers. EUS and IDUS may give further information to tumour structure, but do not provide histology. Aim: To find out the best diagnostic strategy by use of conventional endoscopy. Methods: Retrospective analysis of 43 pts. with tumours of Vater's papilla. Recruitment from 19851999. Histopathological results of endoscopic guided biopsies before surgery were compared to surgical resected specimen by use of sensitivity, specificity, positive (PPV) and negative prediction values (NPV). Macro-
scopic presentation of the tumours during ERCP and EGD at first contact and the end of diagnostics were analysed, as well as results of different endoscopic strategies. Results: After surgery we found 31 carcinomas and 12 adenomas of Vater's papilla. Further results are listed in the table below. Conclusion: At beginn correctness and results of endoscopic yieldet biopsies were very poor. They improved after obtaining Re-biopsies before and after EPT. Therefore we yielded nearly the same diagnostic accuracity as EUS and IDUS did in recent reports before. However negative prediction values are still too low to exclude a malignancy for sure. In any concerns regarding the diagnosis a surgical laparotomy is mandatory therefore. Results ofconventional endoscopic procedures compared tosurgical obtained specimen pts. FiP First biopsy Re-biopsy Biopsy after EPT Re·Biopsy afterEPT Final histology FP
43 43 24 21 32 43 43
Sensitivity % Specificity %
35 58 64 50 68 81 93
8 0 100 100 100 100 63
PPV%
NPV%
50 60 100 100 100 100 87
47 0 57 50 59 66 77
EPr=Endoscopic papillotomy, FiP= First endoscopic presentation, FP=Final endoscopic presentation
2503 URGENT ULTRASONOGRAPHY IN THE DETECTION OF CHOLEDOCHOLITHIASIS WITH OR WITHOUT ACUTE CHOLANGITIS. Yung-Hsiang Yeh, Chi-Chieh Yang, Min-Ho Huang, Show-Chwan Hosp, Chang-Hua, Taiwan, ROC. Purpose: We studied the ability of urgent ultrasonography in detecting choledocholithiasis and evaluated factors which influenced the ultrasonic detection rate of common bile duct stones. MATERIALS AND METHODS: From January 1996 to December 1998, 92 patients who recieved urgent ultrasound examination and subsequently proved to be choledocholithiasis were classified into three groups according to the ultrasound findings; Group I (53 patients): common duct dilatation with stones, Group 11(35 patients): common duct dilatation without stone, Group III(4 patients): no duct dilatation and no stone. Common bile duct size and common duct stone size were measured and compared in these three groups of patients. RESULTS: The overall ultrasonic stone detection rate was 57.6%(53/92). The mean common duct diameter in Group I patients was 16.8:±:6.1mm, in Group II patients was 13.6:±:3.5mm, in Group III patients was 6.5:±: 1.0mm (Group I vs II, III, p<0.OO5). The mean ductal stone size was 23.1:±: 12.2mm in Group I patients,13.0:±:5.3mm in Group II patients, 9.0:±:4.5mmin Group III patients (Group I vs II, III, p<0.OOO5). The stone detection rate was 86.4%(32/37) in patients with common duct stone size ~20mm, 44.1%(15/34) in patients with stone size between 1O-19mm, and 19.0%(4/21) in patients with stone size
Patient No.
53 35 4
ceo stone size
Common bileductsize (mm) Mean SO' Range
Mean
(mm) SD'
Range
16.8 13.6b 6.5
23.1' 13.0d 9.0
12.2 5.3 4.5
5-60 5-25 5-16
8
6.1 3.5 0.1
9-34 9-24 6·7
avsb p<0.01, c vsdp
April 2000
2500 RESULTS OF ENDOSCOPIC VERSUS OPERATIVE MANAGEMENT OF BENIGN TUMORS OF THE AMPULLA OF VATER. Christina Schleicher, Mario Colombo-Benkmann, Heiner Wolters, Dirk Tuebergen, Josef Konturek, Norbert Senninger, Dept of Gen Surg, Muenster, Germany; Dept of Medicine B, Muenster, Germany. Introduction: Since adenomas of the ampulla of Vater are regarded as premalignant lesions, complete removal of these tumors is recommended. The different therapeutic options of ampullary tumors include endoscopic excision (EE) and transduodenal resection of the papilla (TRP). The application of both is discussed controversially. The objective of this study was the evaluation of EE and TRP regarding postinterventional morbidity and recurrences. Patients and Methods: From 1993 until 1998, 36 patients with ampullary tumors were analysed retrospectively. Nineteen patients (12 female! 7 male, mean age 61:±: 11,8 [38-82)) were treated by EE (group A), 17 patients (9 female! 8 male; mean age 55:±: 13,3 [30-73)) underwent TRP (group B). In group B, prior to the transduodenal excision of the papilla, endoscopic biopsy revealed mild to moderate dysplasia (n = 10), severe dysplasia (n=3) and chronic papillitis (n=4). The patients were followed for a mean of 15,8:±:20 and 14:±:11,3 months (pO.05), respectively. Results: The histology of specimens from group A showed mild to moderate dysplasia (n= 12), severe dysplasia (n=5), adenomyoma (n=2) and carcinoma of the papilla (n= 1). Besides post-papillectomy bleeding in two patients, no other complications occurred. The resulting morbidity was 10,5 %. Nine patients (47,4 %) had recurrences, in one patient histology showed incomplete resection of the adenoma. Further management of the recurrences included repeated EE (n=3), TRP (n= 1), Whipple s procedure (n=2) and endoscopic controls including biopsy (n=3). Histologic examination in group B revealed mild to moderate dysplasia (n=7), papillitis (n=5), adenomyoma (n=2) and fibrosis of the papilla (n=3). One patient developed incisional hernia one and stenosis of the neo-papilla. The morbidity was 11,7 %. Recurrences did not occur after TRP, thus the recurrence rate in group B was significantly lower than in group A (p<0,05). Conclusion: The results indicate that tumors of the ampulla of Vater should preferably be treated by TRP, since morbidity of the procedure is comparable to that of EE, while recurrences and consecutive reinterventions are significantly less after operative treatment of the premalignant lesions. Thus TRP is more effective regarding cure of ampullary tumors than EE.
2501 GENOTYPICAL VARIATION OF H. PYLORI ISOLATED FROM GASTRIC ANTRUM AND BODY. Bo R. Son, Kyeong S. Shin, Won C. Woo, Seok-Yong Kim, Chungbuk National Univ, Cheongju, South Korea. Background: Although most infected persons harbor a single H. pylori strain, 0-20% of persons have multiple strains in western countries. The prevalence of different strain colonization has been rarely reported in regions of prevalent H. pylori infection like Korea. The aims of this study were to determine the prevalence of different strain colonization and to detect cagA, iceAl, and babA2 status of H. pylori, isolated from antrum and body biopsy specimens, in Korea. Materials and Methods: Isolation of H. pylori from stomach antrum and body, was obtained from thirty-five patients (24 males, 11 females; median age 52 years, ranging from 20 84 y). None had taken bismuth, antibiotics, or omeprazole with the previous 6 weeks. DNA patterns of H. pylori were determined by random amplification of polymorphic DNA (RAPD) using 1254 and 1281 primers. The status of cagA, iceAl, and babA2 genes of H. pylori was assessed with polymerase chain reaction. Results: Clearly different DNA patterns were identified among the isolates from 35 individual patients. Nineteen (54.3%) patients had single strain of H. pylori in their stomach. Seven (20.0%) and nine (25.7%) patients have subtypical and typical different strains of H. pylori, respectively. Among the 70 isolates of H. pylori from 35 patients, the positive rates of cagA, iceAl, and babA2 genes 95.7% (67170), 80.0% (56170), and 31.4% (22/66), respectively. In 6 out of 19 patients with single strain, the genetic status of cagA, iceAl, and babA2 varied between isolates of antrum and body. The putative cytotoxic genetic status varied in 6 out of 16 patients with subtypical or typical different strains. Conclusion: The prevalence of coco1onization with typical or subtypical different strains is high in Korea. Also, subclones with differing putative cytotoxic genetic status exist within the strains presenting identical banding patterns.
2502 RESULTS OF CONVENTIONAL ENDOSCOPIC DIAGNOSTICS IN TUMOURS OF VATER'S PAPILLA. A mSTOPATHOLOGI· CAL CONTROLLED STUDY WITH 43 PATIENTS. Michael Vogt, Ralf Jakobs, Claus Benz, Juergen Ferdinand Riemann, Clin Ludwigshafen/Rhein, Acad teaching Hosp, Ludwigshafen, Germany; Clin Ludwigshafen/Rhein, Acad teaching Hosp, Ludwigshafen/Rh, Germany. Background: In suspected tumours of Vater's papilla a correct endoscopicbioptic diagnosis is difficult to obtain because of occult carcinoma in deeper layers. EUS and IDUS may give further information to tumour structure, but do not provide histology. Aim: To find out the best diagnostic strategy by use of conventional endoscopy. Methods: Retrospective analysis of 43 pts. with tumours of Vater's papilla. Recruitment from 19851999. Histopathological results of endoscopic guided biopsies before surgery were compared to surgical resected specimen by use of sensitivity, specificity, positive (PPV) and negative prediction values (NPV). Macro-
scopic presentation of the tumours during ERCP and EGD at first contact and the end of diagnostics were analysed, as well as results of different endoscopic strategies. Results: After surgery we found 31 carcinomas and 12 adenomas of Vater's papilla. Further results are listed in the table below. Conclusion: At beginn correctness and results of endoscopic yieldet biopsies were very poor. They improved after obtaining Re-biopsies before and after EPT. Therefore we yielded nearly the same diagnostic accuracity as EUS and IDUS did in recent reports before. However negative prediction values are still too low to exclude a malignancy for sure. In any concerns regarding the diagnosis a surgical laparotomy is mandatory therefore. Results ofconventional endoscopic procedures compared tosurgical obtained specimen pts. FiP First biopsy Re-biopsy Biopsy after EPT Re·Biopsy afterEPT Final histology FP
43 43 24 21 32 43 43
Sensitivity % Specificity %
35 58 64 50 68 81 93
8 0 100 100 100 100 63
PPV%
NPV%
50 60 100 100 100 100 87
47 0 57 50 59 66 77
EPr=Endoscopic papillotomy, FiP= First endoscopic presentation, FP=Final endoscopic presentation
2503 URGENT ULTRASONOGRAPHY IN THE DETECTION OF CHOLEDOCHOLITHIASIS WITH OR WITHOUT ACUTE CHOLANGITIS. Yung-Hsiang Yeh, Chi-Chieh Yang, Min-Ho Huang, Show-Chwan Hosp, Chang-Hua, Taiwan, ROC. Purpose: We studied the ability of urgent ultrasonography in detecting choledocholithiasis and evaluated factors which influenced the ultrasonic detection rate of common bile duct stones. MATERIALS AND METHODS: From January 1996 to December 1998, 92 patients who recieved urgent ultrasound examination and subsequently proved to be choledocholithiasis were classified into three groups according to the ultrasound findings; Group I (53 patients): common duct dilatation with stones, Group 11(35 patients): common duct dilatation without stone, Group III(4 patients): no duct dilatation and no stone. Common bile duct size and common duct stone size were measured and compared in these three groups of patients. RESULTS: The overall ultrasonic stone detection rate was 57.6%(53/92). The mean common duct diameter in Group I patients was 16.8:±:6.1mm, in Group II patients was 13.6:±:3.5mm, in Group III patients was 6.5:±: 1.0mm (Group I vs II, III, p<0.OO5). The mean ductal stone size was 23.1:±: 12.2mm in Group I patients,13.0:±:5.3mm in Group II patients, 9.0:±:4.5mmin Group III patients (Group I vs II, III, p<0.OOO5). The stone detection rate was 86.4%(32/37) in patients with common duct stone size ~20mm, 44.1%(15/34) in patients with stone size between 1O-19mm, and 19.0%(4/21) in patients with stone size
Patient No.
53 35 4
ceo stone size
Common bileductsize (mm) Mean SO' Range
Mean
(mm) SD'
Range
16.8 13.6b 6.5
23.1' 13.0d 9.0
12.2 5.3 4.5
5-60 5-25 5-16
8
6.1 3.5 0.1
9-34 9-24 6·7
avsb p<0.01, c vsdp