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M1581: Change in Gastric Mucosal Patterns Seen by Magnifying NBI Endoscopy During H. Pylori Eradication
Abstracts M1581 Change in Gastric Mucosal Patterns Seen by Magnifying NBI Endoscopy During H. Pylori Eradication Masaaki Okubo, Tomomitsu Tahara, Tomoyuki Shibata, Masakatsu Nakamura, Daisuke Yoshioka, Tomiyasu Arisawa, Ichiro Hirata
M1583 The Usefulness of Early Additional Endoscopic Submucosal Dissection After Incomplete Endoscopic Submucosal Dissection in Patients With Early Gastric Cancer Jin Hee Lee, Tae Hoon Jang, Byung-Hoon Min, Jun Haeng Lee, Hee Jung Son, Poong-Lyul Rhee, Jong Chul Rhee, Jae J Kim
BACKGROUND AND AIM: Magnifying narrow-band imaging (NBI) endoscopy visualizes superficial gastric mucosal and capillary patterns. We aimed to investigate the change in gastric mucosal patterns seen by magnifying NBI endoscopy during H. pylori eradication.PATIENTS AND METHODS: Gastric mucosal patterns in uninvolved gastric corpus were observed by magnifying NBI endoscopy before and 12 week after H. pylori eradication in thirty patients. Mucosal patterns were classified according to our classification (Gastrointest Endosc. 2009; 70: 246-253): type 1—slightly enlarged round pit with unclear or irregular SCEN, type 2— obviously enlarged oval or prolonged pit with increased density of irregular vessels, and type 3—well-demarcated oval or tubulo-villous pit with clearly visible coiled or wavy vessels. By using paired photographs of each case, change in NBI mucosal pattern during H. pylori eradication were judged by consensus manner among 2 blinded endoscopists. Histological assessment was performed according to the updated Sydney system.RESULTS: The prevalence of mucosal patterns in 30 patients was, four type 1 (13.3%), twenty type 2 (66.6%), and six type 3 (20.0%). At 12 weeks after the triple therapy, three type 1(75.0%), seventeen type 2 (85.0%), and four type 3 (66.6%) patients were diagnosed as successful eradication, while one type 1 (25.0%), three type2 (15.0%), and two type 3 (33.3%) patients were diagnosed as failure by the C-urea breath test. At 12 weeks after eradication, type 1, type 2 patterns, successfully treated (n⫽17) all showed remarkable changes of gastric mucosal patterns seen by magnifying NBI. In these cases, enlarged or prolonged pits were improved to small oval or pin hole like round pits, and density of fine irregular vessels were decreased. Histological assessment showed improve of chronic inflammation in all these subjects, while such change was not observed for type 3 (n⫽6), showing severe gastric atrophy, and intestinal metaplasia, regardless of the result of eradication. No changes were found in both NBI mucosal patterns and histological degree of gastritis for one type 1 and three type 2 patients, they were diagnosed as failure.CONCLUSIONS: At least in subjects without severe gastric atrophy or intestinal metaplasia, successful treatment of H. pylori shows change in NBI gastric mucosal patterns, reflecting histological improvement of chronic inflammation.
Background and study aims: It is the principle to perform surgical gastrectomy when the resection margin is involved by tumor after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). On the other hand, there has been no report about the availability of early additional ESD in patients with positive lateral resection margin after initial ESD. And, there is no common opinion with regard to adequate safety margin on the specimen obtained by ESD. The aim of this study is to report the result of early additional ESD in the patients with positive or insufficient lateral resection margin after initial ESD for EGC. Patients and methods: From November, 2003 to July, 2009, 1151 EGCs detected in 1105 patients were treated by initial ESD at Samsung Medical Center (Seoul, South Korea). Among 68 cases in which lateral resection margin was involved by tumor after initial ESD, 12 cases were treated by early additional ESD. And, among 38 cases that lateral safety margin was less than 2mm, early additional ESD was performed in 7 cases. Additional ESD was performed immediately after the confirmation of the pathologic results, which were reported usually 2 days after initial ESD. The knives used in additional ESD were Flex knife and insulation-tipped (IT) knife as with conventional ESD. We retrospectively analyzed the results of early additional ESD. Results: Early additional ESD were performed in 19 cases. The duration between initial ESD and additional ESD was 5⫾3 days (mean⫾S.D.), and procedure time was 77⫾39 minutes (mean⫾S.D.). Complete resection rate was 91.7% (11/12) in the group of positive resection margin and 100% (7/7) in the group of lateral safety margin less than 2mm. In the group of positive resection margin, the resected specimens contained residual cancer in 7 cases and adenoma in 3 cases. Two cases had no residual tumor. In the group of lateral safety margin less than 2mm, all except for one case of residual adenoma had no tumor. Bleeding and perforation occurred in 2 cases and 1 case, respectively, and was managed successfully by medical conservative treatment. Among 18 patients in whom complete resection was achieved, local recurrence and metachronous tumor occurred in one (5.6%) and two cases (11.1%), respectively, during the follow-up duration (16⫾13 months, mean⫾S.D.). Conclusion: Early additional ESD can be an alternative modality of treatment in the selected patients that lateral resection margin is positive or not enough after initial ESD for EGC. Keywords: early gastric cancer, Early additional ESD, Lateral resection margin
M1582 Delayed Bleeding After Endoscopic Submucosal Dissection for Gastric Early Cancer and Adenoma Is Significantly Associated With Anti-Coagulants Agents but Not With Anti-Platelet Agents Kengo Onochi, Mario Jin, Tamotsu Matsuhashi, Masanari Sekine, Yuko Kimura, Yumi Kudo, Shigeto Koizumi, Nobukatsu Kinoshita, Natsumi Hatakeyama, Jinko Kataoka, Reina Ohba, Yoshihiko Inaba, Hirosato Mashima, Hirohide Ohnishi
M1584 Risk Factors of Synchronous or Metachronous Tumor Development in Early Gastric Cancer and Precancerous Lesion: A Review of 1005 Endoscopic Resections of Early Gastric Cancer and Gastric Adenoma Jaekyung Lee, Sang Gyun Kim, Jong Pil Im, Kyoung-Sup Hong, Joo Sung Kim, Hyun Chae Jung, In Sung Song
Background: Endoscopic submucosal dissection (ESD) is rapidly widespread as a therapeutic procedure for early gastric cancer and adenoma. Although its benefits are undisputed, ESD is still at some risks such as perforation and bleeding. Especially, delayed bleeding after ESD is one of the most serious complications of ESD. Aim: To identify the factors that is associated with delayed bleeding after ESD for gastric cancer and adenoma. Methods: Early gastric cancers and adenomas treated by ESD in Akita University Hospital from January 2003 to June 2009 (468 lesions) were enrolled in this study. The potential risk factors of delayed bleeding, including tumor location, the presence of ulcer scar(s), the size of post-ESD ulcers, and receiving anti-coagulants or anti-platelet agents were evaluated. Delayed bleeding was defined as hematemesis or melena that required endoscopic hemostasis, or bleeding from post-ESD ulcers that required endoscopic hemostasis found in second-look endoscopy accompanied with the decreased hemoglobin count by more than 2 g/dL. Administration of anti-coagulants agents and anti-platelet agents was stopped 3-7days before the ESD according the protocol of the Japan Gastroenterological Endoscopy Society. Results: Delayed bleeding occurred in 26 lesions (5.6%). Endoscopic hemostasis was successful for all lesions. The rate of delayed bleeding was significantly higher of the lesions in cases receiving anti-coagulants agents (recipient vs nonrecipient, 23.8% vs 4.7%, respectively; p ⬍ 0.001). Delayed bleeding related to anti-coagulants agents occurred in 5 lesions. Of these, it occurred in 4 lesions after resuming anticoagulation. On the other hand, receiving anti-platelet agents had no association with the delayed bleeding (recipient vs non-recipient, 3.8% vs 5.9%, respectively). Furthermore, the location of the tumors, the presence of ulcer scar(s), or the size of the post-ESD ulcers had no significant relationship with delayed bleeding. Conclusion: Receiving anti-coagulants agents is highly associated with the risk of delayed bleeding after ESD for early gastric cancer and adenoma.
AB260 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
Background: Endoscopic submucosal dissection (ESD) has been an useful treatment option of early gastric cancer (EGC) and gastric adenoma (GA). Through complete pathologic mapping and serial endoscopic follow-up for years after ESD, multiple foci of malignant and precancerous lesions are frequently observed. This study aimed to evaluate associated factors of synchronous or metachronous tumor development after ESD for EGC or GA. Methods: From April 2005 to August 2008, 1005 cases (503 EGCs and 497 GAs) were enrolled prospectively after ESD in Seoul National University Hospital and followed-up for more than one year. Synchronous tumor was defined as an EGC or GA confirmed within one year from initial ESD, and metachronous tumor as an EGC or GA diagnosed after one year from initial ESD. Follow-up endoscopies were performed in 3, 6, 12, 18 months after ESD, and then annually. Complete resection rate, complications, final diagnosis and synchronous or metachronous tumor development were evaluated with associated factors during follow-up. Results: In 1005 cases, synchronous lesions were detected in 256 cases (25.4%), in which 160 cases (62.6%) were revealed from the pathologic mapping of initial resected specimens. Metachronous tumors were detected in 66 cases (6.6%) and the mean duration from initial diagnosis was 800 days (689-911 days, 95% C.I.) In GA cases, synchronous tumor was negatively associated with Helicobacter pylori (H.P) infection (p⫽0.001), and positively associated with the degree of intestinal metaplasia (p⬍0.001), whereas, metachronous tumor development was not associated with H.P infection, mucosal atrophy or the degree of intestinal metaplasia. In EGC cases, synchronous tumor was associated with the degree of intestinal metaplasia (p⬍0.001), whereas, metachronous tumor development was not associated with H.P infection, mucosal atrophy or the degree of intestinal metaplasia. Conclusion: Synchronous or metachronous tumor development was frequently observed in ESD-treated EGC or GA cases. The degree of intestinal metaplasia showed statistical correlation with synchronous lesions. Serial followup is warranted to elucidate synchronous or metachronous tumor development in ESD-treated EGC or GA cases.
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M1583 The Usefulness of Early Additional Endoscopic Submucosal Dissection After Incomplete Endoscopic Submucosal Dissection in Patients With Early Gastric Cancer Jin Hee Lee, Tae Hoon Jang, Byung-Hoon Min, Jun Haeng Lee, Hee Jung Son, Poong-Lyul Rhee, Jong Chul Rhee, Jae J Kim
BACKGROUND AND AIM: Magnifying narrow-band imaging (NBI) endoscopy visualizes superficial gastric mucosal and capillary patterns. We aimed to investigate the change in gastric mucosal patterns seen by magnifying NBI endoscopy during H. pylori eradication.PATIENTS AND METHODS: Gastric mucosal patterns in uninvolved gastric corpus were observed by magnifying NBI endoscopy before and 12 week after H. pylori eradication in thirty patients. Mucosal patterns were classified according to our classification (Gastrointest Endosc. 2009; 70: 246-253): type 1—slightly enlarged round pit with unclear or irregular SCEN, type 2— obviously enlarged oval or prolonged pit with increased density of irregular vessels, and type 3—well-demarcated oval or tubulo-villous pit with clearly visible coiled or wavy vessels. By using paired photographs of each case, change in NBI mucosal pattern during H. pylori eradication were judged by consensus manner among 2 blinded endoscopists. Histological assessment was performed according to the updated Sydney system.RESULTS: The prevalence of mucosal patterns in 30 patients was, four type 1 (13.3%), twenty type 2 (66.6%), and six type 3 (20.0%). At 12 weeks after the triple therapy, three type 1(75.0%), seventeen type 2 (85.0%), and four type 3 (66.6%) patients were diagnosed as successful eradication, while one type 1 (25.0%), three type2 (15.0%), and two type 3 (33.3%) patients were diagnosed as failure by the C-urea breath test. At 12 weeks after eradication, type 1, type 2 patterns, successfully treated (n⫽17) all showed remarkable changes of gastric mucosal patterns seen by magnifying NBI. In these cases, enlarged or prolonged pits were improved to small oval or pin hole like round pits, and density of fine irregular vessels were decreased. Histological assessment showed improve of chronic inflammation in all these subjects, while such change was not observed for type 3 (n⫽6), showing severe gastric atrophy, and intestinal metaplasia, regardless of the result of eradication. No changes were found in both NBI mucosal patterns and histological degree of gastritis for one type 1 and three type 2 patients, they were diagnosed as failure.CONCLUSIONS: At least in subjects without severe gastric atrophy or intestinal metaplasia, successful treatment of H. pylori shows change in NBI gastric mucosal patterns, reflecting histological improvement of chronic inflammation.
Background and study aims: It is the principle to perform surgical gastrectomy when the resection margin is involved by tumor after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). On the other hand, there has been no report about the availability of early additional ESD in patients with positive lateral resection margin after initial ESD. And, there is no common opinion with regard to adequate safety margin on the specimen obtained by ESD. The aim of this study is to report the result of early additional ESD in the patients with positive or insufficient lateral resection margin after initial ESD for EGC. Patients and methods: From November, 2003 to July, 2009, 1151 EGCs detected in 1105 patients were treated by initial ESD at Samsung Medical Center (Seoul, South Korea). Among 68 cases in which lateral resection margin was involved by tumor after initial ESD, 12 cases were treated by early additional ESD. And, among 38 cases that lateral safety margin was less than 2mm, early additional ESD was performed in 7 cases. Additional ESD was performed immediately after the confirmation of the pathologic results, which were reported usually 2 days after initial ESD. The knives used in additional ESD were Flex knife and insulation-tipped (IT) knife as with conventional ESD. We retrospectively analyzed the results of early additional ESD. Results: Early additional ESD were performed in 19 cases. The duration between initial ESD and additional ESD was 5⫾3 days (mean⫾S.D.), and procedure time was 77⫾39 minutes (mean⫾S.D.). Complete resection rate was 91.7% (11/12) in the group of positive resection margin and 100% (7/7) in the group of lateral safety margin less than 2mm. In the group of positive resection margin, the resected specimens contained residual cancer in 7 cases and adenoma in 3 cases. Two cases had no residual tumor. In the group of lateral safety margin less than 2mm, all except for one case of residual adenoma had no tumor. Bleeding and perforation occurred in 2 cases and 1 case, respectively, and was managed successfully by medical conservative treatment. Among 18 patients in whom complete resection was achieved, local recurrence and metachronous tumor occurred in one (5.6%) and two cases (11.1%), respectively, during the follow-up duration (16⫾13 months, mean⫾S.D.). Conclusion: Early additional ESD can be an alternative modality of treatment in the selected patients that lateral resection margin is positive or not enough after initial ESD for EGC. Keywords: early gastric cancer, Early additional ESD, Lateral resection margin
M1582 Delayed Bleeding After Endoscopic Submucosal Dissection for Gastric Early Cancer and Adenoma Is Significantly Associated With Anti-Coagulants Agents but Not With Anti-Platelet Agents Kengo Onochi, Mario Jin, Tamotsu Matsuhashi, Masanari Sekine, Yuko Kimura, Yumi Kudo, Shigeto Koizumi, Nobukatsu Kinoshita, Natsumi Hatakeyama, Jinko Kataoka, Reina Ohba, Yoshihiko Inaba, Hirosato Mashima, Hirohide Ohnishi
M1584 Risk Factors of Synchronous or Metachronous Tumor Development in Early Gastric Cancer and Precancerous Lesion: A Review of 1005 Endoscopic Resections of Early Gastric Cancer and Gastric Adenoma Jaekyung Lee, Sang Gyun Kim, Jong Pil Im, Kyoung-Sup Hong, Joo Sung Kim, Hyun Chae Jung, In Sung Song
Background: Endoscopic submucosal dissection (ESD) is rapidly widespread as a therapeutic procedure for early gastric cancer and adenoma. Although its benefits are undisputed, ESD is still at some risks such as perforation and bleeding. Especially, delayed bleeding after ESD is one of the most serious complications of ESD. Aim: To identify the factors that is associated with delayed bleeding after ESD for gastric cancer and adenoma. Methods: Early gastric cancers and adenomas treated by ESD in Akita University Hospital from January 2003 to June 2009 (468 lesions) were enrolled in this study. The potential risk factors of delayed bleeding, including tumor location, the presence of ulcer scar(s), the size of post-ESD ulcers, and receiving anti-coagulants or anti-platelet agents were evaluated. Delayed bleeding was defined as hematemesis or melena that required endoscopic hemostasis, or bleeding from post-ESD ulcers that required endoscopic hemostasis found in second-look endoscopy accompanied with the decreased hemoglobin count by more than 2 g/dL. Administration of anti-coagulants agents and anti-platelet agents was stopped 3-7days before the ESD according the protocol of the Japan Gastroenterological Endoscopy Society. Results: Delayed bleeding occurred in 26 lesions (5.6%). Endoscopic hemostasis was successful for all lesions. The rate of delayed bleeding was significantly higher of the lesions in cases receiving anti-coagulants agents (recipient vs nonrecipient, 23.8% vs 4.7%, respectively; p ⬍ 0.001). Delayed bleeding related to anti-coagulants agents occurred in 5 lesions. Of these, it occurred in 4 lesions after resuming anticoagulation. On the other hand, receiving anti-platelet agents had no association with the delayed bleeding (recipient vs non-recipient, 3.8% vs 5.9%, respectively). Furthermore, the location of the tumors, the presence of ulcer scar(s), or the size of the post-ESD ulcers had no significant relationship with delayed bleeding. Conclusion: Receiving anti-coagulants agents is highly associated with the risk of delayed bleeding after ESD for early gastric cancer and adenoma.
AB260 GASTROINTESTINAL ENDOSCOPY
Volume 71, No. 5 : 2010
Background: Endoscopic submucosal dissection (ESD) has been an useful treatment option of early gastric cancer (EGC) and gastric adenoma (GA). Through complete pathologic mapping and serial endoscopic follow-up for years after ESD, multiple foci of malignant and precancerous lesions are frequently observed. This study aimed to evaluate associated factors of synchronous or metachronous tumor development after ESD for EGC or GA. Methods: From April 2005 to August 2008, 1005 cases (503 EGCs and 497 GAs) were enrolled prospectively after ESD in Seoul National University Hospital and followed-up for more than one year. Synchronous tumor was defined as an EGC or GA confirmed within one year from initial ESD, and metachronous tumor as an EGC or GA diagnosed after one year from initial ESD. Follow-up endoscopies were performed in 3, 6, 12, 18 months after ESD, and then annually. Complete resection rate, complications, final diagnosis and synchronous or metachronous tumor development were evaluated with associated factors during follow-up. Results: In 1005 cases, synchronous lesions were detected in 256 cases (25.4%), in which 160 cases (62.6%) were revealed from the pathologic mapping of initial resected specimens. Metachronous tumors were detected in 66 cases (6.6%) and the mean duration from initial diagnosis was 800 days (689-911 days, 95% C.I.) In GA cases, synchronous tumor was negatively associated with Helicobacter pylori (H.P) infection (p⫽0.001), and positively associated with the degree of intestinal metaplasia (p⬍0.001), whereas, metachronous tumor development was not associated with H.P infection, mucosal atrophy or the degree of intestinal metaplasia. In EGC cases, synchronous tumor was associated with the degree of intestinal metaplasia (p⬍0.001), whereas, metachronous tumor development was not associated with H.P infection, mucosal atrophy or the degree of intestinal metaplasia. Conclusion: Synchronous or metachronous tumor development was frequently observed in ESD-treated EGC or GA cases. The degree of intestinal metaplasia showed statistical correlation with synchronous lesions. Serial followup is warranted to elucidate synchronous or metachronous tumor development in ESD-treated EGC or GA cases.
www.giejournal.org