- Email: [email protected]
Mo1355 Multicenter Retrospective Analysis of Photodynamic Therapy for Gastric Cancer
Abstracts
have evaluated the clinical efficacy of follow-up endoscopy for gastric cancer after TG. Methods: We reviewed the medical records of 747 patients with TG from 2003 to 2012. We enrolled 267 patients (70 with early gastric cancer (EGC) and 197 with advanced gastric cancer (AGC)), who received one or more follow-up endoscopies and contrast abdomen CT. Results: We found no tumor recurrence in the 70 EGC patients during the mean follow-up periods of 42.118 and 43.219 months by endoscopy and CT, respectively. The mean number of follow-up endoscopy and CT procedures was 4 and 4.1 per person, respectively. In 197 AGC patients, 59 patients (29.8%) had confirmed tumor recurrence during mean follow-up periods of 40.521 and 45.322 months. The mean number of follow-up endoscopy and CT procedures was 3.9 and 7.9 per person, respectively. The most common pattern of tumor recurrence was distant metastasis (nZ35) followed by peritoneal metastasis (nZ11). Among the other 13 cases with loco-regional recurrence, seven cases were regional lymph node metastases, four were anastomosis site recurrences, and two were duodenal stump and jejunal loop site recurrences. Three of the four cases of anastomosis site recurrence were found by both endoscopy and CT; one case was missed by CT. In this case, endoscopy and CT were done on different days and the tumor recurred as a slightly elevated hyperemic mucosa. However, the two cases with duodenal stump and jejunal loop recurrences were detected by CT only. Conclusions: An annual follow-up endoscopy for gastric cancer after TG has a limited role in detection of tumor recurrence, especially in patients with EGC. CT may be sufficient as follow-up method for recurrent gastric cancer after TG.
EGC(n[ 70) Stage IA IB IIA IIB IIIA IIIB IIIC IV Histology Well differentiated Moderate differentiated Poorly differentiated Signet ring cell Mixed Unclassified
AGC(n[ 197)
p-value NA
66 1 2 1
(94.3%) (1.4%) (2.9%) (1.4%) 0 0 0 0
0 (0%) 36 (18.3%) 55 (27.9%) 34 (17.3%) 27 (13.7%) 23 (11.7%) 21 (10.7%) 1 (0.5%)
11 27 24 12 2
(14.5%) (35.5%) (31.6%) (15.8%) (2.6%) 0
1 55 92 41 1 7
(0.5%) (27.9%) (46.7%) (20.8%) (0.5%) (3.6%)
Basal characteristics of the patients Mean age (years old) Sex (male/female) BMI Smoking History Never smoker Past smoker Current smoker Education level No education Elementary school Middle school High school College or University Family history of malignancy Gastrointestinal Hepatopancreaticobiliary Respiratory Urogenital Hematology Breast Unspecified None
EGC (n[ 70)
AGC (n[197)
p-value
59.2 (27-85) 48/22 (2.2:1) 21.8 (16.2-35.4)
58.7 (29-83) 140/57 (2.5:1) 20.7 (12.1-36.8)
0.744 0.892 0.012 0.931
48 (68.6%) 7 (10.0%) 15 (21.4%)
133 (67.5%) 12 (6.1%) 52 (26.4%) 0.238
9 1 10 19 31
(12.9%) (1.4%) (14.3%) (27.1%) (44.3%)
6 42 26 62 61
(3.0%) (21.3%) (13.2%) (31.3%) (31.0%) 0.59
15 2 0 2 3 2 0 46
(21.4%) (2.9%) (0%) (2.9%) (4.3%) (2.9%) (0%) (65.7%)
34 10 5 4 0 5 2 137
(17.3%) (5.1%) (2.5%) (2.0%) (0%) (2.5%) (1.0%) (69.5%)
Basal characteristics of the tumors Gross type I / Borrmann type I IIA / Borrmann type II IIB / Borrmann type III IC / Borrmann type IV III Mixed / Unclassified Size of tumor (cm) Site of tumor Upper third Middle third Lower third Entire
www.giejournal.org
EGC(n[ 70)
AGC(n[ 197)
p-value
76 lesion 3 (3.9%) 5 (6.6%) 7 (9.2%) 43 (56.6%) 0 (0%) 18 (23.6%) 3.1 x 2.3
197 lesion 12 (6.1%) 30 (15.2%) 116 (58.9%) 37 (18.8%)
NA
59 (77.6%) 16 (21.1%) 1 (1.3%) 0 (0%)
175 (88.8%) 12 (6.1%) 0 (0%) 10 (5.1%)
2 (1.0%) 6.7 x 5.2
0.001 0.782
Mo1355 Multicenter Retrospective Analysis of Photodynamic Therapy for Gastric Cancer Yasuyuki Shimoyama*1, Yoshiro Nishiwaki2, Shiko Kuribayashi1, Hiroko Hosaka1, Osamu Kawamura1, Yasumori Fukai1, Tetsuo Nakayama1, Taku Tomizawa1, Hidetoshi Yasuoka1, Masafumi Mizuide1, Motoyasu Kusano1, Masanobu Yamada3 1 Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan; 2Gastroenterological Surgery, Hamamatsu Medical Center, Hamamatsu, Japan; 3Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan Background and Aims: Photodynamic therapy (PDT) is reported to be useful for various diseases in the gastrointestinal field, including esophageal and gastric cancer. PDT has been given to patients with unresectable gastric cancer in Japan since 1988. In this study, the results of PDT performed at 2 centers were combined to assess the utility of this modality for gastric cancer. Subjects and Methods: The subjects were 27 patients (mean age: 73 years, 55 lesions, 69 PDT sessions) who received PDT for gastric cancer at our hospital and the Department of Gastroenterological Surgery of Hamamatsu Medical Center. At 48 hours after intravenous administration of polfimer sodium, fiberoptic irradiation was done using an excimer dye laser at 630 nm during endoscopic observation. If the effect was considered to be insufficient, additional irradiation was performed at 72 and 96 hours after intravenous administration of polfimer sodium. We currently use color CCD endoscopy for PDT that allow observation of the lesion during irradiation. If a monochromatic CCD endoscope is used, lesions cannot be observed during irradiation due to halation. In this study, the outcome of treatment was also compared between color CCD and monochromatic CCD endoscopes. If endoscopy revealed no obvious tumor and pathological examination detected no residual tumor, the outcome was classified as a complete response (CR). Results: The CR rate is shown in the following table. The overall CR rate was 62% (43/69 sessions). It was 87% (26/30), 54% (13/24), and 27% (4/15) when the depth of invasion before PDT was intramucosal, submucosal, and deeper than the tunica muscularis, respectively. It was 71% (35/49) in patients with well-differentiated adenocarcinoma, but was 40% (8/20) in those with mixed adenocarcinoma. The outcome did not improve with an increase in the number of PDT sessions. When the depth of invasion before PDT was intramucosal to submucosal, the CR rate was 69% (33/48 sessions) in the monochromatic CCD endoscope group, but was 100% (6/6) in the color CCD endoscope group, with the outcome being better in the latter group. During follow-up for 1-218 months (median: 47 months), 2 patients died of gastric cancer (15 and 30 months after PDT). No patient had serious adverse effects, such as hemorrhage or perforation. Conclusions: PDT can be performed safely and repeatedly, and is an effective modality for early gastric cancer. CR was not necessarily obtained, presumably because the effect of irradiation on deep lesions was too weak or the horizontal extent of the tumor was not treated completely. Using a color CCD endoscope to observe lesions during irradiation could avoid untreated areas and improve the local cure rate.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB467
Abstracts The CR rate in this study
Depth of invasion before PDT: intramucosal Depth of invasion before PDT: submucosal Depth of invasion before PDT: deeper than the tunica muscularis Total
All patients
Welldifferentiated adenocarcinoma
Mixed with poorly differentiated adenocarcinoma
26/30(87%)
25/28(89%)
1/2(50%)
13/24(54%)
9/15(60%)
4/9(44%)
7/10(70%)
6/13(46%)
4/15(27%)
1/6(17%)
3/9(33%)
3/6(50%)
1/9(11%)
43/69(62%)
35/49(71%)
8/20(40%)
18/24(75%)
18/43(42%)
Mo1356 The Endoscopic Features of Early Gastric Cancer After Successful Eradication of Helicobacter pylori Masami Tanaka*, Akihiro Yamada, Kosuke Nomura, Yasutaka Kuribayashi, Takahito Toba, Tukasa Huruhata, Satoshi Yamashita, Osamu Ogawa, Akira Matsui, Daisuke Kikuchi, Toshifumi Mitani, Shu Hoteya, Toshiro Iizuka, Misturu Kaise Gastroenterology, toranomon hospital, Tokyo, Japan Backgroud: As the eradication of Helicobacter pylori (HP) becomes widespred, the incidence of HP-eradicated gastric cancer is increasing in Japan, but its characteristics in detail remains unclear. In this study, we therefore aimed to elucidate the characteristics of early gastric cancers in patients who underwent HP eradication. Subjects and Methods: Between June 2011 and January 2015, 745 patients with early gastric cancer underwent endoscopic submucosal dissection (ESD). After excluding 30 patients with remnant cancer, 181 patients (210 lesions) who were histologically diagnosed with adenocarcinoma and negative for HP (HP negative) based on urea breath test (UBT) or stool antigen test (HPN group) were included as study subjects. In same study period, 155 patients (177 lesions) underwent ESD positive for HP (HP positive) based on histologically, UBT or stool antigen test were selected as controls (HPP group). Evaluation items were the presence of reddish depressed changes in the background mucosa, sex, age, extent of atrophy, histological type, tumor size, depth of invasion, macroscopic type, location, color tone, and tumor demarcation. When the entire circumference of the tumor was visible under white light, the tumor was defined as well demarcated; if not, the tumor was defined as poorly demarcated. Results: (1) In the background mucosa, reddish depressed changes were observed in 61 (33.8%) HPN patients and 15 (9.7%) HPP patients, with a significant difference between the groups (p<0.05). (2) Mean tumor size was 13.8and 18.2 mm in the HPN and HPP group, respectively (P<0.05). Macroscopic types in the HPN and HPP groups were flat elevated type in 44 (21%) and 74 (42%) patients (P<0.05) and poorly-demarcated type in 74 (35%) and 26 (15%) patients (p<0.05), respectively. (3) Analysis of patients with no reddish depressions in the background mucosa (129 HPN and 139 NPP patients) revealed that HPN patients had a significantly smaller tumor size and higer number of depressed lesions and poorly-demarcated tumors. (4) Analysis of patients with reddish depressed lesion (61 HPN and 15 HPP patients) showed no significant difference in all study items. Conclusion: The findings of this study indicate that the eradication of HP significnatly increses the incidence of reddish depressed changes in the background mucosa in the stomach. A large number of HP-eradicated gastric cancers were flat elevated type and poorly demarcated, which appears to be a factor making the discovery of HP-eradicated gastric cancer difficult.
Mo1357 Overview of Helicobacter Pylori Infection in Saudi Arabia Waleed M. Al-Huzaim* Medicine, Imam Mohammad Bin Saud University, Riyadh, Please Select, Saudi ArabiaW. Al-Huzaim, H. Tamim, S. AL-Shiban, M. Al-Shehri, A. Aodah, S. Al-Talhab, S. Al-Subaie, N. Al-Otaibi, A. Bukhari, R. Al-Mohya Background: Helicobacter pylori (HP) is the most common chronic bacterial infection in humans; it has been demonstrated worldwide and in individuals of all ages. Conservative estimates suggest that 50% of the world’s population is affected by HP, which is a spiral shaped, microaerophilic, gram negative bacterium. Little is known about the epidemiological characteristics of HP in Saudi Arabia. The aim of the current study was to evaluate the risk factors, complications and associated conditions and response to therapy among Saudi Arabian population. Methods: We carried out a chart review of all patients who had a gastric biopsy between January and December of 2007 in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. Information collected included demographic data, clinical characteristics, endoscopic results, associated conditions, and response to treatment. Results: Out of 704 gastric biopsies performed during the study period, 261 (37%) were positive for HP, whereas 443 patients were negative for HP (63%). The majority of the patients were Saudis
AB468 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Irradiated once
Irradiated twice
8/8(100%) 11/21(81%)
Irradiated three times
Monochromatic CCD endoscope
1/1(100%)
23/27(85%)
3/3(100%)
0/1(0%)
10/21(48%)
3/3(100%)
1/2(50%)
Color CCD endoscope
3/8(38%)
1/7(14%)
36/56(64%)
7/13(54%)
(98.8%), 48% were males, with an age range of 1 to 104 years (64.4% between 10 and 40 years old). Major presenting symptom for (HP) positive patients was abdominal pain (90%), Gastro Esophageal Reflux Disease (61.7%), and Irritable Bowel Syndrome (46%). The results of endoscopy, we found the majority had gastritis (92.7%), duodenal ulcer (6.5%), gastric ulcer (5.7%). Regarding the treatment, 73.6% received HP eradication therapy and 32.7% had more than one course of therapy. Symptoms improved in 40% of the patients, where 30% had mild improvement. 7 patients(1.6%) of (HP) negative group had gastric tumor ,whereas 13 (5.5%) of patients with (HP) positive group reported with gastric malignancy. Conclusion: In a large group of patients the prevalence of infection with (HP) for patients who had gastric biopsy is 37%, which has its peak at the middle age and become less in elderly. HP eradication has moderate impact on the abdominal pain improvement. High prevalence of Gastritis among patients with (HP). Most HP infected patients received one course of therapy only. Gastric malignancy is more in patients infected with (HP).
Mo1358 Patients’ Characteristics and Potential Risk Factors associated With Recurrent Gastric Hyperplastic Polyps: A Retrospective study Summer Aldrugh*1, Theyab Alhwiti3, Humberto Sifuentes2, Subbaramiah Sridhar2, Muhammed Sherid2 1 Internal Medicine, University of Massachusetts, Worcester, MA; 2 Gastroenterology, Georgia Regent University, Augusta, GA; 3Industrial Engineering Graduate Program, Auburn University, Auburn, AL Introduction: Majority of Gastric hyperplastic polyps do not recur after regression or removal, but a small subset of these polyps do recur. Potential risk factors associated with recurrence have not been elucidated. We aim is to evaluate the clinical characteristics of patients with recurrent hyperplastic polyps and compare them to those with non- recurrent polyps to better understand its etiology and potential risk factors. Method: Data from patients who were diagnosed with gastric hyperplastic polyps between 1/2006- 1/2015 were reviewed. Patients’ demographics, comorbidities, medical history, endoscopic findings, and histology were collected. Patients were divided into two groups: recurrent hyperplastic polyps (RHP) vs. non- recurrent hyperplastic polyps (NRHP). The RHP group was defined as any patient who developed gastric hyperplastic polyps after removal or regression during the study period. The inclusion criteria were all patients who had confirmed histological diagnosis of hyperplastic polyp. The exclusion criteria were patients < 18 years of age, and those with obscure diagnosis. Results: During a 10-year study period, 100 patients with diagnosis of gastric hyperplastic polyps were identified. Of those, 14% had recurrence (mean age 64.14 8.15 years), and 86% were in the non-recurrent polyps group (mean age 62 13.35 years). Gender and ethnicity of patients were similar in both groups. Patients in the RHP group were more obese compared to the NRHP group (BMI of 36.24 9.24 vs. 30.21 8.04, pZ0. 043). Comorbidities, smoking habits, and alcohol consumption were similar in both groups. History of prior cholecystectomy was present in 42.8% in the RHP group compared to 19.8% in the NRHP group (pZ 0. 056). In the RHP group, a background of chronic gastritis was seen in 41.7%, and H. pylori-induced gastritis in 25% compared to 23.3% and 1.2% respectively in the NRHP group (pZ 0.084). During the initial EDG exam, 19 patients (22.1%) in the NRHP group had multiple polyps compared to 7 patients (50%) in the RHP group (pZ 0.027). Dysplasia and intestinal metaplasia were not different between the two groups (16.7% & 0% vs. 1.2% &7%, pZ0.26, 0.35 respectively). Conclusion: In our study, recurrence of gastric hyperplastic polyps was 14%. Cholecystectomy, obesity, and H.pylori were identified as risk factors for recurrence. These risk factors should be addressed aggressively in patients who have gastric hyperplastic polyps to prevent the recurrence.
www.giejournal.org
have evaluated the clinical efficacy of follow-up endoscopy for gastric cancer after TG. Methods: We reviewed the medical records of 747 patients with TG from 2003 to 2012. We enrolled 267 patients (70 with early gastric cancer (EGC) and 197 with advanced gastric cancer (AGC)), who received one or more follow-up endoscopies and contrast abdomen CT. Results: We found no tumor recurrence in the 70 EGC patients during the mean follow-up periods of 42.118 and 43.219 months by endoscopy and CT, respectively. The mean number of follow-up endoscopy and CT procedures was 4 and 4.1 per person, respectively. In 197 AGC patients, 59 patients (29.8%) had confirmed tumor recurrence during mean follow-up periods of 40.521 and 45.322 months. The mean number of follow-up endoscopy and CT procedures was 3.9 and 7.9 per person, respectively. The most common pattern of tumor recurrence was distant metastasis (nZ35) followed by peritoneal metastasis (nZ11). Among the other 13 cases with loco-regional recurrence, seven cases were regional lymph node metastases, four were anastomosis site recurrences, and two were duodenal stump and jejunal loop site recurrences. Three of the four cases of anastomosis site recurrence were found by both endoscopy and CT; one case was missed by CT. In this case, endoscopy and CT were done on different days and the tumor recurred as a slightly elevated hyperemic mucosa. However, the two cases with duodenal stump and jejunal loop recurrences were detected by CT only. Conclusions: An annual follow-up endoscopy for gastric cancer after TG has a limited role in detection of tumor recurrence, especially in patients with EGC. CT may be sufficient as follow-up method for recurrent gastric cancer after TG.
EGC(n[ 70) Stage IA IB IIA IIB IIIA IIIB IIIC IV Histology Well differentiated Moderate differentiated Poorly differentiated Signet ring cell Mixed Unclassified
AGC(n[ 197)
p-value NA
66 1 2 1
(94.3%) (1.4%) (2.9%) (1.4%) 0 0 0 0
0 (0%) 36 (18.3%) 55 (27.9%) 34 (17.3%) 27 (13.7%) 23 (11.7%) 21 (10.7%) 1 (0.5%)
11 27 24 12 2
(14.5%) (35.5%) (31.6%) (15.8%) (2.6%) 0
1 55 92 41 1 7
(0.5%) (27.9%) (46.7%) (20.8%) (0.5%) (3.6%)
Basal characteristics of the patients Mean age (years old) Sex (male/female) BMI Smoking History Never smoker Past smoker Current smoker Education level No education Elementary school Middle school High school College or University Family history of malignancy Gastrointestinal Hepatopancreaticobiliary Respiratory Urogenital Hematology Breast Unspecified None
EGC (n[ 70)
AGC (n[197)
p-value
59.2 (27-85) 48/22 (2.2:1) 21.8 (16.2-35.4)
58.7 (29-83) 140/57 (2.5:1) 20.7 (12.1-36.8)
0.744 0.892 0.012 0.931
48 (68.6%) 7 (10.0%) 15 (21.4%)
133 (67.5%) 12 (6.1%) 52 (26.4%) 0.238
9 1 10 19 31
(12.9%) (1.4%) (14.3%) (27.1%) (44.3%)
6 42 26 62 61
(3.0%) (21.3%) (13.2%) (31.3%) (31.0%) 0.59
15 2 0 2 3 2 0 46
(21.4%) (2.9%) (0%) (2.9%) (4.3%) (2.9%) (0%) (65.7%)
34 10 5 4 0 5 2 137
(17.3%) (5.1%) (2.5%) (2.0%) (0%) (2.5%) (1.0%) (69.5%)
Basal characteristics of the tumors Gross type I / Borrmann type I IIA / Borrmann type II IIB / Borrmann type III IC / Borrmann type IV III Mixed / Unclassified Size of tumor (cm) Site of tumor Upper third Middle third Lower third Entire
www.giejournal.org
EGC(n[ 70)
AGC(n[ 197)
p-value
76 lesion 3 (3.9%) 5 (6.6%) 7 (9.2%) 43 (56.6%) 0 (0%) 18 (23.6%) 3.1 x 2.3
197 lesion 12 (6.1%) 30 (15.2%) 116 (58.9%) 37 (18.8%)
NA
59 (77.6%) 16 (21.1%) 1 (1.3%) 0 (0%)
175 (88.8%) 12 (6.1%) 0 (0%) 10 (5.1%)
2 (1.0%) 6.7 x 5.2
0.001 0.782
Mo1355 Multicenter Retrospective Analysis of Photodynamic Therapy for Gastric Cancer Yasuyuki Shimoyama*1, Yoshiro Nishiwaki2, Shiko Kuribayashi1, Hiroko Hosaka1, Osamu Kawamura1, Yasumori Fukai1, Tetsuo Nakayama1, Taku Tomizawa1, Hidetoshi Yasuoka1, Masafumi Mizuide1, Motoyasu Kusano1, Masanobu Yamada3 1 Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan; 2Gastroenterological Surgery, Hamamatsu Medical Center, Hamamatsu, Japan; 3Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan Background and Aims: Photodynamic therapy (PDT) is reported to be useful for various diseases in the gastrointestinal field, including esophageal and gastric cancer. PDT has been given to patients with unresectable gastric cancer in Japan since 1988. In this study, the results of PDT performed at 2 centers were combined to assess the utility of this modality for gastric cancer. Subjects and Methods: The subjects were 27 patients (mean age: 73 years, 55 lesions, 69 PDT sessions) who received PDT for gastric cancer at our hospital and the Department of Gastroenterological Surgery of Hamamatsu Medical Center. At 48 hours after intravenous administration of polfimer sodium, fiberoptic irradiation was done using an excimer dye laser at 630 nm during endoscopic observation. If the effect was considered to be insufficient, additional irradiation was performed at 72 and 96 hours after intravenous administration of polfimer sodium. We currently use color CCD endoscopy for PDT that allow observation of the lesion during irradiation. If a monochromatic CCD endoscope is used, lesions cannot be observed during irradiation due to halation. In this study, the outcome of treatment was also compared between color CCD and monochromatic CCD endoscopes. If endoscopy revealed no obvious tumor and pathological examination detected no residual tumor, the outcome was classified as a complete response (CR). Results: The CR rate is shown in the following table. The overall CR rate was 62% (43/69 sessions). It was 87% (26/30), 54% (13/24), and 27% (4/15) when the depth of invasion before PDT was intramucosal, submucosal, and deeper than the tunica muscularis, respectively. It was 71% (35/49) in patients with well-differentiated adenocarcinoma, but was 40% (8/20) in those with mixed adenocarcinoma. The outcome did not improve with an increase in the number of PDT sessions. When the depth of invasion before PDT was intramucosal to submucosal, the CR rate was 69% (33/48 sessions) in the monochromatic CCD endoscope group, but was 100% (6/6) in the color CCD endoscope group, with the outcome being better in the latter group. During follow-up for 1-218 months (median: 47 months), 2 patients died of gastric cancer (15 and 30 months after PDT). No patient had serious adverse effects, such as hemorrhage or perforation. Conclusions: PDT can be performed safely and repeatedly, and is an effective modality for early gastric cancer. CR was not necessarily obtained, presumably because the effect of irradiation on deep lesions was too weak or the horizontal extent of the tumor was not treated completely. Using a color CCD endoscope to observe lesions during irradiation could avoid untreated areas and improve the local cure rate.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB467
Abstracts The CR rate in this study
Depth of invasion before PDT: intramucosal Depth of invasion before PDT: submucosal Depth of invasion before PDT: deeper than the tunica muscularis Total
All patients
Welldifferentiated adenocarcinoma
Mixed with poorly differentiated adenocarcinoma
26/30(87%)
25/28(89%)
1/2(50%)
13/24(54%)
9/15(60%)
4/9(44%)
7/10(70%)
6/13(46%)
4/15(27%)
1/6(17%)
3/9(33%)
3/6(50%)
1/9(11%)
43/69(62%)
35/49(71%)
8/20(40%)
18/24(75%)
18/43(42%)
Mo1356 The Endoscopic Features of Early Gastric Cancer After Successful Eradication of Helicobacter pylori Masami Tanaka*, Akihiro Yamada, Kosuke Nomura, Yasutaka Kuribayashi, Takahito Toba, Tukasa Huruhata, Satoshi Yamashita, Osamu Ogawa, Akira Matsui, Daisuke Kikuchi, Toshifumi Mitani, Shu Hoteya, Toshiro Iizuka, Misturu Kaise Gastroenterology, toranomon hospital, Tokyo, Japan Backgroud: As the eradication of Helicobacter pylori (HP) becomes widespred, the incidence of HP-eradicated gastric cancer is increasing in Japan, but its characteristics in detail remains unclear. In this study, we therefore aimed to elucidate the characteristics of early gastric cancers in patients who underwent HP eradication. Subjects and Methods: Between June 2011 and January 2015, 745 patients with early gastric cancer underwent endoscopic submucosal dissection (ESD). After excluding 30 patients with remnant cancer, 181 patients (210 lesions) who were histologically diagnosed with adenocarcinoma and negative for HP (HP negative) based on urea breath test (UBT) or stool antigen test (HPN group) were included as study subjects. In same study period, 155 patients (177 lesions) underwent ESD positive for HP (HP positive) based on histologically, UBT or stool antigen test were selected as controls (HPP group). Evaluation items were the presence of reddish depressed changes in the background mucosa, sex, age, extent of atrophy, histological type, tumor size, depth of invasion, macroscopic type, location, color tone, and tumor demarcation. When the entire circumference of the tumor was visible under white light, the tumor was defined as well demarcated; if not, the tumor was defined as poorly demarcated. Results: (1) In the background mucosa, reddish depressed changes were observed in 61 (33.8%) HPN patients and 15 (9.7%) HPP patients, with a significant difference between the groups (p<0.05). (2) Mean tumor size was 13.8and 18.2 mm in the HPN and HPP group, respectively (P<0.05). Macroscopic types in the HPN and HPP groups were flat elevated type in 44 (21%) and 74 (42%) patients (P<0.05) and poorly-demarcated type in 74 (35%) and 26 (15%) patients (p<0.05), respectively. (3) Analysis of patients with no reddish depressions in the background mucosa (129 HPN and 139 NPP patients) revealed that HPN patients had a significantly smaller tumor size and higer number of depressed lesions and poorly-demarcated tumors. (4) Analysis of patients with reddish depressed lesion (61 HPN and 15 HPP patients) showed no significant difference in all study items. Conclusion: The findings of this study indicate that the eradication of HP significnatly increses the incidence of reddish depressed changes in the background mucosa in the stomach. A large number of HP-eradicated gastric cancers were flat elevated type and poorly demarcated, which appears to be a factor making the discovery of HP-eradicated gastric cancer difficult.
Mo1357 Overview of Helicobacter Pylori Infection in Saudi Arabia Waleed M. Al-Huzaim* Medicine, Imam Mohammad Bin Saud University, Riyadh, Please Select, Saudi ArabiaW. Al-Huzaim, H. Tamim, S. AL-Shiban, M. Al-Shehri, A. Aodah, S. Al-Talhab, S. Al-Subaie, N. Al-Otaibi, A. Bukhari, R. Al-Mohya Background: Helicobacter pylori (HP) is the most common chronic bacterial infection in humans; it has been demonstrated worldwide and in individuals of all ages. Conservative estimates suggest that 50% of the world’s population is affected by HP, which is a spiral shaped, microaerophilic, gram negative bacterium. Little is known about the epidemiological characteristics of HP in Saudi Arabia. The aim of the current study was to evaluate the risk factors, complications and associated conditions and response to therapy among Saudi Arabian population. Methods: We carried out a chart review of all patients who had a gastric biopsy between January and December of 2007 in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. Information collected included demographic data, clinical characteristics, endoscopic results, associated conditions, and response to treatment. Results: Out of 704 gastric biopsies performed during the study period, 261 (37%) were positive for HP, whereas 443 patients were negative for HP (63%). The majority of the patients were Saudis
AB468 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Irradiated once
Irradiated twice
8/8(100%) 11/21(81%)
Irradiated three times
Monochromatic CCD endoscope
1/1(100%)
23/27(85%)
3/3(100%)
0/1(0%)
10/21(48%)
3/3(100%)
1/2(50%)
Color CCD endoscope
3/8(38%)
1/7(14%)
36/56(64%)
7/13(54%)
(98.8%), 48% were males, with an age range of 1 to 104 years (64.4% between 10 and 40 years old). Major presenting symptom for (HP) positive patients was abdominal pain (90%), Gastro Esophageal Reflux Disease (61.7%), and Irritable Bowel Syndrome (46%). The results of endoscopy, we found the majority had gastritis (92.7%), duodenal ulcer (6.5%), gastric ulcer (5.7%). Regarding the treatment, 73.6% received HP eradication therapy and 32.7% had more than one course of therapy. Symptoms improved in 40% of the patients, where 30% had mild improvement. 7 patients(1.6%) of (HP) negative group had gastric tumor ,whereas 13 (5.5%) of patients with (HP) positive group reported with gastric malignancy. Conclusion: In a large group of patients the prevalence of infection with (HP) for patients who had gastric biopsy is 37%, which has its peak at the middle age and become less in elderly. HP eradication has moderate impact on the abdominal pain improvement. High prevalence of Gastritis among patients with (HP). Most HP infected patients received one course of therapy only. Gastric malignancy is more in patients infected with (HP).
Mo1358 Patients’ Characteristics and Potential Risk Factors associated With Recurrent Gastric Hyperplastic Polyps: A Retrospective study Summer Aldrugh*1, Theyab Alhwiti3, Humberto Sifuentes2, Subbaramiah Sridhar2, Muhammed Sherid2 1 Internal Medicine, University of Massachusetts, Worcester, MA; 2 Gastroenterology, Georgia Regent University, Augusta, GA; 3Industrial Engineering Graduate Program, Auburn University, Auburn, AL Introduction: Majority of Gastric hyperplastic polyps do not recur after regression or removal, but a small subset of these polyps do recur. Potential risk factors associated with recurrence have not been elucidated. We aim is to evaluate the clinical characteristics of patients with recurrent hyperplastic polyps and compare them to those with non- recurrent polyps to better understand its etiology and potential risk factors. Method: Data from patients who were diagnosed with gastric hyperplastic polyps between 1/2006- 1/2015 were reviewed. Patients’ demographics, comorbidities, medical history, endoscopic findings, and histology were collected. Patients were divided into two groups: recurrent hyperplastic polyps (RHP) vs. non- recurrent hyperplastic polyps (NRHP). The RHP group was defined as any patient who developed gastric hyperplastic polyps after removal or regression during the study period. The inclusion criteria were all patients who had confirmed histological diagnosis of hyperplastic polyp. The exclusion criteria were patients < 18 years of age, and those with obscure diagnosis. Results: During a 10-year study period, 100 patients with diagnosis of gastric hyperplastic polyps were identified. Of those, 14% had recurrence (mean age 64.14 8.15 years), and 86% were in the non-recurrent polyps group (mean age 62 13.35 years). Gender and ethnicity of patients were similar in both groups. Patients in the RHP group were more obese compared to the NRHP group (BMI of 36.24 9.24 vs. 30.21 8.04, pZ0. 043). Comorbidities, smoking habits, and alcohol consumption were similar in both groups. History of prior cholecystectomy was present in 42.8% in the RHP group compared to 19.8% in the NRHP group (pZ 0. 056). In the RHP group, a background of chronic gastritis was seen in 41.7%, and H. pylori-induced gastritis in 25% compared to 23.3% and 1.2% respectively in the NRHP group (pZ 0.084). During the initial EDG exam, 19 patients (22.1%) in the NRHP group had multiple polyps compared to 7 patients (50%) in the RHP group (pZ 0.027). Dysplasia and intestinal metaplasia were not different between the two groups (16.7% & 0% vs. 1.2% &7%, pZ0.26, 0.35 respectively). Conclusion: In our study, recurrence of gastric hyperplastic polyps was 14%. Cholecystectomy, obesity, and H.pylori were identified as risk factors for recurrence. These risk factors should be addressed aggressively in patients who have gastric hyperplastic polyps to prevent the recurrence.
www.giejournal.org