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Mo1826 Is a Complete Remission of Intestinal Metaplasia a Suitable Endpoint in Patients Undergoing Radiofrequency Ablation (RFA)? Long-Term Results of RFA Treatment in 62 Consecutive Patients
esophagus were diagnosed endoscopically. The patients' gastric H. pylori infection status was categorized as "negative" or "positive" or "eradicated". The study patients were categorized according to the presence of inlet patch as follows: group A, inlet patch positive; group B, inlet patch negative. Intergroup male-to-female ratios, H. pylori infection rate, and the prevalence of gastrointestinal diseases were compared using the Chi square test. Result: The baseline clinical characteristics are shown in Table 1. A total of 487 patients (237 females and 250 males, mean age 53.7 years) were examined. Of these, 47 patients (9.4%) were inlet patch positive (Group A), and 440 patients were inlet patch negative (Group B). The male-to-female ratio was significantly higher in group A than group B. Mean age was not statistically different in group A and group B. The prevalence of gastric atrophy, reflux esophagitis, esophageal hiatal hernia, and Barrett's esophagus were not different in group A and group B. The 47 inlet patches were pathologically examined, and the histological features were inactive atrophic fundic mucosa with mild to moderate mucus neck cell or pyloric gland cell metaplasia and no intestinal metaplasia except one case with H. pylori infection. Conclusion: Endoscopic detection rate of inlet patch was 9.4%. Male gender was risk factor for inlet patch. Pathological characteristics of inlet patch was mostly inactive fundic gastritis with (pseudo) pyloric gland metaplasia.
there was no relation between age and presence of GIM. 6) There is no statistical difference between sexes.
Membrane Protein CD44v6 Is Not Expressed in Gastric Intestinal Metaplasia in a Sample of Helicobacter pylori Dyspeptic Adult Patients Ronaldo J. Torresini, Luiz E. Mazzoleni, Guilherme B. Sander, Carlos F. Francesconi, Luise Meurer, Diego M. Uchôa, Vinicius D. da Silva, Tobias C. Milbradt, João C. Prolla Introduction: gastric intestinal metaplasia (GIM) is considered a premalignant lesion for gastric cancer. A membrane protein CD44v6 has been suggested as a marker to indicate which patients with GIM should be followed with periodic upper GI endoscopic examinations for gastric cancer screening purposes. Aim: to determine the prevalence of membrane CD44v6 in a population of dyspeptic Helicobacter pylori (Hp) adults patients with GIM. Methods: 641 patients with Rome III criteria for functional dyspeptic (FD) aged ≥18 years were recruited in a primary care setting. Patients were submitted to upper GI endoscopy; biopsy specimens from predetermined locations (gastric mapping) were collected. Staining with HE, Giemsa and urease test were used to detect Hp. Schiff Periodic Acid (SPA), Alcian blue (AB) and high iron diamine (HID) were used to determine the presence of GIM, that was classified according to the type of mucin: type I if AB in goblet cells, type II if HID in goblet cells, and type III if HIDin columnar cells. The presence of CD44v6 evaluated by immunohistochemistry with monoclonal antibody anti-human mouse [(NCL-CD44v6 clone VFF-7), Novocastra®]. Protocol approved by the local IRB. Results: From a total of 75 Hp + patients with GIM, we were able to evaluate 56 patients (Table 1), without statistically difference between sex and age. All our GIM cases were negative for CD44v6 (IHC technique controls were positive). Of the 56 cases of GIM, 55% were classified as type I, 22% as type II, and 23% as type III. Conclusion: Since in our sample we were unable to detect membrane CD44v6 in any patient, we do not think that this marker is of any help in screening patients for early detection of gastric cancer when GIM is detected. Further studies should be performed in order to clarify the genetic or environment factors that might be related to these findings. Table 1
Mo1826 Is a Complete Remission of Intestinal Metaplasia a Suitable Endpoint in Patients Undergoing Radiofrequency Ablation (RFA)? Long-Term Results of RFA Treatment in 62 Consecutive Patients Jana Krajciova, Magdalena Stefanova, Jana Maluskova, Marek Kollar, Julius Spicak, Jan Martinek Introduction: Radiofrequency ablation (RFA) in combination with endoscopic resection (ER) is a method of choice for treatment of early esophageal neoplasia. Complete remission of intestinal metaplasia (CR-IM) and complete remission of dysplasia (CR-D) are commonly used as the endpoints of successful treatment. The relevance of CR-IM (in patients with macroscopically normal neo-Z-line) has recently been challenged. Aims&methods: The aim of this prospective, single center study was to assess the long-term efficacy of RFA. Main outcome measurements were CR-IM or CR-D in patients with/without a complete macroscopic eradication of Barrett's esophagus (BE) and recurrence rate of IM and dysplasia. Conover one-way analysis was used to calculate the risk factors for recurrence of IM. Results: The study involved 62 consecutive patients (mean age 62, range 25-86) undergoing endoscopic treatment for esophageal neoplasia in our center during 2009-2013. Sixty patients were diagnosed with BE related neoplasia, the remaining 2 patients had squamous neoplasia. The median follow-up was 25 months (range 3-60). In 19 patients (31%), RFA was a single treatment modality while in 43 patients (69%), RFA was combined with endoscopic resection or dissection of a visible lesion The indications for endoscopic treatment were as follows: early adenocarcinoma (EAC): 23 (37,1%), early squamous carcinoma (ESC): 2 (3,2%), high-grade intraepithelial neoplasia (HGIN): 20 (32,3%), low-grade intraepithelial neoplasia (LGIN): 17 (27,4%). A total of 117 RFA treatment sessions were performed (37 with HALO 360, 80 with HALO 90). The median number of treatment sessions per patient (ER+RFA) was 2 (1-6). CR-IM and CR-D were achieved in 69% (95% CI 61-81%) and 89% (95% CI 85-97%), respectively. In 80% of patients without CR-IM, the neo-Z-line was completely normal without macroscopically visible islands or tongues of metaplastic mucosa. During the follow-up, there were 6 recurrences at the level of neo-Z-line (out of 33 patients with BE with follow up of at least 18 months after finishing the treatment; 18%) of intestinal metaplasia. In 5 of these patients, the neo-Z-line was macroscopically normal. Low-grade dysplasia (within the Z-line) recurred in 2 patients (5%). High-grade dysplasia and/or carcinoma have not recurred. The risk factors for recurrence of intestinal metaplasia were male sex, younger age and diagnosis of cancer. We did not detect buried glands beneath the new neosquamous epithelium in any patient. Conclusion: Treatment of BE with RFA results in CR-D and CR-IM in a high proportion of patients with a low recurrence rate. A majority of patients without CR-IM or with a recurrence of IM have macroscopically normal neo-Z-line. CR-IM and a recurrence of IM might not be clinically relevant endpoints in patients with macroscopically normal neo-Z-line.
Mo1824 Pattern of Gastric Intestinal Metaplasia (GIM) in Dyspeptic Adults Ronaldo J. Torresini, Luiz E. Mazzoleni, Guilherme B. Sander, Carlos F. Francesconi, Luise Meurer, Diego M. Uchôa, Vinicius D. da Silva, Laura R. De Bona, João C. Prolla Introdution: Helicobacter pylori (Hp)is a known gastric carcinogen and GIM is considered a premalignant lesion. The prevalence of this lesion on a high prevalence country for Hp is unknown. Aim: to evaluate the prevalence of GIM in a population of Hp dyspeptic patients. Methods: 641 patients with Rome III criteria for functional dyspeptic (FD) aged ≥18 years were recruited in a primary care setting. Patients were submitted to upper GI endoscopy; biopsy specimens from predetermined locations (gastric mapping) were collected. All biopsies were stained with HE and Giemsa; those with intestinal metaplasia were stained with Schiff Periodic Acid (SPA), Alcian blue (AB) and high iron diamine (HID) to determine whether they expressed neutral mucins, sialomucins, or sulphomucins. The findings of this group was compared with Hp negative FD patients. Protocol approved by the local IRB. RESULTS: Of 641 patients studied: mean age: 46,0 years; 355 female and 88 male patients; 92 (14.4%) were GIM+; 423 (66%) were HP +. GIM was present 18.2% of HP + patients and in 6.9% of the Hp- group (p< 0.0001). Biopsies of 404 Hp + patients were available for evaluation for the presence of GIM; complete evaluation was possible in 56 of 75 with GIM+. 19 patients were not evaluated: paraffin blocks were lost in 2 and GIM was not found in 17 cases at the recut of the paraffin blocks. GIM type I was present in 55% (31/56); GIM type II in 22% (12/56) and GIM type III in 23% of cases (13/56). There was not difference in age in the 3 MIG groups. GIM was more frequent in the antrum ( 71%); antrum + incisura: 93%. There was no relationship between the extent and type of GIM. The distribution of gastric intestinal metaplasia between the sexes followed the proportion in the group studied. Conclusions: 1) the prevalence of GIM was 14.4% in our population; 2) the presence of GIM is related to the presence of Hp; 3) GIM is more frequent in the antrum and antrum and incisura biopsies; 4) there was no relationship between the extent and type of MIG. 5)
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AGA Abstracts
AGA Abstracts
Mo1825
there was no relation between age and presence of GIM. 6) There is no statistical difference between sexes.
Membrane Protein CD44v6 Is Not Expressed in Gastric Intestinal Metaplasia in a Sample of Helicobacter pylori Dyspeptic Adult Patients Ronaldo J. Torresini, Luiz E. Mazzoleni, Guilherme B. Sander, Carlos F. Francesconi, Luise Meurer, Diego M. Uchôa, Vinicius D. da Silva, Tobias C. Milbradt, João C. Prolla Introduction: gastric intestinal metaplasia (GIM) is considered a premalignant lesion for gastric cancer. A membrane protein CD44v6 has been suggested as a marker to indicate which patients with GIM should be followed with periodic upper GI endoscopic examinations for gastric cancer screening purposes. Aim: to determine the prevalence of membrane CD44v6 in a population of dyspeptic Helicobacter pylori (Hp) adults patients with GIM. Methods: 641 patients with Rome III criteria for functional dyspeptic (FD) aged ≥18 years were recruited in a primary care setting. Patients were submitted to upper GI endoscopy; biopsy specimens from predetermined locations (gastric mapping) were collected. Staining with HE, Giemsa and urease test were used to detect Hp. Schiff Periodic Acid (SPA), Alcian blue (AB) and high iron diamine (HID) were used to determine the presence of GIM, that was classified according to the type of mucin: type I if AB in goblet cells, type II if HID in goblet cells, and type III if HIDin columnar cells. The presence of CD44v6 evaluated by immunohistochemistry with monoclonal antibody anti-human mouse [(NCL-CD44v6 clone VFF-7), Novocastra®]. Protocol approved by the local IRB. Results: From a total of 75 Hp + patients with GIM, we were able to evaluate 56 patients (Table 1), without statistically difference between sex and age. All our GIM cases were negative for CD44v6 (IHC technique controls were positive). Of the 56 cases of GIM, 55% were classified as type I, 22% as type II, and 23% as type III. Conclusion: Since in our sample we were unable to detect membrane CD44v6 in any patient, we do not think that this marker is of any help in screening patients for early detection of gastric cancer when GIM is detected. Further studies should be performed in order to clarify the genetic or environment factors that might be related to these findings. Table 1
Mo1826 Is a Complete Remission of Intestinal Metaplasia a Suitable Endpoint in Patients Undergoing Radiofrequency Ablation (RFA)? Long-Term Results of RFA Treatment in 62 Consecutive Patients Jana Krajciova, Magdalena Stefanova, Jana Maluskova, Marek Kollar, Julius Spicak, Jan Martinek Introduction: Radiofrequency ablation (RFA) in combination with endoscopic resection (ER) is a method of choice for treatment of early esophageal neoplasia. Complete remission of intestinal metaplasia (CR-IM) and complete remission of dysplasia (CR-D) are commonly used as the endpoints of successful treatment. The relevance of CR-IM (in patients with macroscopically normal neo-Z-line) has recently been challenged. Aims&methods: The aim of this prospective, single center study was to assess the long-term efficacy of RFA. Main outcome measurements were CR-IM or CR-D in patients with/without a complete macroscopic eradication of Barrett's esophagus (BE) and recurrence rate of IM and dysplasia. Conover one-way analysis was used to calculate the risk factors for recurrence of IM. Results: The study involved 62 consecutive patients (mean age 62, range 25-86) undergoing endoscopic treatment for esophageal neoplasia in our center during 2009-2013. Sixty patients were diagnosed with BE related neoplasia, the remaining 2 patients had squamous neoplasia. The median follow-up was 25 months (range 3-60). In 19 patients (31%), RFA was a single treatment modality while in 43 patients (69%), RFA was combined with endoscopic resection or dissection of a visible lesion The indications for endoscopic treatment were as follows: early adenocarcinoma (EAC): 23 (37,1%), early squamous carcinoma (ESC): 2 (3,2%), high-grade intraepithelial neoplasia (HGIN): 20 (32,3%), low-grade intraepithelial neoplasia (LGIN): 17 (27,4%). A total of 117 RFA treatment sessions were performed (37 with HALO 360, 80 with HALO 90). The median number of treatment sessions per patient (ER+RFA) was 2 (1-6). CR-IM and CR-D were achieved in 69% (95% CI 61-81%) and 89% (95% CI 85-97%), respectively. In 80% of patients without CR-IM, the neo-Z-line was completely normal without macroscopically visible islands or tongues of metaplastic mucosa. During the follow-up, there were 6 recurrences at the level of neo-Z-line (out of 33 patients with BE with follow up of at least 18 months after finishing the treatment; 18%) of intestinal metaplasia. In 5 of these patients, the neo-Z-line was macroscopically normal. Low-grade dysplasia (within the Z-line) recurred in 2 patients (5%). High-grade dysplasia and/or carcinoma have not recurred. The risk factors for recurrence of intestinal metaplasia were male sex, younger age and diagnosis of cancer. We did not detect buried glands beneath the new neosquamous epithelium in any patient. Conclusion: Treatment of BE with RFA results in CR-D and CR-IM in a high proportion of patients with a low recurrence rate. A majority of patients without CR-IM or with a recurrence of IM have macroscopically normal neo-Z-line. CR-IM and a recurrence of IM might not be clinically relevant endpoints in patients with macroscopically normal neo-Z-line.
Mo1824 Pattern of Gastric Intestinal Metaplasia (GIM) in Dyspeptic Adults Ronaldo J. Torresini, Luiz E. Mazzoleni, Guilherme B. Sander, Carlos F. Francesconi, Luise Meurer, Diego M. Uchôa, Vinicius D. da Silva, Laura R. De Bona, João C. Prolla Introdution: Helicobacter pylori (Hp)is a known gastric carcinogen and GIM is considered a premalignant lesion. The prevalence of this lesion on a high prevalence country for Hp is unknown. Aim: to evaluate the prevalence of GIM in a population of Hp dyspeptic patients. Methods: 641 patients with Rome III criteria for functional dyspeptic (FD) aged ≥18 years were recruited in a primary care setting. Patients were submitted to upper GI endoscopy; biopsy specimens from predetermined locations (gastric mapping) were collected. All biopsies were stained with HE and Giemsa; those with intestinal metaplasia were stained with Schiff Periodic Acid (SPA), Alcian blue (AB) and high iron diamine (HID) to determine whether they expressed neutral mucins, sialomucins, or sulphomucins. The findings of this group was compared with Hp negative FD patients. Protocol approved by the local IRB. RESULTS: Of 641 patients studied: mean age: 46,0 years; 355 female and 88 male patients; 92 (14.4%) were GIM+; 423 (66%) were HP +. GIM was present 18.2% of HP + patients and in 6.9% of the Hp- group (p< 0.0001). Biopsies of 404 Hp + patients were available for evaluation for the presence of GIM; complete evaluation was possible in 56 of 75 with GIM+. 19 patients were not evaluated: paraffin blocks were lost in 2 and GIM was not found in 17 cases at the recut of the paraffin blocks. GIM type I was present in 55% (31/56); GIM type II in 22% (12/56) and GIM type III in 23% of cases (13/56). There was not difference in age in the 3 MIG groups. GIM was more frequent in the antrum ( 71%); antrum + incisura: 93%. There was no relationship between the extent and type of GIM. The distribution of gastric intestinal metaplasia between the sexes followed the proportion in the group studied. Conclusions: 1) the prevalence of GIM was 14.4% in our population; 2) the presence of GIM is related to the presence of Hp; 3) GIM is more frequent in the antrum and antrum and incisura biopsies; 4) there was no relationship between the extent and type of MIG. 5)
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AGA Abstracts
AGA Abstracts
Mo1825