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Significance of Microsatellite Instability in Early Gastric Cancer Treated with Endoscopic Submucosal Dissection
Abstracts
S1475 Efficacy and Safety of Endoscopic Submucosal Dissection for Gastric Cancers in Cirrohotic Patients Keiji Ogura, Makoto Okamoto, Takafumi Sugimoto, Naohisa Yahagi, Mitsuhiro Fujishiro, Naomi Kakushima, Shinya Kodashima, Takao Kawabe, Masao Omata
S1477 The Consideration of Tissue Immunohistochemical Staining After Endoscopic Submucosal Dissection of Early Gastric Cancer Ik Sung Choi, Joo Young Cho, Kyung Min Kim, Wan Jung Kim, In Seop Jung, Chang Beom Ryu, Jin Oh Kim, Joon Seong Lee, Si Young Jin, Chan Sup Shim, Boo Sung Kim
Background and Aims: Prognosis for patients who undergo resection of early gastric cancer is better than that for patients with advanced diseases. However, patients with liver cirrhosis may have high risk for gastric surgery. Endoscopic submucosal dissection (ESD) is less invasive method to resect mucosal legion endoscopically and to remove large tumors in an en bloc fashion. The aim of this study was to evaluate the efficacy and safety of ESD for gastric cancers in patients with liver cirrhosis. Patients and Methods: The patients who underwent ESD for the gastric cancer from April 2004 to October 2006 were analyzed for size of the lesions and the resected specimens, en bloc resection rate, complications, and local recurrence. Results: Eighteen gastric cancers were treated by ESD in 15 cirrhotic patients (male/female 10/5, mean age 69.7 years). Four patients were classified as Child’s class B and the others were as class A. The average maximum diameters of the lesions and resected specimens were 18.4 mm and 34.4 mm respectively. The rate of en bloc resection was 88.9% (16/18). En bloc resection with tumor-free lateral/basal margins (R0 resection) was 77.8% (14/18). Histological evaluation of the resected specimens revealed two cases of angiolymphatic invasion and four cases of submucosal invasion deeper than 500 microm. No perforation occurred. Three patients had post-operative bleeding and underwent emergent gastroscopy for hemostasis and one patient was treated with blood transfusion. Excluding two patients in whom additional endoscopic resection or surgery were carried out, no recurrence was observed during follow-up (mean 13.9 months). Conclusions: ESD can be safely performed for gastric cancers in cirrhotic patients, with high en bloc resection rate. Post-operative bleeding, however, was experienced in 20% of the patients and attention should be paid.
Backgrounds/Aim: Of immunohistochemical stainings in early gastric cancer (EGC) after endoscopic submucosal dissection (ESD), Factor VIII related antigen is associated with vascular invasion and D2-40 is associated with lymphatic invasion. The aim of this study is to evaluate proper therapeutic plan for tumors showing positive factor VIII related antigen and D2-40 after ESD. Materials and Methods: We investigated 15 patients 300 patients with EGCs treated by ESD between Feb. 2003 and Oct. 2006. They included 4 with Factor VIII related antigen, 7 with D2-40 among and 4 in both. Results: Of 15 patients, 60% (9/15) showed no remnant cancer after additional operation, including 2 with Factor VIII related antigen, 3 with D2-40, and 4 with both. 27% (4/15) showed no evidence of recurrence after ESD, including 1 with Factor VIII related antigen and 3 with D2-40. 13% (2/15) had no data due to follow-up loss. This data showed 86% with positive immunohistochemical marker of lymphovascular invasion was cured by minimal invasive surgery or ESD. Conclusion: This preliminary study suggests EGC with positive immunohistochemical markers of lymphovascular invasion after ESD could be followed-up.
S1478 Variation in Diagnostic Yield of Back-to-Back Capsule Endoscopy in Obscure GI Bleeding: Final Results Jennifer S. Kimble, Amitabh Chak, Gerard A. Isenberg, Gregory S. Cooper, Richard C. Wong
S1476 Significance of Microsatellite Instability in Early Gastric Cancer Treated with Endoscopic Submucosal Dissection Kyung Min Kim, Joo Young Cho, I.K. Sung Choi, Wan Jung Kim, in Seop Jung, Chang Beom Ryu, Jin Oh Kim, Joon Seong Lee, S.O. Young Jin, Chan Sup Shim, Boo Sung Kim Background/Aims: Microsatellite instability(MSI) is a form of genetic instability characterized by expansions and contractions of simple sequence repeats in DNA. The aim of this study is to investigate the relationship between MSI and pathologic features in early gastric carcinoma (EGC) treated by endoscopic submucosal dissection (ESD). Materials and methods: This study analyzed 78 cases of EGC in patients treated by ESD between May 2005 and Sep. 2006 at SoonChunHyang University Hospital, Seoul, Korea. One case had synchronous double lesions. Seven cases underwent gastrectomy after ESD. Microsatellite status and four pathologic factors such as differentiation, mucin phenotype, p53, VEGF were assessed for their possible association with MSI. The data were analyzed by Fisher’s exact test (or Chi-square test). Results: MSI-positive cancers were 13.9% (11/79). There are no relationship between MSI and each of four pathologic factors. Conclusions: There is no relationship between MSI and pathologic factors in EGCs treated by ESD. But further study including many more MSI-positive cancers will be needed to evaluate exactly significance of MSI in EGC.
www.giejournal.org
Objective: Missed lesions at CE may lead to unnecessary invasive diagnostic procedures such as intraoperative enteroscopy. The objective of this study is to prospectively evaluate the diagnostic yield of two back-to-back CE studies in patients presenting with obscure GI bleeding. Methods: Patients referred to our institution for CE to evaluate obscure GI bleeding were eligible. For each patient, a second CE study was performed within 4 days of the first. Each study was interpreted by a separate independent reader who was blinded to the findings on the other study. A third reader confirmed all positive findings and reviewed both CE studies in cases where the findings were discordant. Findings were then classified by diagnostic level of certainty using established criteria. Results: Forty-one patients, 11 with overt bleeding and 30 with occult bleeding, completed both CE examinations. Of the 41 capsule pairs 11/41 (27%) detected new lesions on one CE that were not detected on the other CE examination. Seven of these were minor erosions. Four (10%) examinations detected new lesions that changed the diagnostic level of certainty (Table 1). Conclusions: Ten percent of clinically significant lesions may be missed by a single CE suggesting that repeating a nondiagnostic CE is clinically useful in patients with obscure GI bleeding. A new finding on the second capsule could focus the approach of therapeutic procedures such as intraoperative enteroscopy or double balloon enteroscopy. This study is funded by a 2005 ASGE Research & Outcomes & Effectiveness Award Table 1
Capsule Indication
Small bowel finding
A1
IDA/FOBTþ
Normal
B1
IDA/FOBTþ
Normal
C1
IDA/FOBTþ
Normal
D1
IDA/FOBTþ
Trace Blood
Small bowel finding
Level of diagnostic certainty Capsule
Level of diagnostic certainty
Lesion Not Identified Lesion Not Identified
A2
4 AVM
B2
Lesion Not Identified Lesion Not Identified
C2
Presumptive Distal Duodenal Polyp Bleeding Definitive Ileal Ulcer Bleeding Definitive AVM
D2
Presumptive
IDA: Iron Deficiency Anemia FOBT: Fecal Occult Blood Test
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB185
S1475 Efficacy and Safety of Endoscopic Submucosal Dissection for Gastric Cancers in Cirrohotic Patients Keiji Ogura, Makoto Okamoto, Takafumi Sugimoto, Naohisa Yahagi, Mitsuhiro Fujishiro, Naomi Kakushima, Shinya Kodashima, Takao Kawabe, Masao Omata
S1477 The Consideration of Tissue Immunohistochemical Staining After Endoscopic Submucosal Dissection of Early Gastric Cancer Ik Sung Choi, Joo Young Cho, Kyung Min Kim, Wan Jung Kim, In Seop Jung, Chang Beom Ryu, Jin Oh Kim, Joon Seong Lee, Si Young Jin, Chan Sup Shim, Boo Sung Kim
Background and Aims: Prognosis for patients who undergo resection of early gastric cancer is better than that for patients with advanced diseases. However, patients with liver cirrhosis may have high risk for gastric surgery. Endoscopic submucosal dissection (ESD) is less invasive method to resect mucosal legion endoscopically and to remove large tumors in an en bloc fashion. The aim of this study was to evaluate the efficacy and safety of ESD for gastric cancers in patients with liver cirrhosis. Patients and Methods: The patients who underwent ESD for the gastric cancer from April 2004 to October 2006 were analyzed for size of the lesions and the resected specimens, en bloc resection rate, complications, and local recurrence. Results: Eighteen gastric cancers were treated by ESD in 15 cirrhotic patients (male/female 10/5, mean age 69.7 years). Four patients were classified as Child’s class B and the others were as class A. The average maximum diameters of the lesions and resected specimens were 18.4 mm and 34.4 mm respectively. The rate of en bloc resection was 88.9% (16/18). En bloc resection with tumor-free lateral/basal margins (R0 resection) was 77.8% (14/18). Histological evaluation of the resected specimens revealed two cases of angiolymphatic invasion and four cases of submucosal invasion deeper than 500 microm. No perforation occurred. Three patients had post-operative bleeding and underwent emergent gastroscopy for hemostasis and one patient was treated with blood transfusion. Excluding two patients in whom additional endoscopic resection or surgery were carried out, no recurrence was observed during follow-up (mean 13.9 months). Conclusions: ESD can be safely performed for gastric cancers in cirrhotic patients, with high en bloc resection rate. Post-operative bleeding, however, was experienced in 20% of the patients and attention should be paid.
Backgrounds/Aim: Of immunohistochemical stainings in early gastric cancer (EGC) after endoscopic submucosal dissection (ESD), Factor VIII related antigen is associated with vascular invasion and D2-40 is associated with lymphatic invasion. The aim of this study is to evaluate proper therapeutic plan for tumors showing positive factor VIII related antigen and D2-40 after ESD. Materials and Methods: We investigated 15 patients 300 patients with EGCs treated by ESD between Feb. 2003 and Oct. 2006. They included 4 with Factor VIII related antigen, 7 with D2-40 among and 4 in both. Results: Of 15 patients, 60% (9/15) showed no remnant cancer after additional operation, including 2 with Factor VIII related antigen, 3 with D2-40, and 4 with both. 27% (4/15) showed no evidence of recurrence after ESD, including 1 with Factor VIII related antigen and 3 with D2-40. 13% (2/15) had no data due to follow-up loss. This data showed 86% with positive immunohistochemical marker of lymphovascular invasion was cured by minimal invasive surgery or ESD. Conclusion: This preliminary study suggests EGC with positive immunohistochemical markers of lymphovascular invasion after ESD could be followed-up.
S1478 Variation in Diagnostic Yield of Back-to-Back Capsule Endoscopy in Obscure GI Bleeding: Final Results Jennifer S. Kimble, Amitabh Chak, Gerard A. Isenberg, Gregory S. Cooper, Richard C. Wong
S1476 Significance of Microsatellite Instability in Early Gastric Cancer Treated with Endoscopic Submucosal Dissection Kyung Min Kim, Joo Young Cho, I.K. Sung Choi, Wan Jung Kim, in Seop Jung, Chang Beom Ryu, Jin Oh Kim, Joon Seong Lee, S.O. Young Jin, Chan Sup Shim, Boo Sung Kim Background/Aims: Microsatellite instability(MSI) is a form of genetic instability characterized by expansions and contractions of simple sequence repeats in DNA. The aim of this study is to investigate the relationship between MSI and pathologic features in early gastric carcinoma (EGC) treated by endoscopic submucosal dissection (ESD). Materials and methods: This study analyzed 78 cases of EGC in patients treated by ESD between May 2005 and Sep. 2006 at SoonChunHyang University Hospital, Seoul, Korea. One case had synchronous double lesions. Seven cases underwent gastrectomy after ESD. Microsatellite status and four pathologic factors such as differentiation, mucin phenotype, p53, VEGF were assessed for their possible association with MSI. The data were analyzed by Fisher’s exact test (or Chi-square test). Results: MSI-positive cancers were 13.9% (11/79). There are no relationship between MSI and each of four pathologic factors. Conclusions: There is no relationship between MSI and pathologic factors in EGCs treated by ESD. But further study including many more MSI-positive cancers will be needed to evaluate exactly significance of MSI in EGC.
www.giejournal.org
Objective: Missed lesions at CE may lead to unnecessary invasive diagnostic procedures such as intraoperative enteroscopy. The objective of this study is to prospectively evaluate the diagnostic yield of two back-to-back CE studies in patients presenting with obscure GI bleeding. Methods: Patients referred to our institution for CE to evaluate obscure GI bleeding were eligible. For each patient, a second CE study was performed within 4 days of the first. Each study was interpreted by a separate independent reader who was blinded to the findings on the other study. A third reader confirmed all positive findings and reviewed both CE studies in cases where the findings were discordant. Findings were then classified by diagnostic level of certainty using established criteria. Results: Forty-one patients, 11 with overt bleeding and 30 with occult bleeding, completed both CE examinations. Of the 41 capsule pairs 11/41 (27%) detected new lesions on one CE that were not detected on the other CE examination. Seven of these were minor erosions. Four (10%) examinations detected new lesions that changed the diagnostic level of certainty (Table 1). Conclusions: Ten percent of clinically significant lesions may be missed by a single CE suggesting that repeating a nondiagnostic CE is clinically useful in patients with obscure GI bleeding. A new finding on the second capsule could focus the approach of therapeutic procedures such as intraoperative enteroscopy or double balloon enteroscopy. This study is funded by a 2005 ASGE Research & Outcomes & Effectiveness Award Table 1
Capsule Indication
Small bowel finding
A1
IDA/FOBTþ
Normal
B1
IDA/FOBTþ
Normal
C1
IDA/FOBTþ
Normal
D1
IDA/FOBTþ
Trace Blood
Small bowel finding
Level of diagnostic certainty Capsule
Level of diagnostic certainty
Lesion Not Identified Lesion Not Identified
A2
4 AVM
B2
Lesion Not Identified Lesion Not Identified
C2
Presumptive Distal Duodenal Polyp Bleeding Definitive Ileal Ulcer Bleeding Definitive AVM
D2
Presumptive
IDA: Iron Deficiency Anemia FOBT: Fecal Occult Blood Test
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB185