Endoscopic Diagnosis Of Gastric Cancer Research Articles

Efficacy evaluation of upper gastrointestinal endoscopy screening for secondary prevention of gastric cancer using the standardized detection ratio during a medical check-up in Japan.

We used standardized detection ratio to evaluate the quality of nasal upper gastrointestinal endoscopy screening for the secondary prevention of gastric cancer, and examined the gastric cancer risk in the era of total Helicobacter pylori (H. pylori) eradication. We performed 21,931 upper gastrointestinal endoscopies, 77 subjects were diagnosed with gastric cancer. Of these, 28 had gastric cancer after H. pylori eradication, 47 had gastric cancer with H. pylori-positive or others, and 2 had H. pylori-negative gastric cancer. The Standardized detection ratios for men and women were 5.33 and 4.82, respectively. Multivariable logistic regression analyses performed exclusively on first endoscopy subjects, excluding H. pylori-negative gastric cancer, revealed that smoking was a risk factor for developing gastric cancer (adjusted odds ratio, 3.31; 95% confidence interval, 1.65-6.64; p = 0.001). A statistically significant interaction was found between daily alcohol consumpption and H. pylori eradication on gastric cancer development (p = 0.005). In conclusion, relatively high standardized detection ratio values suggest that an appropriate endoscopic diagnosis of gastric cancer should be performed during a medical check-up. Smoking is a risk factor for developing gastric cancer, and continued alcohol consumption suggests a possible risk for developing gastric cancer after H. pylori eradication.

Endoscopic Diagnosis of Gastric Cancer Utilizing Artificial Intelligence (AI)

Endoscopic Diagnosis of Gastric Cancer Utilizing Artificial Intelligence (AI)

Advanced gastric cancer detected during regular follow-up after eradication of Helicobacter pylori.

Helicobacter pylori (H. pylori) is an important risk factor for gastric cancer and is a recognized carcinogen. Although eradication of H. pylori reduces the incidence of gastric cancer, cases can still occur after eradication therapy. A number of such cases have been reported, and their early clinicopathological characteristics are becoming clearer. Some reports mention that endoscopic diagnosis of gastric cancer may be difficult after eradication therapy, because the cancer is covered by non-cancerous epithelium. However, there are few reports on advanced gastric cancer after eradication therapy, and its characteristics remain poorly understood. In view of the predicted increase in frequency of advanced gastric cancer after eradication therapy in the near future, it is important to be aware of these cases. In this report, we describe three cases of advanced gastric cancer detected during routine follow-up after eradication.

Current Status of Photodynamic Diagnosis for Gastric Tumors.

Although the recent development and widespread use of image-enhanced endoscopy and magnifying endoscopy have improved endoscopic diagnosis of gastric cancer, it is somewhat complicated, requires a higher level of expertise, and is still subjective. Photodynamic endoscopic diagnosis (PDED) is based on the fluorescence of photosensitizers that accumulate in tumors, which enables objective evaluation independent of the endoscopist’s experience, and is useful for tumor detection. The objective of this work was to perform a narrative review of PDED for gastric tumors and to introduce our approach to PDED in gastric tumors in our hospital. In our review there have been case reports of PDED for gastric cancer, but its usefulness has not been established because no prospective studies evaluating its usefulness have been performed. In our previous study, 85.7% (42/49) of gastric tumors exhibited fluorescence in PDED. PDED may be useful in the diagnosis of early gastric cancer. Our previous studies were pilot studies in cancer patients; therefore, future prospective studies are required to verify the usefulness of PDED.

Previous Helicobacter pylori infection-induced atrophic gastritis: A distinct disease entity in an understudied population without a history of eradication.

Individuals with chronic atrophic gastritis who are negative for active H. pylori infection with no history of eradication therapy have been identified in clinical practice. By excluding false‐negative and autoimmune gastritis cases, it can be surmised that most of these patients have experienced unintentional eradication of H. pylori after antibiotic treatment for other infectious disease, unreported successful eradication, or H. pylori that spontaneously disappeared. These patients are considered to have previous H. pylori infection–induced atrophic gastritis. In this work, we define these cases based on the following criteria: absence of previous H. pylori eradication; atrophic changes on endoscopy or histologic confirmation of glandular atrophy; negative for a current H. pylori infection diagnosed in the absence of proton‐pump inhibitors or antibiotics; and absence of localized corpus atrophy, positivity for autoantibodies, or characteristic histologic findings suggestive of autoimmune gastritis. The risk of developing gastric cancer depends on the atrophic grade. The reported rate of developing gastric cancer is 0.31%‐0.62% per year for successfully eradicated severely atrophic cases (pathophysiologically equal to unintentionally eradicated cases and unreported eradicated cases), and 0.53%‐0.87% per year for spontaneously resolved cases due to severe atrophy. Therefore, for previous H. pylori infection–induced atrophic gastritis cases, we recommend endoscopic surveillance every 3 years for high‐risk patients, including those with endoscopically severe atrophy or intestinal metaplasia. Because of the difficulty involved in the endoscopic diagnosis of gastric cancer in cases of previous infection, appropriate monitoring of the high‐risk subgroup of this understudied population is especially important.

BREAST CANCER METASTASIS IN THE STOMACH: WHEN THE GASTRECTOMY IS INDICATED ?

ABSTRACTBackground:Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. Aim:Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. Methods:Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. Results:The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. Conclusion:Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion.

Usefulness of Endoscopic Imaging to Visualize Regional Alterations in Acid Secretion of Noncancerous Gastric Mucosa after Helicobacter pylori Eradication.

PurposeEndoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication.Materials and MethodsWe included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and 13C-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint.ResultsInconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE.ConclusionsWe demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).

A CASE OF SMALL EARLY GASTRIC CANCER THAT WAS SUCCESSFULLY DETECTED BY NARROW BAND IMAGING MAGNIFYING ENDOSCOPY

Endoscopic diagnosis of gastric cancer is very often made by conventional white light endoscopy and/or by indigo carmine chromoendoscopy. However, with this method it is difficult to detect and demarcate a small lesion affected by inflammation or a biopsy procedure. We considered it is useful for diagnosis of such small cancers to observe a lesion with a magnifying endoscope combined with a narrow band imaging system.

Sa1632 Trends in Endoscopic Diagnosis of Gastric Cancer 2000-2008: Decline in Prevalence Among Women

Gastric malignancy accounts for 9.9% of all new cancers worldwide, but incidence has been declining for unclear reasons. This may be secondary to better eradication of Helicobacter pylori. The introduction of over the counter (OTC) proton pump inhibitors in 2003, has improved access to triple therapy for H. pylori. The purpose of this study was to determine if there was a change in prevalence of gastric cancer during the 2000 to 2008 period in patients receiving endoscopy (EGD) for dyspepsia. A secondary aim was to identify risk factors for gastric malignancy in the study population.

Outcome Assessment of Endoscopic Diagnosis of Gastric Cancer and Adenoma by Using Forward-viewing Type Endoscope.

Outcome Assessment of Endoscopic Diagnosis of Gastric Cancer and Adenoma by Using Forward-viewing Type Endoscope.

Implications of Serum Pepsinogen I in Early Endoscopic Diagnosis of Gastric Cancer and Dysplasia

The risk of gastric cancer (GCA) is increased in atrophic gastritis. A low serum pepsinogen group I (SPGI) level is a good serologic indicator of atrophic gastritis of the gastric corpus and fundus, and can be used for diagnosis of subjects with atrophic gastritis and of increased risk for GCA. The present study was undertaken to investigate whether SPGI assay and a diagnostic gastroscopy could enable the diagnosis of GCA at an early stage. The study was carried out as part of the Alpha-Tocopherol, Beta-Carotene Cancer prevention study (ATBC study) in Finland, in which 22,436 male smokers aged 50-69 years were screened by SPGI. Low SPGI levels (< 25 microg/l) were found in 2196 (9.8%) men. Upper GI endoscopy (gastroscopy) was performed in 1344 men (61%) and 78% of these had moderate or severe atrophic corpus gastritis in endoscopic biopsies. A control series of 136 men from the ATBC study cohort with abdominal symptoms, but with SPGI > or = 50 microg/l were similarly endoscopied, and 2.2% of these had corpus atrophy. Neoplastic alterations were found in 63 (4.7%; 95% CI: 3.6%-5.8%) of the 1344 endoscopied men with low SPGI levels. Of these, 42 were definite dysplasias of low grade, 7 dysplasias of high grade, 11 invasive carcinomas, of which 7 were 'early' cancers, and 3 carcinoid tumors. In the control series, 1 man (0.7%) of the 136 men had a definite low-grade dysplasia. Thus, 18 (1.3%; 95% CI 0.7%-2.0%) cases with 'severe' neoplastic lesions (4 advanced cancers, 7 early cancers and 7 dysplasias of high grade) were found in the low SPGI group, but there were none in the control group. All four patients with advanced cancer died from the malignancy within 5 years (mean survival time 2.5 years), whereas surgical treatment in all those with early cancer or high-grade dysplasia was curative. One of the seven patients with early cancer and two of the seven with high-grade dysplasia died within 5 years, but none died from the gastric cancer. Thus, curative treatment was given to 14 of 18 men in whom a malignant lesion was found in gastroscopy. This is about 15% of all gastric cancer cases (92 cases) which were diagnosed within 5 years after SPGI screening in the 22,436 men. Among the gastric cancer cases of the main ATBC study, the 5-year survival rate was 33% (85% of the non-survivors died from gastric cancer). We conclude that assay of SPGI followed by endoscopy is an approach which can enable the early diagnosis of gastric cancer at a curable stage.

胃癌診断の精度向上をめざして 内視鏡診断

胃癌診断の精度向上をめざして 内視鏡診断

GASTRIC CANCER ASSOCIATED WITH PREGNANCY

Gastric cancer associated with pregrancy in 100 Japanese women were analyzed in terms of their diagnosis, surgical and obsteristic treatments and prognosis. Since the diagnostic approaches and surgical treatments are often restricted by physical and psychological events in pregnant woemn, 96% of the cases had advanced gastric cancer with a low resectability (46%). The prognosis were consistently so poor that 90% of all women died within 2 years and only 5 patients (5%) underwent radical resection survived for more than postoperative 3 years. We reported a case of early gastric cancer detected at 35 weeks gestation in 30-year-old woman. Following the endoscopic diagnosis of gastric cancer, a living normal child was delivered and consequently curative resection for the gastric cancer was performed. Based on our experience and a review of the literatures, the clinical features and appropriate management of gastric cancer and concomitant pregnancy were discussed.

Gastric enzymes as a screening test for gastric cancer.

Levels of lactic dehydrogenase and beta-glucuronidase were measured in gastric wash samples obtained from 445 patients over 40 years old attending a routine diagnostic endoscopy clinic. An index was derived from the two levels and used as a test for the presence of gastric cancer. Of the 24 patients with an endoscopic diagnosis of gastric cancer, 21 (91.3%) proved positive on this test, including all four cases of early gastric cancer, which were found at repeat endoscopy. The specificity of the test for gastric cancer was 81.3%. Among those patients with false positive results who had endoscopic biopsy were four out of the five cases of severe dysplasia, and four out of the 13 cases of type 2B intestinal metaplasia. Atrophic gastritis alone or with intestinal metaplasia was found in 95.9% of the false positives who were biopsied.

Endoscopic diagnosis of gastric cancer: an analysis of 872 cases in China

Endoscopic examination was performed on 15,888 selected cases between 1974 and 1981 in Hunan Province of China. Eight hundred and seventy-two cases (5.5%) of gastric cancer were suspected endoscopically. Twenty-seven of these 872 cases (3.1% of total gastric cancers) were early gastric cancers. Six hundred and seventy-one of the 872 cases were further investigated, and 661 were proved, giving a 98.5% positive rate. The authors collected a total of 92,190 endoscopic examination cases in China; 7,379 cases (8.0%) were gastric cancer, and 219 of these 7,379 were early cases (3% of all gastric cancer). The results compared with the reports from the United States, Europe, and Japan show that the incidence of gastric cancer and detection of early gastric cancer by endoscopy were much lower in China, the United States, and Europe than in Japan.

Intra-arterial dye method with vasomotors (PIAD method) applied for the endoscopic diagnosis of gastric cancer and the side effects of indigo carmine.

Forty patients with stomach cancer, including 25 patients with early carcinoma, were examined endoscopically during the perfusion of Indigo carmine dye into the celiac artery in association with vasomotors. In all of these patients the diagnosis had been established definitively by aimed biopsies before the procedure. This new endoscopic examination is useful not only to determine the margin of the superficial carcinoma, even when it is covered with regenerative epithelium, but also to detect small lesion less than 10 mm in diameter. Liver function tests in 31 patients who underwent the examination have negated the possibility of acute toxicity of the dye. But this new method should be employed with caution in hypertensive or high-risk patients.