Gastrointestinal Tract Endoscopy Research Articles

A shared group of bacterial taxa in the duodenal microbiota of undernourished Pakistani children with environmental enteric dysfunction.

Environmental enteric dysfunction (EED) is a subclinical syndrome of altered small intestinal function postulated to be an important contributor to childhood undernutrition. The role of small intestinal bacterial communities in the pathophysiology of EED is poorly defined due to a paucity of studies where there has been a direct collection of small intestinal samples from undernourished children. Sixty-three members of a Pakistani cohort identified as being acutely malnourished between 3 and 6 months of age and whose wasting (weight-for-length Z-score [WLZ]) failed to improve after a 2-month nutritional intervention underwent esophagogastroduodenoscopy (EGD). Paired duodenal luminal aspirates and duodenal mucosal biopsies were obtained from 43 children. Duodenal microbiota composition was characterized by sequencing bacterial 16S rRNA gene amplicons. Levels of bacterial taxa (amplicon sequence variants [ASVs]) were referenced to anthropometric indices, histopathologic severity in biopsies, expression of selected genes in the duodenal mucosa, and fecal levels of an immunoinflammatory biomarker (lipocalin-2). A "core" group of eight bacterial ASVs was present in the duodenal samples of 69% of participants. Streptococcus anginosus was the most prevalent, followed by Streptococcus sp., Gemella haemolysans, Streptococcus australis, Granulicatella elegans, Granulicatella adiacens, and Abiotrophia defectiva. At the time of EGD, none of the core taxa were significantly correlated with WLZ. Statistically significant correlations were documented between the abundances of Granulicatella elegans and Granulicatella adiacens and the expression of duodenal mucosal genes involved in immune responses (dual oxidase maturation factor 2, serum amyloid A, and granzyme H). These results suggest that a potential role for members of the oral microbiota in pathogenesis, notably Streptococcus, Gemella, and Granulicatella species, warrants further investigation.IMPORTANCEUndernutrition among women and children is a pressing global health problem. Environmental enteric dysfunction (EED) is a disease of the small intestine (SI) associated with impaired gut mucosal barrier function and reduced capacity for nutrient absorption. The cause of EED is ill-defined. One emerging hypothesis is that alterations in the SI microbiota contribute to EED. We performed a culture-independent analysis of the SI microbiota of a cohort of Pakistani children with undernutrition who had failed a standard nutritional intervention, underwent upper gastrointestinal tract endoscopy, and had histologic evidence of EED in their duodenal mucosal biopsies. The results revealed a shared group of bacterial taxa in their duodenums whose absolute abundances were correlated with levels of the expression of genes in the duodenal mucosa that are involved in inflammatory responses. A number of these bacterial taxa are more typically found in the oral microbiota, a finding that has potential physiologic and therapeutic implications.

Advanced diagnostic endoscopy in the upper gastrointestinal tract: Review of the Japan Gastroenterological Endoscopic Society core sessions.

The Japan Gastroenterological Endoscopy Society (JGES) held four serial symposia between 2021 and 2022 on state-of-the-art issues related to advanced diagnostic endoscopy of the upper gastrointestinal tract. This review summarizes the four core sessions and presents them as a conference report. Eleven studies were discussed in the 101st JGES Core Session, which addressed the challenges and prospects of upper gastroenterological endoscopy. Ten studies were also explored in the 102nd JGES Core Session on advanced upper gastrointestinal endoscopic diagnosis for decision-making regarding therapeutic strategies. Moreover, eight studies were presented during the 103rd JGES Core Session on the development and evaluation of endoscopic artificial intelligence in the field of upper gastrointestinal endoscopy. Twelve studies were also discussed in the 104th JGES Core Session, which focused on the evidence and new developments related to the upper gastrointestinal tract. The endoscopic diagnosis of upper gastrointestinal diseases using image-enhanced endoscopy and AI is one of the most recent topics and has received considerable attention. These four core sessions enabled us to grasp the current state-of-the-art in upper gastrointestinal endoscopic diagnostics and identify future challenges. Based on these studies, we hope that an endoscopic diagnostic system useful in clinical practice is established for each field of upper gastrointestinal endoscopy.

A Preliminary Study Assessing a Transfer Learning Approach to Intestinal Image Analysis to Help Determine Treatment Response in Canine Protein-Losing Enteropathy.

Dogs with protein-losing enteropathy (PLE) caused by inflammatory enteritis, intestinal lymphangiectasia, or both, have a guarded prognosis, with death occurring as a result of the disease in approximately 50% of cases. Although dietary therapy alone is significantly associated with a positive outcome, there is limited ability to differentiate between food-responsive (FR) PLE and immunosuppressant-responsive (IR) PLE at diagnosis in dogs. Our objective was to determine if a transfer learning computational approach to image classification on duodenal biopsy specimens collected at diagnosis was able to differentiate FR-PLE from IR-PLE. This was a retrospective study using paraffin-embedded formalin-fixed duodenal biopsy specimens collected during upper gastrointestinal tract endoscopy as part of the diagnostic investigations from 17 client-owned dogs with PLE due to inflammatory enteritis at a referral teaching hospital that were subsequently classified based on treatment response into FR-PLE (n = 7) or IR-PLE (n = 10) after 4 months of follow-up. A machine-based algorithm was used on lower magnification and higher resolution images of endoscopic duodenal biopsy specimens. Using the pre-trained Convolutional Neural Network model with a 70/30 training/test ratio for images, the model was able to differentiate endoscopic duodenal biopsy images from dogs with FR-PLE and IR-PLE with an accuracy of 83.78%. Our study represents an important first step toward the use of machine learning in improving the decision-making process for clinicians with regard to the initial treatment of canine PLE.

A case of retained surgical mop in abdomen with partial intragastric migration: a case report

Though not uncommon, to retain a foreign body in the abdomen is a preventable error that makes the life of a patient miserable. One of the commonest retained foreign bodies is surgical mop or sponge. Retained mop may cause either an early septic reaction or a late fibrotic reaction. They often cause sinus or fistula and even can transmigrate in to the lumen of viscera. In case of upper abdominal retained mops, they usually erode the thin duodenal wall and rarely stomach. In this case, a mop was retained in the deep subhepatic space 2.5 months ago following open cholecystectomy. It caused an aseptic fibrotic reaction resulting in encapsulation of the mop. It then eroded the antral part of stomach through the lesser curvature and caused luminal obstruction. The patient presented with vomiting after each meal. Upper gastrointestinal tract (GIT) endoscopy revealed a woven fabric object that was impacted and occluded the lumen. The retained mop was removed after laparotomy and the antral wall was repaired well. This case is noteworthy due to its less symptom and penetration into the stomach.

Histopathological Study of Upper Gastrointestinal Tract Endoscopic Biopsies in a Teaching Hospital

Background: When a patient has an upper gastrointestinal disorder-which frequently manifests as dyspepsia-upper gastrointestinal endoscopy is considered the preferred diagnostic procedure. Without a biopsy, endoscopy cannot be considered complete, and the most reliable method for diagnosing lesions seen during endoscopy is histopathology. Methodology: This retrospective study was conducted in the Department of Pathology at A.C.S Medical College and Hospital for one year duration from July 2022 to July 2023. A total of fifty-five endoscopic biopsy specimens were obtained; they were preserved in 10% formalin and regularly stained with hematoxylin and eosin. Results: The majority was found to be 45.4% (25/40) of those aged 61-70, 36.3% (20/55) of those aged 51-60, and 18.1% (10/55) of those aged 40-50.Thirty patients (18.7%) had duodenal lesions, 80 cases (50%) had stomach lesions, and 50 cases (31.2%) had oesophageal lesions. Most upper gastrointestinal tract endoscopic biopsies came from the stomach. Conclusion: Endoscopy is insufficient without biopsy, and the gold standard for diagnosing lesions seen during an endoscopy is histopathology. The particular location of mucosal lesions can be seen with the use of upper gastrointestinal tract endoscopy. Therefore, we may draw the conclusion that using these two approaches together offers a potent diagnostic tool for improved patient care.

High-Flow Nasal Cannula Therapy as an Adjuvant Therapy for Respiratory Support during Endoscopic Techniques: A Narrative Review.

High-flow nasal cannula (HFNC) is a respiratory support technique that delivers a controlled concentration of oxygen with high flow, heat, and humidity via the nasal pathway. As it has many physiological effects, its use has increased for a variety of clinical indications; however, there is limited guidance on using HFNC as a respiratory support tool during endoscopic procedures. We conducted a narrative review to evaluate the effect of HFNC as an adjuvant tool during fiberoptic bronchoscopy (FOB), upper gastrointestinal tract endoscopy, and surgical procedures in adults. A search of the PubMed and Cochrane databases were performed. Approximately 384 publications were retrieved, and 99 were selected (93 original works and 6 case reports with a literature review). In patients who underwent FOB, HFNC appears to be superior to conventional oxygen therapy (COT) in preventing hypoxaemia. In contrast, for gastrointestinal endoscopy, the current evidence is insufficient to recommend HFNC over COT in a cost-effective manner. Finally, in surgical procedures such as laryngeal microsurgery or thoracic surgery, HFNC has been shown to be a safe and effective alternative to orotracheal intubation. As the results are heterogeneous, we advocate for the need for more quality studies to understand the effectiveness of HFNC during endoscopic procedures.

Emergency Endoscopic Interventions in Acute Upper Gastrointestinal Bleeding: A Cohort Study

Introduction: Acute upper gastrointestinal bleeding is a common cause of emergency department admissions. The standard approach for the diagnosis and treatment of acute upper gastrointestinal bleeding (AUGIB) involves an endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well studied, there is limited evidence regarding its effectiveness during the nighttime. Patients and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients with AUGIB referred for emergency endoscopy outside of regular hospital hours. Patients treated with endoscopic hemostatic methods were categorized into day-hours and night-hours groups based on the timing of the gastroscopy. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including hemostasis and recurrence. Results: In the population of 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 had a gastroscopy during the day hours between 8.00 a.m. and 10.00 p.m., while 160 had procedures performed at night between 10:00 p.m. and 8:00 a.m. In the day-hours group, the median time from symptom onset to endoscopy was 10 h (IQR 6–15), compared to 6 h (IQR 4–16) in the night-hours group. The gastroscopy duration (time to reach hemostasis during endoscopy) was significantly shorter during the night hours (p < 0.001). In both groups, endoscopic intervention after the sixth hour from symptom onset yielded improved outcomes, while treatment before the fifth hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant. Conclusions: Our findings indicate that emergency therapeutic gastroscopy for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the sixth hour from symptom onset.

Гетеротопія слизової оболонки шлунка в стравохід у дітей (випадки з практики)

Heterotopia of the gastric mucosa (inlet patch) is an atypical placement of the gastric mucosa in the upper or middle parts of the esophagus, a congenital anomaly that occurs as a result of a violation of tissue differentiation at an early embryonic stage, approximately at 4th week of intrauterine development. Heterotopic gastric mucosa in the upper part of the esophagus is observed in adults in all age groups, its frequency ranges from 0.1% to 3.8%. The frequency of occurrence of this condition among children has been insufficiently studied. Purpose - based on the analysis of clinical data, to familiarize doctors with cases of the inlet patch in the esophagus in children with recurrent dyspeptic and respiratory symptoms, regardless of the treatment. Clinical cases. Cases of the inlet patch among adolescents with long-term dyspeptic and respiratory disorders are described. When conducting an endoscopic examination, the patients revealed spots of the inlet patch in the esophagus. Therefore, in patients with symptoms of upper esophageal dysphagia (lump in the throat, heartburn, sour taste, dysphagia, odynophagia, etc.), a gastroscopic examination should be performed especially carefully. The use of endoscopes with high resolution and electronic chronoscopy creates additional diagnostic possibilities when the іnlet patch is detected. Conclusions. Heterotopic mucosa of the upper esophagus in childhood is diagnosed during fibroesophagogastroduodenoscopy for dyspeptic and espiratory disorders. A diverse clinical picture in the presence of spots in the inlet patch of the esophagus is caused by the production of hydrochloric acid by heterotopic cells of the gastric mucosa. Despite having treated patients who have complaints of recurrent dyspeptic and respiratory symptoms, one should be alert for a possible inlet patch during endoscopy of the upper gastrointestinal tract. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of parents and children was obtained for the study. No conflict of interests was declared by the authors.

Does end-tidal carbon dioxide monitoring in gastrointestinal endoscopy have a clinical advantage?

Aims: In current guidelines recommended CO2 monitoring for patient safety and comfort in sedation for gastrointestinal endoscopy. We aimed to investigate whether carbon dioxide monitoring, which was developed for the early detection of adverse respiratory events shows the expected benefit in its clinical use.
 Methods: Asa I-II patients, average age 48±15, were divided into two groups, standard monitoring was performed on Group S (n=30), and EtCO2, Integrated Pulmonary Index measurements were added to the Group K (n=30). Patients received Fentanyl 1µgr/kg, propofol 1 mg/kg and propofol 10-30 mg in a bolus by providing BIS to be 60-85. Adverse respiratory events were recorded. The time to Fast-tracking score being 14 was recorded and patients with two consecutive Fast-tracking scores of 14 were discharged. Patient satisfaction was questioned the next day.
 Results: There is no difference between groups in heart rate and mean arterial pressure, and decreased during the procedure compared to baseline in both groups. While EtCO2 was similar at all times, IPI was lower than baseline. While the processing time was 21±6 in Group S, it was 38±11 in Group K. No adverse respiratory events occurred. Recovery heart rates, peripheral oxygen saturation, mean arterial pressure and scores were similar. There was no difference in patient satisfaction.
 Conclusions: There wasn’t a clinical advantage with measuring EtCO2 added to the standard monitoring in gastrointestinal tract endoscopy. We believe that more studies are needed on optimum monitoring during moderate sedation in patients with less clinical risk.

Advanced diagnostic endoscopy in the upper gastrointestinal tract: Review of the Japan Gastroenterological Endoscopy Society core sessions.

We held four upper gastrointestinal tract advanced diagnostic endoscopy sessions from the 89th to the 92nd Congress of the Japan Gastroenterological Endoscopy Society. The most common region addressed was the stomach in 25 presentations, followed by the esophagus in 23, duodenum in five, and other in one. Looking at techniques discussed, the most common image enhancement method discussed was narrowband imaging in 29 presentations, blue laser imaging, and linked color imaging (LCI) in 10 each, dual red imaging in three, and autofluorescence imaging in one. Furthermore, there were presentations of new techniques such as M-Chromo-LCI and acetic acid-indigo carmine mixture LCI. There were also six presentations regarding probe-based confocal laser endomicroscopy, and one of endocytoscopy techniques. We also saw presentations of images of gastric subepithelial tumors within the submucosa, 3D endoscopy, the development of computer-aided detection systems for early cancers, and fluorescent imaging.

The effect of anthropometric and metabolic parameters on the development of erosive reflux disease in patients with gastroesophageal reflux disease

Aims: Gastroesophageal reflux disease (GERD) is a common health problem worldwide. Previous studies have reported that central obesity associated with visceral steatosis is an important problem in digestive system diseases, especially reflux-related diseases. This study aimed to examine the effect of body fat distribution on the development of erosive esophagitis. Methods: A total of 131 individuals, 105 patients and 26 healthy volunteers, were included in this study. The FSSG questionnaire was applied to all individuals. Patients with an FSSG questionnaire score of 10 or more underwent upper gastrointestinal tract endoscopy. Patients with esophagitis on endoscopy were included in the erosive esophagitis group, whereas patients without esophagitis were included in the non-erosive group. Serum biochemistry (fasting glucose, insulin, lipid panel, uric acid, TSH, AST, ALT) analyzes were performed. Waist circumference was measured. Body compositions were evaluated using the bioelectrical impedance method (Tanita). Results: Erosive esophagitis was found in 68 of 105 patients enrolled in the study, and non-erosive esophagitis in 37. There was no statistically significant difference in age, BMI, and waist circumference between the erosive, non-erosive and control groups. The visceral fat percentage was higher in the erosive esophagitis group than the other groups (p <0.001). At the end of the pairwise comparison of the groups, it was found that visceral fat value was higher in the erosive group than the non-erosive and control groups, while the visceral fat value was similar in the control and non-erosive groups. Except for the control group, when comparing the erosive and non-erosive groups, it was found that most of the patients in the erosive group were male, their FFM values and muscle mass were relatively high, and visceral fat values were significantly higher. Conclusion: An increase in visceral fat is a more important risk factor for the development of erosive esophagitis than obesity, waist circumference and increased BMI.

Anatomical endoscopic retrograde cholangiopancreatography simulator using moulded meshed silicone: A novel simulator pilot study.

Endoscopic retrograde cholangio-pancreatography (ERCP) has higher rates of morbidity and mortality compared to upper or lower gastrointestinal tract endoscopy. The availability of magnetic resonance cholangiopancreatography means ERCP is usually performed for therapeutic purposes. Simulation could provide an adjunct to patient-based training in ERCP however models to date have been unconvincing. This ERCP simulation model was constructed from moulded meshed silicone by co-designers: Jean Wong and Kai Cheng. The anatomical orientation was based on a combination of anatomical specimens, sectional atlases, and the clinical experience of expert endoscopists. From March to October 2022, we recruited 5 surgeons/gastroenterologists to the expert group and 14 medical students, junior doctors, or surgical/gastroenterological trainees to the novice group. Most experts either agreed or strongly agreed that the simulation anatomy appearance (100%), anatomical orientation (83%), tactile feedback (66%), traversal actions (67%), cannula positioning (66%) and papilla cannulation (67%) resembled the procedure in humans. Experts statistically significantly outperformed novices in obtaining a cannulating position (80% vs. 14%, P = 0.006) and successful papilla cannulation (80% vs. 7%, P = 0.0015) on their first attempt. The novice group had statistically significant improvements in time to obtaining a cannulating position (3.53 vs. 11.5 min, P = 0.006) and passing the duodenoscope to the papilla (2.55 vs. 4 passes, P = 0.009). The simulator showed statistically significant results in face, content, and construct validity. A follow-up validation study should recruit participants across multiple institutions. External validity could be assessed by comparing expert proceduralist simulator performance against clinical ERCP performance.

The gallbladder wall thickness in correlation with portal hemodynamic changes in cirrhotic patients

Background The gallbladder wall thickness (GBWT) is affected by portal hypertension, so GBWT can predict portal hemodynamic changes. Aim To determine whether noninflammatory GBWT correlates with portal hemodynamic changes and esophageal varices (EV) in cirrhotic patients. Patients and methods A total of 80 patients were enrolled in this cross-sectional study. Patients consisted of 30 cirrhotic patients with EV, 30 cirrhotic patients without EV, and 20 noncirrhotic individuals as a control group. Complete blood count, liver function tests, hepatitis C virus antibody, and HBsAg were assessed. Child–Pugh score was calculated in cirrhotic patients. Moreover, abdominal ultrasonography was performed for measuring wall thickness of the gallbladder, spleen length, and portal vein diameter. Moreover, portal vein Doppler was done for portal blood mean flow velocity measurement. Upper gastrointestinal tract endoscopy was done. Results GBWT was significantly increased in cirrhotic patients with EV compared with cirrhotic patients with without EV and noncirrhotic individuals (P<0.001). Moreover, GBWT was significantly correlated with spleen length, portal vein diameter, and portal velocity in cirrhotic patients with EV (P<0.001). Conclusion The GBWT could be one of the simple noninvasive predictors of portal hypertension and EV as it was positively correlated with portal hemodynamic changes that accompany cirrhotic portal hypertension.

Pycnodysostosis- A Rare Diagnosis Not to Miss

Introduction: Pycnodysostosis derived from the Greek words pycnos-density, dys-defect, ostosis-bone is a rare inherited disorder of the bone with an incidence of 1.7 per million births. It is one of the lysosomal storage disorders with a deficiency of enzyme cathepsin K. Along with a history of repeated fractures of the bones, patients with Pycnodysostosis have a short stature, dolichocephalic skull, obtuse mandibular angle, short terminal phalanx. They also have dental abnormalities such as the delayed eruption of permanent teeth, and double rows of teeth. Mild psychomotor problems were noted in a few individuals. Pycnodysostosis is diagnosed by clinical and radiological features as there is no diagnostic criterion. Skulls show open fontanels, generalized osteosclerosis, loss of the normal angle of the jaw, and hypoplasia of facial bones. Social and occupational support needed to prevent recurrent fractures. Orthopaedic and orthodontic cares are needed. Case: A non-diabetic normotensive male of 63 years presented to the medicine outpatients department (OPD) with complaints of burning type, non-radiating moderate intensity pain in the epigastric region for three months following taking of NSAIDs. He gave a history of fractures of different bones following minimal trauma since his childhood and used to take NSAIDs every now and then. He did take orthopaedic consultation for those fractures but the underlying pathophysiology was not explored. Malunion of long bones resulted in a deformed limb. The rest of his past medical history and family history was unremarkable. On clinical examination, we found the patient had short stature with proportionately short limbs. He had dysmorphic features with a large head, small facial structures, frontal and bilateral parietal bossing. Examination of the oral cavity revealed a narrow high arched palate and hypoplastic, overcrowded teeth. His digits were short and stubby. The lower limbs of the patient have angular deformities that resulted from malunion of bones from previous fracture. Haematological and biochemical investigations were normal. Chest X-ray showed multiple ribs fracture on the right side. The patient's clavicle was normal in X-ray. Both tibia and fibula showed a malunited fracture in diaphysis. Computed tomography (CT) of the skull, as well as 3D reconstruction of CT, found open fontanelles and widening of sutures (Figure). Frontal and parietal bossing was noted. There was hypoplasia of the air sinuses. CT scans showed dysplasia of the bones of the face and hands. Hypoplasia was noted in the terminal phalanx of fingers. An endoscopy of the upper gastrointestinal tract found multiple erosion around the antrum of the stomach. Considering the clinical and radiological feature diagnosis of Pycnodysostosis with NSAIDs-induced antral erosion was made. The patient and his caregivers were briefed about the diagnosis. Consultation from a multidisciplinary team was done concerning his treatment. Conclusion: It is important to diagnose Pycnodysostosis early as it allows proper planning to prevent future fractures. While assessing a patient with short stature with a history of repeated bone fracture Pycnodysostosis should be considered along with other differentials.

Endoscopic Findings and Histopathological Patterns of Gastric Mucosal Biopsies in Functional Dyspepsia: A Clinicopathological Study

Background: Endoscopic examination of the gastrointestinal tract through macroscopic and histopathological evaluation provides a tool to differentiate the major causes of functional dyspepsia. The distinction is not always clear. This study aimed to assess the frequency and type of the macroscopic and histopathological changes in gastrointestinal tract endoscopy in patients with symptoms of functional dyspepsia. Methods: A cross-sectional study was performed on 97 patients aged 10–85 years who underwent gastroscopy due to functional dyspepsia symptoms. The patients had no history of weight loss, major comorbidities like diabetes or cirrhosis, non-steroidal anti-inflammatory drug (NSAID) consumption, peptic ulcer, or any other confounding causes. Biopsy specimens were taken from the stomach and duodenum for histopathological examination. The presence of Helicobacter pylori infection was established based on histopathological examination and a positive rapid urease test. Results: Gastric biopsies of 97 patients with functional dyspepsia were studied. In histological examination of gastric mucosal biopsies, chronic inflammation was present in 94 (96.9%), activity was seen in 47 (48.5%), glandular atrophy was seen in 3 (3.1%), and intestinal metaplasia was seen in 9 (9.2%) patients. H. pylori was identified on gastric mucosal biopsies in 46 (47.4%) patients based on sections stained with H&E and Giemsa. Conclusion: According to the obtained results, it is concluded that patients with functional dyspepsia have a higher frequency of gastric mucosal inflammation and H. pylori infection.

Value of Serological Biomarker Panel in Diagnosis of Atrophic Gastritis and Helicobacter pylori Infection.

Background: Gastric cancer is one of the most common types of cancer worldwide. Helicobacter pylori infection is clearly correlated with gastric carcinogenesis. Therefore, the use of a new non-invasive test, known as the GastroPanel test, can be very helpful to identify patients at a high risk, including those with atrophic gastritis, intestinal metaplasia, and dysplasia. This study aimed to compare the results of GastroPanel test with the pathological findings of patients with gastric atrophy to find a safe and simple alternative for endoscopy and biopsy as invasive methods. Methods: This cross-sectional study was performed on patients with indigestion, who were referred to Motahari Clinic and Shahid Faghihi Hospital of Shiraz, Iran, since April 2017 until August 2017 for endoscopy of the upper gastrointestinal tract. The serum levels of gastrin-17 (G17), pepsinogen I (PGI), and pepsinogen II (PGII), as well as H. pylori antibody IgG, were determined by ELISA assays. Two biopsy specimens from the antrum and gastric body were taken for standard histological analyses and rapid urease test. A pathologist examined the biopsy specimens of patients blindly. Results: A total of 153 patients with indigestion (62.7% female; mean age, 63.7 years; 37.3% male; mean age, 64.9 years) were included in this study. The G17 levels significantly increased in patients with chronic atrophic gastritis (CAG) of the body (9.7 vs. 32.8 pmol/L; P = 0.04) and reduced in patients with antral CAG (1.8 vs. 29.1 pmol/L; P = 0.01). The results were acceptable for all three types of CAG, including the antral, body, and multifocal CAG (AUCs of 97%, 91%, and 88% for body, antral, and multifocal CAG, respectively). The difference in PGII level was not significant. Also, the PGI and PGI/PGII ratio did not show a significant difference (unacceptably low AUCs for all). The H. pylori antibody levels were higher in patients infected with H. pylori (251 EIU vs. 109 EIU, AUC = 70, P = 0.01). There was a significant relationship between antibody tests and histopathology. Conclusion: Contrary to Biohit's claims, the GastroPanel kit is not accurate enough to detect CAG; therefore, it cannot be used for establishing a clinical diagnosis.

Clinical significance of incidental 18 FDG PET uptake in the gastrointestinal tract: a retrospective cohort study.

Incidental gastrointestinal tract (GIT) uptake is found in up to 6.3% of patients undergoing positron emission tomography (PET). This may be physiologic or pathologic and requires endoscopic assessment. To determine the diagnostic yield of endoscopy in this setting and characterise PET avidity as a predictor of clinically significant findings. We retrospectively reviewed all consecutive patients undergoing upper endoscopy or colonoscopy for incidental 18 FDG PET positivity in the GIT. A total of 255 patients (62% male, median age 67 years) underwent colonoscopy or sigmoidoscopy for 276 separate areas of PET avidity in the colon. Malignancy was found in 44 cases (16%), and a significant polyp was found in an additional 103 cases (37%). Neoplastic change was found more often in the case of intense compared with non-intense PET avidity (odds ratio (OR) 3.40, 95% confidence interval (CI) 1.95-5.93, P < 0.001), and in focal compared with diffuse uptake (OR 5.97, 95% CI 2.9-12.2, P < 0.001). Upper GIT endoscopy was performed in 75 patients (46 male, median age 63 years) for 77 isolated areas with PET avidity. Malignancy was found in 16 cases (21%), and all were new primary lesions. Numerically, malignant findings were more common in intense (29.7%) than non-intense (12.5%) PET avidity (OR 2.96, 95%, CI 0.92-9.57, P = 0.069). Both focal and intense colonic 18 FDG uptake correlate strongly with a high-risk polyp or malignant lesion. Up to 21% of all gastroscopies performed for evaluation of incidental PET uptake diagnosed a new primary malignancy. These referrals need appropriate triaging and timely endoscopic assessment.

Abstract B049: Perceptions of gastric cancer screening in Asian Americans

Abstract Background: Endoscopy of the upper gastrointestinal tract is an effective way to screen for gastric cancer (GC) and benefits of screening are evident in countries that have implemented nationwide screening. Despite being disproportionately affected by GC, Asian Americans lack knowledge of GC risk factors and resources to make informed decision on GC screening. Experts recommend shared decision making between providers and patients regarding endoscopy for GC screening. However, we lack decision support tools for providers and patients at high risk for GC. Objective: This qualitative study aims to 1) explore patient experiences and perspectives on GC screening with endoscopy on concepts such as perceived GC risk, risk factors, early detection methods, and healthcare navigation, 2) explore provider knowledge, beliefs, and practice patterns regarding GC screening and GC prevention, and 3) develop a decision aid to support shared decision making for GC screening in the Asian American population. Methods: We interviewed primary care providers [PCP] and gastroenterologists in medical networks in Southern California that primarily serve Asian American communities, and patient populations in these medical networks with an initial focus on Korean and Vietnamese Americans who face the highest risk of GC among Asian Americans. Qualitative data was collected using one-on-one interviews with patients and providers. The interview was then transcribed and coded following reflexive thematic analysis. Results: To date, we have interviewed 6 patients and 5 providers and data collection continues. Several key themes were identified during the interviews: Among patients there is a lack of understanding of Helicobacter pylori (H. pylori) as a risk factor for GC, while dietary factors were frequently perceived as risk factors. Providers found GC screening to be beneficial for Korean and Vietnamese populations, and recommended GC screening simultaneous to screening colonoscopy, to reduce patient burden and cost. Patients who had experience with upper endoscopy found it to be acceptable. On the other hand, patients’ desired costs for upper endoscopy were much lower than market out-of-pocket costs of endoscopy. A preliminary decision aid was developed and edited in response to the results. The decision aid presents educational information including risk of GC in Korean and Vietnamese American relative to the general U.S. population, risk factors of GC, GC screening procedures, and risks and benefits of screening. The decision aid offers opportunity to assess personal attitudes towards GC screening, and allows for patients to indicate their intentions for GC screening for discussion with their providers. The decision aid will be further refined with additional qualitative data. Conclusion: Perceptions towards GC screening is generally positive among Asian patients and providers, but the costs of screening are a concern. Patients need education on H. pylori as a risk factor for GC. Citation Format: Simon Kim, Christie Y. Jeon, Celina Shirazipour. Perceptions of gastric cancer screening in Asian Americans [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B049.

Oxidative imbalance increases the risk for colonic polyp and colorectal cancer development.

The role of oxidative stress in the pathogenesis of colorectal carcinoma (CRC) has garnered considerable interest recently. Specific oxidative factors have been implicated in the pathogenesis of adenomatous polyps and ultimately adenocarcinoma. To evaluate the effect of oxidative imbalance as quantified by specific serological markers in the development of sporadic colon adenocarcinoma. A total of 170 patients that underwent endoscopy of the lower gastrointestinal tract in a tertiary center within 3 years were included in the study. They were allocated in three groups; those with sporadic colon adenocarcinoma (n = 56, 32.9%), those with colonic polyps (n = 33, 19.4%) and healthy controls (n = 81, 47.7%). All patients were evaluated for oxidant activity and antioxidant capacity with serum measurements of specific markers such as vitamins A, 25(OH) D3, E, C, B12, folic acid, glutathione, selenium (Se), zinc (Zn), free iron (Fe2+), and malondialdehyde and results were compared between groups. Serum levels of vitamins C, E, D, Se, Zn, vitamin B12 and total antioxidant capacity were significantly lower in the combined neoplasia/polyp group than in the control group (P = 0.002, P = 0.009, P < 0.001, P < 0.001, P < 0.001, P = 0.020 and P < 0.001, correspondingly). Increased levels of vitamin E (P = 0.004), vitamin D (P < 0.001), Se (P < 0.001) and Zn (P < 0.001) seem to bestow a protective effect on the development of CRC. For vitamin D (P < 0.001) and Zn (P = 0.036), this effect seems to extend to the development of colon polyps as well. On the other hand, elevated serum levels of malondialdehyde are associated with a higher risk of CRC (OR = 2.09 compared to controls, P = 0.004). Regarding colonic polyp development, increased concentrations of vitamin Α and Fe2+ are associated with a higher risk, whereas lower levels of malondialdehyde with a lower risk. Increased oxidative stress may play an important role in the pathogenesis and progression of CRC. Antioxidants' presence may exert a protective effect in the very early stages of colon carcinogenesis.

Lymph node recurrence and re-excision after primary tumor resection of a histiocytic sarcoma of duodenal origin: a case report

BackgroundHistiocytic sarcoma is a rare malignant tumor that is similar in characteristics to a mature histiocyte/macrophage and is a relatively new disease entity. In approximately one-third of cases, the site of origin is a lymph node; development from the gastrointestinal tract, spleen, soft tissue, and skin has further been reported. The tumor characteristics are not well-understood as reports on its clinical presentation and treatment are limited. We report a case of duodenal primary histiocytic sarcoma.Case presentationAn elevated lesion in the second part of the duodenum was detected in a 70-year-old woman during routine examination using upper gastrointestinal tract endoscopy. Blood biochemistry findings were normal for tumor markers. No abnormal findings were observed in the blood count and biochemical examination. Upper gastrointestinal endoscopy revealed a 20-mm elevated lesion with a slight depression in the center, opposite to the papilla of the descending duodenum. The biopsy showed erosions of the mucosal epithelium and inflammatory cell infiltration, but no evidence of malignancy. Ultrasound-guided endoscopy revealed an ischemic tumor of submucosal origin, and bowel biopsy suggested a histiocytic sarcoma. Distant metastasis and lymph node enlargement were absent on abdominal sonography, computed tomography, and magnetic resonance imaging. Duodenal segmental resection was performed. Immunostaining of the excised lesion was positive for CD68, CD163, CD4, CD5, CD15, and CD45 and negative for CD1a, CD21, CD34, MPO, and S-100 protein. Ki-67 positivity was approximately 20%. Based on these findings, the diagnosis of histiocytic sarcoma was confirmed. Ten months after the surgery, a lymph node recurrence in the dorsum of the pancreatic uncus was observed. No evidence of recurrence was found in any other part; hence, we performed pancreaticoduodenectomy. Pathological findings of the excised lymph node confirmed the recurrence of histiocytic sarcoma in the lymph node.ConclusionsThis is the first reported case of a duodenal primary histiocytic sarcoma with recurrence in the lymph node after the primary resection. The patient was treated for recurrence by lymph node excision and pancreaticoduodenectomy.