Submucosal Carcinoma Research Articles

Expression of CXCL12 and its receptor CXCR4 correlates with lymph node metastasis in submucosal esophageal cancer

The chemokine CXCL12 and its receptor CXCR4 are involved in cell migration, proliferation, and angiogenesis, and promote organ-specific localization of distant metastases in various carcinomas. We examined their expression and microvessel density (MVD) in submucosal esophageal squamous cell carcinoma (ESCC) and analyzed their connection to clinicopathological findings including lymph node micrometastasis (LMM). Eighty-six patients with submucosal ESCC underwent curative resection from 1985 to 2002. Immunohistochemical staining of CXCL12, CXCR4, and CD34 was performed with primary tumors, and staining of cytokeratin was performed with dissected lymph nodes. MVD was calculated from CD34 expression, and LMM detected by cytokeratin staining. Expression of CXCL12, but not CXCR4, correlated with lymph node metastasis. There was no significant correlation between the expression of CXCL12 and/or CXCR4 and MVD. LMM was detected in 8 cases and 14 lymph nodes. CXCL12 expression and high MVD were found in tumors with lymph node metastasis including LMM. Furthermore, in the CXCR4-positive tumors, positive CXCL12 expression was more significantly correlated with lymph node metastasis and/or LMM than negative CXCL12 expression. Evaluation of CXCL12 and CXCR4 expression should assist detection of lymph node metastasis including LMM in submucosal ESCC.

Clinical significance of type VIpit pattern subclassification in determining the depth of invasion of colorectal neoplasms

To clarify whether subclassification of the type V(I) pit pattern on the basis of magnifying colonoscopy findings is useful in determining the type and depth of invasion of colorectal neoplasms. We retrospectively analyzed 272 colorectal neoplasms (117 dysplasias and 155 submucosal invasive carcinomas; 228 patients) with a type V pit pattern [type V(I), n = 202; type V(N), n = 70 (Kudo and Tsuruta classification system)]. We divided lesions with a type V(I) pit pattern into two subclasses, mildly irregular lesions and severely irregular lesions, according to the prominent and detailed magnifying colonoscopy findings. We examined the relation between these two subclasses and histology/invasion depth. One hundred and four lesions (51.5%) were judged to be mildly irregular, and 98 lesions (48.5%) were judged to be severely irregular. Ninety-seven (93.3%) mildly irregular lesions showed dysplasias or submucosal invasion of less than 1000 microm (SM < 1000 microm). Fifty-five (56.1%) severely irregular lesions showed submucosal invasion equal to or deeper than 1000 microm (SM > or = 1000 microm). Mild irregularity was found significantly more often in dysplasias or lesions with SM < 1000 microm than in lesions with SM > or = 1000 microm (P < 0.01). Subclassification of the type V(I) pit pattern is useful for identifying dysplasias or lesions with SM < 1000 microm.

Gene profiles between non-invasive and invasive colon cancer using laser microdissection and polypeptide analysis

To explore the expression of differential gene expression profiles of target cell between non-invasive submucosal and invasive advanced tumor in colon carcinoma using laser microdissection (LMD) in combination with polypeptide analysis. Normal colon tissue samples from 20 healthy individuals and 30 cancer tissue samples from early non-invasive colon cancer cells were obtained. The cells from these samples were used LMD independently after P27-based amplification. aRNA from advanced colon cancer cells and metastatic cancer cells of 40 cases were applied to LMD and polypeptide analysis, semiquantitative reverse transcribed polymerase chain reaction (RT-PCR) and immunohistochemical assays were used to verify the results of microarray and further identify differentially expressed genes in non-invasive early stages of colon cancer. Five gene expressions were changed in colon carcinoma cells compared with that of controls. Of the five genes, three genes were downregulated and two were upregulated in invasive submucosal colon carcinoma compared with non-invasive cases. The results were confirmed at the level of aRNA and gene expression. Five genes were further identified as differentially expressed genes in the majority of cases (> 50%, 25/40) in progression of colon cancer, and their expression patterns of which were similar to tumor suppressor genes or oncogenes. This study suggested that combined use of polypeptide analysis might identify early expression profiles of five differential genes associated with the invasion of colon cancer. These results reveal that this gene may be a marker of submucosal invasion in early colon cancer.

Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers

The nonlifting sign is widely used for evaluating the invasion depth of colorectal tumors, and it is commonly accepted that EMR is contraindicated for colorectal tumors with a nonlifting sign because of the probability of massive submucosal invasion. To identify the clinicopathologic factors that affect the nonlifting sign in submucosal invasive colorectal carcinoma (SICC). Details regarding a history of biopsy, postbiopsy days, tumor location, tumor configuration, tumor size, depth of submucosal invasion, histologic type, adenomatous remnants, and angiolymphatic invasion were studied in relation to the nonlifting sign. National Cancer Center, Korea. The study involved 76 patients with SICC treated by endoscopic or surgical resection, in whom the tumor was examined for the nonlifting sign from 2001 to 2006. The nonlifting sign was observed in 15 cases (19.7%). A deep submucosal invasion, a history of biopsy, and the absence of adenomatous remnants were identified as factors affecting the nonlifting sign in univariate and multivariate analyses (P < .05). An increase in the number of postbiopsy days was associated with the nonlifting sign in endoscopically resectable SICC, and all 11 sm1 cancer cases with fewer than 21 postbiopsy days showed lifting. A history of biopsy and the absence of adenomatous remnants, in addition to deep submucosal invasion, were found to influence the nonlifting sign in SICC. It may be best that mechanical stimulation such as forceps biopsies are minimized before EMR, and EMR should be tried as soon as possible if biopsy was performed.

Nonsurgical treatments for submucosal esophageal squamous cell carcinomas

Esophageal cancer is a disease with a poor prognosis. As with superficial esophageal cancers, lymph node metastases are seen rarely if the tumors are limited to the epithelium or lamina propria, but when cancers invade the submucosa, there is a high incidence of lymph node involvement. Surgery with radical lymph node dissection is a standard treatment for treating submucosal esophageal cancers. However, it is usually associated with a reduced level of quality of life for the patients, who are often elderly and have various medical complications making them unfit for aggressive surgery. According to these background indications, various nonsurgical treatments have been developed to preserve the esophagus and to achieve a less invasive cure for such patients. Definitive radiotherapy could be a treatment option for patients with superficial carcinomas, particularly for those with mucosal cancers with an unresectable width by endoscopic mucosal resection (EMR). Although there have been some retrospective analyses with a small number of patients, they could not draw definitive conclusions. Definitive chemoradiotherapy has become one of the treatment options for patients who desire nonsurgical treatment. It has shown similar survival rates with those seen for radical surgery in two retrospective analyses and one multicenter prospective phase II study. The combination of primary EMR and prophylactic chemoradiotherapy has also shown promising results with less invasiveness than surgery. These nonsurgical approaches are now under evaluation in two multi-institutional studies run by the Japan Clinical Oncology Group (JCOG), which will clarify the optimal treatment for this disease.

GERD und Komplikationen: Wann ist der Chirurg gefragt?

Esophagitis, ulcer with potential for bleeding and peptic stenosis are typical complications of gastroesophageal reflux disease (GERD). Whereas GERD is frequent with symptom prevalence of 30 % in the normal population, ulcer and peptic stenosis have become very rare. Consequently surgical interventions due to these complications are only necessary in exceptional cases. After successful bougienage and response to adequate medical treatment, surgical indications for peptic stenosis or ulcer are not different to those for other forms of reflux disease. GERD patients with a "short esophagus" and axial hiatal hernia are difficult to treat either by medication or surgery. However, intrathoracic fundoplication may lead to acceptable results. Extraesophageal manifestations of GERD are caused by a severe reflux up to the cervical esophagus. The resulting laryngitis or pulmonary problems require antireflux surgery more often than in the absence of these symptoms. Long-standing reflux can lead to the development of Barrett mucosa, which represents a precancerous for esophageal adenocarcinoma and can be considered as a special complication of GERD. Retrospective data show that progression of Barrett mucosa or its malignant degeneration cannot be prevented by fundoplication. However, in a comparative study concerning low-grade neoplasia fundoplication leads to significantly more cases with regression than medication. High-grade neoplasia has to be removed in all cases. With regard to the prerequisite for correct indications the long-term results of endoscopic or surgical procedures are equal, but endoscopic mucosectomy is favoured due to its lower invasiveness. Indications for surgery by limited or radical esophagectomy are incomplete removal of neoplasia after mucosectomy, long Barrett's esophagus with multifocal lesions or suspicion of submucosal carcinoma.

Clinicopathological characteristics as predictive factrs for lymph node metastasis in submucosal gastric cancer

OBJECTIVE To identify clinicopathological characteristics as predictive factors for lymph node metastasis in submucosal gastric cancer, and in addition to establish objective criteria as indications for endoscopic submucosal dissection (ESD). METHODS Data from 130 patients with submucosal gastric cancer were collected, and the relationship between their clinicopathological characteris -tics and the presence of lymph node metastasis was retrospectively analyzed by multivariate analysis. RESULTS In the multivariate logistic regression model, a tumor size of 2 cm or more and an undifferentiated histologic type were found to be inde -pendent risk clinicopathological characteristics for lymph node metastasis. Among 130 patients with submucosal carcinoma, no lymph node metastases were observed in 17 patients who showed neither of the two risk clinicopathological characteristics. Lymph node metastasis occurred in 61.1% (22/36) of the patients who had both risk clinicopathological characteristics. CONCLUSION A tumor size of 2 cm or more and an undifferentiated histologic type were significantly and independently related to lymph node metastasis in submucosal gastric cancer. It is rational for the paitients with neither of these two independent risk clinicopathological characteristics to undergo an ESD.

Significance of Neoplastic Involvement of Margins Obtained by Endoscopic Mucosal Resection in Barrett's Esophagus

Although EMR has been used for elimination of neoplasia in BE, the significance of positive carcinoma margins and depth of invasion on endoscopic resection pathology has not been assessed using a valid standard. The aim of this study was to assess the accuracy of tumor staging by EMR using esophagectomy as the standard. Medical records of patients, who underwent endoscopic resection for esophageal carcinoma or high-grade dysplasia in BE followed by esophagectomy, were reviewed. Data were abstracted from a prospectively maintained EMR database. Endosonography and endoscopic resection were performed by a single experienced endoscopist. Two experienced GI pathologists interpreted all histological results. Standard statistical tests were used to compare continuous and categorical variables. Twenty-five patients were included in the study. Three patients had mucosal carcinoma and 16 had submucosal carcinoma following endoscopic resection. Surgical pathology staging was consistent with preoperative EMR staging in all patients. No patient with negative mucosal resection margins had residual tumor at the resection site at esophagectomy. In patients with submucosal carcinoma, 8 had residual carcinoma at the EMR site at surgery and 5 patients had metastatic lymphadenopathy. Tumor staging using EMR pathology is accurate when compared with surgical pathology following esophagectomy. Negative margins on EMR pathology correlate with absence of residual disease at the EMR site at esophagectomy. Submucosal carcinoma on EMR specimens was associated with a high prevalence of residual disease at surgery (50%) and metastatic lymphadenopathy (31%).

Efficacy, Safety, and Clinical Outcomes of Endoscopic Submucosal Dissection Using Bipolar-Current Needle-Knife in Colorectal Mucosal Tumors Compare with Conventional ESD Using Monopolar-Current Devices

Background: Endoscopic submucosal dissection (ESD) using monopolar devices (ESD-M) has been developed for en bloc resection of mucosal gastric tumors. ESD for colorectal tumors is still controversial because of its technical difficulty. Recent data suggests that ESD for colorectal tumors has high complication rates. Bipolar needle knife can cut the submucosa safely, remove a lesion completely, and minimizes damage to deeper tissues. Thus, ESD using bipolar devices (bipolar-current needle-knife and bipolar hemostatic forceps) for colorectal tumors is another accepted modality. Objective: We evaluated the clinical outcome of ESD using bipolar-current knife (ESD-B). Data from consecutive ESD procedures for colorectal tumors performed by using sodium hyaluronate over a 36-month period were reviewed retrospectively. The objective was to determine the safety and efficacy of ESD-B in comparison with ESD-M. Setting: A historical control study was performed between ESD-M and ESD-B. Patients and Methods: The en bloc resection rate, residual rate, and complications were assessed. ESD of 35 colorectal tumors was performed in our institutes. Indications were adenoma (20%), intramucosal carcinoma (51%), submucosal carcinoma (11%), carcinoid (11%) and benign lymphoid polyp (6%). Lesions were divided into two groups. Conventional ESD-M group was performed in 17 patients from November 2003 to May 2006, and ESD-B group was performed in 18 patients from June 2006 to November 2006. Locations were rectum 100% in ESD-M and rectum 39%, sigmoid colon 28%, discending colon 6%, transverse colon 22%, ascending colon 6% in ESD-B. Results: Among patients who underwent ESD-B, 100% en bloc resections were achieved compared to 94% in ESD-M (ns). No residual tumors were found in both groups. Mean diameter and mean required time were not different between groups (23.4 mm, 38.3 mins in ESD-B, and 23.1 mm, 49.7 mins in ESD-M). One perforation occurred during ESD-B and was treated by surgery. No patient developed massive hemorrhage, and there were no other immediate postprocedure complications. Conclusion: ESD using bipolar-current needle knife is effective for colorectal tumors equally to monopolar-current devices. The advantage of this new instrument is the possibility of using a bipolar current, which is safer than monopolar current. The technical details and usage instructions are discussed.

Case of submucosal esophageal carcinoma with multiple liver metastasis showing high serum levels of CEA and CA19-9

A 57-year-old man was admitted because of abdominal fullness. An abdominal ultrasonographic study disclosed multiple space-occupying lesions (SOL) in the liver. On blood examinationC the serum levels of CEA and CA19-9 were significantly high while those of AFP and SCC were within normal ranges. Endoscopically biopsied specimens of the lower esophagus histologically revealed poorly differentiated squamous cell carcinoma. Pathohistologically similar findings were obtained from the needle biopsied specimen of the SOL in the liver. Thus the patient was diagnosed as having squamous cell carcinoma of the esophagus with liver metastasis. On the 41st hospital day the patient died and an autopsy was performed. Although multiple metastases were recognized, cancer cells were limited within the submucosa of the esophagus. Immunostaining of CEA and CA19-9 was positive on the carcinoma cells both in the esophagus and the liver. Thus a relation between the biological malignancy of esophageal cancer and serum levels of CEA and CA19-9 was suggested.

Histopathological and genetic differences between polypoid and non-polypoid submucosal colorectal carcinoma

To investigate the histopathological and genetic differences between polypoid growth (PG) and non-polypoid growth (NPG) submucosal invasive colorectal carcinoma (CRC). A total of 96 cases of submucosal CRC were divided into two groups according to their growth type; 60 cases of PG and 36 cases of NPG. The size, histological degree of dysplasia, depth of submucosal invasion and lymph node metastasis were compared between the two groups. Furthermore, expression of p53 was detected by immunohistochemical staining, and K-ras gene mutation was examined by polymerase chain reaction based single-strand conformation polymorphism (SSCP). The average size of the lesions in the NPG group was significantly smaller than those in the PG group (7.5 mm vs 13.8 mm, P<0.001). The histological degree of dysplasia tended to be more severe in NPG group, while the incidence of submucosal massive invasion and the lymph node metastasis were both significantly higher in the NPG type than in the PG group (64.3% vs 43.3%, P=0.004; 43% vs 7%, P=0.008, respectively). In addition, K-ras gene mutations were detected in 67% of lesions in the PG group, but none in the NPG group, while no difference in p53 immunohistochemical expression was found between the two groups. Compared with PG submucosal CRC, NPG type demonstrates more frequent submucosal massive invasion, more lymph node metastasis and a higher degree dysplasia. Genetically, NPG type shows much less frequent K-ras mutation.

Relationship between lymph node metastasis and E-cadherin expression in submucosal invasive gastric carcinomas with gastric-phenotype

Recent advances in immunohistochemical staining have led to the proposition of a classification of gastric carcinomas based on cellular phenotypes, and the degree of biological malignancy of gastric-phenotype carcinomas has attracted particular attention. One hundred and seven submucosal (SM) invasive carcinomas encountered in our center were examined for their histological type, cellular phenotype, and E-cadherin expression status to clarify their relationships with lymph node metastasis. Eleven (10.3%) of 107 SM gastric carcinomas were lymph node metastasis-positive. Gastric-phenotype carcinomas accounted for 20.6%, with a lymph node metastasis rate of 27.3% (6/22), which was significantly higher (p<0.05) than those of intestinal-phenotype carcinomas (5.9%) and mixed-phenotype carcinomas (2.9%). In terms of E-cadherin expression, only carcinomas with reduced E-cadherin expression showed lymph node metastasis at a rate significantly higher than that of carcinomas with normal E-cadherin expression (p<0.05). The lymph node metastasis rate (46.2%) of gastric-phenotype carcinomas with reduced E-cadherin expression was significantly higher than those of carcinomas of other phenotypes (p<0.05). Since gastric-phenotype differentiated carcinomas with reduced E-cadherin expression have the potential for becoming undifferentiated, the risk of lymph node metastasis should be considered.

Clinicopathological evaluation of biological behavior of submucosal invasive gastric carcinomas: relationship among lymph node metastasis, mucin phenotype and proliferative activity

Gastric carcinomas have been classified into the differentiated and undifferentiated type, on the basis of its tendency to gland formation. As a result of recent advances in mucin histochemistry, mucin phenotypes of gastric carcinomas have been investigated. However, no consensus on the evaluation of the grade of malignancy of early gastric carcinomas regarding mucin phenotype expression has developed. To address this issue, we evaluated the lymph node metastasis rate and proliferative activity of a submucosal invasive (sm) gastric carcinoma according to mucin phenotype expression. In resected surgical specimens from 108 patients with a single sm gastric carcinoma, the association between clinicopathological factors and lymph node metastasis was evaluated. In all cases, immunohistochemical staining with human gastric mucin, Muc-2, and CD10 and mucin histochemical staining by paradoxical concanavalin A staining were performed. The mucin phenotypes were classified into gastric-type (G-type), intestinal-type (I-type), mixed gastric and intestinal type (M-type), or a lack of mucin (LOM), using these as markers. To evaluate the cell proliferative activity of the gastric carcinoma, proliferating cell nuclear antigen (PCNA) staining was also performed. The rate of lymph node metastasis was higher for G-type sm carcinomas. A multivariate analysis showed that the G-type and lymphatic invasion were independent factors of lymph node metastasis. However, the PCNA-labeling index (PCNA-LI) was low for G-type carcinomas irrespective of the presence or absence of lymph node metastasis. In I-type carcinomas, PCNA-LI was significantly higher in cases that were positive for lymph node metastasis than in negative cases. G-type and lymphatic invasion are independent risk factors for lymph node metastasis of an sm gastric carcinoma, and proliferative activity may be a significant parameter for lymph node metastasis in cases with I-type carcinomas.

Serrated adenoma with a submucosal colorectal carcinoma, report of a case

Serrated adenoma（以下，SA）は大腸に発生する腺腫の亜型のひとつで通常の腺腫に比べ生物学的悪性度が同等あるいは低いとされてきたが1996年にsessile serrated adenoma（以下，SSA）が報告され通常のSAに比べ生物学的悪性度が高いことが明らかとなってきた。SA由来と考えられた大腸SM癌を経験した。SSAの内視鏡治療には，生物学的悪性度を考慮する必要があると思われた。

Risk for high-grade dysplasia or invasive carcinoma in colorectal flat adenomas in a Spanish population

Aim to determine the frequency and malignancy risk of colonic flat adenomas among patients with colorectal polyps in a Spanish population. Methods 1300 consecutive colonoscopic examinations were reviewed; 640 polyps were detected and removed endoscopically in 298 patients. Chromoendoscopy with 0.2% indigo carmine was applied to clarify the macroscopical appearance of flat lesions. The following data was collected for flat and protruding polyps: size, location (proximal or distal to splenic flexure), histology (neoplastic or non neoplastic), high grade dysplasia (HGD) and submucosal invasive carcinoma (SIC) or beyond. Results 490 polyps (76.6%) were adenomas and 150 (23.4%) hyperplastic; 114 (23.3%) adenomas were flat (3 flat-depressed) whereas 376 (76.7%) were protruding. The diameter of flat and protruding adenomas was 9.2 ± 7.9. mm and 7.0 ± 5.9 mm, respectively (p < 0.001). A proximal location was more frequent for flat (63.1%) than for protruding adenomas (48.7%) (p = 0.003). The rate of HGD or SIC was significantly higher in flat than in protruding adenomas (7.0 vs 2.6%; p < 0.04). Two of the 3 flat-depressed lesions (both ≤ 10 mm in diameter) were carcinomas (T1 and T2, respectively). Flat adenomas had an increased risk for HGD or SIC (OR = 2,7; CI, 1,04-7,04; p < 0.05). Conclusions In a Spanish population, flat adenomas represent nearly one quarter of all colorectal neoplastic polyps, their most frequent location being the right colon and they bear a higher risk of malignancy than protruding adenomas, especially for the flat depressed type.

Histopathological risk factors for lymph node metastasis in submucosal invasive colorectal carcinoma of pedunculated or semipedunculated type

Aims: To evaluate the histopathological risk factors for lymph node metastasis in cases of pedunculated or semipedunculated submucosal invasive colorectal carcinoma (SICC). Methods: A total of 48 patients with non-sessile...

The Vienna classification applied to colorectal adenomas

In 1999, a group of Western and Asian pathologists gathered in Vienna reached consensus regarding the classification of gastrointestinal epithelial neoplasia. In this study, that classification is applied to colorectal adenomas. Colorectal adenomas from 1552 patients were histologically classified according to the categories listed in Vienna: category 3, low-grade dysplasia; 4.1, high-grade dysplasia; 4.2, carcinoma in situ; 4.3, suspicious of intramucosal carcinoma; 5.1, intramucosal carcinoma; and 5.2, submucosal carcinoma. The criteria used to diagnose these lesions are described in detail. Adenomas with dysplasia (categories 3 and 4.1) or with carcinoma (categories 4.2, 4.3, 5.1 and 5.2) were analyzed separately. On basis of their configuration, adenomas were classified into tubular, tubulovillous, villous, serrated, microtubular and combined phenotypes (i.e. other than tubulovillous). The highest percentage of adenomas with carcinoma was found amongst villous adenomas (29.6%), followed by combined adenomas (27.8%). Villous adenoma with carcinoma was the most frequent neoplasia at all ages; combined adenomas with carcinoma were more frequent among younger patients. In elderly patients (> or = 60 years of age) the highest percentage of adenomas with carcinoma was recorded in villous adenomas (28.1%), followed by serrated adenomas (19.2%). Villous adenomas and combined adenomas with carcinoma were more frequent in males. The Vienna classification of colorectal adenomas seems to be influenced by parameters inherent to the patient such as age and sex and by the histological phenotype of the adenoma. With the recent improvement in medical technology it is possible to laser-microdissect a defined group of neoplastic glands (such as with carcinoma in situ or with intramucosal carcinoma) for specific molecular analysis. This modern technology will permit in future the translation of histological structures into molecular terms.

Endoscopic Diagnosis of Depth and Extension of Cancer Invasion of Superficial Barrett's Adenocarcinoma

Endoscopic Diagnosis of Depth and Extension of Cancer Invasion of Superficial Barrett’s Adenocarcinoma Iizuka Toshiro, Yahagi Naohisa, Hoteya Shu, Yamamoto Takashi Objective: There are few cases of superficial Barrett’s adenocarcinoma, even though Barrett’s adenocarcinoma is increasing in these days. But there are some cases to indicate endoscopic treatment in advanced of early detection. In an endoscopic treatment it is very important to make a diagnosis of depth and extension of the cancer precisely, because these have a close relation to both recurrence and lymph node metastasis. So we investigated to the accuracy of depth and extension of our cases retrospectively. Subjects and Methods: In this study 13 patients who were diagnosed of superficial Barrtte’s adenocarcinoma between January, 1998 and September, 2005 were included. The accuracy of depth and extension of cancer was investigated. For diagnosing depth of invasion by EUS, a small soft balloon with an effective length of 1 cm was used, as well as a 30 MHz probe from Olympus. For diagnosing extension of invasion, both ordinary endoscopy and spraying indigocarmine were used. Results: Clinicopathological features of all 13 lesions show as follows: there were 5 lesions of m carcinoma and 8 of sm carcinoma histologically, 9 lesions were macroscopically classified as an elevated type and 4 as a depressed type. As a treatment 5 lesions underwent surgical resection, 4 endoscopic resection, and 4 surgical resection after endoscopic treatment. The cancer growth under normal squamous epithelium was detected in 8 cases (62%), this extension size was 5.4 mm in average, and the cancer growth under normal columnar epithelium was detected in 4 cases (31%). The accurate diagnosis rate of depth of invasion by EUS was 77%; diagnosis rate for mucosal carcinoma and submucosal carcinoma was 67 and 86%, respectively. The correct diagnosis rate of lateral margin was 75%, but it was impossible to diagnose lateral margin in 2 cases because of cancer growth under normal squamous epithelium. Discussion: In order to cure superficial Barrett’s adenocarcinoma by endoscopic treatment, it would be a task to make a correct diagnosis of depth and extension of cancer invasion.

High Resolution Colonoscopy With Chromoscopy Versus Standard Colonoscopy for the Detection of Colonic Neoplasia: A Randomized Study

High-resolution colonoscopy with chromoscopy (HRC) is a technique designed to improve the detection of colonic neoplasias. We prospectively compared standard colonoscopy (SC) and HRC in a randomized multicenter trial. Patients (n = 203; age, 58 +/- 10 years; sex ratio, 1) were recruited according to the following criteria: (1) a history of either familial or personal colonic neoplasia or (2) alarm symptoms after the age of 60 years. After randomization, an SC was performed in 100 patients (resolution, < or = 410,000 pixels) and a HRC in 103 patients (Fujinon EC485ZW, 850,000 pixels). In the HRC group, each colonic segment was examined before and after spraying with indigo carmine 0.4%. Two hundred seventy-six polyps were detected in 198 patients. One hundred sixty of them were hyperplastic polyps, 116 were adenomas, and 2 were carcinomas. The numbers of hyperplastic polyps and purely flat adenomas were significantly higher in the HRC group than in the SC group (1.1 +/- 1.6 vs 0.5 +/- 1.4 and 0.22 +/- 0.68 vs 0.07 +/- 0.29, respectively; P = .01 and P = .04), but there was no significant difference in the total number of adenomas per patient (primary end point) detected between the HRC and the SC groups (0.6 +/- 1.0 vs 0.5 +/- 0.9, respectively). Although HRC improves detection of purely flat adenomas and hyperplastic polyps, the overall detection of colonic adenomas in a population at increased risk of neoplasia is not significantly improved. These findings do not support the routine use of HRC in clinical practice.

Endobrachyœsophage : place de la résection

Surgical resection has a limited place in the management of Barrett's oesophagus with high-grade dysplasia, except when failure of endoscopic mucosectomy is likely (extended Barrett's oesophagus, nodular or ulcerated lesions at endoscopy). For superficial carcinoma, it is often difficult to differentiate mucosal carcinoma (carrying a risk of nodal metastasis less than 7%) from submucosal carcinoma (carrying a risk of nodal metastasis ranging from 16 to 47%), oesophagectomy is routinely indicated if operative risk is low. When operative risk is not minimal, endoscopic mucosectomy is indicated for lesions limited to the mucosa and the proximal third of submucosa; for lesions extending beyond, an oesophagectomy must be discussed. These indications must take into account both age and general condition of the patient, as well as the expertise in oesophageal surgery of the group.