Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

AIM: To analyze the effect of bipolar electrocoagula-tion and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS: An experimental evaluation was performed at Hospital das Clinicas of the University of So Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was his-topathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until thelamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS: Involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of en-ergy were used with argon plasma. In the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. In the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was em-ployed.CONCLUSION: Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used.     

Multiband mucosectomy for advanced dysplastic lesions in the upper digestive tract

Endoscopic resection(ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection(EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy(MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resectioncap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.     

氩离子凝固术治疗消化道息肉的应用价值

目的探讨氩离子凝固术的临床应用价值,评估其安全性及疗效。方法对2004年1月至2006年1月在哈尔滨医科大学附属第二医院消化內镜诊疗中心就诊的70例消化道息肉患者,采用德国ERBE公司生产的APC300EA型内镜下专用氩气刀,对广基扁平息肉进行经内镜下氩离子凝固术(APC)根除治疗。其中,直径在0.2~0.8cm广基、扁平息肉仅行APC切除治疗,直径在1.0~2.0cm的细蒂或粗蒂及宽基底大息肉行高频电切局部创面渗血,再行APC止血治疗。结果本组病例全部临床治愈。其中,一次成功切除50余枚息肉2例,20余枚2例,10余枚3例,仅用圈套器一次成功切除结肠多发有蒂大息肉30余枚2例。术后仅有2例患者出现无症状的局部黏膜下气泡,1周后复查无其他并发症发生。结论APC结合高频电切在各种消化道息肉病变治疗中安全性好,可有效止血,副反应少,操作简便,尤其是在扁平、广基息肉的治疗中可作为首选方法。     

Safety and efficacy of a new high power argon plasma coagulation system (hp-APC) in lesions of the upper gastrointestinal tract

BACKGROUND: The aim of this study was to analyze safety and efficacy of a new high power argon plasma coagulation system in the upper gastrointestinal tract. METHODS: Data of 215 patients treated with a high power argon plasma coagulation system in the upper gastrointestinal tract 04/2003-01/2004, using a VIO APC device (VIO 300 D with APC 2; Erbe Elektromedizin, Tübingen, Germany; pulsed argon plasma coagulation, 20-120 W), were reviewed and analyzed. Indications were as follows: additive ablation therapy in curative treatment of early Barrett's cancer (122 patients); palliative treatment of oesophageal cancer (n=27); gastric adenoma/carcinoma (n=19); Zenker's diverticulum (n=8); and other. In 190/215 patients (149 males; mean age 67 years), the data were completely analyzable. Minor and major complications were evaluated. RESULTS: Minor complications (odynophagia, pain, fever) occurred in 24/277 sessions (8.7%); major complications (stenosis) in 3/277 sessions (1.1%) using at least 50 W. No perforation or bleeding occurred. The mean number of treatment sessions required was 1.46 (1-7); in the palliative treatment of oesophageal cancer, it was 2.5 (1-5). CONCLUSIONS: The high power argon plasma coagulation system was effective and safe in various gastrointestinal conditions. Due to it's high effectiveness and a low number of sessions required in tumour debulking, this high power argon plasma coagulation system might be used as an alternative to Nd:YAG laser.     

Colon explosion during argon plasma coagulation

Even when APC and other high-energy driven procedures are performed in compliance with preventive measures, the risk of colon explosion cannot completely be avoided. To date, meticulous full bowel cleansing with preparation without sugar compounds that may be malabsorbed should be carried out before any APC treatment in the colon.     

Gemcitabine in advanced biliary tract cancers

The annual incidence of hepatobiliary cancer has been steadily increasing in the USA from 15,000 in 1993 to 22,200 in 2000. Despite this increase, it still continues to be a rare neoplasm. Surgical resection is the treatment of choice, but a high percentage of patients are unsuitable for resection. These patients have a very poor prognosis because of the lack of efficacious therapy options. Thus, overall survival in these patients ranges from 3 to 12 months, depending on the extent of disease and its site of origin. For some time, mitomycin C, doxorubicin and 5-fluorouracil have been considered among the most active chemotherapeutic agents, with a response rate ranging from 10 to 20%. More recently, gemcitabine has become the reference agent for these neoplasias because of the histologically common origin of biliary cancer and exocrine pancreatic cancer. However, its role has yet to be well-defined. Here we examine clinical trials designed for locally advanced and metastatic biliary tract cancer and review the existing data supporting palliative therapy with gemcitabine alone or in association with other drugs.     

老年消化道癌症患者抑郁与免疫抑制酸性蛋白的关系

目的:研究晚期消化道癌症患者抑郁与免疫抑制酸性蛋白(immunosupressive acidic protein,IAP)等之间关系,并观察抗抑郁治疗后上述指标的变化,探讨抑郁与免疫功能之间关系.方法:采用Zung量表对晚期消化道癌症患者43例行抑郁测评的同时采用单向免疫琼脂扩散法检测外周血IAP含量,采用流式细胞仪检测外周血CD3,CD4,CD8和NK细胞百分比,根据Zung测评结果,以百忧解对抑郁患者进行干预,抑郁纠正的同时再次检测上述指标结果:本组患者抑郁的发生率为44%;抑郁评分与IAP呈正相关(r=0.549,P<0.01),与CD3,CD4呈负相关(r=-0.163,P<0.001;r= -0.163,P<0.001),与NK,CD8无相关(r=0.262,P>0.05:r=0.611,P>0.05);抑郁组与非抑郁组数据分析表明IAP,CD3和CD4有显著差异(IAP:908.33±275.75 mg/L vs 537.60±282.64 mg/L,P<0.01;CD3:67.05±13.12 vs 73.27±8.03.P<0.05:CD4:36.68±11.29 vs 43.72±9.16.P<0.05);抗抑郁治疗后IAP变化明显(P<0.05),CD3,CD4,CD8,NK无明显变化(均P>0.05).结论:老年晚期消化道癌症患者抑郁与免疫功能相关,伴发抑郁的患者免疫功能低下,抗抑郁治疗后免疫功能改善.     

Symptom-to-diagnosis interval and survival in cancers of the digestive tract

The objective was to identify the main correlates of the symptom-to-diagnosis interval (SDI) and to analyze their influence upon the survival in patients with cancers of the digestive tract. Two hundred forty-eight symptomatic patients with cancer of the esophagus (N = 31), stomach (N = 70), colon (N = 84), and rectum (N = 66) were interviewed and prospectively followed (median follow-up of 77 months). Cox's regression was used to assess the relative risk (RR) of death according to SDI. The median SDI was about 4 months, with nonsignificant differences by sex, age, social class, family history of cancer, or tumor site. The RR of death varied significantly by age (P = 0.012), tumor site (P < 0.01), tumor stage (P < 0.01), and type of hospital admission (P < 0.01). After adjustment for known and potential predictors of survival and as compared to an SDI < 2.5 months, the RR of death was 0.89 (95% CI: 0.61–1.32) for an SDI of 2.5–6 months, 0.78 (95% CI: 0.49–1.26) for SDI > 6–12 months, and 0.81 (95% CI: 0.44–1.49) for SDI > 12 months. These results do not imply that specific actions to hasten diagnosis must of necessity be ineffective, but underscore what a challenging task the secondary prevention of cancer remains.     

Geriatric diseases of the upper digestive tract]

During aging, secretion and motility of the upper GI tract slow down. The reduction of these functions, however, does not create complaints. In the higher age groups, a number of symptoms from age-dependent diseases occur more frequently, e.g., dysphagia in response to cerebral ischemia, or disturbed gastric emptying caused by diabetic visceral neuropathy. Moreover, certain GI diseases occur more often in the elderly, e.g., chronic atrophic gastritis, NSAR-induced gastric ulcers, malignancies, and others. In contrast, almost nothing is known about diseases or symptoms of the GI tract that might be specific for the elderly. With only a few exceptions, there are no age-dependent clinical differences. Nevertheless, intestinal diseases often develop more rapidly and the mortality is higher in the elderly than in younger people.     

全基因组关联分析在消化系肿瘤中的研究进展

全基因组关联分析(genome-wide association study,GWAS)是应用人类基因组中单核苷酸多态性(single nucleotide polymorphism,SNP)为标记进行分析,以期发现影响复杂性疾病发生的遗传特征的一种新策略.因其可在全基因组范围内进行整体研究,能够一次性对疾病与基因的关联进行轮廓性概览,所以在过去的5年中,全基因组关联研究方法已被证明是研究复杂疾病一种有效手段.近年,各国科学家运用全基因组关联分析在人类肿瘤,特别是在消化系肿瘤的研究中取得了一系列重要的研究成果,本文将综述消化系肿瘤GWAS研究进展,并展望GWAS所面临的挑战及可能的解决策略.     

Somatic mutations of mitochondrial DNA in digestive tract cancers

BACKGROUND: Somatic mutations of mitochondrial DNA (mtDNA) have been reported to play an important role in the carcinogenesis of several human cancers. However, there are few reports on mtDNA mutations in digestive tract cancers, including esophageal, gastric and colorectal cancers. The present study examined somatic mtDNA mutations in these cancers. METHODS: Samples of 82 esophageal cancers, 96 gastric cancers and 138 colorectal cancers were collected. Mutations in the D310 mononucleotide repeat of mtDNA were examined by microsatellite assay. RESULTS: Frequencies of mtDNA mutations were similar in each digestive tract cancer: 14% (7/51) in esophageal cancers, 15% (14/94) in gastric cancers and 8% (11/133) in colorectal cancers. There were no significant relationships between mtDNA mutations and clinicopathological features, such as patient age or sex, tumor location, depth of tumor invasion and lymph node metastasis in each digestive tract cancer. CONCLUSIONS: The results suggest that mtDNA mutations play a role in the development but not progression in each digestive tract cancer, and that the role of mtDNA mutations might be similar among the digestive tract cancers.     

内镜下氩离子凝固术治疗Barrett食管

目的对氩离子凝固术（APC）治疗Barrett食管（BE）的疗效进行前瞻性评估。方法选择2004年3月至2005年1月经胃镜检查、病理证实的15例BE患者进行60WAPC治疗，术后予质子泵抑制剂辅助治疗。对其疗程、疗效、并发症进行评估。结果15例均完成治疗，平均随访期为13．2个月。12例仅需1次APC治疗即获得消除，3例需2次治疗，平均烧灼次数为1．2次。8例治疗期间有轻度并发症，其中7例为胸骨后疼痛，1例治疗后出现轻度吞咽困难，未予手术治疗，半年后逐步缓解。1例在BE完全消除后6个月再现肠上皮化生，该例患者再次予以APC治疗，之后6个月内2次胃镜检查未发现复发，治疗总有效率为93％。结论APC治疗是一种安全、有效的治疗BE的方法。