Pulsatile Wave in Esophageal Wall Blood Vessels after Endoscopic Therapy for Esophageal Varices

Abstract: This study was designed to evaluate the clinical significance of the pulsatile wave in esophageal wall blood vessels after endoscopic therapy using endoscopic color Doppler ultrasonography (ECDUS) in 53 patients with esophageal varices. Ten of the 53 had recurrent intramucosal venous dilatation (F₀ type) of the esophagus, four of F₃ type and 39 of F₂ type. The endoscopic therapy techniques used in this study included endoscopic injection sclerotherapy (EIS) and heat-probe coagulation treatment (HPT) in 23 cases, endoscopic variceal ligation (EVL), EIS and HPT in 14, EVL and HPT in six, and HPT only in ten. The pulsatile wave in esophageal wall blood vessels was delineated in 10 of 53 (18.9%) patients using ECDUS after endoscopic therapy. Herein, we describe the ECDUS findings of pulsatile wave-positive cases. The esophageal wall was thickened yielding a low echoic pattern, and the pulsatile wave in blood vessels was delineated by color flow from the extra to the intra-esophageal wall in all patients. We calculated the maximum velocity (V_max), minimum velocity (V_min) and pulsatility index (PI). V_max of the pulsatile wave in blood vessels was found to be 9.7–24.0cm/sec (16.9±4.8cm/sec), V_min 3.0–14.3cm/sec (5.6±3.4cm/sec), and PI 0.81–1.72 (1.33±0.28). We also investigated the prognosis of pulsatile wave-positive patients. Esophageal varices recurred in two of the 10 cases. The PI of these cases were 0.81 and 0.98. There was no recurrence of esophageal varices in cases with PI values over 1.0.     

PERORAL PANCREATOSCOPY: CURRENT STATUS AND FUTURE EXPECTATIONS USING NARROW BAND IMAGING

Peroral pancreatoscopy (POPS) under duodenoscopic assistance provide direct visual assessment of the pancreatic duct, tissue sampling, and therapeutic interventions. Sometimes, pancreatoscopy can confirm accurate diagnosis, such as differential diagnosis of filling defects between intraductal tumors and stones. However, it is often difficult to differentiate malignant from benign strictures solely on pancreatoscopy. It is currently considered that intraductal papillary mucinous neoplasm (IPMN) is the most suitable indication of POPS. POPS has several problems: image resolution, fragility and maneuverability. Concerning image resolution, the quality has been improved with the development of a video pancreatoscope. Moreover, the recently developed endoscopic optical technology of narrow band imaging (NBI) is now available to video pancreatoscopy. This will allow direct visual assessment. Although currently POPS has several problems, further improvement will assist POPS to become a useful modality in combination with NBI.     

Increased DNA damage in ALDH2-deficient alcoholics

Drinking alcohol is a risk factor for cancers of the oral cavity, pharynx, larynx, and esophagus. Although many studies suggest that acetaldehyde, a major metabolite of orally ingested alcohol, plays a crucial role in cancer initiation, the link between the aldehyde dehydrogenase-2 (ALDH2) genotype and acetaldehyde-derived DNA damage has not yet been explored. We have developed a sensitive and quantitative method for detecting the acetaldehyde-derived DNA adducts, N(2)-ethyl-2'-deoxyguanosine (N(2)-Et-dG), alpha-S- and alpha-R-methyl-gamma-hydroxy-1,N(2)-propano-2'-deoxyguanosine (alpha-S-Me-gamma-OH-PdG and alpha-R-Me-gamma-OH-PdG), and N(2)-(2,6-dimethyl-1,3-dioxan-4-yl)-deoxyguanosine (N(2)-Dio-dG), by using liquid chromatography electrospray tandem mass spectrometry (LC/ESI-MS/MS) and stable-isotope internal standards. We determined the DNA adducts in 44 blood DNA samples from Japanese alcoholic patients. The levels of three acetaldehyde-derived DNA adducts, N(2)-Et-dG, alpha-S-Me-gamma-OH-PdG, and alpha-R-Me-gamma-OH-PdG, were significantly higher in alcoholics with the ALDH2 1/2 2 genotype compared to those with the ALDH2 1/2 1 genotype. N(2)-Dio-dG was not detected in any of the DNA samples analyzed. These results provide molecular evidence that the ALDH2 genotype affects the genotoxic damage caused by acetaldehyde.