Prospective comparison of the perceived preoperative computed tomographic, endosonographic and histopathological stage of oesophageal cancer related to body mass indices

Pre-morbid weight loss and low body mass index (BMI) have been reported to be associated with decreased odds of misclassification of the defined stage of oesophageal cancer by endoluminal ultrasound (EUS). The aim of this study was to assess the strengths of agreement between the perceived preoperative radiological T and N stage compared with the final histopathological stage related to four categories of BMI (low <20, normal 20-24.9, high 25-30, and obese >30 kg/m(2)). One hundred sixty-six patients with oesophageal carcinoma were studied. Strength of agreement between the CT and EUS stages and histopathological stage was determined by the weighted kappa statistic (Kw). Kw for EUS T stage related to increasing BMI category was 0.840 (P = 0.0001) to 0.620 (P = 0.001), compared with 0.415 (P = 0.018) to 0.260 (P = 0.011) for CT. Kw for EUS N stage related to increasing BMI category was 0.438 (P = 0.067) to 0.513 (P = 0.010), compared with 0.143 (P = 0.584) to 0.582 (P = 0.030) for CT. EUS was good at predicting tumour infiltration irrespective of BMI when compared with CT, while CT N staging accuracy improved with higher BMIs. Multidisciplinary teams should be aware of these limitations when planning treatment strategies.     

Prospective comparison of endosonography, computed tomography, and histopathological stage of junctional oesophagogastric cancer

AIMS: To assess the strength of agreement between the perceived preoperative stage of Siewert II (oesophagogastric junction) and Siewert III (proximal gastric tumours) as determined by computed tomography (CT) and endoscopic ultrasound (EUS), both alone and in combination, with histopathological stage. METHODS: Forty-four patients with Siewert II (n=18) and III (n=26) adenocarcinomas of the oesophagogastric junction underwent preoperative CT at their local hospitals followed by specialist EUS, and the strengths of the agreement between the radiological stages and the histopathological stages were determined by the weighted Kappa statistic (Kw). RESULTS: Kw for Siewert II T and N stages was 0.491 (p=0.016) and 0.4 (p=0.087) for CT compared with 0.852 (p=0.0001) and 1 (p=0.0001) for EUS. Kw for Siewert III T and N stages was 0.181 (p=0.206) and 0.121 (p=0.376) for CT compared with 0.173 (p=0.195) and 0.263 (p=0.031) for EUS. CONCLUSION: Siewert II tumour T and N stages were more accurately predicted by EUS than CT, but Siewert III tumour T and N stages were more difficult to assess, arguably because of anatomical constraints at the oesophagogastric junction. CT and EUS are complimentary techniques, and these results highlight the importance of multidisciplinary discussion in planning treatment.     

Varied light and scanning electron microscopic appearances of barium sulphate in smears and histological sections

The various light and scanning electron microscopic appearances of barium sulphate in smears and in histopathological lesions in sections are illustrated. One type of barium sulphate (E-Z-HD) includes much larger, bright birefringent particles and has very different appearances from other widely used types. Such larger particles in sections were not originally suspected to be barium sulphate and were identified only by energy dispersive x ray analysis in a scanning electron microscope. This form of barium sulphate is used for double contrast upper gastrointestinal radiography, and is not thought to have been responsible for the lesions in which it has been observed by us.     

Gastric emptying of solids in normal children--a preliminary report

Objective

The physiological range of gastric emptying in healthy children has not previously been documented. The aim of this study was to establish the range of normal gastric emptying in children aged between 5 and 10 years with a Tc 99m-labelled solid meal acceptable to most of the children.

Methods

A list of 7 child-friendly foods was compiled. Thirty-one children aged 5 to 10 years completed a questionnaire, ranking their favourite food choices. A volume survey, to decide the weight of solid meal for the study, was carried out in 20 children.After ethical approval, gastric emptying was monitored in healthy children aged 5 to 10 years with a ^99mTc-labelled solid meal selected by the methodology given hereinabove. Geometric mean counts were obtained from anterior and posterior gamma camera images, and data were used to produce normal emptying curves. In each case, a T_1/2 gastric emptying time (time taken to empty half the stomach contents) was calculated.

Results

The overall preference was a chocolate Technecrispy cake, and the volume survey suggested a 30-g weight for the study. Twenty-four subjects consumed the meal and completed the study. The mean T_1/2 gastric emptying time was 107.2 minutes (2 SD; range, 54.6-159.8 minutes).

Conclusions

Chocolate Technecrispy cake was acceptable to most healthy children between 5 and 10 years of age and gave mean T_1/2 gastric emptying time of 107.2 minutes. This meal can now be used for paediatric patients with transit problems.     

Validity of 13C octanoic acid breath test for measurement of solid meal gastric emptying time in children

Background/Purpose

It is important to establish a physiologic range of gastric emptying (GE) in children. Gastric emptying time measured with ⁹⁹Tc-labeled solid meal (GE^Tc) is the gold standard. Large-scale studies with GE^Tc are ideal but not feasible because of radiation exposure. The ¹³C-labeled octanoic acid breath test (GE^13C) does not involve radiation and is suitable for large studies. The aim of this study was to validate GE^13C with GE^Tc and to explore whether GE^13C could be used to establish a physiologic range of GE in children.

Method

Twenty-five healthy children underwent simultaneous GE^Tc and GE^13C using a standardized solid test meal. The time taken for the stomach to empty half its content (T½^13C) and solid lag phase (lag^13C) for GE^13C were computed from the fractional excretion of ¹³C in expired air. T½^13C and lag^13C were compared with corresponding values obtained by GE^Tc.

Result

Correlation coefficient between T½^13C and T½^Tc was 0.69 (P < .01; r = 0.92 if 3 outliers were omitted). Correlation coefficient between lag^13C and lag^Tc was 0.39 (P < .05). There was good agreement between the methods by the Bland Altman method.

Conclusion

There is good agreement between GE^13C and GE^Tc. GE^13C can be safely used to establish the reference range of GE in healthy children.     

Open-access gastroscopy is associated with improved outcomes in gastric cancer

OBJECTIVE: To examine whether patients with gastric cancer diagnosed via open-access gastroscopy (OAG) differ in their outcomes compared with patients referred conventionally to outpatient clinics or as acute emergencies. DESIGN AND SETTING: Prospective observational study in the gastroenterology and surgical units of a large district general hospital. PARTICIPANTS: One hundred consecutive patients with gastric adenocarcinoma. MAIN OUTCOME MEASURES: Data were collected prospectively and subdivided into two groups according to whether the patients were referred via the open-access route or the conventional route. RESULTS: Diagnostic delay from onset of symptoms was shorter for patients referred via OAG compared with those referred conventionally. Stages of disease were significantly earlier in patients referred via OAG compared with patients referred conventionally. Potentially curative resection was significantly more likely following OAG than after conventional referral. Cumulative five-year survival for patients referred via OAG was 30% compared with 12% after conventional outpatient referral and 13% after acute referral. Multivariate analysis revealed three factors to be associated with survival: stage of disease, distant metastases and referral via the open-access route. CONCLUSIONS: Gastric cancers presenting at OAG were diagnosed at an earlier stage than cancers diagnosed after conventional referral. This led to a higher proportion of potentially curative resections and better five-year survival.