Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer

<p>Abstract</p> <p>Background</p> <p>There have been no reports discussing which imaging procedures are truly necessary before treatment of endoscopically-diagnosed early gastric cancer (eEGC). The aim of this pilot study was to show which imaging examinations are essential to select indicated treatment or appropriate strategy in patients with eEGC.</p> <p>Methods</p> <p>In 140 consecutive patients (95 men, 45 women; age, 66.4 +/- 11.3 years [mean +/- standard deviation], range, 33-90) with eEGC which were diagnosed during two years, the pre-treatment results of ultrasonography (US) and contrast-enhanced computed tomography (CT) of the abdomen, barium enema (BE) and chest radiography (CR) were retrospectively reviewed. Useful findings that might affect indication or strategy were evaluated.</p> <p>Results</p> <p>US demonstrated useful findings in 13 of 140 patients (9.3%): biliary tract stones (n = 11) and other malignant tumors (n = 2). Only one useful finding was demonstrated on CT (pancreatic intraductal papillary mucinous tumor) but not on US (0.7%; 95% confidential interval [CI], 2.1%). BE demonstrated colorectal carcinomas in six patients and polyps in 10 patients, altering treatment strategy (11.4%; 95%CI, 6.1-16.7%). Of these, only two colorectal carcinomas were detected on CT. CR showed three relevant findings (2.1%): pulmonary carcinoma (n = 1) and cardiomegaly (n = 2). Seventy-nine patients (56%) were treated surgically and 56 patients were treated by endoscopic intervention. The remaining five patients received no treatment due to various reasons.</p> <p>Conclusions</p> <p>US, BE and CR may be essential as pre-treatment imaging examinations because they occasionally detect findings which affect treatment indication and strategy, although abdominal contrast-enhanced CT rarely provide additional information.</p

Improving the endoscopic detection of early oesophageal neoplasia

The endoscopic detection of oesophageal cancer is complex; largely owing to the subtle appearances of early oesophageal lesions on endoscopy, as well as clinician experience. Early detection is vital, since lesions confined to the mucosal or superficial layers of the submucosa can be treated with endoscopic eradication therapies to good effect. Conversely, patients presenting with late stage oesophageal cancer have very poor outcomes. Improving the detection of oesophageal cancer requires a multifaceted approach. Since the symptoms patients present with are often vague until the disease has progressed beyond the point that it is curable, developing a way to risk stratify or rationalise patient access to endoscopy, based on objective markers of the presence of serious underlying pathology, is vital to allow adequate resource provision in the modern UK endoscopy unit. In patients who do undergo endoscopy there remains a significant mis-rate of cancers in those with de-novo oesophageal cancer as well as those enrolled in Barrett’s oesophagus surveillance programs. We postulate that advanced imaging technologies, in combination with artificial intelligence systems, may improve the diagnostic performance of endoscopists assessing for oesophageal cancers. This body of work presents a comprehensive review of the literature surrounding the epidemiology, detection, classification and endoscopic treatment modalities for both squamous cell and adenocarcinomas of the oesophagus. It also presents four studies undertaken with the overarching aim of improving the endoscopic detection of oesophageal cancer. The first study presents a methodology for the quantification of a biomarker from gastric aspirate samples and an assessment of whether differences in expression levels can be used to predict the presence of neoplasia in patients with or without Barrett’s oesophagus. The second study investigates the role of a novel, advanced endoscopic imaging technology and whether it improves the diagnostic performance of expert and trainee endoscopists assessing Barrett’s oesophagus for the presence of dysplasia or adenocarcinoma. The final two studies present a significant body of work assessing the feasibility and diagnostic performance of a novel artificial intelligence system designed as part of this thesis, for the detection and characterisation of squamous cell cancer of the oesophagus based on microvascular patterns

Therapeutic Gastrointestinal Endoscopy

Endoscopy has had a big role in the development of modern gastroenterology. Modern endoscopy will certainly be more therapeutic. It started with endoscopic hemostasis and polipectomy, than beginning of the 1970's with the advent of endoscopic sphincterotomy extended to biliopancreatic pathology and has a huge impact in this difficult pathology. Plastic stents made the first steps in endoscopic palliation of neoplastic jaundice, metallic stents, covered or uncovered are better for biliary palliation and can be used also for palliation neoplastic obstruction at different levels of the digestive tube. Resection of digestive tumors has evolved now to sub-mucosal resection, looking to have one-piece complete resection. Interventional endoscopy is now very complex and takes a lot of time for endoscopists to learn properly these techniques. This book is a very good up-to-date overview of new techniques of interventional endoscopy for those who want to learn or develop their knowledges in this field

Abstracts of the International Medical Students’ Congress of Bucharest (IMSCB) 2019

Abstracts of the International Medical Students’ Congress of Bucharest (IMSCB) 2019

Colorectal neuroendocrine neoplasms — management guidelines (recommended by the Polish Network of Neuroendocrine Tumours)

Nowotwory/guzy neuroendokrynne (NEN/NET) jelita grubego są rozpoznawane coraz częściej, szczególnie guzy odbytnicy. To zjawisko jest najprawdopodobniej związane z powszechnym wykonywaniem kolonoskopii przesiewowych. Coraz więcej przemawia za tym, że NEN odbytnicy i okrężnicy to dwie odrębne choroby. Nowotwory neuroendokrynne odbytnicy są najczęściej zmianami niewielkich roz­miarów, cechują się niskim lub umiarkowanym stopniem złośliwości histologicznej, dobrym rokowaniem i większość z nich kwalifikuje się do leczenia endoskopowego. Natomiast NEN okrężnicy to często nowotwory agresywne, niskozróżnicowane, o złej lub niepewnej prognozie, wymagające operacji. Zasady postępowania z tymi chorymi stale się zmieniają. Opierając się na najnowszym piśmiennictwie oraz ustaleniach wypracowanych na spotkaniu roboczym Polskiej Sieci Guzów Neuroendokrynnych (grudzień 2016 r.) w pracy uzupełniono i uaktualniono dane i wytyczne postępowania dotyczące NEN jelita grubego, opublikowane w Endokrynologii Polskiej 2013; 64: 494–504.Neuroendocrine neoplasms/tumours (NENs/NETs) of the large intestine are detected increasingly often, especially rectal tumours, which is probably associated with the widespread use of screening colonoscopy. There is a growing body of evidence supporting the thesis that the NENs of the rectum and the NENs of the colon are two different diseases. Rectal NENs are usually small lesions, of low to moderate histological malignancy, associated with good prognosis, and most may be treated endoscopically. NENs of the colon, however, are often aggressive, poorly differentiated, associated with a poor or uncer­tain prognosis, and require surgical treatment. The management guidelines regarding these groups of patients are constantly changing. On the basis of the recent literature data and conclusions reached by the working meeting of the Polish Network of Neuroendocrine Tumours (December 2016), this study completes and updates the data and management guidelines regarding colorectal NENs published in Endokrynologia Polska 2013; 64: 358–368.

Detectability of Colon Polyp Using Computed Virtual Chromoendoscopy with Flexible Spectral Imaging Color Enhancement

The aim of this pilot study was to assess the feasibility of using computed virtual chromoendoscopy with the flexible spectral imaging color enhancement (FICE) for colon neoplasia screening. A modified back-to-back colonoscopy using FICE and white light in the right-sided colon was conducted prospectively for the consecutive patients attending for the postoperative (sigmoidectomy or anterior resection) follow-up colonoscopy. Histopathology of detected lesions was confirmed by evaluation of endoscopic resection or biopsy specimens. One-hundred and two patients were enrolled, and 100 patients (61 males and mean age 63 years) were finally analyzed. The total number of polyps detected by FICE and white light colonoscopy was 65 and 45, respectively. The miss rate for all polyps with FICE (24%) was significantly less than that with white light (46%) (P = 0.03). Colonoscopy using FICE could beneficially enhance the detection of neoplastic lesions in the right-sided colon compared to white light colonoscopy