Comparison of Narrowband Imaging with Autofluorescence Imaging for Endoscopic Visualization of Superficial Squamous Cell Carcinoma Lesions of the Esophagus

Aim. To compare narrowband imaging (NBI) and autofluorescence imaging (AFI) endoscopic visualization for identifying superficial esophageal squamous cell carcinoma (SCC). Methods. Twenty-four patients with superficial esophageal carcinomas diagnosed at previous hospitals were enrolled in this study. Lesions were initially detected using white-light endoscopy and then observed with both NBI and AFI. Endoscopic images documented each method, and three endoscopists experienced in esophageal imaging retrospectively reviewed respective images of histologically confirmed esophageal SCCs. Images were assessed for quality in identifying superficial SCCs and rated as excellent, fair, or poor by the three reviewers with interobserver agreement calculated using kappa (κ) statistics. Results. Thirty-one lesions histologically confirmed as superficial esophageal SCCs were detected in 24 patients. NBI images of 27 lesions (87%) were rated as excellent, three as fair, and one as poor compared to AFI images of 19 lesions (61%) rated as excellent, 10 as fair and two as poor (P<0.05). Moderate interobserver agreement (κ=0.42, 95% CI 0.24–0.60) resulted in NBI while fair agreement (κ=0.35, 95% CI 0.18–0.51) was achieved using AFI. Conclusion. NBI may be more effective than AFI for visualization of esophageal SCC

Disección submucosa endoscópica (ESD) para tumores colorrectales

6 páginasBackground: Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, however, it is not widely used in the colorectum because of its technical difficulty. Objective: To determine the feasibility of using ESD for treating large superficial colorectal tumors. Patients: A total of 400 consecutive patients were treated by ESD for 405 lesions at National Cancer Center Hospital, Tokyo, Japan. Interventions: Endoscopic submucosal dissection procedures were performed using a bipolar needle knife (B-knife) or an insulation-tip knife (IT knife). Results: The en-bloc resection rate was 87% and the curative resection rate was 86% among the 405 ESDs: 101 involved tubular adenomas, 255 intramucosal cancers and minute submucosal cancers, 46 submucosal deep cancers and 3 others (MALT and carcinoid tumors). The median operation time was 90 minutes and the mean size of resected specimens was 40 mm (range: 15 mm-150 mm). Perforations occurred in 14 (3.5%) cases and postoperative bleeding in four (1%) cases, but only one perforation case needed emergency surgery because endoscopic clipping was ineffective. Limitations: Conducted at single center. Conclusions: Endoscopic submucosal dissection is a feasible technique for treating large superficial colorectal tumors because it provides a higher en-bloc resection rate and is less invasive than surgical resection.Antecedentes: La disección endoscópica submucosa (DES) es aceptada como un tratamiento mínimamente invasivo para el cáncer gástrico temprano, sin embargo, no se usa ampliamente en el colorrectal debido a su dificultad técnica. Objetivo: Determinar la viabilidad del uso de DES para el tratamiento de tumores colorrectales superficiales grandes. Pacientes: Un total de 400 pacientes consecutivos fueron tratados mediante ESD por 405 lesiones en el Hospital del Centro Nacional del Cáncer, Tokio, Japón. Intervenciones: Los procedimientos endoscópicos de disección submucosa se realizaron utilizando un bisturí de aguja bipolar (cuchillo B) o un bisturí con punta aislante (cuchillo IT). Resultados: La tasa de resección en bloque fue del 87% y la tasa de resección curativa fue del 86% entre las 405 DES: 101 involucraron adenomas tubulares, 255 cánceres intramucosos y cánceres submucosos diminutos, 46 cánceres submucosos profundos y otros 3 (MALT y tumores carcinoides). . El tiempo quirúrgico medio fue de 90   minutos y el tamaño medio de las muestras resecadas fue de 40   mm (rango: 15   mm-150   mm). Se produjeron perforaciones en 14 (3,5%) casos y sangrado posoperatorio en cuatro (1%) casos, pero sólo un caso de perforación requirió cirugía de emergencia porque el clip endoscópico fue ineficaz. Limitaciones: Realizado en un solo centro. Conclusiones: La disección submucosa endoscópica es una técnica factible para el tratamiento de tumores colorrectales superficiales grandes porque proporciona una mayor tasa de resección en bloque y es menos invasiva que la resección quirúrgica

Psychological Stress Exacerbates Inflammation of the Ileum via the Corticotropin-Releasing Hormone-Mast Cell Axis in a Mouse Model of Eosinophilic Enteritis

The effects of psychological stress on eosinophilic gastrointestinal disorders have not been elucidated. This study investigated the effects of psychological stress in a mouse model of eosinophilic enteritis (EoN). BALB/c mice were treated with ovalbumin (OVA) to create an EoN model and subjected to either water avoidance stress (WAS) or sham stress (SS). Microscopic inflammation, eosinophil and mast cell counts, mRNA expression, and protein levels of type 2 helper T cell (Th2) cytokines in the ileum were compared between groups. We evaluated ex vivo intestinal permeability using an Ussing chamber. A corticotropin-releasing hormone type 1 receptor (CRH-R1) antagonist was administered before WAS, and its effects were analyzed. WAS significantly increased diarrhea occurrence and, eosinophil and mast cell counts, and decreased the villus/crypt ratio compared to those in the SS group. The mRNA expression of CRH, interleukin IL-4, IL-5, IL-13, eotaxin-1, and mast cell tryptase β2 significantly increased, and the protein levels of IL-5, IL-13, and OVA-specific immunoglobulin E (IgE) also significantly increased in the WAS group. Moreover, WAS significantly increased the intestinal permeability. The CRH-R1 antagonist significantly inhibited all changes induced by WAS. Psychological stress exacerbated ileal inflammation via the CRH-mast cell axis in an EoN mouse model

Acceptance of COVID-19 Vaccines among Patients with Inflammatory Bowel Disease in Japan

Coronavirus disease 2019 (COVID-19) vaccination is recommended for patients with inflammatory bowel disease (IBD). However, the acceptance of COVID-19 vaccines has not been sufficiently evaluated in patients with IBD. We aimed to assess the acceptance and hesitancy of COVID-19 vaccination and related factors among these patients. A retrospective cohort study using a self-reported questionnaire was performed among patients with IBD between 22 June 2021 and 30 August 2021. Of the 187 participants, 10.2% (n = 19) were hesitant to be vaccinated. Patients in the vaccine-hesitant group were younger (p = 0.009) and had a shorter disease duration (p = 0.020). Vedolizumab was prescribed more frequently (p = 0.024) and immunomodulators were less frequently used (p = 0.027) in this group. Multivariable logistic regression analysis identified age (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.92&ndash;1.00, p = 0.042) and the use of immunomodulators (OR: 0.08, 95% CI: 0.01&ndash;0.66, p = 0.019) as independent significant factors for vaccine hesitancy. The COVID-19 vaccine hesitancy rate in patients with IBD in Japan was 10% in this study. The Japanese COVID-19 vaccination campaign appears to be successful. The risk of COVID-19 among patients with IBD requires adequate measures to ensure that vaccines are accepted by vaccine-hesitant patients. These findings may be helpful in achieving adequate vaccination rates