8 research outputs found
Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease
Aim To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of pediatric patients investigated for Crohn's disease (CD) attending a UK tertiary center. Methods and Results Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy (IC), and MRE. The accuracy and agreement of SICUS in detecting small bowel lesions and CDârelated complications were assessed using kappa (Îș) coefficient statistics. A total of 93 patients (median age 15âyears, range 2â17, 49 male) underwent SICUS; 58 had suspected and 35 had established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8 and 100% and for TUS 85.7 and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7 and 100% and TUS 80 and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (Îș = 0.73) but fair in TUS (Îș = 0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (Îș = 0.84), with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (Îș = 0.63) and moderate (Îș = 0.53), respectively. Agreement between SICUS and MRE was substantial for detecting strictures (Îș = 0.77) and dilatation (Îș = 0.68). Conclusions SICUS offers a radiationâfree alternative for assessing pediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice
PB.33: Vacuum-assisted biopsy for lesions of uncertain malignant potential: further evidence of its suitability as a safe alternative to surgery
Increased Expression of VEGF, COX-2, and Ki-67 in Barrett's Esophagus: Does the Length Matter?
Barrettâs esophagus (BE) is a major complication of gastroesophageal
reflux disease due to its neoplastic potential. The length of the
metaplastic epithelium has been associated with cancer risk.
Angiogenesis, inflammation, and increased cell proliferation are early
events in the malignant sequence. Vascular endothelial growth factor
(VEGF), cyclooxygenase-2 (COX-2) and Ki-67 are indirect markers of these
complex mechanisms.
To examine the expression of VEGF, COX-2 and Ki-67 in BE and investigate
whether there is an association to Barrettâs length.
Immunohistochemistry for VEGF, COX-2, and Ki-67 was performed in
well-characterized Barrettâs samples, evaluated using a qualitative
scale and compared between long (LSBE) and short (SSBE) segments.
The study population consisted of 98 patients (78 men). LSBE and SSBE
was diagnosed in 33 (33.7%) and 65 (66.3%) cases, respectively. VEGF
was expressed in vascular endothelium of all Barrettâs specimens. COX-2
and Ki-67 expression in metaplastic epithelia was strong in 81.6 and
61.2% of the samples, respectively. Ki-67 expression was significantly
stronger in LSBE (p = 0.035), whereas VEGF expression was significantly
increased in SSBE (p = 0.031). COX-2 expression was not associated with
Barrettâs length.
VEGF, COX-2, and Ki-67 were overexpressed in the majority of Barrettâs
samples. The length was inversely associated with VEGF expression and
directly associated with Ki-67 expression
Inflammatory infiltration of metaplastic epithelium and correlation to previous diagnosis of esophagitis and Barrett's length
Objective. The contact of the gastric refluxate with the lower esophagus
results in an inflammatory-mediated tissue damage. The role of
inflammation both in the development and in the advance of Barrettâs
esophagus (BE) has not been elucidated. The aim of this study was to
assess the inflammatory infiltration in metaplastic Barrettâs epithelium
and to explore the association of microscopic inflammation to healed
esophagitis and Barrettâs length. Material and methods. Inflammatory
infiltration was qualitatively evaluated in well-characterized Barrettâs
specimens. Esophagitis was healed prior to histological sampling.
Univariate comparative analysis was performed based on BE length.
Results. Ninety-eight patients (78 male, mean age 58.3 +/- 13.3 yrs)
were retrospectively studied. Thirty-three cases with long segment BE
(LSBE) (33.7%) were spotted. Inflammatory infiltration was mild,
moderate, and severe in 35 (35.7%), 54 (55.1%), and 9 (9.1%)
specimens, respectively. The samples with moderate/severe inflammatory
infiltration were obtained from patients who had more frequently been
diagnosed with esophagitis (p = 0.025). Hiatal hernia (p = 0.001),
esophagitis (p = 0.019), and previous use of antisecretory drugs (p =
0.005) were more common in LSBE. Conclusions. Inflammatory infiltration
of Barrettâs epithelium was largely moderate despite preceding healing
of erosions with PPIs. Previous diagnosis of esophagitis correlated to
the degree of inflammation. No association of inflammation to Barrettâs
length was established