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At least 1,063 records · Page 59Linked to original sources
PubMed1979

Early gastric cancer: report of twenty-five cases.

Among 267 surgical specimens of histologically proved cancer of the stomach during the last 20 years (1957 to 1976), 25 were classified as early gastric cancer. Of these early gastric cancers, 16 were found during the last 5 year period. The increasing number of early gastric cancers found in the recent years may be attributed to the more aggressive diagnostic approaches in patients who have symptoms suggestive of peptic ulcer disease. Another factor which may contribute to the increased incidence of early detection of gastric cancer is a more aggressive surgical treatment in patients with a gastric ulcer. Some patients with early gastric cancer will remain undetected if the surgical treatment was vagotomy and pyloroplasty. Lymph node metastases were present in six patients in this series. Of these 25 patients who had gastric resection for early cancer, follow-up was available in 20. Two patients were noted to have local recurrence at 3 and 8 years, respectively, after the initial operation. One of these two patients died after reoperation and the other still is living. One other patient died of cerebral hemorrhage 12 years following the initial operation of gastric resection. The remaining 17 patients all are living, with no evidence of recurrence. From these results it is concluded that (1) routine gastroscopy should be done in patients with radiological gastric abnormalities and in patients with symptoms suggestive of peptic ulcer disease, even though the upper gastrointestinal series is normal; (2) multiple biopsies should be taken from gastric lesions seen on gastroscopy; and (3) gastrectomy is the treatment of choice, since some of the early gastric cancers in this series would have remained undetected if vagotomy and pyloroplasty had been performed.

Adult↗
PubMed1979

[Correlation of gastroscopic, pathohistologic, cytologic and cytochemical analysis of ulcer lesions and other pathologic changes in the gastric mucosa. Preliminary study].

This paper concerns our first experience of correlation analysis between the gastroscopic, pathohystologic, cytologic and cytochemical findings of different organic gastric lesion on gastroscopy. The authors' experience is based on 78 patients in whom 450 biopsies were performed. For an adequate analysis, 135 samples of pathohystologic anc cytological examinations were useful and only 80 samples for cytochemical analysis. From these examinations it is possible to conclude that the cytochemical reactions of the group of patients with inflammatory lesions and intestinal metaplasia showed changes in the level of enzyme aminopolypeptidase together with the presence of acid mucopolysacharides. In the group of patients with lesions showing an ulcer, carcinoma or suspect malignancies, the changes occured in the composition of enzymes such as acid phosphatase, DNP Diaphoresis and nonspecific esterases. With such combined examinations the percentage of correct diagnoses was increased in comparison with conventional method of gastroscopy and biopsy.

Gastric Mucosa↗
PubMed1978

[A case of congenital double pyloric canal (author's transl)].

In the case of 47-year-old patient who had been suffering for several months from a duodenal ulcer disease, a so called double pylorus was traced by applying fiberoptic gastroscopy. At the same time proof was found for the ulcera duodeni. Owing to the fiberoptic result of two regularly pyloric canals it was already doubted, that this was only a question of a secondary pyloro duodenal fistula caused by peptic ulcer. A particular and differentiating pathological anatomical examination of the surgical specimen showed as a result, that the patient was suffering from a congenital duplication of the pyloric canal by a pyloric ligament. The duodenal ulcers, proofed by x-ray examination and gastroscopy, were recognised as a secondary disease of a locus minoris resistentiae.

Congenital Abnormalities↗
PubMed1983

[Adverse effects of ketoprofen on the gastroduodenal mucosa. Comparison of the 2 oral forms].

Twenty healthy volunteers were entered into a double-blind study designed to compare the digestive tolerance, evaluated by fiberoptic gastroscopy, of Profenid capsules and Bi-Profenid tablets. Ten subjects were given 6 Profenid 50 mg capsules daily and the remaining ten were given 2 Bi-Profenid 150 mg tablets daily. Each drug was given for seven days. Fiberoptic gastroscopy was done before and after treatment with the use of a scoring system. A better score was obtained with the tablets as compared to the capsules. While the incidence of lesions found in the antrum and bulb did not differ between the two forms, lesions of the fundus were less frequent with Bi-Profenid 150 mg. This reflects a reduction in the contact effects of Bi-Profenid on the gastric mucosa, while the systemic effect of ketoprofen remains unchanged.

Adult↗
PubMed1980

Partial gastrectomy for peptic ulcer by the Krønlein method. An outpatient follow-up study 12 years later with particular reference to endoscopy with biopsy and brush cytology and to clinical-chemical and radiological results.

Forty-six patients were studied 12 years after partial gastrectomy for peptic ulcer. They had all been subjected to a standard Billroth II type operation as described by Krønlein, with emphasis laid upon the transverse position of the gastrojejunostomy. The clinical examination was supplemented by an outpatient gastroscopy with photography, biopsy and brush cytology, and by a series of blood analyses and X-ray of the gastric remnant. The general finding on gastroscopy was a slightly injected mucosa with flattened folds near the anastomosis, no or slight reflux of bile. The cytological examination revealed metaplasia in 7.5-15 per cent of the specimens, no sign of dysplasia or carcinoma. Biopsy showed severe atrophic gastritis in 0-13 per cent of the specimens, slight to moderate in 58-96 per cent, no signs of cellular atypia or irregular arrangements. Judged by the results of blood analyses a deficiency in iron, Vitamin B12 or both, was demonstrated in about 25 per cent of patients and of these more than 50 per cent were anaemic. X-ray examination showed that 70 per cent of the patients had an emptying time of the gastric remnant of 10-20 minutes. A transverse position of the anastomosis could be demonstrated in about 67 per cent. The necessity of a close follow-up of these patients is stressed.

Adult↗
PubMed1981

[Multicentric early cancer of the stomach (author's transl)].

In more than 16000 gastroscopies we found 65 (0.4%) cases of early cancer (e.c.), that is an amount of 12.3% of the total diagnosed cancers of the stomach. In 8 patients we found two or three sites of involvement in the stomach (12.3%). The control reading of 53 gastrocamerafilms with e.c. shows, that 20% of suspicious areas have been missed by using the routine interpretation and gastroscopy. It is proposed, that before each stomach surgery for e.c., the upper gastric region be investigated carefully for missed second lesions. This is rather difficult with prograde optic gastroscops. The instrument of choice for that purpose is the gastrocamera.

Adult↗
PubMed1981

[Early gastric cancer: a retrospective study of our cases (1974-1979)].

A retrospective analysis of 3052 gastroscopies made by our Digestive Endoscopy Department from 1974 to 1979 was carried out. 14 Early Gastric Cancers out of a total of 157 gastric carcinomas were diagnosed (8.9%), with an EGC: Gastroscopies ratio = 1:218. From the macroscopic point of view 8 were found to belong to type III, 5 to type II, and 1 to type I. The main location was the lesser curvature (angulus-antrum). With regard to the degree of infiltration, 2 were found to belong to stage 0a, 8 to stage 0b, and 5 to stage I. The endoscopic observation gave reason to suspect the presence of a malignant lesion in 6 of the 14 cases. The bioptic examination proved positive in 10 cases, while in 4 the diagnosis was made on the operatory piece. The importance of multiple bioptic samples is again confirmed. Cytology performed by brushing showed malignant tumoral cells in 4 cases, and again in 4 cases the radiological examination led to suspicion of degenerated gastric ulcer. 13 patients were subjected to surgery during which no metastases to the locoregional lymphonodes were found; the patients are all alive. We started gastric carcinoma screening by selecting the patients on the basis of a worksheet covering epidemiological, clinical, biohumoural and instrumental parameters, since the prognosis for the disease is directly proportional to the earliness of its diagnosis.

Adolescent↗
PubMed1995

[Endoscopic gastrointestinal findings in patients with human immunodeficiency virus infection].

From January 1992 to August 1993, 150 endoscopies (114 fiber gastroscopies, 29 fiber colonoscopies and 7 CPRE) were carried out in a total of 142 anti HIV positive patients. The most frequent clinical manifestations leading to the exploration were dysphagia, epigastric pain, diarrhea and upper or lower gastrointestinal bleeding. Endoscopic alterations were observed in most of the exploration although specific diagnosis was only achieved in approximately one third of the patients with the most frequent being esophagitis by Candida and CMV (21% and 5%, respectively in the fiber gastroscopies performed). Digestive manifestations were varied in the patients in whom esophagitis by Candida was diagnosed while dysphagia and diarrhea were the symptoms commonly observed in the patients with esophagitis or colitis by CMV. The diagnostic profitability of endoscopy was high in patients presenting dysphagia, diarrhea, gastrointestinal bleeding or in those in whom endoscopy was performed for tumoral staging or to evaluate the possible existence of manifestations secondary to the presence of portal hypertension.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Screening for gastrointestinal neoplasia: efficacy and cost of two different approaches in a clinical rehabilitation centre.

Mortality from colorectal cancer (CRC) can be reduced by screening of asymptomatic individuals and by removal of colorectal adenomas (CRA). It is still under debate which screening method should be used. In a clinical rehabilitation centre we compared two widely different approaches: faecal occult blood testing (FOBT) with subsequent endoscopy of test-positives in an unselected patient group, and primary sigmoidoscopy of asymptomatic persons between 50 and 60 years of age. Between January 1988 and October 1991 a FOBT was offered to all--symptomatic and asymptomatic--6,500 in-patients of a clinical rehabilitation centre and lower/upper GI-endoscopy was suggested to test-positives (study A). In the latter half of this period 1,166 persons without bowel symptoms and/or disease and aged 50-60 years were invited to a screening sigmoidoscopy (study B). In study A 95% of the patients (n = 6,234) returned a complete FOBT, which was positive in 186 (2.98%). 126 of these 186 patients (68%) accepted further investigation, and a total of 78 sigmoidoscopies, 78 colonoscopies and 47 gastroscopies were performed. Six patients in whom a malignancy was detected (1 gastric, 1 rectal and 4 colonic; all in a curable stage) underwent surgery. In 28 patients CRA were identified and removed by snare excision. In study B 658/1,166 asymptomatic in-patients accepted the screening sigmoidoscopy (56%). Rectosigmoid adenomas were identified in 153 (23%). One rectal cancer was found. Of these cases, 116 underwent an additional colonoscopy, disclosing proximal adenomas in 39 patients (33.6%). The cost of identifying one CRA-bearer was $1,436 in study A and $271 in study B (assuming: FOBT = $3.00; sigmoidoscopy = $63.00; colonoscopy = $135; gastroscopy = $108). In study A, the cost of identifying one patient with cancer would have been $5,435, if the cost of identifying one CRA-bearer was set to $271 as in study B. Screening for CRC was well-accepted in the health-orientated environment of a rehabilitation centre. The cost of identifying a CRA-bearer with screening sigmoidoscopy was about one-fifth of that using preselection with a FOBT. However, with FOBT a higher number of cancers was found. For the discovery of CRA, mass-screening with sigmoidoscopy of persons above the age of 50 years can be advised. For the detection of both CRA and CRC, screening with FOBT and subsequent endoscopy is an acceptable and cost-effective method.

Adenoma↗
PubMed1995

Chronic atrophic fundic gastritis diagnosed by a modified Congo red test.

BACKGROUND AND STUDY AIMS: Chronic atrophic fundic gastritis (CAFG) is associated with several diseases, such as gastric cancer, gastric ulcer, pernicious anemia, and bacterial overgrowth. In spite of recent technical improvements, the gastroscopic diagnosis of CAFG remains uncertain. Congo red chromogastroscopy is capable of visualizing acid-producing normal fundic mucosa, but has hitherto not been suitable for routine use. The aim of our study was to establish a reliable endoscopic technique with which to diagnose CAFG. PATIENTS AND METHODS: This prospective study comprises 124 consecutive patients (71 women, 53 min) with a mean age of 65 years (range 36-92). Macroscopic evaluation of the gastric fundic mucosa in routine endoscopy using video techniques was compared with evaluation by means of a modified endoscopic Congo red test (MCRT). In routine gastroscopy, CAFG was recognized by the thin, friable mucosa, with a marked visible vascular pattern and fold atrophy. With MCRT, the diagnosis of CAFG was made within five minutes' observation when no red-to-blue color shift in the fundic mucosa could be induced by 0.2 mu g/kg intravenous pentagastrin. The results were then compared with the histological examination of biopsies from the fundic mucosa. RESULTS: CAFG was confirmed by histology in 40 of 124 cases. The diagnostic sensitivity of MCRT was 1.0 (40/40), with a positive predictive value of 0.90, whereas the values for macroscopic gastroscopic evaluation were 0.25 (10/40) and 0.50, respectively. CONCLUSIONS: We conclude that MCRT is a sensitive, fast, and cost-effective method of identifying patients with CAFG, and well suited for use in routine gastroscopy.

Adolescent↗
PubMed1997

Development and evaluation of an endoscopic technique permitting rapid visualization of the cardiac region of the porcine stomach.

Our study was designed to ascertain whether a flexible videoscope could be used to efficiently monitor ulcers of the pars esophagea in a large group of grower-finisher swine. Gastroscopy was performed on 2 separate occasions in 32 pigs following anesthesia with intravenous pentobarbital, and ulcers of the pars esophagea were subjectively graded. The pigs were then necropsied. Grades from the second endoscopic examination were compared for agreement with grades derived from gross inspection of the pars esophagea at necropsy, and with grades derived from histopathologic examination of sections of the same region. The pars esophagea was adequately visualized in all endoscopic examinations. The average duration of each examination, from anesthetic induction, was approximately 8 min. Gastroscopy permitted appreciation of a wide range of focal and diffuse superficial and deep ulcerative lesions of the pars esophagea, but failed to unequivocally identify parakeratosis of the pars esophagea. Agreement between endoscopic and subsequent necroscopic and histopathologic gradings of ulcerations was poor. We concluded that the use of a flexible videoscope permitted rapid inspection of the pars esophagea, and was therefore a practical method of experimentally monitoring the progression of spontaneous gastric ulcers in pigs. We also postulated that the poor agreement between endoscopic and postmortem findings occurred because endoscopy was possibly more sensitive at detecting small and superficial ulcerations. However, further studies are needed to verify the accuracy of endoscopic diagnosis of gastric ulcers in the live pig.

Animals↗
PubMed1986

Gastric polyposis and malignancy.

Gastric malignancies developed in 15 patients with gastric polyps (seven men, eight women; mean age 66 +/- 8.8 years) during a 14-year follow-up of 170 patients (8.8 per cent). The polyps were hyperplastic in 90 per cent of the patients, adenomas in 8.2 per cent and leiomyomas in 1.8 per cent. During follow-up 4.7 per cent of the patients had both adenomas and hyperplastic polyps. Ten patients developed adenocarcinoma, two lymphoma, one lymphoid sarcoma, one carcinoid tumour and one severe dysplasia. The incidence of malignancy was sevenfold higher than expected (P less than 0.01). There is an associated but lower risk of malignancy in stomachs with hyperplastic polyps than with adenomas; 2 of the 15 stomachs with adenomas and 3 of the 142 hyperplastic polyps showed later malignancy (P less than 0.001). Before the diagnosis of malignancy 1.1 +/- 1.4 (0-4) gastroscopies were done and 12 +/- 19 (0-48) months had elapsed since the first examination and detection of polyps, whereas the mean number of gastroscopies and length of follow-up period in all patients with polyps was 1.9 +/- 0.9 (0-10) and 68 +/- 35 (0-156) months, respectively. Eleven patients had a stage I malignancy and four had a stage IV tumour. The survival rate of the eight patients with malignancy found at the first examination was better (6/8) than for those diagnosed during the follow-up period (3/7) (P less than 0.01; chi2 test). The results show the high risk of malignancy in stomach polyps, adenomas or hyperplasia, and stress the importance of careful and repeated examination of these patients.

Adenoma↗
PubMed2006

Expression of Lewis antigens and their precursors in gastric mucosa: relationship with Helicobacter pylori infection and gastric carcinogenesis.

Lewis (Le)-associated antigens are carbohydrates that are related biochemically to the ABO blood groups, and may have a role in Helicobacter pylori adherence. To evaluate their relationship to clinicopathological outcomes, gastric Le expression, including type 1 precursor, type 1 H, Le(a), Le(b), Le(x), Le(y) and sialylated Le(a) (CA19-9), was evaluated immunohistochemically in 233 gastric biopsy specimens obtained at routine gastroscopy. Expression was also investigated in gastric tissues showing chronic gastritis, intestinal metaplasia, and carcinoma from 42 patients with gastric cancer. A polymerase chain reaction was performed for H. pylori and the bacterial babA2 gene. We identified type 1 precursor expression in 34.3%, type 1 H in 55.8%, Le(a) in 44.2%, Le(b) in 82.0%, Le(x) in 44.2%, Le(y) 56.7%, and CA19-9 in 16.3% of the 233 gastric biopsy specimens. Expression of type 1 H, Le(b), and CA19-9 was significantly associated with H. pylori infection and histological features (p < 0.05), and expression of type 1 H was an independent predictive factor for H. pylori infection by multivariate logistic regression (p = 0.020). Positivity for the babA2 genotype correlated significantly with H. pylori infection and type 1 H expression in gastric biopsy specimens (p < 0.05). The babA2 genotype was more frequent in gastric mucosa from the gastric cancer patients than in gastric biopsy specimens from routine gastroscopy (p = 0.009). In the 42 gastric cancer patients, the frequency of type 1 precursor, Le(a), and Le(x) expression was significantly higher in intestinal metaplasia and carcinoma than in chronic gastritis (p < 0.05), but the frequency of type 1 H and Le(b) expression was significantly lower in intestinal metaplasia and carcinoma (p < 0.05). In conclusion, Le expression, especially that of type 1 H, was significantly associated with clinicopathological features. In gastric cancer patients, Le expression was altered in intestinal metaplasia and carcinoma in comparison with chronic gastritis.

Adhesins, Bacterial↗
PubMed1981

Comparison of the combination of cholestyramine/alginates with placebo in the treatment of postgastrectomy biliary reflux gastritis.

Postgastrectomy biliary reflux gastritis is quite common. Several drugs have been used in its treatment, including the bile acid-binding resin cholestyramine, which seemed ineffective, possibly because of its rapid disappearance from the gastric remnant. It was suggested that by using alginates, which form a raft floating on the gastric contents, cholestyramine would be retained in the stomach for a longer period. 32 patients received either placebo or cholestyramine/alginates/bicarbonate (CAB). Gastroscopy with biopsies, laboratory studies and physical examination were performed before and after the trial. A two week intervals patients were interviewed about the effect on symptoms. A detailed Y-ray study was made of 5 patients, in which a series of pictures was taken after ingestion either of placebo or CAB together with a novel contrast medium. There was no statistical difference between treatment groups with respect to symptoms, gastroscopy or histological findings, nor did the X-ray study show any difference in retention time between placebo and CAB.

Adult↗
PubMedDate not supplied

Postural epigastric pain: a unique symptom of primary cytomegalovirus gastritis?

Cytomegalovirus (CMV) gastritis has been reported in transplant patients. Symptoms are considered nonspecific, and gastroscopy with biopsy is usually performed to establish the diagnosis. Three patients are described here 1 to 3 months after solid organ transplantation, with primary CMV gastritis, confirmed by gastroscopy, histopathologic examination and cultures. The clinical presentation in all three cases was sharp epigastric pain that decreased in a supine position, increased while sitting and further increased when standing or walking. The epigastric pain completely resolved after treatment with ganciclovir. To the best of our knowledge, such postural epigastric pain has not been described as a specific symptom in any other clinical entity and may be a unique sign of primary CMV gastritis.

Adolescent↗
PubMed2005

Rare causes of gastric outlet obstruction in children.

Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.

Adolescent↗
PubMed2006

Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases.

Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied. This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There were 16 consecutive children and adolescents (12 boys, 4 girls) and 15 adults (9 men, 6 women) referred to us for suspected small bowel diseases from August 2002 to September 2005. Among the pediatrics, six patients were less than 10 years old. Technique for capsule placement, gastric transit time, small bowel transit time, excretion time of capsule endoscopy, capsule findings, and complications were recorded. All 16 pediatric patients described that the capsule was easy to swallow except for three children. Finally we delivered the capsule under gastroscopy with overtube for these three children. No capsule retention occurred during our study. Median recording time was 7 h 44 min (range 6 h 51 min-9 h 11 min). Median gastric transit time was 83.5 min (range 4-296 min). Median small bowel transit time was 270 min (range 142-484 min). Median excretion time of capsule was 33.9 h (range 12-96 h). There was no significant difference in excretion time of capsule, gastric transit time and small bowel transit time between pediatric patients and adult patients (P > 0.05). CE was positive in 12 patients, including Crohn's disease (4), hemangioma (2), angiodysplasia (2), Meckel diverticulum (1), polyp (1), aphthous ulcer in ascending colon (1), and cobblestone appearance of ileal mucosa. CE has been performed safely in a small series of pediatric patients after ingestion or endoscopic placement of the capsule. The high yield of abnormal findings was comparable to those of adult patients.

Adolescent↗
PubMed2006

Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked.

BACKGROUND: In August 2004, the United Kingdom Department of Health advisory body published dyspepsia referral guidelines for primary care practitioners. These guidelines advised empiric treatment with antisecretory medications and referral for endoscopy only in the presence of alarm symptoms. The current study aimed to evaluate the effect of these guidelines on the detection of esophagogastric cancer. METHODS: The study reviewed a prospectively compiled database of 4,018 subjects who underwent open access gastroscopy during the years 1990 to 1998. The main outcome measures for the study were cancer detection rates, International Union Against Cancer (UICC) stage, and survival. RESULTS: Gastroscopy identified esophagogastric carcinoma in 123 (3%) of the 4,018 subjects. Of these 123 patients, 104 (85%) with esophagogastric cancer had "alarm" symptoms (anemia, mass, dysphagia, weight loss, vomiting) and would have satisfied the referral criteria. The remaining 15% would not have been referred for initial endoscopic assessment because their symptoms were those of uncomplicated "benign" dyspepsia. The patients with "alarm" symptoms had a significantly more advanced tumor stage (metastatic disease in 47% vs 11%; p < 0.001), were less likely to undergo surgical resection (50% vs 95%; p < 0.001), and had a poorer survival (median, 11 vs 39 months; p = 0.01) than their counterparts without such symptoms. CONCLUSIONS: The use of alarm symptoms to select dyspeptics for endoscopy identifies patients with advanced and usually incurable esophagogastric cancer. Patients with early curable cancers often have only dyspeptic symptoms, and their diagnosis will be delayed until the symptoms of advanced cancer develop.

Adult↗