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Farrell CC, Khanna S, Hoque MT, Plaga A, Basset N, Syed I, Biouss G, Aufreiter S, Marcon N, Bendayan R, Kim YI, O'Connor DL. Low-dose daily folic acid (400 μg) supplementation does not affect regulation of folate transporters found present throughout the terminal ileum and colon of humans: a randomized clinical trial. Am J Clin Nutr 2024; 119:809-820. [PMID: 38157986 DOI: 10.1016/j.ajcnut.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Folic acid supplementation during the periconceptional period reduces the risk of neural tube defects in infants, but concern over chronic folic acid exposure remains. An improved understanding of folate absorption may clarify potential risks. Folate transporters have been characterized in the small intestine, but less so in the colon of healthy, free-living humans. The impact of folic acid fortification or supplementation on regulation of these transporters along the intestinal tract is unknown. OBJECTIVE The objective was to characterize expression of folate transporters/receptor (FT/R) and folate hydrolase, glutamate carboxypeptidase II (GCPII), from the terminal ileum and throughout the colon of adults and assess the impact of supplemental folic acid. METHODS In this 16-wk open-labeled randomized clinical trial, adults consumed a low folic acid-containing diet, a folate-free multivitamin, and either a 400 μg folic acid supplement or no folic acid supplement. Dietary intakes and blood were assessed at baseline, 8 wk, and 16 wk (time of colonoscopy). Messenger RNA (mRNA) expression and protein expression of FT/R and GCPII were assessed in the terminal ileum, cecum, and ascending and descending colon. RESULTS Among 24 randomly assigned subjects, no differences in dietary folate intake or blood folate were observed at baseline. Mean ± SD red blood cell folate at 16 wk was 1765 ± 426 and 911 ± 242 nmol/L in the 400 and 0 μg folic acid group, respectively (P < 0.0001). Reduced folate carrier, proton-coupled folate transporter, and folate-receptor alpha expression were detected in the terminal ileum and colon, as were efflux transporters of breast cancer resistance protein and multidrug resistance protein-3. Other than a higher mRNA expression of FR-alpha and GCPII in the 400 μg supplement group in the ascending colon, no treatment differences were observed (P < 0.02). CONCLUSIONS Folate transporters are present throughout the terminal ileum and colon; there is little evidence that a low dose of folic acid supplementation affects colonic absorption. This trial was registered at clinicaltrials.gov as NCT03421483.
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Affiliation(s)
- Colleen C Farrell
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Siya Khanna
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Md Tozammel Hoque
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Aneta Plaga
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nancy Basset
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ishba Syed
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - George Biouss
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susanne Aufreiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Reina Bendayan
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Young-In Kim
- Division of Gastroenterology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Li S, Fujiyoshi Y, Jugnundan S, May G, Marcon N, Mosko J, Teshima C. Impact of Residing in Below Median Household Income Districts on Outcomes in Patients with Advanced Barrett's Esophagus. J Can Assoc Gastroenterol 2023; 6:137-144. [PMID: 37538188 PMCID: PMC10395662 DOI: 10.1093/jcag/gwad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background Barrett's esophagus (BE) is a premalignant condition to esophageal adenocarcinoma (EAC). Low socioeconomic (SES) status adversely impacts care and outcomes in patients with EAC, but this has not been evaluated in BE. As the treatment of BE is similarly intensive, we aimed to evaluate the effect of SES on achieving complete eradication of intestinal metaplasia (CE-IM), dysplasia (CE-D) and development of invasive EAC. Methods Our study was a retrospective cohort study. Consecutive patients between January 1, 2010, to December 31, 2018, referred for BE-associated high-grade dysplasia or intramucosal adenocarcinoma were included. Pre, intra and post-procedural data were collected. Household income data was collected from the 2016 census based on postal code region. Patients were divided into income groups relative to the 2016 median household income in Ontario. Multivariate regression was performed for outcomes of interest. Results Four hundred and fifty-nine patients were included. Rate of CE-IM was similar between income groups. Fifty-five per cent (n = 144/264) versus 65% (n = 48/264) in the below and above-income groups achieved CE-D, respectively, P = 0.02. Eighteen per cent (n = 48/264) versus 11% (n = 22/195) were found to have invasive EAC during their treatment course in below and above-income groups, respectively, P = 0.04. Residing in a below-median-income district was associated with developing invasive EAC (Odds Ratio, [OR] 1.84, 95% confidence interval [CI] 1.01 to 3.35) and failure to achieve CE-D (OR 0.64, 95% CI 0.42 to 0.97). Conclusions Residing in low-income districts is associated with worse outcomes in patients with advanced BE. Further research is needed to guide future initiatives to address the potential impact of SES barriers in the optimal care of BE.
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Affiliation(s)
- Suqing Li
- Correspondence: Suqing Li, MD, FRCPC, Therapeutic Endoscopy & Gastroenterology, Division of Gastroenterology, Department of Medicine, University of Calgary, CWPH 6D62, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada, e-mail:
| | - Yusuke Fujiyoshi
- Division of Gastroenterology and Hepatology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sechiv Jugnundan
- Division of Gastroenterology and Hepatology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Gary May
- Division of Gastroenterology and Hepatology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology and Hepatology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jeffrey Mosko
- Division of Gastroenterology and Hepatology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Christopher Teshima
- Division of Gastroenterology and Hepatology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
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Schoeman S, Kobayashi R, Marcon N, May G, Mosko J, Teshima C. Outpatient flexible endoscopic diverticulotomy for the management of Zenker's diverticulum: a retrospective analysis of a large single-center cohort. Gastrointest Endosc 2023; 97:226-231.e2. [PMID: 36228698 DOI: 10.1016/j.gie.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUNDS AND AIMS Flexible endoscopic Zenker's diverticulotomy (EZD) is well established as a safe and effective technique. Because of rare but concerning adverse events, most centers admit patients for observation and barium swallow study. Our center routinely performs EZD as a day procedure, discharging appropriate patients on the same day after clinical review. This study evaluates outcomes of this cohort compared with previously published studies where patients are admitted for observation. METHODS A retrospective analysis was performed of EZD procedures done at our center using a flexible endoscope and, in most cases, a diverticulotomy overtube with patients under moderate sedation or general anesthesia. Patients were observed for 2 hours and discharged if no clinical concerns were found. Patient comorbidities, American Society of Anesthesiologists physical status, and endoscopic adverse events were recorded against the American Society for Gastrointestinal Endoscopy severity grading system. RESULTS Two hundred forty EZD procedures were performed between January 2015 and February 2021. Eleven (4.6%) intraprocedural adverse events occurred: 4 perforations, 4 bleeds, and 1 each postprocedural pain, delirium, and vomiting, respectively. All were recognized within the 2-hour observation period and were managed conservatively, except 1 patient who required surgery. Six patients (2.5%) presented with delayed adverse events: 2 bleeds, 2 perforations, and 2 postprocedural pain. All patients recovered uneventfully with supportive care. CONCLUSIONS All significant adverse events requiring endoscopic or surgical intervention were identified before discharge. Delayed adverse events occurred in 2.5% of cases, all of which were managed supportively. Our data are comparable with published cohorts of admitted patients, demonstrating that appropriately selected patients may be managed as outpatients while maintaining similar safety outcomes.
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Affiliation(s)
- Scott Schoeman
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada; Division of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ryosuke Kobayashi
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada; Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Norman Marcon
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gary May
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Mosko
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher Teshima
- Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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Li S, Mosko J, May G, Kandel G, Kortan P, Marcon N, Teshima C. A61 USE OF ADJUNCTIVE REMOVAL TECHNIQUES FOR ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLONIC POLYPS IS PREDICTIVE OF POLYP RECURRENCE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Endoscopic mucosal resection (EMR) allows for safe and effective removal of large non-pedunculated colon polyps. However, prior studies have shown significant recurrence rates between 10–30% after EMR, which have led to recommendations for close endoscopic follow-up and the use of techniques such as snare tip soft coagulation (STSC) to EMR margins to prevent recurrence. Models such as the Size/Morphology/Site/Access score (SMSA) have been developed to aid in identifying polyp complexity and patients at high risk of recurrence. Numerous individual risk factors for recurrence have previously been reported, however the significance of these factors have varied between studies, with limited data from Canadian centres.
Aims
To evaluate predictors of recurrence for large non-pedunculated polyps following EMR.
Methods
Consecutive patients between April 1, 2017 to March 1, 2019 who underwent EMR were retrospectively identified from endoscopy unit administrative records. Patients with non-pedunculated colorectal polyps ≥ 2 cm that were removed by EMR were included if follow-up endoscopy data were available. Polyps found to contain invasive adenocarcinoma on histology and/or were referred for surgical resection were excluded. Patient demographic, pre-procedural, intra-procedural, and post-procedural data to time of first follow-up colonoscopy were extracted. Recurrence was defined as a positive pathology specimen from the EMR scar at follow-up. Adjunctive techniques were defined as the use of any non-snare resection or ablation technique for removal of visible adenoma at the time of the EMR. Chi-square and multivariate regression analyses were conducted for variables of interest.
Results
517 patients underwent large polyp EMR during the study time period with 265 patients satisfying inclusion criteria. Median age of patients was 67 years (IQR 14); 48% were female. STSC was performed to EMR margins in 94% of cases. 30.9% and 69.1% of polyps were SMSA grade 3 and grade 4 respectively. Adjunctive removal techniques were utilized in 31% of patients, 95% of which was hot avulsion. 15% of patients had recurrence on follow-up endoscopy. Higher SMSA grade was associated with the use of adjunctive techniques (20% vs. 37%, p=0.006). The use of adjunctive removal techniques (OR 2.92, p=0.007) and male gender (OR 3.45, p=0.002) were the only factors found to be significantly predictive of recurrence on multivariate analysis.
Conclusions
Male gender and the use of adjunctive removal techniques, particularly hot avulsion, are independently predictive of recurrence after EMR of large complex colorectal polyps. Male patients and those who require hot avulsion may be considered high risk for recurrence and warrant closer follow-up.
Funding Agencies
None
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Affiliation(s)
- S Li
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Mosko
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON, Canada
| | - G May
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON, Canada
| | - G Kandel
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON, Canada
| | - P Kortan
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON, Canada
| | - N Marcon
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON, Canada
| | - C Teshima
- The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, ON, Canada
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Shimamura Y, Iwaya Y, Kobayashi R, Rodriguez de Santiago E, Muwanwella N, Raftopoulos S, Mosko JD, May GR, Kandel G, Kortan P, Marcon N, Teshima CW. Clinical and pathological predictors of failure of endoscopic therapy for Barrett's related high-grade dysplasia and early esophageal adenocarcinoma. Surg Endosc 2020; 35:5468-5479. [PMID: 32989547 DOI: 10.1007/s00464-020-08037-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Multimodal endoscopic treatment for Barrett's esophagus (BE) related high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) is safe and effective. However, there is a paucity of data to predict the response to endoscopic treatment. This study aimed to identify predictors of failure to achieve complete eradication of neoplasia (CE-N) and complete eradication of intestinal metaplasia (CE-IM). METHODS We performed a retrospective analysis of prospectively collected data of all HGD/EAC cases treated endoscopically at a tertiary referral center. Only patients with confirmed HGD/EAC from initial endoscopic mucosal resection (EMR) were included. Potential predictive variables including clinical characteristics, endoscopic features, and index histologic parameters of the EMR specimens were evaluated using multivariate Cox regression. RESULTS A total of 457 patients were diagnosed with HGD/EAC by initial EMR from January 2008 to January 2019. Of these, 366 patients who underwent subsequent endoscopic treatment with or without RFA were included. Cumulative incidence rates at 3 years for CE-N and CE-IM were 91.4% (95% CI 87.8-94.2%) and 66.8% (95% CI 61.2-72.3%), respectively during a median follow-up period of 35 months. BE segment of 3-10 cm (HR 0.45; 95% CI 0.36-0.57) and > 10 cm (HR 0.25; 95% CI 0.15-0.40) were independent clinical predictors associated with failure to achieve CE-N. With respect to CE-IM, increasing age (HR 0.88; 95% CI 0.78-1.00) was another predictor along with BE segment of 3-10 cm (HR 0.37; 95% CI 0.28-0.49) and > 10 cm (HR 0.15; 95% CI 0.07-0.30). Lymphovascular invasion increased the risk of CE-N and CE-IM failure in EAC cases. CONCLUSION Failure to achieve CE-N and CE-IM is associated with long-segment BE and other clinical variables. Patients with these predictors should be considered for a more intensive endoscopic treatment approach at expert centers.
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Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Yugo Iwaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ryosuke Kobayashi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Enrique Rodriguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramon Y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Niroshan Muwanwella
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Spiro Raftopoulos
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jeffrey D Mosko
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Gary R May
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Gabor Kandel
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Paul Kortan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Christopher W Teshima
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Belghazi K, Marcon N, Teshima C, Wang KK, Milano RV, Mostafavi N, Wallace MB, Kandel P, Mejía Pérez LK, Bourke MJ, Bahin F, Everson MA, Haidry R, Ginsberg GG, Ma GK, Koch AD, Ragunath K, Ortiz-Fernandez-Sordo J, di Pietro M, Seewald S, Weusten BL, Schoon EJ, Bisschops R, Bergman JJ, Pouw RE. Risk factors for serious adverse events associated with multiband mucosectomy in Barrett's esophagus: an international multicenter analysis of 3827 endoscopic resection procedures. Gastrointest Endosc 2020; 92:259-268.e2. [PMID: 32240684 DOI: 10.1016/j.gie.2020.03.3842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Multiband mucosectomy (MBM) is a widely used technique for the treatment of Barrett's esophagus (BE). However, large multicenter studies enabling a generalizable estimation of the risk of serious adverse events, such as perforation and postprocedural bleeding, are lacking. The aim of this study was to estimate the rate of, and risk factors for, serious adverse events associated with MBM. METHODS In this retrospective analysis, consecutive patients who underwent MBM for treatment of BE in 14 tertiary referral centers in Europe, the United States, Canada, and Australia were included. Primary outcomes were perforation and postprocedural bleeding rate. Potential risk factors were identified by logistic regression. RESULTS Between 2001 and 2016, a total of 3827 MBM procedures were performed in 2447 patients (84% male, mean age 66 years, median BE length C2M4). Perforation occurred in 17 procedures (0.4%; 95% confidence interval [CI], 0.3-0.7), of which 15 could be treated endoscopically or conservatively. Female gender was an independent risk factor for perforation (odds ratio [OR], 2.77; 95% CI, 1.02-7.57; P = .05). Postprocedural bleeding occurred after 35 procedures (0.9%; 95% CI, 0.6-1.3). The number of resections (OR, 1.15; 95% CI, 1.06-1.25; P < .001) was significantly associated with postprocedural bleeding. CONCLUSION The results of this study show that MBM for BE is safe with a low risk of serious adverse events. In addition, most of the adverse events could be managed endoscopically or conservatively. The number of resections was an independent risk factor for postprocedural bleeding.
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Affiliation(s)
- Kamar Belghazi
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Norman Marcon
- Department of Gastroenterology, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Christopher Teshima
- Department of Gastroenterology, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Kenneth K Wang
- Department of Gastroenterology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Reza V Milano
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nahid Mostafavi
- Biostatistical Unit, Department of Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael B Wallace
- Department of Gastroenterology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Pujan Kandel
- Department of Gastroenterology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Farzan Bahin
- Department of Gastroenterology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Martin A Everson
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Rehan Haidry
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Gregory G Ginsberg
- Gastroenterology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gene K Ma
- Gastroenterology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, Cancer Institute, Rotterdam, the Netherlands
| | - Krish Ragunath
- Nottingham Digestive Diseases Centre & NIHR Biomedical Research Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | - Jacobo Ortiz-Fernandez-Sordo
- Nottingham Digestive Diseases Centre & NIHR Biomedical Research Centre, Nottingham University Hospital, Nottingham, United Kingdom
| | | | - Stefan Seewald
- Department of Gastroenterology, GastroZentrum Hirslanden Zürich, Switzerland
| | - Bas L Weusten
- Department of Gastroenterology and Hepatology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, KU Leuven, Belgium
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Iwaya Y, Shimamura Y, Goda K, Rodríguez de Santiago E, Coneys JG, Mosko JD, Kandel G, Kortan P, May G, Marcon N, Teshima C. Clinical characteristics of young patients with early Barrett’s neoplasia. World J Gastroenterol 2019; 25:3069-3078. [PMID: 31293342 PMCID: PMC6603815 DOI: 10.3748/wjg.v25.i24.3069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) may appear in young patients with Barrett’s esophagus (BE). However, characteristics of Barrett’s-related neoplasia in this younger population remain unknown.
AIM To identify clinical characteristics that differ between young and old patients with early-stage Barrett’s-related neoplasia.
METHODS We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC (pT1) and HGD at a tertiary-referral center between 2001 and 2017. Baseline characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and treatment outcomes [complete eradication of neoplasia (CE-N), complete eradication of intestinal metaplasia (CE-IM), recurrence of neoplasia and recurrence of intestinal metaplasia] were retrieved. Multivariate analyses were performed to identify factors that differed significantly between older and younger (≤ 50 years) patients.
RESULTS We identified 450 patients with T1 EAC and HGD (74% and 26%, respectively); 45 (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to present with ongoing gastroesophageal reflux disease (GERD) symptoms (55% vs 38%, P = 0.04) and to be obese (body mass index > 30, 48% vs 32%, P = 0.04). Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.04-3.85, P = 0.04] and to be obese (OR 2.06, 95%CI 1.07-3.98, P = 0.03) whereas the young group was less likely to have a smoking history (OR 0.39, 95%CI 0.20-0.75, P < 0.01) compared to the old group. However, there were no significant differences regarding tumor histology, CE-N, CE-IM, recurrence of neoplasia and recurrence of intestinal metaplasia (mean follow-up, 44.3 mo).
CONCLUSION While guidelines recommend BE screening in patients > 50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.
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Affiliation(s)
- Yugo Iwaya
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Yuto Shimamura
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan
| | | | - John Gerard Coneys
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Jeffrey D Mosko
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Gabor Kandel
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Paul Kortan
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Gary May
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Norman Marcon
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
| | - Christopher Teshima
- Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
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Repici A, Wallace MB, East JE, Sharma P, Ramirez FC, Bruining DH, Young M, Gatof D, Irene Mimi Canto M, Marcon N, Cannizzaro R, Kiesslich R, Rutter M, Dekker E, Siersema PD, Spaander M, Kupcinskas L, Jonaitis L, Bisschops R, Radaelli F, Bhandari P, Wilson A, Early D, Gupta N, Vieth M, Lauwers GY, Rossini M, Hassan C. Efficacy of Per-oral Methylene Blue Formulation for Screening Colonoscopy. Gastroenterology 2019; 156:2198-2207.e1. [PMID: 30742834 DOI: 10.1053/j.gastro.2019.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Topically applied methylene blue dye chromoendoscopy is effective in improving detection of colorectal neoplasia. When combined with a pH- and time-dependent multimatrix structure, a per-oral methylene blue formulation (MB-MMX) can be delivered directly to the colorectal mucosa. METHODS We performed a phase 3 study of 1205 patients scheduled for colorectal cancer screening or surveillance colonoscopies (50-75 years old) at 20 sites in Europe and the United States, from December 2013 through October 2016. Patients were randomly assigned to groups given 200 mg MB-MMX, placebo, or 100 mg MB-MMX (ratio of 2:2:1). The 100-mg MB-MMX group was included for masking purposes. MB-MMX and placebo tablets were administered with a 4-L polyethylene glycol-based bowel preparation. The patients then underwent colonoscopy by an experienced endoscopist with centralized double-reading. The primary endpoint was the proportion of patients with 1 adenoma or carcinoma (adenoma detection rate [ADR]). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for differences in detection between the 200-mg MB-MMX and placebo groups. False-positive (resection rate for non-neoplastic polyps) and adverse events were assessed as secondary endpoints. RESULTS The ADR was higher for the MB-MMX group (273 of 485 patients, 56.29%) than the placebo group (229 of 479 patients, 47.81%) (OR 1.46; 95% CI 1.09-1.96). The proportion of patients with nonpolypoid lesions was higher in the MB-MMX group (213 of 485 patients, 43.92%) than the placebo group (168 of 479 patients, 35.07%) (OR 1.66; 95% CI 1.21-2.26). The proportion of patients with adenomas ≤5 mm was higher in the MB-MMX group (180 of 485 patients, 37.11%) than the placebo group (148 of 479 patients, 30.90%) (OR 1.36; 95% CI 1.01-1.83), but there was no difference between groups in detection of polypoid or larger lesions. The false-positive rate did not differ significantly between groups (83 [23.31%] of 356 patients with non-neoplastic lesions in the MB-MMX vs 97 [29.75%] of 326 patients with non-neoplastic lesions in the placebo group). Overall, 0.7% of patients had severe adverse events but there was no significant difference between groups. CONCLUSIONS In a phase 3 trial of patients undergoing screening or surveillance colonoscopies, we found MB-MMX led to an absolute 8.5% increase in ADR, compared with placebo, without increasing the removal of non-neoplastic lesions. Clinicaltrials.gov no: NCT01694966.
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Affiliation(s)
| | | | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Prateek Sharma
- Kansas City Veterans Affairs Hospital, Kansas City, Missouri
| | | | | | | | - David Gatof
- Clinical Research of the Rockies, Lafayette, Colorado
| | | | | | | | - Ralf Kiesslich
- St. Marienkrankenhaus, Frankfurt, Germany; Horst Schmidt Kliniken GmbH, Wiesbaden, Germany
| | - Matt Rutter
- University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | | | | | | | | | | | | | | | - Pradeep Bhandari
- Solent Centre for Digestive Diseases, Portsmouth, United Kingdom
| | - Ana Wilson
- St. Mark's Hospital, London, United Kingdom
| | - Dayna Early
- Washington University School of Medicine, St. Louis, Missouri
| | - Neil Gupta
- Loyola University Medical Center, Maywood, Illinois
| | - Michael Vieth
- Institut für Pathologie Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | | | - Cesare Hassan
- Ospedale Nuovo Regina, Margherita, Gastroenterology Unit, Roma, Italy
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9
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Zhou Z, Kalatskaya I, Russell D, Marcon N, Cirocco M, Krzyzanowski PM, Streutker C, Liang H, Litle VR, Godfrey TE, Stein L. Combined EsophaCap cytology and MUC2 immunohistochemistry for screening of intestinal metaplasia, dysplasia and carcinoma. Clin Exp Gastroenterol 2019; 12:219-229. [PMID: 31190949 PMCID: PMC6527096 DOI: 10.2147/ceg.s186958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/30/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose: The incidence of esophageal adenocarcinoma (EAC) has increased by 700% in Western countries over the last 30 years. Although clinical guidelines call for endoscopic surveillance for EAC among high-risk populations, fewer than 5% of new EAC patients are under surveillance at the time of diagnosis. We studied the accuracy of combined cytopathology and MUC2 immunohistochemistry (IHC) for screening of Intestinal Metaplasia (IM), dysplasia and EAC, using specimens collected from the EsophaCap swallowable encapsulated cytology sponge from Canada and United States. Patients and methods: By comparing the EsophaCap cytological diagnosis with concurrent endoscopic biopsies performed on the same patients in 28 cases, we first built up the cytology diagnostic categories and criteria. Based on these criteria, 136 cases were evaluated by both cytology and MUC2 IHC with blinded to patient biopsy diagnosis. Results: We first set up categories and criteria for cytological diagnosis of EscophaCap samples. Based on these, we divided our evaluated cytological samples into two groups: non-IM group and IM or dysplasia or adenocarcinoma group. Using the biopsy as our gold standard to screen IM, dysplasia and EAC by combined cytology and MUC2 IHC, the sensitivity and specificity were 68% and 91%, respectively, which is in the range of clinically useful cytological screening tests such as the cervical Pap smear. Conclusions: Combined EsophaCap cytology and MUC2 IHC could be a good screening test for IM and Beyond.
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Affiliation(s)
- Zhongren Zhou
- Department of Pathology & Immunology, Washington University, Saint Louis, MO, USA
| | - Irina Kalatskaya
- Department of Adaptive Oncology, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Donna Russell
- Department of Pathology & Immunology, Washington University, Saint Louis, MO, USA
| | - Norman Marcon
- Division of Gastroenterology, Department of Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Maria Cirocco
- Division of Gastroenterology, Department of Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paul M Krzyzanowski
- Department of Adaptive Oncology, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Cathy Streutker
- Division of Gastroenterology, Department of Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hua Liang
- Department of Statistics, George Washington University, Washington, DC, USA
| | - Virginia R Litle
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Tony E Godfrey
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Lincoln Stein
- Department of Adaptive Oncology, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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10
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Iwaya Y, Streutker C, Marcon N. A Schwannoma of the Small Bowel. Clin Gastroenterol Hepatol 2019; 17:e35. [PMID: 29410002 DOI: 10.1016/j.cgh.2018.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Yugo Iwaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Streutker
- Division of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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11
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Iwaya Y, Streutker CJ, Coneys JG, Marcon N. Hemangiolymphangioma of the small bowel: A rare cause of chronic anemia. Dig Liver Dis 2018; 50:1248. [PMID: 29886080 DOI: 10.1016/j.dld.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/04/2018] [Accepted: 05/06/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Yugo Iwaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Catherine J Streutker
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Gerard Coneys
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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Affiliation(s)
- Yugo Iwaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Division of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Corwyn Rowsell
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Division of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vikas Gupta
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Division of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Division of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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13
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Pouw RE, Beyna T, Belghazi K, Koch AD, Schoon EJ, Haidry R, Weusten BL, Bisschops R, Shaheen NJ, Wallace MB, Marcon N, Heise-Ginsburg R, Gotink AW, Wang KK, Leggett CL, Ortiz-Fernández-Sordo J, Ragunath K, DiPietro M, Pech O, Neuhaus H, Bergman JJ. A prospective multicenter study using a new multiband mucosectomy device for endoscopic resection of early neoplasia in Barrett's esophagus. Gastrointest Endosc 2018; 88:647-654. [PMID: 30220300 DOI: 10.1016/j.gie.2018.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/27/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Early neoplasia in Barrett's esophagus (BE) can be effectively and safely removed by endoscopic resection (ER) using multiband mucosectomy (MBM). This study aimed to document performance of a novel MBM device designed for improved visualization, easier passage of accessories, and better suction power compared with other marketed MBM devices. METHODS This international, single-arm, prospective registry in 14 referral centers (Europe, 10; United States, 3; Canada, 1) included patients with early BE neoplasia scheduled for ER. The primary endpoint was successful ER defined as complete resection of the delineated area in 1 procedure. Secondary outcomes were adverse events and procedure time. RESULTS A total of 332 lesions was included in 291 patients (248 men; mean age, 67 years [standard deviation, 9.6]). ER indication was high-grade dysplasia in 64%, early adenocarcinoma in 19%, lesion with low-grade dysplasia in 11%, and a lesion without definite histology in 6%. Successful ER was reached in 322 of 332 lesions (97%; 95% confidence interval [CI], 94.6%-98.4%). A perforation occurred in 3 of 332 procedures (.9%; 95% CI, .31%-2.62%), all were managed endoscopically, and patients were admitted with intravenous antibiotics during days 2, 3, and 9. Postprocedural bleeding requiring an intervention occurred in 5 of 332 resections (1.5%; 95% CI, .65%-3.48%). Dysphagia requiring dilatation occurred in 11 patients (3.8%; 95% CI, 2.1%-6.6%). Median procedure time was 16 minutes (interquartile range, 12.0-26.0). CONCLUSIONS In expert hands, the novel MBM device proved to be effective for resection of early neoplastic lesions in BE, with successful ER in 97% of procedures. Severe adverse events were rare and were effectively managed endoscopically or conservatively. (Clinical trial registration number: NCT02482701.).
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Affiliation(s)
- Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Torsten Beyna
- Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus, Düsseldorf, Germany
| | - Kamar Belghazi
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Rehan Haidry
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Bas L Weusten
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Raf Bisschops
- Department of Gastroenterology, UZ Gasthuisberg, Leuven, Belgium
| | - Nicholas J Shaheen
- Department of Gastroenterology, University North Carolina Hospital, Chapel Hill, North Carolina, USA
| | - Michael B Wallace
- Department of Gastroenterology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Norman Marcon
- Department of Gastroenterology, St Michaels Hospital, Toronto, Ontario, Canada
| | - Rachel Heise-Ginsburg
- Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus, Düsseldorf, Germany
| | - Anniek W Gotink
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Kenneth K Wang
- Department of Gastroenterology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Cadman L Leggett
- Department of Gastroenterology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jacobo Ortiz-Fernández-Sordo
- Nottingham Digestive Diseases Centre, University of Nottingham and NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Krish Ragunath
- Nottingham Digestive Diseases Centre, University of Nottingham and NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Oliver Pech
- Department of Gastroenterology, St John of God Hospital, Regensburg, Germany
| | - Horst Neuhaus
- Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus, Düsseldorf, Germany
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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14
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Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, The Centre of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Canada
| | - Hamzah Akram
- Division of Gastroenterology, The Centre of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Canada
| | - Shawn Winer
- Division of Pathology, Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto, Canada
| | - Norman Marcon
- Division of Gastroenterology, The Centre of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Canada
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15
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Aranda-Hernández J, Shimamura Y, Grin A, Iwaya Y, Cirocco M, Kandel G, May G, Kortan P, Raftopoulos S, Marcon N. Hot avulsion may be effective as salvage treatment for focal Barrett's esophagus remaining after endoscopic therapy for dysplasia or early cancer: a preliminary study. Endoscopy 2018; 50:8-13. [PMID: 29065436 DOI: 10.1055/s-0043-119986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND STUDY AIM Both endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) are used to treat Barrett's esophagus (BE) complicated by dysplasia and intramucosal cancer. However, focal areas of BE can remain after otherwise successful application of these techniques. We report the results of hot avulsion using a hot biopsy forceps to resect these residual focal areas. PATIENTS AND METHODS This was a retrospective study from a prospective database in a tertiary reference center from August 2013 to May 2015. All included patients had undergone hot avulsion for eradication of residual focal areas of BE that were ≤ 1 cm and not suspicious for dysplasia, following at least one previous endoscopic treatment for dysplasia or intramucosal cancer. RESULTS 35 patients harboring 124 residual areas of 1 - 7 mm were treated with hot avulsion. After a mean follow-up of 17.4 months, all patients achieved complete eradication of residual focal BE. One of the patients required a second hot avulsion treatment. Hot avulsion provided samples in all cases but limited the assessment of dysplasia (cautery artifact) in 20.2 % of them. The only complication was bleeding in two patients, which was easily stopped by soft coagulation. CONCLUSIONS Hot avulsion appears to be effective and safe in removing focal BE ≤ 1 cm at its greatest length remaining after endoscopic treatment for dysplasia or early cancer. Further studies are required before this technique can be considered the standard of care.
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Affiliation(s)
- Javier Aranda-Hernández
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Yuto Shimamura
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Andrea Grin
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Yugo Iwaya
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Maria Cirocco
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Gabor Kandel
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Gary May
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Paul Kortan
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Spiro Raftopoulos
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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16
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Shimamura Y, Ikeya T, Marcon N, Mosko JD. Endoscopic diagnosis and treatment of early esophageal squamous neoplasia. World J Gastrointest Endosc 2017; 9:438-447. [PMID: 28979708 PMCID: PMC5605343 DOI: 10.4253/wjge.v9.i9.438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/14/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023] Open
Abstract
Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality. It carries a poor prognosis as more than half of patients present with advanced and unresectable disease. One contributing factor is the increased risk of lymph node metastases at early stages of disease. As such, it is essential to detect squamous cell neoplasia (SCN) at an early stage. In order to risk stratify lesions, endoscopists must be able to perform image enhanced endoscopy including magnification and Lugol’s chromoendoscopy. The assessment of both the horizontal extent and depth of any lesion is also of utmost importance prior to treatment. Endoscopic mucosal resection and submucosal dissection remain the standard of care with literature supportive their respective use. Radiofrequency ablation and other endoscopic treatments are currently available although should not be considered first line at this time. Our objective is to review the current options for the endoscopic diagnosis and treatment of esophageal SCN.
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Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B1W8, Canada
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Norman Marcon
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B1W8, Canada
| | - Jeffrey D Mosko
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B1W8, Canada
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17
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Lim L, Streutker CJ, Marcon N, Cirocco M, Lao A, Iakovlev VV, DaCosta R, Wilson BC. A feasibility study of photoacoustic imaging of ex vivo endoscopic mucosal resection tissues from Barrett's esophagus patients. Endosc Int Open 2017; 5:E775-E783. [PMID: 28791328 PMCID: PMC5546898 DOI: 10.1055/s-0043-111790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/02/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Accurate endoscopic detection of dysplasia in patients with Barrett's esophagus (BE) remains a major clinical challenge. The current standard is to take multiple biopsies under endoscopic image guidance, but this leaves the majority of the tissue unsampled, leading to significant risk of missing dysplasia. Furthermore, determining whether there is submucosal invasion is essential for proper staging. Hence, there is a clinical need for a rapid in vivo wide-field imaging method to identify dysplasia in BE, with the capability of imaging beyond the mucosal layer. We conducted an ex vivo feasibility study using photoacoustic imaging (PAI) in patients undergoing endoscopic mucosal resection (EMR) for known dysplasia. The objective was to characterize the esophageal microvascular pattern, with the long-term goal of performing in vivo endoscopic PAI for dysplasia detection and therapeutic guidance. MATERIALS AND METHODS EMR tissues were mounted luminal side up. The tissues were scanned over a field of view of 14 mm (width) by 15 mm (depth) at 680, 750, and 850 nm (40 MHz acoustic central frequency). Ultrasound and photoacoustic images were simultaneously acquired. Tissues were then sliced and fixed in formalin for histopathology with hematoxylin and eosin staining. A total of 13 EMR specimens from eight patients were included in the analysis, which consisted of co-registration of the photoacoustic images with corresponding pathologist-classified histological images. We conducted mean difference test of the total hemoglobin distribution between tissue classes. RESULTS Dysplastic and nondysplastic BE can be distinguished from squamous tissue in 84 % of region-of-interest comparisons (42/50). However, the ability of intrinsic PAI to distinguish dysplasia from NDBE, which is the clinically important challenge, was only about 33 % (10/30). CONCLUSION We demonstrated the technical feasibility of this approach. Based on our ex vivo data, changes in total hemoglobin content from intrinsic PAI (i. e. without exogenous contrast) can differentiate BE from squamous esophageal mucosa. However, most likely intrinsic PAI is unable to differentiate dysplastic from nondysplastic BE with adequate sensitivity for clinical translation.
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Affiliation(s)
- Liang Lim
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada,Corresponding author Liang Lim, PhD University Health Network – Princess Margaret Cancer Centre101 College StreetPMCRT #15-301V TorontoOntario M5G 1L7Canada
| | | | | | | | | | | | - Ralph DaCosta
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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18
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Poneros JM, Faye AS, Barr Fritcher EG, Sen A, Anandasabapathy S, Bresalier RS, Marcon N, Turgeon DK, Appelman H, Normolle D, Morrison LE, Brenner DE, Halling KC. A Multicenter Study of a Fluorescence In Situ Hybridization Probe Set for Diagnosing High-Grade Dysplasia and Adenocarcinoma in Barrett's Esophagus. Dig Dis Sci 2017; 62:1216-1222. [PMID: 28265829 PMCID: PMC6052443 DOI: 10.1007/s10620-017-4517-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Preliminary single-institution data suggest that fluorescence in situ hybridization (FISH) may be useful for detecting high-grade dysplasia (HGD) and esophageal adenocarcinoma (EA) in patients with Barrett's esophagus (BE). This multicenter study aims to validate the measurement of polysomy (gain of at least two loci) by FISH as a way to discriminate degrees of dysplasia in BE specimens. METHODS Tissue specimens were collected from four different hospitals and read by both the local pathology department ("Site diagnosis") and a single central pathologist ("Review diagnosis") at a separate institution. The specimens then underwent FISH analysis using probes 8q24 (MYC), 9p21 (CDKN2A), 17q12 (ERBB2), and 20q13 (ZNF217) for comparison. A total of 46 non-BE, 42 non-dysplastic specialized intestinal metaplasia (SIM), 23 indefinite-grade dysplasia (IGD), 10 low-grade dysplasia (LGD), 29 HGD, and 42 EA specimens were analyzed. RESULTS We found that polysomy, as detected by FISH, was the predominant chromosomal abnormality present as dysplasia increased. Polysomy was also the best predictor for the presence of dysplasia or EA when comparing its area under the curve to that of other FISH abnormalities. We observed that if at least 10% of cells had polysomy within a specimen, the FISH probe was able to differentiate between EA/HGD and the remaining pathologies with a sensitivity of 80% and a specificity of 88%. CONCLUSIONS This study demonstrates that using FISH to determine the percentage of cells with polysomy can accurately and objectively aid in the diagnosis of HGD/EA in BE specimens.
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Affiliation(s)
- John M. Poneros
- Department of Gastroenterology, Columbia University, Medical Center, 161 Fort Washington Avenue, Suite 862,, New York, NY 10032, USA
| | - Adam S. Faye
- Department of Internal Medicine, Columbia University, Medical Center, 177 Fort Washington Avenue, Milstein 6C-, 12, New York, NY 10032, USA
| | - Emily G. Barr Fritcher
- Department of Laboratory Medicine and Pathology, Mayo, Clinic, 200 First SW, Rochester, MN 55905, USA
| | - Ananda Sen
- Department of Biostatistics, University of Michigan Medical, Center, Ann Arbor, MI, USA,Department of Family Medicine, University of Michigan, Medical School, 1018 Fuller St., Ann Arbor, MI 48104, USA
| | - Sharmila Anandasabapathy
- Department of Gastroenterology, Baylor College of, Medicine, Baylor St. Luke’s Medical Center Clinic, 7200, Cambridge Street Suite 10C, Houston, TX 77030, USA
| | - Robert S. Bresalier
- Department of Gastroenterology, University of Texas M.D., Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466,, Houston, TX 77030, USA
| | - Norman Marcon
- Department of Gastroenterology, University of Toronto,, Toronto, ON, Canada,St. Michael’s Hospital, University of Toronto, 30 Bond, Street, 16-062 Cardinal Carter South Wing, Toronto,, ON M5B 1W8, Canada
| | - D. Kim Turgeon
- Department of Internal Medicine, University of Michigan, Medical Center, Ann Arbor, MI, USA,Department of Gastroenterology, University of Michigan, Health System, Taubman Center Floor 3, Reception D,, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Henry Appelman
- Department of Pathology, University of Michigan Medical, Center, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | - Daniel Normolle
- Department of Biostatistics, University of Pittsburgh Cancer, Institute, 201 North Craig Street, Sterling Plaza Suite 325,, Pittsburgh, PA 15213, USA
| | | | - Dean E. Brenner
- Department of Internal Medicine, University of Michigan, Medical Center, Ann Arbor, MI, USA,Department of Pharmacology, University of Michigan, Medical Center, 1500 E Medical Center Dr #2150,, Ann Arbor, MI 48109, USA
| | - Kevin C. Halling
- Department of Laboratory Medicine and Pathology, Mayo, Clinic, 200 First SW, Rochester, MN 55905, USA
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Shimamura Y, Winer S, Marcon N. A Giant Circumferential Inlet Patch With Acid Secretion Causing Stricture. Clin Gastroenterol Hepatol 2017; 15:A22-A23. [PMID: 27729241 DOI: 10.1016/j.cgh.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/01/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, Department of Medicine, The Centre of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Winer
- Division of Pathology, Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, The Centre of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Winer
- Department of Pathology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Niroshan Muwanwella
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yuto Shimamura
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Robert Bechara
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan; Gastrointestinal Diseases Research Unit, Queen University Kingston General Hospital, Kingston, Ontario, Canada
| | - Norman Marcon
- University of Toronto, Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine J Streutker
- University of Toronto, Department of Laboratory Medicine and Pathobiology, Division of Pathology, St. Michael's Hospital, Toronto, Ontario, Canada
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Hart R, Streutker C, Grin A, Grantcharov T, Marcon N, Brezden-Masley C. 2243 A retrospective review of clinical-pathological variables in gastric cancer patients at a tertiary academic centre. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lim L, Streutker CJ, Marcon N, Cirocco M, Iakovlev VV, DaCosta R, Foster FS, Wilson BC. Clinical study ofex vivophotoacoustic imaging in endoscopic mucosal resection tissues. ACTA ACUST UNITED AC 2015. [DOI: 10.1117/12.2075451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Filliatre L, Ortonne N, Delaunay C, Thomas J, Chetouani A, Marcon N, Bastien C. L’ulcère cutanéo-muqueux EBV+, une entité morphologiquement inquiétante contrastant avec un excellent pronostic : à propos d’un cas. Ann Pathol 2014. [DOI: 10.1016/j.annpat.2014.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Douplik A, Zanati S, Saiko G, Streutker C, Loshchenov M, Adler D, Cho S, Chen D, Cirocco M, Marcon N, Fengler J, Wilson BC. Diffuse reflectance spectroscopy in Barrett's esophagus: developing a large field-of-view screening method discriminating dysplasia from metaplasia. J Biophotonics 2014; 7:304-311. [PMID: 23125097 DOI: 10.1002/jbio.201200114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/25/2012] [Accepted: 09/26/2012] [Indexed: 06/01/2023]
Abstract
We evaluated diffuse reflectance spectroscopy implemented as a small field-of-view technique for discrimination of dysplasia from metaplasia in Barrett's esophagus as an adjuvant to autofluorescence endoscopy. Using linear discriminant analysis on 2579 spectra measured in 54 patients identified an optimum a 4-wavelength classifier (at 485, 513, 598 and 629 nm). Sensitivity and specificity for a test data set were 0.67 and 0.85, respectively. Spectroscopic results show that this technique could be implemented in wide-field imaging mode to improve the accuracy of existing endoscopy techniques for finding early pre-malignant lesions in Barrett's esophagus. Results show that the discrimination occurs likely due to redistribution of blood content in the tissue sensed by the optical probing with the wavelength-dependent sampling depth.
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Affiliation(s)
- Alexandre Douplik
- Ontario Cancer Institute, Ontario, Canada; Xillix Technologies Corp., Richmond, British Columbia, Canada.
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Brar SS, Mahar AL, Helyer LK, Swallow C, Law C, Paszat L, Seevaratnam R, Cardoso R, McLeod R, Dixon M, Yohanathan L, Lourenco LG, Bocicariu A, Bekaii-Saab T, Chau I, Church N, Coit D, Crane CH, Earle C, Mansfield P, Marcon N, Miner T, Noh SH, Porter G, Posner MC, Prachand V, Sano T, van de Velde C, Wong S, Coburn NG. Processes of care in the multidisciplinary treatment of gastric cancer: results of a RAND/UCLA expert panel. JAMA Surg 2014; 149:18-25. [PMID: 24225775 DOI: 10.1001/jamasurg.2013.3959] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE There is growing interest in reducing the variations and deficiencies in the multidisciplinary management of gastric cancer. OBJECTIVE To define optimal treatment strategies for gastric adenocarcinoma (GC). DESIGN, SETTING, AND PARTICIPANTS RAND/UCLA Appropriateness Method involving a multidisciplinary expert panel of 16 physicians from 6 countries. INTERVENTIONS Gastrectomy, perioperative chemotherapy, adjuvant chemoradiation, surveillance endoscopy, and best supportive care. MAIN OUTCOMES AND MEASURES Panelists scored 416 scenarios regarding treatment scenarios for appropriateness from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1 to 3 were considered inappropriate; 4 to 6, uncertain; and 7 to 9, appropriate. Agreement was reached when 12 of 16 panelists scored the scenario similarly. Appropriate scenarios agreed on were subsequently scored for necessity. RESULTS For patients with T1N0 disease, surgery alone was considered appropriate, while there was no agreement over surgery alone for patients T2N0 disease. Perioperative chemotherapy was appropriate for patients who had T1-2N2-3 or T3-4 GC without major symptoms. Adjuvant chemoradiotherapy was classified as appropriate for T1-2N1-3 or T3-4 proximal GC and necessary for T1-2N2-3 or T3-4 distal GC. There was no agreement regarding surveillance imaging and endoscopy following gastrectomy. Surveillance endoscopy was deemed to be appropriate after endoscopic resection. For patients with metastatic GC, surgical resection was considered inappropriate for those with no major symptoms, unless the disease was limited to positive cytology alone, in which case there was disagreement. CONCLUSIONS AND RELEVANCE Patients with GC being treated with curative intent should be considered for multimodal treatment. For patients with incurable disease, surgical interventions should be considered only for the management of major bleeding or obstruction.
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Affiliation(s)
- Savtaj S Brar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada3Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lucy K Helyer
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Carol Swallow
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Calvin Law
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence Paszat
- Institute for Clinical Effectiveness Studies, Toronto, Ontario, Canada
| | | | | | - Robin McLeod
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Dixon
- Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | | | - Laercio G Lourenco
- Department of Gastroenterology Surgery, São Paulo Federal University, São Paulo, Brazil
| | | | - Tanios Bekaii-Saab
- Departments of Medicine and Pharmacology, Ohio State University, Columbus
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Neal Church
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Craig Earle
- Institute for Clinical Effectiveness Studies, Toronto, Ontario, Canada14Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Mansfield
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Norman Marcon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Miner
- Department of Surgery, Brown University, Providence, Rhode Island
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Geoff Porter
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - Vivek Prachand
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Takeshi Sano
- Department of Surgery, Cancer Institute Hospital, Tokyo, Japan
| | | | - Sandra Wong
- Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Sunnybrook Research Institute, Toronto, Ontario, Canada5Institute for Clinical Effectiveness Studies, Toronto, Ontario, Canada
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Abstract
Barrett esophagus is recognized as a risk factor for the development of dysplasia and adenocarcinoma of the esophagus. Cancer is usually diagnosed at an advanced stage with a 5-year survival rate of 15%. Most of these patients present de novo and are not part of a surveillance program. Endoscopic screening with improvement in recognition of early lesions may change this pattern. In the past, patients diagnosed with dysplasia and mucosal cancer were best managed by esophagectomy. Endoscopic techniques such as endoscopic mucosal resection and radiofrequency ablation have resulted in high curative rates and a shift away from esophagectomy. This pathway is supported by the literature review of esophagectomies performed for mucosal disease, as well as pathologists' interpretation of endoscopic mucosal specimens, which document the low risk of lymph node metastasis. The role of endoscopic therapy for superficial submucosal disease continues to be a challenge.
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Affiliation(s)
- Javier Aranda-Hernandez
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Maria Cirocco
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, The Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
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Espino A, Cirocco M, Dacosta R, Marcon N. Advanced imaging technologies for the detection of dysplasia and early cancer in barrett esophagus. Clin Endosc 2014; 47:47-54. [PMID: 24570883 PMCID: PMC3928491 DOI: 10.5946/ce.2014.47.1.47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 12/14/2022] Open
Abstract
Advanced esophageal adenocarcinomas arising from Barrett esophagus (BE) are tumors with an increasing incidence and poor prognosis. The aim of endoscopic surveillance of BE is to detect dysplasia, particularly high-grade dysplasia and intramucosal cancers that can subsequently be treated endoscopically before progression to invasive cancer with lymph node metastases. Current surveillance practice standards require the collection of random 4-quadrant biopsy specimens over every 1 to 2 cm of BE (Seattle protocol) to detect dysplasia with the assistance of white light endoscopy, in addition to performing targeted biopsies of recognizable lesions. This approach is labor-intensive but should currently be considered state of the art. Chromoendoscopy, virtual chromoendoscopy (e.g., narrow band imaging), and confocal laser endomicroscopy, in addition to high-definition standard endoscopy, might increase the diagnostic yield for the detection of dysplastic lesions. Until these modalities have been demonstrated to enhance efficiency or cost effectiveness, the standard protocol will remain careful examination using conventional off the shelf high-resolution endoscopes, combined with as longer inspection time which is associated with increased detection of dysplasia.
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Affiliation(s)
- Alberto Espino
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Maria Cirocco
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Ralph Dacosta
- Department of Medical Biophysics, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Norman Marcon
- Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada
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Abstract
The holy grail of gastrointestinal endoscopy consists of the detection, in vivo characterization, and endoscopic removal of early or premalignant mucosal lesions. While our ability to achieve this goal has improved substantially since the development of the modern video-endoscope, inadequate visual inspection, errors of interpretation, and lesion subtlety all contribute to the continued suboptimal detection and assessment of early neoplasia. A myriad of new technologies has thus emerged that may help resolve these shortcomings; high magnification endoscopes, as well as the techniques of dye-based and virtual chromoendoscopy, are now widely available, while confocal laser endomicroscopy and endocystoscopy, optical coherence tomography, and autofluorescence imaging are generally applicable only in a research setting. Such technologies can be broadly categorized according to whether they potentially afford endoscopists improved detection, or real-time characterization, of mucosal lesions. Enhanced detection of otherwise "invisible" lesions, such as a flat area of intramucosal adenocarcinoma within Barrett's esophagus, carries the potential of an endoscopic cure prior to the development into a more advanced or metastatic disease. The ability to characterize a lesion to achieve an in vivo diagnosis, such as a colonic polyp, potentially affords endoscopists the ability to decide which lesions require removal and which can be safely left behind or discarded without histological assessment. Furthermore targeted biopsies, such as in the surveillance of chronic colitis, may prove to be more accurate and efficacious than the current protocol of random biopsies. An important caveat in the discussion of developing technologies in early cancer detection is the fundamental importance of a health-care system that promotes screening programs to recruit at-risk individuals. The ideal tool to optimize the use of endoscopy in population screening would be a panel of reliable biomarkers (blood, stool, or urine) that could effectively select a high-risk group, thus reducing the indiscriminate use of an expensive technology. The following review summarizes the current endoscopic imaging techniques available, and in development, for the early identification of gastrointestinal neoplasia.
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Affiliation(s)
- P Urquhart
- St Michael's Hospital, Toronto, ON, Canada
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Dixon M, Mahar A, Paszat L, McLeod R, Law C, Swallow C, Helyer L, Seeveratnam R, Cardoso R, Bekaii-Saab T, Chau I, Church N, Coit D, Crane CH, Earle C, Mansfield P, Marcon N, Miner T, Noh SH, Porter G, Posner MC, Prachand V, Sano T, Van de Velde CJH, Wong S, Coburn N. What provider volumes and characteristics are appropriate for gastric cancer resection? Results of an international RAND/UCLA expert panel. Surgery 2013; 154:1100-9. [PMID: 24075275 DOI: 10.1016/j.surg.2013.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND A relationship between higher volume providers and improved outcomes has been suggested by some studies and has been used to construct guidelines for many diseases. For gastric cancer (GC), however, optimal volume cutoffs are not clear. METHODS A multidisciplinary expert panel of 16 physicians from 6 countries scored 120 scenarios regarding provider characteristics for gastric resections for GC. Appropriateness of scenarios was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1 to 3 were considered inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. Agreement was reached when 12 of 16 panelists scored the statement similarly. Appropriate scenarios agreed on were scored subsequently for necessity. RESULTS Surgeon and hospital practice volume scenarios were evaluated. The panel felt it was inappropriate for surgeons doing ≤2 GC cases per year to perform a multivisceral resection (MVR), D2 lymphadenectomy (D2-LND), or laparoscopic total gastrectomy, and ≤6 GC cases per year for an MVR involving a pancreatoduodenectomy (MVR-PD), or endoscopic mucosal resections (EMR). It was considered appropriate for surgeons doing ≥11 GC cases per year to perform open gastrectomy or D2-LND, and ≥20 GC cases per year for any MVR, laparoscopic gastrectomy, or EMR. For hospitals, it was considered inappropriate for hospitals managing ≤4 GC cases per year to perform D2-LND or laparoscopic total gastrectomy, and ≤10 GC cases per year, for MVR-PD or EMR. Hospital volumes ≥21 cases per year was considered appropriate for any GC procedure. It was inappropriate for an MVR to be performed in a hospital without interventional radiology services and for a MVR-PD in a hospital with no level I intensive care unit. CONCLUSION Appropriate and inappropriate provider volumes for a variety of gastric procedures have been defined by an international expert panel.
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Affiliation(s)
- Matthew Dixon
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, Maimonides Medical Center, Brooklyn, NY
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Brar S, Law C, McLeod R, Helyer L, Swallow C, Paszat L, Seevaratnam R, Cardoso R, Dixon M, Mahar A, Lourenco LG, Yohanathan L, Bocicariu A, Bekaii-Saab T, Chau I, Church N, Coit D, Crane CH, Earle C, Mansfield P, Marcon N, Miner T, Noh SH, Porter G, Posner MC, Prachand V, Sano T, van de Velde C, Wong S, Coburn N. Defining surgical quality in gastric cancer: a RAND/UCLA appropriateness study. J Am Coll Surg 2013; 217:347-57.e1. [PMID: 23664139 DOI: 10.1016/j.jamcollsurg.2013.01.067] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/29/2012] [Accepted: 01/29/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Savtaj Brar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Dixon M, Seevaratnam R, Wirtzfeld D, McLeod R, Helyer L, Law C, Swallow C, Paszat L, Bocicariu A, Cardoso R, Mahar A, Bekaii-Saab T, Chau I, Church N, Coit D, Crane CH, Earle C, Mansfield P, Marcon N, Miner T, Noh SH, Porter G, Posner MC, Prachand V, Sano T, Van de Velde CJH, Wong S, Coburn N. A RAND/UCLA Appropriateness Study of the Management of Familial Gastric Cancer. Ann Surg Oncol 2012; 20:533-41. [DOI: 10.1245/s10434-012-2584-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Indexed: 12/21/2022]
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Efthymiou M, Raftopoulos S, Marcon N. Flexible endoscopic septoplasty for bilobed Zenker's diverticulum. Gastrointest Endosc 2012; 75:1110-1. [PMID: 21821250 DOI: 10.1016/j.gie.2011.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 05/26/2011] [Indexed: 12/11/2022]
Affiliation(s)
- Marios Efthymiou
- Center for Therapeutic and Oncologic Endoscopy, St. Michael's Hospital, Toronto, Ontario, Canada
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Raftopoulos SC, Efthymiou M, Marcon N, Streutker C. Education and Imaging. Gastrointestinal: A sheep in wolf's clothing. J Gastroenterol Hepatol 2012; 27:841. [PMID: 22436059 DOI: 10.1111/j.1440-1746.2012.07090.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- S C Raftopoulos
- Center for Therapeutic Endoscopy and Endoscopic Oncology, St Michael's Hospital, Toronto, Ontario, Canada
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Affiliation(s)
- M Efthymiou
- Therapeutic Endoscopy Unit, St Michael's Hospital, Toronto, Ontario, Canada
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Falk GW, Sontag S, Cruz-Correa M, Weinberg D, Chak A, Hur C, Fleischer D, Smyrk T, Butar N, Foster N, Romero Y, Corley D, DeVault K, Marcon N, Schnell T. Abstract CN06-03: Randomized double-blinded phase II trial of esomeprazole versus esomeprazole + two doses of aspirin in Barrett's esophagus patients. Cancer Prev Res (Phila) 2011. [DOI: 10.1158/1940-6207.prev-11-cn06-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Aims: In patients with Barrett's esophagus (BE), reflux-induced injury promotes esophageal adenocarcinoma, presumably through cyclooxygenase 2 (COX-2) related pathways. Proton pump inhibitors (PPIs) and nonsteroidal anti-inflammatory drugs (NSAIDs) may interrupt reflux-associated carcinogenesis by reducing acid exposure and subsequent inflammation. However, clinical trial data regarding the chemopreventive efficacy of a PPI + NSAID combination are limited. The aim of this multi-center, randomized, phase II trial was to assess the effects of a 28-day intervention with esomeprazole 40 mg bid and aspirin 81 mg qd, 325 mg qd, or placebo qd on tissue prostaglandin E2 (PGE2) concentrations in BE patients.
Methods: Using the infrastructure of the Cancer Prevention Network, participants (> 18 years) with histologically confirmed non dysplastic BE were randomly assigned to receive one of three interventions for 28 days: (arm A) esomeprazole 40 mg bid+ aspirin 81 mg placebo qd + aspirin 325 mg placebo qd (n=42); (arm B) esomeprazole 40 mg bid+ aspirin 81 mg qd + aspirin placebo 325 qd (n=63); (arm C) esomeprazole 40 mg bid + aspirin 81 mg qd placebo + aspirin 325 mg qd (n=63). Esophageal biopsies were obtained pre- and post-intervention to assess change in PGE2 concentration as the primary endpoint.
Results: In total, 122 participants were randomized, 121 (99%) completed the trial per protocol, and 115 (94%) were evaluated for the primary endpoint. Baseline characteristics were similar across intervention arms. The absolute change (mean + SD) in tissue PGE2 concentration was −67.6 (229.68) in Arm A, −120.9 (281.28) in Arm B (p = 0.10 vs Arm A) and −174.9 (263.62) in Arm C (p = 0.02 vs Arm A).
Conclusions: In combination with esomeprazole 40 mg twice per day, aspirin 325 mg per day significantly reduced tissue PGE2 concentration in BE patients after a 28-day intervention, as compared to aspirin placebo. Given the relevance of PGE2 pathways in BE-associated carcinogenesis, further evaluation of this chemoprevention strategy in larger, more definitive phase III trials is warranted.
Citation Information: Cancer Prev Res 2011;4(10 Suppl):CN06-03.
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Affiliation(s)
| | | | | | | | | | - Chin Hur
- 6Massachusetts General Hospital, Boston, MA
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Zois CD, Christodoulou DK, Katsanos KH, Sigounas D, Batistatou A, Hatzi V, Marcon N, Tsianos EV. Endoscopic resection and histological evaluation of colorectal polyps: Is it a definitive treatment? Ann Gastroenterol 2011; 24:115-120. [PMID: 24713725 PMCID: PMC3959298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/31/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND AIMS Primary aim of the present study was the evaluation of efficacy and safety of endoscopic polypectomy in a tertiary advanced endoscopic laboratory in Northwestern Greece. Additional aim was to estimate the effectiveness of endoscopic treatment of colorectal polyps and record the clinical course. METHODS One hundred and fifty consecutive patients (97 men) with colorectal polyps of size larger than 0.5 cm were included. The size, topography, shape and presence of pedicle were recorded for every polyp. Concerning the size, polyps were divided into: <1 cm, between 1-2 cm, >2 cm. RESULTS The rectum and sigmoid were the most common sites of detection (76.6%). Endoscopic resection was successful and the complication rate was very low (2.6%). The majority of the removed polyps were neoplastic (87.1%). Most neoplastic polyps were tubulovillous adenomas (50.8%). Low-grade dysplasia was detected in most of the polyps (82.9%), but highgrade dysplasia or invasive carcinoma was also detected in some patients. In total, 10 patients underwent surgical resection. Regular follow-up did not reveal significant residual polyps or recurrence of the lesions. CONCLUSION Endoscopic polypectomy is effective and safe and leads to complete resection of neoplastic polyps in the majority of cases.
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Affiliation(s)
- Christos D. Zois
- 1st Division of Internal Medicine & Hepato-Gastroenterology Unit (Christos D. Zois, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Dimitrios Sigounas, Vasiliki Hatzi, Epameinondas V. Tsianos)
| | - Dimitrios K. Christodoulou
- 1st Division of Internal Medicine & Hepato-Gastroenterology Unit (Christos D. Zois, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Dimitrios Sigounas, Vasiliki Hatzi, Epameinondas V. Tsianos)
| | - Konstantinos H. Katsanos
- 1st Division of Internal Medicine & Hepato-Gastroenterology Unit (Christos D. Zois, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Dimitrios Sigounas, Vasiliki Hatzi, Epameinondas V. Tsianos)
| | - Dimitrios Sigounas
- 1st Division of Internal Medicine & Hepato-Gastroenterology Unit (Christos D. Zois, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Dimitrios Sigounas, Vasiliki Hatzi, Epameinondas V. Tsianos)
| | - Anna Batistatou
- Department of Pathology, Medical School of Ioannina (Anna Batistatou)
| | - Vasiliki Hatzi
- 1st Division of Internal Medicine & Hepato-Gastroenterology Unit (Christos D. Zois, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Dimitrios Sigounas, Vasiliki Hatzi, Epameinondas V. Tsianos)
| | - Norman Marcon
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St Michael’s Hospital, University of Toronto, Ontario, Canada (Norman Marcon)
| | - Epameinondas V. Tsianos
- 1st Division of Internal Medicine & Hepato-Gastroenterology Unit (Christos D. Zois, Dimitrios K. Christodoulou, Konstantinos H. Katsanos, Dimitrios Sigounas, Vasiliki Hatzi, Epameinondas V. Tsianos),
Correspondence to: Prof. Epameinondas V. Tsianos, MD, PhD, 1st Department of Internal Medicine, Medical School, University of Ioannina, Leoforos Panepistimiou, 451 10 Ioannina, Greece. Tel. +302651007501; Fax +302651007016; e-mail:
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Bruce WR, Cani PD, Cirocco M, DaCosta RS, Giacca A, Kim YI, Lee O, Liu Z, Ma DW, Marcon N, Minkin S, O'Brien PJ. Abstract B34: Association of endogenous oxidative and aldehyde stress: Implications for studies of colon carcinogenesis. Cancer Prev Res (Phila) 2010. [DOI: 10.1158/1940-6207.prev-10-b34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The results of a small pilot study provided new insights into the process of colon carcinogenesis.
Background: The known risk factors for colorectal cancer (CRC) suggested that CRC resulted from the interaction of exposure to energy excess and to oxidative stress [McKeown-Eyssen G et al. pp 673-693 in “Endogenous Toxins” Wiley, 2010]. The suggestion was supported by: cellular studies that demonstrated the cytotoxicity and genotoxicity of excess energy substrate (fructose) with oxidative stress (H2O2); animal studies that showed a wide range of pathology associated with fructose-based diets when combined with oxidative stress; and clinical studies that described the association of advanced glycation end-products (AGEs) with chronic diseases associated with the Western lifestyle.
Methods: A pilot case-control study at a hospital-based gastroenterology clinic was conducted to assess methods for future tests of the hypothesis. It was based on an analysis of plasma samples collected from patients with (n = 20) or without (n = 21) colonoscopy-demonstrated polyps.
Results: Although as anticipated none of the differences between polyp and non-polyp plasma samples achieved statistical significance, there were unexpectedly strong associations of the concentrations of the endogenous plasma aldehydes, glyoxal and methylglyoxal (r = 0.92), and glyoxal and 4-hydroxynonenal (r = 0.52) across the collected samples.
Conclusions: The associations were likely a consequence of the known interaction of endogenous aldehydes with oxidative stress: endogenous aldehydes increased oxidative stress; oxidative stress increased the formation of endogenous aldehydes [e.g. Vander Jagt DL. Drug Metab Drug Interact 2008;23:93-124]. The products of such interactions, AGEs and advanced lipid oxidation endproducts (ALEs), could explain the known accumulation of fluorescent lipofuscin observed with dysplastic adenomas.
Impact: Exposure to endogenous aldehydes and oxidation products is complex. Endogenous aldehyde derived — AGEs could provide robust biomarkers of this exposure including information relating to the tissues, cells and cellular organelles affected.
Citation Information: Cancer Prev Res 2010;3(12 Suppl):B34.
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Affiliation(s)
| | | | | | | | | | | | - Owen Lee
- 1University of Toronto, Toronto, ON, Canada
| | - Zhen Liu
- 1University of Toronto, Toronto, ON, Canada
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Bressenot A, Marcon N, Feuillu B, Gauchotte G, Montagne K. [Primary leiomyosarcoma of the epididymis: a case report with review of the literature]. Prog Urol 2009; 19:643-7. [PMID: 19800557 DOI: 10.1016/j.purol.2009.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 04/02/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
Primary epididymal leiomyosarcoma is uncommon: only 16 cases has been reported in the literature. We present an additionnal case in a 78-year-old man, treated for a prostatic adenocarcinoma by gonadorelin (LH-RH) analogue, who had an epididymal tumor. A right orchidectomy with high ligation of the spermatic cord was performed. The diagnostic of primary leiomyosarcoma of the epididymis was made. The patient is dead 2 years later with no recurrence of disease. A review of reported cases is made.
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Affiliation(s)
- A Bressenot
- Service d'Anatomie et de Cytologie Pathologique, CHU Nancy-Brabois, Vandoeuvre-les-Nancy Cedex, France.
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Aufreiter S, Gregory JF, Pfeiffer CM, Fazili Z, Kim YI, Marcon N, Kamalaporn P, Pencharz PB, O'Connor DL. Folate is absorbed across the colon of adults: evidence from cecal infusion of (13)C-labeled [6S]-5-formyltetrahydrofolic acid. Am J Clin Nutr 2009; 90:116-23. [PMID: 19439459 PMCID: PMC6443296 DOI: 10.3945/ajcn.2008.27345] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Folate deficiency increases the risk of several human diseases. Likewise, high intakes of folate, particularly synthetic folic acid intake, may be associated with adverse health outcomes in humans. A more comprehensive understanding of the "input side" of folate nutrition may help to set dietary recommendations that strike the right balance between health benefits and risks. It is well known that the microflora in the colon produce large quantities of folate that approach or exceed recommended dietary intakes; however, there is no direct evidence of the bioavailability of this pool in humans. OBJECTIVE The objective was to determine whether, and to what extent, the natural folate vitamer 5-formyltetrahydrofolic acid is absorbed across the intact colon of humans. DESIGN During screening colonoscopy, 684 nmol (320 microg) [(13)C]glutamyl-5-formyltetrahydrofolic acid was infused directly into the cecum of 6 healthy adults. Three or more weeks later, each subject received an intravenous injection of the same compound (172 nmol). Blood samples were collected before and after each treatment. The ratio of labeled to unlabeled folates was determined in plasma by tandem mass spectrometry. RESULTS The apparent rate of folate absorption across the colon of a bolus dose of [(13)C]5-formyltetrahydrofolic acid infused into the cecum was 0.6 +/- 0.2 nmol/h, as determined by the appearance of [(13)C(5)]5-methyltetrahydrofolic acid in plasma. In comparison, the rate of appearance of [(13)C(5)]5-methyltetrahydrofolic acid after an intravenous injection of [(13)C(5)]5-formyltetrahydrofolate was 7 +/- 1.2 nmol/h. CONCLUSION Physiologic doses of natural folate are absorbed across the intact colon in humans.
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Affiliation(s)
- Susanne Aufreiter
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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Bronner MP, Overholt BF, Taylor SL, Haggitt RC, Wang KK, Burdick JS, Lightdale CJ, Kimmey M, Nava HR, Sivak MV, Nishioka N, Barr H, Canto MI, Marcon N, Pedrosa M, Grace M, Depot M. Squamous overgrowth is not a safety concern for photodynamic therapy for Barrett's esophagus with high-grade dysplasia. Gastroenterology 2009; 136:56-64; quiz 351-2. [PMID: 18996379 DOI: 10.1053/j.gastro.2008.10.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/26/2008] [Accepted: 10/02/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Photodynamic therapy with porfimer sodium combined with acid suppression (PHOPDT) is used to treat patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD). A 5-year phase 3 trial was conducted to determine the extent of squamous overgrowth of BE with HGD after PHOPDT. METHODS Squamous overgrowth was compared in patients with BE with HGD randomly assigned (2:1) to receive PHOPDT (n=138) or 20 mg omeprazole twice daily (n=70). Patients underwent 4-quadrant jumbo esophageal biopsies every 2 cm throughout the pretreatment length of BE until 4 consecutive quarterly follow-up results were negative for HGD and then biannually up to 5 years or treatment failure. Endoscopies were reviewed by blinded gastroenterology pathologists. RESULTS Histologic assessment of 33,658 biopsies showed no significant difference (P> .05) in squamous overgrowth between groups when compared per patient (30% vs 33%) or per biopsy (0.5% vs 1.3%), or when the average number of biopsies with squamous overgrowth were compared per patient (0.48 vs 0.66). The highest grade of neoplasia per endoscopy was not found exclusively beneath squamous mucosa in any patient. CONCLUSIONS No difference was observed in squamous overgrowth between patients given PHOPDT plus omeprazole compared with only omeprazole. Squamous overgrowth did not obscure the most advanced neoplasia in any patient. Treatment of HGD with PHOPDT in patients with BE does not present a long-term risk of failure to detect subsquamous dysplasia or carcinoma.
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Cho S, Zanati S, Yong E, Cirocco M, Kandel G, Kortan P, May G, Marcon N. Endoscopic cryotherapy for the management of gastric antral vascular ectasia. Gastrointest Endosc 2008; 68:895-902. [PMID: 18640673 DOI: 10.1016/j.gie.2008.03.1109] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 03/25/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic GI bleeding. OBJECTIVE To assess the efficacy and safety of cryotherapy for endoscopic treatment of GAVE. DESIGN Patients received 3 sessions of endoscopic cryotherapy at 3-week to 6-week intervals and had a follow-up endoscopy 4 weeks thereafter. They were followed prospectively in terms of clinical and endoscopic response. SETTING Tertiary-care center, between October 2004 and April 2006. PATIENTS The patients were 43 to 89 years of age, with a diagnosis of GAVE and documented iron deficiency anemia. Eight patients had a history of overt GI bleeding. Eight patients (67%) had previously been treated with argon plasma coagulation (APC) (median 6 sessions, range 1-10 sessions) and failed to respond or had a recurrence. RESULTS Twelve patients were enrolled. Six patients (50%) had a complete response, and 6 patients had a partial response. The mean number of units of blood transfused in the period of 3 months before cryotherapy and during the period of follow-up of 3 months was 4.6 and 1.7 units, respectively. An increased mean Hb level, from 9.9 to 11.3 g/dL, was noted. The average duration of the cryotherapy was 5 minutes (range 1-15 minutes). In 32 of 36 cryotherapy treatment sessions performed (89%), it was technically possible to treat more than 90% of GAVE lesions. There were no immediate cryotherapy-related complications, and none of the patients required admission after the procedure. LIMITATIONS A pilot study from a single center. CONCLUSIONS Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to APC therapy. Optimal cryogen, delivery device, and treatment protocols are yet to be determined.
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Affiliation(s)
- Sarah Cho
- The Centre for Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Saravanan R, Kamalaporn P, Streutker C, May G, Kandel G, Marcon N, Kortan P. Gastric polyp in pernicious anemia: an argument to remove even when biopsy shows hyperplasia. Endoscopy 2008; 40 Suppl 2:E77-8. [PMID: 18633890 DOI: 10.1055/s-2007-995506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- R Saravanan
- Digestive Disease Centre, Bristol Royal Infirmary, Bristol, UK.
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Qiu Y, Patwa TH, Xu L, Shedden K, Misek DE, Tuck M, Jin G, Ruffin MT, Turgeon DK, Synal S, Bresalier R, Marcon N, Brenner DE, Lubman DM. Plasma glycoprotein profiling for colorectal cancer biomarker identification by lectin glycoarray and lectin blot. J Proteome Res 2008; 7:1693-703. [PMID: 18311904 DOI: 10.1021/pr700706s] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) remains a major worldwide cause of cancer-related morbidity and mortality largely due to the insidious onset of the disease. The current clinical procedures utilized for disease diagnosis are invasive, unpleasant, and inconvenient; hence, the need for simple blood tests that could be used for the early detection of CRC. In this work, we have developed methods for glycoproteomics analysis to identify plasma markers with utility to assist in the detection of colorectal cancer (CRC). Following immunodepletion of the most abundant plasma proteins, the plasma N -linked glycoproteins were enriched using lectin affinity chromatography and subsequently further separated by nonporous silica reversed-phase (NPS-RP)-HPLC. Individual RP-HPLC fractions were printed on nitrocellulose coated slides which were then probed with lectins to determine glycan patterns in plasma samples from 9 normal, 5 adenoma, and 6 colorectal cancer patients. Statistical tools, including principal component analysis, hierarchical clustering, and Z-statistics analysis, were employed to identify distinctive glycosylation patterns. Patients diagnosed with colorectal cancer or adenomas were shown to have dramatically higher levels of sialylation and fucosylation as compared to normal controls. Plasma glycoproteins with aberrant glycosylation were identified by nano-LC-MS/MS, while a lectin blotting methodology was used to validate proteins with significantly altered glycosylation as a function of cancer progression. The potential markers identified in this study for diagnosis to distinguish colorectal cancer from adenoma and normal include elevated sialylation and fucosylation in complement C3, histidine-rich glycoprotein, and kininogen-1. These potential markers of colorectal cancer were subsequently validated by lectin blotting in an independent set of plasma samples obtained from 10 CRC patients, 10 patients with adenomas, and 10 normal subjects. These results demonstrate the utility of this strategy for the identification of N -linked glycan patterns as potential markers of CRC in human plasma, and may have the utility to distinguish different disease states.
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Affiliation(s)
- Yinghua Qiu
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, USA
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Pohl J, Blancas JM, Cave D, Choi KY, Delvaux M, Ell C, Gay G, Jacobs MAJM, Marcon N, Matsui T, May A, Mulder CJ, Pennazio M, Perez-Cuadrado E, Sugano K, Vilmann P, Yamamoto H, Yano T, Zhong JJ. Consensus report of the 2nd International Conference on double balloon endoscopy. Endoscopy 2008; 40:156-60. [PMID: 18253908 DOI: 10.1055/s-2007-966994] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- J Pohl
- Department of Internal Medicine II, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
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Overholt BF, Wang KK, Burdick JS, Lightdale CJ, Kimmey M, Nava HR, Sivak MV, Nishioka N, Barr H, Marcon N, Pedrosa M, Bronner MP, Grace M, Depot M. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett's high-grade dysplasia. Gastrointest Endosc 2007; 66:460-8. [PMID: 17643436 DOI: 10.1016/j.gie.2006.12.037] [Citation(s) in RCA: 278] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 12/18/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Barrett's esophagus (BE) with high-grade dysplasia (HGD) is a risk factor for development of esophageal carcinoma. Photodynamic therapy (PDT) with Photofrin (PHO) has been used to eliminate HGD in BE. OBJECTIVE Our purpose was to compare PHOPDT plus omeprazole with omeprazole only (OM). DESIGN Five-year follow-up of a randomized, multicenter, multinational, pathology-blinded HGD trial. SETTING 30 sites in 4 countries. PATIENTS 208. INTERVENTIONS Patients with BE and HGD were randomized (2:1) to PHOPDT (n=138) or OM (n=70) into a 2-year trial followed up for 3 more years. PHOPDT patients received 2 mg/kg PHO intravenously followed by endoscopic laser light exposure of Barrett's mucosa at a wavelength of 630 nm within 40 to 50 hours to a maximum of 3 courses at least 90 days apart. Both groups received 20 mg of OM twice daily. Pathologists at one center assessed biopsy specimens in a blinded fashion. MAIN OUTCOME MEASUREMENT HGD ablation status over 5 years of follow-up. RESULTS At 5 years PHOPDT was significantly more effective than OM in eliminating HGD (77% [106/138] vs 39% [27/70], P<.0001). A secondary outcome measure preventing progression to cancer showed a significant difference (P=.027) with about half the likelihood of cancer occurring in PHOPDT (21/138 [15%]) compared with OM (20/70 [29%]), with a significantly (P=.004) longer time to progression to cancer favoring PHOPDT. LIMITATIONS Not all patients were available for follow-up. CONCLUSIONS This 5-year randomized trial of BE patients with HGD demonstrates that PHOPDT is a clinically and statistically effective therapy in producing long-term ablation of HGD and reducing the potential impact of cancer compared with OM.
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Sugano K, Marcon N. The First International Workshop on Double Balloon Endoscopy: a consensus meeting report. Gastrointest Endosc 2007; 66:S7-11. [PMID: 17709038 DOI: 10.1016/j.gie.2007.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 02/09/2007] [Indexed: 12/22/2022]
Affiliation(s)
- Kentaro Sugano
- Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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