All Articles

Alma R. Catala-Valentin¹, Samuel Mikhail¹, Joshua N. Bernard¹, Matthew Caldwell¹, Sean Moore¹ and Claudia D. Andl^1*

¹Burnett School of Biomedical Sciences, University of Central Florida, Orlando FL, USA

Human resident microbial communities have received increased attention in the context of health and disease because a loss of balance in microbial homeostasis can contribute to disease. While the gut microbiome-host interactions are well studied for their roles in inflammatory bowel disease and colon cancers, little is known about the causative influence of bacteria on upper gastrointestinal tract (UGT) tumorigenesis, including the oral cavity, pharynx, esophagus, and stomach. Risk factors linked to upper gastrointestinal carcinogenesis, such as cigarette smoking, alcohol consumption, poor oral hygiene, and gastroesophageal reflux disease, disrupt the bacterial homeostasis and open a niche for pathogenic bacteria. We present mechanisms including chronic inflammation, disruption of cell signaling, and production of environmental metabolites that help explain how the pathogens Fusobacterium nucleatum, Porphyromonas gingivalis, and Campylobacter concisus, among others, can promote carcinogenesis. We provide examples of bacterial species that could be having a protective role in tumorigenesis, a research area that is less explored. Additionally, we discuss the limitations and challenges during patient sampling and screening, which need to be overcome to help characterize microbiomes associated with UGT cancers. Overall, this review presents an emerging model of synergy and discord of bacteria-host relationships in the UGT.

Ariel Pérez Mendoza¹*, and Ángel Mario Zárate Guzmán²

¹Endoscopy Department, Unidad Médica de Atención Ambulatoria Número 7; Instituto Mexicano del Seguro Social, Monterrey City, Nuevo Leon, México

²Endoscopy Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, México

The objective of this publication is to review endoscopic techniques that allow improving the detection of gastric precancerous lesions (GPL) and early gastric cancer (EGC). These techniques can be divided into two: those used with white light endoscopy (WLE) and those that used technologies to improve endoscopic imaging. An adequate preparation to achieve optimal gastric cleaning it’s necessary. In order to avoid missed lesions, a standardized procedure must be performed, with an orderly and systematic examination. And if available, use technologies that have been shown to improve the detection and characterization of early gastric cancer.

F.J. Pérez Lara PhD¹*, J.M. Hernández González MD², F. Moya Donoso MD²

¹ Chief of Surgery Service. Hospital de Antequera. Málaga

² Digestive Surgeon. Service of Surgery. Hospital de Antequera. Málaga

Satoshi Tabuchi¹, Kazuo Koyanagi²*, Soji Ozawa², Shigeyuki Kawachi¹

¹Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center

²Department of Gastroenterological Surgery, Tokai University School of Medicine

Verrucous carcinoma of the esophagus (VCE) is a special variant form of esophageal squamous cell carcinoma. VCE presents a unique superficial growth pattern that is characterized as an exophytic, slow-growing mass. We reviewed previous reports of the 56 cases and divided them into two groups: from 1967 to 1999 (19 cases; the former period) and from 2000 to 2020 (37 cases; the latter period) to compare the diagnosis and prognosis of VCE. Patients with T4 disease tended to be higher in 6 (32%) of the19 cases in the former period. On the other hand, T1 and T2 diseases were high in 23 (62%) and T4 was very low; only 2 (5%) of the 37 cases in the latter period. It is presumed that surveillance by endoscopic examination has become common, as the risk factors and characteristic appearances of VCE are well known. Moreover, improvements in surgical procedures and perioperative management in recent years has been related to the favorable prognoses in the latter period. Since reports in the literature have stated that chemotherapy and radiotherapy might be inadequate as means of curative therapy, esophagectomy should be recommended as curative treatment because of VCE’s low potential for lymph node and distant organ metastasis.

Beatriz Cros Montalban*, Pilar Palacios Gasos, Rocio Ferrer Sotelo, Jose Fernado Trebolle, Monica Valero Sabater, Carlos Yanez Benitez, Elena Gonzalvo Gonzalez, Juan Luis Blas Laina

Hospital Royo Villanova, Zaragoza, Spain

The malignant peripheral nerve sheath tumor (MPNST) is a spindle cell sarcoma, which accounts for 5-10% of soft tissue sarcomas. We present the case of a 39-year-old woman with a history of Neurofibromatosis type 1, who in the study for abdominal pain was diagnosed on abdominopelvic CT with a large retroperitoneal adenopathic conglomerate without distant extension. By laparoscopy, complete exeresis of the lesion was performed, with nil complications in the postoperative period. In the histological sections, a nodular lesion of 4 cm in diameter was identified, with neoplastic proliferation showing diverse growth patterns, low mitotic index and positive immunohistochemistry for S-100 and Vimentin, confirming the diagnosis. MPNSTs are aggressive behavioral sarcomas with a high recurrence rate. They present distant metastases, even in early clinical stages. The treatment of choice is complete resection with free margins, because of the high rate of recurrence and limited therapeutic response to radiotherapy and chemotherapy.

Hailu Wondimu Gebresellassie¹, Bereket Amare²

¹Department of surgery, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

²Senior pathology resident at department of pathology, SOM, CHS, AAU, Ethiopia

Background: There are only a few published works of literature on gastric cancer in Africa. Surgery is the main treatment of gastric cancers that are confined to the stomach and regional lymph nodes. There are limitations in the adequacy of surgery and the availability of neo-adjuvant and adjuvant chemotherapy in Africa. This paper addresses short term one-month outcome of surgery and quality of surgery in terms of lymphadenectomy.

Method: This is a prospective descriptive study of outcomes and quality of surgery of gastric cancer in a tertiary teaching hospital in Addis Ababa, Ethiopia from September 2018 to August 2019 in GI unit of the department of surgery, school of medicine of Addis Ababa University.

Result: 47 patients underwent surgery with a male to female ratio of 1.47:1. Patients’ age range from 26 to 80 years, mean of 52.7 +/_8.4, and a median of 50 years. The commonest age group were 41-50, accounting for 34 % followed by age group of 51-60 (27.6%). Gastric adenocarcinoma accounts for 85.1%. Distal (antrum and pylorus) were involved in 46.8 %. Distal subtotal gastrectomy is the commonest procedure done with curative intent and a bypass gastro-jejunostomy for palliation. Adequate lymph node dissection was achieved in less than a third of patients. There were 9 major morbidity and 6 deaths making post-operative morbidity and mortality rate of 19% and 12.8% respectively.

Conclusion: Although morbidity and mortality of surgery in this study is acceptable, the quality of cancer surgery is not good. We in Africa need to have better training to be able to do a proper and acceptable oncologic surgery for gastric cancer. This can be achieved by creating partnerships with other nations of better expertise and experience in the management of gastric cancer.

Beatriz Cros Montalbán*, Jorge García Egea, Ana Nogués Pevidal, Issa Talal El-Abur, Carlos Yánez Benítez, José Fernando Trebollé, Paola Gracia Gimeno, Juan Luis Blas Laína

Hospital Royo Villanova, Zaragoza, Spain

Adrenal hemorrhage is a rare complication that can compromise patient survival. We present the case of a 74-year-old man who, in the complicated post-operative period of a subtotal colectomy for transverse colon adenocarcinoma adjacent to the splenic angle, had significant asthenia, hypotension, and hyponatremia on the blood test. Abdominal CT scan and basal cortisol in blood were performed, compatible with bilateral adrenal hemorrhage and adrenal insufficiency. Treatment with intravenous corticoid was initiated, with the recovery of blood pressure and natremia. The clinical manifestations of bilateral adrenal hemorrhage secondary to intra-abdominal sepsis are usually imperceptible and attributed to other post-operative problems, making it difficult to reach a diagnosis, although early detection makes it possible to treat satisfactorily.

Mayer B. Davidson

Charles R. University, Los Angeles, California

Swati G. Patel^1,2*, Frank I. Scott¹, Ananya Das³, Douglas K. Rex⁴, Sarah McGill⁵, Tonya Kaltenbach⁶, Dennis J. Ahnen¹, Amit Rastogi⁷, Sachin Wani¹

¹Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

²Veterans Affairs Hospital, Denver, CO, USA

³Arizona Center for Digestive Health, Gilbert, AZ, USA

⁴Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

⁵Division of Gastroenterology & Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

⁶Division of Gastroenterology & Hepatology, University of California, San Francisco, CA, USA

⁷Division of Gastroenterology & Hepatology, University of Kansas, Kansas City, KS, USA

Background: Endoscopists and new computer-aided programs can achieve performance benchmarks for real-time diagnosis of colorectal polyps using Narrow-Band Imaging (NBI), though do not perform as well as endoscopists with expertise in advanced imaging. Previous cost-effectiveness studies on optical diagnosis have focused on expert performance, potentially over-estimating its benefits.

Aim: Determine cost-effectiveness of an NBI ‘characterize, resect and discard (CRD)’ strategy using updated assumptions based on non-expert performance.

Methods: Markov model was constructed to compare cost-effectiveness of the CRD strategy, where diminutive polyps characterized as non-adenomas with high confidence are not resected and adenomas are resected and discarded, versus standard of care (SOC) in which all polyps are resected with histologic analysis. Rates related to NBI performance, missed polyps, polyp progression, malignancy, and complications, as well as quality-adjusted life years (QALYs) were derived from the literature. Costs were age and insurer-specific. Mean QALYs and costs were calculated using first order Monte Carlo simulation. Deterministic and probabilistic sensitivity analyses were conducted.

Results: The mean QALY estimates were similar for the CRD (8.563, 95% CI: 8.557-8.571) and SOC strategy (8.563, 8.557-8.571), but costs were reduced ($2,693.06 vs. $2,800.27, mean incremental cost savings: $107.21/person). Accounting for colonoscopy rates, the CRD strategy would save $708 million to $1.06 billion annually. The model was sensitive to the incidence of tubular adenomas; the results were otherwise robust in all other one-way and probabilistic analyses.

Conclusions: An NBI CRD strategy is cost-effective when compared to the SOC, even when employed by non-experts. The appreciated benefit is primarily due to cost savings of the CRD strategy.

ABBREVIATIONS

Colorectal Cancer (CRC), Narrow Band Imaging (NBI), American Society for Gastrointestinal Endoscopy (ASGE), Negative Predictive Value (NPV), Positive Predictive Value (PPV), Preservation and Incorporation of Valuable Endoscopic Innovation (PIVI), First Order Monte Carlo Simulation (FOMCS), Standard of Care (SOC), Characterize, Resect & Discard (CRD), Quality Adjusted Life Year (QALY), Incremental Cost Effectiveness Ratio (ICER), Sessile Serrated Polyp (SSP), Willingness to Pay (WTP), Adenoma Detection Rate (ADR)