Novel Method for Differentiating Histological Types of Gastric Adenocarcinoma by Using Confocal Raman Microspectroscopy.

Gastric adenocarcinoma, a single heterogeneous disease with multiple epidemiological and histopathological characteristics, accounts for approximately 10% of cancers worldwide. It is categorized into four histological types: papillary adenocarcinoma (PAC), tubular adenocarcinoma (TAC), mucinous adenocarcinoma (MAC), and signet ring cell adenocarcinoma (SRC). Effective differentiation of the four types of adenocarcinoma will greatly improve the treatment of gastric adenocarcinoma to increase its five-year survival rate.

Differentiating gastrointestinal stromal tumors from gastric adenocarcinomas and normal mucosae using confocal Raman microspectroscopy.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and gastric adenocarcinomas are a common cancer worldwide. To differentiate GISTs from adenocarcinomas is important because the surgical processes for both are different; the former excises the tumor with negative margins, while the latter requires radical gastrectomy with lymph node dissection. Endoscopy with biopsy is used to distinguish GISTs from adenocarcinomas; however, it may cause tumor bleeding in GISTs.

Positive cyclin T expression as a favorable prognostic factor in treating gastric gastrointestinal stromal tumors.

Positive transcriptional elongation factor b (P-TEFb) contains the catalytic subunit cyclin-dependent kinase 9 (Cdk9) and the regulatory subunit cyclin T. Cyclin T1 and Cdk9 are the key factors of the PTEFb pathways and are overexpressed in the human head and neck carcinoma cell line. However, there have been limited studies regarding the role of cyclin T1 and Cdk9 in gastric gastrointestinal stromal tumors (GISTs).

Increased cyclin T1 expression as a favorable prognostic factor in treating gastric adenocarcinoma.

The expression of cyclin A, B1, D1 and E in gastric adenocarcinoma is known to be associated with clinical outcome. However, few studies have investigated the role of cyclin T1 and cyclin-dependent kinase 9 (CDK9) in gastric adenocarcinoma. Therefore, this study assessed the clinical significance of cyclin T1 and CDK9 expression in gastric adenocarcinoma.

Transpancreatic precut sphincterotomy for biliary access: the relation of sphincterotomy size to immediate success rate of biliary cannulation.

Background. Transpancreatic precut sphincterotomy (TPS) is an option for difficult common bile duct (CBD) access, and the reports are few, with immediate success rate varying from 60 to 96%. The description of relation between the size of TPS and the immediate success rate of CBD cannulation was not found in the literature.

Linear endoscopic ultrasound for clinically suspected bile duct stones.

Background: Radial endoscopic ultrasound (EUS) is a less invasive imaging modality used to evaluate common bile duct stones (CBDS) and is as accurate as endoscopic retrograde cholangiography (ERCP). Patients classified as high risk for suspected CBDS were found to have stones in only two-thirds of cases, and an argument could be made for performing EUS in these high-risk patients. There are very few reports of linear EUS for CBDS detection.

Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor.

Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis. A solitary Peutz-Jeghers type polyp of the stomach is rare. We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months.

An uncommon cause of hiccups: sarcoidosis presenting solely as hiccups.

Common causes of hiccups are over-distension of the stomach, a sudden change in gastrointestinal temperature, excessive alcohol and tobacco ingestion, and sudden excitement or emotional changes. Common presenting symptoms of sarcoidosis include cough, dyspnea, and chest pain. It is very rare for a sarcoidosis patient to present with hiccups.

Role of endoscopic ultrasound-guided fine-needle aspiration in lung and mediastinal lesions.

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was initially introduced for diagnosing gastrointestinal and pancreatic lesions, and later on for lung and mediastinal lesions. It can provide tissue diagnosis of lung cancer where bronchoscopy is non-diagnostic. It is a minimally invasive method for lymph node (N) and metastasis (M) staging of non-small cell lung cancer, and is helpful for tissue proof of mediastinal mass with unknown origin.

Feasibility of individualized treatment for hepatitis C patients in the real world.

Background And Aim: Individualized treatment with a combination of peg-interferon and ribavirin for patients with hepatitis C virus (HCV) infection has been validated in randomized controlled clinical trials, but its usefulness in the real world is unknown. The aim of the present study was to assess the feasibility of individualized treatment for HCV patients compared with standard therapy in a real-life clinical setting.

Methods: A total of 253 naïve patients with HCV infection who received peg-interferon and ribavirin combination treatment were analyzed and grouped into one of three clinical settings: (i) infection with genotype non-1 (HCV non-1) and treatment for standard 24 weeks (n = 105; none received an abbreviated therapy); (ii) genotype 1 (HCV-1) and standard therapy for either 24 weeks (n = 71) or 48 weeks (n = 21); and (iii) HCV-1 and individualized treatment (n = 56).

Experience of endoscopic ultrasound-guided fine needle aspiration in a regional teaching hospital.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was first reported in 1991 and 1992 for gastric submucosal tumor and pancreas cancer. Subsequently, the indications have expanded to mediastinal lesions, liver, spleen, adrenal gland, ascites, pleural effusion, intra-abdominal lymph nodes. We report our experience of EUS-FNA and the number of cases required during the learning curve.

Endoscopic mucosal resection of early esophageal carcinoma--experience of 9 cases.

Background: Early esophageal mucosal carcinoma (M1 and M2) can be treated by ablation, or by endoscopic resection such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection. Endoscopic resection enables pathologic examination of resected specimens. We hereby report our experiences with early esophageal cancer and its endoscopically observed types, chromoendoscopy with Lugol's iodine and EMR results.

Management and patient survival in hepatocellular carcinoma: does the physician's level of experience matter?

Introduction: The prognostic determinants of hepatocellular carcinoma (HCC) depend on tumor stage, liver function reserve, and treatments offered. The clinical impact of the physician's experience on HCC management and the survival outcome is unknown.

Methods: A total of 103 patients were managed by one high-volume physician and 249 patients by seven low-volume physicians.

Autoimmune chronic pancreatitis.

Background: Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis that is characterized by swelling of the pancreas, narrowing of the main pancreatic duct (MPD), elevation of serum gamma globulin, or immunoglobulin G or presence of autoantibody, lymphoplasmacytic infiltration and dense fibrosis on histopathology. It is responsive to steroid therapy. The incidence of AIP can reach 5-6% of chronic pancreatitis.

Difficult Endoscopic Retrieval of a Migrated Stent inside a Pseudocyst.

Endoscopic ultrasound (EUS) guided pseudocyst drainage can have complications such as bleeding, perforation, infection, and stent migration. We report a case of iatrogenic migration of stent inside a large dumbbell-shaped pseudocyst managed successfully with a difficult endoscopic retrieval procedure.

Major complications of ultrasound-guided percutaneous radiofrequency ablations for liver malignancies: single center experience.

Background And Aim: Despite radiofrequency ablation (RFA) for malignant liver nodular lesions having promising therapeutic effects, the trade-off between the risks and benefits must be acceptable. This study analyzed the major complications of ultrasound (US)-guided percutaneous RFA procedures encountered at a single center, by a single physician.

Methods: A total of 104 patients (total 183 tumors) underwent 172 US-guided percutaneous RFA sessions between May 2003 and March 2006.

Predictors of alpha-fetoprotein elevation in patients with chronic hepatitis C, but not hepatocellular carcinoma, and its normalization after pegylated interferon alfa 2a-ribavirin combination therapy.

Background And Aim: Elevated serum alpha-fetoprotein (AFP) levels are noted in patients with chronic hepatitis C (CHC) without hepatocellular carcinoma (HCC). The change in AFP levels after treatment with pegylated interferon and ribavirin (Peg-IFN/RBV) combination therapy is still unknown. The aim of this study was to investigate the predictors of elevated serum AFP in patients with CHC, and its change after Peg-IFN/RBV therapy.

Hemoclip treatment for post-endoscopic sphincterotomy bleeding.

Background: The incidence of bleeding after endoscopic sphincterotomy (EST) ranges from 2%-12.1%. Endoscopic treatments include injection and thermal therapy, which can have recurrent bleeding and potential complications of chemical and thermal injuries.

Biliary stenting with puncturing technique using Baron aspiration needle in ulcerative papillary carcinoma.

A 60 year-old man with obstructive jaundice due to an ulcerative papillary carcinoma underwent endoscopic retrograde cholangiopancreatography. Owing to the totally destroyed papilla of Vater, access to the biliary tract was impossible. Instead of needle knife fistulotomy, puncturing with an 18-G aspiration needle on the supra-papillary bulge followed by biliary stenting was performed successfully.