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Duodenal neuroendocrine tumors (NETs) are rare subepithelial tumors that arise from the neuroendocrine cells beneath the epithelial layer. However, an accurate histopathological diagnosis is difficult when tissue samples are obtained using conventional endoscopic forceps biopsy alone. This study aimed to evaluate the magnifying endoscopy with narrow-band imaging (ME-NBI) findings of duodenal NETs. We retrospectively analyzed a database of 22 duodenal NETs from 21 patients who underwent ME-NBI between January 2011 and June 2022. The ME-NBI, endosonographic, and histopathologic findings of duodenal NETs were analyzed. Nineteen lesions were located in the bulb, two were located in the superior duodenal angle, and one was located in the second portion of the duodenum. Eighteen lesions (82%) had IIa morphology, and nine (41%) had central depression on the surface. On endoscopic ultrasonography, almost all lesions (20/22, 91%) were located in the second and/or third layers, and the median tumor size was 6 mm. During ME-NBI, the microsurface pattern was regular in 18 lesions (82%) and absent in 4 (18%). The microvascular pattern was regular in 17 lesions (77%), irregular in 4 (18%), and absent in 1 (5%). Thickened subepithelial vessels were observed in 15 (68%) lesions. There was no difference in tumor size according to the presence or absence of thickened subepithelial vessels (6.1 ± 1.8 mm vs. 5.9 ± 3.8 mm, p = 0.860). In conclusion, the characteristic ME-NBI findings of duodenal NETs were regular microsurface and microvascular patterns and the presence of thickened subepithelial vessels. These ME-NBI features may be useful for differentiating duodenal NETs from other duodenal subepithelial lesions. [ABSTRACT FROM AUTHOR]

Background: Data concerning the long-term outcomes of endoscopic submucosal dissection (ESD) versus surgery for early gastric cancer (EGC) are limited. We aimed to compare the long-term outcomes of ESD and surgery for patients with EGC. Methods: Data were reviewed from patients treated by ESD or surgery for EGC in 2005-2010. The primary outcome was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), disease-free survival (DFS), recurrence-free survival (RFS), treatment-related complications, and hospital stay duration. Results: Among 617 patients, 342 underwent ESD and 275 underwent surgery. The 5-year OS rates were similar between the ESD group and the surgery group (96.9% vs 98.1%, P = 0.581). In a propensity-score-matched analysis of 117 pairs, there were no significant differences in the OS rates (96.5% vs 99.1%, P = 0.125) and DSS rates (100% vs 99.1%, P = 0.317) between the ESD group and the surgery group. The ESD group had a significantly lower DFS rate (90.3% vs 98.0%, P = 0.002), a significantly lower RFS rate (95.1% vs 98.0%, P = 0.033), a significantly higher early complication rate (6.7% vs 1.5%, P < 0.001), a significantly lower late complication rate (0% vs 9.1%, P < 0.001), and a significantly shorter median hospital stay (3 days vs 10 days, P < 0.001) than the surgery group. Conclusions: ESD and surgery have comparable OS rates in patients with EGC. ESD has benefits, including a lower late complication rate and shorter hospital stay. However, RFS and DFS rates might be lower after ESD than after surgery. [ABSTRACT FROM AUTHOR]

Objective. Predicting the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) is important when selecting among therapeutic strategies. The aim of this study was to compare magnifying endoscopy with narrow-band imaging (ME-NBI) with endoscopic ultrasonography (EUS) for predicting the depth of tumor invasion in patients with SESCC. Methods. This study enrolled 51 patients with SESCC (52 SESCC lesions) who underwent both ME-NBI and EUS at Pusan National University Hospital during 2010-2013. We reviewed the patients' medical records and compared ME-NBI and EUS findings with histopathological results according to clinicopathological factors. Results. A total of 46 lesions in 45 patients were included in the final analysis. ME-NBI and EUS had overall accuracies of 76.1% and 84.8%, respectively, in distinguishing mucosal from non-mucosal cancers. There were no differences between ME-NBI and EUS in terms of sensitivities and specificities in distinguishing mucosal from non-mucosal cancers ( p = 0.500 and p = 0.688, respectively). When both ME-NBI and EUS suggested a mucosal depth of lesion invasion, the frequency of mucosal cancer in the final histopathology was 94%. However, if either ME-NBI or EUS suggested a non-mucosal depth of invasion, the frequency of mucosal cancer was only 21%. Conclusion. ME-NBI and EUS are accurate predictors of SESCC invasion depth. If both methods suggest a mucosal depth of lesion invasion, the accuracy of the prediction is increased. Therefore, when possible, it would be better to evaluate the invasion depth of SESCC using both ME-NBI and EUS before deciding to perform endoscopic resection. [ABSTRACT FROM AUTHOR]

Objective. Limited information is available on predictors of the response to proton pump inhibitor (PPI) treatment in patients with gastroesophageal reflux disease (GERD). Endoscopic grading of gastroesophageal flap valve (GEFV) is simple and reproducible, and can provide useful information on patients with suspected reflux undergoing an endoscopy. The aim of this study was to prospectively identify predictors, including endoscopic findings such as GEFV, for PPI treatment outcomes in patients with GERD. Material and methods. One hundred and fifty consecutive patients with GERD were enrolled. All patients were treated with pantoprazole 40 mg daily for 8 weeks. Treatment response was defined as greater than 50% reduction in symptom scores between the two symptom assessments (i.e., over 4 or 8 weeks). Univariate and multivariate logistic regression analyses between responders and non-responders were performed to identify variables predicting response to pantoprazole treatment. Results. Of the 150 consecutive patients considered for this study, 31 were excluded based on exclusion criteria and/or refusal to participate, leaving 119 eligible patients. After 4-week pantoprazole treatment, 70 of 119 (58.8%) patients were classified as responders. Patients with obesity and Helicobacter pylori infection demonstrated a higher response rate to 4-week pantoprazole treatment (odds ratio (OR) 5.28, p == 0.008; OR 3.76, p == 0.023, respectively). Patients with abnormal GEFV showed a lower response rate to 4-week treatment (OR 0.17, p == 0.016). After 8-week treatment, 86 of 119 (72.3%) patients were classified as responders. Abnormal GEFV and aspirin intake were associated with a lower response rate to 8-week treatment (OR 0.17, p == 0.021; OR 0.11, p == 0.020, respectively). Conclusions. Abnormal GEFV was a significant independent factor predicting poor response to both 4-week and 8-week pantoprazole treatment. Endoscopic grading of GEFV provides useful information for predicting the response to PPI treatment in patients with GERD. [ABSTRACT FROM AUTHOR]

The endoscopic grade of the gastroesophageal flap valve (GEFV) is suggested to be a good predictor of reflux status. The aim of this study was to investigate the association of the GEFV and gastroesophageal and gastropharyngeal reflux. A total of 364 patients (151 men and 233 women; mean age, 52.2 years) who underwent endoscopy, esophageal manometry, and ambulatory 24-h dual-probe pH monitoring were included. GEFV was graded I through IV using Hill's classification; then, GEFV was classified into two groups: a normal GEFV group (grades I and II) and an abnormal GEFV group (grades III and IV). Findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared between the groups. Increased GEFV grade was significantly associated with an increased prevalence of both reflux esophagitis and Barrett's epithelium ( P < 0.001). Lower esophageal sphincter pressure was significantly lower in the abnormal GEFV group than in the normal GEFV group ( P < 0.001). All variables showing gastroesophageal reflux in the distal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group ( P < 0.001). In addition, all variables, except the supine time of pH < 4, showing gastropharyngeal reflux in the proximal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group ( P < 0.001). The frequency of gastroesophageal reflux disease and of gastropharyngeal reflux disease was significantly higher in the abnormal GEFV group than in the normal GEFV group ( P < 0.001). Endoscopic grading of the GEFV is easy and provides useful information about the status of gastroesophageal and gastropharyngeal reflux. [ABSTRACT FROM AUTHOR]

Objective Fluid supplementation and red blood cell (RBC) transfusions form first-line management strategies to maintain circulating blood volumes in patients with upper gastrointestinal bleeding (UGIB). In this study, we aimed to analyze the utility of the AIMS65 score in predicting the volume of RBC transfusion required in patients with bleeding peptic ulcers. Methods In this single-center, retrospective study, the data of patients admitted between January 2019 and December 2019 with suspected UGIB were retrospectively reviewed. The RBC volume transfused during pre- and postendoscopic hemostasis was measured in relation to various patient factors including the AIMS65 scores. Results Transfusion rates, the mean number of transfused RBC units, and the duration of hospital stay differed significantly between patients with low AIMS65 scores and those with high AIMS65 scores. Patients with an AIMS65 score of 3 were transfused with more RBC units in the postendoscopic hemostasis period, compared with those with an AIMS65 score of 0, 1, or 2 (with a mean of 4.33 ± 2.07 and 2.67 ± 4.1 units transfused during the pre-endoscopic and postendoscopic hemostasis periods, respectively). Conclusion Patients with UGIB and with an AIMS65 score of 3 were more likely to require transfusions of RBCs. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) may facilitate tissue acquisition for a definitive diagnosis of gastrointestinal subepithelial tumors (SETs). This study aimed to determine the diagnostic yield of EUS-FNB using a novel 20-gauge ProCore needle with a coiled sheath in tissue sampling of gastrointestinal SETs.Methods: Between July 2016 and February 2017, 39 patients with gastrointestinal SETs were prospectively recruited from six university hospitals in Korea. Hypoechoic SETs ≥2 cm in size and originating from the submucosal and/or muscularis propria layer under EUS were eligible. This study was registered on ClinicalTrials.gov (NCT02884154).Results: A total of 36 patients were included in the final analyses. EUS-FNB was diagnostic in 88.9% of SETs. Tissue adequacy was judged as optimal in 97.2% of FNB specimens according to on-site visual evaluation by endosonographers, and in 88.9% of specimens according to pathologists. A macroscopically optimal core sample was obtained with two needle passes in 94.4% of cases. Technical failure rate was encountered in two cases (5.6%) after two needle passes. There were two cases (5.6%) of bleeding, which was managed endoscopically.Conclusions: EUS-FNB using a 20-gauge ProCore needle is a technically feasible and effective modality for histopathologic diagnosis of gastrointestinal SETs, providing adequate core samples with fewer needle passes; ClinicalTrials.gov number, NCT02884154. [ABSTRACT FROM AUTHOR]

Aims Endoscopic resection is a safe and effective method to treat gastric epithelia dysplasia (GED). However, the development of metachronous and synchronous lesions after treatment has become a major concern. In this study, we investigated clinicopathologic features of 105 GED lesions from endoscopic resections between January 2008 and December 2009. Our goal is to find histologic factors that predict synchronous and metachronous lesions after ESD treatment. We assessed the degree of intestinal metaplasia (IM) and atrophy, type of IM, presence of gastritis cystica profunda, and crypt dysplasia in the adjacent mucosa. Methods and results We divided 105 GED lesions into three groups: a single group without metachronous or synchronous GED or adenocarcinoma (n = 35); a multiple synchronous group (n = 30, group with synchronous occurrence of GED or adenocarcinoma after treatment); and a multiple metachronous group (n = 40, group with metachronous occurrence of GED or adenocarcinoma after treatment). The multiple metachronous and synchronous groups showed larger sizes (p = 0.003) and higher grades (p = 0.021) as compared with the single group. Furthermore, marked IM and atrophy in adjacent mucosa were more easily seen in the multiple metachronous and synchronous groups as compared with the single group (p < 0.0001). Interestingly, the presence of incomplete type of IM (p = 0.025) and crypt dysplasia (p < 0.0001) in background mucosa was associated with occurrence of metachronous and synchronous lesions following endoscopic resection of GED. Conclusions The histological features of background mucosa, such as intestinal metaplasia, atrophy, and crypt dysplasia could be used as indicators of occurrence of metachronous and synchronous lesions after endoscopic treatment of GED. [ABSTRACT FROM AUTHOR]

Background and aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is commonly used to obtain tissue external to the gastrointestinal tract. EUS-FNA is relatively safe, but occasionally adverse events have been reported. There is scarcity of data on risk factors of adverse events. The aim of this study is to identify risk factors associated with EUS-FNA. Methods: In this multicenter case-control study, we retrospectively reviewed 4,097 cases between 2009 and 2012 at 15 hospitals in Korea. Among the patients there were 104 cases (2.5%) who had adverse events of which 12 (0.29%) were severe. We matched 520 controls (1:5 ratios) stratified by hospital to analyze the potential risk factors. Results: The most common adverse events were pancreatitis (45/104, 43.3%) and infection (46/104, 44.2%). Endoscopic retrograde cholangiopancreatography (ERCP) on the same day was a risk factor of all adverse events [OR = 2.41, 95% CI (1.41, 4.12)], pancreatitis [OR = 2.31, 95% CI (1.02, 5.25)], and infection [OR = 2.75, 95% CI (1.31, 5.78)]. More than 15 to-and-fro movements during puncture increased the risk of pancreatitis [OR = 2.30, 95% CI (1.11, 4.77)] and infection [OR = 3.65, 95% CI (1.55, 8.59)]. A higher number of punctures was positively correlated with pancreatitis [OR = 1.34, 95% CI (1.08, 1.67)] but negatively correlated with infection [OR = 0.66, 95% CI (0.48, 0.89)]. Conclusions: EUS-FNA is a safe procedure in which serious adverse events are rare. We define some risk factors of adverse events during EUS-FNA, including ERCP on the same day, a higher number of punctures, and more than 15 to-and-fro movements. [ABSTRACT FROM AUTHOR]

Aims Previous reports have shown that gastric epithelial dysplasia ( GED) limited to the crypt (gastric crypt dysplasia, GCD) is commonly identified at the periphery of gastric carcinoma. However, it is unknown whether GCD is endoscopically identifiable, and how it relates to classic GED lesions. Methods and results We investigated 1196 consecutive endoscopic resections of GED lesions between January 2011 and December 2014. We also evaluated clinicopathological features of these lesions, as well as the immunohistochemical expression of mucin (Muc)2, Muc5AC, Muc6, CD10, Ki67 and p53. We found 51 (4.3%) lesions composed microscopically of GCD among 1196 GED lesions. Those were elevated mucosal lesions (66.7%) similar in colour and texture to the adjacent mucosa (68.6%). GCD was likely to have an antropyloric location and a higher grade than the adenomatous type, similar to the foveolar and hybrid types ( P < 0.05). A gastric immunophenotype was more common in GCD compared to adenomatous GED ( P < 0.05). Ki-67- and p53-positive cells were more evident in GCD compared to the adjacent gastric mucosa. Conclusions Our results demonstrated that GCD can be an endoscopically identifiable lesion, sharing many similarities with foveolar and hybrid GED, for which it may represent a precursor lesion in the gastric carcinogenic sequence. [ABSTRACT FROM AUTHOR]

Among submucosal tumors ( SMT), gastric glomus tumors are rare vascular tumors, and only a few cases where glomus tumors have been differentiated from other mesenchymal tumors by endoscopic ultrasonography ( EUS) or computed tomography ( CT) have been reported. In this case series, we aimed to analyze the EUS and CT characteristics of gastric glomus tumors. Seven patients with gastric glomus tumors were retrospectively enrolled in this study. EUS showed that all the tumors were located in the fourth EUS layer (muscularis propria) and had distinct borders. The tumors had a heterogeneous appearance with either hypo- or hyperechogenicity, and all the tumors except one had the characteristic peripheral halo around them. On CT scans,all the tumors appeared as well-defined SMT with a clear margin and showed the same characteristics in the different phases of CT. During dynamic contrast-enhanced CT, the tumors showed strong enhancement in the arterial phase and prolonged enhancement in the delayed phase. This case series shows the characteristic EUS findings and the distinguishing features of CT scans for gastric glomus tumors; these findings will help in differentiating gastric glomus tumors from other SMT. [ABSTRACT FROM AUTHOR]

Abstract: Identification of abnormal bile related to various pathological processes in the pancreaticobiliary tract can be important in the diagnosis of disease and the determination of appropriate treatment. Magnetic resonance (MR) imaging can allow comprehensive evaluation of abnormal bile because MR usually provides better tissue characterization than other imaging modalities. A high-intensity signal from bile is frequently encountered on T1-weighted images and can be seen in concentrated bile, sludge, stones, or hemobilia. Contrast-enhanced MR features, such as inhomogeneous hepatic enhancement in the arterial phase and papillitis or mild-to-moderate bile duct wall thickening with enhancement, along with clinical characteristics, may suggest clinically significant bile, such as sludge or purulent bile, rather than merely concentrated bile. A history of trauma and appropriate imaging findings in the hepatobiliary tract can support a diagnosis of hemobilia. MR imaging may assist in diagnosing intraductal papillary mucinous neoplasm of the bile duct via detection of an intraductal mass or several indirect signs, suggesting a large amount of mucin. Additionally, Gd-EOB-DTPA-enhanced MR may delineate mucin as a filling defect surrounding hyperintense bile. A floating filling defect on all MR sequences is helpful in discriminating pneumobilia from other intraluminal filling defects. Familiarity with the various different MR features of abnormal bile signals can therefore facilitate accurate diagnosis and treatment. [Copyright &y& Elsevier]