Histopathological pattern of endoscopic gastric biopsies in dyspeptic patients in a Nigerian population

Background and Objective: Dyspepsia is one of the most common complaints encountered in the general outpatient and gastroenterology clinics in Nigeria. Histopathological assessment of endoscopic gastric mucosa biopsy is crucial to delineate the exact cause of dyspepsia to guide patients' management. This study aimed to determine and document the histopathological basis of dyspepsia among dyspeptic patients at our facility. Material sand Methods: This was a three year descriptive retrospective study and the materials consisted of all gastric endoscopic biopsies taken from clinically diagnosed dyspeptic patients sent to the Department of Histopathology of the Federal Medical Centre, Owerri, Nigeria. Results: The biopsies were from 64 (53.2%) male patients and 56 (46.8%) female patients, giving a male to female ratio of 1.14:1. The age range of the patients was 28-82 years with a mean of 56 years at presentation. Helicobacter Pylori (H. Pylori) bacilli were identified in the samples of 42 (35%) patients but absent in samples of 78 (65%) patients. The histopathological pattern of the aetiological basis of dyspepsia in this study consisted of gastritis (96, 80%), functional (17, 14.2%), adenocarcinoma (4, 3.3%) and polyps (3, 2.5%). H. Pylori bacilli were seen only in patients with gastritis (42/96, 43.8%), and it affected 19 (45.2%) male patients and 23 (54.8%) female patients. Chronic active H. Pylori associated gastritis (24, 25%) was the most common form of gastritis seen during the study period. Conclusion: The main organic cause of dyspepsia in our setting was chronic gastric followed in the distant by gastric adenocarcinoma and polyp. Dyspepsia and H. Pylori associated gastritis did not show a significant gender predilection

Clinical profile of patients presented with esophageal carcinoma in tertiary care teaching medical college of Gujarat, India

Background: Esophageal cancer is associated with multiple risk factors and associated with poor prognosis. Incidence of Esophageal cancer is increases now a days and it became a sixth leading cause of cancer related death in world. The purpose of this study was to know the clinical profile of patients of esophageal cancer in a tertiary care teaching hospital of Gujrat, India.Methods: This is a retrospective hospital record based study for a period of 2015 to 2018 in which 103 patients with endoscopic biopsy confirmed cases of esophageal cancer were analyzed for clinical profile.Results: Esophageal cancer was most common in low socioeconomic men (66%) of 5th decades (26.21%) associated with tobacco chewing (64.07%) as a major risk factor and dysphagia (86.76%) as most common presenting feature. Most common type and involvement were sqamous type (72.81%) and distal third (50.48%) part of the esophagus respectively.Conclusions: Primordial prevention and screening of patients may decrease mortality related to esophageal carcinoma.

Consistency analysis of gastric cancer HER-2 expression among endoscopic biopsy and radical operation specimens / 中国肿瘤临床

Objective:To analyze the consistency of HER-2 expression among endoscopic biopsy and radical operation specimens of gastric adenocarcinoma and to investigate the clinical application value of HER-2 detection in trastuzumab treated patients. Methods:From March 2013 to February 2014, 167 patients from Shanghai Changhai Hospital were diagnosed with gastric adenocarcinoma using endoscopic biopsy specimens. The corresponding surgical specimens were collected for pathological analysis. The relevant clinical and pathological data were collected. HER-2 protein expression of endoscopic biopsy specimens was detected by immunohistochemistry (IHC). HER-2 protein expression and gene amplification status of the corresponding tumor resection specimens were detected by IHC and fluorescence in situ hybridization (FISH). Results were analyzed for clinicopathological characteristics. Results:Among the 167 cas-es, 18 cases (10.8%) were HER-2 positive, including 10 cases showing IHC3+and 8 cases showing IHC2+with FISH positive. The consis-tency rate result among endoscopic biopsy and surgical operation specimens was 82%. Excluding the cases showing IHC2+, the true positive rate and the true negative rate were 73.3%and 97.0%, respectively. Conclusion:HER-2 detection of endoscopic biopsy speci-men by IHC shows great predictive value. The main reason for the difference of surgery and biopsy specimens is the heterogeneity of tumor expression. Increasing the number of specimens and combined testing with FISH are important methods to reduce misjudge-ment.

Strongyloides Hyperinfection in Renal Transplant - diagnosis by Endoscopic Intestinal Biopsy.

Introduction: Intestinal parasites continue to be a significant health problem in renal transplantation patients. Strongyloides infection is unique that it excretes larvae and can continue life cycle by auto infective cycle also. Presentation of the case: We present a 26 years old man presented with acute cellular rejection after three months of kidney transplantation. Before transplantation stool of both recipient and donor was negative for parasites. He received three doses of intravenous methylprednisolone. After one month he presented with severe epigastric pain and vomiting. On examination he was malnourished, dehydrated and lost two kilograms of weight over one month. His serum albumin was 2.9 mg/dL. Pain did not subside with proton pump inhibitors. Stool examination was negative for parasites. As index of suspicion for parasites was high, upper GI endoscopy was done; it showed multiple ulcers in duodenum. Biopsy of the ulcer showed strongyloides infection He was treated with ivermectin. Abdomen Pain was subsided soon. He gained weight of 1.5 kilograms over next month. Conclusion: When transplant patients from developing country with recent increase of immunosupression presents with severe abdomen pain, the intestinal parasitic infection should be entertained. If stool examination is negative and serology is unavailable, early evaluation by endoscopic biopsy is helpful to diagnose strongyloides. Prolonged treatment with ivermectin and follow-up stool examinations are important for complete cure of strongyloides infection.

Intramural Hematoma of the Esophagus after Endoscopic Pinch Biopsy

Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.

The Diagnostic Accuracy of Endoscopic Biopsy for Gastric Dysplasia

PURPOSE: There is controversy over the treatment for low grade dysplasia, while resection is recommended for high grade dysplasia. But the concordance of the grade of dysplasia between pre- and post-resection is low because of sampling errors with endoscopic biopsy. We attempted to establish a clearer direction for the treatment of dysplasia by clarifying the discrepancy between the pre- and post-resection diagnoses. MATERIALS AND METHODS: We performed a retrospective review of 126 patients who had undergone resection with the diagnosis of dysplasia on biopsy at Bundang CHA Hospital from 1999 to 2009. RESULTS: Seventy patients were diagnosed with low grade dysplasia and 56 patients were diagnosed with high grade dysplasia. Among the 33 patients who received gastrectomy with lymph node dissection, 30 patients were revealed to have invasive cancers and 4 patients showed lymph node metastasis. Discordance between the diagnoses from biopsy and resection occurred in 55 patients (44%). There was no correlation on the comparative analysis between the size, location or gross type of lesion and the grade of dysplasia. CONCLUSIONS: The rate of discordance between the diagnoses of endoscopic biopsy and the post resection pathologic report was as high as 44%. Endoscopic mucosal resection was not sufficient for some patients who were diagnosed with dysplasia on biopsy due to the presence of lymph node metastasis. It is necessary to be prudent when determining the follow-up and treatment based solely on the result of the biopsy.

The Diagnostic Accuracy of Endoscopic Biopsy for Gastric Dysplasia

PURPOSE: There is controversy over the treatment for low grade dysplasia, while resection is recommended for high grade dysplasia. But the concordance of the grade of dysplasia between pre- and post-resection is low because of sampling errors with endoscopic biopsy. We attempted to establish a clearer direction for the treatment of dysplasia by clarifying the discrepancy between the pre- and post-resection diagnoses. MATERIALS AND METHODS: We performed a retrospective review of 126 patients who had undergone resection with the diagnosis of dysplasia on biopsy at Bundang CHA Hospital from 1999 to 2009. RESULTS: Seventy patients were diagnosed with low grade dysplasia and 56 patients were diagnosed with high grade dysplasia. Among the 33 patients who received gastrectomy with lymph node dissection, 30 patients were revealed to have invasive cancers and 4 patients showed lymph node metastasis. Discordance between the diagnoses from biopsy and resection occurred in 55 patients (44%). There was no correlation on the comparative analysis between the size, location or gross type of lesion and the grade of dysplasia. CONCLUSIONS: The rate of discordance between the diagnoses of endoscopic biopsy and the post resection pathologic report was as high as 44%. Endoscopic mucosal resection was not sufficient for some patients who were diagnosed with dysplasia on biopsy due to the presence of lymph node metastasis. It is necessary to be prudent when determining the follow-up and treatment based solely on the result of the biopsy.

Histopathologic features of ulcerative colitis and Crohn's disease / 中华消化内镜杂志

Objective To retrospectively study histopathologic features of ulcerous colitis (UC) and Crohn's disease (CD) by endoscopic biopsy. Methods Data of age, gender and intestinal involvement of 106 cases of CD and 180 cases of UC confirmed by pathology were reviewed. Mucosal architecture, chronic inflammation, acute inflammation and epithelial features were evaluated based on histopathological criteria.These features were compared between the two groups. Results Compared with CD cases, UC showed significantly higher percentage of architectural disorders ( P ＜ 0. 05 ), lower percentage of discontinuous chronic inflammation ( P ＜ 0. 05 ) and higher incidence of cryptitis, crypt abscesses and polymorph cells in lamina propria (P ＜0. 05 ), and higher rate of epithelium damage, flattened and less mucous cell as well. Granuloma, pseudo pylorus glands metaplasia and narrow ulcer only occurred in CD cases. Lesions of 90% (162/180) cases of UC were limited to colon, while those of 28% (30/106) of CD cases to ileocecum, and those of 56% (59/106) CD cases involved different parts of gastrointestinal tract. Conclusion Diagnosis of CD and UC needs comprehensive analysis. Diagnostic evidence for CD includes focal involvement of ileocecum, the multifocal involvement in gastrointestinal tract, granuloma, discontinuous inflammation, pyloric gland metaplasia, while that for UC includes mucosal damage limited to colon, continuous chronic inflammation, architectural disorders, or epithelial damage.

Roles of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal region tumors in children / 第三军医大学学报

Objective To investigate the roles of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal region tumors in children. Methods Endoscopic biopsy and third ventriculostomy were performed in 9 pediatric patients with pineal region tumors. Results Successful third ventriculostomy, confirmed by MRI, was performed in 9 cases of children with obstructive hydrocephalus. No complications were found in all patients. Conclusion Endoscopic biopsy and third ventriculostomy are effective neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors.

Endoscopic Sentinel Node Biopsy / 한국유방암학회지

PURPOSE: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis. However there have been some controversies in clinical application because of its various identification rates and false negative rates. We present the usefulness of dye-guided endoscopic sentinel node biopsy. METHODS: Between October 2002 and June 2003, 30 breast cancer patients with clinically node negative results underwent endoscopic blue dye-guided sentinel node biopsy from the Department of Surgery at Kangbuk Samsung Hospital. The technique involved the injection of 5 ml of 1% isosulfan blue into subareolar plexus. The Visiport docked with Telescope was inserted through a low transverse axillary incison lateral to pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatics directly into blue (or nonblue) lymph nodes. The identification rate and false negative rate was evaluated. RESULTS: The mean number of sentinel nodes was 2.2. The identification rate of th sentinel node was 93.3% (28/30). Among 22 patients with negative sentinel nodes on frozen section, 10 patients underwent axillary node dissection and the results were negative in all cases, indicating false negative rate of 0% (0/10). The overall accuracy, sensitivity and specificity were 100%. CONCLUSION: The endoscopic technique of sentinel node biopsy can minimize the operative bleeding by handling the knife of Visiport pallelel to exposed vessels under endoscopic monitor analysis and and keep better operative visual field and less invasiveness. With the bright illumination of the endoscopic light, blue-stained sentinel lymphatics could be identified more easily. Our technique of dye-guided endoscopic sentinel node biopsy demonstrates a high sentinel node identification rate and absent false negative rate, promising it could be an alternative to the classic sentinel node biopsy.

Histologic identification of helicobacter pylori and gastric pathology in endoscopic biopsy specimens: A report of 213 cases.

Histology of gastric biopsy specimens from 213 patients was studied. Microscopic observation of hematoxylin & eosin stained sections was the main method for identification of Helicobacter pylori. Results of 200 cases were compared with biochemical test, Gram's stain and culture of concurrent specimens. Relations between presence of H. pylori and gastric pathology were analyzed. Histologic presence of H. pylori is significantly correlated with presence and activity of gastritis and intestinal metaplasia.

A Case of Gastric Strongyloidiasis Diagnosed by Endoscopic Biopsy / 대한소화기내시경학회지

Korea Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.

Histopathological Features of Endoscopic Biopsies in Ischemic Colitis

Ischemic colitis still remains largely underdiagnosed despite the fact that it is one of the most common disorders of the large bowel. The aims of the present study were to evaluate the variable histologic findings of ischemic colitis and to find out helpful histopathological features in diagnosis. Retrospective review of the clinical symptoms, underlying diseases, endoscopic findings of 23 patients, and the histologic features of 37 biopsies was done. We analyzed the significant pathologic features in the histologically diagnosed ischemic colitis group and compared the biopsy time between the histologically diagnosed ischemic colitis group and the non-diagnosed group. Comparison of the endoscopic biopsy time between the group that showed significant histologic features and the group that showed no significant histologic features was also done. The age of the patients ranged from 27 to 87 years. Most patients had abdominal pain, hematemesis, and melena. Endoscopic differential diagnoses included ischemic colitis, ulcerative colitis, infectious colitis, tuberculous colitis, Crohn's disease, and pseudomembranous colitis. Histologic features and diagnoses were also variable. The coagulative necrosis of mucosa and the epithelial desquamation were frequently detected in the group pathologically diagnosed as ischemic colitis. The most pathognomonic finding was coagulative necrosis of the mucosa that was almost always detected within seven days after the onset of clinical symptoms. Recognition of variable patterns of ischemic colitis in a biopsy specimen will direct the clinician to evaluate the vascular system. Early endoscopic biopsy is essential for the precise diagnosis of ischemic colitis.

The Relationship of Helicobacter pylori Infection and Upper Gastrointestinal Diseases in Korean Adults

Helicobacter pylori infection is associated with various gastrointestinal disorders. It has been proved that those who are infected leads to gastritis in 100% and that there is no natural recovery. Therefore, treatment to cradicate the organism is essential to block the natural course of many disorders of the gastrointestinal tract, that may lead to gastric cancer which is the number one leading cause of death among cancer in Korea. The study was conducted in order to find out the prevalence of H. pylori infection in Inchon area and the relationship between H. pylori infection and its diverse pathology. The study involved 1,872 applicants screened for Helicobacter pylori infection by serology antibody test in the Health Promotion Center at Inha University Hospital in Inchon, Among them, 1,203(64.3%) were positive including 651 males(67.2%), and 524 females(61,0%). There was no significant statistical difference among age groups. In males of age group 40-49 years of age, and females of age group 50-59, H. pylori infection were most common. There were no differences among the H. pylori positive and negative group with respect to fatally history, past history, lob, lifestyle behavior (including smoking, drinking, and exercise), Epigastaic pain, diarrhea, rectal bleeding were more common and statistically different in H pylori positives compared to those of negatives. In the findings of upper gastrointestinal barium swallow, there were no differences between the two groups. H. pylori positive group showed more endoscopic findings compared to negative group, Out of the 1,239 total findings H pylori positive group showed 873 endoscopic findings as opposed to 366 in the negative group. Among the H pylori positive group, chronic superficial gastritis was most common with 338, followed by gastric crosion 134, duodenal ulcer 53. In the negative group, chronic superficial gastritis was also the most common with 160, followed by gastric crosion 79, and hiatal hernia 32 Gastric subepithelial hemorrhage(p<0.001), duodenal ulcer(p<0.022), intestinal metaplasia(p<0.024) were found to be significantly common in H pylori positive group compared to those of the negative group. Hiatal hernia(p<0.001) was found to be higher in the negative group. The sensitivity and specificity of CLO test performed during the endoscopy procedure were 79.9% and 100%, respectively. The sensitivity and specificity of endoscopic diopsy were 51.9% and 100%, respectively.

The Correlation between the Proliferative Activity in Biopsied Specimen of Gastric Adenocarcinoma and the Pathologic Findings of Resected Specimen

Studies on the correlation between proliferative activity of biopsied specimen and pathologic findings of resected specimen have been carried out to find the prognostic factors. To estimate the proliferative activity, 100 cases of biopsied specimen of gastric adenocarcinoma were tested for the PCNA (proliferating cell nuclear antigen) and the AgNOR (argyrophilic nucleolar organizer region) by the immunohistochemical and histochemical stainings, respectively. The resected tumors classified by histologic type, differentiation, depth of invasion, and nodal metastatic status were followed by cell cycle analysis using flow cytometry. The PCNA LI (labelling index) were higher in well or moderately differentiated tumors (P<0.01) than the poorly differentiated ones and the aneuploid tumors (P<0.05) more than in diploid ones. However, there were no correlations among histologic types, depth of invasion, nodal metastatic status and PCNA LI. The AgNOR counts were higher in advanced tumor than in the EGC (early gastric cancer) (P<0.01). In cases with nodal metastasis, most of them showed the AgNOR counts higher than those without nodal metastasis. There were no correlations between the AgNOR counts and the DNA ploidy, histologic type, or differentiation. High PCNA LI and high AgNOR counts were shown in cases with advanced tumors (P=0.000) and nodal metastasis (P<0.05). No correlation was shown with the histologic type or differentiation. The results show that proliferative activity of the biopsied specimen of gastric adenocarcinoma is correlated with the differentiation and the invasion depth of resected specimen. Especially, better correlation is obtained by analyzing both the PCNA LI and the AgNOR counts than by analyzing each.

Histologic and cytologic study of multiple endoscopic biopsy of gastric ulcer.

A prospective study was carried out on 50 patients with an endoscopicaly proven gastric ulcer. In each patient, multiple endoscopic biopsy specimens were taken for histologic and examinations. In 44 group-A patients with endoscopicaly benign gastric ulcers, both histologic and cytologic examinations failed to discover an overlooked malignant ulcer. This did not imply, however, that both methods were useless in this respect, as the number of patients studied was not very large. In 6 group-B patients in whom a malignant gastric ulcer was evident of otherwise suspected endoscopicaly, both histologic and cytologic examinations did not appear to offer any extra benefit over that of the histologic examination alone. A false-positive reading for malignancy was encountered with the cytologic interpretation in 1 patient of groups B. The authors thus consider that for most endoscopic units in Thailand, multiple endoscopic biopsy sampling for a histologic study with or without a cytlogic study may be reserved only for those gastric ulcer cases in which there is an endoscopic suspicion of an underlying malignancy. The cytologic examination may be implemented only if such facility is readily available. Finally, the “touch-smear” technique for collecting a cytologic specimen would be a convenient and reliable method to be employed.