Neutrophil-lymphocyte Ratio: Predictor of High-grade Dysplasia in Colorectal Polyp

ABSTRACT Objective: To determine the value of neutrophil-lymphocyte ratio for predicting high-grade dysplasia among patients with neoplastic colorectal polyp. Method: We evaluated 30 patients with non-neoplastic polyp, 61 patients with neoplastic polyp (32 with high-grade dysplasia/29 without high-grade dysplasia), and 30 patients with normal colonoscopy as control group. Mean platelet volume, red cell distribution width, neutrophil and lymphocyte levels were recorded and neutrophil-lymphocyte ratio was calculated. Results: Mean neutrophil-lymphocyte ratio of patients with neoplastic polyp were higher than patients with non-neoplastic polyp and control group (2.56 ± 1.47, 1.77 ± 0.44, 1.76 ± 0.62, retrospectively) (p = 0.001). Mean platelet volume of patients with neoplastic polyp (8.76 ± 1.06) was lower than patients with non- neoplastic polyp (9.50 ± 1.27) and control group (10.96 ± 0.83) (p < 0.001). Mean neutrophil-lymphocyte ratio of patients with high-grade dysplasia (3.03 ± 1.88) was significantly higher than patients without high-grade dysplasia (2.14 ± 0.77) (p = 0.022). The cut-off value of neutrophil-lymphocyte ratio to predict the presence of high-grade dysplasia was 2.044 (sensitivity: 69%, specificity: 68%). Conclusion: Neutrophil-lymphocyte ratio, which is a simple non-invasive index can predict high-grade dysplasia and neoplastic polyp. Although mean platelet volume and red cell distribution width are not useful for identifying high-grade dysplasia in patients with colorectal polyp, mean platelet volume may be associated with neoplastic polyp.

A Case of Endoscopic Full-Thickness Resection in a Patient with Gastric High-Grade Dysplasia Unsuitable for Endoscopic Submucosal Dissection

Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8x0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.

Colonic Carcinoma and Tubular Adenoma with High Grade Dysplasia Resembling Submucosal Tumor / 대한소화기내시경학회지

Colorectal carcinoma arises from the epithelium of the colorectal mucosa, and so it displays various macroscopic appearances with abnormal mucosal changes. But submucosal tumor-like colorectal carcinoma is very rare. We report here on two such cases along with a review of the relevant literature. The first case was submucosal tumor-like colorectal carcinoma that was initially diagnosed as rectal submucosal tumor, but the follow-up endoscopic exam revealed ulceroinfiltrative type adenocarcinoma. The second case was an endoscopically determined polypoid lesion combined with submucosal tumor, but it was found to be tubular adenoma with high grade dysplasia combined with a mucin pool collection in the submucosa after surgical resection.

Esófago de Barrett: actualización del tratamiento endoscópico / Barrett's esophagus: update of the endoscopic treatment

El manejo actual del esófago de Barrett incluye el tratamiento de los síntomas de enfermedad por reflujo gastroesofágico, la prevención del daño erosivo y la vigilancia endoscópica para detectar la progresión a displasia de alto grado y adenocarcinoma esofágico. Ante la presencia de displasia de alto grado y cáncer superficial, se han intentado terapias menos invasivas, alternativas a la cirugía resectiva, como el Argon Plasma Coagulator, Electrocoagulación Multipolar, Heater Probe, asociados o no a cirugía antirreflujo, la Terapia Fotodinámica y en los últimos años la ablación endoscópica por radiofrecuencia o BARREx. Se vislumbran además como terapias de destrucción del epitelio de Barrett actualmente en estudio la terapia ultrasónica y la crioterapia. La Resección Mucosa Endoscópica del epitelio de Barrett, procedimiento con potencial curativo, es además la única técnica que permite el análisis histopatológico del tejido. En la presente revisión analizaremos los resultados obtenidos con las diferentes terapias endoscópicas actuales y en desarrollo para el esófago de Barrett.

Actual Barrett’s esophagus management includes symptomatic approach for GERD in order to prevent erosive injury, and endoscopic & histologycal surveillance to detect dysplasia and early cancer. In high-grade dysplasia and superficial carcinoma, less aggressive procedures has been attempted to avoid extended surgery, such as Argon Plasma Coagulator, Multipolar Coagulation, Heater Probe, Photodynamic Therapy, and recently radiofrequency local treatment, associated or not to antireflux surgery. Ultrasonic therapy and Cryotherapy are new approaches, which are under clinical investigation. Barrett’s epithelium resection utilizing endoscopical mucosal resection is a new promising procedure, which comes to the arena, allowing besides the compromised epithelium removal, its complete pathological evaluation and probably a curative intent. The actual revision intents to discuss the results of the different alternatives at the platform of treatment in dysplastic Barrett’s or early carcinoma growing in the Barrett’s epithelium.

A Case of High Grade Dysplasia in Sporadic Fundic Gland Polyp / 대한소화기내시경학회지

Fundic gland polyps (FGP) are the most common type of gastric polyps, with an incidence on endoscopy of 0.8~1.9%. They have been considered as benign lesions, without the potential for malignant transformation. High grade dysplasia and gastric adenocarcinomas associated with FGP have been described in patients with familial, as well as attenuated adenomatous polyposis (FAP). In contrast, dysplasia associated with FGP in non-FAP patients is extremely rare, and there have been no reports of sporadic FGP with high grade dysplasia in the Korean literature. Herein, we report one case of high grade dysplasia associated with sporadic FGP in a non-FAP patient treated with an endoscopic polypectomy.

A Case of Gastritis Cystica Profunda Associated with High Grade Tubular Adenoma / 대한소화기학회지

Gastritis cystica profunda is usually characterized by hyperplastic and cystic dilatation of pseudopyloric gland with submucosal invasion. These lesions possess malignant histologic features as metaplastic and even dysplastic alteration can be observed, however they usually exhibit benign behavior. Macroscopically, gastritis cystica profunda may present as a submucosal tumor or as a polyp. In rare case, however, it can be found as a giant mucosal fold. The proposed pathogenesis of lesion relates to ischemia, chronic inflammation, and the presence of foreign body. Herein, we report a case of gastritis cystica profunda associated with high grade tubular adenoma in a patient without antecedent surgery.

Comparison of Clinicopathologic Findings between Colorectal Adenoma with High Grade Dysplasia and Colorectal Carcinoma with Mucosal Invasion / 대한소화기내시경학회지

BACKGROUND/AIMS: The precancerous lesion of colorectal cancer is adenoma. Adenoma with high grade dysplasia has been known as the lesion having high malignant potentials. The cancer with invasion to mucosa is limted to the mucosa, and it is difficult to pathologically differentiate the adenoma with high grade dysplasia. METHODS: Fifty three adenomas with high grade dysplasia (type I group) and 40 cancers with invasion to mucosa (type II group) for 4 years, were analyzed for the colonoscopic findings and pathological findings before and after EMR. RESULTS: Mean ages were 57.0 years old for type I group and 60.4 for type II group. Chief complaint for colonoscopy was rectal bleeding (21.0%) for type I group, and rectal bleeding (35.0%) for type II group. Mean sizes of the lesions were 1.18 cm for type I group, and 1.71 cm for type II group. Locations of the lesion were rectum 43.4%, sigmoid colon 32.1%, proximal colon 24.5% for type I group, and rectum 45.7%, sigmoid colon 42.9%, proximal colon 11.4% for type II group. Shapes of the lesions were Is 46.9%, Ip 30.6%, Isp 18.4%, LST 4.1% for type I group, and Isp 34.2%, Ip 31.6%, Is 18.4%, LST 5%, IIa depression 5%, Is+IIc 5% for type II group. Methods for therapy were EMR 60.4%, operation 1.9%, electrocoagulation 11.3%, observation 26.4% for type I group, and EMR 85.0%, operation 15.0% for type II group. Pathological agreement before and after EMR was 57.1% for type I group and 31.3% for type II group. CONCLUSIONS: Type II group had more rectal bleeding, larger, more Isp type, more EMR therapy, more pathological disagreement ratio before and after EMR, than type I group.