A survey on clinical practice of digestive endoscopy in county-level hospitals of Yunnan Province / 中华消化内镜杂志

Objective:To analyze general information, diagnosis and treatment of digestive endoscopy departments in county-level hospitals of Yunnan Province, thus to provide evidence for improving the endoscopic diagnosis and therapy in these hospitals.Methods:An online survey was performed to collect quality-related information of digestive endoscopy centers (departments) at county-level hospitals of Yunnan from January 2019 to January 2020, including endoscopic equipment, endoscopic techniques, staffing, number of operations, and quality control.Results:A total of 143 county-level hospitals were involved in this study. Each hospital owned only 1.74 endoscopy operation rooms on average, 1.42 regular endoscopy workstation, 4 endoscopes. There were only 10 endoscopic ultrasonography workstations and 2 enteroscopy workstations respectively installed in these hospitals. Endoscopic retrograde cholangiopancreatography was independently performed in only 4 hospitals. There were 392 professional endoscopists in all 143 hospitals, 18.62% (73/392) of whom were able to perform endoscopic therapy of grade 4, while only 6.12% (24/392) of whom could perform endoscopic submucosal dissection (ESD) independently. In 2019, the early diagnostic rate of gastrointestinal tract cancer in these hospitals was 19.48% (1 133/5 817). The early diagnostic rate was 21.04% (276/1 312) for esophageal cancer, 19.53% (397/2 033) for gastric cancer, and 18.61% (460/2 472) for colorectal cancer. The colorectal adenoma detection rate was 12.83% (12 207/95 148). The rate of reaching cecum during colonoscopy was 70.49% (67 067/95 148). The complete resection rate of ESD was 12.54% (221/1 763).Conclusion:The general situation of digestive endoscopy in county-level hospitals of Yunnan is far from being well-developed, which may be attributed to slow upgrading of equipments, inadequate training of endoscopic professionals and undemanding quality control. It is highly significant to improve medical service and quality of diagnosis and treatment of digestive endoscopy in these hospitals, on the basis of a complete endoscopy quality control system with a high standard.

Correlation of Metabolic Dysfunction-associated Fatty Liver Disease With Colorectal Adenoma and Early Colorectal Cancer / 胃肠病学

Background: The terminology of nonalcoholic fatty liver disease (NAFLD) was changed to metabolic dysfunction ⁃ associated fatty liver disease (MAFLD) in 2020. NAFLD has been confirmed to be a risk factor for colorectal neoplasms, but the association between MAFLD and colorectal neoplasms is conflicting. Aims: To investigate the correlation of MAFLD with colorectal adenoma and early colorectal cancer. Methods: The clinical information of 701 patients who met the criteria and were admitted to Renmin Hospital of Wuhan University from January 2021 to August 2021 was collected retrospectively. Among them, 274 colorectal adenoma patients with low ⁃ grade intraepithelial neoplasia or without intraepithelial neoplasia were classified as adenoma group, 21 patients with high ⁃ grade intraepithelial neoplasia, intramucosal carcinoma, and submucosal carcinoma were classified as early cancer group, and 406 patients with normal colonoscopy or non⁃adenomatous polyps were served as control group. The general information and prevalence of MAFLD between these groups were compared. Furthermore, the correlation of MAFLD with colorectal adenoma and early colorectal cancer, and the gender difference of these correlations were analyzed by Logistic regression models. Subgroup analysis was performed based on the clinicopathological characteristics of colorectal adenoma. Results: When adjusting the confounding variables including gender, age, smoking, alcohol drinking, diabetes, hypertension, and serum creatinine, MAFLD was significantly associated with the prevalence of colorectal adenoma (OR=1.83, 95% CI: 1.04 ⁃ 3.22, P=0.037) and early colorectal cancer (OR=3.91, 95% CI: 1.14⁃13.42, P=0.031). When stratified as gender, the significant association remained in females (OR=4.04, 95% CI: 1.56 ⁃ 10.47, P=0.004), but not in males. In addition, no correlation was found between MAFLD and the location, size, number, and advanced histology of colorectal adenoma (all P>0.05). Conclusions: MAFLD is an independent risk factor for colorectal adenoma and early colorectal cancer. MAFLD is specifically associated with increased risk of colorectal adenoma in females but not in males.

Tamización primaria con prueba ADN-VPH en mujeres menores de 30 años: evaluación de tecnología sanitaria / Primary HPV-DNA screening in women under 30 years of age: health technology assessment

Antecedentes A partir del 2014 en Colombia se incorporó la Tamización primaria con prueba de Virus del Papiloma Humano (VPH) desde los 30 hasta los 65 años, cuando la prueba es positiva se hace triage con citología para remisión a colposcopia. Actualmente se discute la conveniencia de iniciar la tamización con prueba de ADN de VPH a partir de los 25 años. De esta manera, el objetivo de esta evaluación de tecnologías sanitarias es analizar la evidencia disponible en torno a la seguridad, efectividad, costoefectividad, valores y preferencias, dilemas éticos y aspectos relacionados con la implementación para el contexto colombiano de la prueba ADN-VPH como estrategia de tamización cervical en mujeres menores de 30 años. Dominios a evaluar Eficacia clínica y seguridad 1. Tasa acumulada de neoplasia intraepitelial cervical (NIC) grado 2 o más avanzado luego de 2 rondas de tamización. 2. Tasas acumuladas de cáncer invasor de cérvix luego de 2 rondas de tamización. 3. Seguridad: remisión a colposcopia. Costo-efectividad Costo efectividad para Colombia. Otros dominios considerados Aspectos éticos asociados a la tamización cervical en mujeres menores de 30 años. Aspectos organizacionales y del individuo. Barreras y facilitadores relacionados con la implementación en el contexto colombiano de la tamización cervical en mujeres menores de 30 años. Métodos Evaluación de efectividad y seguridad clínicas Se realizó una búsqueda sistemática de la literatura en MEDLINE, Embase y CENTRAL de revisiones sistemáticas y ensayos clínicos. Se calificó el cuerpo de la evidencia con la aproximación GRADE. Posteriormente, se convocó a un grupo interdisciplinario a una mesa de trabajo en donde se presentó la evidencia recuperada, dando paso a la discusión y a la construcción de las conclusiones, siguiendo los lineamientos de un consenso formal acorde a la metodología RAND/UCLA. Estudio económico Se hizo una búsqueda sistemática de la literatura de estudios que hubieran evaluado el costo-efectividad para Colombia. Resultados De 7.659 referencias recuperadas se incluyeron 8 estudios. Resultados clínicos Se realizó un análisis integrativo de 5 ensayos clínicos aleatorizados que cumplieron con los citerios de inclusión. Cuando se compara frente a la citología, la tamización primaria con ADN-VPH en mujeres menores de 30 años, podría asociarse con una mayor frecuencia de detección de lesiones NIC2+ durante la primera ronda de cribado (RR: 1.57; IC: 1,20 a 2,04; certeza en la evidencia baja), con una menor incidencia de NIC2+ (RR:0,67; IC: 0,48 a 0,92; certeza en la evidencia baja) y se asocia con una menor frecuencia de carcinoma invasor al término del seguimiento (RR: 0,19; IC: 0,07 a 0,53; certeza en la evidencia alta). Resultados económicos Desde el punto de vista económico, la alternativa de ADN-VPH y triage con citología desde los 25 años quizás representa la alternativa más costo-efectiva para Colombia (razón costo-efectividad incremental $8.820.980 COP año 2013). Otras implicaciones Dos estudios sugieren que las barreras de implementación, atribuibles a circunstancias de intermediación, de orden público y de carácter geográfico, podrían ser solventadas por nuevas tecnologías o estrategias de cribado. Es importante considerar alternativas de forma de administración y de prestación de servicios para solventar algunas barreras de aceptabilidad y acceso. Todo programa de tamización cervical debe contemplar los principios éticos de no maleficencia, beneficencia, autonomía y equidad. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años. Conclusiones El uso de la prueba ADN-VPH como estrategia de tamización en mujeres menores de 30 años es una intervención probablemente efectiva y costoefectiva para Colombia. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.

Background Primary screening with Human Papilloma Virus (HPV) testing was introduced in Colombia in 2014 for individuals between 30 and 65 years of age. When the result is positive, cytology triage is performed for colposcopy referral. The convenience of initiating HPV-DNA testing for screening at 25 years of age is currently a subject of discussion. Therefore, the objective of this health technology assessment (HTA) is to analyze the available evidence regarding safety, efficacy, cost-effectiveness, values and preferences, ethical dilemmas and considerations pertaining to the implementation of the HPV-DNA test as a cervical screening strategy in women under 30 years of age in the Colombian context. Domains to be assessed Clinical efficacy and safety 1. Cumulative rate of cervical intraepithelial neoplasia (CIN) grade 2 or high-er after 2 screening rounds. 2. Cumulative rates of invasive cancer of the uterine cervix after 2 screening rounds. 3. Safety: referral to colposcopy Cost-effectiveness Cost-effectiveness for Colombia. Other domains considered Ethical considerations associated with cervical screening in women under 30 years of age. Organizational and individual considerations. Barriers and facilitators pertaining to the implementation of cervical screening in women under 30 years of age in the Colombian context. Methods Clinical efficacy and safety assessment A systematic literature search of systematic reviews and clinical trials was conducted in MEDLINE, Embase and CENTRAL. The body of evidence was rated using the GRADE approach. An interdisciplinary team was then convened to create a working group to review the retrieved evidence. This led to the discussion and construction of the conclusions following the guidelines of a formal consensus in accordance with the RAND/UCLA methodology. Economic study Systematic literature research of studies that had assessed cost-effectiveness for Colombia. Results Out of the 7,659 references retrieved, 8 studies were included. Clinical outcomes An integrative analysis of 5 randomized clinical trials that met the inclusion critera was performed. Compared with cytology, primary HPV-DNA testing in women under 30 years of age could be associated with a lower frequency of CIN+2 lesions during the first screening round (RR: 1.57; CI: 1.20 to 2.04; low evidence certainty), and a lower incidence of CIN+2 (RR: 0.67; CI: 0.48 to 0.92; low evidence certainty). Moreover, it is associated with a lower frequency of invasive carcinoma at the end of follow-up (RR: 0.19; CI: 0.07 to 0.53; high evidence certainty). Economic results From the financial point of view, the use of HPVDNA testing plus cytology-based triage starting at 25 years of age is perhaps the most cost-effective option for Colombia (incremental cost-effectiveness ratio, COP 8,820,980 in 2013). Other implications Two studies suggest that barriers to implementation attributable to intermediation, public unrest and geographic considerations could be overcome with the use of new screening technologies or strategies. It is important to consider administration and service provision alternatives in order to overcome some acceptability and access barriers. Any cervical screening program must take into consideration ethical principles of nonmaleficence, beneficence, autonomy and equity. Future studies should focus on analyzing new screening techniques with emphasis on the population under 30 years of age. Conclusions The use of HPV-DNA testing as a screening strategy in women under 30 years of age is a potentially efficacious and cost-effective intervention for Colombia. Future studies should focus on analyzing new screening technologies, with emphasis on the population under 30 years of age.

Therapeutic effect of endoscopy on early cancer of duodenal papilla / 中华消化内镜杂志

Objective:To evaluate the clinical efficacy of endoscopy for early cancer of duodenal papilla.Methods:A retrospective analysis was performed on data collected from 23 consecutive patients with early cancer of duodenal papilla, who underwent endoscopic treatment from January 2015 to January 2021 in Beijing Friendship Hospital. Baseline data, endoscopic and pathological data, occurrence and outcome of complications were studied.Results:Twenty-three patients successfully received endoscopic treatment. The maximal diameter of lesions evaluated under endoscopy was 1.90±0.83 cm. Among the 23 cases, 20 underwent endoscopic mucosal resection and 3 underwent endoscopic piecemeal mucosal resection. Delayed bleeding occurred in 5 cases (21.7%), 3 patients (13.0%) developed postoperative hyperamylasemia, 6 patients (26.1%) developed mild acute pancreatitis, and 1 patient (4.3%) had pancreatic duct stent displacement after the operation, which improved after medical or endoscopic treatment. No perforation occurred during the perioperative period. In terms of final pathology, the en bloc resection rate was 82.6% (19/23), and the complete resection rate was 78.3% (18/23). Preoperative endoscopic ultrasonography showed that 19 lesions were confined to the mucosal layer, which were all demonstrated by postoperative pathology. Four other cases were suspected to be involved in the submucosa or the end of the pancreaticobiliary duct under endoscopic ultrasonography, two of which were confined to the mucosal layer, and the other 2 cases involved the submucosal layer, so additional surgery was performed. A total of 18 patients were followed up, among whom 14 achieved complete resection of postoperative pathology, and 2 patients (14.3%, 2/14) were found to have recurrence at 12 and 51 months respectively after the treatment and did not relapse after surgical treatment and endoscopic treatment respectively. Among 4 other patients of follow-up whose pathology did not achieve complete resection, 1 had no recurrence, and the other 3 received additional surgical treatment without recurrence.Conclusion:Endoscopic treatment for early cancer of duodenal papilla is safe and effective. It is necessary to improve preoperative evaluation, stay alert to perioperative complications, and pay attention to regular postoperative endoscopic follow-up.

Total body mapping in the follow-up of melanocytic lesions: recommendations of the Brazilian Society of Dermatology

Abstract Total body mapping comprises photographic documentation of the entire body surface followed by digital dermatoscopy of selected melanocytic lesions, aiming to compare their evolution over time and identify new lesions. As this is an exam based on comparative analysis of serial dermoscopic body images, standardization of the technique for performing total body mapping is essential. Prepared by specialists from the Brazilian Society of Dermatology, using the modified Delphi method, this article provides recommendations for carrying out total body mapping in Brazil, regarding its indications, technical aspects, and the issuing of the report.

Análisis de los métodos de detección de lesiones orales potencialmente malignas. Revisión sistemática tipo paraguas / Analysis of the detection methods for potentially malignant oral lesions. An umbrella systematic review

Resumen Propósito: determinar la efectividad de detección de lesiones orales potencialmente malignas de cuatro métodos por medio de revisión sistemática tipo paraguas. Fuente de los datos: la búsqueda fue realizada con bases de datos Pubmed y EBSCOhost. Restricción de los años 2013-2018. Estrategia de búsqueda: (early detection of cáncer) AND (mouth neoplasms), (early detection of cáncer) AND (diagnostic techniques and procedures), (mouth neoplasms) AND (diagnostic techniques and procedures). Selección de los estudios: fueron seleccionadas a través de lectura crítica y la lista de chequeo del formato PRISMA, aquellas revisiones sistemáticas cuyo objetivo sea evaluar la efectividad de al menos uno de los métodos de detección de lesiones orales potencialmente malignas, seis estudios cumplieron con los criterios de inclusión. Extracción de datos: mediante la realización de lectura crítica de las revisiones sistemáticas seleccionadas previamente. Resultado de síntesis de los datos: se determina la efectividad a través de la comparación de las medias de porcentajes de sensibilidad y especificidad. Las medias de sensibilidad y especificidad de Vizilite fueron de 81.31 y 25.4%, de Microlux DL de 82.63 y 69.52%, de azul de toluidina de 82.07 y 66.27% y de citología exfoliativa de 76.77 y 80.87%, respectivamente. Conclusiones: los métodos de detección de lesiones orales premalignas evaluados en el presente estudio requieren mayor respaldo de evidencia científica para validar su efectividad. El método con mayor eficacia es el Microlux/DL, debido a sus altos niveles de sensibilidad y especificidad.

Abstract Objective: to determine the effectiveness of four methods for detecting potentially malignant oral lesions through an umbrella systematic review. Source of data: the search was performed in the PubMed and EBSCOhost databases. Years of search limited to 2013-2018. Search strategy: (early detection of cancer) AND (mouth neoplasms), (early detection of cancer) AND (diagnostic techniques and procedures), (mouth neoplasms) AND (diagnostic techniques and procedures). Study selection: using critical reading and the PRISMA checklist, systematic reviews with the objective of evaluating the effectiveness of at least one of the detection methods for potentially malignant oral lesions were selected; six studies met the inclusion criteria. Data extraction: through critical reading of the previously selected systematic reviews. Results of data synthesis: effectiveness was determined by comparing the mean percentages of sensitivity and specificity. Vizilite's sensitivity and specificity means were 81.31 and 25.4%, Microlux DL's were 82.63 and 69.52%, toluidine blue's were 82.07 and 66.27%, and exfoliative cytology's were 76.77 and 80.87%, respectively. Conclusions: the detection methods for pre-malignant oral lesions evaluated in this study need greater scientific evidence to validate their effectiveness. The method with the greatest effectiveness is Microlux/DL, due to its high levels of sensitivity and specificity.

Evaluation of breast cancer in women under 50 in a Mastology service in the Federal District, Brazil

Introduction: Breast cancer is a relevant public health issue, and its incidence has increased in patients aged less than 50 years. This population usually receives a late diagnosis, which contributes with the poor prognosis of the condition. Objective: To assess the percentage of patients diagnosed with breast cancer before the age of 50 and compare them with the group that was diagnosed after the age of 50. Results: The general mean age was 54 years; 75.68% of the patients were younger than 50 years, aged between 40 and 49 years. Among the ones who were younger than 50, 35.14% were in stage T4; 55.41% underwent neoadjuvant chemotherapy; 16.22% presented distant metastasis; and 10.81%, locoregional metastasis. On the other hand, among those aged more than 50, 22.71% were in stage T4; 30.68% underwent neoadjuvant chemotherapy; 11.36% presented distant metastasis; and 6.82%, locoregional metastasis. Conclusion: Breast cancer in women aged less than 50 years in a Mastology service in the Federal District has been a matter of concern, for presenting more advanced tumors at the time of diagnosis; screening is still debatable.

Endoscopic Fine Examination for Early Cancer Screening in Patients With Gastric Low-grade Intraepithelial Neoplasia / 胃肠病学

Background: There are limitations in diagnosis based on common white light endoscopy (C-WLE) and guided forcep biopsy, which may lead to missing or misdiagnosis of early cancer. Aims: To evaluate the value of endoscopic fine examination for early cancer screening in patients with low-grade intraepithelial neoplasia (LGIN). Methods: Fifty patients with gastric LGIN diagnosed by C-WLE-based pathology from Aug. 2016 to Feb. 2019 at Changzhou Hospital of Traditional Chinese Medicine were enrolled. All the patients were reexamined three months later, of them 30 patients with typical morphological changes of Ⅱa, Ⅱc and Ⅱa+Ⅱc underwent endoscopic fine examination with magnifying endoscopy and narrow-band imaging (ME-NBI) for screening of early cancer. Endoscopic submucosal dissection (ESD) was also performed. Results: According to VS classification, 15 of the 30 patients having endoscopic fine examination performed were diagnosed as early cancer and the other 15 were diagnosed as non-cancerous lesions. Pathology based on biopsy under endoscopic fine examination revealed 10 high-grade intraepithelial neoplasia (HGIN)/gastric cancer and 20 LGIN/chronic inflammation. Pathology based on ESD revealed 14 HGIN/gastric cancer and 16 LGIN/chronic inflammation. Taken ESD pathology as the gold standard, the sensitivity and negative predictive value of endoscopic fine examination for diagnosis of early gastric cancer both were 100%, significantly higher than those of C-WLE- and ME-NBI-biopsy pathology (P<0.05). Conclusions: Endoscopic fine examination with ME-NBI can improve the detection of early cancer and prevent missing diagnosis in patients with gastric LGIN indicated by C-WLE-biopsy.

Characteristics of the early gastroesophageal junction cancer under the white-light endoscopy / 实用医学杂志

Objective To investigate the characteristics of the early gastroesophageal junction(GEJ)can-cer under the white-light endoscopy.Method We analyzed 70 cases of pathology-proven early GEJ cancer retrospec-tively. We investigated the predilection sites of different Siewert types,the lesion features under the white-light endoscopy,and the associations among the Siewert types,Barrett esophagus and the intestinal metaplasia. Results Siewert Ⅱ was the most of the early GEJ cancer(64%). Barrett esophagus was the most of SiewertⅠ(85%).No statistical significances of the intestinal metaplasia were found among different Siewert types.SiewertⅠlesion was located on the right front wall the most.Of Siewert Ⅱlesion was located on the back wall the most.The main endoscopic type was Type 0~Ⅱ.The most of the early GEJ cancer under the white-light endoscopy has clear demarcation(89%)and irregular surface appearance(81%),and the main color of mucosa lesion was red(76%). Conclusion The early GEJ cancer under the white-light endoscopy shows the subtle characteristic changes.Under-standing and paying attention to the above characteristics will help to improve the diagnosis of the early GEJ cancer.

A retrospective cohort study of the long-term effects of endoscopic submucosal dissection in treating early gastrointestinal cancer or precancerous lesions / 中国内镜杂志

Objective A retrospective cohort study was carried out to observe the long-term effect of ESD in treating early gastrointestinal cancer or precancerous lesions. Methods The clinical and follow-up data of 73 patients were collected. Kaplan-Meier, Log-rank and Breslow test and Cox's proportional hazards regression model were used to analyze the data. Results The median survival time in the gastric and colo-rectal early cancer or precancerous lesions is longer than 65 months in our study, respectively. For esophagus, the median survival time was 44.5 months; the disease free survival time (DFS) after ESD was significantly reduced in the esophagus, compared to the stomach and colo-rectum (χ2 = 12.61, P = 0.000; χ2 = 7.09, P = 0.008); the degree of atypia (or infiltration), and lesion size were considered to be two factors to influence the DFS after ESD (P = 0.027, OR

Advances in Application of Blue Laser Imaging in Diagnosis of Early Upper Gastrointestinal Cancer / 胃肠病学

Blue laser imaging (BLI) is a new endoscopic system equipped with the laser beam emitting two different wavelengths.It produces bright and high resolution images for observation of microvascular and microsurface patterns of esophageal and gastric mucosa, helping the diagnosis of early upper gastrointestinal cancer.Compared with the existed endoscopic techniques, BLI shows its unique advantages.In this article, advances in application of BLI in diagnosis of early upper gastrointestinal cancer were reviewed.

Retinoblastoma in Mexico: part I. A review of general knowledge of the disease, diagnosis, and management / Retinoblastoma en México: parte I. Revisión del conocimiento general de la enfermedad, diagnóstico y tratamiento

AbstractThis is the first of a two-part review that aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico (including the authors' experience at the leading Rb centers), identify the gaps in practice, and propose solutions to improve diagnosis, treatment, and patient uptake. In this first part, general knowledge of Rb diagnosis and management is summarized with a focus on the latest advances in chemotherapy. A general review of peer-reviewed literature of Rb was conducted on PubMed. Key findings were summarized.Provided there is early detection and referral of patients followed by appropriate conservative management, Rb is curable. In developed countries, the primary treatment outcome is ocular salvage with sight preservation. Advanced chemotherapeutic options such as intra-arterial and intravitreal chemotherapy can now save even the most advanced tumors.Advances in Rb therapy are generally limited to developed countries. The implications in Mexico, of the findings from this review will be discussed in Part 2, which will be a comprehensive situational analysis of the state of Rb programming in Mexico, including a review of current demographic data available from hospitals that have Rb programs or treat Rb.

ResumenEsta es la primera parte de un trabajo de revisión donde se reportan los conocimientos actuales del retinoblastoma (Rb) y sus implicaciones en México (incluyendo la experiencia de los autores en los principales centros de referencia), así como las brechas en la práctica y las posibles soluciones para mejorar el diagnóstico, tratamiento y referencia de pacientes. En esta parte se resumen los conocimientos generales del Rb, su diagnóstico y tratamiento. Se realizó una revisión de los avances más recientes en esta enfermedad publicados en PubMed y se resumieron los hallazgos más importantes.La sospecha oportuna y la referencia adecuada de pacientes permiten que el tratamiento conservador del Rb sea curativo. En países en vías de desarrollo, el tratamiento primario es el salvamento ocular y la preservación de la visión. Las opciones de quimioterapia intraarterial o intravítrea permiten ofrecer opciones terapéuticas en estos pacientes.Los avances en el tratamiento del Rb están generalmente limitados a países industrializados. Las implicaciones de los hallazgos de esta revisión serán discutidas en la segunda parte, la cual será un análisis de la situación de los programas hospitalarios del Rb en México, incluyendo la revisión de los datos demográficos disponibles de los centros de referencia más importantes.

Endoscopic submucosal dissection in patients with high grade intraepithelial neoplasia and/or early cancer of remnant stomach after partial gastrectomy / 中华消化内镜杂志

Objective To evaluate the feasibility,safety and efficacy of ESD for precancerous lesions and early cancer of remnant stomach after partial gastrectomy.Methods ESD was performed in 11 cases of high grade intraepithelial neoplasia/early cancer of remnant stomach.The short-term and long-term indices including time of procedure,complication,En Bloc resection rate,R0resection rate,local recurrence rate as well as lymph node metastasis were recorded and analysed.Results ESD was completed in all patients with only one case of delayed massive bleeding which was controlled by endoscopy successfully.Average procedure time,En Bloc resection rate,R0 resection rate were 85.5 minutes,100％ and 90％,respectively.No local recurrence or lymph node metastasis was detected during post-ESD surveillance (15 ～ 51 months).Conclusion High grade intraepithelial neoplasia and early cancer of remnant stomach after partial gastrectomy might be indication for ESD because of its safety and definite effect.Additionally,careful management of the fibre tissue is the key to procedure success.

Persons with disabilities, cancer screening and related factors / Pessoas com deficiência, exames preventivos de câncer e fatores relacionados

The scope of this article is to describe persons with disabilities (PwD) being subjected to cancer screening and the relationship between some social variables and inequalities in performing these tests. A cross-sectional study of cancer screening among PwD was conducted in 2007 with 333 participants interviewed in residence in 4 cities of São Paulo. Variables in the practice of cancer screening, disabilities, gender, age, income of main family breadwinner, ethnicity, use of health services, assistance required, private health insurance, and coverage by the family health program were studied. Frequencies, χ²-test, trend χ² percentages and the Odds Ratios (OR) were used for data analysis. 44% of PwD attended at least one cancer screening at the appropriate time. Persons with visual disabilities and with hearing disabilities were subjected to more screening examinations than those with mobility disabilities and women were attended in screening exams more than men. Persons between the ages of 21 and 60 reported cancer screening more frequently than those between 80 and 97 years of age. The outcomes indicate that PwD have different attitudes toward cancer screening according to the type of disability, gender, and age, which were the variables that directly influenced cancer screening exams.

O objetivo deste artigo é descrever a realização de exames preventivos de câncer entre pessoas com deficiências (PD) e a relação entre algumas variáveis sociais e as desigualdades na realização dos exames. Estudo transversal sobre exames preventivos de câncer entre PD. Foram entrevistadas em domicílio 333 pessoas em quatro cidades de São Paulo, em 2007. Estudou-se variáveis relacionadas aos exames preventivos, deficiências, gênero, idade, renda do chefe da família, etnia, uso de serviços de saúde, assistência necessária, plano privado de saúde e cobertura pela Estratégia de Saúde da Família. Para a análise usou-se frequências, porcentagens, teste de χ², χ² de tendência e Odds Ratio (OR). Dos entrevistados, 44% realizou pelo menos um exame preventivo na época correta. Pessoas com deficiência visual e com deficiência auditiva fizeram mais exames do que aqueles com deficiência física. Mulheres fizeram mais exames que os homens e pessoas com idade entre 21 e 60 anos relataram maior frequência de exames que aquelas entre 80 e 97 anos. Os achados indicam que as PD tiveram diferentes padrões de realização de exames preventivos segundo o tipo de deficiência, gênero e idade, sendo estas as variáveis de influência direta na realização de exames preventivos de câncer.

Nanochips y nanosensores para eldiagnóstico temprano de cáncer oral: una revisión / Nanochips and nanosensors for harly oral cancer diagnosis: a review

Antecedentes: El cáncer oral es una de las enfermedades más agresivas y con mayor probabilidadde metástasis; en estadios iniciales es generalmente indetectable y de baja consulta,por lo que se dificulta realizar un tratamiento conservador. Existen diversas técnicas delaboratorio con base en microscopía (como inmunofluorescencia), inmunohistoquímica yotras que facilitan el diagnóstico temprano de la enfermedad. Adicionalmente, los avancesen nanomedicina brindan nuevas herramientas de detección a partir de cambios moleculares(biomarcadores) que presentan las células en proceso de malignización. Objetivo:Describir las características clínicas y moleculares de lesiones premalignas y cáncer oral ylos métodos de diagnóstico usando nanotecnología (nanochips, nanosensores, etc.), comoun método eficaz para la detección temprana del cáncer. Método: Se buscó literatura sobrenanotecnología y diagnóstico de cáncer oral en bases de datos como Science Direct yPubMed; la información de cada uno de los artículos se sintetizó con resúmenes individualespor los investigadores, se agrupó y redactó. Resultados: Se seleccionaron 46 artículos que,de acuerdo con su contenido, se agruparon según su temática principal; toda la informaciónse relacionó en una tabla por subtemas en Excel® 2007. Conclusiones: La literatura revisadasugiere que las herramientas nanotecnológicas pueden ser una alternativa útil y rápida,aunque por el momento costosa, para la detección puntual de biomarcadores presentes enestadios iniciales del cáncer oral. Cabe mencionar que su aplicación clínica en países comoColombia es limitada por factores como insuficientes recursos asignados a la investigacióny poca investigación en esta temática...

Background: Oral cancer is one of the most aggressive diseases with a high likelihood ofmetastases; it is undetectable during initial stages with low medical visits, making it difficultto provide conservative treatment. Several techniques such as microscopy (using for instanceimmunofluorescence) and immunohistochemistry make early diagnosis and cancerdetection easier. In addition, advances in nanomedicine offer new tools to detect molecularchanges (biological markers/biomarkers) in cells during a malignant process. Purpose:Describe molecular and clinic characteristics of premalignant lesions and oral cancer, aswell as techniques involving nanotechnology (lab-on-a-chip devices, nanosensors, etc.) aseffective methods for early cancer diagnosis. Methods: A literature review on nanotechnologyand oral cancer using databases such as Science Direct and PubMed was carried out;data from each article were summarized, grouped, and described. Results: 46 articles wereselected and grouped according to their main topic; data were compiled in an Excel 2007spreadsheet. Conclusions: The literature reviewed suggests that tools using nanotechnologycan be a useful and a quick alternative, though expensive, to detect specific biomarkers thatare present in early stages of oral cancer. It is important to point out that their clinical usein countries like Colombia is still limited by factors like the lack of resources allocated forresearch and the little research carried out on this subject...

Preoperative biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection / 中华消化内镜杂志

ObjectiveTo evaluate preoperative biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection (ESD).MethodsClinical data of 195 patients diagnosed as having gastric intraepithelial neoplasia (GIEN) or early cancer by preoperative biopsy were retrospectively analyzed.The discrepancy between endoscopic biopsies and pathological diagnosis after ESD were studied.ResultsThe overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 93.8％ (183/195) and complete consistency rate was 50.8％ (99/195).For low-grade and highgrade gastric intraepithelial neoplasia ( LGIEN),the complete consistency rates were 49.4％ (42/85)and 38.0％ (30/79),respectively,which were not different ( P ＞ 0.05 ).For early cancer it was 87.1％(27/31 ),which was significantly higher than those in the LGIEN group and HGIEN group ( P ＜ 0.05 ).Post-ESD diagnosis was more severe than biopsy in 66 patients (33.8％,66/195 ),including 36 LGIEN (42.4％,36/85) and 30 HGIEN (38.0％,30/79).Final pathological diagnosis was milder than biopsy in 18 patients (9.2％,18/195),i.e.14 HGIEN (17.7％,14/79) and 4 early cancer (12.9％,4/31).Gastritis was diagnosed in 12 patients (6.2％,12/195),i.e.7 LGIEN (8.2％,7/85) and 5 HGIEN (6.3％,5/79).ConclusionPreoperative biopsy is insufficient for accurate diagnosis of gastric mucosal lesions,but facilitates resection of gastric mucosal lesions by ESD.

Tratamiento endoscópico de cáncer gástrico temprano en Colombia con seguimiento a cinco años / Five year monitoring of endoscopic treatment for early gastric cancer in Colombia

El cáncer gástrico temprano (CGT), cada día se diagnostica más frecuentemente no solo en Japón sino en todo el mundo y, aunque su tratamiento endoscópico es relativamente sencillo, en nuestro medio hay poca experiencia sobre seguimiento a largo plazo después de un tratamiento endoscópico exitoso, por lo cual decidimos realizar el presente trabajo en pacientes con CGT, con los siguientes objetivos: 1. Determinar la eficacia del tratamiento endoscópico en la curación de los CGT. 2. Investigar la incidencia de recurrencia tumoral después de cinco años de seguimiento.Materiales y métodos. Se incluyeron prospectivamente desde marzo 2002 a junio 2004, pacientes a quienes se les diagnosticó CGT en Hospital El Tunal y fueron seguidos por lo menos cinco años. El diagnóstico endoscópico se hizo de acuerdo a la clasificación de la Sociedad japonesa. Recibieron tratamiento endoscópico aquellos con CGT tipo I, IIa, IIb que tuvieran menos de 20 mm, histológicamente bien diferenciados o moderadamente diferenciados. Resultados. Se incluyeron 11 pacientes. Hombres 63,6%. La edad promedio fue 66,1 años. Todos los CGT se encontraron en el cuerpo gástrico. Se realizó resección con asa en siete pacientes, inyección y resección con copa de plástico en un paciente, inyección y colocación de banda: un paciente, tracción y resección con asa (endoscopio de doble canal) 2 pacientes. En 2 pacientes la resección fue incompleta. El promedio de seguimiento fue 71,3 meses (60 a 84 meses). Ningún paciente ha tenido recurrencia tumoral.Conclusiones. La mucosectomía es un método sencillo, seguro y curativo del CGT, además es fácilmente realizable por un gastroenterólogo bien formado.

Early gastric cancer (EGC) is being diagnosed more frequently as each day passes. This is true not only in Japan but around the world. Even though the endoscopic treatment is relatively simple, our field does not yet have enough experience in long term monitoring after successful endoscopic treatment. For this reason we undertook this study and targeted the following objectives: 1. To determine the efficiency of endoscopic treatment in curing EGC. 2. To investigate the incidence of recurrence of tumors after five years of monitoring. Materials and Methods. Between March 2002 and June 2004 we prospectively included patients who were diagnosed with EGC at El Tunal Hospital and monitored for at least 5 years. Endoscopic diagnoses were done according to the classification of the Japanese Society. Patients diagnosed with types I, IIa and IIb of less than 20mm and which were histologically well-differentiated or moderately differentiated were endoscopically treated.Results. 11 patients were included in this study. 63.6% were men. The average age was 66.1 years. All the EGCs were found in the gastric body. Loop resection was performed on seven patients, resection and injection with plastic cup on 1 patient, injection and band placement on 1 patient, traction and loop resection (double channel endoscopy) on two patients. The resection was incomplete in 2 patients. The average monitoring time was 71.3 months (60 to 84 months). There were no incidences of tumor recurrence. Conclusions. Mucosectomy is a simple, safe and curative method for EGC. It is easily performed by a well-trained gastroenterologist.

Cáncer gástrico precoz múltiple: Reporte de casos

Se realiza un estudio de revisión de casos en el Centro de Control de Cáncer Gastrointestinal "Dr. Luís Andersón" de cuatro pacientes con diagnóstico endoscópico de cáncer gástrico precoz múltiple, corroborado en acto operatorio encontrando 2 lesiones en cada caso ubicadas a nivel de cuerpo gástrico en tres de ellos y en uno, una lesión en cuerpo y otra en antro, con diagnóstico histológico de adenocarcinoma en todos ellos, solo uno con células en anillo de sello. Todos los pacientes presentaron una sobrevida post-operatoria (Kapllan -Meyer) a los 5 años del 100%.

A review study of cases at the Centro de Control de cancer Gastrointestinal " Dr. Luis Anderson " was made of four patients with an endoscopic diagnosis of multiple early gastric cancer, corroborated at surgery by finding 2 injuries in each case located at the level of the gastric body in three of them and in one, an injury in the body and another one at the antrum, with histological diagnosis of adenocarcinoma in all of them, only one with signet-ring cells. All the patients presented a postoperative survival (Kapllan - Meyer) at 5 years of 100%.

Early Cancer of the Gastric Stump after Gastrojejunostomy for Duodenal Ulcer Obstruction / 대한소화기내시경학회지

Cancer of the gastric stump, first described by Balfour in 1922, is defined as the cancer detected more than 5 years after surgery for a benign disease. We experienced a case of cancer found at the gastric stump after gastrojejunostomy in a 53 years old male patients, proven pathologically as a early cancer. He visited to our hospital with the chief complaint of epigastric pain and indigestion for 1 Months. On past history, he has been received gastrojejunostomy due to duodenal ulcer obstruction, 23 years ago, Gastrofiberscopy was done, and we could find the early gastric cancer lesions at the anterior wall of gastric angle as type Ilc+III and antrum as type IIa. The microscopic finding of the multiple endoscopic biopsies at the gastic angle and antrum revealed the adenocarcinoma of signet ring cell type infiltrated to the level of submucosa. And so, we could diagnose these lesions as a early gastric cancer in the gastric stump after gastrojejunostomy. He was treated with subtotal gastrectomy and discharged with cured condition. Therefore, we report this case with a literature review.