Anti-acid treatment for ulcerated early gastric cancer may be a treatment option avoiding unnecessary gastrectomy: a cohort study.

Diagnosing the invasion depth of ulcerated early gastric cancer is usually inaccurate, especially for endoscopists in primary care clinics who are often not experts in this area. In reality, many patients with open ulcers who can be treated with endoscopic submucosal dissection (ESD) are referred for surgery. Materials and methods: Twelve patients with ulcerated early gastric cancer who were treated with proton pump inhibitors, including vonoprazan, and underwent ESD were included in the study. Conventional endoscopic and narrow-band images were evaluated by five board-certified endoscopists (two physicians: A, B, and three gastrointestinal surgeons: C, D, and E). They assessed the invasion depth, and the results were compared with the pathologic diagnosis. Results: The accuracy of the invasion depth diagnosis was 38.3%. According to the pretreatment diagnosis of invasion depth, gastrectomy was recommended for 41.7% (5/12) of the cases. However, histological examination revealed that additional gastrectomy was required in only one case (8.3%). Thus, in four out of five patients unnecessary gastrectomy could be avoided. Post-ESD mild melena occurred in only one case, and there was no case of perforation. Conclusion: Antiacid treatment contributed to avoid unnecessary gastrectomy in four out of five patients for whom gastrectomy was indicated based on an inaccurate pretreatment diagnosis of the invasion depth.

Malignant melanoma in the stomach treated with endoscopic submucosal dissection: a case report.

The initial appearance of malignant melanoma localized in the stomach has never been reported previously. We encountered a patient with gastric melanoma in the stomach, which was histologically confirmed to be confined to the mucosa. Case Presentation: The patient, when in her 40s, had undergone surgery for malignant melanoma of the left heel. However, there were no detailed records of pathological findings. The patient had a 4-mm black elevated lesion in her stomach observed on esophagogastroduodenoscopy after the eradication of Helicobacter pylori. A year later, esophagogastroduodenoscopy showed that the lesion had increased to 8 mm. A biopsy was performed, but no malignancy was found; the patient continued to be followed up. Esophagogastroduodenoscopy performed at the 2-year follow-up revealed that the melanotic lesion had increased to 15 mm, and biopsy was performed and revealed a malignant melanoma. Clinical Discussion: Endoscopic submucosal dissection was performed for gastric malignant melanoma. The margin of the resected malignant melanoma was negative; vascular and lymphatic invasions were not observed, and the lesion was confined to the mucosa. Conclusion: We suggest that even if the first biopsy of a melanotic lesion shows no evidence of malignancy, the lesion should be closely monitored. This is the first reported case of endoscopic submucosal dissection of localized gastric malignant melanoma confined to the mucosa.

Cases of Rapid Hepatitis B Surface Antigen Reduction after COVID-19 Vaccination.

Objective One of the therapeutic goals for chronic infection with hepatitis B virus is the clearance of hepatitis B surface antigen (HBsAg) from the blood, as a high load of HBsAg has been proposed to induce antigen-specific immunotolerance. To achieve HBsAg reduction, Pegylated interferon and nucleos (t) ide analogs are used to treat chronic hepatitis B. Following the coronavirus disease 2019 (COVID-19) outbreak, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly spread worldwide, and vaccination with mRNA COVID-19 vaccines has been conducted since 2021 in Japan. We experienced three clinical cases in which HBsAg levels rapidly decreased after injection of the COVID-19 vaccine without any incentive. Method To examine whether the vaccine administration was involved in the HBsAg reduction, the number of patients with chronic hepatitis B showing a change in the HBsAg levels during the period before the commencement of the COVID-19 vaccination program in Japan (i.e. until the end of 2020; pre-vaccination-program period) was compared to the number of those who showed a change in HBsAg levels after the initiation of the program (i.e. 2021 onwards; post-vaccination-program period). Results The number of patients whose HBsAg levels was reduced by >50% per year was prominent after the initiation of the vaccination program. Although the involvement of vaccination in HBsAg reduction was not statistically proven (p=0.0532), the result suggests that the administration of COVID-19 vaccines may have been involved in HBsAg reduction in patients with chronic hepatitis B. Conclusion COVID-19 vaccines may be involved in HBsAg reduction.

Gel immersion endoscopic mucosal resection in early gastric cancer with bleeding: A case report.

Gel immersion endoscopy was developed by Yano for the treatment of bleeding. In this case, we performed gel immersion endoscopic mucosal resection to treat a bleeding gastric cancer. An 80-year-old man, with chronic renal failure and on aspirin treatment for ischemic heart disease, underwent endoscopic treatment for multiple early gastric cancers on the anterior and posterior walls of the pyloric ring. An endoscopic submucosal dissection was performed for gastric cancer on the anterior wall; however, the removal of the cancer on the posterior wall was complicated by tumor prolapse and bleeding. Gel formulation (VISCOCLEAR® Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) was used to immerse the bleeding tumor and subsequently facilitate the endoscopic mucosal resection. Various factors, such as the use of antithrombotic medication and underlying renal disease, can increase the risk of bleeding during endoscopic gastric cancer resection. If bleeding persists, the resection margin becomes obscured. Gel formulations, such as VISCOCLEAR®, can be applied to control bleeding and improve visibility. In this case, gel immersion was useful for endoscopic mucosal resection of the bleeding tumor. The use of gel immersion endoscopic resection should be considered for the treatment of early gastric cancer, however further cases should be evaluated.

Iron chelator deferasirox inhibits NF-κB activity in hepatoma cells and changes sorafenib-induced programmed cell deaths.

OBJECTIVE: The improvements of antitumor effects and tolerability on chemotherapy for advanced hepatocellular carcinoma (HCC) are warranted. Here, we aimed to elucidate the mechanism of the combining effect of tyrosine kinase inhibitor sorafenib (SOR) and iron chelator deferasirox (DFX) in human hepatoma cell lines, HepG2 and Huh-7. METHODS: The types of programmed cell deaths (PCDs); necrosis/necroptosis and apoptosis, were evaluated by flow cytometry and fluorescent microscopy. Human cleaved caspase-3 was analyzed by ELISA for apoptosis. GSH assay was used for ferroptosis. PCDs inhibition was analyzed by adding apoptosis inhibitor Z-VAD-FMK, ferroptosis inhibitor ferrostatin-1, necroptosis inhibitor necrosulfonamide, respectively. The expression of NF-κB was quantified by Western blotting. RESULTS: In SOR monotherapy, cleaved caspase-3 expression was increased in all concentrations, confirming the result that SOR induces apoptosis. In SOR monotherapy, GSH/GSSG ratio was decreased on concentration-dependent, showing that SOR also induced ferroptosis. Lipid Peroxidation caused by SOR, corresponding to ferroptosis, was suppressed by DFX. In fluorescence microscopy of SOR monotherapy, apoptosis was observed at a constant rate on all concentrations, while necroptosis and ferroptosis were increased on high concentration. In sorafenib and deferasirox combinations, sub G1 phase increased additively. In SOR and DFX combinations, the cytotoxic effects were not suppressed by ferrostatin-1, but suppressed by Z-VAD-FMK and necrosulfonamide. In each monotherapy, and SOR + DFX combinations, the expression of NF-κB in nucleus was suppressed. Regarding PCD by SOR and DFX combination, ferroptosis was suppressed and both apoptosis and necroptosis became dominant. CONCLUSION: Suppression of NF-κB is possibly involved in the effect of DFX. As a result, SOR and DFX combination showed additive antitumor effects for HCC through the mechanism of programed cell deaths and NF-kB signal modification.