Endosonographic radial tumor thickness after neoadjuvant chemoradiation therapy to predict response and survival in patients with locally advanced esophageal cancer: a prospective multicenter phase ll study by the Swiss Group for Clinical Cancer Research (SAKK 75/02).

BACKGROUND: EUS response assessment in patients with locally advanced esophageal cancer undergoing neoadjuvant chemoradiation therapy (CRT) is limited by disintegration of the involved anatomic structures. OBJECTIVE: Predictive and prognostic values of a prospectively defined maximum tumor thickness (MTT). DESIGN: Prospective open-label phase ll study (SAKK 75/02). SETTING: Multicenter, nationwide. PATIENTS: Of 66 patients with primary CRT, 56 underwent en bloc esophagectomy. INTERVENTIONS: EUS-measured MTT before and 2-5 weeks after CRT (yMTT). MAIN OUTCOME MEASUREMENTS: Cutoffs: (1) absolute thickness (yMTT) after CRT < or = 6 mm; (2) relative reduction compared with baseline (ratio yMTT/MTT) < or = 50%. Correlation between EUS measurements and histopathologic tumor regression grade (TRG) and overall survival (OS). RESULTS: Sixteen of 56 patients were not included for EUS evaluation (10 severe stenosis, 5 MTT not measured, 1 intolerance to second EUS). Characteristics (n = 40) were as follow: median age, 60 years; squamous cell carcinoma, 42%; and adenocarcinoma (AC), 58%. Initial stage was: 10 T2N1, 3 T3N0, 26 T3N1, 1 T3Nx; 14 of 23 AC Siewert type 1. Wilcoxon rank sum test showed significant correlation of TRG1 with yMTT < or = 6 mm (P = .008) and yMTT/MTT < or = 50% (P = .003). The effect of yMTT on TRG1 was significant (P = .0193; odds ratio, 0.687 [95% CI, 0.502-0.941]). The predefined cutoff of < or = 6 mm for yMTT was predictive for TRG1 (P = .0037; Fisher exact test). After a median follow-up of 28.6 months, there was a clear trend for benefit in OS with yMTT < or = 6 mm and yMTT/MTT < or = 50%. LIMITATIONS: Small sample size. CONCLUSION: In a multicenter setting, MTT measured by EUS after CRT was highly predictive for response and showed a clear trend for predicting survival.

Detection and endoscopic therapy of early esophageal adenocarcinoma.

PURPOSE OF REVIEW: This review summarizes recent progress on endoscopic diagnosis and treatment of esophageal high-grade intraepithelial neoplasia and early adenocarcinoma and critically analyzes the literature in the context of preexisting scientific data. RECENT FINDINGS: Narrow band imaging and computed virtual chromoendoscopy enhanced visualization of the mucosal morphology. The type of mucosal and capillary patterns seen on narrow band imaging predicted the presence of specialized intestinal metaplasia, high-grade intraepithelial neoplasia and early adenocarcinoma. Endocytoscopy lacked sufficient image quality for clinical use currently. Optical coherence tomography had the potential to diagnose specialized intestinal metaplasia and dysplasia. Photodynamic therapy produced long-term ablation of high-grade intraepithelial neoplasia and reduced cancer risk. Endoscopic radiofrequency ablation of Barrett's mucosa did not cause strictures and buried glandular mucosa. Localized and radical or complete circumferential endoscopic mucosal resections were effective and safe. SUMMARY: Virtual chromoendoscopy detected subtle mucosal lesions and facilitated targeted biopsies. Photodynamic therapy was effective in the long term. Endoscopic radiofrequency ablation appeared promising. Localized and radical or complete circumferential endoscopic mucosa resections were effective therapies.

Application of bleeding prophylactic criteria (NICE) in patients with acute gastrointestinal bleeding. A Swiss prospective study.

Multiple treatment guidelines for nonsteroidal anti-inflammatory drugs (NSAIDs) suggest that patients with one or more risk factors for NSAID-related ulcer complications should be prescribed preventive strategies such as acid-suppressive drugs, misoprostol or COX-2-specific inhibitors to reduce their risk of serious ulcer complications. However data are lacking as to how many patients have been on preventive measures in accordance to the National Institute for Clinical Excellence (NICE) criteria in our population. We therefore evaluated the extent to which patients with acute gastrointestinal bleeding have been under ulcer-preventive strategies at the time of hospital entry. In a one-year-bleeding-study at the Waid city hospital, Zürich, ulcer preventive treatment was practiced in only 25% of 214 patients with acute gastrointestinal bleeding. We conclude that ulcer prevention in everyday medical practice is still being seldom applied.

Recurrent acute and chronic pancreatitis in two brothers with familial chylomicronemia syndrome.

The chylomicronemia syndrome is well recognized as a rare etiologic factor of acute pancreatitis; however, whether hypertriglyceridemia can cause chronic pancreatitis (CP) remains unclear. We describe the long-time course of 2 brothers with the familial chylomicronemia syndrome caused by identical compound heterozygous mutations in the lipoprotein lipase (LPL) gene with markedly reduced LPL activity. Other etiologic factors were excluded, including mutations in the PRSS1, SPINK1, and CFTR gene. Although both brothers had recurrent acute pancreatitis and the same LPL genotype, CP became evident in only one patient. Progression to CP was associated with a more severe disease course. Thus, the chylomicronemia syndrome may cause CP in the absence of other known causative factors, and similar to alcoholic and hereditary CP, a more severe disease course is associated with disease progression.