Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU".

BACKGROUND: Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly. AIMS: To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres. PATIENTS: Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms. METHODS: Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection. RESULTS: A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction. CONCLUSIONS: Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.

Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study.

BACKGROUND: There is a lack of multicenter prospective studies on complications of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). METHODS: We studied 2769 consecutive patients undergoing ERCP at nine centers in the Triveneto region of Italy over a 2-year period. Six centers performed ERCP on less than 200 patients per year (small centers). General and ERCP-specific major complications were predefined. Data were collected at the time of ERCP, before discharge, and in cases of readmission within 30 days. ERCP was defined as therapeutic when endoscopic sphincterotomy (n = 1583), precut (n = 419), or drainage (n = 701) had been carried out, singularly or in combination. RESULTS: One hundred eleven major complications (4.0%) were recorded: moderate-severe pancreatitis 36 (1.3%), cholangitis 24 (0.87%), hemorrhage 21 (0.76%), duodenal perforation 16 (0.58%), others 14 (0.51%). Among 942 diagnostic ERCPs there were 13 major complications (1.38%) and 2 deaths (0.21%), whereas among 1827 therapeutic ERCPs there were 98 major complications (5.4%) and 9 deaths (0.49%). The difference in the incidence of complications between diagnostic and therapeutic ERCPs was statistically significant (p < 0.0001). Small center and precut were recognized as independent risk factors for overall major complications of therapeutic ERCP, whereas the following risk factors were identified in relation to specific complications: (1) pancreatitis: age less than 70 years, pancreatic duct opacification, and nondilated common bile duct; (2) cholangitis: small center, jaundice; (3) hemorrhage: small center; and (4) retroperitoneal duodenal perforation: precut, intramural injection of contrast medium, and Billroth II gastrectomy. CONCLUSIONS: Major complications are mostly associated with therapeutic procedures and low case volume. Present data support a policy of centralization of ERCP in referral centers. A more selected and safer use of precut may be expected to further limit the adverse events of ERCP.

Lipomas of the esophagus: a new case.

We present a new case of esophageal lipoma. The rarity of this tumor and its submucosal origin can create problems for the correct diagnosis. Symptoms, when present, are of mechanical origin (obstruction) with dysphagia. Treatment is endoscopic or surgical removal.

[Indications for the use of latissimus dorsi myocutaneous flap in breast reconstruction. Personal experience]. / Indicazioni all'impiego del lembo miocutaneo di gran dorsale nella ricostruzione mammaria. Esperienza personale.

The paper illustrates the results of the application of the latissimus dorsi myo-cutaneous flap in breast reconstruction following mastectomy due to cancer in five patients with three different indications. Following a critical evaluation of the indications and results of breast reconstruction using the rectus abdominis myocutaneous flap, the Authors conclude by confirming the validity of indications given and the positive characteristics of the myo-cutaneous flap used.

[Usefulness of long-term follow-up of gastric ulcer: a case load contribution to the natural history of gastric ulcer in relation to treatment with H2-blockaders]. / Utilità di un follow-up endoscopico a lungo termine nell'ulcera gastrica: contributo casistico alla storia naturale dell'ug in rapporto alla terapia con h2-bloccanti.

Thorough long-term clinical, endoscopic and biopsy follow-up (from 6 months to greater than 8 years; mean follow-up: 3 years 3 months) of a group of 202 cases of apparently benign gastric ulcer has enabled us to evaluate the natural history of gastric ulcer in relation to medical therapy with H2-blockers and to patient compliance when using such drugs. The results confirm the efficacy of H2-antagonist therapy in gastric ulcer healing and in the prevention of relapse. Thorough follow-up, moreover, made it possible to keep surgical operations for non-neoplastic causes down to very low numbers, only 3 patients (1.5%) being operated on for haemorrhagic emergencies and 12 (6%) for non-response to therapy.

[Usefulness of long-term endoscopic follow-up of gastric ulcer. Study of related epithelial dysplasia]. / Utilità di un follow-up endoscopico a lungo termine nell'ulcera gastrica. Studio della displasia epiteliale associata.

Over the period from January 1980 to March 1988 the frequency of dysplastic abnormalities associated wits 202 apparently benign gastric ulcers was determined and their course monitored. The relevant data were then evaluated separately for the various subgroups the ulcers were divided into on the basis of their natural history. No correlation was detected between natural history of gastric ulcer, dysplasia and onset of cancer. Though all dysplastic forms (mild, moderate and severe) may regress, all three showed a possibility of progression to EGC, obviously in increasing percentages: mild dysplasia: 2.53%; moderate dysplasia: 4.76%; severe dysplasia: 14.29%. The last of these three values appears to indicate a greater risk of cancer onset than in simple gastric ulcer and thus proves a useful marker for a more thorough monitoring of such patients.