WATS3D versus forceps biopsy in screening for Barrett's esophagus: experience in community endoscopy centers.

BACKGROUND: Barrett's esophagus (BE) is a premalignant condition diagnosed using systematic 4-quadrant forceps biopsies (FB) during endoscopy. This method is fraught with errors due to the randomness of sampling and variability among operators. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is an emerging technique used to collect esophageal samples. The aim of this study was to evaluate WATS3D as a diagnostic tool for detecting BE in addition to FB, compared to FB alone. METHODS: A retrospective observational cohort study was conducted and included patients who underwent screening for BE with WATS3D and FB between January 2015 and January 2019 across 3 endoscopy centers in Wichita, Kansas. The FB specimens were reviewed by community pathologists, while the WATS3D samples were sent to CDX technology labs, NY. RESULTS: A total of 108 patients were screened for BE using both modalities concurrently. FB and WATS3D detected 62 (57.4%) and 83 (76%) cases of BE, respectively. The absolute difference of 21 cases (18.6%) of BE was attributed to the addition of WATS3D. The number needed to test with WATS3D was 5. We divided the sample into 4 groups to compare the agreement across all groups: (FB-; WATS3D+), (FB-; WATS3D-), (FB+; WATS3D+), and (FB+ and WATS3D-). Overall agreement by kappa statistic was 0.74. CONCLUSION: WATS3D identified 21 cases of BE missed by FB. Using WATS3D in addition to FB increased the yield of BE during surveillance endoscopy, with no increase in complications.

Case Report: Simultaneously diagnosed gastric adenocarcinoma and pernicious anemia - a classic association.

Primary gastric cancer remains one of the most prevalent malignancies worldwide. Often patients remain asymptomatic until it is detected at an advanced stage with a poor prognosis. Thus, it's characteristically difficult to initially diagnose until it becomes late stage, at which point prognosis becomes poor. Pernicious anemia is a classic risk factor for the development of primary gastric cancer, but is uncommonly seen in clinical practice. Over time, patients who produce the autoantibodies to intrinsic factor that cause pernicious anemia typically will present initially with clinically significant megaloblastic anemia and peripheral neuropathy. However, patients can also present with more nonspecific signs and symptoms. Thus, clinicians should remain vigilant as circulating anti-intrinsic factor antibodies only worsen the disease over time and increase the risk of developing primary gastric cancer. This report not only presents the rare concurrent diagnosis of pernicious anemia and gastric cancer, but also aims to increase clinical awareness of these two conditions' classic association because early diagnosis and treatment significantly impacts morbidity and mortality.

Autoimmune metaplastic atrophic gastritis and association with neuroendocrine tumors of the stomach.

Autoimmune metaplastic atrophic gastritis (AMAG) previously called type A chronic gastritis is an immune-mediated chronic inflammatory disease characterized by the immune-mediated destruction of gastric parietal cells in the fundus and body of the stomach. AMAG is an uncommon disease that often presents with hematological manifestations and may lead to the development of gastric carcinoids. AMAG can be reliably diagnosed by antibody assays, functional serology, and histology. The understanding of the disease process is essential for the detection and management of hematological complications and gastric lesions. The prevalence of AMAG is on the rise and subsequently gastric carcinoids. However, this association is not well recognized in clinical practice, and management and diagnosis of AMAG and gastric carcinoids remain suboptimal. In the current review, we will discuss the pathophysiology, diagnosis and management of AMAG. A special focus is given to the association between AMAG and gastric carcinoids. We will also review the management options of type 1 gastric carcinoids.

Isolated Ileal Stricture Secondary to Antigen-Negative GI Histoplasmosis in a Patient on Immunosuppressive Therapy.

We present a case of antigen-negative disseminated histoplasmosis manifesting as an isolated ileal stricture in a patient on chronic infliximab and methotrexate. Diagnosis can be challenging due to imperfect tests, and this condition should remain in the differential, even with negative testing. Mortality of untreated disseminated histoplasmosis can be as high as 80%.

Abdominal Pain and Ascites: Not Always Related to Portal Hypertension.

Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract with an estimated prevalence of one in 100,000. The typical presentation consists of vague gastrointestinal symptoms with the mucosal involvement of the digestive system. Rarely, it presents as eosinophilic ascites. We report the case of a 22-year-old female who presented with acute onset abdominal pain and ascites. The laboratory studies were remarkable for eosinophilia and the ascitic fluid demonstrated high eosinophilic counts. Push enteroscopy with biopsy supported the diagnosis of eosinophilic gastroenteritis, with likely serosal involvement. Other differential diagnoses were excluded. A prednisone taper along with dietary treatment was initiated. We report complete resolution of symptoms two weeks following the initiation of therapy. Nine months later, she remains asymptomatic without recurrence of ascites.

Long-term results of the mucosal ablation of Barrett's esophagus: efficacy and recurrence.

BACKGROUND AND STUDY AIMS: It has been postulated that the endoscopic ablation of Barrett's esophagus can lead to complete eradication of the disease. This study was undertaken to evaluate the efficacy of endoscopic eradication therapy for Barrett's esophagus and the rates of recurrence of intestinal metaplasia. PATIENTS AND METHODS: As part of an initial randomized controlled trial, patients with nondysplastic or low grade dysplastic Barrett's esophagus underwent mucosal ablation. Following ablation, the patients had annual surveillance endoscopies. Recurrence was defined as the presence of intestinal metaplasia after initial complete eradication had been achieved. RESULTS: A total of 28 patients with Barrett's esophagus were followed for a mean of 6.4 years after ablation therapy. At baseline, the majority of the patients had nondysplastic Barrett's esophagus (79 %). Initial complete eradication of intestinal metaplasia was achieved at a mean of 4.1 months. During long-term follow-up, initial recurrence of intestinal metaplasia was seen in 14 of the 28 of patients (50 %) at a mean of 40 months, and further maintenance ablation therapy was applied. At the final follow-up, 36 % of the patients had complete eradication of intestinal metaplasia, 18 % of the patients had intestinal metaplasia, and 21 % had died of unrelated causes; invasive esophageal adenocarcinoma had developed in 1 patient. CONCLUSIONS: The long-term results of this study demonstrate a recurrence rate of 50 % after complete eradication of Barrett's esophagus with endoscopic eradication therapy. In addition, re-recurrence (in 36 %), even after further maintenance endoscopic eradication therapy, and deaths unrelated to the disease (21 %) occurred. Complete remission of Barrett's esophagus appears to be a difficult goal to achieve. These results call into question the role of ablation in patients with low risk Barrett's esophagus.