Scanning electron microscopy of dysplastic Barrett's epithelium.

Twenty-six patients with Barrett's esophagus (BE) were followed prospectively by endoscopic examination and biopsy. Two biopsies were taken from each of 4 areas of BE. One was processed for light microscopy (LM) and one for scanning electron microscopy (SEM). Those in whom dysplastic BE was demonstrated by LM were reexamined at 6-mo intervals, and the others at yearly intervals. One patient had low grade dysplasia (LGD) by LM on entry, and in 2 others, LGD was recognized on the second examination. These changes have persisted in semiannual examinations over 3, 2, and 2 yr, respectively. SEM prints were examined without knowledge of LM findings, and features that might correlate with LGD by LM were sought. SEM findings were similar to those of Zwas et al. (Gastroenterology 90:1932, 1986) in that most glandular cells had surface features unlike either gastric or intestinal cells but unique to BE. In the patient with LGD on entry, there was an aggregate of very large cells covered by short microvilli with bald patches. In the other patients with LGD, there was more variation in size and shape of cells than in nondysplastic cases.

Complications of endoscopic injection sclerotherapy: a review.

As endoscopic injection sclerotherapy becomes more widely applied to the treatment of bleeding esophageal varices, an increasing number of complications are being reported. Dysphagia, chest pain, and fever are usually transient and incosequential but may herald more serious life-threatening sequelae. Mortality commonly results from the major complications of recurrent bleeding, perforation, sepsis, and respiratory disorders. We carried out a review of sclerotherapy complications to understand their basis and to determine what measures can be taken to prevent or manage them.

Yersinia colitis masquerading as pseudomembranous colitis.

We describe a 15-month-old male who presented with fever and diarrhea 24 hr after receiving antibiotics for otitis media. A flexible sigmoidoscopy was initially interpreted endoscopically as antibiotic-associated pseudomembranous colitis, and the patient was treated with vancomycin. The diagnosis of antibiotic-associated colitis was excluded in our patient by the negative stool examination for Clostridium difficile toxin, the failure to obtain supportive features on rectal biopsy, and the failure to demonstrate sigmoidoscopic improvement with vancomycin therapy. Thirteen days later, Y. enterocolitica was cultured from the initial stool specimens. In this case, the raised central whitish area on an erythematous base was misinterpreted as pseudomembranous colitis.

Epithelial proliferation in human fundic mucosa after antrectomy and vagotomy.

Changes in the gastric mucosa after a partial gastrectomy may predispose to neoplasia, but epithelial proliferation in such patients has not been studied well. Therefore, we obtained one or more suction biopsies of fundic mucosa from 6 volunteers (controls), 5 patients in whom a duodenal ulcer had healed, and 6 patients with antrectomy and vagotomy. Biopsies were organ cultured over tritiated thymidine-containing medium to label proliferating cells, and processed for light microscopy and autoradiography. The measurements of proliferation that were used, namely, the total number of cells in the gastric pits, the number of cells in the proliferative zone, the number of labeled cells in the proliferative zone, and proliferation index (number of cells in the proliferative zone/total number of cells in the gastric pit) all indicated that epithelial proliferation is increased significantly in fundic mucosa of patients after antrectomy and vagotomy when compared with fundic mucosa from normal controls or patients with healed duodenal ulcer. Proliferation was increased most in biopsies that showed atrophic gastritis. The enhancement of epithelial proliferation after antrectomy and vagotomy may be due to the development of gastritic changes, but an additional effect of vagotomy cannot be excluded. Further, the expansion of the proliferative zone suggests a disorder of proliferation which may predispose to malignant transformation.