Significance of sucrose permeability test in detecting early gastric cancer and changes of permeability after endoscopic mucosal resection.

BACKGROUND/AIMS: To evaluate the diagnostic value of sucrose permeability test (SPT) with special reference to early gastric cancer (EGC), and to assess the changes of urinary sucrose level after treatment of gastric damage: gastric ulcer (GU) or EGC. METHODOLOGY: Ninety subjects were included in this study, that is; 18 patients with GU, 25 EGC, 17 advance gastric cancer (AGC), and 30 healthy volunteers (HV). SPT was conducted before treatment in all the subjects, and in 6 patients each with GU and EGC after treatment- proton pump inhibitor for GU and endoscopic mucosal resection for EGC. Diagnostic values were calculated based on cut-off values estimated from the ROC curves. RESULTS: The mean amount of sucrose excreted into urine in HV, GU, EGC, and AGC was 50.8 +/- 28.0 mg, 225.9 +/- 201.1 mg, 170.2 +/- 86.4 mg, and 426.2 +/- 155.0 mg, respectively, showing significant differences between HV and gastric disease groups (p < 0.01). The sensitivity for detecting GU, EGC, and AGC was 94.4%, 88.0%, and 100%, respectively. Sucrose excretion in GU and EGC was significantly decreased after treatment (262.4 +/- 121.2 to 80.6 +/- 42.1, and 246.0 +/- 136.9 to 139.1 +/- 69.2, p < 0.05 and p < 0.001, respectively). CONCLUSIONS: SPT was considered useful to detect not only GU or AGC but also EGC with a high sensitivity. A significant decrease of sucrose excretion was observed after treatment in EGC.

Placement of the Bravo wireless pH monitoring capsule onto the gastric wall under endoscopic guidance.

BACKGROUND: The Bravo system was designed mainly to monitor esophageal pH, and there have been no reports on gastric pH monitoring using this system. OBJECTIVE: To place the Bravo capsule on the gastric wall and monitor gastric pH. DESIGN: Experimental clinical trial with the cooperation of volunteers. SETTING: Academic medical center. PATIENTS: Eleven volunteers (9 men, 2 women; mean age 38 years; 3 had symptoms of GERD). INTERVENTIONS: The Bravo system was introduced into the esophagus and stomach along a thin endoscope and capsules were attached, one each to the esophageal and gastric walls under direct vision through the endoscope. Esophageal and gastric pHs were simultaneously monitored. RESULTS: The 2 capsules were successfully placed in 10 of the 11 subjects, and both esophageal and gastric pHs were monitored for 48 hours in 9 subjects. Mild to moderate precordial pain was observed in 7 subjects, but no other complications or side effects were observed in this study. The gastric pH of 10 subjects increased after meals and returned to baseline pH 2 hours later. Decrease of esophageal pH was observed 1 hour after a meal in the symptomatic subjects and corresponded to the time when gastric pH decreased secondary to the increase of pH with meals. CONCLUSIONS: The Bravo capsule is easily placed on the gastric wall under endoscopic assistance and enables long ambulatory monitoring of gastric pH.

Objective assessment of the antispasmodic effect of shakuyaku-kanzo-to (TJ-68), a Chinese herbal medicine, on the colonic wall by direct spraying during colonoscopy.

AIM: To objectively evaluate the effect of TJ-68 on colonic spasms during colonoscopy. METHODS: One hundred and one patients subjected to screening colonoscopy were randomly assigned to two groups: TJ-68 in 51 subjects and saline as the control in 50. The endoscope was inserted into the sigmoid colon, then a spastic region was identified and the tip of the colonoscope was positioned at a distance of about 10 mm from the spastic region. The endoscopic view was recorded before and after direct spraying of the TJ-68 solution or warm saline. The intraluminal area of the spastic region was serially measured using a computer image analyzer and expressed as pixel counts. The area under the curve (AUC) was calculated from the pixel curve. Statistical significance was assessed by Wilcoxon's test and Mann-Whitney U test. RESULTS: The mean AUC of the spastic region before and after TJ-68 spraying was 29,128 and 121,943 pixels, respectively, while with saline, it was 31,635 pixels and 48,617 pixels, respectively. Thus, the AUC significantly increased after TJ-68 spraying compared with the spraying of saline (P<0.001). CONCLUSION: Direct spraying of TJ-68 on the colonic mucosa suppressed colonic spasm and it may be useful during colonoscopy when anticholinergic agents are contraindicated.

Significance of a novel sucrose permeability test using serum in the diagnosis of early gastric cancer.

AIM: To investigate the usefulness of sucrose permeability test using serum in the diagnosis of gastric diseases, with special reference to early gastric cancer (EGC). METHODS: A total of 63 subjects, including 11 patients with gastric ulcer, 20 patients with gastric cancer (13, early; 7, advanced) and 32 healthy controls, were studied. Blood and urine samples were collected repeatedly for 5 h before and after the sucrose loading. Sucrose levels were measured by a newly developed enzymatic method. RESULTS: Serum sucrose levels started to increase 15 min after loading, and peaked at 60 min in the gastric disease groups. The levels for gastric ulcer, EGC and advanced gastric cancer (AGC) at 60 min were significantly higher than that in the healthy controls (26.9+/-2.4, 34.4+/-5.0, and 71.8+/-15.6 vs 7.9+/-0.7 mol/L, respectively, P<0.01). The cut-off level set at 15.4 mol/L (60 min) offered the best distinction between EGC patients and healthy controls; and the sensitivity and specificity were 92.3% and 93.8%, respectively, while those of the urine method were 76.9% and 93.8%, respectively. CONCLUSIONS: The gastric permeability test using serum is reliable for the detection of EGC, and this test can provide results much earlier than the conventional urine method. This test may offer a useful alternative to more invasive tests for EGC.

A sensitive enzymatic assay for the determination of sucrose in serum and urine.

BACKGROUND: Sucrose permeability has been suggested as a simple and non-invasive marker of gastric mucosal damage. We here report on a sensitive enzymatic assay using four sequential enzyme reactions coupled with reduced thio-NADPH. METHODS: Sucrose is phosphorylated by sucrose phosphorylase (EC2.4.1.7). The subsequent reaction in the presence of phosphoglucomutase (EC5.4.2.2) and glucose-1,6-diphosphate forms glucose-6-phosphate. Sucrose of the monad forms the dyad thio-NADPH. The reaction is monitored by changes in absorbance at 405 nm. RESULTS: The lower limit of detection (3SD method) was 2.8 micromol/l for serum and 7.0 micromol/l for urine. The precision of the method was <4.0%, and has sufficient analytical range. CONCLUSIONS: The assay was sensitive enough to monitor serum sucrose concentrations during the sucrose permeability test and an automated assay may be useful in a large number of subjects.