Quantitative endoscopic and histologic activity assessment of ulcerative colitis.

BACKGROUND: Correct assessment of the severity and activity of ulcerative colitis (UC) is necessary for determining effective treatment and predicting prognosis. The correlation between histologic activity and endoscopic activity, however, has not yet been determined by using a quantitative scoring system. STUDY AIMS: To compare the endoscopic activity index (EAI), detected during colonoscopy, with the histologic activity index (HAI) detected in biopsy samples taken from the same colon segments of UC patients in order to determine the degree of agreement between both assessments. PATIENTS AND METHODS: Ninety-six UC patients participated in this prospective study. EAIs and HAIs were obtained by summing the scores given for each mucosal/histological change to produce a total score between 1 and 12. The correlation between EAI and HAI was calculated. RESULTS: There was a positive correlation between HAI and EAI (r = 0.78; p < 0.001). There was no statistical inconsistency between the EAI and HAI results (p = 0.625, using the McNemar test). The whole group kappa coefficient was 0.607 (p < 0.001). CONCLUSION: Endoscopic and histologic activity of mucosal disease in patients with UC are generally consistent. Measuring both histologic and endoscopic activity with a quantitative scoring system during patient follow-up would be a more accurate method for monitoring UC patients.

Endoscopic ultrasonography in the evaluation of dilated common bile duct.

Abdominal ultrasonography (US) is the procedure of first choice in the evaluation of a dilated common bile duct (CBD). Dilated bile ducts and the level of obstruction can be reliably demonstrated with US, but the cause can be determined in only two thirds of patients. The aim of this prospective study was to assess the value of endoscopic ultrasonography (EUS) in detecting the cause of CBD dilatation in patients in whom US could not demonstrate the cause of dilation or in whom US revealed equivocal results. This 13-month study included the evaluation of 985 patients. Ninety consecutive patients found to have an enlarged CBD (diameter, > or =7 mm) of unexplained origin during US examination were included in this study. All patients were evaluated by EUS. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography with or without sphincterotomy ( n = 72) and surgical exploration ( n = 17). The following diagnoses were made by EUS: choledocholithiasis in 40 patients, benign distal stricture in 8, choledochal cyst in 2, and ova of Ascaris in 1. The dilatation of CBD was found by EUS examination to be caused by a tumor in 13 cases. These included tumor of the papilla of the Vater in six patients, distal cholangiocarcinoma in five, and pancreatic head cancer in two. Endoscopic ultrasonography provided an accurate explanation for CBD dilatation in 70 of the 76 patients (92%). We conclude that the diagnostic strategy for cholestasis should include US as a first choice. When the diagnosis of biliary obstruction remains probable, EUS should be carried out. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be reserved for therapeutic use rather than diagnostic.

Phagocytic activity in familial Mediterranean fever.

Familial Mediterranean fever (FMF) is an autosomal recessive disease. Although the possibility of multiple immunologic mechanisms have been studied, the actual mechanism is still unresolved. Forty-one patients with FMF (24 males and 17 females with a mean age and disease duration of 17.8 +/- 4.1 and 4.7 +/- 2.3 years, respectively) and 14 healthy controls (10 males and 4 females with a mean age 23.2 +/- 5.1) were involved in the study. A phagotest was studied in both the patients and control groups with a FACScalibur Flow. All patients were in the acute stages of the disease and had not undergone colchicine treatment for 2 months. The percentage blood phagocytic activity of both granulocytes and monocytes were 84.23 +/- 8.76 and 67.28 +/- 10.15 in the patient group and 94.68 +/- 3.24 and 76.23 +/- 5.7 in the control group, respectively. There was no statistically significant difference in the percentage of phagocytic activity of the granulocytes and monocytes between the FMF patients and healthy controls (p > 0.05 and p > 0.05, respectively).

Preoperative diagnosis of mucinous gastric adenocarcinoma by endoscopic ultrasonography.

OBJECTIVES: The aims of this study were to investigate the characteristic features of mucinous gastric carcinoma on endoscopic ultrasonography (EUS) and to demonstrate the usefulness of EUS in the preoperative diagnosis of this disease. METHODS: Twelve patients with mucinous gastric carcinoma who underwent EUS examination between April 1984 and April 1995 were enrolled in this study. All patients subsequently underwent surgery. Histopathologically, tumors were classified according to the mucin content (high or moderate) and the glandular formation of the tumor cells (well or poorly differentiated). Finally, the histological and endosonographic features were compared. RESULTS: In all patients, the infiltrated wall appeared echogenic because of diffusely distributed, reticular, highly echoic speckles in the submucosa and muscularis propria. The presence of mucinous lakes surrounded by reactive fibrous tissue correlated well with reticular, highly echoic speckles on EUS. There was an increase in echogenicity and thickness of the muscularis propria, depending on the invasion of the mucin. Although the boundary between submucosa and muscularis propria was distinct and the five-layered gastric wall structure was generally preserved, the mucosal layer was not discriminated in patients with poorly differentiated mucinous carcinoma with high mucin content. CONCLUSIONS: As a preoperative diagnostic procedure, EUS may be useful in recognizing the mucinous component of gastric tumors and may facilitate the differentiation of mucinous carcinoma from other gastric epithelial tumors.

Detection of K-ras point mutations at codon 12 in pure pancreatic juice for the diagnosis of pancreatic cancer by PCR-RFLP analysis.

The present study was undertaken to detect K-ras point mutations at codon 12 in pure pancreatic juice (PPJ) for the diagnosis of pancreatic cancer (PC) using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. PPJ was collected through a cannula under a duodenal fiberscope from 26 patients with PC and 32 patients with chronic pancreatitis (CP). DNA was extracted from PPJ and was used as the template for PCR. Analysis of PPJ by PCR-RFLP with BstNI revealed that the incidence of K-ras point mutations at codon 12 was 81% (21/26) in patients with PC and 6% (2/32) in those with CP. With reference to the location of PC, the incidence of K-ras mutations was 79% (11/14) in the head, 86% (6/7) in the body, and 80% (4/5) in the tail of the pancreas. The incidence of K-ras mutants was 50% (1/2) in tumor size 1 (TS1; < or = 2.0 cm in size), 71% (5/7) in TS2 (2.1 to < or = 4.0 cm), 89% (8/9) in TS3 (4.1 to < or = 6.0 cm), and 88% (7/8) in TS4 (> 6.1 cm). These results suggested that analysis of K-ras point mutations at codon 12 in PPJ using the PCR-RFLP method is a promising new genetic test for the diagnosis of PC.

Endoscopic therapy for early gastric cancer. Utility of endosonography and evaluation of prognosis.

We analyzed 30 endoscopically treated patients with early gastric cancer in terms of the utility of endoscopic ultrasonography (EUS) and the evaluation of prognosis. Endoscopic therapy for early gastric cancer included strip biopsy, laser irradiation, and OK-432 injection. Examination of the depth of cancer invasion in the strip biopsy specimens showed that the diagnostic accuracy of EUS was 85.7%. Complete resection rate in strip biopsy was 82.8%, and the patients with incompletely resected cancer were successfully treated with laser irradiation and/or OK432 injection. The prognosis of the patients treated with strip biopsy was good. Three patients died of causes other than gastric cancer. Local recurrence and a heterochronous new lesion developed in six patients, but all of these cases were successfully treated with additional strip biopsy. All but one patient treated with laser irradiation and/or OK 432 injection survived during the study period. These results suggest that EUS is useful in determining the indication of endoscopic therapies and that prognosis is good in patients with early gastric cancer treated endoscopically.

Endosonographic evaluation of giant gastric folds.

Giant gastric folds develop in several benign and malignant diseases. We used endoscopic ultrasonography to evaluate giant gastric folds in 15 patients with Borrmann type IV scirrhous carcinoma, 8 patients with gastric lymphoma, 5 patients with anisakiasis, 1 patient with Menetrier's disease, and 6 normal subjects with simple gastric hyperrugosity. With a 7.5 MHz transducer, a five-layered gastric wall structure was imaged. The thickness of the gastric wall and each layer was measured and compared with the endosonographic findings of 16 healthy subjects. Endoscopic ultrasonography findings revealed that the second layer alone was thickened in Menetrier's disease, and the third layer alone enlarged in anisakiasis. Most of the patients with scirrhous carcinoma showed an abnormally enlarged third and fourth layer. The second layer together with the third layer was thickened in healthy subjects with simple hyperrugosity and also in patients with gastric lymphoma. However, the fourth ultrasound layer corresponding to the muscularis propria was significantly thickened only in malignant conditions. It is concluded that endoscopic ultrasonography can visualize the structure of giant gastric folds and may facilitate the differentiation of benign from malignant etiologies.

Comparison of lansoprazole and famotidine for gastric ulcer by endoscopic ultrasonography: a preliminary trial.

To compare the efficacy of lansoprazole and famotidine in the treatment of gastric ulcer, 24 patients with gastric ulcer were treated for 8 weeks. They were assessed by endoscopic ultrasonography (EUS), which provides cross-sectional images of the gastric wall as well as endoscopic images. Patients were randomly assigned to receive either lansoprazole 30 mg once daily (n = 12), or famotidine 20 mg twice daily (n = 12). The healing rate after 4 weeks of treatment was 80% in the lansoprazole group and 40% in the famotidine group. After 8 weeks of treatment, the respective healing rates were 100 and 72.7%. Healing to Sakita's S2 stage of scarring occurred significantly more often in the lansoprazole group than in the famotidine group after 4 weeks (50% vs. 0%; p < 0.05). After 4 weeks of treatment, the submucosal fibrous tissues detected by EUS were significantly less extensive in the lansoprazole-treated patients with deep ulcers (reaching the muscle layer or serosa) than in the famotidine-treated patients with deep ulcers (p < 0.01). These results suggest that lansoprazole may be more effective in ulcer healing than famotidine, particularly in patients with deep gastric ulcers.

Endosonography of a submucosal tumor-like gastric lesion caused by fibrotic ulcer healing.

A 61-year-old woman with a gastric antral ulcer scar had a lesion that showed a submucosal tumor-like appearance on endosonography, which proved at resection to represent dense submucosal fibrous tissue. The reason for this marked reaction has not yet been established. Although we felt that the endosonographic pattern most likely showed submucosal fibrosis, in view of her past medical history, malignant lymphoma or aberrant pancreas could not be ruled out with certainty.