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ABSTRACT: BACKGROUND: Although the accurate estimation of tumor size is essential for proper patient selection for endoscopic resection in early gastric cancer (EGC), no study has been conducted to date on tumor size estimation. We aimed to evaluate the accuracy of endoscopic visual estimation of tumor size of EGC. METHODS: In 508 EGC patients that underwent endoscopic resection, endoscopic visual estimations were performed retrospectively by independent two endoscopists using still images. Data were compared with pathologic measurements as gold standard. Inter-observer agreement was determined using the Bland-Altman method and intra-class correlation coefficients (ICC). Measurement discrepancies were presented as differences between measurements. RESULTS: The ICC between the two endoscopists was 0.915 (95 % CI 0.900-0.928). Mean endoscopic estimates for both endoscopists were significantly lower than mean pathologic measurements (1.50 and 1.67 vs. 1.80 cm, P < 0.001). Absolute differences between average endoscopic estimates and pathologic measurements were found to be acceptable in most cases: an absolute difference of <0.4 cm was found for 80 % (404/508) of cases. Bland-Altman plot showed that 94 % of cases lay within the 95 % limits of agreement. Measurement discrepancy was proportional to tumor size and increased for an undifferentiated histology. CONCLUSIONS: Endoscopic visual estimations were found to show reliable agreement with pathologic measurement in EGC patients undergoing endoscopic resection, together with good inter-observer agreement. Further prospective study is needed to confirm the validity of this method.
Digestive Diseases and Sciences 04/2013; · 2.12 Impact Factor
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ABSTRACT: BACKGROUND: In cases with a tumor-positive resection margin after endoscopic resection of early gastric cancer (EGC), not all patients are found to have residual or recurrent tumor. The aim of this study was to identify risk factors associated with residual/recurrent tumor in patients with incomplete endoscopic resection of EGC. METHODS: A retrospective analysis was performed on consecutive patients who underwent endoscopic resection of EGC at a single institution in South Korea. Patients with a tumor-positive resection margin in the specimen were divided into two groups, with and without residual/recurrent tumor, and the clinicopathologic characteristics were compared. RESULTS: A total of 102 patients with a tumor-positive lateral or vertical resection margin after endoscopic mucosal resection (n = 10) or submucosal dissection (n = 92) were enrolled. Overall, the rate of residual/recurrent tumor was 33.3 % (34/102): 17 residual tumors in 46 patients who immediately underwent additional endoscopic or surgical resection, and 17 recurrent tumors in 56 patients who were initially followed up with regular endoscopy during a median period of 17 (range = 2-70) months. Univariate analysis showed that the presence of ulcer, the direction of the tumor-positive resection margin, and length of lateral resection margin involvement by the tumor were associated with the incidence of residual/recurrent tumor. In multivariate analysis, total length (cm) of lateral resection margin involvement was the only independent risk factor for residual/recurrent tumor (OR 2.05; 95 % CI 1.22-3.44, p = 0.006). CONCLUSIONS: Patients with extensive tumor involvement of a lateral resection margin after endoscopic resection of EGC should consider additional endoscopic or surgical resection due to a high risk of residual/recurrent tumor.
Surgical Endoscopy 12/2012; · 4.01 Impact Factor
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Joo Hyun Lim,
Sang Gyun Kim,
Ji Won Kim,
Yoon Jin Choi,
Jieun Kwon,
Ji Yeon Kim,
Yun Bin Lee, Jeongmin Choi,
Jong Pil Im,
Joo Sung Kim,
Hyun Chae Jung,
In Sung Song
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ABSTRACT: It is rarely known whether antiplatelets increase the risk of bleeding after endoscopic submucosal dissection (ESD).
To evaluate the effect of antiplatelets on post-ESD bleeding.
Retrospective study.
Single, tertiary-care referral center.
This study involved 1591 gastric neoplasms (815 adenomas and 776 early gastric cancers) in 1503 patients who had ESD between April 2005 and April 2010.
ESD.
Overt hematemesis/hematochezia, a drop of hemoglobin >2 g/dL from baseline, or requirement of endoscopic hemostasis, angiographic embolization, and/or transfusion.
Of 1591 subjects, 274 took antiplatelets, among whom 102 discontinued them for 7 days or more before ESD. Post-ESD bleeding occurred in 94 subjects including 20 from the continuation group, 6 from the withdrawal group, and 68 from the no-antiplatelet group. In univariate analysis, antiplatelets, early gastric cancer (EGC), comorbidity, and specimen diameter were related to post-ESD bleeding. In multivariate analysis, EGC (odds ratio [OR] 1.839; 95% confidence interval [CI], 1.168-2.896; P = .009), comorbidity (OR 2.246; 95% CI, 1.280-3.939; P = .005), and specimen diameter (OR 2.315; 95% CI, 1.282-4.180; P = .005) were independent risk factors of post-ESD bleeding, whereas antiplatelet usage was not (OR 1.596; 95% CI, 0.877-2.903; P = .126). In subgroup analysis, continuous antiplatelet usage was not found to be an independent risk factor of post-ESD bleeding in multivariate analysis (OR 2.027; P = .146). Among 102 subjects who discontinued antiplatelets, 1 developed an acute cerebral infarction (1.0%).
A retrospective, single-center analysis.
In ESD for antiplatelet users, continuous administration was not found to have an independent significant association with bleeding.
Gastrointestinal endoscopy 02/2012; 75(4):719-27. · 6.71 Impact Factor
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ABSTRACT: Although endoscopic resection for early gastric cancer (EGC) is increasingly available, it has not been determined whether indications for endoscopic resection are equally acceptable for multiple EGCs.
To compare the various clinicopathologic factors and risk of lymph node (LN) metastasis between multiple and solitary EGCs.
Case-control study.
University hospital.
This study involved 1717 patients with 156 multiple and 1561 solitary EGCs.
Gastrectomy with LN dissection.
Incidence of LN metastasis.
In multiple EGCs, main lesions had larger tumor size and deeper invasion depth than the accessory lesions (P < .001). The clinicopathologic features of multiple EGCs were similar to those of solitary EGCs with respect to tumor size, depth of invasion, lymphovascular invasion, and incidence of LN metastasis. Importantly, the risk of LN metastasis in multiple EGCs that met the indication criteria for endoscopic resection was not significantly different from that in solitary EGCs. Tumors meeting conventional indications for endoscopic resection had no risk of LN metastasis, whereas tumors meeting expanded indications showed a similar risk of LN metastasis in the two groups. In multiple EGCs, tumor size ≥3 cm and lymphovascular invasion were independent risk factors of LN metastasis.
Small number of patients with multiple EGCs studied.
Multiple EGCs had clinicopathologic characteristics and risk of LN metastasis similar to those of solitary EGCs. Endoscopic resection may be adopted as curative treatment for multiple EGCs that meet indications for endoscopic resection. Further studies are needed to verify the present study results.
Gastrointestinal endoscopy 08/2011; 74(2):276-84. · 6.71 Impact Factor
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Su Jin Chung,
Seon Hee Lim, Jeongmin Choi,
Donghee Kim,
Young Sun Kim,
Min Jeong Park,
Jeong Yoon Yim,
Joo Sung Kim,
Sang-Heon Cho,
Hyun Chae Jung,
In Sung Song
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ABSTRACT: The role of Helicobacter pylori in gastroesophageal reflux disease remains still controversial and the effect of the organism on severity of reflux esophagitis have been rarely issued. The aim of this study was to investigate the relationship between H. pylori infection and reflux esophagitis, and especially the severity of reflux esophagitis.
We performed a cross-sectional case-control study of 5,616 subjects undergoing both upper endoscopy and H. pylori serology during health Check-up (2,808 cases vs age- and sex-matched controls). Smoking, alcohol, body mass index and waist circum - ference were added to a multiple regression model.
Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001). Positive serology for H. pylori independently reduced the risk of reflux esophagitis (adjusted OR, 0.44; 95% CI, 0.39-0.49). Notably, the negative associations continued across the grade of esophagitis with adjusted ORs of 0.63 in LA-M, 0.36 in LA-A or LA-B and 0.20 in LA-C or LA-D (P < 0.001).
In a age-sex matched Korean, H. pylori seropositivity was independently and inversely associated with the risk and severity of reflux esophagitis, suggesting the organism may have a protective role against gastroesophageal reflux disease.
Journal of neurogastroenterology and motility 07/2011; 17(3):267-73.
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Jeongmin Choi,
Chung Hyeon Kim,
Donghee Kim,
Su Jin Chung,
Ji Hyun Song,
Jung Mook Kang,
Jong In Yang,
Min Jung Park,
Young Sun Kim,
Jeong Yoon Yim,
Seon Hee Lim,
Joo Sung Kim,
Hyun Chae Jung,
In Sung Song
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ABSTRACT: This study aimed to evaluate the efficacy of a new polyclonal enzyme immunoassay for the detection of Helicobacter pylori (H. pylori) antigen in stool by determination of the optimal cut-off value in the screening population.
A consecutive 515 patients undergoing a routine health check-up were prospectively enrolled. H. pylori infection was defined if at least two of four tests (histology, rapid urease test, (13)C-urea breath test, and serology) were positive. A stool antigen test (EZ-STEP H. pylori) was performed for the detection of H. pylori. The optimal cut-off value was determined by the receiver-operator characteristic curve. The diagnostic performance of each test was evaluated with regard to the histological diagnosis of atrophic gastritis (AG)/intestinal metaplasia (IM), degree of AG/IM, and old age.
Sensitivity, specificity, positive and negative predictive values, and accuracy of the stool antigen test were 93.1%, 94.6%, 95.1%, 92.3%, and 93.8%, respectively. The sensitivity of histology, rapid urease test, and the (13)C-urea breath test ranged from 89.1% to 97.6%, and their specificity was > 98%, while serology had high sensitivity, but low specificity. The accuracy of the stool antigen test was comparable to that of other methods (93.6-95.9%), whereas it was higher than that of serology. The stool antigen test still showed good diagnostic performance in the setting of progression of AG/IM and in patients over 40 years.
The performance of a new stool antigen test was comparable to that of other methods in the diagnosis of H. pylori infection for the screening population, even with the presence of AG/IM.
Journal of Gastroenterology and Hepatology 03/2011; 26(6):1053-9. · 2.87 Impact Factor
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ABSTRACT: Although conventional endoscopy is a good diagnostic tool to evaluate tumor depth (T staging) in early gastric cancer (EGC), its accuracy has not been determined and no consensus has been reached regarding standard endoscopic criteria.
To evaluate the diagnostic accuracy of endoscopic T staging and to identify the characteristic endoscopic features for mucosal (T1m) and submucosal (T1sm) tumors.
Retrospective study.
A consecutive 2105 patients with EGC who underwent either surgical (n=1624) or endoscopic (n=481) resection.
Endoscopic staging was performed by consensus of 2 endoscopists based on the characteristic endoscopic criteria of T1m (smooth surface protrusion or depression, slight marginal elevation, and the smooth tapering of converging folds) and T1sm (irregular surface, marked marginal elevation, and clubbing/abrupt cutting/fusion of converging folds). The endoscopic staging was compared with the pathologic staging of the resected specimen.
The overall accuracy of endoscopic staging was 78.0% (1642/2105). The sensitivity, specificity, and positive and negative predictive values of T1m endoscopic staging were 85.5%, 73.9%, 82.0%, and 78.5%, whereas those for T1sm were 72.6%, 81.9%, 71.9%, and 82.4%, respectively.
Retrospective study. Endoscopic predictions for T1sm tumors were correct in only 72% of cases.
Conventional endoscopy was found to provide reliable accuracy for T staging in EGC and may be an effective method for assessing penetration depth. A detailed endoscopic evaluation regarding tumor base, margin, and converging folds may provide useful information to determine tumor depth and to select the optimal therapeutic strategy, particularly for endoscopic resection.
Gastrointestinal endoscopy 02/2011; 73(5):917-27. · 6.71 Impact Factor
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ABSTRACT: Endoscopic resection as curative treatment of early gastric cancer (EGC) requires accurate staging for depth of invasion (T) before therapy. This study aimed to compare T staging of EGC using a miniprobe with that of conventional endoscopy (CE).
A total of 388 patients with suspected of EGC by CE were prospectively enrolled in the study. After miniprobe staging by an experienced endosonographer, CE staging was performed by another endoscopist who was blinded to the miniprobe assessment. Patients underwent either endoscopic resection (n = 325) or surgery (=63) according to staging results. Results of each method were compared with the histology of the resected specimen. Clinicopathological factors affecting accuracy of each test were also evaluated.
Overall accuracy of miniprobe and CE staging was 78.9% (306/388) and 81.4% (316/388), respectively (p = 0.052). Sensitivity for T1m was more than 95% (miniprobe 98.7%, CE 97.7%), whereas sensitivity for T1sm was lower at 6.6% for miniprobe and 23.7% for CE (p = 0.002). Among nine lesions identically considered submucosal invasion by both methods, three were T1sm cancer. Diagnostic accuracy of the miniprobe was lower than that of CE with respect to lesions located in the lower third of the stomach, differentiated histology, or massive submucosal invasion.
Overall accuracy of the miniprobe and CE for T staging in EGC was approximately 80% with no significant difference. Accurate prediction of both techniques for submucosal invasion was poor, even by using a combination of the two methods. The use of the miniprobe may not increase the positive predictive value for T staging over the use of CE alone.
Surgical Endoscopy 12/2010; 24(12):3177-85. · 4.01 Impact Factor
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Surgical Endoscopy 10/2010; · 4.01 Impact Factor
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ABSTRACT: Endoscopic ultrasonography (EUS) has been a useful method for the accurate staging of esophageal cancer. This study aimed to compare the diagnostic performance of EUS, positron emission tomography (PET), and computed tomography (CT) in the locoregional staging of resectable esophageal cancer.
A total of 109 patients with resectable esophageal cancer were prospectively enrolled and retrospectively reviewed for evaluation of preoperative EUS, PET, and CT. The sensitivity, specificity, and accuracy of tumor depth (T) staging and regional lymph nodal (N) staging for each test were compared with the postoperative histopathologic stage as the gold standard.
The overall accuracy of EUS for T staging was 72%, and it was the only method for delineating the layers of the esophageal wall. The sensitivities for N staging were 42% for EUS, 49% for PET, and 35% for CT, and their specificities were, respectively, 91, 87, and 93%. The accuracy for N staging was 66% for EUS, 68% for PET, and 63% for CT, and it did not differ significantly across the three tests.
Preoperative EUS for the locoregional staging of esophageal cancer provides excellent T staging accuracy and similar accuracy for N staging compared with PET and CT. Especially in T staging, EUS could play an important role in the choice of candidates for esophageal cancer surgery.
Surgical Endoscopy 06/2010; 24(6):1380-6. · 4.01 Impact Factor
