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Gastroenterology Feb 2022Gastroesophageal reflux disease (GERD) is associated with an increased risk of cancer of the upper gastrointestinal tract. This study aimed to assess whether and to what...
BACKGROUND AND AIMS
Gastroesophageal reflux disease (GERD) is associated with an increased risk of cancer of the upper gastrointestinal tract. This study aimed to assess whether and to what extent a negative upper endoscopy in patients with GERD is associated with decreased incidence and mortality in upper gastrointestinal cancer (ie, esophageal, gastric, or duodenal cancer).
METHODS
We conducted a population-based cohort study of all patients with newly diagnosed GERD between July 1, 1979 and December 31, 2018 in Denmark, Finland, Norway, and Sweden. The exposure, negative upper endoscopy, was examined as a time-varying exposure, where participants contributed unexposed person-time from GERD diagnosis until screened and exposed person-time from the negative upper endoscopy. The incidence and mortality in upper gastrointestinal cancer were assessed using parametric flexible models, providing adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS
Among 1,062,740 patients with GERD (median age 58 years; 52% were women) followed for a mean of 7.0 person-years, 5324 (0.5%) developed upper gastrointestinal cancer and 4465 (0.4%) died from such cancer. Patients who had a negative upper endoscopy had a 55% decreased risk of upper gastrointestinal cancer compared with those who did not undergo endoscopy (HR, 0.45; 95% CI, 0.43-0.48), a decrease that was more pronounced during more recent years (HR, 0.34; 95% CI, 0.30-0.38 from 2008 onward), and was otherwise stable across sex and age groups. The corresponding reduction in upper gastrointestinal mortality among patients with upper endoscopy was 61% (adjusted HR, 0.39; 95% CI, 0.37-0.42). The risk reduction after a negative upper endoscopy in incidence and mortality lasted for 5 and at least 10 years, respectively.
CONCLUSIONS
Negative upper endoscopy is associated with strong and long-lasting decreases in incidence and mortality in upper gastrointestinal cancer in patients with GERD.
Topics: Adult; Aged; Duodenal Neoplasms; Endoscopy, Digestive System; Esophageal Neoplasms; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Proportional Hazards Models; Risk Assessment; Stomach Neoplasms
PubMed: 34627859
DOI: 10.1053/j.gastro.2021.10.003 -
Scientific Reports Apr 2022We aimed to explore factors associated with prognosis in patients with metastatic small bowel adenocarcinoma (SBA) as well as to develop and validate nomograms to...
We aimed to explore factors associated with prognosis in patients with metastatic small bowel adenocarcinoma (SBA) as well as to develop and validate nomograms to predict overall survival (OS) and cancer-specific survival (CSS). Relevant information of patients diagnosed between 2004 and 2016 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms for predicting 1- and 3-year OS and CSS were established with potential risk factors screened from multivariate cox regression analysis. The discrimination and accuracy of the nomograms were assessed by concordance index (C-index), calibration plots, and the area under receiver operating characteristic curve (AUC). In total, 373 SBA patients with M1 category were enrolled. Multivariate analysis revealed that age, size and grade of primary tumor, primary tumor surgery, and chemotherapy were significant variables associated with OS and CSS. The C-index values of the nomogram for OS were 0.715 and 0.687 in the training and validation cohorts, respectively. For CSS, it was 0.711 and 0.690, respectively. Through AUC, decision curve analysis (DCA) and calibration plots, the nomograms displayed satisfactory prognostic predicted ability and clinical application both in the OS and CSS. Our models could be served as a reliable tool for prognostic evaluation of patients with metastatic SBA, which are favorable in facilitating individualized survival predictions and clinical decision-making.
Topics: Adenocarcinoma; Duodenal Neoplasms; Humans; Neoplasm Staging; Nomograms; Prognosis; Retrospective Studies; SEER Program
PubMed: 35396531
DOI: 10.1038/s41598-022-09986-0 -
Saudi Journal of Gastroenterology :... 2021To observe and preliminarily evaluate the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of... (Observational Study)
Observational Study
BACKGROUND
To observe and preliminarily evaluate the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of non-ampullary duodenal lesions (NADLs).
METHODS
This retrospective observational study included 84 patients who underwent endoscopic resection (ER) with non-ampullary duodenal lesions, between March 2010 and November 2020, at the Cancer Hospital of the Chinese Academy of Medical Sciences (Beijing, China). Data on patient demographics, therapeutic outcomes, and follow-up results were analyzed.
RESULTS
There were 44 patients undergoing EMR, and 40 patients accepting ESD. The overall en bloc resection rate was 98.8% (83/84). For the neoplastic lesions, the overall en bloc resection rate and curative rate were 98.5% (67/68) and 89.7% (61/68), respectively. The procedure-related bleeding and perforation rates were 2.4% and 10.7%, respectively. Univariate analysis results indicated that the main correlation factor of non-curative pathologic resection was tumor size (p = 0.004) and resection size (P < 0.01). There showed a higher curative rate in patients with tumors less than 25 mm in diameter. Multivariate logistic regression analyses determined that the tumor size (OR 0.935; 95% CI 0.878-0.995; P = 0.035) was associated with non-curative resection. No recurrences were observed in patients who had undergone a complete ER during a follow-up period of 42.8 months (range, 3-127 months).
CONCLUSION
Endoscopic resection is an effective, safe, and feasible treatment for non-ampullary duodenal lesions.
Topics: Duodenal Neoplasms; Duodenum; Endoscopic Mucosal Resection; Humans; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 33642354
DOI: 10.4103/sjg.sjg_646_20 -
Journal of Digestive Diseases Aug 2022Non-functioning gastrin-producing neuroendocrine neoplasms (NEN) of the duodenum are rare gastrointestinal tumors without a clinical syndrome due to gastrin production.... (Observational Study)
Observational Study
OBJECTIVES
Non-functioning gastrin-producing neuroendocrine neoplasms (NEN) of the duodenum are rare gastrointestinal tumors without a clinical syndrome due to gastrin production. Their incidence has significantly increased as an incidental finding during endoscopic studies. The aim of this study was to describe the characteristics and prognostic factors of this emergent and infrequent neoplasm.
METHODS
We performed a retrospective observational study based on the duodenal NENs samples with positive staining for gastrin at the Department of Pathology, University Hospital 12-de-Octubre (Madrid, Spain) between 2000 and 2017. Patients with clinically functional tumors ([Zollinger-Ellison syndrome] or gastrin >1000 pg/mL), with previously diagnosed multiple endocrine neoplasia (MEN) syndrome or synchronous neoplasia were excluded. Clinicopathological and therapeutic variables, follow-up, recurrence, and mortality data were collected.
RESULTS
In all, 21 patients were included. Most of the tumors were diagnosed incidentally as a single small polypoid lesion limited to mucosa/submucosa and with a low histological grade. Four (19.0%) patients presented with metastatic involvement at diagnosis (lymphatic and/or hepatic). These four patients also had a high or intermediate mitotic grade and infiltration further than submucosa. Local resection was applied in most cases as curative treatment. There were two cases of tumor recurrence and two tumor-related deaths with a 5-year disease-free survival of 81.0%.
CONCLUSIONS
The majority of these tumors were diagnosed at a localized stage and had a good prognosis with treatment. Nevertheless, given the potential metastatic risk, a close follow-up is necessary, especially in those with aggressive pathological factors such as deep infiltration or high histological grade.
Topics: Humans; Neuroendocrine Tumors; Gastrins; Retrospective Studies; Duodenal Neoplasms
PubMed: 36168962
DOI: 10.1111/1751-2980.13129 -
World Journal of Gastroenterology May 2015To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs). (Comparative Study)
Comparative Study
AIM
To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).
METHODS
Clinicopathological data were reviewed for 84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September 2002 and August 2014 at a single prefectural cancer center. Superficial NADETs were defined as lesions confined to the mucosa or submucosa. Demographic and clinicopathological data were retrieved from charts, endoscopic and pathologic reports. Endoscopic reports included endoscopic diagnosis, location, gross type, diameter, color, and presence or absence of biopsy. Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained. Endoscopic images were obtained using routine, front-view, high-resolution video endoscopy, and chromoendoscopy with indigocarmine was performed for all lesions. Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma. Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens. Sensitivity, specificity, and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.
RESULTS
The majority (81%) of the lesions were located in the second portion of the duodenum. The median lesion diameter was 14.5 mm according to final histology. Surgery was performed for 49 lesions from 39 patients, and 35 lesions from 35 patients were endoscopically resected. Final histology confirmed 65 carcinomas, 15 adenomas, and 3 hyperplasias. A final diagnosis of duodenal carcinoma was made for 91% (52/57) of the lesions diagnosed as carcinoma by endoscopy and 93% (42/45) of the lesions diagnosed as carcinoma by biopsy. The sensitivity, specificity, and accuracy of endoscopic diagnoses were 80%, 72%, and 78%, respectively, whereas those of biopsy diagnoses were 72%, 80%, and 74%, respectively. Preoperative diagnoses of carcinomas were made in 88% (57/65) of the carcinoma lesions via endoscopy or biopsy. Endoscopic findings associated with carcinoma were red color, depression, and mixed-type morphology.
CONCLUSION
Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.
Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Biopsy; Coloring Agents; Duodenal Neoplasms; Duodenoscopy; Female; Humans; Hyperplasia; Indigo Carmine; Japan; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Video Recording
PubMed: 25987780
DOI: 10.3748/wjg.v21.i18.5560 -
Revista Espanola de Enfermedades... Jun 2022duodenal subepithelial lesions (SELs) are increasingly detected during endoscopic examinations. However, no feasible and safe methods are available to remove duodenal...
INTRODUCTION AND AIM
duodenal subepithelial lesions (SELs) are increasingly detected during endoscopic examinations. However, no feasible and safe methods are available to remove duodenal SELs. The present study aimed to assess the feasibility and safety of endoscopic resection in combination with ligation (ER-L) for the removal of duodenal SELs.
PATIENTS AND METHODS
a total of 101 patients with duodenal SELs underwent ER-L from February 2010 to February 2020. The primary outcomes were complete resection, en bloc resection and R0 resection. The secondary outcomes included procedure duration, bleeding, perforation and residual lesions. A total of 101 patients with 101 duodenal SELs (ranged from 8.4 mm to 20.2 mm in size) were included in the study.
RESULTS
most of the SELs (95.1 %) originated from the submucosal layer and were successfully removed using ER-L. The rates of complete resection, en bloc resection and R0 resection were 100 %, 96.0 % and 88.1 %, respectively. The median procedure duration was eight minutes. There were no severe complications, except for four patients who developed post-procedure bleeding (4.0 %) and recovered after conservative treatment. Furthermore, no residual lesions were detected during the follow-up period (median of 36 months). In fact, logistic regression analysis showed that the size of duodenal SELs was an independent factor for R0 resection during the ER-L procedure.
CONCLUSION
in conclusion, ER-L is feasible and safe to remove duodenal SELs that originate from the submucosal layer and are less than 20 mm. However, the feasibility and safety of the ER-L should be further confirmed when removing the duodenal SELs that originate from the muscularis propria (MP) layer and are larger than 20 mm in diameter.
Topics: Duodenal Neoplasms; Duodenum; Endoscopic Mucosal Resection; Humans; Ligation; Retrospective Studies; Stomach Neoplasms; Treatment Outcome
PubMed: 34565164
DOI: 10.17235/reed.2021.8105/2021 -
European Journal of Surgical Oncology :... Oct 2019Gastrointestinal stromal tumors (GISTs), with a primary occurrence in the duodenum and proximal jejunum, are rare and treatment is poorly understood. This study aimed to...
INTRODUCTION
Gastrointestinal stromal tumors (GISTs), with a primary occurrence in the duodenum and proximal jejunum, are rare and treatment is poorly understood. This study aimed to evaluate the main factors influencing the prognosis of GIST resection in this complex anatomical structure.
MATERIALS AND METHODS
This retrospective study included 47 patients who underwent surgery for primary GIST of the duodenum (20) and proximal jejunum (27) between 2012 and 2017. Perioperative clinical data as well as relapse and survival information were collected.
RESULTS
All patients underwent negative margin resection (R0) of duodenal and proximal jejunum GISTs. Complications occurred more frequently in treatment of duodenal GISTs than proximal jejunum GISTs (p = 0.003). GISTs in D3 (the 3rd portion of duodenum) were related to larger tumor size (p = 0.001), higher probability of severe complication rate (p = 0.042), longer hospital stays (p = 0.023) and fasting time (p = 0.020). More complications were found for patients with digestive reconstruction than limited resection (p = 0.010). Additionally, patients with a tumor mass larger than 5 cm or a mitotic index greater than 5 mitoses/50 HPFs showed poorer therapeutic outcomes. The 1- and 3-year overall survival was 97.9% and 86.1%, respectively and were not influenced by operation type (p = 0.061) or GIST position (p = 0.447).
CONCLUSION
With negative operational margins, limited resection is a safe and feasible procedure for duodenal and proximal jejunum GIST patients and unnecessary digestive reconstruction should be avoided. Considering the severe complication rate, resection for GISTs in D3 should be performed with care.
Topics: Adult; Aged; Aged, 80 and over; China; Digestive System Surgical Procedures; Duodenal Neoplasms; Duodenum; Female; Follow-Up Studies; Gastrointestinal Stromal Tumors; Humans; Incidence; Jejunal Neoplasms; Jejunum; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Retrospective Studies; Survival Rate; Young Adult
PubMed: 31085027
DOI: 10.1016/j.ejso.2019.05.002 -
Medicine Jan 2021Primary periampullary duodenal cancer accounts for 3% to 17% of periampullary cancers. There are no previous reports of metachronous primary colon and periampullary...
RATIONALE
Primary periampullary duodenal cancer accounts for 3% to 17% of periampullary cancers. There are no previous reports of metachronous primary colon and periampullary duodenal cancer.
PATIENT CONCERNS
We present a case of primary periampullary duodenal cancer that occurred metachronously after colon cancer.
DIAGNOSES
Imaging and endoscopic examinations, serum tumor marker levels, and pathology confirmed metachronous colon and periampullary duodenal cancer, with 14-month interval between the diagnoses of the 2 malignancies.
INTERVENTION
The patient received right hemicolectomy combined with mFOLFOX6 chemotherapy for colon cancer and pancreatoduodenectomy for periampullary duodenal cancer.
OUTCOMES
The patient has been followed up for 6 years since the pancreatoduodenectomy and shows no signs of recurrence or metastasis.
LESSONS
The risk of developing a second malignancy may be associated with the site of the first tumor. Patients with right colon cancer may have particularly high risk of developing small intestinal cancer, including duodenal cancer. Early detection and active surgical treatments can improve prognosis. Long-term regular follow-up is necessary to detect new malignancies occurring after the diagnosis colon cancer.
Topics: Abdominal Pain; Aged; Antigens, Tumor-Associated, Carbohydrate; Carcinoembryonic Antigen; Duodenal Neoplasms; Humans; Male; Neoplasms, Second Primary; Prognosis; Ultrasonography
PubMed: 33546078
DOI: 10.1097/MD.0000000000024378 -
Internal Medicine (Tokyo, Japan) May 2019Carcinosarcoma is a biphasic malignant tumor comprising both carcinomatous and sarcomatous components; its occurrence in the duodenum is very rare. We herein report the... (Review)
Review
Carcinosarcoma is a biphasic malignant tumor comprising both carcinomatous and sarcomatous components; its occurrence in the duodenum is very rare. We herein report the case of a 96-year-old woman with duodenal carcinosarcoma showing rapid growth within the past year. The tumor was found to be bulging into the lumen and predominantly comprised sarcomatoid components with focal positive staining for cytokeratin. Therefore, the tumor was diagnosed as duodenal carcinosarcoma. The clinical information of the present case and our literature review of the 12 cases reported to date will help physicians diagnose and treat this rare tumor.
Topics: Aged, 80 and over; Carcinosarcoma; Duodenal Neoplasms; Endoscopy, Digestive System; Fatal Outcome; Female; Humans; Incidental Findings; Intestinal Obstruction; Liver Neoplasms; Rare Diseases
PubMed: 30568154
DOI: 10.2169/internalmedicine.2094-18 -
Journal of Clinical Pathology Jan 2016For many years, it was generally accepted that the vast majority of the colorectal carcinomas (CRCs) evolved from conventional adenomas, via the adenoma-carcinoma... (Review)
Review
For many years, it was generally accepted that the vast majority of the colorectal carcinomas (CRCs) evolved from conventional adenomas, via the adenoma-carcinoma sequence. More recently, serrated colorectal polyps (hyperplastic polyps, sessile serrated polyps and traditional serrated adenomas (TSAs)) have emerged as an alternative pathway of colorectal carcinogenesis. It has been estimated that about 30% of the CRC progress via the serrated pathway. Recently, TSAs were also detected in the upper digestive tract. In this work, we review the literature on TSA in the oesophagus, the stomach, the duodenum, the pancreatic main duct and the gallbladder. The review indicated that 53.4% (n=39) out of the 73 TSA of the upper digestive tract now in record showed a simultaneously growing invasive carcinoma. As a corollary, TSAs of the upper digestive tract are aggressive adenomas that should be radically excised, either endoscopically or surgically, to rule out the possibility of a synchronously growing invasive adenocarcinoma or to prevent cancer progression. The present findings substantiate a TSA pathway of carcinogenesis in the upper digestive tract.
Topics: Adenoma; Biomarkers, Tumor; Biopsy; Duodenal Neoplasms; Esophageal Neoplasms; Gallbladder; Humans; Immunohistochemistry; Neoplasm Invasiveness; Pancreatic Neoplasms; Prognosis; Stomach Neoplasms
PubMed: 26468393
DOI: 10.1136/jclinpath-2015-203258