Introduction/Aim: Gastric neuroendocrine tumors (GNETs) frequently have an indolent clinical course, despite their metastatic potential. The aim of the study was to identify prognostic factors ...associated with overall survival and risk of metastases and to evaluate the impact of serial measurements of chromogranin A (CgA). Methods: The authors performed a retrospective cohort study including consecutive patients with GNET diagnosed between 2010 and 2019, with a minimum follow-up of 1 year. Univariate and multivariate analyses were performed. Results: We included 132 patients with GNET (type I, 113 patients; type II, 1 patient; type III, 14 patients; type IV, 2 patients; not classifiable, 2 patients), with 61% being female and a mean age at diagnosis of 66 years. During the follow-up period (median 66 months), 3 (2.3%) patients died due to metastatic disease (1 patient with type III and 2 patients with type IV). Male gender (p = 0.030), type III/IV (p < 0.001), Ki-67 index >20% (p < 0.001), grade 2/3 (p < 0.001), invasion beyond the submucosa (p < 0.001), and presence of metastases (p < 0.001) were identified as risk factors for mortality in the univariate analysis. Metastasis developed in 7 patients (5.3%). Multivariable analysis revealed that Ki-67 >20% (p = 0.016) was an independent risk factor for metastasis. Overall, CgA showed a sensitivity of 20% for detection of recurrence and a specificity of 79% (sensitivity of 8% and specificity of 71% in type I GNETs). Conclusion: Identification of risk factors for the presence of metastases and for mortality in these groups of patients can help in individualizing the therapeutic strategy. CgA seems to be a weak marker for monitoring patients with GNET.
Introduction: With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of ...gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% 95% CI: 3.8–9.6% vs. 35.8% 95% CI: 23.9–48.5%. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 95% CI: 0.127–0.954), shorter ICU length of stay (mean difference −14.77 days 95% CI: −26.57 to −2.98), and time until AL resolution (17.6 days 95% CI: 14.1–21.2 vs. 39.4 days 95% CI: 27.0–51.8) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay. Conclusions: Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).
The pro-carcinogenic effects of prostaglandin E2 (PGE2) in colonic mucosa are not only regulated by the rates between Cyclooxygenase-2 (COX-2) biosynthesis and 15-Hydroxyprostaglandin Dehydrogenase ...(15-PGDH)-dependent degradation but also the steady-state levels of PGE2 in extracellular microenvironment, maintained by key specific prostaglandin transporters, the Multidrug Resistance Protein (MRP4) (efflux carrier) and Prostaglandin Transporter (PGT) (influx carrier). To understand the contribution of genetic variability in genes coding for COX-2/15-PGDH/MRP4/PGT proteins in CRC development, we conducted a hospital-based case-control study involving 246 CRC patients and 480 cancer-free controls. A total of 51 tagSNPs were characterized using the Sequenom platform through multiplexed amplification followed by mass-spectrometric product separation or allelic discrimination using real-time PCR. Seven tagSNPs were implicated in CRC development: the rs689466 in COX-2 gene, the rs1346271 and rs1426945 in 15-PGDH, the rs6439448 and rs7616492 in PGT and rs1751051 and rs1751031 in MRP4 coding genes. Upon a stratified analysis a measurable gene-environment interaction was noticed between rs689466 and smoking habits, with individuals ever-smokers carriers of rs689466 GG homozygous genotype having a nearly 6-fold increased susceptibility for CRC onset (95%CI: 1.49-22.42, P = 0.011). Furthermore, the multifactor dimensionality reduction (MDR) analysis identified an overall four-factor best gene-gene interactive model, including the rs1426945, rs6439448, rs1751051 and rs1751031 polymorphisms. This model had the highest cross-validation consistency (10/10, P<0.0001) and an accuracy of 0.6957 and was further associated with a 5-fold increased risk for CRC development (95%CI: 3.89-7.02, P<0.0001). In conclusion, specific low penetrance genes in the pro-carcinogenic PGE2 pathway appear to modulate the genetic susceptibility for CRC development. A clearer understanding on CRC etiology through the identification of biomarkers of colorectal carcinogenesis might allow a better definition of risk models that are more likely to benefit from targeted preventive strategies to reduce CRC burden.
Using narrow band imaging, the columnar inlet revealed regular circular/oval mucosa surrounded by regular vessels (Fig. 4), suggestive of oxyntic type mucosa. Due to the risk of symptoms relapse with ...proton-pump inhibitor (PPI) withdrawal, therapeutic options, namely argon plasma coagulation (APC) and long-term PPI, were discussed with the patient. Conflict of Interest Statement The authors have no conflicts of interest to declare.
Even though the workload is much greater compared to the previous years, the amazing work of the editorial team but particularly that of the reviewers has allowed us to significantly improve our ...times, which are now attractive for the authors (Fig. 1). See PDF. Review and publication times. Since 2015, the review and editorial times have been in line with the best journals in the area. * For resubmitted articles. Pedro Pimentel-Nunesa,b,c, Miguel Bispod, Nuno Almeidae, Mariana Machadof aDepartment of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal bDepartment of Surgery and Physiology, Porto Faculty of Medicine, Porto, Portugal cCINTESIS/Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto, Portugal dDepartment of Gastroenterology and Digestive Endoscopy, Champalimaud Foundation, Lisbon, Portugal eGastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal fGastroenterology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal 1 Pimentel Nunes P . GE-ANew Path! GE PortJGastroenterol. 2015 Mar;22(1): 1.
Introduction: Gastrointestinal neuroendocrine tumors (GI-NETs) are being more frequently diagnosed and treated by endoscopic resection (ER) techniques. However, comparison studies of the different ER ...techniques or long-term outcomes are rarely reported. Methods: This was a single-center retrospective study analyzing short and long-term outcomes after ER of gastric, duodenum, and rectal GI-NETs. Comparison between standard EMR (sEMR), EMR with a cap (EMRc), and endoscopic submucosal dissection (ESD) was made. Results: Fifty-three patients with GI-NET (25 gastric, 15 duodenal, and 13 rectal; sEMR = 21; EMRc = 19; ESD = 13) were included in the analysis. Median tumor size was 11 mm (range 4–20), significantly larger in the ESD and EMRc groups compared to the sEMR group (p < 0.05). Complete ER was possible in all cases with 68% histological complete resection (no difference between the groups). Complication rate was significantly higher in the EMRc group (EMRc 32%, ESD 8%, and EMRs 0%, p = 0.01). Local recurrence occurred in only one patient, and systemic recurrence in 6%, with size ≥ 12 mm being a risk factor for systemic recurrence (p = 0.05). Specific disease-free survival after ER was 98%. Conclusion: ER is a safe and highly effective treatment particularly for less than 12 mm luminal GI-NETs. EMRc is associated with a high complication rate and should be avoided. sEMR is an easy and safe technique that is associated with long-term curability, and it is probably the best therapeutic option for most luminal GI-NETs. ESD appears to be the best option for lesions that cannot be resected en bloc with sEMR. Multicenter, prospective randomized trials should confirm these results.
...the number of submissions increased (and so the workload) and the time for publication in PubMed also significantly increased. Time is expressed in weeks. * Final decision for resubmitted ...articles. Since 2016, GE is also indexed in Scopus and citations can be measured using CiteScore (https://www.scopus.com/sourceid/21100453530). ...since 2017 the number of submitted articles is not significantly increasing, meaning that we are having difficulties reaching different authors (even though the submitted articles from non-Portuguese authors has increased). ...even though submission of original articles has increased, more than 50% of them are rejected (85% rejection rate for non-Portuguese authors).
PDF
