Anthony M. Gamboa

Treatment allocation in patients with early-stage esophageal adenocarcinoma: Prevalence and predictors of lymph node involvement

In considering treatment allocation for patients with early esophageal adenocarcinoma, the incidence of lymph node metastasis is a critical determinant; however, this has not been well defined or stratified by the relevant clinical predictors of lymph node spread.

Mo1135 Trends in the Incidence of Esophageal Adenocarcinoma and Early Stage Esophageal Adenocarcinoma in the United States

G A A b st ra ct s difference with 139 (65%) females and 74 (35%) males having IEM-A versus 5 (33%) females and 10 (66%) males with IEM-P (p = 0.035). The mean age of IEM-P patients (61.7 years) was significantly higher (p < 0.05) than that of IEM-A (55.7 years). There was no significant difference in the race: 153 (72%) whites, 56 (26%) blacks in IEM-A versus 11 (73%) whites and 4 (27%) blacks in IEM-P. 147/228 patients had an ambulatory reflux study done. 88 (61%) were abnormal. Of those 84 were IEM-A (60%) and 4 IEM-P (80%) (p = 0.36). Finally, abnormal bolus transit for both liquid and viscous was present in 10/ 11 (91%) of IEM-P versus 128/182 (70% of 182) of IEM-A. Failure to find p < 0.05 for reflux and bolus transit likely due to type II statistical error. Conclusions: These results support the hypothesis that there are 2 distinct clinical subtypes of IEM. Furthermore, they suggest that IEM-P with an older male predominance and with a trend to more severe reflux and more abnormal bolus transit is a more severe manifestation than IEM-A. IEM subtypes: IEM-A and IEM-P

Cannulation time is a more accurate measure of cannulation difficulty in endoscopic retrograde cholangiopancreatography than the number of attempts.

Background: Cannulation of the common bile duct (CBD) is the initial and sometime challenging step in endoscopic retrograde cholangiopancreatography (ERCP) procedure. Endoscopists often use cannulation attempts and cannulation time to grade cannulation difficulty, but a standard system has yet to be established. The objective of this study was to compare cannulation times with numbers of cannulation attempts, as measures of cannulation difficulty. Methods: We conducted a prospective study in a tertiary referral center, enrolling 58 patients who were undergoing ERCP for a variety of indications. Cannulation time and the number of cannulation attempts were recorded for each patient. A subset of 14 ERCPs had two observers assessing attempts at cannulation. Cannulation time, number of attempts and inter-observer variability in assessment of attempts were compared and studied. Results: The degree of agreement between two the methods (cannulation times and number of cannulation attempts) was unacceptable. There were considerable discrepancies between attempt tallies from two observers but the mean difference was statistically insignificant. Conclusion: The grade of cannulation difficulty for a given ERCP procedure may differ when different methods are used (total cannulation time vs number of attempts); thus, grading by different methods should not be used interchangeably. Cannulation time is a more objective and more accurate assessment tool for grading cannulation difficulty than the number of attempts to cannulate the papilla.

The Role of Endoscopy in the Diagnosis, Staging, and Management of Esophageal Cancer

The incidence of esophageal adenocarcinoma (EAC) has increased approximately 700 % since the late 1970s, outpacing the rate of growth of other major epithelial malignancies. Meanwhile the incidence of esophageal squamous cell carcinoma (ESCC) has declined over several decades. While SCC has no known premalignant condition amenable to screening or treatment, EAC is preceded by Barrett’s esophagus (BE), or intestinal metaplasia, in a metaplasia-dysplasia-carcinoma sequence. Therefore, BE has been a target for screening efforts and eradication via endoscopic approaches in order to detect and prevent EAC. The risk of developing EAC among patients with untreated BE is thought to be 0.4–0.5 % per year. Men and patients with long-segment BE have a higher risk of progression. The relatively good 5-year prognosis in early-stage disease compared with advanced stages has led to efforts aimed at the early detection of esophageal cancer in BE. The use of endoscopy for the prevention, diagnosis, and treatment of esophageal cancer continues to evolve.

Sa2041 Predictors of Lymph Nodal Metastases With Resectable Pancreatic Adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed at an advanced stage. Breath testing is a non-invasive method that detects volatile organic compounds (VOCs). The aim was to identify VOCs that discriminate patients with PDAC from those with chronic pancreatitis (CP) and healthy controls. Methods: Blood was obtained from healthy controls (screening colonoscopy), severe CP (SCP, imaging demonstrating pancreatic calcifications), minimal change CP (MCCP, ≥4 standard endoscopic ultrasound (EUS) criteria and endoscopic pancreatic function testing peak bicarbonate <80 mEq), and PDAC (positive cytology obtained by EUS guided fine needle aspiration).Twenty milliliters of headspace was removed from the samples and analyzed for 22 VOCs by selected ion flow tube mass spectrometry. Analysis of variance was used to assess differences in VOC levels and receiver operating characteristic (ROC) analysis was performed to assess the role of VOCs in distinguishing PDAC from severe CP, MCCP and healthy controls. Results: 73 patients were included (20 healthy controls, 19 MCCP, 18 SCP and 16 PDAC). Adjusting for tobacco and alcohol usage, acetonitrile, ethanol, isoprene, 1-heptene, ammonia, ethane and triethyl amine were found to be associated with PDAC compared to all groups. ROC

Mo1042 Incidence and Predictors of Lymph Nodal Metastases in Patients With Cholangiocarcinoma in the United States

A S L D A b st ra ct s Multivariate logistic regression analyses showed that younger age, African-American race, scirrhous, spindle cell or pleomorphic histology and severe fibrosis score were independent factors associated with AFP-elevated HCC. Conclusions: Elevated pretreatment serum AFP level (i.e. A-stage) is an AJCC-stage independent poor prognostic factor in HCC. We recommend the incorporation of A-stage within the current TNM-based AJCC staging system to enhance estimates of survival and aid therapeutic decision-making, especially in earlier stage HCC.