C. Descamps

Controlled Trial of Cimetidine in Reflux Esophagitis

In an eight-week double-blind trial, the effectiveness of cimetidine (1.6 g/day) was compared to placebo in 34 patients with symptomatic esophagitis confirmed by endoscopy with biopsies and/or by acid infusion test. Patients treated with cimetidine had significantly less symptomatic days during the first six weeks and less symptomatic nights during the first two weeks, and they consumed less antacids during the whole trial period. Endoscopic evaluation of 17 patients on cimetidine and of 15 patients on placebo did not show any significant difference in severity and extent of esophageal lesions after eight weeks, but histological assessment of 16 patients on cimetidine and 13 patients on placebo showed a significant improvement after eight weeks of cimetidine (P<0.025). These results show that cimetidine has a rapid effect on symptoms of reflux esophagitis and that, in some cases, it may reduce the esophageal lesions after eight weeks.

Hepatobiliary cystadenocarcinoma without ovarian stroma and normal CA 19-9 levels. Unusually prolonged evolution.

Hepatobiliary cystadenoma and cystadenocarcinoma are rare tumors of the liver. The differential diagnosis of cystadenoma includes other cystic neoplasms, nonneoplastic cysts, and even on some occasions parasitic liver involvement. It has been suggested that elevated serum level of the tumor marker CA 19-9 may be of value in distinguishing between cystadenoma with ovarian stroma and hydatid disease. We report the unique case of a male patient with a hepatobiliary cystadenocarcinoma without ovarian stroma of prolonged evolution characterized by a normal CA 19-9 serum level, low cyst fluid CA 19-9, and a very weak CA 19-9 expression on cyst epithelium.

Endoscopic Nd:YAG treatment of superficial gastric carcinoma: Experience in 18 western inoperable patients

Endoscopic treatment of superficial gastric cancer has been reported to be effective by many Japanese teams. In this study, the Nd:YAG laser was used to treat superficial gastric carcinoma in inoperable Caucasian patients with the aim of obtaining a complete response, i.e., disappearance of the lesion endoscopically and biopsy specimens negative for cancer. Eighteen patients unsuitable for surgery with various endoscopic patterns of superficial gastric cancer were treated with the Nd:YAG laser. The endoscopic pattern was type I in 4 patients, type II in 10 (5 type IIa, 1 type IIb, 2 type IIc, 2 mixed IIa + IIc), and type III in 4. Staging by echoendoscopy was performed in 11 patients (T1N0). Nd:YAG laser destruction of the gastric tumor was performed in all cases, with a mean of 4.4 laser sessions per patient. Tumor response was assessed by endoscopy and biopsy. Follow-up averaged 33 +/- 23 (SD) months. Five patients died of diseases unrelated to gastric cancer. An initial complete response was obtained in 16 (89%) patients after a mean of 1.7 laser sessions; histologic evidence of cancer persisted in 2 patients during the entire follow-up period. Among patients with an initial complete response, recurrence was observed in 2. One of them was successfully re-treated. At the end of the follow-up period, 14 (77.7%) of the 18 patients had a complete tumoral response; only 4 patients had histologic evidence of cancer. In 3 of these 4 patients, pretherapeutic echoendoscopic staging had not been performed. Among the 14 patients exhibiting a complete response, 3 had negative biopsy results more than 5 years after diagnosis. No complications occurred. In gastric cancer classified as T1N0 on the basis of pretherapeutic echoendoscopy, a high tumor response rate and even 5-year disease-free survival can be obtained with endoscopic Nd:YAG laser treatment. Endoscopic laser destruction thus appears to be a valuable therapeutic alternative to surgery in inoperable patients with superficial gastric cancer.

Per oral dual-scope rendezvous technique for endoscopic bridging of complete pancreatic duct disruption.

A 43-year-old man with a history of heavy alcohol consumption and recent acute pancreatitis was admitted for recurrent epigastric pain and diagnosed as having a 4-cm pancreatic pseudocyst. Endoscopic retrograde cholangiopancreatography (ERCP) showed a pancreas divisum with total obstruction of the main pancreatic duct (MPD) in the mid-pancreas and no communication with the fluid collection. Minor papilla sphincterotomy was performed with placement of a 7-Fr plastic stent (Zimmon, Wilson-Cook, Winston-Salem, North Carolina, USA) in the pancreatic duct. Endoscopic ultrasound-guided cystogastrostomy was carried out (Pentax EG3860UT, Hamburg, Germany) and a single, 10-Fr double-pigtail stent was placed.