G. Missale

The pathology of gastric cardia : A prospective, endoscopic, and morphologic study

“Carditis” (inflammation of the gastric cardiac mucosa) may be associated with gastroesophageal reflux disease (GERD), whereas other studies argue that Helicobacter pylori could play a significant role in the chronic cardiac damage. We examined prospectively histologic features of gastric cardia, esophagitis, and H. pylori status in 204 consecutive subjects with GERD symptoms (57.3% male, 42.7% female mean age 49.2 y) undergoing upper gastrointestinal endoscopy with multiple biopsies in the distal esophagus, cardiac region, and stomach. These were assessed for esophagitis landmarks [Ismail Beigi grading (g0-3)], gastritis, and H. pylori infection (Sydney classification). The average symptom duration was 10.8 months. Endoscopy showed no erosive disease in 54.5% patients, grade “A” esophagitis in 37.6%, “B” in 8%, and “C” in 1 case. Histologic examination disclosed g0 in 8.3% patients, g1 in 78.4%, g2 in 12.8%, and g3 in 1; analysis of the cardia showed oxyntic mucosa in 27.9% patients and chronic cardiac mucosa inflammation in 72.1%. Carditis was significantly related to macroscopic esophagitis (P=0.044) and heartburn score (P=0.001). H. pylori cardiac infection was present in 27.4% cases (73.2% associated with cardiac mucosa). Gastric H. pylori infection was demonstrated in 35% patients. H. pylori in the cardiac region was associated with gastric H. pylori infection (P=0.001) and with paucity of GERD symptoms (P=0.05). A good correlation between carditis and GERD, concerning symptoms and macroscopic esophagitis was found in this study. H. pylori-related carditis is likely to be differently compared with the GERD-related type.

P.1.167: ROLE OF SMALL BOWEL CAPSULE ENDOSCOPY IN PATIENTS WITH HEREDITARY INTESTINAL POLYPOSIS: A SINGLE CENTER EXPERIENCE

22.4% required additional argon-plasma-coagulation. Due to size ( 4 mm), 5.1% were treated by forceps biopsy and additional APC-therapy. Local recurrence developed in 42.3% and was retreated endoscopically. Only one major complication (single perforation) was recorded. Minor complications (14.2%) consisted in either immediate bleeding after resection or bleeding up to 48 h after endoscopic therapy. All complications could be managed endoscopically.Endoscopic mucosal resection, if necessary combined with argonplasma-coagulation, represents an efficient and acceptably safe technique for treating duodenal adenomata. However, in comparison with colonic polypectomy, local recurrence and complications are more common. Follow-up endoscopy is recommended in short intervals such as 3 months. As relevant bleeding can occur up to 48 hours after resection, patients are in need of close monitoring. EMR should therefore not be performed in an outpatient setting.