Giancarlo D'Ambra

Type I gastric carcinoids: a prospective study on endoscopic management and recurrence rate.

Background: Type I gastric carcinoids (TIGCs) are neuroendocrine neoplasms arising from enterochromaffin-like cells in atrophic body gastritis. Data regarding their evolution in prospective series are scarce, thus treatment and follow-up are not codified. Our aim was to evaluate clinical outcome and recurrence in TIGCs managed by endoscopic approach. Methods: 33 patients (24 females; median age 65 years, range 23–81) were included and managed through endoscopic follow-up every 6–12 months, with lesion removal and multiple gastric biopsies. Baseline clinical and histological features were analyzed as risk factors by Cox regression. Results: At diagnosis, 7 tumors were intramucosal carcinoids and 26 were polyps (median diameter 5 mm, range 2–20), multiple in 17 patients. Associated severe atrophy was present in 21 cases (63.6%), while mild atrophy was found in 6 cases (18.2%). During a 46-month median follow-up, survival was 100% and no metastases occurred. One patient developed a less-differentiated carcinoid that was radically treated by surgery. 21 patients (63.6%) had recurrence after a median of 8 months, 14 of these (66.6%) had a second recurrence after a median of 8 months following the previous carcinoid removal. Median recurrence-free survival was 24 months. Neither clinical nor biochemical recurrence-predicting factors were found. Conclusions: Although about 60% of TIGCs had recurrence after endoscopic resection, endoscopic management may be considered safe and effective.

3412 A standard protocol of biopsies during upper gi endoscopy (ugie) improve the diagnosis in patients with iron deficency anemia (ida).

Endoscopists who investigate patients with IDA and no specific gastrointestinal (GI) symptoms, usually make effort to identify a source of bleeding. About 38% of patients with IDA still have an unsolved problem (no detectable lesions D.C. Rockey `93) despite they had been submitted upper and lower GI endoscopy. Little emphasis has been put in considering iron malabsorption as an ethiological factor for IDA.Aim: determine the prevalence of gastric and duodenal diseases among patients with unexplained IDA that underwent to UGIE and the value of endoscopic alterations in selecting patients for biopsy. Methods: 150 consecutive patients (32 M, 118F) (median age 44, range 20-74) referred from the Hemathologic Dpt., with unexplained anemia, without GI symptoms and excluded for GI bleeding lesions were submitted to UGIE with a standard protocol of double biopsies of the fundus, antrum and duodenum. Endoscopic and histological findings were referred according to Sydney classification. Results:endoscopic findings: table 1. 21 (41%)out of the 51 pts with normal mucosa at endoscopy had normal fundus and duodenum at histology, 22 (43%) Cronic fundic Atrofic Gastritis (CGA) and 8 (16%) a Coeliac Disease (CD). 16 (20%) out of 80 CGA at histology were suspected at endoscopy. 12(57%) out of 21 CD at histology were suspected at endoscopy, but only 9(42.8) confirmed. Conclusions: Because CAG and CD were suspected at endoscopy only in (18.6%)pts while at histology were found in(67.3%), by routine biopsies in anemic patients, without any bleeding lesions, the number of diagnosis can be increased of 2.6 fold. Then, because the discrepancy between histology and endoscopic finding the latter cannot select patients for biopsy and a standard routine protocol of biopsie should be recommended in IDA patients.