Hiroshi Kawata

Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate

BACKGROUND Circumferential mucosal incision around a lesion is effective for reliable endoscopic mucosal resection. However, mucosal incision with a needle knife is difficult, even with submucosal injection of normal saline solution. To make needle-knife incision easier and safer, sodium hyaluronate has been used rather than normal saline solution. The aim of this study was to evaluate the clinical outcome of endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. METHODS For 70 gastric lesions treated by submucosal injection of sodium hyaluronate, the size of the lesion and the resection specimen, the en bloc resection rate, complications, and local recurrence during follow-up were assessed. RESULTS The mean size of the lesions and resection specimens were, respectively, 19.9 mm and 30.0 mm. The en bloc resection rates were 89% (42/47) for lesions up to 20 mm in diameter and 48% (11/23) for those greater than 20 mm (1-20 mm vs. >20 mm, p = 0.0004). Three patients underwent surgery because of invasive cancer in the EMR specimen. During follow-up (median 14 months, range 3-38 months), 2 recurrent lesions were found. No major complication occurred. CONCLUSIONS Submucosal injection of sodium hyaluronate is a reliable method with a high success rate for en bloc resection of lesions up to 20 mm in diameter. Mucosal incision with a needle knife can be performed safely with submucosal injection of sodium hyaluronate.

Aberrant Expression of CDX2 in the Gastric Mucosa With and Without Intestinal Metaplasia: Effect of Eradication of Helicobacter pylori

Background. The intestine‐specific transcription factor CDX2 plays an important role in differentiation and maintenance of intestinal epithelial cells. Development and progression of intestinal metaplasia (IM) in the stomach is closely associated with Helicobacter pylori‐gastritis. We investigated expression of CDX2 protein in the gastric mucosa with and without IM before and after eradication of H. pylori.

p53 expression in the gastric mucosa before and after eradication of Helicobacter pylori.

Accumulation of p53 has been recognized in the gastric mucosa infected with Helicobacter pylori. We investigated the prevalence of p53‐positive cells in the gastric mucosa before and one month after eradication of H. pylori and the relationship between p53 positivity and inflammation and cell proliferation.

Change in apoptosis in the gastric surface epithelium and glands after eradication of Helicobacter pylori.

BACKGROUND Change in apoptosis in gastric glands after eradication of Helicobacter pylori has never been reported. AIMS The purpose of this paper is to investigate the change in apoptosis in gastric glands after eradication of Heliobacter pylori. PATIENTS AND METHODS We studied 23 Heliobacter pylori-positive patients with duodenal and gastric ulcers, who were monitored for 6-12 months after eradication, and eight controls. Biopsies were taken from the antrum and body. Apoptosis was evaluated immunohistochemically using anti-single stranded DNA antibody. Apoptotic index was calculated by counting immunostained cells in surface epithelial and glandular cells. RESULTS In the surface epithelium, Apoptotic indexes were significantly higher in patients than in controls. In the upper portion of fundic glands, apoptotic indexes were significantly higher in patients with gastric ulcers (14.2% (9.3, 17.8)) (median (1st quartile, 3rd quartile)) than in controls (8.0% (2.0, 9.0), p < 0.01) and decreased significantly after eradication (3.4% (2.0, 5.3)), p < 0.01). In pyloric glands, apoptotic indexes were no different between patients and controls. In the lower portion of fundic glands, apoptotic indexes were very low, both in patients and in controls. CONCLUSIONS Our results showed that apoptosis, not only of surface epithelial cells but also of glandular cells in the upper portion of fundic glands, increased in Heliobacter pylori-positive patients with gastric ulcers and decreased to normal levels after eradication of Heliobacter pylori.