Seibi Kobayashi

A Comparative Case‐Control Study of Colorectal Cancer and Adenoma

We conducted a comparative case‐control study of colorectal cancer and adenoma involving 221 cases with colorectal cancer, 525 cases with colorectal adenoma and 578 neighborhood controls. Daily vegetables intake was associated with lower risks of distal colon adenoma (relative risk (RR)=0.59, 95% confidence interval (CI): 0.39–0.89) and rectal cancer (RR=0.46, 95% CI: 0.25–0.84). Daily beans intake was associated with lower risk of colon adenoma (RR=0.58, 95% CI: 0.37–0.91 for the proximal colon and RR=0.63, 95% CI: 0.45–0.88 for the distal colon) and daily intake of seaweeds was associated with lower risk of rectal cancer (RR=0.42, 95% CI: 0.22–0.82). Daily intake of fish and shellfish also showed an inverse association with the risk of colon adenoma (RR=0.67, 95% CI: 0.45–0.99 for the proximal colon and RR=0.70, 95% CI: 0.52–0.94 for the distal colon). Generally, intakes of animal or vegetable fat‐rich foods, especially meats, were associated with decreases in risks of both adenoma and cancer, though the association of cancer was not statistically significant. Other than dietary factors, daily alcohol drinking was associated with an increased risk of adenoma in the proximal colon (RR=1.95, 95% CI: 1.15–3.29) and ex‐drinkers showed higher risks for colon adenoma and colorectal cancer. Sports or occupational activities and coffee drinking were inversely associated and family history of colorectal cancer was positively associated with the risks of both colorectal adenoma and cancer.

A prospective study of atrophic gastritis and stomach cancer risk

The relation of atrophic gastritis, other gastric lesions and lifestyle factors to stomach cancer risk was prospectively studied among 3,914 subjects who underwent gastroscopic examination and responded to a questionnaire survey at the Aichi Cancer Center Hospital. During 4.4 years of follow‐up on average, 45 incident cases of stomach cancer were identified at least three months after the initial examination. If the baseline endoscopic findings indicated the presence of atrophic gastritis, the risk of developing stomach cancer was increased 5.73‐fold, compared with no indication at the baseline. The risk further increased with advancing degree of atrophy and increasing extension of atrophy on the lesser curvature. These trends in the relative risks were statistically significant (P= 0.027 and P= 0.041, respectively). The risk of developing stomach cancer was statistically significantly increased among subjects with gastric polyps, but not among those with gastric ulcer. Stomach cancer cases tended to consume more cigarettes, alcohol, rice, pickles and salted fish gut/cod roe and less fruits and vegetables and to have more family histories of stomach cancer than noncases, although these differences were not statistically significant. The results of the present study provide additional evidence on the relation between atrophic gastritis and stomach cancer and suggest a need for intensive follow‐up of patients with atrophic gastritis and gastric polyps.

Endoscopic and biopsy criteria for the diagnosis of esophagitis with a fiberoptic esophagoscope.

Endoscopic and biopsy criteria for the diagnosis of esophagitis with a fiberoptic esophagoscope were introduced and a good correlation between them was reported. Erosion and ulceration were reliable endoscopic signs of esophagitis, with histological confirmation in every case. An endoscopic finding of erythema alone was of less value. A pronounced ingrowth of the lamina propria with associated capillaries into the squamous epithelium represents esophagitis and is often associated with an erythematous mucosal change on endoscopy. It has been emphasized that this may be demonstrated even without the whole of the lamina propria in the biopsy specimen. A histological diagnosis of esophagitis was made in 90% of the patients with endoscopic esophagitis. Thus the criteria introduced here seem to be acceptable for the diagnosis of esophagitis from endoscopic biopsy specimens.

Protective factor against progression from atrophic gastritis to gastric cancer—data from a cohort study in Japan

To investigate the association between atrophic gastritis and gastric cancer and to identify the risk and protective factors for the progression of atrophic gastritis to cancer, we conducted a prospective study on 5,373 subjects with neither cancer nor resected stomach who underwent gastroscopic examination and completed a life‐style questionnaire. After an average of 6 years of follow‐up, 69 gastric‐cancer cases were identified, 65 from the subjects with atrophic gastritis and 4 from the subjects without atrophic gastritis. The presence of atrophic gastritis increased the risk of gastric cancer 2.19‐fold, the risk trend increasing with the degree and the extension of atrophy [relative risk (RR) 1.60 for mild atrophy and 2.85 for moderate and severe atrophy]. Among the subjects with atrophic gastritis, family history of gastric cancer (RR 2.27) and a preference for spicy food (RR 1.84) increased the risk, and self‐administered meal controls, such as portion reduction (RR 0.44) reduction of salty food (RR 0.56), and the change to the consumption of easily digested food (RR 0.57) decreased the risk of gastric cancer. The results of this study suggest that atrophic gastritis increases the risk of gastric cancer but that dietary modification prevents the progression from atrophic gastritis to gastric cancer, regardless of pre‐cancerous lesions.

Late gastric carcinoma developing after surgery for benign conditions

Seven cases of late carcinoma developing in the stomach after surgery for benign conditions are presented. Gastroscopic biopsies demonstrated a higher incidence of atrophic gastritis in these patients than in a control group, and frequent polypoid formation at or near the anastomotic site. These changes were seen more often in patients with gastrojejunostomy than in patients with the Billroth I operation. Since the radiographic approach was unsatisfactory, the value of gastroscopy, and of cytology and biopsy under direct vision is emphasized to detect this complication in its early stage.

Atrophic gastritis and stomach cancer risk: cross-sectional analyses.

The relationship between atrophic gastritis and stomach cancer risk was investigated in case‐control analyses involving 387 cases with stomach cancer and 5,422 control subjects who received gastroscopic examination at Aichi Cancer Center Hospital from April, 1985 to March, 1989. The presence of atrophic gastritis, the degree and extension of the atrophy and the presence of granularity and erosion were diagnosed endoscopically by six gastroenterologists. The prevalence of atrophic gastritis increased with age and was higher in males than in females. The relative risk (RR) of stomach cancer was S.13 (95% confidence interval (CI): 2.79–9.42) if a subject had any type of atrophic gastritis. The risk further increased with advancing degree of atrophy and increasing extension on the greater and lesser curvatures. The RR associated with severe atrophy was 7.73 (95% CI: 3.95–15.12). These associations remained significant when analyzed by sex and age. The presence of granularity and erosion did not much affect the estimated risks. A clear difference in risk appeared in the analyses by histological type of cancer. The RR associated with atrophic gastritis was 24.71 (95% CI: 3.46–176.68) for the intestinal type and 3.49 (95% CI: 1.77–6.87) for the diffuse type. These findings may suggest a need for intensive follow‐up of patients with severe atrophic gastritis.

Fiberduodenoscopy: analysis of 353 examinations

Endoscopic examination of the duodenum was successful in 95.7% of 353 cases enploying the Machida FDS-L and the Olympus JF instruments. In the duodenal bulb, active ulcer crater and scar were differentiated. Biopsy specimens were readily obtained, including that from an early carcinoma of the papilla. Pancreatography was accomplished in 12 cases.

CYCLIN D1 EXPRESSION IS USEFUL AS A PROGNOSTIC INDICATOR FOR ADVANCED ESOPHAGEAL CARCINOMAS, BUT NOT FOR SUPERFICIAL TUMORS

The purpose of the present study was to define the overexpression of cyclin D1 in superficial and advanced esophageal carcinomas and to investigate whether the expression of this molecule indicates a poor prognosis. This study included 41 patients with superficial esophageal carcinomas (Tis and T1) and 48 patients with advanced esophageal carcinomas (T2, T3, and T4). The expression of cyclin D1 in surgically resected specimens was evaluated immunohistochemically with a monoclonal antibody. Positive immunoreactivity was found in 31 of 89 cases (35%). Overexpression of cyclin D1 did not correlate with TNM classification or histologic type. Of the 48 patients with advanced esophageal carcinomas, 32 patients with cyclin D1-negative tumors survived longer than did 16 patients with cyclin D1-positive tumors (P = 0.0017). In contrast, we observed no survival difference between patients with cyclin D1-positive and -negative superficial esophageal carcinoma. These results suggest that cyclin D1 indicates a poor prognosis in cases of advanced esophageal carcinoma but not in cases of superficial esophageal carcinoma.

Endoscopic MRI Using 3D-Spoiled GRASS (SPGR) Sequence for Local Staging of Rectal Carcinoma

Objective Magnetic resonance imaging was performed with an MR endoscope to evaluate the depth of invasion of rectal carcinomas. Materials and Methods Twenty-two patients with rectal carcinomas were studied prior to surgery with MRI using a 3D-fast spoiled GRASS (SPGR) sequence, a nonmagnetic endoscope and an antenna probe. Results The MR images on 3D-fast SPGR sequence showed that the normal bowel mucosa had a high signal intensity, the submucosal layer had a low signal intensity, and the muscularis propria had moderate signal intensity. Small tumors had moderate signal intensity similar to the muscularis propria. Advanced tumors with considerable volume revealed heterogeneous findings with intermediate and low signal intensities. The depth of wall invasion by rectal carcinoma was correctly staged with endoscopic MRI in 16 of 22 patients. Conclusion This technique may be useful for the accurate staging of the depth of invasion by rectal carcinomas.

Endoscopic follow-up of gastric polyps.

The authors describe protracted observation of gastric polyps in 118 cases. Only 4 instances of eventual adenocarcinoma, suspected of being malignant change, were found. In 7 cases polyps increased in size, while in 4 cases polyps diminished. A majority of gastric polyps remained static.