Takashi Ishikawa

ENDOLUMINAL GASTROPLICATION FOR GASTROESOPHAGEAL REFLUX APPEARING AFTER GASTRIC SURGERY

Endoluminal gastroplication (ELGP) is a new endoscopic treatment for gastroesophageal reflux disease (GERD). However, its efficacy has been reported only for primary GERD but not for postoperative GERD. Here we report the first two cases of GERD that appeared after gastric surgery and were successfully treated by ELGP. Both patients developed GERD after gastric surgery. Esophagogastrofiberscopy showed esophagitis and small hiatal hernia. The symptoms failed to disappear after medical therapy and ELGP was performed. ELGP involved the use of the BARD (EndoCinchTM) endoscopic suturing system, where two to three plications were placed at the esophagogastric junction. Procedure time, start of soft diet and hospital stay were 55 min, the first postoperative day (POD), 5 days and 60 min, 1 POD and 5 days, for patients 1 and 2, respectively. No adverse events were noted apart from mild and transient epigastric pain. The GERD‐related symptoms markedly improved after ELGP. Improvements were also noted in acid exposure time and bile reflux time after the procedure. ELGP is safe and effective for GERD that develops after surgery although this needs to be confirmed in long‐term follow‐up studies. ELGP is potentially suitable for GERD after Billroth‐I distal gastrectomy with lymph node dissection for gastric cancer.

CLINICAL SIGNIFICANCE OF TUMOR MARKERS IN BREAST CANCER

CA15-3, NCC-ST-439, BCA225 and CEA were measured in patients with breast cancer and the clinical significance of the these tumor markers were studied on. In primary breast cancers, the positive rates of them were 11_??_14%. With an advance in the stage of the disease, the positive rate for each marker increased, but in stages I and II the positive rate was low, indicating that these markers were unsatisfactory for screening. In recurrent cases following surgery for breast cancer, all the tumor markers showed a positive rate higher than that in non-recurrent cases. The positive rates of tumor markers at the time when definite diagnosis of recurrent cancer was made were high in the liver and bone, but low in lymph nodes, skin and thoracic wall. Organ specificity of these tumor markers could not be confirmed. The positive rates in recurrent breast cancers increased with combination assay, suggesting that tumor marker determination is extremely useful for postoperative screening. In particular, the positive rates of CEA and CA15-3 showed the highest value of 66.0% and the correlation was also, low, indicating that the combination is satisfactory.