Endoscopic Classification of Esophagic Eosinophilia

Introduction： EoE （eosinophilic esophagitis） is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium. In Brazil, it remains a poorly diagnosed disease due to the lack of interaction between the clinician, the endoscopist, and the pathologist. The diagnosis is performed by histological study of esophageal biopsies, with at least fifteen eosinophils per high-power field （EOS/HPF）. Some doubts remain with respect to patients with a clinical picture and symptoms compatible with the disease （EoE）, but who have a lower number of eosinophils than established. The main objective of this study was to create an endoscopic classification for EsEo （esophageal eosinophilia）, which pointed the way to the endoscopist towards the diagnosis. Methods： This study was a prospective, two-year study, at a gastrointestinal endoscopy center where all patients with endoscopic symptoms and/or endoscopic findings suggestive of EsEo were biopsied for histological examination of EOS/HPF. After the study and compilation of the results, a retrospective study was performed, based on a review of electronic medical records, where the same diagnosis was searched, although at a period when this classification was not adopted. Results： A total of 4,251 endoscopies were performed between September 2011 and September 2013. Two biopsies were performed, aimed at lesions, in 133 patients with clinical picture or imaging suggestive of EsEo. Eosinophils were found in 55 patients, corresponding to an incidence of 1.29% of the total population studied and 41.35% of the suspected cases of the disease. EoE was diagnosed in 24 patients during the period of this study. In the two-year retrospective study, only two cases of EoE were found. Conclusions： The results of this study demonstrate that the endoscopic standardization of esophageal lesions, suggestive of eosinophilia, in this case by classification, alerts the endoscopist for the diagnosis of EoE, prompting him to perform targeted biopsies. Further, it was observed that two samples of esophageal tissue were sufficient for the diagnosis. The relationship between the clinical picture, endoscopy, and histology was not evident in this study.

Operative link on gastritis assessment stage is an appropriate predictor of early gastric cancer

AIM: To assess the predictive value of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stages in gastric cancer.METHODS: A prospective study was conducted with 71 patients with early gastric cancer (EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy (EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori (H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively (P = 0.005), the proportions of OLGA stages III-IV cases were 52.1% and 22.4%, respectively (P < 0.001), and the proportions of OLGIM stages III-IV cases were 42.3% and 19.9%, respectively (P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA (OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages III-IV (OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages III-IV (P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA (75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages III-IV (OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.

Risk factors of major intraoperative bleeding and postoperative bleeding associated with endoscopic submucosal dissection for gastric neoplasms

Background:Endoscopic resection bleeding(ERB)classification was proposed by the authors’team to evaluate the severity of intraoperative bleeding(IB)during endoscopic submucosal dissection(ESD).This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB(MIB)and postoperative bleeding(PB)associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital.All patients were divided into the non-MIB group(including ERB-0,ERB-controlled 1[ERB-c1],and ERB-c2)and the MIB group(including ERB-c3 and ERB-uncontrolled[ERB-unc])according to the ERB classification.Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients,773(57.95%)had ERB-0,477(35.76%)had ERB-c1,77(5.77%)had ERB-c2,7(0.52%)had ERB-c3,and no patients had ERB-unc.The rate of PB in patients with IB classifications of ERB-0,ERB-c1,ERB-c2,and ERB-c3 were 2.20%(17/773),3.35%(16/477),9.09%(7/77),and 2/7,respectively.In multivariate analysis,proximal location(odds ratio[OR]:1.488;95%confidence interval[CI]:1.045-3.645;P=0.047)was the only significant risk factor of MIB.Chronic kidney disease(CKD)(OR:7.844;95%CI:1.637-37.583;P=0.010)and MIB(ERB-c3)(OR:13.932;95%CI:2.585-74.794;P=0.002)were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB.Additionally,CKD and MIB(ERB-c3)were independent risk factors of PB.More attention should be paid to these high-risk patients for MIB and PB.