Esophagogastric premalignant conditions. A literature review

Esophagogastric cancers are serious malignancies with high mortality and low overall survival for advanced tumors. Detection of premalignant lesions and early treatment of malignant lesions are of paramount importance. Precancerous esophagogastric conditions develop from interaction between environmental and genetic factors. Chronic irritation and inflammation may result in metaplasia, increased mutations, cellularatypia, and altered function (dysplasia). Helicobacter pylori (HP) infection is one of the most important risk factors for gastric carcinogenesis, but other environmental factors (e.g. alcohol, tobacco, nitrites, infection) and autoimmune disorders play a role as well. Esophageal adenocarcinoma (EAC) usually arises in the distal esophagus and is linked to obesity, gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE). Squamous cell carcinoma (ESCC) typically occurs in the presence of risk factors causing chronic inflammation (e.g. tobacco, alcohol abuse, achalasia, tylosis). Highquality endoscopic imaging is of primary importance in the diagnosis and assessment of premalignant and early malignant esophagogastric lesions. Biological markers such as aberrant p53 protein expression may be associated with increased risk of malignant transformation of precancerous lesions; however, none of those biomarkers has been validated for either diagnosis or risk stratification yet

Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Background The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures-Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). Methods Two online questionnaires-first having 11 questions on SG/GBP frequency with a follow-up of 5-10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR-a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. Results Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 +/- 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 +/- 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). Conclusion Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development

Esophagogastric premalignant conditions. A literature review

Esophagogastric cancers are serious malignancies with high mortality and low overall survival for advanced tumors. Detection of premalignant lesions and early treatment of malignant lesions are of paramount importance. Precancerous esophagogastric conditions develop from interaction between environmental and genetic factors. Chronic irritation and inflammation may result in metaplasia, increased mutations, cellular atypia, and altered function (dysplasia). Helicobacter pylori (HP) infection is one of the most important risk factors for gastric carcinogenesis, but other environmental factors (e.g. alcohol, tobacco, nitrites, infection) and autoimmune disorders play a role as well. Esophageal adenocarcinoma (EAC) usually arises in the distal esophagus and is linked to obesity, gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE). Squamous cell carcinoma (ESCC) typically occurs in the presence of risk factors causing chronic inflammation (e.g. tobacco, alcohol abuse, achalasia, tylosis). Highquality endoscopic imaging is of primary importance in the diagnosis and assessment of premalignant and early malignant esophagogastric lesions. Biological markers such as aberrant p53 protein expression may be associated with increased risk of malignant transformation of precancerous lesions; however, none of those biomarkers has been validated for either diagnosis or risk stratification yet.</jats:p

<i>The Reversal of a Protective Stoma Is Feasible Before the Complete Healing of a Colorectal Anastomotic Leak</i>

A proximal diverting stoma is recommended in “high-risk” conditions after total mesorectal excision. The aim of the study is to assess whether, after checking the anastomosis by using a water-soluble contrast enema (WCE), the closure of the ileostomy is feasible and safe, even in the presence of a persistent radiological leak. From 2003 to 2010, 210 colorectal anastomoses were performed. Ileostomy was carried out in “high-risk” anastomosis. A radiological control was performed 2 weeks later. If a leakage was present, conservative therapy controlled by serial WCEs was prescribed. Ileostomy closure was performed in the absence of leakage or with persistent leakage without clinical signs of pelvic infections. Seventy patients (33.3%) had a protective ileostomy. Fifty-eight of these (82.9%) had an uneventful course, whereas 12 (17.1%) had clinical leakage. All 70 patients were submitted to WCE after 2 weeks. Nine of 58 patients (15.5%) and eight of 12 patients with clinical anastomotic leakage showed a leakage at radiology. All these patients were scheduled another WCE 2 months later. It showed that the anastomosis had been healed in seven patients, whereas the 10 patients with leaks remained with ostomy until the third enema 1 month later. For all these patients, closure of the ileostomy was planned despite persistent radiological and subclinical leakage. A radiological study using WCE before closure of the stoma is essential and stoma closure, in the presence of a persistent leakage, is possible in selected patients. </jats:p

The reversal of a protective stoma is feasible before the complete healing of a colorectal anastomotic leak

discussione sulla possibilit\ue0 di chiudere anticipatamente una stomia di protezione, anche in caso di incompleta guarigione radiologica della deiscenza anastomotic

Duodenal Obstruction in a Patient Previously Treated With EndoVascular Aneurysm Sealing System Repair

The Nellix® endovascular aneurysm sealing system (EVAS) is a relatively novel approach for the treatment of abdominal aortic aneurysms (AAAs). We present herein a case of duodenal obstruction (DO) which occurred following an EVAS treatment for the repair of an AAA. A 77-year old man was admitted to our hospital with acute abdominal pain and recurrent vomiting. Computed tomography (CT) revealed a retroperitoneal 66 × 59 × 90 mm (antero-posterior, AP; latero-lateral, LL; cranio-caudal: CC) solid mass located in the epigastrium, corresponding to the infrarenal abdominal aortic aneurysm sac, previously treated by EVAS. An exploratory laparotomy was performed, which revealed a retroperitoneal mass compressing the third and fourth parts of the duodenum. A gastroenteroanastomosis was performed in order to bypass the duodenal obstruction. An extensive search of biomedical literature databases was conducted to identify similar cases. To our knowledge, this is the first reported case of DO following an AAA repair with EVAS. </jats:p