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Outcomes of endoscopic sub-mucosal dissection in laterally spreading colorectal polyps: A tertiary care centre experience from India. 内镜下粘膜下剥离术治疗横向扩散的大肠息肉的效果:印度一家三级医疗中心的经验。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-01 DOI: 10.1007/s12664-024-01635-w
Zaheer Nabi, Manchu Chaithanya, Pradev Inavolu, Mohan Ramchandani, Palle Manohar Reddy, Mahiboob Sayyed, Jahangeer Basha, Partha Pal, Anuradha Sekharan, Rajesh Goud, Praveen Reddy, Nitin Jagtap, Rama Kotla, Rakesh Kalpala, Santhosh Darisetty, Sundeep Lakhtakia, Guduru Venkat Rao, Manu Tandan, Rajesh Gupta, Rangarao Devarasetti, Pradeep Rebala, Mahesh Shetty, D Nageshwar Reddy

Background: Endoscopic sub-mucosal dissection (ESD) is an established endoscopic modality for the management of colorectal polyps. However, there are no studies regarding the outcomes of ESD from India. In this study, we aimed at evaluating the outcomes of ESD in patients with adenomatous polyps in the colon and rectum.

Methods: Data of consecutive patients who underwent ESD for colorectal polyps from 2018 to 2021 were analyzed, retrospectively. The primary outcome of the study was the technical success of ESD. The secondary outcomes included the rate of histologically complete resection (R0), adverse events and recurrence.

Results: Seventy patients (63.5 years, 60% males) underwent ESD for polyps in colon and rectum. A majority were located in rectum (80%) and sigmoid colon (15.7%). Narrow band classification of the polyps was Japanese Narrow Band Imaging Expert Team (JNET)-2a in 50 (71.4%) and JNET-2b in 13 (18.6%) patients. ESD was technically successful in 64 (91.4%) patients using conventional technique (72.8%) and pocket or tunnelling technique (18.6%). There were no major adverse events. Histologically RO was achieved in 58 (82.8%) patients and deep sub-mucosal invasion was noted in 12 patients. At a median follow-up of 19 (interquartile range [IQR] 15-27) months, recurrence was noticed in four (5.7%) patients all of which could be managed endoscopically.

Conclusion: ESD, performed at a tertiary care centre in India, yields high rates of technical success and histologically R0, with a relatively low incidence of adverse events and recurrences.

背景:内镜黏膜下剥离术(ESD)是一种治疗结直肠息肉的成熟内镜方法。然而,印度还没有关于 ESD 效果的研究。在这项研究中,我们旨在评估结肠和直肠腺瘤性息肉患者接受 ESD 治疗的效果:对 2018 年至 2021 年期间因结肠直肠息肉接受 ESD 治疗的连续患者数据进行了回顾性分析。研究的主要结果是ESD的技术成功率。次要结果包括组织学完全切除率(R0)、不良事件和复发率:70名患者(63.5岁,60%为男性)因结肠和直肠息肉接受了ESD手术。大部分息肉位于直肠(80%)和乙状结肠(15.7%)。50 名患者(71.4%)的息肉窄带分类为日本窄带成像专家组(JNET)-2a,13 名患者(18.6%)的息肉窄带分类为 JNET-2b。采用传统技术(72.8%)和袋式或隧道式技术(18.6%)的 64 例(91.4%)患者中,ESD 技术均获得成功。无重大不良事件发生。58例(82.8%)患者的组织学结果为RO,12例患者的组织学结果为深层粘膜下侵犯。中位随访时间为 19 个月(四分位距[IQR] 15-27 个月),发现有 4 例(5.7%)患者复发,均可通过内镜治疗:结论:在印度的一家三级医疗中心进行的ESD手术技术成功率高,组织学结果为R0,不良事件和复发率相对较低。
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引用次数: 0
Application of machine-learning model to optimize colonic adenoma detection in India. 在印度应用机器学习模型优化结肠腺瘤检测。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-17 DOI: 10.1007/s12664-024-01530-4
Nitin Jagtap, Rakesh Kalapala, Hardik Rughwani, Aniruddha Pratap Singh, Pradev Inavolu, Mohan Ramchandani, Sundeep Lakhtakia, P Manohar Reddy, Anuradha Sekaran, Manu Tandan, Zaheer Nabi, Jahangeer Basha, Rajesh Gupta, Sana Fathima Memon, G Venkat Rao, Prateek Sharma, D Nageshwar Reddy

Aims: There is limited data on the prevalence and risk factors of colonic adenoma from the Indian sub-continent. We aimed at developing a machine-learning model to optimize colonic adenoma detection in a prospective cohort.

Methods: All consecutive adult patients undergoing diagnostic colonoscopy were enrolled between October 2020 and November 2022. Patients with a high risk of colonic adenoma were excluded. The predictive model was developed using the gradient-boosting machine (GBM)-learning method. The GBM model was optimized further by adjusting the learning rate and the number of trees and 10-fold cross-validation.

Results: Total 10,320 patients (mean age 45.18 ± 14.82 years; 69% men) were included in the study. In the overall population, 1152 (11.2%) patients had at least one adenoma. In patients with age > 50 years, hospital-based adenoma prevalence was 19.5% (808/4144). The area under the receiver operating curve (AUC) (SD) of the logistic regression model was 72.55% (4.91), while the AUCs for deep learning, decision tree, random forest and gradient-boosted tree model were 76.25% (4.22%), 65.95% (4.01%), 79.38% (4.91%) and 84.76% (2.86%), respectively. After model optimization and cross-validation, the AUC of the gradient-boosted tree model has increased to 92.2% (1.1%).

Conclusions: Machine-learning models may predict colorectal adenoma more accurately than logistic regression. A machine-learning model may help optimize the use of colonoscopy to prevent colorectal cancers.

Trial registration: ClinicalTrials.gov (ID: NCT04512729).

目的:印度次大陆有关结肠腺瘤发病率和风险因素的数据有限。我们旨在开发一种机器学习模型,以优化前瞻性队列中的结肠腺瘤检测:2020年10月至2022年11月期间,所有接受诊断性结肠镜检查的连续成年患者均被纳入研究。排除了结肠腺瘤高风险患者。使用梯度提升机器(GBM)学习方法开发了预测模型。通过调整学习率和树的数量以及 10 倍交叉验证,进一步优化了 GBM 模型:研究共纳入 10320 名患者(平均年龄 45.18 ± 14.82 岁;69% 为男性)。在所有患者中,有 1152 人(11.2%)至少患有一个腺瘤。在年龄大于 50 岁的患者中,医院腺瘤发病率为 19.5%(808/4144)。逻辑回归模型的接受者操作曲线下面积(AUC)(标度)为 72.55% (4.91),而深度学习、决策树、随机森林和梯度增强树模型的接受者操作曲线下面积(AUC)分别为 76.25% (4.22%)、65.95% (4.01%)、79.38% (4.91%) 和 84.76% (2.86%)。经过模型优化和交叉验证后,梯度提升树模型的AUC提高到了92.2%(1.1%):结论:与逻辑回归相比,机器学习模型可以更准确地预测结直肠腺瘤。机器学习模型有助于优化结肠镜检查的使用,预防结直肠癌:试验注册:ClinicalTrials.gov(ID:NCT04512729)。
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引用次数: 0
Same-day yoga-based Laghu Shankhaprakshalana versus standard polyethylene glycol for rescue colonoscopy in inadequate bowel preparation-Feasibility and cost-effectiveness. 在肠道准备不足的情况下,当天进行基于瑜伽的 Laghu Shankhaprakshalana 与标准聚乙二醇结肠镜检查--可行性与成本效益。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01638-7
Manas Kumar Panigrahi, Shubham Gupta, Mitali Madhumita Rath, Jain Harsh Prakash, Prajna Anirvan, Mansi Chaudhary, Abhijeet Rai, Hemanta Kumar Nayak, Ajay Ghosh R U, Biswa Mohan Padhy
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引用次数: 0
Capsule endoscopy for obscure gastrointestinal bleed in the tropics: A single-center experience on 350 patients. 在热带地区进行胶囊内镜检查治疗不明显的消化道出血:350名患者的单中心经验。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-03-22 DOI: 10.1007/s12664-024-01526-0
Uday C Ghoshal, Piyush Mishra, Akash Mathur, Sai Prathap Reddy, Bushra Fatima, Asha Misra

Background: Obscure gastrointestinal bleed (OGIB), now called small bowel bleed (SBB), comprises 5% to 10% of all gastrointestinal (GI) bleed episodes and capsule endoscopy (CE) is a tool for its evaluation. Studies on CE in a large sample of SBB patients from the tropics are limited.

Methods: We did a retrospective analysis of a prospectively maintained database of patients with SBB undergoing CE using PillCam or MiroCam CE.

Results: Of 350 patients (age 52.4 ± 17.4 years; 248 [70.9%] male) undergoing CE, 243 (69.4%) and 107 (30.6%) had overt and occult SBB, respectively. CE detected lesions in 244 (69.7%) patients (single lesion in 172 [49.1%]; multiple in 72 [20.6%]). The single lesions included vascular malformations (52, 14.9%), ulcer/erosion (47, 13.4%), tumor (24, 6.9%), hookworm (19, 5.4%), stricture (15, 4.3%), hemobilia (1, 0.3%) and blood without identifiable lesion (9, 2.6%). Of 72 with multiple lesions, ulcer with stricture was the commonest finding (n = 43, 12.3%). No abnormality was detected in 106 (30.3%) patients. The frequency of lesion detection was comparable among patients with overt and occult SBB (173/243, 71.2% vs. 71/107, 66.3%, respectively; p = 0.4). Younger patients (0 to 39 years) more often had multiple lesions on CE than the older (≥ 40 years) ones (26/76, 34.2% vs. 46/228, 20.2%, respectively; p = 0.001).

Conclusion: CE has a high diagnostic yield in SBB in the tropics, regardless of the type of bleed or of CE brand and the duration of recording. Multiple lesions associated with SBB are commoner among younger (< 40 years) patients.

背景:隐匿性胃肠道出血(OGIB),现称为小肠出血(SBB),占所有胃肠道出血病例的5%至10%,胶囊内镜(CE)是对其进行评估的一种工具。对热带地区大样本 SBB 患者进行胶囊内镜检查的研究非常有限:方法:我们对使用 PillCam 或 MiroCam CE 进行 CE 检查的 SBB 患者的前瞻性数据库进行了回顾性分析:在接受CE检查的350名患者(年龄为52.4 ± 17.4岁;248名[70.9%]男性)中,分别有243名(69.4%)和107名(30.6%)患有显性和隐性SBB。CE在244例(69.7%)患者中发现了病变(单发病变172例[49.1%];多发病变72例[20.6%])。单发病变包括血管畸形(52 例,14.9%)、溃疡/糜烂(47 例,13.4%)、肿瘤(24 例,6.9%)、钩虫(19 例,5.4%)、狭窄(15 例,4.3%)、血瘘(1 例,0.3%)和无法确定病变的血液(9 例,2.6%)。在 72 例有多处病变的患者中,最常见的病变是溃疡伴狭窄(43 例,12.3%)。106名患者(30.3%)未发现异常。显性和隐性 SBB 患者发现病变的频率相当(分别为 173/243,71.2% 和 71/107,66.3%;P = 0.4)。与年龄较大(≥40 岁)的患者相比,年轻患者(0 至 39 岁)在 CE 中出现多个病灶的比例更高(分别为 26/76, 34.2% vs. 46/228, 20.2%;p = 0.001):结论:在热带地区,无论出血类型或CE品牌以及记录时间长短,CE对SBB的诊断率都很高。与 SBB 相关的多发病变在年轻人中更为常见(P=0.001)。
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引用次数: 0
Robotics in interventional endoscopy-evolution and the way forward. 介入内窥镜检查中的机器人技术--演变与未来之路。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-22 DOI: 10.1007/s12664-024-01663-6
Zaheer Nabi, Chaithanya Manchu, D Nageshwar Reddy

The integration of robotics into gastrointestinal (GI) endoscopy represents a transformative advancement and bears the potential to bridge the gap between traditional limitations by offering unprecedented precision and control in diagnostic and therapeutic procedures. This review explores the historical progression, current applications and future potential of robotic platforms in GI endoscopy. Originally designed for surgical applications, robotic systems have expanded their reach into endoscopy, potentially enhancing procedural accuracy and reducing ergonomic strain on practitioners. Natural Orifice Transluminal Endoscopic Surgery (NOTES) emerged as a promising technique, leveraging natural orifices to perform minimally invasive surgeries. Despite its initial potential, several factors, including limitations of the available instrumentations and lack of reliable closure techniques, hindered its widespread adoption and progress. Conventional endoscopic tools often fall short in terms of triangulation, traction and degrees of freedom, necessitating the adoption of robotic interventions. Over recent decades, robotic endoscopy has significantly evolved, focusing on both diagnostic and complex therapeutic procedures such as endoscopic sub-mucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). Various robotic platforms demonstrate enhanced safety and efficiency in GI procedures. As the field progresses, the emphasis on clinical validation, advanced training and the exploration of new applications remains crucial. Continuous innovation in robotic technology and endoscopic techniques promises to overcome existing limitations, further revolutionizing the management of GI diseases and improving patient outcomes.

将机器人技术整合到消化道内窥镜检查中代表着一种变革性的进步,有可能通过在诊断和治疗过程中提供前所未有的精确度和控制力来弥补传统限制之间的差距。本综述探讨了消化内镜机器人平台的历史进程、当前应用和未来潜力。机器人系统最初是为外科应用而设计的,现在已将其应用范围扩展到内窥镜检查领域,有可能提高手术的准确性并减轻从业人员的人体工程学负担。自然孔腔内窥镜手术(NOTES)是一种很有前途的技术,它利用自然孔腔进行微创手术。尽管该技术最初很有潜力,但包括现有器械的局限性和缺乏可靠的闭合技术在内的一些因素阻碍了它的广泛应用和发展。传统的内窥镜工具往往在三角、牵引和自由度方面存在不足,因此有必要采用机器人介入技术。近几十年来,机器人内窥镜得到了长足发展,主要用于诊断和复杂的治疗程序,如内窥镜粘膜下剥离术(ESD)和内窥镜全厚切除术(EFTR)。各种机器人平台在消化道手术中都表现出更高的安全性和效率。随着该领域的发展,临床验证、高级培训和新应用的探索仍是重点。机器人技术和内窥镜技术的不断创新有望克服现有的局限性,进一步革新消化道疾病的治疗并改善患者的预后。
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引用次数: 0
Prevalence of work-related musculoskeletal disorders and its determinants among endoscopists in India. 印度内镜医师中与工作相关的肌肉骨骼疾病的发病率及其决定因素。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01625-y
Balaji Musunuri, Ganesh Bhat, Athish Shetty, Shiran Shetty, Ganesh C Pai
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引用次数: 0
Prevention, detection and management of adverse events of third-space endoscopy. 第三空间内窥镜检查不良事件的预防、检测和管理。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-11 DOI: 10.1007/s12664-024-01665-4
Rohan Yewale, Amit Daphale, Ashish Gandhi, Amol Bapaye

Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.

第三空间内窥镜(TSE)或使用粘膜瓣阀的粘膜下内窥镜(SEMF)使内窥镜医师能够在胃肠道深层进行手术,或进入纵隔/腹膜腔进行自然孔经口内窥镜手术(NOTES)。TSE 手术本质上是内窥镜外科手术,学习曲线不尽相同。TSE 过程中发生的不良事件(AEs)是特定的,在整个 TSE 过程中都遵循一定的模式。这些不良事件可根据不良事件的类型、相对于手术的出现时间或严重程度进行大致分类。在 TSE 过程中会遇到的三大类 AE 包括充气相关 AE、粘膜损伤 (MI) 和出血。其他相关的 AE 包括感染性并发症、吸入性肺炎、术后胸痛/腹痛、肺不张、心律失常、胸腔积液和肺栓塞。根据手术类型和复杂程度的不同,TSE 手术中 AEs 的报告发生率也不尽相同。了解潜在的风险因素、技术提示和预防措施、早期识别的报警信号、严重程度评估、AEs 形态学特征,最后迅速选择适当的管理策略,这些对于成功的临床结果至关重要,势在必行。本综述讨论了预防、早期发现和处理 TSE 相关 AE 的现有证据和实用指南。
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引用次数: 0
Endoscopic ultrasound-guided vascular interventions: A review (with videos). 内窥镜超声引导下的血管介入治疗:回顾(附视频)。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01681-4
Praveer Rai, Pankaj Kumar, Umair Shamsul Hoda, Kartik Balankhe

Endoscopic ultrasound (EUS) has evolved from a diagnostic to an interventional modality, allowing precise vascular access and therapy. EUS-guided vascular access of the portal vein has received increasing attention in recent years as a diagnostic and therapeutic tool. EUS-guided portal pressure gradient directly measures the hepatic vein portal pressure gradient and is crucial for understanding of liver function and prognostication of liver disease. EUS facilitates the sampling of portal venous blood to obtain circulating tumor cells (CTCs) in pancreatobiliary malignancies. This technique aids in the diagnosis and staging of cancers. EUS-guided interventions have a substantial potential for diagnosing portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma. EUS-guided coil and glue embolization have higher efficacy for the treatment of gastric varices than direct endoscopic glue. Pseudoaneurysm (PsA), a rare vascular complication of acute and chronic pancreatitis, is typically managed with interventional radiology (IR)-guided embolization and surgery. EUS is increasingly used in specialized centers for non-variceal gastrointestinal bleeding, particularly for pseudoaneurysm-related bleeding. There is limited data on EUS-guided intervention for bleeding ectopic varices, rectal varices and Dieulafoy lesions, but it is becoming more widely accepted. In this extensive review, we evaluated both current and potential future applications of EUS-guided vascular interventions, including EUS-guided gastric variceal bleed therapy, rectal and ectopic varices, pseudoaneurysmal bleeding, splenic artery embolization, portal pressure gradient measurement, portal vein sampling for CTCs, fine needle aspiration of PVTT, intrahepatic portosystemic shunt placement, liver tumor ablation and EUS-guided cardiac intervention.

内窥镜超声(EUS)已从一种诊断方式发展成为一种介入方式,可实现精确的血管通路和治疗。近年来,EUS 引导下的门静脉血管通路作为一种诊断和治疗工具受到越来越多的关注。EUS 引导下的门静脉压力梯度可直接测量肝静脉门静脉压力梯度,对于了解肝功能和肝病预后至关重要。在胰胆管恶性肿瘤中,EUS 方便了门静脉血液取样,以获取循环肿瘤细胞(CTC)。这项技术有助于癌症的诊断和分期。EUS 引导下的介入治疗在诊断肝细胞癌患者的门静脉肿瘤血栓(PVTT)方面具有很大的潜力。EUS 引导下的线圈和胶水栓塞治疗胃静脉曲张的疗效高于直接内镜胶水栓塞。假性动脉瘤(PsA)是急性和慢性胰腺炎的一种罕见血管并发症,通常采用介入放射学(IR)引导的栓塞和手术治疗。越来越多的专科中心使用 EUS 治疗非静脉胃肠道出血,尤其是假性动脉瘤相关出血。关于 EUS 引导下介入治疗异位静脉曲张、直肠静脉曲张和 Dieulafoy 病变出血的数据有限,但它正被越来越广泛地接受。在这篇内容广泛的综述中,我们评估了 EUS 引导下血管介入治疗的当前应用和未来可能的应用,包括 EUS 引导下的胃静脉曲张出血治疗、直肠和异位静脉曲张、假性动脉瘤出血、脾动脉栓塞、门静脉压力梯度测量、门静脉四氯化碳取样、PVTT 的细针抽吸、肝内门脉分流置管、肝肿瘤消融和 EUS 引导下的心脏介入治疗。
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引用次数: 0
Advanced endoscopic resection for early gastrointestinal cancers in India: Challenges and opportunities await! 印度早期胃肠道癌症的先进内窥镜切除术:挑战与机遇并存!
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01686-z
Sridhar Sundaram, Akhil Mahajan, Prachi Patil
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引用次数: 0
Prognostic and predictive significance of p53 and ATRX in neuroendocrine neoplasms of GIT and pancreas and their utility as an adjunct to accurate diagnosis-An eight-year retrospective study. p53和ATRX在消化道和胰腺神经内分泌肿瘤中的预后和预测意义及其作为精确诊断辅助手段的实用性--一项为期八年的回顾性研究。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01678-z
Divya Achutha Ail, Roopa Rachel Paulose

Introduction: Neuroendocrine neoplasms of gastrointestinal tract (GIT) and pancreas are heterogenous tumors. World Health Organization (WHO) 2019 classification introduced Grade (G)3 neuroendocrine tumor (NET) distinct from neuroendocrine carcinoma (NEC), based on molecular differences and to triage the patients for appropriate therapy. This distinction largely relies on morphology, which can be challenging at times. Genomic profiling has revealed TP53 and RB1 mutations in NECs, while death domain-associated protein 6 (DAXX) and alpha-thalassemia/mental retardation X-linked (ATRX), in G3NET. Their role as biological markers in differentiating these entities and their significance as prognostic markers are not yet established. This study aims at analyzing the diagnostic and prognostic role of p53 and ATRX in neuroendocrine neoplasms of GIT and pancreas.

Methodology: A single-centre, eight-year retrospective study of neuroendocrine neoplasm of GIT and pancreas comprised G2NET, G3NET and NEC. Tumor slides were stained by immunohistochemistry for p53 and ATRX. Strong nuclear staining of > 50% of tumor cells for p53 was considered mutated. Nuclear staining of ATRX in < 5% of tumor cells was considered ATRX loss. Expression of p53 and ATRX was analyzed and correlated with tumor grades and patient survival.

Results: Fifty-five patients with gastro-entero-pancreatic neuroendocrine neoplasm were studied, comprising G2NET (58%), G3NET (16%) and NEC (26%). Median age of diagnosis was 59 years with male predominance. The pancreas was the most common site followed by the small bowel. NEC showed lower survival compared to G3 and G2NET. Mutated p53 immunohistochemical expression was more frequent among NEC than G3NET. Patients with mutated p53 had significantly lower survival irrespective of the grade (p = 0.001). There was no association of ATRX loss with grade or survival.

Conclusion: G3NETs are genetically different from NECs. Use of immunohistochemistry for p53 in addition to histomorphology may facilitate accurate categorization of NEC and G3NET. Mutated p53 may also be used as an independent prognostic marker in neuroendocrine tumors of GIT and pancreas.

导言:胃肠道(GIT)和胰腺的神经内分泌肿瘤是一种异质性肿瘤。世界卫生组织(WHO)2019 年的分类引入了有别于神经内分泌癌(NEC)的 3 级(G)神经内分泌肿瘤(NET),其依据是分子差异和对患者进行适当的治疗分流。这种区分在很大程度上依赖于形态学,而形态学有时具有挑战性。基因组分析发现,NEC 中存在 TP53 和 RB1 突变,而 G3NET 中存在死亡结构域相关蛋白 6 (DAXX) 和阿尔法地中海贫血/智力低下 X 连锁 (ATRX)。它们作为生物学标志物在区分这些实体中的作用及其作为预后标志物的意义尚未确定。本研究旨在分析p53和ATRX在消化道和胰腺神经内分泌肿瘤中的诊断和预后作用:方法:对G2NET、G3NET和NEC等消化道和胰腺神经内分泌肿瘤进行为期8年的单中心回顾性研究。肿瘤切片采用免疫组化法对 p53 和 ATRX 进行染色。超过50%的肿瘤细胞的p53核染色为突变。结果显示 ATRX 的核染色:研究了55例胃-肠-胰神经内分泌肿瘤患者,包括G2NET(58%)、G3NET(16%)和NEC(26%)。确诊年龄中位数为59岁,男性居多。胰腺是最常见的肿瘤部位,其次是小肠。与G3和G2NET相比,NEC的存活率较低。与G3NET相比,NEC中p53免疫组化突变表达更为常见。无论级别如何,p53突变患者的生存率都明显较低(p = 0.001)。ATRX缺失与分级和生存率没有关系:结论:G3NET在遗传学上不同于NEC。结论:G3NET与NEC在基因上有所不同。除了组织形态学外,使用免疫组化方法检测p53可能有助于对NEC和G3NET进行准确分类。突变的p53也可作为消化道和胰腺神经内分泌肿瘤的独立预后标志物。
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引用次数: 0
期刊
Indian Journal of Gastroenterology
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