Evaluation and Management of Mallory – Weiss Syndrome: A Review

Upper gastrointestinal bleeding is a symptom of Mallory-Weiss syndrome, which is caused by longitudinal mucosal lacerations (known as Mallory-Weiss tears) near the gastroesophageal junction or gastric cardia. Mallory-Weiss syndrome is rather prevalent, accounting for 3 to 10% of all upper gastrointestinal bleeding episodes. In mild circumstances, the disease may be asymptomatic. Hematemesis is the presenting symptom in 85 percent of patients. Blood is present in varying amounts, ranging from blood-streaked mucous to huge bright red haemorrhage. Other symptoms such as melena, dizziness, or syncope might occur as a result of heavy bleeding. The majority of the time, the bleeding is little and ends on its own. Endoscopy is frequently used to confirm the diagnosis of MWS. Although most patients may be treated with monitoring or conservative medicinal treatment, certain cases require endoscopic or surgical treatment. Despite the fact that MWS is a common cause of nonvariceal upper gastrointestinal bleeding (NVUGIB), little research has been done on it. This article discusses MWS Etiology, epidemiology, evaluation and management.

Carcinoid of the Operated Stomach: Difficulties in Diagnosis

Gastric neuroendocrine tumors commonly called carcinoids arise from enterochromaffin cells of the stomach and are rare. Recently, their incidence has increased, which may be due to the improvement of diagnostic and therapeutic capabilities. The article describes a rare clinical case of gastric carcinoid 23 years after surgical removal of gastric cardia cancer.

Focal amplifications are associated with chromothripsis events and diverse prognoses in gastric cardia adenocarcinoma

The role of focal amplifications and extrachromosomal DNA (ecDNA) is unknown in gastric cardia adenocarcinoma (GCA). Here, we identify frequent focal amplifications and ecDNAs in Chinese GCA patient samples, and find focal amplifications in the GCA cohort are associated with the chromothripsis process and may be induced by accumulated DNA damage due to local dietary habits. We observe diverse correlations between the presence of oncogene focal amplifications and prognosis, where ERBB2 focal amplifications positively correlate with prognosis and EGFR focal amplifications negatively correlate with prognosis. Large-scale ERBB2 immunohistochemistry results from 1668 GCA patients show survival probability of ERBB2 positive patients is lower than that of ERBB2 negative patients when their surviving time is under 2 years, however, the tendency is opposite when their surviving time is longer than 2 years. Our observations indicate that the ERBB2 focal amplifications may represent a good prognostic marker in GCA patients.

Novel Metabolic Biomarker for Early Detection and Prognosis to the Patients with Gastric Cardia Adnocarcinoma

Background: Gastric cardia adenocarcinoma (GCA), which has been normalized as type II of adenocarcinoma at esophagogastric junction in western countries. In clinical, most of the GCA patients are lack of early alarming symptoms, more than 90% of GCA patients were diagnosed at advanced stage, resulted in a very poor prognosis, with less than 20% of 5-year survival. Obviously, early detection for GCA plays crucial role in decreasing the high mortality. Metabolomics allows for appraisal of small molecular mass compounds in a biofluid, which may provide a way for finding biomarkers for GCA. Methods: The serum metabolic features of 276 curatively resected GCA patients and 588 healthy control participates were collected from the database of State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital of Zhengzhou University to discover the metabolic dysregulation by using the ultraperformance liquid chromatography-mass spectrometry (UPLC-MS). Joint pathway analysis with metabolites identified, survival analysis and auxiliary diagnosis metabolites were discussed in present work. Results: A sum of 200 known differential metabolites were obtained with p＜0.05 and fold change FC≥1.25 or FC≤0.8 by comparison GCA and healthy control participates. 12 metabolites significant correlated with survival (p＜0.05) and 17 metabolites for potential auxiliary diagnosis(FC＞1.5 or FC＜0.67) for GCA. Dysregulated arginine biosynthesis was an important pathway of GCA. 9 differential metabolites of 12-ketolithocholic acid, 2-Hydroxybutanoic acid, Aldosterone, All-trans-13,14-dihydroretinol, Hododeoxycholic acid, L-histidine, Malonic acid, Prostaglandin E2 and Sphingosine were identified as potential metabolic markers for distinguishing the GCA and healthy control (AUC=0.976, sensitivity =0.913, specificity =0.027, optimal cut off value=0.470). Conclusions: This work was first identified 12 metabolites significant correlated with survival and 17 metabolites for potential auxiliary diagnosis for GCA. In addition, arginine biosynthesis pathway metabolism showed important roles in GCA. Results provide the understanding of the molecular difference between GCA and healthy control. The novel plasma biomarkers panel could clearly distinguish GCA patients from the healthy control group. This finding may form the basis for the development of a minimally invasive method for GCA detection.

Spatiotemporal Trends in the Incidence of Gastrointestinal Neoplasms in Wuwei City of Northwestern China From 1995 to 2016: A Hospital-Based Retrospective Observational Study

ObjectiveTo determine the characteristics and spatiotemporal distribution of major gastrointestinal (GI) neoplasms in inpatients from 1995 to 2016 in Wuwei city, northwestern China.MethodData from all paper and electronic medical records entered between 1995 and 2016 at 12 major public hospitals in Wuwei city were retrospectively collected. Patients with GI neoplasms were identified and classified according to the International Classification of Diseases (ICD)-10. Trends in the incidence of major GI neoplasms were expressed as an annual percentage change (APC), and the Z test was used to assess the time fluctuation trends. Age-standardized incidence rates (ASIRs) were also calculated and the corresponding APC was estimated by the Joinpoint software for long-term trend analysis. Thematic maps of annual incidence at the township level were produced.ResultsAmong the 19,137 new inpatients identified with GI neoplasms in Wuwei, gastric cancer was the leading cause of morbidity, followed by cancers of the esophagus, colorectum, gastric cardia, liver, and pancreas with ASIRs of 21.8, 11.0, 5.8, 5.7, 4.4, and 1.7 per 100,000 person-years, respectively. Overall, there was a steady increase in the ASIR for all GI neoplasms, and male cases were 2.1 times more frequent than female cases. The ASIR significantly increased by 12.2% per year from 1995 to 2009 for all GI neoplasms, and the increase rates ranged 9.4%-16.7% per year for the individual GI neoplasm. Despite an increase by 1.4% per year from 2009 to 2016, the ASIR decreased for esophageal and gastric cardia cancers by 4.6% and 17.3% per year, respectively. The annual incidence of all GI neoplasms showed significantly differential geographic distributions among different townships of the city during the study period.

743 SIEWERT TYPE II GASTRIC CARDIA CANCER: ANALYSIS OF THE RESULTS OF DIFFERENT SURGICAL OPTIONS

The management of gastric cardia tumors should be carried out from a multidisciplinary approach, there is currently a clear controversy regarding the most appropriate surgical approach to use in type II tumors. Depending on their topographic anatomical characteristics based on the degree of gastric invasion and esophageal, the surgical technique may change: esophagectomy, gastrectomy with distal esophagectomy, or total esophageal gastrectomy. Methods Retrospective and analytical study of patients diagnosed with type II gastric cardia adenocarcinoma (based on the results of the pathological study of the resection specimen) who underwent surgical treatment in our center from June 2012 to June 2020. Different preoperative parameters, the surgical techniques used and the results obtained were analyzed. Results 25 patients were studied, 84% male. 60% were locally advanced tumors with 56% affected nodes. 12 Ivor-Lewis esophagectomies, 5 esophagogastrectomies with coloplasty, and 5 extended total gastrectomies were performed. There was no resection proximal or distal margin involvement, but circumferential margin was affected in 60% of cases of extended gastrectomy and in 1 case of Ivor-Lewis esophagectomy. Median number of lymph nodes removed was 22(5–37) and 2(0–12) affected, being higher in total esophagogastrectomy. Postoperative morbidity was 40% and 90-day mortality 4% (1 case). The mean follow-up was 37 months, noting recurrence in 9 cases (36%), with disease-free survival of 44%. Conclusion The surgical treatment approach in type II gastric tumors is controversial, and there are multiple options to consider. According to the results of this study, the Ivor-Lewis esophagectomy shows to be a safe approach with satisfactory oncological results in tumors that do not require a total esophagogastrectomy.

Extrachromosomal DNA is associated with chromothripsis events and diverse prognoses in gastric cardia adenocarcinoma

Extrachromosomal DNA plays an important role in oncogene amplification in tumour cells and poor outcomes across multiple cancers. However, the function of extrachromosomal DNA in gastric cardia adenocarcinoma (GCA) is very limited. Here, we investigated the availability and function of extrachromosomal DNA in GCA from a Chinese cohort of GCA using whole-genome sequencing (WGS), whole-exome sequencing (WES), and immunohistochemistry. For the first time, we identified the ecDNA amplicons present in most GCA patients, and found that some oncogenes are present as ecDNA amplicons in these patients. We found that oncogene ecDNA amplicons in the GCA cohort were associated with the chromothripsis process and may be induced by accumulated DNA damage due to local dietary habits in the geographic region. Strikingly, we observed diverse correlations between the presence of ecDNA oncogene amplicons and prognosis, where ERBB2 ecDNA amplicons correlated with good prognosis, EGFR ecDNA amplicons correlated with poor prognosis, and CCNE1 ecDNA amplicons did not correlate with prognosis. Large-scale ERBB2 immunohistochemistry results from 1668 GCA patients revealed that there was a positive correlation between the presence of ERBB2 and prognosis in 2-7-year survival; however, there was a negative correlation between the presence of ERBB2 and prognosis in 0-2-year survival. Our observations indicate that the presence of ERBB2 ecDNA in GCA patients may represent a good prognosis marker.