Colorectal anastomotic benign strictures represent a challenging complication. Endoscopic dilation represents a valid and safe treatment. The purpose of this study is to retrospectively investigate the results of endoscopic balloon dilation for anastomotic stricture after anterior rectal resection for cancer in an institution. Twenty-four symptomatic patients with benign colorectal anastomotic stricture were treated between April 2001 and January 2005. All patients underwent dilation using through-the-scope balloon technique. The success of dilation, the number of sessions required, complications, recurrence, and the relationship between the number of dilation sessions and recurrence were assessed. Dilation was successful in 22 (91.7%) patients. There were no procedure-related complications. The mean number of sessions required was 2.3. There was no relationship between the number of dilation sessions and stricture recurrence. Through-the-scope dilation is effective and safe for benign colorectal anastomotic strictures after anterior resection. There was no relationship between the number of dilation sessions and recurrence.

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Nodal metastasis is an important prognostic indicator in head and neck cancers, including salivary carcinomas. In these, the risk for lymph node metastasis is variable and strongly associated with the tumor histologic type. The aim of the current study was to evaluate the lymphatic vessel density (LVD) and expressions of lymphangiogenic growth factors by tumor cells in different histologic types of salivary carcinomas subdivided according to the risk for nodal metastasis. In 15 high-risk (undifferentiated, high-grade mucoepidermoid and salivary duct carcinomas) and 60 low/moderate-risk tumors (adenoid cystic, low/intermediate-grade mucoepidermoid, acinic cell, myoepithelial, epithelial-myoepithelial and polymorphic lowgrade carcinomas) the expressions of vascular endothelial growth factor-C (VEGF-C), hepatocyte growth factor (HGF) and D2-40 (for assessing LVD) were examined. No significant differences were encountered between high-and low/moderate/-risk carcinomas regarding LVD and VEGF-C or HGF expressions. Furthermore, the expression of these proteins did not correlate with LVD. Lymphatic vascular invasion was found mainly in high-risk carcinomas. Intratumoral LVD was significantly lower than peritumoral, regardless of the risk for metastasis and primary site of the lesion. The histologic types of salivary carcinomas which are associated with high-risk for nodal metastasis do not present increased LVD or VEGF-C and HGF expressions. The greater tendency for metastasis in these carcinomas seems to be related to their capacity to invade lymph vessels. Further studies on tumor cell interactions with lymphatic endothelial cells are needed to improve our understanding of the metastatic potential of salivary carcinomas. Key words: lymph vessels, salivary carcinoma, VEGF-C, HGF.Nodal metastasis is an important prognostic predictor in head and neck cancers, including salivary carcinomas. The risk for lymph node metastasis in these carcinomas is highly variable (9% -85%) [1] and strongly associated with the tumor histologic type [1][2][3][4][5]. It is a general consensus that high-grade mucoepidermoid carcinomas, salivary duct carcinomas, undifferentiated carcinomas and squamous cell carcinomas are high-risk tumors for nodal metastasis [1,[3][4][5]. In these the risk for neck metastasis has been described to be >50% [1] and, thus, elective neck dissection is considered in their management [1][2][3].Lymph vessels provide the main avenue for nodal metastasis and in head and neck squamous cell carcinoma (HNSCC) it has been shown that tumors of different anatomic regions do not vary significantly in their lymphangiogenic properties [6,7]. However, a high lymph vessel density (LVD) seems to be an indicator of the risk of lymph node metastasis in HNSCC [6][7][8][9]. Regarding salivary gland tumors, the lymphatic vessels have rarely been studied [10][11][12] and in a particular type of salivary carcinoma, i.e. in those arising in pleomorphic adenomas (CXPA) the lymphatic network was found to be composed mainly of pre-existing ...

RESUMO -Racional -O índigo-carmim é empregado como corante de contraste habitualmente instilado sobre a mucosa colorretal objetivando melhor visualizar lesão já detectada à colonoscopia convencional. O exame da mucosa colorretal previamente corada após administração anterógrada do corante levaria a maior sensibilidade na detecção de lesões menores e resultante maior sensibilidade da colonoscopia no diagnóstico de lesões diminutas, fazendo da cromoendoscopia de contraste excelente opção de rastreamento do câncer colorretal. Os resultados da cromoendoscopia do cólon após administração oral do índigo-carmim resultam de experiência individual restrita. Objetivo -Avaliar a qualidade da cromoendoscopia com índigo-carmim nos diversos segmentos cólicos após administração por via oral desse corante. Pacientes e métodos -Cinqüenta pacientes consecutivamente submetidos a videocolonoscopia foram analisados. Uma cápsula contendo 100 mg de índigo-carmim era oferecida aos pacientes 30 minutos antes da solução de manitol empregada rotineiramente para preparo intestinal mecânico. O efeito do contraste foi avaliado em três segmentos intestinais: cólon direito, cólon esquerdo e reto e foi classificado pelo examinador como bom, regular ou ruim, de acordo com critérios pré-estabelecidos. Resultados -O cólon direito apresentou-se com bom efeito de contraste em apenas 9 (18,8%) pacientes, enquanto que em 32 (66,6%) e em 7 (14,6%) pacientes o efeito obtido foi regular e ruim, respectivamente. Quanto à avaliação dos segmentos distais, não foi observado bom resultado em nenhum paciente. Não se observou coloração da mucosa do cólon esquerdo (qualidade ruim) em 80,9% dos pacientes; tampouco não foi observada distribuição do contraste no reto em 92% dos casos. Conclusão -Apesar da simplicidade, a administração de índigo-carmim por via oral parece ineficaz para o rastreamento de pequenas lesões realizado por cromoendoscopia de contraste uma vez que a qualidade desta verificada no cólon, principalmente em segmentos mais distais, foi regular ou ruim para a grande maioria dos pacientes.DESCRITORES -Indigotindissulfonato sódico. Colonoscopia.

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Background and Aim: Progression of endoscopic diagnosis contributes improvement of detecting early gastric cancer (EGC). Endoscopic resection like endoscopic submucosal dissection (ESD) achieves surefire treatment of EGC. Now metachronous gastric cancer (MGC) after ESD becomes a problem. We analyzed the patients who had MGC after ESD to clarify the feature of MGC. Methods: We conducted retrospective analysis of EGC cases resected by ESD in our institution. From April 2014 through August 2019, 393 patients were performed ESD and 38 cases (9.7%) were MGC including 10 synchronous (within 1 year after ESD). We analyzed age, sex, interval of recurrence, location, macroscopic type, histological type, size of tumor, depth of invasion, history of eradication of Helicobacter Pylori (HP), detecting method and curative ratio by ESD. The study was approved by IRB. Result: The outcomes were as follows: MGC including synchronous was 9.7% (38/393) during this surveillance. Sex: male/female ratio was 35/3. Average age: 74.0AE4.7 years old (61-86, median 74). Average interval of recurrence: 45.7AE41.6 months (2-168, median 33.5). 68% (26/38) of cases experienced a recurrence within 5 years after previous ESD. The maximum recurrence was 3 times. Location: Upper 19, Middle 4, Lower 15. 76% (29/38) of cases arose from different location from the previous one. Macroscopic type: 0-IIa 12, 0-IIb 4, 0-IIc 22. 42% of cases were same type as previous one. Histological type: 37 tubular adenocarcinoma and 1 poorly differentiated adenocarcinoma. Average size: 11.4AE7.8 mm (1.5-37, median 10). Depth of invasion: M 36, SM 2. History of eradication of HP: 53% (20/38). In those cases, the longest interval of recurrence was 12 years and the shortest one was 2 years. Detecting method: white-light imaging 74%, indigo carmine dye 26%. Narrow-band imaging (NBI) or magnifying endoscopy with NBI was not used at the first detection of EGC. Curative ratio by ESD: 97% (37/38). Almost cases were less than 30mm tubular adenocarcinoma existed in mucosal layer, therefore, they were curative. Just one case (por, SM1) was not curative by ESD. Conclusion: In our analysis, MGC after ESD was 9.7%. The majority of cases were curative by ESD. 53% of cases had history of eradication of HP. They had severe atrophic gastritis and metaplasia. Even after eradication of HP, the patients performed ESD for EGC also still need continuous periodic endoscopic examination. To make sure effectivity of eradication of HP after ESD for EGC, additional prospective analysis is necessary.