Mucins of the gastroduodenal junction are secreted by the mucous surface and mucusproducing glandular cells in the stomach, and by goblet cells and Brunner's glands in the duodenum. Developmental studies have demonstrated that Brunner's glands can arise from undifferentiated gastric epithelium and/or intestinal epithelium in the proximal duodenum. The aim of this study was to investigate the carbohydrate composition of mucins from this region and compare it with that of mucins from Brunner's glands to evaluate the probable evolution of mucins from these glands. Toward that end, paraffin sections from 13 mammalian species were stained by classic carbohydrate histochemistry and treated with 13 lectins. In general, the mucous surface cells of the stomach, pyloric glands, duodenal goblet cells, and Brunner's glands secretory epithelium had different lectin-binding patterns. However, the lectin-binding profile of the secretory epithelium of Brunner's glands resembled that of pyloric glands more closely than that of duodenal goblet cells and mucous surface cells of the stomach. Mucins from Brunner's glands and pyloric glands showed a greater terminal carbohydrate residue diversity than those of gastric mucous surface cells or duodenal goblet cells. The lectin-binding profile argues for the evolution of similar mucins from the epithelia of Brunner's glands and pyloric glands. The greater diversity of carbohydrate residues in mucins secreted by Brunner's glands suggests that their mucus is more adaptable. This may explain why Brunner's glands metaplasia rather than goblet cell metaplasia is seen in the mucosa adjacent to chronic intestinal ulcers. Anat Rec Part A 278A:540 -550, 2004. Key words: Brunner's glands; carbohydrate histochemistry; comparative anatomy; gastroduodenal junction; histogenesis; lectin; mucinThe epithelial cells that line the gastrointestinal tract of mammals are protected in part from the somewhat harsh environment of acid, proteolytic enzymes, and abrasives in the lumen by a mucus layer. In the stomach the mucus layer, which is several microns thick, is secreted by both the epithelium lining the gastric mucosa and mucus-producing cells of the gastric glands, while in the duodenum it is secreted by goblet cells and Brunner's glands, which are located in the submucosa. Mucus is a highly hydrated gel that consists of about 95% water, 5% mucins, and minor components, such as electrolytes (Allen, 1981;Neutra and Forstner, 1987). Mucins are high-molecularweight glycoproteins that have gel-forming properties which are highly glycosylated and which in turn are responsible for their protective function.A particular morphological feature of the duodenal submucosa is the presence of Brunner's glands. Brunner's glands are specific to mammals and have been observed in all mammals examined to date (Krause, 1988). They are

Background:Early diagnosis represents the best opportunity for cure of colorectal cancer. Current screening programmes use faecal occult blood testing for screening, which has limited sensitivity and poor specificity.Methods:In this study we looked at a series of previously described diagnostic markers utilising circulating free DNA (cfDNA), with a preparation method allowing small DNA fragments to be isolated. The Circulating free DNA was isolated from samples obtained from 85 patients, including 35 patients without endoscopic abnormality, a group of 26 patients with benign colorectal adenomas, and 24 patients with colorectal carcinomas. In each case, polymerase chain reaction (PCR) was performed for Line1 79 bp, Line1 300 bp, Alu 115 bp, Alu 247 bp, and mitochondrial primers. In addition, carcinoembryonic antigen (CEA) was measured by ELISA. Each marker was analysed between normal, polyp, and cancer populations, and the best performing analysed in combination by logistic regression.Results:The best model was able to discriminate normal from populations with adenoma or carcinoma using three DNA markers and CEA, showing an area under the receiver operator characteristic (ROC) curve of 0.855 with a positive predictive value of 81.1% for polyps and cancer diagnosis.Conclusion:These circulating markers in combination with other markers offer the prospect of a simple blood test as a possible secondary screen for colorectal cancers and polyps in patients with positive faecal occult blood tests.

The size/morphology/site/access scoring system is easy to use and provides valuable information on the lesion complexity and success and complication rates of endoscopic resection. This can be used for service planning, training endoscopists, and providing prognostic information for patients.

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IntroductionThe traditional approach to the management of large colonic polyps has been surgery. Endoscopic mucosal resection (EMR) is an emerging technique for the removal of large colorectal lesions. Most of the published literature comes from Japan, with limited data regarding safety, effi cacy and outcome in the west. We aim to assess the feasibility and safety of EMR in the colon in a western setting. Methods A prospective review of patients undergoing EMR of colonic neoplasia >2 cm in size was performed. All patients were tertiary referrals from experienced consultants. The polyps were considered technically challenging due to size, diffi cult lesion access (peri-diverticular, peri-appendicular, touching the dentate line), or recurrences on previous EMR scars. They were referred to our service prior to surgical referral. Lesions were assessed using indigocarmine chromoendoscopy, and lesions with features suggestive of invasive malignancy were excluded. Completeness of resection was recorded by the endoscopist. Patients were followed up endoscopically where appropriate to assess for incomplete resection or recurrence. Results 214 patients with 214 polyps underwent EMR. The mean size was 43 mm (range 20-150). 180 were fl at and 46 were on the right side of the colon. Primary reason for referral was the size in 91 cases, lesion access in 107 cases and a previous failed resection in 16 cases. Endoscopic clearance at fi rst attempt was achieved in 92% of cases. Residual or recurrent disease was seen at the fi rst endoscopic follow-up in 17% cases requiring further endoscopic resection. Overall endoscopic

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