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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow‐up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level‐C1 EGC. For patients with a level‐C2 EGC, close follow‐up is suggested for low‐risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 42-year-old Chinese woman with a protruded polyp at the ascending colon. Topics discussed include results of various medical tests; complications of dysplasia; and the usage of white light endoscopy, narrow band imaging and chromoendoscopy in the treatment.

Background and Study Aims Small bowel Crohn's disease ( SBCD) patients are frequently assessed by capsule endoscopy ( CE), which enables direct visualization of small bowel mucosal abnormalities; however, the correlations between CE scoring index ( CESI), C-reactive protein ( CRP), and disease activity indices remain undefined. We aimed to determine correlations between the CESI, clinical disease activity indices, and CRP in SBCD patients. Patients and Methods A prospective study was conducted between October 2008 and February 2011 on 58 established SBCD patients and suspected patients who received a definitive SBCD diagnosis during study. Patients underwent complete CE and were scored according to the CESI and Harvey- Bradshaw index ( HBI). Statistical correlation among CESI, HBI, and CRP was assessed. Results Weak, but significant, correlations were found between CESI and HBI (r = 0.4, P < 0.01). The correlation between CESI and CRP was moderate (r = 0.58, P < 0.01). The median CRP value was significantly higher in patients with moderate to severe CESI compared with the mild group (22.60 ± 16.79 mg/ L vs 11.88 ± 8.39 mg/ L, P < 0.01). Changes between baseline and follow-up CESI failed to correlate with the delta- HBI or delta- CRP (both, P > 0.05). Conclusions In this cohort of SBCD patients, clinical disease activity index was not reliable predictors of mucosal inflammation. CRP, however, might be a useful inflammatory marker for evaluating the moderate to severe CE activity in SBCD patients. Furthermore, therapy-induced clinical and biological improvement was not associated with repair of SBCD mucosal lesions. [ABSTRACT FROM AUTHOR]

Objective Endoscopic resection ( ER) was introduced to China from Japan, while most pathologists are influenced by Western criteria. Japanese and Western pathologists have debated for decades how best to distinguish between gastric intraepithelial neoplasia ( GIEN) and early gastric cancer ( EGC). In this study we aimed to find out how to solve this pathological discrepancy and improve the curative resection of lesions based on our experiences. Methods In total, 143 patients with GIEN or EGC were treated by ER in our hospital from April 2008 to April 2012. The risk factors related to the degree of malignancy of the lesions and the non-curability of ER were analyzed. Pathological discrepancy between forceps biopsies and ER specimens was also compared. Results According to the histological types of the ER specimens, there were 67 patients with low-grade intraepithelial neoplasia ( LGIN), 35 with high-grade intraepithelial neoplasia ( HGIN) and 41 with EGC. The ER histological type was significantly correlated with gender, ER method, macroscopic type, tumor size, ulcer and histological type of the forceps biopsy ( P < 0.05). The discrepancy between forceps biopsy and ER specimens was 41.3% (59/143). Furthermore, the depth of tumor invasion and ER histological type were associated with the curative resection of HGIN and EGC ( P < 0.05). Conclusions The pathological discrepancy shows that patients with HGIN in forceps biopsy should be considered candidates for ER. The risk factors of lesion malignancy and ER curability indicate the great importance of pretreatment evaluation for ER. [ABSTRACT FROM AUTHOR]

Background and Aims: A recent placebo-controlled trial showed that rebamipide, which is a mucosal-protective antiulcer agent, promoted gastric ulcer healing without affecting the Helicobacter pylori status. We conducted a randomized, double-blind trial to compare the healing effects of rebamipide and the proton-pump inhibitor omeprazole in H. pylori-positive gastric ulcers after H. pylori eradication therapy. Methods: After completion of 1 week of eradication therapy, 132 patients with H. pylori-positive gastric ulcer were enrolled in 5 Chinese and 4 Korean institutions. Patients were randomly assigned to take either 20 mg of omeprazole (n = 63) or 300 mg of rebamipide (n = 65) daily for 7 weeks. Healing was defined as complete recovery and S1 and S2 stage ulcer according to the Sakita-Miwa classification. Results: Healing rates at 12 weeks were 81.5% (53/65) and 82.5% (52/63) in the rebamipide and omeprazole groups, respectively. There was no significant difference in treatment efficacy, as evidenced by gastric ulcer healing rates (absolute difference -1.0%; 95% confidence interval -10.7 to 8.7; p = 0.88). The H. pylori eradication rate and ulcer healing rate did not differ between the groups, the latter regardless of eradication outcome. Conclusions: Rebamipide is as effective as omeprazole in treating of H. pylori-positive gastric ulcer after eradication therapy. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective. Lactoferrin as a glucoprotein that can reflect the activity of neutrophil leukocytes is a specific and sensitive indicator in the evaluation of intestinal inflammation. The aim of this study was to evaluate the relationship between fecal lactoferrin and intestinal inflammation by quantitative analysis and the effect of fecal lactoferrin in measuring the activity of inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD). Material and methods. A total of 177 fresh stool samples were collected from 42 active UC, 17 inactive UC, 13 active CD, 5 inactive CD, 41 infectious bowel disease, 25 irritable bowel syndrome (IBS) and 34 healthy volunteers. IBD-SCAN was used quantitatively to measure the level of fecal lactoferrin. A modified Harvey-Bradshaw Active Index was used to evaluate the activity of IBD. Results. Fecal lactoferrin was 3.15±1.60 µg/g in healthy volunteers, 2.54±1.49 µg/g in IBS, 83.3±29.9 µg/g in infectious bowel disease, 1126.29±431.21 µg/g in active UC, 1035.25±456.59 µg/g in active CD, 96.58±82.46 µg/g in inactive UC and 133.52±88.89 µg/g in inactive CD. Fecal lactoferrin was significantly higher in active IBD than in inactive IBD, IBS and infectious bowel disease. The sensitivity and specificity of fecal lactoferrin were 92% and 88%, respectively, for UC, and 92% and 80%, respectively, for CD. Conclusions. Fecal lactoferrin is a sensitive and specific marker in measuring the activity of IBD. It provides us with a valid method in discriminating between inflammatory and non-inflammatory bowel disease. In addition, an elevated fecal lactoferrin level can lead us to exclude IBS in clinical practice. [ABSTRACT FROM AUTHOR]