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Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR.A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n = 366) or vice versa (6-minute-first group, 6MF, n = 367). The primary outcome was the lesion-level AMR.The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P0.001) and participant-level AMR (10.9% vs 25.9%, P0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P = 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P = 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P = 0.01) of 6MF without compromising detection efficiency ( P = 0.79). In addition, a lower false-negative rate for adenomas ( P = 0.002) and high-risk adenomas ( P0.05), and a lower rate of shortening surveillance schedule ( P0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P = 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR.In addition to increasing ADR, 9-minute m-WT also significantly reduces the AMR and AAMR of screening colonoscopy without compromising detection efficiency.

Brunner’s gland adenoma is a rare tumour of the duodenum, which is usually benign. A 71-year-old woman presenting with epigastric pain, upper gastrointestinal haemorrhage and melaena was reported in this paper. Upper gastro-intestinal (GI) endoscopy revealed a large pedunculated tumour on the superior part of the duodenal bulb. Endoscopic polypectomy was successfully performed by clipping and nylon thread without any complications. Histological examination revealed a Brunner’s gland adenoma.

Background: The specialized columnar epithelium of Barrett's esophagus can be detected by obtaining random or 4 quadrant biopsy specimens at conventional endoscopy. However, little is known about the fine mucosal structure of specialized columnar epithelium. Methods: Thirty patients with Barrett's esophagus were studied by magnifying endoscopy. The fine mucosal pattern (pit pattern) of 67 regions in Barrett's mucosa was recorded and compared with methylene blue staining. Histologic, mucin immunohistologic, and cell proliferation analyses of biopsy specimens were performed in relation to the pit patterns determined by magnifying endoscopy. Results: Pit pattern was classified into 5 types. Tubular and villous pit patterns were not only characteristics of both specialized columnar epithelium and methylene blue absorption, but also possessed an intestinal mucin phenotype with a high Ki-labeling index, whereas other pit patterns (dot and straight) did not have specialized columnar epithelium and were categorized as the gastric phenotype. The long oval pit pattern had an intermediate phenotype between gastric and intestinal. Conclusions: The classification of the superficial mucosal appearance of Barrett's epithelium by magnifying endoscopy reflects not only histologic features but also mucin phenotypes. (Gastrointest Endosc 2002;55:641-7.)

BACKGROUND Overexpression of the matrix serine proteinase (MSP) trypsin has been implicated in tumor growth, invasion, and metastasis. The objective of this study was to clarify the clinicopathologic and prognostic significance of trypsin expression in esophageal squamous cell carcinomas (SCC). METHODS Production of trypsin in tissue extracts was analyzed by immunoblotting and gelatin zymography. The authors analyzed the association between immunohistochemically detected trypsin expression in esophageal SCC and clinicopathologic characteristics, and they investigated whether trypsin is a predictor of recurrence and/or survival. RESULTS Overproduction and activation of trypsin was observed in 6 of 10 tumor extracts. The trypsin immunoreactivities at the invasive front were more intense than those at the superficial layer. Sections with immunostaining signals in greater than 30% of carcinoma cells at the invasive front, which were observed in 52 (52%) cases, were judged to be positive for trypsin. Trypsin positivity was significantly correlated with the depth of invasion (P < 0.0001), lymph node metastasis (P = 0.0048), advanced pTNM classification (P = 0.0006), recurrence (P = 0.0003), and recurrence within the first postoperative year (P = 0.0005). Patients with trypsin positive carcinoma had significantly shorter disease free and overall survival times than did those with trypsin negative carcinoma (P < 0.0001 and P < 0.0001, respectively). Trypsin retained its significant predictive value for disease free and overall survival in multivariate analysis that included conventional clinicopathologic factors (P = 0.0029 and P = 0.0006, respectively). Patients with concomitant overexpression of trypsin and matrilysin at the invasive front, in which they often were colocalized, had the worst prognosis. CONCLUSIONS The authors' results suggest that trypsin plays a key role in the progression of esophageal carcinoma. Detection of trypsin expression as well as matrilysin is useful for the prediction of recurrence and poor prognosis. Cancer 2001;91:1324–31. © 2001 American Cancer Society.