Shiro Urayama

BACKGROUND In endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), submucosal lifting agents such as crystalloid-oil emulsion solution (COES) are used for improved effect. Starch-based polysaccharide solution (SPS), which in powder form acts as effective hemostatic agent, are now available as an alternative lifting agent. AIM To compare SPS to COES outcomes as lifting agents in colonic EMR and ESD. METHODS This is a retrospective study of patients who underwent colonic EMR or ESD and received submucosal injection of either SPS or COES at a single academic center from March 2021 to November 2023. A total of 79 patients were included in the COES group and 99 patients in the SPS group from chart review. Intraprocedural bleeding was defined as bleeding during a procedure requiring hemostatic intervention. Adverse events included were perforation or post-procedure gastrointestinal bleed within the first 30-day period. Data were analyzed using t -test and χ 2 test. RESULTS Successful resection was achieved in all 178 patients. Average lesion size in SPS group was 2.6 cm vs 2.4 cm in COES group. Average procedure time was 22 minutes shorter in the SPS group (P < 0.05). Intraprocedural bleeding was 24.1% more frequent in COES group (P < 0.01). The 30-day adverse events were 9.37% more frequent in the COES group (P < 0.01). En bloc resection was achieved 22.2% more frequently in patients receiving SPS submucosal injection (P < 0.01). CONCLUSION SPS colonic submucosal injection appears to be beneficial over COES, as it is associated with lower intraprocedural bleeding, less adverse events, shorter procedures, and more frequent en bloc resections.

Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer

Spreadsheet of sample mean sequencing depths

PDF file of supplementary methods and materials, and supplementary figures and tables

Spreadsheet of counts of patients with SNV/indel mutations in each gene

PDF file of supplementary methods and materials, and supplementary figures and tables

Gastric cancer is a leading cause of cancer mortality and health disparities in Latinos. We evaluated gastric intratumoral heterogeneity using multiregional sequencing of >700 cancer genes in 115 tumor biopsies from 32 patients, 29 who were Latinos. Analyses focused on comparisons with The Cancer Genome Atlas (TCGA) and on mutation clonality, druggability, and signatures. We found that only approximately 30% of all mutations were clonal and that only 61% of the known TCGA gastric cancer drivers harbored clonal mutations. Multiple clonal mutations were found in new candidate gastric cancer drivers such as EYS, FAT4, PCDHA1, RAD50, EXO1, RECQL4, and FSIP2. The genomically stable (GS) molecular subtype, which has the worse prognosis, was identified in 48% of our Latino patients, a fraction that was >2.3-fold higher than in TCGA Asian and White patients. Only a third of all tumors harbored clonal pathogenic mutations in druggable genes, with most (93%) GS tumors lacking actionable clonal mutations. Mutation signature analyses revealed that, in microsatellite-stable (MSS) tumors, DNA repair mutations were common for both tumor initiation and progression, while tobacco, POLE, and inflammation signatures likely initiate carcinogenesis. MSS tumor progression was likely driven by aging- and aflatoxin-associated mutations, as these latter changes were usually nonclonal. In microsatellite-unstable tumors, nonclonal tobacco-associated mutations were common. Our study, therefore, contributed to advancing gastric cancer molecular diagnostics and suggests clonal status is important to understanding gastric tumorigenesis. Our findings of a higher frequency of a poor prognosis associated molecular subtype in Latinos and a possible new aflatoxin gastric cancer etiology also advance cancer disparities research.Significance:Our study contributes to advancing our knowledge of gastric carcinogenesis, diagnostics, and cancer health disparities.

Gastric cancer is a leading cause of cancer mortality and health disparities in Latinos. We evaluated gastric intratumoral heterogeneity using multiregional sequencing of >700 cancer genes in 115 tumor biopsies from 32 patients, 29 who were Latinos. Analyses focused on comparisons with The Cancer Genome Atlas (TCGA) and on mutation clonality, druggability, and signatures. We found that only approximately 30% of all mutations were clonal and that only 61% of the known TCGA gastric cancer drivers harbored clonal mutations. Multiple clonal mutations were found in new candidate gastric cancer drivers such as EYS, FAT4, PCDHA1, RAD50, EXO1, RECQL4, and FSIP2. The genomically stable (GS) molecular subtype, which has the worse prognosis, was identified in 48% of our Latino patients, a fraction that was >2.3-fold higher than in TCGA Asian and White patients. Only a third of all tumors harbored clonal pathogenic mutations in druggable genes, with most (93%) GS tumors lacking actionable clonal mutations. Mutation signature analyses revealed that, in microsatellite-stable (MSS) tumors, DNA repair mutations were common for both tumor initiation and progression, while tobacco, POLE, and inflammation signatures likely initiate carcinogenesis. MSS tumor progression was likely driven by aging- and aflatoxin-associated mutations, as these latter changes were usually nonclonal. In microsatellite-unstable tumors, nonclonal tobacco-associated mutations were common. Our study, therefore, contributed to advancing gastric cancer molecular diagnostics and suggests clonal status is important to understanding gastric tumorigenesis. Our findings of a higher frequency of a poor prognosis associated molecular subtype in Latinos and a possible new aflatoxin gastric cancer etiology also advance cancer disparities research.Significance:Our study contributes to advancing our knowledge of gastric carcinogenesis, diagnostics, and cancer health disparities.

Spreadsheet of counts of patients with SNV/indel mutations in each gene

Spreadsheet of pan-cancer panel gene composition, with citation codes