Browsing by Author "Simić, Aleksandar (7003795237)"

Barrett's esophagus (BE) is a well established precursor of esophageal adenocarcinoma. Both, surveillance and therapeutic strategies have been proposed over the years. Recent deve-lopment of endoscopic radiofrequency ablation (RFA) brought new perspectives in the treatment of BE, with excellent initial results. The study of 40 pts with macroscopically visible BE on endoscopy and biopsy proven goblet cells presence, was conducted from January 2010 until March 2012. In all pts a complete symptomatic, endoscopic and manometric evaluation was performed. Initially RFA HALO 90 and 360 were performed in 28 and 12 pts respectively. Repeated treatments were conducted in 7 pts. The overall number was 50, while the mean number of RFA procedures per patient was 1.25. The mean circumferential length and maximal extent of BE were 1.61 and 3.29 cm respectively. We did not encounter esophageal perforation or hemorrhage during the procedure. Complications were transient short-term retrosternal pain (23 pts) and dysphagia (11 pts). Three months after the RFA mean values of cumulative symptom and heartburn score dropped significantly (p < 0.05). Functional diagnostics did not disclose any statistically significant decrease of lower esophageal sphincter pressure or esophageal body contraction amplitudes. One year foIlow-up was obtained in 26 pts and revealed a complete macroscopically visible BE eradication. So far, in 19 pts a laparoscopic Nissen fundoplication was performed up to 3 months after complete RFA BE eradication. HALO RFA procedure is safe and very effective in the treatment of pts with BE, does not lead to esophageal function impairment, and produces no long term and serious side effects.

Background/Aim. KIT (KIT proto-oncogene receptor tyrosine kinase) and PDGFRA (platelet-derived growth factor receptor alpha) gene mutations represent major molecular forces inside the gastrointestinal stromal tumors (GIST). Aim of this study was to evaluate these mutations in the patients who underwent surgical resection of gastric GIST, but without imatinib mesylate treatment. Methods. Retrospective clinical study included patients who were operated on due to gastric GIST from November 2000 till November 2016. A molecular analysis of paraffin embedded tumor tissue was performed, and the patients with the presence of KIT and PDGFRA mutations were further evaluated, with regard to the pathological tumor stage, disease recurrence and overall survival. Results. Out of 45 patients in total, 43 patients had KIT and PDGFRA mutations, and 2 patients were classified as the wild type GIST. After curative resection, 11 patients were classified as a low risk GIST, 8 as an intermediate risk and 26 as a high risk GIST. The KIT mutations were present in 37 patients, most commonly as deletion in exon 11. The PDGFRA mutations were present in 6 patients. The presence of KIT mutation had a strong statistical correlation with the mitotic index (p = 0.021). After the ten-year follow-up, all patients with the PDGFRA mutations were alive, while those with the KIT mutations had a survival rate of 71% (p = 0.31). Conclusion. The presence of KIT exon 11 deletion in the patients with primarily resected gastric GIST is associated with the higher mitotic index and worse overall survival than those present with the PDGFRA mutations. This results suggest prognostic significance towards more aggressive behaviors. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Objective: To evaluate multidetector computed tomography (MDCT) findings in patients with achalasia, to assess its role in differentiating subtypes in detecting lung involvement and extra-esophageal thoracic complications. Subjects and Methods: This clinical retrospective study included 51 patients with manometrically confirmed achalasia who underwent chest X-ray and MDCT in diagnostic work-up. Esophageal wall thickness and morphology, luminal dilatation, lung changes, and extra-esophageal manifestations were analyzed on MDCT by 2 readers. Wilcoxon, Kruskal-Wallis and Mann-Whitney test were used for assessing the differences among the achalasia subtypes, and intra-class correlation coefficients (ICC) assessing the inter-observer agreement between the measurements of 2 readers. Results: Fourteen (27.5%) patients had achalasia subtype I, 21 (60.8%) had subtype II while 6 (11.8%) had subtype III. Esophageal wall thickness of the esophageal body (EB) and distal esophageal segment (DES) as well as nodular/lobulated appearance of DES were found significantly more often in subtype III (p = 0.024, p < 0.001, p = 0.009, respectively). Esophageal dilatation gradually decreased from subtype I to III (p = 0.006). Chest X-ray revealed lung changes in 9 (17%) and MDCT in 21 (41%) patients (p = 0.001), most frequently in subtype I, with predominance of ground-glass opacities. Tracheal/carinal compression was detected in 27 (52.9%) and left atrial compression in 17 (33.3%) patients. Excellent inter-observer agreement was observed in measuring the EB and DES wall thickness, and diameter of EB (ICC 0.829, 0.901, and 0.922). Conclusion: MDCT is a useful tool for detecting lung and extra-esophageal thoracic complications in patients with achalasia, and could be a valuable additional imaging modality in the differentiation of achalasia subtypes. © 2019 The Author(s) Published by S. Karger AG, Basel.