Introduction

CDH1 gene mutations are associated with gastric and breast cancer. The risk of colorectal cancer may be increased in the presence of this mutation, although evidence is scarce.

Aims & Methods

Aims: To assess the presence of high-risk colorectal polyps (polyp with ≥10mm or with high-grade dysplasia, ≥5 adenomas, any serrated polyp ≥10mm or with dysplasia) and colorectal cancer in patients on surveillance program with mutation in CDH1 gene.
Methods: Retrospective study in patients with CDH1 gene mutation followed in a family risk appointment in a tertiary care hospital.

Results

Data from 36 patients with a mean age of 44.22±14.77 years, 20 males, with a mean follow-up of 5.5 years. Twenty-seven patients had family history of gastric cancer and 9 of gastric and breast cancer; twelve patients had never undergone colonoscopy (age ≤ 40 years). Of the 24 patients who had already undergone at least one colonoscopy, 12 (50%) never removed polyps. Only 4 patients had high-risk polyps (age 30, 52, 59 and 77 years) and no patient presented with colorectal cancer during follow-up.

Conclusion

Although this is a small sample, our study revealed a low percentage of patients with hereditary diffuse gastric cancer with high-risk colorectal polyps (and only one patient with a high-risk polyp aged <50 years) and no patients with colorectal cancer, similar to a population without a CDH1 mutation. Further studies with larger sample sizes are needed to clarify the impact of CDH1 mutation on colorectal cancer.

Introduction

ESD has become the standard treatment for early gastric cancer. Recently, the number of patients taking antithrombotic agents (ATAs) has increased, and the prevention of post-ESD bleeding is a main concern. EHS after gastric ESD has been developed to solve these problems, but the effectiveness and procedural success rate of EHS is not known. Here we investigate the successful introduction of EHS and evaluate the safety and effectiveness of the EHS.

Aims & Methods

11 patients who underwent EHS after gastric ESD from December 2022 to April 2024 were included in this study. Patient and lesion background, endoscopic findings, and treatment outcomes were reviewed retrospectively. A V-loc 180 available barbed suture (VLOCL0604; Covidien, Mansfield, Mass, USA) and through-the scope flexible needle holder (SutuArt, Olympus, Tokyo, Japan) were used for EHS. The same endoscopist and the assistant performed Ex vivo training model prior to clinical introduction.

Results

Mean age was 74.8±7.3 years, 9 males and 2 females, and 4 with and 7 without ATAs. The lesion locations were as follows: upper/middle/lower = 4/0/7. Mean tumor size was 15.4±5.3 mm, mean defect size was 30.3±5.4 mm, and mean resection time was 46.6±26.4 minutes. The mean time needed for suturing was 30.6±9.6 minutes, and a mean of 4.7±0.4 stitches were placed. Suturing speed （resection area/suturing time) was 20.9±7.5 mm²/min. Complete suture was achieved in all patients, and they began clear fluid on POD1. There were no adverse events during EHS such as bleeding or perforation.

Conclusion

In EHS, complete suture was achieved in all cases, with no post-ESD bleeding or delayed perforation. Further data is needed to confirm its effectiveness.

References

1) O. Goto et al. Endoscopic hand-suturing is feasible, safe, and may reduce bleeding risk after gastric endoscopic submucosal dissection: a multicenter pilot study (with video). Gastrointest Endosc 2020 ; 91(5): 1195-1202.