**Part 3**

**The Stomach and Duodenum** 

96 Gastrointestinal Endoscopy

One advantage of EMR/ESD is that histopathological examination is possible, which allows us to identify the patients who do not need chemotherapy or radiotherapy. EMR/ESD seemed to be effective because there was no local recurrence and residual tumor. There were many high risk patients in our series, so deaths from other causes were frequent. Thus, a randomized controlled trial will be needed to evaluate the correct survival rate. There were also cases of cervical and mediastinal lymph node recurrence in our series. These lymph nodes are removed by esophagectomy with 3-field dissection, so recurrences would have been avoided if esophagectomy had been performed in such patients. Accordingly,

[1] Makuuchi H., Machimura T., Soh Y., Mizutani K., Shimada H., Sugihara T., Tokuda Y.,

[2] Inoue H., Endo M., Takeshita K., Yoshino K., Muraoka Y., Yoneshima H. (1992) et al.: A

[3] Oyama T., Kikuchi Y. (2002). Aggressive endoscopic mucosal resection in the upper GI tract—Hook knife EMR method. Min Invas Ther. Allied Technol. 11: 291–5. [4] Japanese society for esophageal disease (2007) Guidelines for clinical and pathologic

[5] Oyama T., Tomori A., Hotta K., Morita S., Kominato, Tanaka M (2005). Endoscopic

[6] Kato H., Tachimori Y., Watanabe H., Yamaguchi H., Ishikawa T., Itabashi M. (1990)

[7] Isono K., Sato H., Nakayama K. (1991) Results of nationwide study on the three-field

[8] Ide H., Kobayashi A. (1997) The choice of treatment for esophageal cancer. Ann Thorac

[9] Makuuchi H., Machimura T., Mizutani K., Shimada H., Sugano K., Chino O., Sugihara T.,

[10] Makuuchi H. (1996) Endoscopic mucosal resection for early esophageal cancer. Dig

[11] Nakagawa S., Watanebe H. (1994) Mucosal carcinoma of the esophagus - Their

[13] Makuuchi H., Shimada H., Chino O., Tanaka H., Nishi T. (1998) Possibility of

Stomach and Intestine 33: 993-1002 (Japanese, English abstract).

features. Stomach and Intestine 29: 273-288 (Japanese, English abstract). [12] Tomimatsu H., Kato Y., Yanagisawa A., Ninomiya Y., Ueda M., Matsubara T. (1999)

Tajima T., Mitomi T., Ohmori T., Tsuzuki T., Kumagai Y. (1993) Endoscopic mucosal resection for early esophageal cancer by the EEMR-tube method. Stomach

subclassification of depth of invasion, histologic risk factor and macroscopic

Pathological investiganion of esophageal carcinoma with submucosal invasion: Conparison of lymph node metastasis - positive and negative cases. Endoscopia

endoscopic mucosal resection in patients with m3 and sm1 esophageal cancer.

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lymph node dissection of esophageal cancer. Oncology 48: 411-420.

Sasaki T., Tajima T., Mitomi T., Ohmori T., Miyoshi H. (1991) Endoscopic mucosectomy for mucosal carcinomas in the esophagus. Jpn J Surg Gastroenterol

new simplified technique of endoscopic esophageal mucosal resection using a cap-

submucosal dissection of early esophageal cancer. Clin Gastroenterol Heptol 3: S67-

EMR/ESD needs to be selected carefully.

Cardiovasc Surg 3: 87-95.

Endosc 8: 175-179.

24: 2599-2603 (Japanese, English abstract).

fitted panendoscope (EMRC). Surg Endosc 6: 264-265.

Superficial esophageal carcinoma. Cancer 66: 2319-2323.

and Intestine 28: 153-159 (Japanese, English abstract).

Digestiva 11: 1355-1361 (Japanese, English abstract).

**5. References** 

70.

**9** 

*Iran* 

**Clarithromycin Resistance and** 

Mohammad Kargar1, Maryam Baghernejad1, Abbas Doosti2 and Sadegh Ghorbani-Dalini3

*2Biotechnologe Research Center, Shahrekord Branch,* 

*Islamic Azad University, Shahrekord,* 

*Islamic Azad University, Jahrom,* 

*23S rRNA* **Mutations in** *Helicobacter pylori*

*1Department of Microbiology, Jahrom Branch, Islamic Azad University, Jahrom,* 

*Helicobacter pylori* infects about 50% of the world's population and is a major cause of chronic gastritis, is strongly associated with the development of gastric and duodenal ulcers and has been linked with gastric adenocarcinoma and B-cell mucosa-associated lymphoid

*H. pylori* Infection results in a sequence of events, ultimately resulting in the development of some gastrointestinal disorders. The sequence was first suggested by Correa et al. in 1975 and has since been supported by many other studies. Colonization of the gastric mucosa by *H. pylori* first lead to the induction of an inflammatory response, predominantly by Th1 (T helper cells type 1). The initial acute gastritis is followed by active chronic gastritis, which lasts for life if the infection is not treated. Nevertheless, *H. pylori*-positive subjects are mostly unaware of this inflammation due to the lack of clinical symptoms. The Th1 response results in epithelial cell damage rather than in the removal of *H. pylori* because *H. pylori* is not an intracellular pathogen. The ongoing presence of *H. pylori* thus causes a lifelong proinflammatory response coupled to cellular damage and initiates the histological cascade. The continuous production of reactive oxygen species that results from the ongoing inflammation can result in DNA damage, thus inducing the multiple mutations thought to

Among the new methods of magnifying endoscopy, a prototype of endocytoscopy developed by Olympus was used for ex vivo visualization of *Helicobacter pylori* on experimentally infected gastric biopsies. Moving bacteria were observed at 1100× magnification, giving hope for a possible direct detection during endoscopy. Kim et al. also used magnifying endoscopy on 103 patients to classify the gastric surface according to four patterns: flat, irregular, papillary or nonstructured, which were then compared to the updated Sydney System for histologic gastritis. Histologic gastritis was found in 91% of the biopsy sections with a nonflat type, and among them, 96% were confirmed to harbor *H. pylori* infection. In another study, the magnified endoscopic findings in the gastric body

be required for initiation of the cancer cascade depicted in Figure 1 (3, 4).

**1. Introduction** 

tissue lymphoma [1, 2].

*3Department of Microbiology, Jahrom Branch, Young Researcher's Club,* 
