A method to quantitate the relative nuclear area of colorectal polyps by image analysis.

Image analysis of the nuclear area was performed on Feulgen-stained sections from 94 colorectal polyps: 57 colorectal adenomas with or without invasive growth, 28 hyperplastic polyps and 9 Peutz-Jeghers hamartomas (without dysplasia or carcinoma). The lowest mean values of nuclear area were recorded in control cases: in hyperplastic polyps (27.3%), followed by hamartomatous polyps (34.7%). The nuclear area was significantly increased in tubular adenomas with low-grade dysplasia (37.9%), in villous adenomas with low-grade dysplasia (41.16%) and in tubular and villous adenomas with high-grade dysplasia (47.0% and 46.0%, respectively). The nuclear area in villous adenomas with invasive growth was significantly higher than in all other adenomas without invasive growth (56.0%). The present data suggest that the nuclear area in colorectal polyps (as deduced by image analysis studies) correlates well with the degree of nuclear atypia. Thus, measurements of nuclear area appear to be an important parameter in studies aiming to elucidate the malignant potential of these lesions.     

Is Surveillance Colonoscopy Necessary for Patients with Sporadic Gastric Hyperplastic Polyps?

Background

Gastric polyps, such as adenomas and hyperplastic polyps, can be found in various colonic polyposis syndromes. Unlike in sporadic gastric adenomas, in which the increased risk of colorectal neoplasia has been well characterized, information in sporadic gastric hyperplastic polyps was limited.

Aim

To evaluate the association of sporadic gastric hyperplastic polyps with synchronous colorectal neoplasia in a large cohort.

Methods

Patients with sporadic gastric hyperplastic polyps who underwent colonoscopy simultaneously or within six months were consecutively enrolled. Each patient was compared with two randomly selected age and sex matched controls without gastric polyps who also underwent colonoscopy in the same period. Data of patients’ demographics and characteristics of the gastrointestinal polyps were documented.

Results

A total of 261 cases in 118,576 patients who underwent esophagogastroduodenoscopy were diagnosed as sporadic gastric hyperplastic polyps, and 192 of 261 (73.6%) patients underwent colonoscopy. Colorectal neoplasias were identified in 46 (24.0%) of 192 cases and in 40 (10.4%) of 384 controls (P＜0.001). The mean size and distribution of colorectal neoplasias were not significantly different between the two groups. There was a significantly higher rate of colorectal adenoma (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.9–5.3) in the gastric hyperplastic polyps group than in the control group, while the prevalence of colorectal cancer was similar in the two groups. Logistic regression analysis also suggested that the presence of gastric hyperplastic polyps (OR 2.5, 95% CI 1.5–4.0) was an independent risk factor for colorectal neoplasias.

Conclusion

The risk of colorectal adenoma increases in patients with sporadic gastric hyperplastic polyps, and surveillance colonoscopy for these patients should be considered.     

Colorectal carcinoma and its precursors: role of argyrophilic nucleolar organizer regions (AgNORs).

A silver colloid technique to identify Argyrophilic Organizer Region (AgNOR) was applied to 5 hyperplastic polyps, 5 adenomas with low grade dysplasia, 5 adenomas with high grade dysplasia and 15 adenocarcinomas of the large bowel (5 well differentiated, 5 moderately differentiated and 5 poorly differentiated). The authors suggest the plainness and usefulness of simultaneous application of clumps per cell, AgNORs per clump and total AgNORs counts in the evaluation of neoplastic and preneoplastic lesions of the colon. In fact the results show that the number of clumps per cell is useful to distinguish hyperplastic polyps from adenomas with high grade dysplasia and from all the adenocarcinomas. Using the number of AgNORs per clump there is significant difference between hyperplastic polyps and adenomas with high grade dysplasia and between adenomas with low grade dysplasia and well differentiated adenocarcinomas. Finally the total number of AgNORs can discriminate hyperplastic polyps from adenomas with high grade dysplasia and these from adenomas with low grade dysplasia.     

胃底腺息肉与胃增生性息肉的临床、内镜特征分析

目的:分析胃底腺息肉与胃增生性息肉的临床、内镜下等特点。方法:回顾性搜集胃镜检出的经病理证实的胃底腺息肉和胃增生性息肉393例纳入分析,按年龄、性别、发生部位、大小、幽门螺杆菌(helicobacter pylori)感染状态、是否使用质子泵抑制剂(proton pump inhibitor)等因素进行分析比较。结果:393例增生性息肉与胃底腺息肉中,男178例,女215例,男女比例为1:1.2,年龄28~89岁。随着年龄的增高,胃息肉发生率越高,但各年龄段分布差异无统计学意义(P>0.05)。不同部位的增生性息肉与胃底腺性息肉大小相比差异有统计学意义(P<0.05)。两种胃息肉的性别分布差异有统计学意义(P<0.05)。增生性息肉H.pylori感染率较胃底腺性息肉高(P<0.05),而胃底腺息肉质子泵抑制剂使用率较胃增生性息肉高(P<0.05)。结论:增生性息肉与幽门螺旋杆菌感染有关,胃底腺息肉与质子泵抑制剂使用有关。对胃底腺息肉与胃增生性息肉的临床、内镜特点的分析有助于胃镜检查对胃息肉性质的初步判断,提高诊断的准确性。     

Immunohistochemical staining patterns of MUC1, MUC2, MUC4, and MUC5AC mucins in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum.

We studied the distribution of the four human apomucins MUC1, MUC2, MUC4, and MUC5AC in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum using immunohistochemical techniques, with the aim of comparing and contrasting their patterns of expression. A series of 12 hyperplastic polyps, 27 serrated adenomas, and 20 traditional adenomas was studied. No significant change in apomucin expression was observed in traditional adenomas compared with normal colorectal epithelium, except for MUC5AC, which was present in 12 of the adenomas (60%) and only 20% of the normal samples. In both hyperplastic polyps and serrated adenomas, MUC2 and MUC5AC mucin expression was consistently and markedly increased. In 50% of the hyperplastic polyps, MUC4 was reduced but in the remaining cases was similar to normal. Loss of MUC4 expression was observed in all serrated adenomas. MUC1 was not increased in the hyperplastic polyps but increased expression was seen in 17 of the serrated adenomas (63%). Similar altered distribution patterns of MUC2, MUC4, and MUC5AC were seen in hyperplastic polyps and serrated adenomas, whereas traditional adenomas showed little change from normal patterns of expression. Although hyperplastic polyps are commonly defined as benign lesions without neoplastic potential, the similar phenotypes of hyperplastic and serrated adenomas and the existence of mixed polyps suggest that these lesions may represent a histogenetic continuum.     

Potential role of nuclear appearance in pathologic recognition and delimitation of sessile serrated polyps of the colon: a karyometric study

OBJECTIVE: To estimate the extent to which surgical pathologists can rely on abnormal nuclear appearance to recognize sessile serrated adenoma (SSP) and to define its extent. STUDY DESIGN: Digitized images of nuclei of superficial crypt cells from SSPs, banal hyperplastic polyps (BHPs), tubular adenomas (TAs) and normal colonic mucosa (N) in surgical pathology specimens were analyzed for size, shape, area, optical density (summed and average) and 22 Markovian texture characteristics. RESULTS: Statistical classification functions correctly distinguished TA from N nuclear image profiles in 93.3% of cases, SSP from N in 70.0% and BHP from N in 74.1%. SSP nuclear feature vectors were less effectively separated from N than BHP and TA on discriminant analysis of the combined data set, and correct classification was achieved in 79.6% of TAs, 53.5% of SSPs and N and 64.2% of BHPs. CONCLUSION: Karyometry distinguished stained nuclei of TAs, but had limited ability to separate nuclei of SSP from those of N and BHP. This suggests that the pathologist attempting to diagnose or delimit the margins of an SSP will find nuclear appearances less helpful than when examining a TA.     

Neuroendocrine (ECL cell) differentiation of spontaneous gastric carcinomas of cotton rats (Sigmodon hispidus).

BACKGROUND AND PURPOSE: Female inbred cotton rats develop adenocarcinomas in the oxyntic mucosa. Since a female preponderance is typical for enterochromaffin-like (ECL) cell tumors, we examined such tumors for ECL cells. Gastrin plays a decisive role in ECL cell tumorigenesis, so blood gastrin concentration and gastric mucosal pH were measured. METHODS: The stomachs from six female cotton rats (6 to 8 months old) were studied histologically, and at euthanasia, gastric mucosal pH was determined. Euthanasia was performed on 15 other female cotton rats of similar age for determination of blood gastrin values by radioimmunoassay (RIA) and gastric mucosal pH. Rats were classified macroscopically to have normal or thick oxyntic mucosa, with or without tumor. RESULTS: Among the six cotton rats studied histologically, two 6-month-old rats had normal and two others had thick gastric mucosa, whereas two 8-month-old rats had thick mucosa with tumors. The ECL cells were markedly hyperplastic in all rats with thick mucosa, and ECL cells were found in the neoplastic parenchyma. All cotton rats with normal-appearing gastric mucosa had pH <2.5, whereas 14 rats with thick mucosa had pH >3.1 and hypergastrinemia. CONCLUSIONS: Gastrin may play a major role in ECL cell hyperplasia and, perhaps, in adenocarcinoma genesis.     

Hyperplastic polyps and sessile serrated ‘adenomas’ of the colon and rectum display gastric pyloric differentiation

The serrated polyp-neoplasia pathway is a novel concept that has been demonstrated to differ from the conventional adenoma-carcinoma pathway. To characterize the phenotypic patterns of differentiation in colorectal serrated polyps, we examined the immunohistochemical expression profile of gastric (MUC5AC, TFF1, MUC6, GlcNAcα1 → 4Gal → R, and PDX1) and intestinal (MUC2, TFF3, and CDX2) epithelial markers in 15 hyperplastic polyps (HPs), 29 sessile serrated adenomas (SSAs),12 traditional serrated adenomas (TSAs), and 16 conventional adenomas (CAs). MUC5AC and TFF1 were upregulated in the HPs, SSAs, and TSAs. MUC6 was expressed in the HPs and SSAs. GlcNAcα1 → 4Gal → R was expressed only in the SSAs. Although MUC2 expression was preserved, TFF3 was downregulated in the HPs, SSAs, and TSAs. PDX1 was upregulated in the HPs, SSAs, and TSAs. On the other hand, CDX2 was downregulated in the HPs and SSAs. The colorectal serrated polyps showed higher expression of gastric makers than CAs. The HPs and SSAs showed gastric and intestinal mixed phenotype expression with gastric pyloric organoid differentiation and almost identical, but different from the TSAs, marker profile. PDX1 up-regulation and CDX2 down-regulation could be important for the induction of a gastric pyloric pattern of cell differentiation in colorectal serrated polyps.     

A new mouse model for studying EGFR-dependent gastric polyps

Hyperactivation of the epidermal growth factor receptor (EGFR) in gastric cells due to excess of its ligand transforming growth factor-α (TGFA) is associated with hyperplastic lesions in Ménétrier's disease patients and in transgenic mice. Other EGFR ligands, however, have never been associated with stomach diseases. Here, we report that overexpression of the EGFR ligand betacellulin (BTC) results in a severe, age-dependent hyperplasia of foveolar epithelium. The stomach weight of affected mice reached up to 3g representing more than 10% of total body weight. The preexisting corpus mucosa was severely depleted, and both parietal and chief cells were replaced by proliferating foveolar epithelium. The lesions were more severe in male as compared to female transgenic mice, and partially regressed in the former after castration-mediated androgen removal. The gastric hyperplasia fully disappeared when BTC-tg mice were crossed into the Egfr(Wa5) background expressing a dominant-negative EGFR, indicating that the phenotype is EGFR-dependent. This is, to our knowledge, the first report of hyperplastic gastric lesions due to the overexpression of an EGFR ligand other than TGFA. BTC-tg mice are therefore a new, promising model for studying EGFR-dependent gastric polyps.     

Nuclear volume in type I gastric intestinal metaplasia

OBJECTIVE: To retrospectively compare nuclear size of epithelial cells in type I intestinal metaplasia (IM) from various pathologic lesions of gastric mucosa. STUDY DESIGN: Endoscopic mucosal biopsies with type I IM from intestinal type gastric carcinoma (n = 25), chronic gastritis (n = 40) and benign ulcer (n = 32) cases were analyzed. After standard fixation, embedding, sectioning, routine hematoxylin and eosin and alcian blue--periodic acid--Schiff reaction (pH 1.0 and 2.5) staining were used for identification of IM. The mean point sampled nuclear intercept was estimated by the original test system and 100x objective at a total magnification of 1,200x. To obtain the mean nuclear volume, the cubed nuclear intercept was multiplied by pi/3. In each case 100 epithelial cell nuclei were analyzed. RESULTS: In type I IM in gastric carcinoma cases there was significantly greater nuclear volume (118.34 +/- 10.32 micron 3) than in type I IM in other pathologic states of gastric mucosa (77.72 +/- 8.58 micron 3). CONCLUSION: The karyometric findings of the present study suggest a difference between type I IM found in benign pathologic states and type I IM found in gastric mucosa surrounding carcinoma, despite morphologic and histochemical similarities. Nuclear volume may be used in early detection of precancerous states of gastric mucosa.     

Computerized morphometric study on fine needle aspirates of cellular follicular lesions of the thyroid

OBJECTIVE: To investigate the value of computerized nuclear morphometry in the differential diagnosis of cellular follicular lesions of the thyroid cytologically diagnosed on fine needle aspiration (FNA) smears. STUDY DESIGN: Sixty cases of FNA thyroid smears were cytologically diagnosed and classified as follows: 30 cases of follicular carcinoma, 20 cases of cellular hyperplastic nodules and 10 cases of follicular adenoma. Using an image analysis system, two morphometric variables, nuclear area and major axis length of the nucleus, were measured for each case. RESULTS: For both nuclear morphometric variables, statistical differences were found between carcinomas and hyperplastic nodules as well as between carcinomas and adenomas. No statistical differences were found between the nuclear variables in either hyperplastic nodules or adenomas. CONCLUSION: The results confirm the aim of our study, to establish nuclear morphometry by computerized image analysis as an additional tool in the differential diagnosis of thyroid follicular lesions cytologically diagnosed on FNA smears.     

Benign epithelial gastric polyps--frequency,location, and age and sex distribution

Prospective investigation has been undertaken with the aim to study the frequency, location and age and sex distribution of various histological types of benign gastric epithelial polyps. Histological type--adenomatous, hyperplastic and fundic gland polyps--was diagnosed on the basis of at least three histological samples taken from the polyp. Biopsy samples were also taken from the antrum and the body of the stomach so that gastritis could be graded and classified, and the presence of H. pylori could be determined by histology. All 6,700 patients, who had undergone upper gastrointestinal endoscopy in a one-year period, participated in this study. Among them 42 benign gastric epithelial polyp were found in 31 patients: adenomatous gastric polyps in 7 patients, hyperplastic gastric polyp in 21 and fundic gland polyp in 3 patients. All patients with hyperplastic polyps had chronic active superficial gastritis, whereas most of the patients with adenomatous polyps had a chronic atrophic gastritis with high prevalence of intestinal metaplasia. Among 21 patients with hyperplastic gastric polyps, 16 (76%) patients were positive for H. pylori infection in contrast to only 2 patients (29%) with adenomatous gastric polyps and 1 patient (33%) with fundic gland polyp. Presented data indicates that hyperplastic gastric polyps are the most common and they are associated with the presence of chronic active superficial gastritis and concomitant H. pylori infection. Adenomatous polyps are rarer and they tend to be associated with chronic atrophic gastritis and intestinal metaplasia. Fundic gland polyp is the rarest type of gastric polyps.     

Fine needle aspiration diagnosis of hyperplastic and neoplastic follicular nodules of the thyroid. A morphometric study.

The differentiation of hyperplastic nodules, follicular adenomas and follicular carcinomas from fine needle aspiration (FNA) cytology smears may be difficult. To better define the diagnostic criteria, we studied the morphometric parameters of nuclear area (NA), nuclear:cytoplasmic ratio and nuclear roundness (NR) in single cells and cell aggregates. In addition, we quantitated the percentage of touching or overlapping nuclei (NO) and the percentage of extent of nuclear area of overlap (NAO) in cellular aggregates. We measured cellular samples from FNA aspirates obtained from 20 hyperplastic nodules, 21 follicular adenomas, 5 encapsulated follicular carcinomas and 22 invasive follicular carcinomas, all of which were subsequently confirmed by histologic examination. Cellular aggregates provided the maximum diagnostic information. Stepwise discriminant analysis revealed that nuclear size, nuclear roundness and the percentage NAO allow optimum differentiation of hyperplasia, adenomas and carcinomas. Clearly, all of the poorly differentiated carcinomas (large NA, low NR, high NO and NAO) could be reliably diagnosed. Discriminant analysis allowed the differentiation of carcinoma from adenoma in 20/22 carcinomas (91%) and all 21 adenomas (although 2 adenomas were called hyperplasias and 3 hyperplasias were called adenomas).     

Progastrin production transitions from Bmi1+/Prox1+ to Lgr5high cells during early intestinal tumorigenesis

Progastrin is an unprocessed soluble peptide precursor with a well-described tumor-promoting role in colorectal cancer. It is expressed at small levels in the healthy intestinal mucosa, and its expression is enhanced at early stages of intestinal tumor development, with high levels of this peptide in hyperplastic intestinal polyps being associated with poor neoplasm-free survival in patients. Yet, the precise type of progastrin-producing cells in the healthy intestinal mucosa and in early adenomas remains unclear. Here, we used a combination of immunostaining, RNAscope labelling and retrospective analysis of single cell RNAseq results to demonstrate that progastrin is produced within intestinal crypts by a subset of Bmi1⁺/Prox1⁺/LGR5^low endocrine cells, previously shown to act as replacement stem cells in case of mucosal injury. In contrast, our findings indicate that intestinal stem cells, specified by expression of the Wnt signaling target LGR5, become the main source of progastrin production in early mouse and human intestinal adenomas. Collectively our results suggest that the previously identified feed-forward mechanisms between progastrin and Wnt signaling is a hallmark of early neoplastic transformation in mouse and human colonic adenomas.     

Variation in expression of gastric leptin according to differentiation and growth pattern in gastric adenocarcinoma

Leptin is an adipocyte-derived hormone that regulates body fat stores and feeding behavior. The presence of leptin in stomach epithelium was recently demonstrated in the rat and humans, and gastric leptin has been linked to the control of meal size, local inflammatory responses, and paracrine and autocrine functions through leptin receptors in the stomach. We compared the expression patterns of leptin and of the long variant of the leptin receptor (Ob-Rb) between areas with non-ulcerated mucosa and with hyperplastic polyps, adenoma, or adenocarcinoma to evaluate the expression relative to different disease states. Leptin and Ob-Rb were expressed in hyperplastic polyps, adenoma, and adenocarcinoma. In the gastric adenocarcinoma, leptin was expressed significantly less in the poorly differentiated and diffuse-type groups than in the well-differentiated and moderately differentiated groups or in the intestinal type. Based upon our findings, we suggest the possibility that leptin expression can have a pathophysiologic role about the differentiation or growth pattern of gastric adenocarcinoma. A further series of experiments is necessary to elucidate the pathophysiological role of leptin in the differentiation of gastric adenocarcinoma.     

Anaerobic bacterial populations on normal and diseased human biopsy tissue obtained at colonoscopy.

Human epithelium was cultured to characterize differences in microbial populations between regions of normal colon and between polyps, inflammatory bowel disease, and cancer and their respective adjacent normal mucosa. Twenty-one patients (12 polyps, 5 inflammatory bowel disease, 4 cancer) underwent colonoscopy with anaerobic culture of mucosal biopsies from normal and diseased ascending, transverse, descending, and sigmoid colon. No differences for total number of organisms and recovery of species between ascending colon and other normal regions were seen except for sigmoid colon. Significant differences between polyps and adjacent normal tissue were seen for total number of organisms and recovery of genera and species. No significant differences in total number of organisms and recovery of genera were seen between cancer and inflammatory bowel disease and their respective adjacent normal tissue. The recovery of genera from polyps and normal tissue was Bacteroides greater than Fusobacterium greater than Clostridium greater than Eubacterium greater than Peptostreptococcus. These data suggest that (i) the total number of anaerobic organisms and species remained relatively constant, except for lower numbers in normal distal colon which were probably a result of the preparation for colonoscopy; (ii) polyp formation favored increased microbial colonization; and (iii) the increased number of organisms generally reflected those genera and species seen on adjacent normal mucosa.     

Involvement of cyclooxygenase-2 in gastric mucosal hypertrophy in gastrin transgenic mice

Gastrin promotes gastric mucosal growth, and hypergastrinemia induces gastric mucosal hypertrophy. Recently, it has been reported that gastrin induces cyclooxygenase-2 (COX-2) in human gastric and colorectal cancer cell lines. However, whether COX-2 is involved in gastrin-induced gastric mucosal growth in vivo is unknown. We investigated the role of COX-2 in gastrin-induced gastric mucosal hypertrophy using gastrin transgenic mice. Hypergastrinemic mice [mice with mutated gastrin under the control of the beta-actin promoter (ACT-GAS mice)] received the COX-2 inhibitor celecoxib (0, 200, or 500 mg/kg of diet) from 5 wk of age and were killed at 16 or 24 wk. Some ACT-GAS mice received celecoxib from 16 wk and were killed at 24 wk. Eighty-week-old ACT-GAS mice without celecoxib treatment were also examined. The thickness of the gastric mucosa, cell populations, COX-2 expression, and PGE(2) levels were evaluated. All ACT-GAS mice showed gastric mucosal hypertrophy, and four of six 80-wk-old ACT-GAS mice developed gastric cancer. COX-2 was expressed in interstitial cells of the hypertrophic gastric mucosa and gastric cancers. Moreover, PGE(2) levels in the gastric mucosa of ACT-GAS mice were significantly higher than those of normal mice. With treatment with celecoxib, PGE(2) levels, the gastric mucosal thickness, and the number of total gastric cells per gastric gland of ACT-GAS mice were significantly decreased. The decrease in gastric mucosal thickness was caused by a reduction of foveolar hyperplasia. The thickness of glandules and the number of Ki67-positive cells were not significantly changed. In conclusion, COX-2 contributes to gastrin-induced mucosal hypertrophy of the stomach.     

Improved method for mapping gastric intestinal metaplasia using selective histochemical morphometry

A gastrectomy specimen containing two tubular adenomas from a 67-year-old woman was mapped by an improved method using selective histochemical staining. The specimen was divided into 83 blocks measuring 4.0 cm x 0.5 cm. Sections from the blocks were stained with alcian blue (pH 2.5) to detect mucin. Alcian blue-stained fields were easily identified and measured with the aid of a MOP 30 interactive digital image analyzer. The total area of gastric mucosa analyzed in the 83 sections measured 3,270.9 sq mm while the area occupied by alcian blue-stained goblet cells measured 755.9 sq mm (23.1% of the total area). Intestinal metaplasia was present in 46 of 83 blocks. Both the mean size of alcian blue-positive fields per section as well as the number of alcian blue-positive fields per section were significantly larger in the antral zone I and the intermediate zone II than in the fundal zones III, IV and V. The highest proportion of gastric mucosa with intestinal metaplasia was not found around the two gastric adenomas, but elsewhere. There was no significant difference in the proportion of intestinal metaplasia between the greater and lesser curvatures, further challenging the belief that intestinal metaplasia is always greatest along the lesser curvature. The method described will permit future studies of the possible association between intestinal metaplasia and dysplasias and adenocarcinomas of the stomach.     

内镜下黏膜切除术治疗胃息肉的疗效及对血清ProGRP、PGI水平的影响

摘要 目的：探讨内镜下黏膜切除术治疗胃息肉的疗效及对血清胃泌素释放肽前体（ProGRP）、胃蛋白酶原I（PGI）水平的影响。方法：选取我院2019年8月到2022年8月收治的120例胃息肉患者作为研究对象，依照手术方式的不同进行分组，其中将选择常规内镜下电凝切除术治疗的60例患者分为对照组，选择内镜下黏膜切除术治疗的60例患者分为观察组。对比两组患者不良反应发生情况与治疗费用，手术前与手术后血清ProGRP、PGI表达水平以及炎症因子表达水平，对比两组患者整体切除率和并发症发生情况。结果：两组患者总治疗费用对比无差异（P＞0.05），观察组患者术后不良反应发生率较对照组低（P＜0.05）；两组患者手术前血清ProGRP、PGI水平对比无差异（P＞0.05），治疗后两组患者均降低，且观察组较对照组低（P＜0.05）；两组患者手术前PCT、CRP、IL-6、IL-2对比无明显差异（P＞0.05），手术后两组患者PCT、CRP、IL-6、IL-2均升高，且观察组低于对照组（P＜0.05）；两组患者胃息肉均被完整切除，整体切除率对比无差异；且观察组穿孔、迟发性出血以及感染等并发症发生率虽低于对照组，但比较无差异（P＞0.05）。结论：对胃息肉患者采取内镜下黏膜切除术与常规内镜下电凝切除术均能够完整的切除胃息肉，且治疗费用相当。而应用内镜下黏膜切除术能够降低患者ProGRP、PGI水平，降低机体炎症因子反应，且并发症发生率较低，值得临床应用推广。     

Portal hypertensive gastric mucosa has reduced activation of MAP kinase (ERK2) in response to alcohol injury: a key to impaired healing?

Portal hypertensive (PHT) gastric mucosa has increased susceptibility to injury and impaired mucosal healing. Because our previous study showed that ulcer-induced activation of mitogen-activated protein (MAP) kinase (ERK) plays a pivotal role in gastric mucosal healing, we investigated whether ERK activation is altered in PHT gastric mucosa following alcohol injury. We studied ERK2 phosphorylation and activity and expression of MAP kinase phosphatase-1 (MKP-1) in gastric mucosa of PHT and sham-operated (SO) normal rats both at baseline and following alcohol injury. In SO gastric mucosa, ERK2 phosphorylation and activity were significantly increased time-dependently following alcohol injury: by 221% and 137%, respectively at 24 h vs. baseline. In contrast, in PHT gastric mucosa following alcohol injury, neither ERK2 phosphorylation nor activity was increased versus baseline. In PHT gastric mucosa, MKP-1 mRNA and protein expression were increased at baseline versus SO rats and were increased further following alcohol injury with values higher by 20%-40% at each study time versus SO rats. Because ERK2 is crucial for mucosal healing, reduced ERK2 activation resulting from the overexpression of MKP-1 might be the basis for the impaired mucosal healing in PHT gastric mucosa.