mesna and Stomach-Neoplasms

Previous animal studies and a pilot clinical trial demonstrated that submucosal injection of a thiol compound called mesna could chemically soften connective tissues and thus facilitate endoscopic submucosal dissection (ESD).. To evaluate whether mesna injection could reduce procedural times for gastric ESD.. Double-blind, block-randomized, controlled trial.. University hospital.. A total of 101 patients with superficial gastric cancer indicated for ESD were enrolled and randomly assigned to either the mesna or control (saline solution) group.. Traditional ESD was performed with a single bolus injection of mesna or saline solution.. Time for submucosal dissection (TSD).. En bloc resection was achieved for all lesions in the mesna group (53/53) and 51 of 52 lesions (98.08%) in the control group. TSD was not statistically different between the groups (18.62 ± 13.9 [mean ± SD] minutes for the mesna group and 24.58 ± 24.55 [mean ± SD] minutes for the control group; P = .128), and there were fewer time-consuming cases (times over 30 minutes) in the mesna group compared with controls (7/53 vs 15/52; P = .049). Multivariate regression analysis demonstrated that use of mesna, specimen size, and the presence of fibrous scars were significantly correlated with TSD (P < .05).. Single-center study.. TSD was not significantly different between the mesna and control injection groups, but multivariate analysis indicated that mesna injection reduced procedural challenges associated with the submucosal dissection. (. UMIN000003786.).

Topics: Cicatrix; Dissection; Double-Blind Method; Female; Gastric Mucosa; Gastroscopy; Humans; Male; Mesna; Operative Time; Protective Agents; Stomach Neoplasms

A randomized in vivo animal study previously demonstrated that topical injection of mesna solution (sodium-2-mercaptoethanesulfonate) chemically softened submucosal connective tissues and facilitated mechanical dissection of the submucosal tissue plane. The present study evaluated the technical feasibility and safety of chemically assisted endoscopic submucosal dissection (CA-ESD) using mesna in 20 consecutive patients who underwent endoscopic excision of gastric neoplasm.. Following the margination of the lesion with a mucosal circumcision, 4 - 12 mL of 10 % mesna solution was injected into the submucosal layer. Mechanical submucosal dissection was then performed by bluntly cleaving the chemically treated submucosal layer with the tip of a cap-fitted gastroscope. The use of cautery was restricted to prophylactic hemostasis, dissection of the coagulated vessels and persistent submucosal tissues, and the final snare resection. Post-therapeutic ulceration repair and adverse events were followed up during a 1-week hospitalization and by repeat endoscopies at 1 day, 1 week, and 1 month after the procedure.. Sixteen gastric cancers and four adenomas were treated in this study. The sampled tissue measured 38.25 +/- 14.53 mm, with an en bloc resection rate of 100 %. Mean operation time was 21.17 +/- 11.6 minutes. The time spent using cautery was limited to 26.1 % of the total submucosal dissection time. Ulcerations healed normally without complications.. This preliminary study demonstrates that submucosal injection of mesna facilitates and expedites mechanical submucosal dissection. The major limitations in this study include the single-arm study design and a small patient population.

Topics: Adenocarcinoma; Adenoma; Carcinoma, Signet Ring Cell; Dissection; Expectorants; Gastric Mucosa; Gastroscopy; Humans; Mesna; Protective Agents; Stomach Neoplasms

Gastric (67)gallium uptake in patients with peptic ulcer has been described in many publications literature. We present the case of a jejunal (67)gallium uptake in a patient with a background of total gastrectomy due to a diffuse large B cell gastric lymphoma, associated to benign peptic ulcer which had been identified by endoscopy. We have not found any similar cases in regards to (67)gallium reported in the literature. This study aims to present a review of the causes of gastrointestinal uptake of (67)gallium and of the utility of the radiotracer in patients with gastric lymphoma.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Doxorubicin; Etoposide; Fatal Outcome; Follow-Up Studies; Gallium Radioisotopes; Gastrectomy; Gastroscopy; Humans; Ifosfamide; Lymphoma, Large B-Cell, Diffuse; Male; Mesna; Methylprednisolone; Mitoxantrone; Neoplasm Recurrence, Local; Paclitaxel; Prednisone; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Adjuvant; Stomach Neoplasms; Stomach Ulcer; Tomography, X-Ray Computed; Vincristine