esophagus were diagnosed endoscopically. The patients' gastric H. pylori infection statuswas categorized as "negative" or "positive" or "eradicated". The study patients were categorizedaccording to the presence of inlet patch as follows: group A, inlet patch positive; group B,inlet patch negative. Intergroup male-to-female ratios, H. pylori infection rate, and theprevalence of gastrointestinal diseases were compared using the Chi square test. Result:The baseline clinical characteristics are shown in Table 1. A total of 487 patients (237females and 250 males, mean age 53.7 years) were examined. Of these, 47 patients (9.4%)were inlet patch positive (Group A), and 440 patients were inlet patch negative (Group B).The male-to-female ratio was significantly higher in group A than group B. Mean age wasnot statistically different in group A and group B. The prevalence of gastric atrophy, refluxesophagitis, esophageal hiatal hernia, and Barrett's esophagus were not different in groupA and group B. The 47 inlet patches were pathologically examined, and the histologicalfeatures were inactive atrophic fundic mucosa with mild to moderate mucus neck cell orpyloric gland cell metaplasia and no intestinal metaplasia except one case with H. pyloriinfection. Conclusion: Endoscopic detection rate of inlet patch was 9.4%. Male gender wasrisk factor for inlet patch. Pathological characteristics of inlet patch was mostly inactivefundic gastritis with (pseudo) pyloric gland metaplasia.

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Pattern of Gastric Intestinal Metaplasia (GIM) in Dyspeptic AdultsRonaldo J. Torresini, Luiz E. Mazzoleni, Guilherme B. Sander, Carlos F. Francesconi,Luise Meurer, Diego M. Uchôa, Vinicius D. da Silva, Laura R. De Bona, João C. Prolla

Introdution: Helicobacter pylori (Hp)is a known gastric carcinogen and GIM is considereda premalignant lesion. The prevalence of this lesion on a high prevalence country for Hpis unknown. Aim: to evaluate the prevalence of GIM in a population of Hp dyspeptic patients.Methods: 641 patients with Rome III criteria for functional dyspeptic (FD) aged ≥18 yearswere recruited in a primary care setting. Patients were submitted to upper GI endoscopy;biopsy specimens from predetermined locations (gastric mapping) were collected. All biopsieswere stained with HE and Giemsa; those with intestinal metaplasia were stained with SchiffPeriodic Acid (SPA), Alcian blue (AB) and high iron diamine (HID) to determine whetherthey expressed neutral mucins, sialomucins, or sulphomucins. The findings of this groupwas compared with Hp negative FD patients. Protocol approved by the local IRB. RESULTS:Of 641 patients studied: mean age: 46,0 years; 355 female and 88 male patients; 92 (14.4%)were GIM+; 423 (66%) were HP +. GIM was present 18.2% of HP + patients and in 6.9%of the Hp- group (p< 0.0001). Biopsies of 404 Hp + patients were available for evaluationfor the presence of GIM; complete evaluation was possible in 56 of 75 with GIM+. 19patients were not evaluated: paraffin blocks were lost in 2 and GIM was not found in 17cases at the recut of the paraffin blocks. GIM type I was present in 55% (31/56); GIM typeII in 22% (12/56) and GIM type III in 23% of cases (13/56). There was not difference inage in the 3 MIG groups. GIM was more frequent in the antrum ( 71%); antrum + incisura:93%. There was no relationship between the extent and type of GIM. The distribution ofgastric intestinal metaplasia between the sexes followed the proportion in the group studied.Conclusions: 1) the prevalence of GIM was 14.4% in our population; 2) the presence ofGIM is related to the presence of Hp; 3) GIM is more frequent in the antrum and antrumand incisura biopsies; 4) there was no relationship between the extent and type of MIG. 5)

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there was no relation between age and presence of GIM. 6) There is no statistical differencebetween sexes.

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Membrane Protein CD44v6 Is Not Expressed in Gastric Intestinal Metaplasiain a Sample of Helicobacter pylori Dyspeptic Adult PatientsRonaldo J. Torresini, Luiz E. Mazzoleni, Guilherme B. Sander, Carlos F. Francesconi,Luise Meurer, Diego M. Uchôa, Vinicius D. da Silva, Tobias C. Milbradt, João C. Prolla

Introduction: gastric intestinal metaplasia (GIM) is considered a premalignant lesion forgastric cancer. A membrane protein CD44v6 has been suggested as a marker to indicatewhich patients with GIM should be followed with periodic upper GI endoscopic examinationsfor gastric cancer screening purposes. Aim: to determine the prevalence of membrane CD44v6in a population of dyspeptic Helicobacter pylori (Hp) adults patients with GIM. Methods:641 patients with Rome III criteria for functional dyspeptic (FD) aged ≥18 years wererecruited in a primary care setting. Patients were submitted to upper GI endoscopy; biopsyspecimens from predetermined locations (gastric mapping) were collected. Staining withHE, Giemsa and urease test were used to detect Hp. Schiff Periodic Acid (SPA), Alcian blue(AB) and high iron diamine (HID) were used to determine the presence of GIM, that wasclassified according to the type of mucin: type I if AB in goblet cells, type II if HID ingoblet cells, and type III if HIDin columnar cells. The presence of CD44v6 evaluated byimmunohistochemistry with monoclonal antibody anti-human mouse [(NCL-CD44v6 cloneVFF-7), Novocastra®]. Protocol approved by the local IRB. Results: From a total of 75 Hp+ patients with GIM, we were able to evaluate 56 patients (Table 1), without statisticallydifference between sex and age. All our GIM cases were negative for CD44v6 (IHC techniquecontrols were positive). Of the 56 cases of GIM, 55% were classified as type I, 22% as typeII, and 23% as type III. Conclusion: Since in our sample we were unable to detect membraneCD44v6 in any patient, we do not think that this marker is of any help in screening patientsfor early detection of gastric cancer when GIM is detected. Further studies should beperformed in order to clarify the genetic or environment factors that might be related tothese findings.Table 1

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Is a Complete Remission of Intestinal Metaplasia a Suitable Endpoint inPatients Undergoing Radiofrequency Ablation (RFA)? Long-Term Results ofRFA Treatment in 62 Consecutive PatientsJana Krajciova, Magdalena Stefanova, Jana Maluskova, Marek Kollar, Julius Spicak, JanMartinek

Introduction: Radiofrequency ablation (RFA) in combination with endoscopic resection (ER)is a method of choice for treatment of early esophageal neoplasia. Complete remission ofintestinal metaplasia (CR-IM) and complete remission of dysplasia (CR-D) are commonlyused as the endpoints of successful treatment. The relevance of CR-IM (in patients withmacroscopically normal neo-Z-line) has recently been challenged. Aims&methods: The aimof this prospective, single center study was to assess the long-term efficacy of RFA. Mainoutcome measurements were CR-IM or CR-D in patients with/without a complete macro-scopic eradication of Barrett's esophagus (BE) and recurrence rate of IM and dysplasia.Conover one-way analysis was used to calculate the risk factors for recurrence of IM.Results: The study involved 62 consecutive patients (mean age 62, range 25-86) undergoingendoscopic treatment for esophageal neoplasia in our center during 2009-2013. Sixty patientswere diagnosed with BE related neoplasia, the remaining 2 patients had squamous neoplasia.The median follow-up was 25 months (range 3-60). In 19 patients (31%), RFA was a singletreatment modality while in 43 patients (69%), RFA was combined with endoscopic resectionor dissection of a visible lesion The indications for endoscopic treatment were as follows:early adenocarcinoma (EAC): 23 (37,1%), early squamous carcinoma (ESC): 2 (3,2%),high-grade intraepithelial neoplasia (HGIN): 20 (32,3%), low-grade intraepithelial neoplasia(LGIN): 17 (27,4%). A total of 117 RFA treatment sessions were performed (37 with HALO360, 80 with HALO 90). The median number of treatment sessions per patient (ER+RFA)was 2 (1-6). CR-IM and CR-D were achieved in 69% (95% CI 61-81%) and 89% (95% CI85-97%), respectively. In 80% of patients without CR-IM, the neo-Z-line was completelynormal without macroscopically visible islands or tongues of metaplastic mucosa. Duringthe follow-up, there were 6 recurrences at the level of neo-Z-line (out of 33 patients withBE with follow up of at least 18 months after finishing the treatment; 18%) of intestinalmetaplasia. In 5 of these patients, the neo-Z-line was macroscopically normal. Low-gradedysplasia (within the Z-line) recurred in 2 patients (5%). High-grade dysplasia and/orcarcinoma have not recurred. The risk factors for recurrence of intestinal metaplasia weremale sex, younger age and diagnosis of cancer. We did not detect buried glands beneaththe new neosquamous epithelium in any patient. Conclusion: Treatment of BE with RFAresults in CR-D and CR-IM in a high proportion of patients with a low recurrence rate. Amajority of patients without CR-IM or with a recurrence of IM have macroscopically normalneo-Z-line. CR-IM and a recurrence of IM might not be clinically relevant endpoints inpatients with macroscopically normal neo-Z-line.

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