Update on gastroenterology

In the field of mass detection of colorectal cancer by Hemoccult(R) test, t he results of the Burgundy study confirm the two european studies previousl y published and encourage to extend this training to the whole country. In oncogenetic field, a recent publication suggest some different clinical cri teria that Amsterdam criteria to define a Lynch syndrome. When genetic mark ers are performed in a population selected according to these type I criter ia, HNPCC mutation could be detected in 28% of cases. In colorectal cancer surgery, the debate remains open on the place of coeliosurgery. A recent pu blished series of 135 colon cancers operated by coeliosurgery do not show a ny recurrence on trocar orifices. A US study has confirmed the prognostic v alue of the number of lymph nodes analyzed after resection of colorectal ca ncer. In adjuvant treatment of stage II colon cancer, two contradictory pub lications have been reported in the Journal of Clinical Oncology. However, the results of the Impact B2 Group are more consistent and support the fact that chemotherapy cannot be recommended as a standard treatment in stage I I colon cancer. The actualities in the liver metastases focused on the new local destruction technics that are cryosurgery and radiofrequency. Concern ing the chemotherapy of metastatic colorectal cancer, important results hav e been published in second line therapy showing the superiority of Campto(R ) compared to best supportive care or 5FU based chemotherapy both in term o f overall survival and quality of life, In first line chemotherapy, the sup eriority of bi-therapies (LV5FU2 and oxaliplatin or LV5FU2 and irinotecan) has been confirmed compared to LV5FU2 alone. A recent publication showed th at patients older than 70 years tolerate chemotherapy for colorectal cancer as well as younger patients with the same efficacy. In esophagus carcinoma , the most important study didn't show any efficacy of neoadjuvant chemothe rapy by 5FU-cisplatin in operable adenocarcinoma of squamous carcinoma of e sophagus. The final results of dutch's study in node dissection for gastric cancer do not find any benefit in overall survival comparing D2 versus D1 dissection with a substantial increase in morbidity and mortality in the D2 arm, specially when splenopancreatectomy was performed. Finally, an import ant study has confirmed the value of per echoendoscopy biopsies for the dia gnosis of positive lymph nodes and pancreatic tumors.