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Dig Liver Dis [journal]
- The diet of Templar Knights: Their secret to longevity? [EDITORIAL]
- Dig Liver Dis 2014 Apr 16.
- The reliability, validity, and usefulness of single-operator cholangioscopy. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 15.
- Management of rectal cancers in relation to treatment guidelines: a population-based study comparing Italian and French patients. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 15.
Few studies have investigated rectal cancer management at the population level. We compared how rectal cancers diagnosed in Italy (2003-2005) and France (2005) were managed, and evaluated the extent to which management adhered to European guidelines.Samples of 3938 Italian and 2287 French colorectal cancer patients were randomly extracted from 8 and 12 cancer registries respectively. Rectal cancer patients (860 Italian, 559 French) were analysed. Logistic regression models estimated odds ratios (ORs) of being treated with curative intent, receiving sphincter-saving surgery, and receiving preoperative radiotherapy.Similar proportions of Italian and French patients were treated with curative intent (70% vs. 67%; OR=0.92 [0.73-1.16]); the respective proportions receiving sphincter-saving surgery were 21% and 33% (OR=1.15 [0.86-1.53]). In about 50% of those treated with curative intent, ≥12 lymph nodes were harvested in both countries. The proportion receiving postoperative radiotherapy was higher in Italy than in France (25% vs. 11%, p<0.01), but French patients were more likely to receive preoperative radiotherapy (52% vs. 21%; OR=4.06 [2.79-5.91]).The proportions of patients receiving preoperative radiotherapy and the numbers of lymph nodes sampled were low in both countries. Centralising treatment and potentiating screening would be practical ways of improving outcomes and adhering to guidelines.
- Colonic endoscopic mucosal resection of large polyps: Is it safe in the very elderly? [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 11.
Outcomes on colon endoscopic mucosal resection in the very elderly patient population are unknown.Aims of this study were to evaluate the outcomes and safety of colon endoscopic mucosal resection in this target population.Observational, retrospective study of patients ≥80 years of age that underwent colon endoscopic mucosal resection ≥2cm. Demographics, American Society of Anesthesiologists classification, procedural data, and surgical treatment data were collected.One-hundred-and-thirty-one colon endoscopic mucosal resections were performed on 99 patients ≥80 years of age with a mean age of 84. The majority of American Society of Anesthesiologists class was II. Mean lesion size was 3.3cm (range, 2-12.5cm), more procedures were performed in the right colon and adenoma/tubulovillous adenoma was the most common pathology. En bloc resection was performed on 26.7% of polyps (N=35). Eight procedure-related adverse events (8/131, 6.1%) occurred. No anaesthesia related adverse events or deaths occurred. Six patients required a colonic operation, and overall, 94% of the patient cohort evaded a colon operation.Colon endoscopic mucosal resection in very elderly patients can be performed at experienced endoscopy centres with a low rate of complications and offers these patients a non-surgical option of management of colorectal lesions.
- One or two operator technique and quality performance of colonoscopy: A randomised controlled trial. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 7.
The two-operator technique for colonoscopy, with the endoscopy assistant actively advancing and withdrawing the scope, is still commonly practiced in Europe. As uncontrolled data has suggested that the one-operator technique is associated with a higher adenoma detection rate, we tested the hypothesis that the two-operator-technique can achieve comparable performances in terms of adenoma detection.Non-inferiority trial in which consecutive adult outpatients were randomised to undergo colonoscopy by one (one-operator) or by four endoscopists. Each performed half the procedures by one-operator and half by two-operator technique independently of routine clinical practice. Main outcome measure was adenoma detection rate.352 subjects (49% males, mean age 60±12.1 years) were randomised to one (n=176) or to two-operator technique (n=176) colonoscopy. No significant differences were found in adenoma detection (33% vs. 30.7%, p=0.65), or cecal intubation rate, procedure times, and patient tolerability. No differences were found in the subgroup analysis according to routinely adopted colonoscopy technique.This study does not confirm a higher adenoma detection rate for one-operator technique colonoscopy. Changing current practice to improve adenoma detection rate for endoscopists routinely using two-operator technique is not warranted.
- The learning effect of a training programme on the diagnosis of oesophageal lesions by narrow band imaging magnification among endoscopists of varying experience. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 8.
Magnifying narrow-band imaging using intra-epithelial papillary capillary loop analysis has been confirmed as a promising diagnostic modality for oesophageal lesions. Little is known about its learning curve.To evaluate the effect of a training programme on the diagnosis of oesophageal lesions by different modalities among endoscopists of varying experience.We divided endoscopists into three groups based on their experience. A 2-h training programme on magnifying narrow-band imaging and intra-epithelial papillary capillary loop patterns was provided to trainees. They evaluated the test images and suggested diagnoses both before and after training. Diagnostic accuracy and interobserver agreement of three modalities were analysed.The diagnostic accuracies of magnifying narrow-band imaging for differentiating oesophageal neoplastic lesions and predicting lesion depth were significantly improved in less-experienced (92.8% vs. 55.9%, 63.8% vs. 17.5%) and non-experienced endoscopist groups (84.2% vs. 47.4%, 50% vs. 10%), and kappa (κ) values for both groups achieved good agreement after training (0.76 vs. 0.43, 0.68 vs. 0.24, respectively), all P<0.05.Magnifying narrow-band imaging could be learnt easily and rapidly by beginners. For diagnosis of oesophageal neoplastic lesions, our training programme improved the diagnostic skill of less-experienced endoscopists to the level of highly experienced endoscopists.
- The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 7.
The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer.(18)Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3.Overall, 21% of patients had a maximum standardized uptake value ≤3, and 60% of those had undergone neoadjuvant treatment (P=0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8U/mL for the entire cohort and 292U/mL for metastatic patients (P=0.112).The widespread application of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9>200U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.
- Optimization of upper gastrointestinal endoscopy: Value of real-time gastric juice analysis. [LETTER]
- Dig Liver Dis 2014 Apr 7.