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Dig Liver Dis [journal]
- 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.
- Impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 4.
The pathophysiological mechanisms underlying proton pump inhibitor-refractory reflux oesophagitis has been scarcely studied.To assess impedance-pH parameters relevant to the pathogenesis of refractory reflux oesophagitis.Cases referred for heartburn/regurgitation refractory to high-dosage proton pump inhibitors between January 2008 and December 2012 were reviewed and subdivided into refractory oesophagitis (29 patients, 72% males, median age 50 years), healed oesophagitis (18 patients, 67% males, median age 54 years), and non-erosive reflux disease (49 patients, 53% males, median age 42 years). On-therapy impedance-pH tracings were blindly re-analysed by one observer to assess gastric and oesophageal acid exposure time and chemical clearance as expressed by the post-reflux swallow-induced peristaltic wave index.The median gastric and oesophageal acid exposure time did not differ among the three groups (35%, 34%, 41% and 1.2%, 0.7%, 0.8%, respectively; P>0.05 for all comparisons). A normal oesophageal acid exposure time was found in two thirds of patients with refractory oesophagitis. The post-reflux swallow-induced peristaltic wave index was significantly lower in refractory oesophagitis (16%) than in healed oesophagitis (30%) and non-erosive reflux disease (29%) (P=0.003).Refractory reflux oesophagitis is characterized by impairment of chemical clearance. Adequate acid suppression is found in the majority of patients who would likely not benefit from further proton pump inhibitor dose escalation.
- Efficacy of pancreatic stenting prior to extracorporeal shock wave lithotripsy for pancreatic stones. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 2.
Extracorporeal shock wave lithotripsy is the first-line therapy for large pancreatic duct stones; however, it requires a long duration of therapy.To clarify the effect of pancreatic stenting prior to extracorporeal shock wave lithotripsy on shortening the duration of therapy and reducing complications.We retrospectively compared 45 patients who underwent pancreatic stenting prior to extracorporeal shock wave lithotripsy (stenting group) and 35 patients who did not undergo stenting prior to extracorporeal shock wave lithotripsy (non-stenting group) with regard to the cumulative number of shock waves required for stone fragmentation (stone size <3mm) and the rate of complications.The stenting group was associated with a significantly lower cumulative number of shock waves in univariate analysis (log-rank, p=0.046) and multivariate Cox proportional hazard analysis (hazard ratio, 1.88; 95% confidence interval, 1.13-3.14; p=0.015) than the non-stenting group. The frequency of pancreatitis tends to be lower in the stenting group than the non-stenting group (2.2% [1/45] vs 11.4% [4/35]; p=0.162).Pancreatic stenting prior to extracorporeal shock wave lithotripsy reduced the cumulative number of shock waves required for pancreatic stone fragmentation, and could be useful to shorten the duration of therapy.
- Adrenal rest tumour of the liver. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 2.
- Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Apr 2.
Endoscopic ultrasound fine needle aspiration has a central role in the diagnostic algorithm of solid pancreatic masses. Data comparing the fine needle aspiration performed with different aspiration volume and without aspiration are lacking. We compared endoscopic ultrasound fine needle aspiration performed with the 22 gauge needle with different aspiration volumes (10, 20 and 0ml), for adequacy, diagnostic accuracy and complications.Prospective clinical study at four referral centres. Endoscopic ultrasound fine needle aspiration was performed with a 22G needle with both volume aspiration (10 and 20 cc) and without syringe, in randomly assigned sequence. The cyto-pathologist was blinded as to which aspiration was used for each specimen.100 patients met the inclusion criteria, 88 completed the study. The masses had a mean size of 32.21±11.24mm. Sample adequacy evaluated on site was 87.5% with 20ml aspiration vs. 76.1% with 10ml (p=0.051), and 45.4% without aspiration (20ml vs. 0ml p<0.001; 10ml vs. 0ml p<0.001). The diagnostic accuracy was significantly better with 20ml than with 10ml and 0ml (86.2% vs. 69.0% vs. 49.4% p<0.001).A significantly higher adequacy and accuracy were observed with the 20ml aspiration puncture, therefore performing all passes with this volume aspiration may improve the diagnostic power of fine needle aspiration.