Background/Aims:

Some patients with portal hypertension due to hepatitis B cirrhosis who were suitable for periesophagogastric devascularization with splenectomy (PDS) also met the indications of liver transplantation (LT), the study compared the effect of PDS and LT, and of PDS followed by LT when required. Methodology: Patients with portal hypertension due to hepatitis B cirrhosis were analyzed. Patients were organized into PDS or LT groups, and PDS followed by LT.

Results:

The PDS group suffered from lower incidence of severe postoperative complications (p=0.007) and perioperative death (p=0.015) than group LT. The 1-, 3- and 5-year survival rates of the PDS and LT groups were 99.3%, 98.1% and 89.0%, and 91.1%, 85.4% and 79.0%, respectively (p=0.04). There were no significant differences in severe postoperative complications (p=1.000) or perioperative mortality (p=1.000) between the PDS followed by LT and the LT groups, and their 1-, 3- and 5-year survival rates were 91.2%, 82.1% and 82.1%, and 91.1%, 85.4% and 79.0%, respectively (p=0.694).

Conclusion:

For patients with portal hypertension due to hepatitis B cirrhosis, when they satisfy the indications for both PDS and LT, we appeal to perform PDS as bridging therapy for final liver transplantation.

Background/Aims:

Different differentiations of cancer have resulted in its unique biological characteristics. We screen and appraise differentially expressed proteins in different differentiated gastric adenocarcinoma with comparative proteomics technology in order to find regulatory factors of tumor differentiation related and finally reach the purpose of tumor differentiation reversal. Methodology: With two-dimensional fluorescence difference gel electrophoresis (2-D DIGE) and liquid chromatography in conjunction with tandem mass spectrometry (LC-MS/MS), the differentially expressed proteins from 8 patients with different differentiated gastric adenocarcinoma were identified and some factors identified were verified with application of QPCR and Western blot techniques.

Results:

Significant differences in 35 protein spots were found and 48 kinds of proteins were identified. Other than structural proteins and non-specific protein, six possible proteins associated with tumor differentiation were determined - the serine protease inhibitor B1 (serine protease inhibitor, clade B, member 1, SERPINB1), calcium-phospholipid binding protein III (annexin A3), transcription factor Nm23-H1, adenine phosphoribosyl-transferase enzyme APRT (Adenine Phosphoribosyltransferase in APO and AMP), glutathione S-transferase P1-1 (GST-π-1), antimicrobial peptides Dermcidin-lL. The identified SERPINB1, annexin A3, of the South Affiliated Hospital, Hebei Medical University, Shijiazhuang, China Nm23-H1 and APRT were verified, confirming the expression of these factors was in line with proteomics identification.

Conclusions:

Protein expression in different differentiated gastric adenocarcinoma was varied.

Background/Aims:

To clarify the usefulness of screening ultrasonography (US) to diagnose gastric and colorectal cancer, patient records were analyzed retrospectively. Methodology: Ultrasonography was performed for patients with abdominal symptoms. They were then subjected to computed tomography (CT) when diagnosed with gastric cancer, colorectal cancer, or bowel obstruction. Patient records were analyzed retrospectively after final diagnosis of gastric cancer or colorectal cancer by endoscopy, surgery or necropsy.

Results:

Twelve patients were diagnosed with colorectal cancer and six with gastric cancer. The detailed structure of colorectal cancer was visible as wall thickening with US, while cancer was often illustrated as a mass by CT. Loss of stratification was clear with US in 11 patients. US demonstrated wall thickening in 10 patients and a mass in 1 patient, while CT demonstrated wall thickening in 3 patients and a mass in 8 patients. The structure of colorectal cancer was more obvious when using US than when using CT. One patient demonstrated focal wall thickening with US, but this was not detected by CT.

Conclusions:

US is useful for diagnosis of gastric cancer and colorectal cancer. US produces more detailed findings in colorectal cancer than CT.

Background/Aims:

Neoadjuvant chemoradiation for rectal cancers may result in complete clinical response (cCR) in some patients. The aim of this study was to analyze the long-term outcomes of such patients in a tertiary cancer center. Methodology: Patients with rectal cancer who had a cCR to neoadjuvant chemoradiation were divided into two groups: Group A (n=23) did not undergo surgery, and Group B (n=10) underwent elective surgery. The recurrence patterns and survival outcomes were compared between the two groups.

Results:

After a median follow-up of 72 months (range 12-180), seven patients (30%) in Group A developed an isolated local recurrence. In Group B, after a median follow-up of 37 months (range 12-180) there were no local recurrences. The median disease-free and overall survival was 36 months (range 6-168) and 66 months (range 12-180) in Group A and 36 months (range 12-180) and 37 months (range 18-180) in Group B respectively.

Conclusions:

Our results suggest that surgery could be avoided in selected patients with rectal cancer who have a cCR to neoadjuvant chemoradiation. However, until the safety of a non-surgical approach is proven in a prospective randomized trial, it cannot be recommended outside a clinical protocol study.

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Background/Aims:

This 3-institution study assessed the short-term clinical outcome and safety profile of the NiTi Biodynamix ColonRingTM compression anastomosis in elective colorectal resection. Methodology: A prospective, open-label, non-randomized trial was conducted at 3 separate institutions between October 2008 to October 2009 in patients undergoing elective colorectal resection with the Biodynamix ColonRingTM compression anastomosis ring, assessing technical factors in its operative use, immediate and short-term clinical outcome parameters (length of hospital stay, time to first passage of flatus and stool and to oral intake) and peri-operative complications including anastomotic failure or stenosis and wound infection.

Results:

Forty patients (22 females, mean age 65.9 years; range 36-83 years were included in the analysis with 14 cases being performed laparoscopically. The median duration of surgery was 120 minutes (range 60-456 minutes) with a mean anastomotic time of 14.8 minutes (range 1.75-50 minutes). The mean height of anastomosis from the anal verge was 18.2cm. The median time to passage of first flatus and first stool was 2.4 and 3.5 days, respectively with a mean hospital stay of 7.3 days. There was one postoperative death (unrelated to an anastomotic complication) with 2 anastomotic leaks (5%), 2 wound infections (5%) and no cases of early anastomotic stricture.

Conclusions:

The compression anastomosis ColonRingTM handles easily with an acceptable clinical outcome following both laparoscopic and open use. The incidence of anastomotic and wound complications is comparable to conventional stapled technology.

Background/Aims:

The objective of this study was to define the clinical, biochemical and ultrasonographic criteria correlating with a likelihood of a positive preoperative endoscopic ultrasound (EUS) in patients presenting with acute gallstone-related pancreatobiliary disease. Methodology: All patients who underwent EUS prior to elective laparoscopic cholecystectomy were analyzed at the Gastroenterology Unit, Kaplan Medical Center, following acute admission with cholecystitis, cholelithiasis, cholangitis, acute pancreatitis and obstructive jaundice.

Results:

One hundred and seventy four patients met the inclusion criteria. EUS showed choledocholithiasis in 37 (21.3%) with 35/37 undergoing a preoperative ERCP (24/35 cases - 64.9% positive yield). Twenty seven of the positive EUS studies (73%) were performed during the acute illness, with 50 of the 137 negative studies (36.4%) performed during the acute phase of the illness (p=0.0001). On multivariate analysis, a positive EUS was more commonly found during the acute phase of the illness [OR: 3.445; 95% CI: 1.48-8.008, p=0.004] or if there was transient jaundice [OR: 1.167; 95% CI: 1.002-1.36, p=0.047].

Conclusions:

The timing of the examination influences the detection rate of CBD stones by EUS prior to surgery although it may be appropriate to more selectively use EUS in those patients with hyperbilirubinaemia and/or where the CBD is dilated.

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Background/Aims:

To compare the performance of the Child-Turcotte-Pugh (CTP), the Okuda, the Cancer of Liver Italian Program (CLIP), the Barcelona Clinic Liver Cancer (BCLC), the Chinese staging (CS), Chinese university prognostic index (CUPI), Japan integrated staging (JIS), the Tokyo and the French staging systems, in predicting the survival of patients with primary liver cancer (PLC) receiving transarterial chemoembolization (TACE). Methodology: The clinical data of patients undergoing TACE in our department were retrospectively analyzed and compared with the 9 staging systems based on survival after TACE.

Results:

A cohort of 60 patients was involved. The survival curves showed that Okuda, BCLC, CS and JIS had better discriminatory ability. By the Cox regression model, Okuda, CS and JIS showed a stronger significance on prognosis. The staging systems with smaller value of -2Ln(L), Akaike Information criterion (AIC) and Schwarz-Bayesian criterion (SBC) were CS, JIS, CLIP and BCLC. An analysis involving 11 factors by Cox model indicated that ascites and vascular invasion were independent prognostic factors.

Conclusions:

JIS provides better prognostic stratification for a cohort of the patients with PLC receiving TACE. However, studies with larger samples are still required.

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Background/Aims:

The aims of this study were to evaluate the frequency of gallstones and the related risk factors in patients with liver cirrhosis. Methodology: Patients (n=1,333) with liver cirrhosis who were diagnosed at Yeungnam University Hospital between January 2006 and December 2008 were analyzed retrospectively. Healthy people (n=16,922) who underwent an examination at the health promotion center were enrolled as a control group. We analyzed the clinical and laboratory findings between the cirrhotic patients with and without gallstones.

Results:

Liver cirrhosis was an independent risk factor for gallstone formation (OR: 2.017; p=0.00). Diabetes and hypertriglyceridemia increased the risk for gallstones by 2.2-fold and 1.9-fold in cirrhotic patents, respectively. The severity of the liver cirrhosis according to the Child-Pugh class carried a significantly greater risk of gallstone formation. Multiple logistic regression analysis showed that diabetes, hypertriglyceridemia, and Child-Pugh class C were significantly related to the risk of gallstone formation in patients with liver cirrhosis.

Conclusions:

The prevalence of gallstones is significantly higher in patients with liver cirrhosis, and the related risk factors are diabetes, hypertriglyceridemia and severity of liver cirrhosis.

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Background/Aims:

The most optimal treatment for acute cholecystitis in high risk patients and severe acute cholecystitis remains still controversial. We review the outcomes of a two step treatment with percutaneous cholecystostomy and delayed laparoscopic cholecystectomy (DLC). Methodology: We collected data prospectively from January 2004 to April 2010 from 26 patients that underwent percutaneous transhepatic CT-guided cholecystostomy and DLC.

Results:

Percutaneous transhepatic CT-guided cholecystostomy was achieved in all cases with no complications. There was just one catheter dislodgement. Most of patients, 92%, improved after drainage. There was one case of mortality. Laparoscopic cholecystectomy was achieved in 88% of patients with no mortality, and a low rate of morbidity (7.6%) and of conversion to open surgery. Pre-operative percutaneous cholangiogram showed additional and useful information in 55.5% of patients.

Conclusions:

Two-step minimally invasive treatment combining percutaneous transhepatic CT-guided cholecystostomy and DLC is safe and feasible and report low morbi-mortality rates.