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Journal Cover   United European Gastroenterology Journal
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
   Published by Sage Publications Homepage  [819 journals]
  • Emerging indications of endoscopic radiofrequency ablation
    • Authors: Becq, A; Camus, M, Rahmi, G, de Parades, V, Marteau, P, Dray, X.
      Pages: 313 - 324
      Abstract: Introduction Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. Results Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency. In the setting of chronic hemorrhagic radiation proctopathy, a prospective monocenter study and a retrospective multicenter study (total 56 patients) suggest that RFA is an efficient treatment. A retrospective comparative study (64 patients) suggests that RFA improves stents patency in malignant biliary strictures. Conclusions Endoscopic RFA is an upcoming treatment modality in early esophageal squamous intra-epithelial neoplasia, as well as in gastric, rectal, and biliary diseases.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615571159
      Issue No: Vol. 3, No. 4 (2015)
       
  • Systematic review and meta-analysis: Efficacy and safety of POEM for
           achalasia
    • Authors: Barbieri, L. A; Hassan, C, Rosati, R, Romario, U. F, Correale, L, Repici, A.
      Pages: 325 - 334
      Abstract: Background Peroral endoscopic esophageal myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller myotomy for treating achalasia patients. In the last years, a number of prospective and retrospective experiences with POEM use for achalasia have been published. Methods Relevant publications in which patients affected by achalasia underwent POEM treatment were identified by PubMed databases for the period 2010 – 2013. From each study, we extracted the number and type of major complications (defined as those requiring any additional medical or surgical intervention). Data were pooled, using random-effects models. Heterogeneity among studies was assessed by using Cochran's Q and the I 2 statistic. Results We found 16 studies that provided data on 551 patients. The median surveillance period was 6 months (range: 3–12). The median of mean POEM duration was 156 minutes (range: 42–112). Median myotomy length was 10 cm (range: 6–14). Technical and clinical success were reported in 97% (95% CI: 94–98%) and 93% (407/428; 95% CI: 90–95%). No heterogeneity (I 2 = 0%) or publication bias was present in both estimates. When limiting the analysis only to adverse events that require medical or surgical interventions, major adverse events occurred in 14% (95% CI: 11–17%); however, only one patient needed post-POEM surgery (0.2%; 95% CI: 0–0.5%). Conclusions POEM appeared to be a highly feasible and effective endoscopic treatment for achalasia. Despite POEM being apparently associated with relatively high morbidity, most patients are successfully managed conservatively, so that POEM appears as a very safe procedure; however, POEM should only be performed in centers able to treat POEM complications, such as pneumothorax or pneumoperitoneum.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615581732
      Issue No: Vol. 3, No. 4 (2015)
       
  • IBD-related work disability in the community: Prevalence, severity and
           predictive factors. A cross-sectional study
    • Authors: Ramos, A; Calvet, X, Sicilia, B, Vergara, M, Figuerola, A, Motos, J, Sastre, A, Villoria, A, Gomollon, F.
      Pages: 335 - 342
      Abstract: Background and aims Data on the prevalence of work disability in patients with inflammatory bowel disease (IBD) are heterogeneous. As most studies have been performed in selected, often severe, IBD patients, the true prevalence of disability in the community remains controversial. The aim of this cross-sectional study was to evaluate the prevalence and severity of disability and its predictive factors in a community-based IBD population. Patients and methods Patients recorded in the community-based IBD register at the Hospital Universitario de Burgos were contacted. After informed consent they completed a set of questionnaires including demographic, clinical, disability and quality of life data. The statistical study was performed using SPSS 21. Results A total of 293 patients were included – 151 Crohn's disease (CD), 142 ulcerative colitis (UC), 137 female, mean age: 45 ± 11 years, mean time since diagnosis: 10.6 ± 11 years. Twelve patients (4.1%) had a work-disability pension. In addition, 93 (32%) of all patients had an officially recognized disability degree, which was generally moderate (n = 73, 25%) or severe (N = 16, 5%). Age, time since IBD diagnosis, CD, perianal disease, incontinence, active disease, the need for anti-TNF or psychological treatment, previous surgeries and the number of diagnostic tests and medical visits in the previous year were predictors of disability. Major predictors of qualifying for a disability pension were age, IBD activity, incontinence, need for biological drugs and ostomy. Conclusion Mild to moderate work disability is frequent in IBD. However, only a minority of patients develop severe disability qualifying them for a pension.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615577532
      Issue No: Vol. 3, No. 4 (2015)
       
  • Comparison of 22G reverse-beveled versus standard needle for endoscopic
           ultrasound-guided sampling of solid pancreatic lesions
    • Authors: Alatawi, A; Beuvon, F, Grabar, S, Leblanc, S, Chaussade, S, Terris, B, Barret, M, Prat, F.
      Pages: 343 - 352
      Abstract: Objectives Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using standard needles has a high diagnostic value in the evaluation of solid pancreatic masses. Fenestrated needles have been developed to improve the quality of EUS-guided tissue sampling by providing core biopsies (FNB). Methods Patients with solid pancreatic masses of >2 cm were prospectively included in our study and randomized to receive EUS sampling, using either a standard 22G FNA or a 22G Procore® FNB needle. The main study endpoint was the number of needle passes required to obtain a diagnosis in more than 90% of cases. Results We included 100 patients (male = 63, female = 37; mean age = 68.4 years) in our study. We found that 88% of the lesions were malignant, with a mean size of 32 mm. A sample adequate for diagnosis was obtained in more than 90% of cases after the second needle pass in the FNB group, versus the third needle pass in the FNA group. Slide cellularity and presence of tissue microfragments were significantly higher in the FNB group. Sensitivity for the diagnosis of malignancy was 88.4% versus 97.8% for the EUS-FNA and EUS-FNB group, respectively, while specificity for both techniques was 100%. No complications were recorded. Conclusions Although the accuracy of both needle types for proving malignancy was similar, a lower number of passes was required with the FNB needles to achieve the same contributive sample rate as with the FNA needles. FNB also improved the histopathological quality of specimens, suggesting an overall superiority of FNB sampling.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615577533
      Issue No: Vol. 3, No. 4 (2015)
       
  • Is there a proximal shift in the distribution of colorectal adenomas?
    • Authors: de Oliveira, A. M. F; Anapaz, V, Lourenco, L, Graca Rodrigues, C, Folgado Alberto, S, Martins, A, Ramos de Deus, J, Reis, J.
      Pages: 353 - 357
      Abstract: Introduction Several studies have shown a proximal shift of colorectal cancer (CRC) during the last decades. However, few have analyzed the changing distribution of adenomas over time. Aim The aim of this study was to compare the site and the characteristics of colorectal adenomas, in a single center, during two periods. Methods We conducted a retrospective, observational study in a single hospital of adenomas removed during a total colonoscopy in two one-year periods: 2003 (period 1) and 2012 (period 2). Patients with inflammatory bowel disease, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome, or history of CRC were excluded from the study. The 2 statistical test was performed. P values less than 0.05 were considered statistically significant. Results During the two considered periods, a total of 864 adenomas from 2394 complete colonoscopies were analyzed: 333 adenomas from 998 colonoscopies during period 1 and 531 adenomas from 1396 colonoscopies during period 2. There was a significant increase in the proportion of adenomatous polyps in the proximal colon from period 1 to 2 (30.6% to 38.8% (p = 0.015)). Comparing the advanced features of adenomas between the two periods, it was noted that in period 2, the number of adenomas with size ≥1 cm (p = 0.001), high-grade dysplasia (p = 0.001), and villous features (p < 0.0001) had a significant increase compared to period 1. Conclusion Incidence of adenomatous polyps in the proximal colon as well as adenomas with advanced features has increased in the last years. This finding may have important implications regarding methods of CRC screening.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615577534
      Issue No: Vol. 3, No. 4 (2015)
       
  • The safety of same-day CT colonography following incomplete colonoscopy
           with polypectomy
    • Authors: Lara, L. F; Avalos, D, Huynh, H, Jimenez-Cantisano, B, Padron, M, Pimentel, R, Erim, T, Schneider, A, Ukleja, A, Parlade, A, Castro, F.
      Pages: 358 - 363
      Abstract: Background Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC. Objective The objective of this article is to describe the complications including colon perforations associated with same-day CTC in a cohort who had polypectomies but an incomplete colonoscopy. Design We conducted a retrospective study. Setting Our study took place in a single, tertiary referral center. Patients We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy. Interventions Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC. Main outcome measurements: Our main outcome measurements included perforation rate with long-term follow-up. Results A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were ≤ 5 mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up. Limitations Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD. Conclusions Radiologists’ apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of same-day CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615577881
      Issue No: Vol. 3, No. 4 (2015)
       
  • Screening for hepatitis C in average and high-risk populations of Qatar
           using rapid point-of-care testing
    • Authors: Sharma, M; Al Kaabi, S, John, A. K, Al Dweik, N, Ullah Wani, H, Babu Thandassary, R, Derbala, M. F, Al Ejji, K, Sultan, K, Pasic, F, Al Mohannadi, M, Yacoub, R, Butt, M. T, Singh, R.
      Pages: 364 - 370
      Abstract: Background Screening for hepatitis C has been found to be beneficial in high-risk individuals and ‘baby boomers’. Objective Our aim was to screen for hepatitis C in average and high-risk individuals and compare the disease characteristics and response to treatment among the screened group (SG) and non-screened group (NSG). Method Community-based screening for hepatitis C was done in the average and high-risk populations of Qatar. Screening was done using rapid point-of-care testing. All patients with stage 1 fibrosis on liver biopsy were treated with pegylated interferon and ribavirin. Results In total, 13,704 people were screened and 272 (2%, 95% CI (1.8–2.2%) had positive antibodies to hepatitis C. During the same period, 237 non-screened patients (NSG) with hepatitis C were referred for treatment. Alanine and aspartate aminotransferases (ALT, AST) and overall fibrosis were significantly lower in the SG as compared with the NSG (p = 0.04, 0.04 and 0.01, respectively). The response to treatment was similar in the SG as compared with the NSG (sustained viral response 61.7 % versus 69.1%, p = 0.55). Average-risk patients had significantly lower ALT levels (p = 0.04) but had similar response to treatment as the high-risk individuals (sustained viral response 63.2 % versus 61%, p = 0.87). Conclusion Screening detects hepatitis C with lesser fibrosis but does not result in better response to pegylated interferon and ribavirin as compared with non-screened patients.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615580725
      Issue No: Vol. 3, No. 4 (2015)
       
  • Management of Crohn's disease - are guidelines transferred to clinical
           practice?
    • Authors: Klag, T; Stange, E. F, Wehkamp, J.
      Pages: 371 - 380
      Abstract: Background Management of Crohn’s disease (CD) is a clinical challenge. In terms of an evidence-based approach, clinical guidelines help to deal with this challenge. However, little is known about guideline adherence concerning the management of CD in Germany. Objective To survey German gastroenterologists with regards to their guideline adherence in daily clinical care. Method A web-based national survey was conducted among German gastroenterologists. Results A total of 175 inflammatory bowel disease (IBD) practitioners responded to the survey. Overall, in the different clinical situations covered in the questionnaire guideline adherence is good. However, the 5-aminosalicylic acid (5-ASA) prescribing habits represent a striking exception. About 10–36% use 5-ASA as mono-therapy in CD, depending on the clinical scenario. Predominantly it is used in mild CD and in colonic involvement. To maintain a surgically achieved remission, therapeutic decisions broadly rely on individual approaches with azathioprine and 5-ASA being used by about 30% of the respondents. Cessation of smoking as a "therapeutic" strategy of maintenance therapy is used by only half of the surveyed physicians. Conclusion Amongst German IBD practitioners, the guideline adherence is good overall. Reflecting ongoing uncertainty about the efficacy of mesalazine, its use in Crohn’s disease is still heterogeneous.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615580228
      Issue No: Vol. 3, No. 4 (2015)
       
  • Are the definitions for chronic diarrhoea adequate? Evaluation of two
           different definitions in patients with chronic diarrhoea
    • Authors: Stotzer, P.-O; Abrahamsson, H, Bajor, A, Kilander, A, Sadik, R, Sjovall, H, Simren, M.
      Pages: 381 - 386
      Abstract: Background The classical definition of chronic diarrhoea is ≥3 defecations/day, with a stool weight of more than 200 g and duration of ≥4 weeks. However, with this definition many patients with substantial symptoms and pathology will be excluded from further investigations. As a consequence other definitions have been proposed, mainly based on evaluation of the stool form. Objective To evaluate the accuracy of the classic criteria for diarrhoea in comparison with a definition based on stool consistency, using the Bristol Stool Form Scale. Methods All patients were investigated with laboratory tests, upper and lower gastrointestinal endoscopy with biopsies, and SeHCAT test. They were asked to complete a diary recording stool frequency and consistency during a week, as well as other gastrointestinal symptoms (pain, bloating and gas). Results One hundred and thirty-nine subjects were eligible for analysis. Ninety-one had an organic cause of diarrhoea. Fifty-three patients had ≥3 loose stools/day, whereas 86 reported
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615580219
      Issue No: Vol. 3, No. 4 (2015)
       
  • Risk factors for polyp retrieval failure in colonoscopy
    • Authors: Fernandes, C; Pinho, R, Ribeiro, I, Silva, J, Ponte, A, Carvalho, J.
      Pages: 387 - 392
      Abstract: Introduction Colonoscopy is able to diagnose, resect and retrieve colonic polyps. Although retrieval of resected polyps is still globally advised, it is not always successful. We aimed to define the risk factors for polyp retrieval failure in colonoscopy. Methods A single-center, retrospective study assessed 3507 consecutive and non-urgent colonoscopies, performed between September 2011 and December 2012. Colonoscopies were included in our analysis if the diagnosis of at least one polyp was established, and one or more snare polypectomies were performed. Demographic and technical data were collected according to the patient’s endoscopy report. Results A total of 1109 polyps were analyzed, corresponding to 496 colonoscopies from 483 different patients. We found that 53 (4.8%) of the resected polyps were not retrieved. In a univariate analysis, the factors associated with polyp retrieval failure were: age, polyp size, resection technique, bowel preparation, location and the presence of a previous colorectal surgery (p < 0.05). In the multivariate analysis, a previous colorectal surgery, resection by cold snare, location in the right colon, inadequate bowel preparation and a polyp size up to 5 mm were independently associated with higher polyp retrieval failure (p < 0.05). Discussion Different and well-defined factors were associated with polyp retrieval failure. Because bowel preparation was the only modifiable factor identified, a special focus should be given to this topic.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615572041
      Issue No: Vol. 3, No. 4 (2015)
       
  • Aseptic non-touch technique and catheter-related bloodstream infection in
           children receiving parenteral nutrition at home
    • Authors: Mutalib, M; Evans, V, Hughes, A, Hill, S.
      Pages: 393 - 398
      Abstract: Objectives Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. Methods We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. Results Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days. Conclusion In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615576444
      Issue No: Vol. 3, No. 4 (2015)
       
  • UEG E-learning: The future has arrived
    • Pages: 399 - 399
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615596317
      Issue No: Vol. 3, No. 4 (2015)
       
  • What it means to receive the UEG Rising Star Award
    • Pages: 400 - 402
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615596322
      Issue No: Vol. 3, No. 4 (2015)
       
  • Young Talent Group introduces young guest editors for UEG Journal
    • Pages: 403 - 403
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615596323
      Issue No: Vol. 3, No. 4 (2015)
       
  • Erratum
    • Pages: 404 - 404
      Abstract: Use of probe-based confocal laser endomicroscopy (pCLE) in gastrointestinal applications. A consensus report based on clinical evidence by Galmiche et al., United European Gatroenterology Journal June 2015; 3: 230–254, doi: 10.1177/2050640614566066.
      PubDate: 2015-08-04T05:43:55-07:00
      DOI: 10.1177/2050640615596718
      Issue No: Vol. 3, No. 4 (2015)
       
 
 
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