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Journal Cover United European Gastroenterology Journal
  [2 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
   Published by Sage Publications Homepage  [835 journals]
  • Budd-Chiari syndrome
    • Authors: Martens, P; Nevens, F.
      Pages: 489 - 500
      Abstract: Budd-Chiari syndrome (BCS) is a rare and potentially life-threatening disorder characterized by obstruction of the hepatic outflow tract at any level between the junction of the inferior vena cava with the right atrium and the small hepatic veins. In the West, BCS is a rare hepatic manifestation of one or more underlying prothrombotic risk factors. The most common underlying prothrombotic risk factor is a myeloproliferative disorder, although it is now recognized that almost half of patients have multiple underlying prothrombotic risk factors. Clinical manifestations can be diverse, making BCS a possible differential diagnosis of many acute and chronic liver diseases. The index of suspicion should be very low if there is a known underlying prothrombotic risk factor and new onset of liver disease. Doppler ultrasound is sufficient for confirming the diagnosis, although tomographic imaging (computed tomography (CT) or magnetic resonance imaging (MRI)) is often necessary for further treatment and discussion with a multidisciplinary team. Anticoagulation is the cornerstone of the treatment. Despite the use of anticoagulation, the majority of patients need additional (more invasive) treatment strategies. Algorithms consisting of local angioplasty, TIPS and liver transplantation have been proposed, with treatment choice dictated by a lack of response to a less-invasive treatment regimen. The application of these treatment strategies allows for a five-year survival rate of 90%. In the long term the disease course of BCS can sometimes be complicated by recurrence, progression of the underlying myeloproliferative disorder, or development of post-transplant lymphoma in transplant patients.
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615582293
      Issue No: Vol. 3, No. 6 (2015)
  • Measurement of the tumor invasion depth into the submucosa in early
           adenocarcinoma of the esophagus (pT1b): Can microns be the new standard
           for the endoscopist'
    • Authors: Manner, H; Pech, O.
      Pages: 501 - 504
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615617724
      Issue No: Vol. 3, No. 6 (2015)
  • Submucosal invasion and risk of lymph node invasion in early Barretts
           cancer: potential impact of different classification systems on patient
    • Authors: Fotis, D; Doukas, M, Wijnhoven, B. P, Didden, P, Biermann, K, Bruno, M. J, Koch, A. D.
      Pages: 505 - 513
      Abstract: Background Due to the high mortality and morbidity rates of esophagectomy, endoscopic mucosal resection (EMR) is increasingly used for the curative treatment of early low risk Barrett’s adenocarcinoma. Objective This retrospective cohort study aimed to assess the prevalence of lymph node metastases (LNM) in submucosal (T1b) esophageal adenocarcinomas (EAC) in relation to the absolute depth of submucosal tumor invasion and demonstrate the efficacy of EMR for low risk (well and moderately differentiated without lymphovascular invasion) EAC with sm1 invasion (submucosal invasion ≤500 µm) according to the Paris classification. Methods The pathology reports of patients undergoing endoscopic resection and surgery from January 1994 until December 2013 at one center were reviewed and 54 patients with submucosal invasion were included. LNM were evaluated in surgical specimens and by follow up examinations in case of EMR. Results No LNM were observed in 10 patients with sm1 adenocarcinomas that underwent endoscopic resection. Three of them underwent supplementary endoscopic eradication therapy with a median follow up of 27 months for patients with sm1 tumors. In the surgical series two patients (29%) with sm1 invasion according to the pragmatic classification (subdivision of the submucosa into three equal thirds), staged as sm2-3 in the Paris classification, had LNM. The rate of LNM for surgical patients with low risk sm1 tumors was 10% according to the pragmatic classification and 0% according to Paris classification. Conclusion Different classifications of the tumor invasion depth lead to different LNM risks and treatment strategies for sm1 adenocarcinomas. Patients with low risk sm1 adenocarcinomas appear to be suitable candidates for EMR.
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615581965
      Issue No: Vol. 3, No. 6 (2015)
  • Efficacy and safety of laparo-endoscopic resections of colorectal
           neoplasia: A systematic review
    • Authors: Arezzo, A; Passera, R, Migliore, M, Cirocchi, R, Galloro, G, Manta, R, Morino, M.
      Pages: 514 - 522
      Abstract: Objective The purpose of this review is to assess the efficacy and safety of laparo-endoscopic local resections for colorectal lesions not suitable for endoscopic resection. Summary background data The combined laparo-endoscopic approach has been proposed for large colorectal lesions unsuitable for endoscopic resection, in order to reduce morbidity of common laparoscopic resection. However, data on the efficacy and safety of laparo-endoscopic local resections are still controversial. Methods An Embase search of papers published during the period 1985–2014 was performed. Published studies that evaluated laparo-endoscopic resections for colorectal lesions were assessed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) recommendations by two authors. Forest plots on primary (per-lesion rate of further surgery, including surgery for complications and surgery for oncologic radical treatment) and secondary outcomes were produced based on fixed and random effects models. Heterogeneity was assessed using the I 2 statistic. Risk for within-study bias was ascertained with QUADAS (Quality Assessment of Diagnostic Accuracy Studies) system. Results A total of 11 studies provided data on 707 lesions treated with a combined laparo-endoscopic approach. A variety of techniques were reported. The overall per-lesion rate of further surgery was 9.5%, while per-lesion rate of further surgery for oncologic treatment was 7.9%, per-lesion rate of further surgery for complications treatment was 3.5%, incidence of adenocarcinoma was 10.5%, incidence of overall complications was 7.9%, incidence of conversion to open surgery 4.3% and incidence of recurrence was 5.4%. Conclusions Despite laparo-endoscopic approach ensures limited invasiveness, it is affected by a consistent rate of complications and oncologic inadequacy that often requires further surgical treatment.
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615581967
      Issue No: Vol. 3, No. 6 (2015)
  • Myenteric plexitis: A frequent feature in patients undergoing surgery for
           colonic diverticular disease
    • Authors: Bassotti, G; Villanacci, V, Sidoni, A, Nascimbeni, R, Dore, M. P, Binda, G. A, Bandelloni, R, Salemme, M, Del Sordo, R, Cadei, M, Manca, A, Bernardini, N, Maurer, C. A, Cathomas, G.
      Pages: 523 - 528
      Abstract: Background Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Objectives Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. Methods We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Results Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. Conclusions In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease.
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640614563822
      Issue No: Vol. 3, No. 6 (2015)
  • Adrenal insufficiency predicts early mortality in patients with cirrhosis
    • Authors: Chawlani, R; Arora, A, Ranjan, P, Sharma, P, Tyagi, P, Bansal, N, Singla, V, Arora, V, Kotecha, H. L, Kirnake, V, Toshniwal, J, Kumar, A.
      Pages: 529 - 538
      Abstract: Background Adrenal insufficiency (AI), also known as hepato-adrenal syndrome, is a well-known entity in cirrhotic patients. However, factors associated with AI and its effect on survival are still not clear. We determined the prevalence of AI in patients with cirrhosis who had no hemodynamic instability or any acute deterioration, and studied its influence on short-term survival. Patients and methods In consecutive cirrhotic patients, presence of AI was determined either by total serum cortisol
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640614552314
      Issue No: Vol. 3, No. 6 (2015)
  • The association between Helicobacter pylori infection and inflammatory
           bowel disease based on meta-analysis
    • Authors: Rokkas, T; Gisbert, J, Niv, Y, OMorain, C.
      Pages: 539 - 550
      Abstract: Background In humans there are epidemiological data suggesting a protective effect of Helicobacter pylori (H. pylori) infection against the development of autoimmune diseases and in addition, there are laboratory data illustrating H. pylori’s ability to induce immune tolerance and limit inflammatory responses. Thus, numerous observational studies have examined the association between H. pylori infection and inflammatory bowel disease (IBD) with various results. Objective We performed a meta-analysis of available studies to better define the association of H. pylori infection and IBD. Methods Medical literature searches for human studies were performed through September 2014, using suitable keywords. In each study the risk ratio (RR) of H. pylori infection in IBD patients vs controls was calculated and pooled estimates were obtained using fixed- or random-effects models as appropriate. Heterogeneity between studies was evaluated using Cochran Q test and I2 statistics, whereas the likelihood of publication bias was assessed by constructing funnel plots. Results Thirty-three studies were eligible for meta-analysis, including 4400 IBD patients and 4763 controls. Overall 26.5% of IBD patients were positive for H. pylori infection, compared to 44.7% of individuals in the control group. There was significant heterogeneity in the included studies (Q = 137.2, df (Q) =32, I2 = 77%, p < 0.001) and therefore the random-effects model of meta-analysis was used. The obtained pool RR estimation was 0.62 (95% confidence interval (CI) 0.55–0.71, test for overall effect Z = –7.04, p < 0.001). There was no evidence of publication bias. Conclusion The results of this meta-analysis showed a significant negative association between H. pylori infection and IBD that supports a possible protective benefit of H. pylori infection against the development of IBD.
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615580889
      Issue No: Vol. 3, No. 6 (2015)
  • Outcome of probe-based confocal laser endomicroscopy (pCLE) during
           endoscopic retrograde cholangiopancreatography: A single-center
           prospective study in 45 patients
    • Pages: 551 - 560
      Abstract: Background Diagnosis of pre-malignant and malignant lesions in the bile duct and the pancreas is sometimes cumbersome. This applies in particular to intraductal papillary mucinous neoplasia (IPMN) and bile duct strictures in primary sclerosing cholangitis (PSC). Aims To evaluate in a prospective cohort study the sensitivity and specificity of probe-based confocal laser microscopy (pCLE) during endoscopic retrograde cholangiopancreatography (ERCP). Methods We performed pCLE together with mother-baby endoscopy (SpyGlass) during 50 ERCP sessions in 45 patients. The Miami and Paris criteria were applied. Clinical diagnosis via imaging was compared to pCLE and the final pathological diagnosis from surgically-resected, biopsy, or cytology specimens. Patients were followed up for at least 1 year. Results We were able to perform pCLE in all patients. Prior to endoscopy, the diagnosis was benign in 23 patients and undetermined (suspicious) in 16 patients, while six patients had an unequivocal diagnosis of malignancy. Sensitivity was 91% and specificity 52%. The positive (PPV) and negative predictive value (NPV) was 82% and 100%, respectively. Apart from mild post-ERCP pancreatitis in two patients, no complications occurred. Conclusions Our study showed that pCLE is a safe, expert endoscopic method with high technical feasibility, high sensitivity and high NPV. It provided diagnostic information that can be helpful for decisions on patient management, especially in the case of IPMN and unclear pancreatic lesions, in individuals whom are at increased risk for pancreatic cancer.
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615579806
      Issue No: Vol. 3, No. 6 (2015)
  • Late-breaking abstracts
    • Pages: 561 - 571
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615616068
      Issue No: Vol. 3, No. 6 (2015)
  • Reflecting on a memorable UEG Week 2015...
    • Authors: Simren; M.
      Pages: 572 - 572
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615618824
      Issue No: Vol. 3, No. 6 (2015)
  • UEG Week Barcelona 2015 Award Winners
    • Pages: 573 - 574
      PubDate: 2015-11-30T06:18:15-08:00
      DOI: 10.1177/2050640615618825
      Issue No: Vol. 3, No. 6 (2015)
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