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United European Gastroenterology Journal

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ISSN (Print) 2050-6406 - ISSN (Online) 2050-6414
Published by Sage Publications

[676 journals]

Synopsis of recent guidelines on pancreatic exocrine insufficiency
- Authors: Lohr, J.-M; Oliver, M. R, Frulloni, L.
  Pages: 79 - 83
  Abstract: Background In recent years, three national gastroenterology societies established guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency (PEI). In addition, the Cochrane Collaboration issued a review. Objective The purpose of this paper is to present an overview of the recommendations and concordance between the four recent published guidelines and stimulate further discussion. Methods A review of the Australian, German and Italian guidelines and the Cochrane review was conducted, and a synthesis was made of common statements. Results There is a high degree of agreement on almost all items within these guidelines, both in the diagnosis of PEI and in terms of therapy and approach to management of PEI. In addition, novel emerging developments are highlighted, such as the fecal elastase-1 test, which is widely used but is not suitable for measuring mild-to-moderate PEI despite its ability to positively establish the diagnosis of severe PEI. One of the few novel tests proving to be useful is the 13C mixed-chain triglycerides (MCT) breath test. This test, albeit an excellent quantitative test, is not widely used and is rarely available. The use of this test is making it apparent that there is a difference between treating the symptoms of PEI and treating malnutrition, the broader underlying defect. This may have direct consequences for the dosing of pancreatic enzymes (pancreatin), in that the consensus starting dose of all guidelines may be too low for some patients. Although chronic pancreatitis in adults and cystic fibrosis in children account for the main evidence base used for PEI, other indications are also discussed. Conclusions There is good concordance between recommendations provided by international groups. More prospective studies are required in many areas, including the use of pancreatic enzymes in other gastrointestinal disorders, such as celiac disease and irritable bowel syndrome (IBS). We also need to assess the feasibility of the 13C MCT breath test. At the same time, it needs to be confirmed that higher doses of pancreatic enzymes are really necessary to not only relieve the symptoms of PEI but also treat malnutrition appropriately.
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613476500|hwp:master-id:spueg;2050640613476500
  Issue No: Vol. 1, No. 2 (2013)
Molecular imaging in endoscopy
- Authors: Hoetker, M. S; Goetz, M.
  Pages: 84 - 92
  Abstract: Molecular imaging focuses on the molecular signature of cells rather than morphological changes in the tissue. The need for this novel type of imaging arises from the often difficult detection and characterization especially of small and/or premalignant lesions. Molecular imaging specifically visualizes biological properties of a lesion and might thereby be able to close diagnostic gaps, e.g. when differentiating hyperplastic from neoplastic polyps or detecting the margins of intraepithelial neoplastic spread. Additionally, not only the detection and discrimination of lesions could be improved: based on the molecular features identified using molecular imaging, therapy regimens could be adjusted on the day of diagnosis to allow for personalized medicine and optimized care for each individual patient.
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613483291|hwp:master-id:spueg;2050640613483291
  Issue No: Vol. 1, No. 2 (2013)
Comparison of a standard fully covered stent with a super-thick silicone-covered stent for the treatment of refractory esophageal benign strictures: A prospective multicenter study
- Authors: Chaput, U; Heresbach, D, Audureau, E, Vanbiervliet, G, Gaudric, M, Bichard, P, Bauret, P, Coumaros, D, Ponchon, T, Fumex, F, Bensoussan, E, Lamouliatte, H, Chryssostalis, A, Robin, F, Prat, F.
  Pages: 93 - 102
  Abstract: Background Some esophageal strictures resist endoscopic treatments. There is a need for new treatments, such as specifically designed stents. Objective Our study sought to compare the results achieved with a standard, fully covered metallic stent (FCMS) and those achieved using a stent designed specifically for benign strictures (BS-FCMS). Patients and methods The study used a prospective, multicenter, controlled design, with patients recruited from tertiary referral centers. Patients with refractory esophageal strictures were included. Standard FCMS were used in group 1 (N = 24), and BS-FCMS were used in group 2 (N = 17). Patients were followed for 24 months after stent removal. The main outcomes measured were stricture resolution rate, 24 months’ recurrence rate and stent-related morbidity. Results Early stent migrations occurred in one (4.1%) patient from group 1 and five (29.4%) from group 2 (p < 0.05). During esophageal stenting, complications occurred in six patients (25%) in group 1 and six patients (35.3%) in group 2 (p = 0.47), respectively. Fifty percent of complications were attributed to migration. There was no procedure-related morbidity associated with the extraction of the stent. The stricture resolution rate was, respectively, 95.2% in group 1 and 87.5% in group 2 (the difference between the two groups is not significant). During follow-up, stricture recurrence occurred in 15/19 patients (group 1, 79%) and 7/8 patients (group 2, 87.5%; p = 1.0). The median time to recurrence of esophageal stricture was 1.7 months (group 1, 0.6–12 months) and 1 month (group 2, 0.1–6 months). Study limitations include its nonrandomized design. Conclusion The stricture resolution rate was high at the end of the stenting period for both types of stents without any statistical difference between the two groups, but the long-term results were disappointing, with stricture recurring frequently and rapidly in both groups.
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613476501|hwp:master-id:spueg;2050640613476501
  Issue No: Vol. 1, No. 2 (2013)
Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction
- Authors: Dhir, V; Bhandari, S, Bapat, M, Joshi, N, Vivekanandarajah, S, Maydeo, A.
  Pages: 103 - 108
  Abstract: Background EUS-guided rendezvous procedure (EUS-RV) can be done by the transhepatic (TH) or the extrahepatic (EH) route. There is no data on the preferred access route when both routes are available. Study aim To compare the success, complications, and duration of hospitalization for patients undergoing EUS-RV by the TH or the EH route. Patients and methods Patients with distal common bile duct (CBD) obstruction, who failed selective cannulation, underwent EUS-RV by the TH route through the stomach or the EH route through the duodenum. Results A total of 35 patients were analysed (17 TH, 18 EH). The mean procedure time was significantly longer for the TH group (34.4 vs. 25.7 min; p = 0.0004). There was no difference in the technical success (94.1 vs. 100%). However, the TH group had a higher incidence of post-procedure pain (44.1 vs. 5.5%; p = 0.017), bile leak (11.7 vs. 0; p = 0.228), and air under diaphragm (11.7 vs. 0; p = 0.228). All bile leaks were small and managed conservatively. Duration of hospitalization was significantly higher for the TH group (2.52 vs. 0.17 days; p = 0.015). Conclusions EUS-RV has similar success rate by the TH or the EH route. However, the TH route has higher post-procedure pain, longer procedure time, and longer duration of hospitalization. The EH route should be preferred for EUS-RV in patients with distal CBD obstruction when both access routes are technically feasible.
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613480145|hwp:master-id:spueg;2050640613480145
  Issue No: Vol. 1, No. 2 (2013)
Smoking, breastfeeding, physical inactivity, contact with animals, and size of the family influence the risk of inflammatory bowel disease: A Slovak case-control study
- Authors: Hlavaty, T; Toth, J, Koller, T, Krajcovicova, A, Oravcova, S, Zelinkova, Z, Huorka, M.
  Pages: 109 - 119
  Abstract: Background The aetiology of inflammatory bowel disease (IBD) is not known but is likely to involve a combination of genetic predisposition and environmental risk factors. Smoking has been associated consistently with a higher risk of Crohn’s disease (CD), while appendectomy and smoking appear to diminish the risk of ulcerative colitis (UC). The roles of other environmental factors are unclear. The aim of the present study was to evaluate the association of CD and UC with several environmental risk factors. Methods This case–control study included 338 patients (190 CD, 148 UC) and 355 controls. All subjects completed a detailed questionnaire regarding breastfeeding duration, history of helminthic infections, allergic diseases, appendectomy, household size, housing type, contact with specific domestic animals, physical activity, and smoking. Associations between risk factors and CD and UC were investigated by univariate and multivariate analysis. Results On multivariate analysis, CD associated with smoking at diagnosis (odds ratio, OR, 3.7, 95% CI 2.2–6.2; p < 0.001), being breastfed for
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613478011|hwp:master-id:spueg;2050640613478011
  Issue No: Vol. 1, No. 2 (2013)
Endomicroscopy in bile duct: Inflammation interferes with pCLE applied in the bile duct: A prospective study of 54 patients
- Authors: Caillol, F; Bories, E, Poizat, F, Pesenti, C, Esterni, B, Monges, G, Giovannini, M.
  Pages: 120 - 127
  Abstract: Background The preoperative diagnosis of biliary stenosis is associated with low accuracy. As a consequence, probe-based confocal laser endomicroscopy (pCLE), an in-vivo histological imaging technique, was applied in the bile duct. The aim of this study was to establish whether previous inflammation of the bile duct affects confocal interpretation. The findings from pCLE were compared in two groups of patients: those in whom there had been no cholangitis nor stenting and those in whom stents had been used and subsequently retrieved or who had suffered cholangitis. Patients and methods pCLE was performed on 54 patients (mean age 66 years; 31 men, 23 women) from September 2008 to July 2011. Patients were divided in two groups: group 1: 39 patients who had not undergone a biliary procedure in the month preceding the pCLE procedure; and group 2: 15 patients who had undergone stent placement or presented with cholangitis in the month preceding the pCLE procedure. Endoscopic and pCLE data were collected prospectively. pCLE results were compared to benchmark histology (surgery, endoultrasonography, percutaneous biopsy). Patients with a benign stricture who did not undergo operation were followed for 1 year. pCLE images of the bile duct were obtained during endoscopic retrograde cholangiopancreatography procedures. pCLE images were interpreted prospectively using the Miami classification in vivo and in real time. Results In group 1, sensitivity, specificity, and accuracy were 88, 83, and 87%, respectively. In group 2, sensitivity, specificity, and accuracy were 75, 71, and 73%, respectively. Diagnostic accuracy of pCLE was lower when applied to group 2 (p < 0,001). The investigation is less reliable in bile ducts affected by inflammation from cholangitis or previous stenting. Conclusions Inflammatory lesions of the bile duct interfere with interpretation of pCLE. A refined pCLE description of inflammatory lesions should improve accuracy of pCLE in bile duct stenosis.
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613483462|hwp:master-id:spueg;2050640613483462
  Issue No: Vol. 1, No. 2 (2013)
UEG Week attendance and abstract submission: What's in it for me'
- Pages: 128 - 129
  PubDate: 2013-04-08T02:07:09-07:00
  DOI: 10.1177/2050640613483399|hwp:resource-id:spueg;1/2/128
  Issue No: Vol. 1, No. 2 (2013)