Background
Few studies have investigated measures to prevent small bowel injuries induced by aspirin. Our aim was to evaluate the effect of probiotic treatment on the small bowel injuries induced by ...chronic low-dose aspirin use.
Methods
Thirty-five patients who took low-dose enteric-coated aspirin 100 mg daily (for more than 3 months) plus omeprazole 20 mg daily and were diagnosed as having unexplained iron deficiency anemia participated in this prospective randomized controlled trial. We assigned the patients to receive probiotic treatment with
Lactobacillus casei
for 3 months (
L. casei
group) or not receive the probiotic (control group). Patients underwent capsule endoscopy (CE) before and after treatment.
Results
Twenty-five patients, including 13 in the
L. casei
group and 12 in the control group, underwent the full analysis. Significant decreases in the number of mucosal breaks and the CE score were observed at the 3-month evaluation in the
L. casei
group as compared with the results in the control group (
P
= 0.039). The change from the baseline in the median number of mucosal breaks in the
L. casei
group was −2, as compared with 0.5 in the control group. The change from the baseline in the median CE score in the
L. casei
group was −228 compared with −4 in the control group (
P
= 0.026).
Conclusions
Co-administration of
L. casei
is effective for the treatment of aspirin-associated small bowel injury.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background/Purpose
Placement of uncovered self‐expandable metallic stents (U‐SEMSs) of patients with unresectable perihilar cholangiocarcinoma (UPHC) is recommended as the treatment of first choice ...to address bile stasis. The aim of this study was to determine which of the following two endoscopic stents might be the stent of first choice for the treatment of biliary stasis in patients with UPHC: plastic stents (PSs) or U‐SEMSs.
Methods
U‐SEMSs, deployed as a stent‐in‐stent, were selected as the stents of first choice from 2013 and 2014, while PSs began to be selected as the stents of first choice from 2015 onward.
Results
The median time to recurrent biliary obstruction were 66 days in the PS group (N = 38) and 105 days in the U‐SEMS group (N = 37; P = .04). Emergency endoscopy was necessitated in 76.3% (29/38) of patients of the PS group and 54.1% (20/37) of patients of the U‐SEMS group (P = .0434). The success rate of the first reintervention was 96.5% (27/29) in the PS group and 55% (11/20) in the U‐SEMS group (P = .0002). Sustainable chemotherapy could be carried out in 55.2% of patients in the PS group and 32.4% of patients in the U‐SEMS group (P = .0472). Multivariate analysis identified selection of U‐SEMS as the stent of first choice as the only independent factor predictive of successful reintervention (P = .0016, odds ratio = 0.058). However, the stent selection was not an independent factor for feasible chemotherapy.
Conclusions
Plastic stent placement could enhance the success rate of reintervention in patients with UPHC and might be facilitated by sustainable chemotherapy. However, stent selection might not have an influence on the prognosis.
Highlight
Placement of uncovered self‐expandable metallic stents is recommended as the treatment of choice in patients with unresectable perihilar cholangiocarcinoma. Iwasaki and colleagues conclude that plastic stent placement could enhance the success rate of reintervention in these patients and might facilitate sustainable chemotherapy. Stent selection, however, may not affect the prognosis.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Immune checkpoint inhibitors are widely used in clinical practice, and immune-related adverse events (irAE) have been reported. An irAE liver injury, cholangitis, has been reported to occur ...frequently in patients who respond to treatment with immune checkpoint inhibitors. Sclerosing cholangitis is rare, occurring in only 4.5% of patients with liver injury who respond to immune checkpoint inhibitor therapy, and often difficult to diagnose. Ultrasonography shows thickness of the bile duct wall, cholangiography shows no obvious obstruction or stenosis, and cholangioscopy shows erosions and ulcerative changes on the surface of the bile duct. In patients who use immune checkpoint-inhibitors, damage of the biliary system should always be considered as irAE sclerosing cholangitis, and a definitive diagnosis should be made using various imaging studies. Although irAE sclerosing cholangitis is treated using steroids, it is often refractory to treatment and intractable.
Background/Purpose
The relationship between autoimmune pancreatitis (AIP) and malignancy has been reported. However, the potential risk for cancer in patients with immunoglobulin 4 (IgG4)‐related ...sclerosing cholangitis (IgG4‐SC) is unclear. The present study aimed to evaluate the incidence of cancer in IgG4‐SC patients.
Methods
We retrospectively collected clinical data for 121 patients diagnosed with IgG4‐SC from 7 hospitals. We calculated the standardized incidence ratio (SIR) of cancer in IgG4‐SC patients based on the national cancer rates. The SIR of the period after the diagnosis of IgG4‐SC were calculated.
Results
The mean follow‐up period was 6.4 years, with 121 IgG4‐SC patients. During the follow‐up period, 26 patients had cancer, and 29 cancers were diagnosed. The SIR of cancer after the diagnosis of IgG4‐SC was 1.90 (95% confidence interval CI 1.67‐2.21). The SIR of pancreatic and bile duct cancer was 10.30 and 8.88, respectively. The SIR of cancer in <1 year, 1‐5 years, and >5 years after diagnosis of IgG4‐SC were 2.58, 1.01, and 2.44, respectively.
Conclusions
IgG4‐SC patients have a high risk of cancer including pancreatic and bile duct cancer. The risk of cancer was high less <1 year and >5 years after diagnosis of IgG4‐SC. Therefore, IgG4‐SC patients may require careful long‐term follow‐up.
Highlight
In this retrospective study, Kurita and colleagues found that the risk of cancer, including pancreatic and bile duct cancer, is high in patients with IgG4‐related sclerosing cholangitis. The risk was high <1 year and >5 years after diagnosis, suggesting that patients with IgG4‐related sclerosing cholangitis may require careful long‐term follow‐up.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background and Aim
Immunoglobulin G4‐related sclerosing cholangitis (IgG4‐SC) presents as isolated proximal‐type sclerosing cholangitis (i‐SC). The present study sought to clarify the imaging ...differences between i‐SC and Klatskin tumor. Differences between i‐SC and IgG4‐SC associated with autoimmune pancreatitis (AIP‐SC) were also studied.
Methods
Differentiating factors between i‐SC and Klatskin tumor were studied. Serum IgG4 level, CA19‐9 level, computed tomography (CT) findings, cholangiography findings (symmetrical smooth long stricture extending into the upper bile duct SSLS), endosonographic features (continuous symmetrical mucosal lesion to the hilar part CSML), endoscopic biopsy results, treatment, relapse, and survival were also compared between patients with i‐SC and those with AIP‐SC.
Results
For a differential diagnosis between i‐SC (N = 9) and Klatskin tumor (N = 47), the cut‐off value of serum IgG4 level was 150 mg/dL (sensitivity, 0.857, specificity, 0.966). Logistic regression analysis indicated that serum IgG4 level, presence of SSLS, presence of CSML, and presence of swollen ampulla are independent factor for identifying i‐SC. Relapse rate was significantly higher in the IgG4‐SC with AIP group than in the i‐SC group (log rank, P = 0.046).
Conclusion
Isolated proximal‐type sclerosing cholangitis presents as a nodular lesion with SSLS and/or CSML mimicking a Klatskin tumor. Those endoscopic features might provide a diagnostic clue for i‐SC. i‐SC is likely to have a more favorable prognosis than IgG4‐SC with AIP.
Full text
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Purpose
The utility of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for gastric subepithelial lesions (SELs) has been reported. In this study, we examined the optimal number of needle ...punctures during EUS-FNB for gastric SELs without rapid on-site evaluation (ROSE). The factors that allowed for a single needle puncture to arrive at the correct diagnosis were also analyzed.
Methods
We conducted a retrospective study of all patients who underwent EUS-FNB to evaluate gastric SELs between April 2015 and September 2020; 51 patients with 57 gastric SELs were enrolled. The optimal number of needle punctures was determined when additional needle passes did not increase diagnostic sensitivity by more than 10%. Factors allowing for only a single needle puncture to arrive at the correct diagnosis were identified by univariate and multivariate logistic regression analyses.
Results
EUS-FNB resulted in a definitive final diagnosis in 48 of 57 lesions (84%). Lesions in the gastric body (odds ratio OR 6.15, 95% confidence interval CI 1.75–21.6;
P
< 0.01) and lesions punctured using a 22G Franseen needle (OR 3.61, 95% CI 1.07–12.3;
P
= 0.04) were independent factors that allowed for only a single needle puncture to arrive at the correct diagnosis. The optimal number of needle punctures for lesions using a 22G Franseen needle in the gastric body and other lesions was two and three, respectively.
Conclusion
The optimal number of needle punctures in EUS-FNB for gastric SELs without ROSE was two or three, depending on the location and type of needle used.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Relapse and spontaneous remission (SR) are characteristic features of autoimmune pancreatitis (AIP).
Aim and methods
We conducted a study to determine if the predictive factors might be ...potentially related to the relapse in 70 consecutive AIP patients. Regarding SR, we studied the data of patients without corticosteroid treatment (CST).
Results
CST was administered to 60% (42/70) of the patients; however, relapse was noted in 45.2% (19/42) of these patients. In 95% (18/19) of the AIP patients developing relapse, the relapse occurred within 3 years. The relapse rate was 80% (12/15) in the AIP patients administered CST for less than 12 months and 25.9% (7/27) in those administered CST for over 12 months (
p
< 0.01). The results of univariate analysis revealed significant association of relapse with the presence of jaundice, IgG4 seropositivity, presence of diffuse pancreas swelling, duodenal papillitis (DP), history of initial CST, and history of supportive treatment (
p
< 0.05), whereas multivariate analysis revealed that IgG4 seropositivity (OR 10.506,
p
= 0.0422) and the presence of jaundice (OR 6.945,
p
= 0.0174) are significant independent factors predictive of relapse in AIP patients. SR was recognized in 65.0% (13/20) of AIP patients without CST. The results of univariate analysis revealed that SR was associated with IgG4 seropositivity (
p
< 0.05), and multivariate analysis identified IgG4 seropositivity (OR 0.032,
p
= 0.0092) as a significant independent factor predictive of SR in these cases.
Conclusion
AIP patients with IgG4 seropositivity and jaundice are at a higher risk of relapse and they could therefore be candidates for over 3 years of maintenance CST. AIP patients with IgG4 seronegativity have a high likelihood of SR.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The presence of main pancreatic duct (MPD) dilatation is important for diagnosing pancreatic ductal adenocarcinomas (PDACs). However, we occasionally encounter PDAC cases without MPD dilatation. The ...objectives of this study were to compare the clinical findings and prognosis of pathologically diagnosed PDAC cases with and without MPD dilatation and to extract factors related to the prognosis of PDAC. The 281 patients pathologically diagnosed with PDAC were divided into two groups: the dilatation group (
= 215), consisting of patients with MPD dilatation of 3 mm or more, and the non-dilatation group (
= 66), consisting of patients with MPD dilatation less than 3 mm. We found that the non-dilatation group had more cancers in the pancreatic tail, more advanced disease stage, lower resectability, and worse prognoses than the dilatation group. Clinical stage and history of surgery or chemotherapy were identified as significant prognostic factors for PDAC, while tumor location was not. Endoscopic ultrasonography (EUS), diffusion-weighted magnetic resonance imaging (DW-MRI), and contrast-enhanced computed tomography had a high tumor detection rate for PDAC even in the non-dilatation group. Construction of a diagnostic system centered on EUS and DW-MRI is necessary for the early diagnosis of PDAC without MPD dilatation, which can improve its prognosis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
