Summary
Background
Gastric phytobezoars represent the most common bezoars in patients with poor gastric motility. A variety of dissolution therapies and endoscopic fragmentation techniques have been ...evaluated as conservative treatment so as to avoid surgery.
Aim
To investigate the effectiveness of Coca‐Cola for gastric phytobezoars dissolution.
Methods
We performed a systematic search to identify publications on gastric phytobezoars to assess the efficacy of Coca‐Cola as a dissolution therapy. Diospyrobezoars, formed after persimmon ingestion, are a distinct type of phytobezoars characterized by their hard consistency. Thus, these two subgroups of bezoars were compared in terms of successful dissolution.
Results
Over a 10‐year period (2002–2012), 24 papers including 46 patients have been published. In 91.3% of the cases, phytobezoar resolution with Coca‐Cola administration was successful, either as a single treatment (50%) or combined with further endoscopic techniques, whereas only 4 patients underwent surgery. Phytobezoars were more likely to dissolve after initial attempt with Coca‐Cola compared with diospyrobezoars (60.6% vs. 23%, P = 0.022).
Conclusions
Coca‐Cola alone is effective in gastric phytobezoar dissolution in half of the cases and, combined with additional endoscopic methods, is successful in more than 90% of them.
These recommendations on video capsule endoscopy, an emerging technology with an impact on the practice of endoscopy, were developed by the European Society of Gastrointestinal Endoscopy (ESGE) ...Guidelines Committee. The first draft of each section was prepared by one or two members of the writing team, who were selected as experts on the content of that section on the basis of their published work. They used evidence-based methodology, performing MEDLINE and PubMed literature searches to identify relevant clinical studies. Abstracts from scientific meetings were included only if there was no published full paper on a particular topic. If there was disagreement, the first author of the Guideline made the final decision. Recommendations were graded according to the strength of the supporting evidence. The draft guideline was critically reviewed by all authors and submitted to the ESGE councillors for their critical review before approval of the final document. The ESGE Guidelines Committee acknowledges that this document is based on a critical review of the data available at the time of preparation and that further studies may be needed to clarify some aspects. Moreover, this Guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. This document should be regarded as supplying recommendations only to gastroenterologists in providing care to their patients. It is not a set of rules and should not be construed as establishing a legal standard of care, or as encouraging, advocating, requiring, or discouraging any particular treatment. These recommendations must be interpreted according to the clinician's knowledge, expertise, and clinical judgment in the management of individual patients and, if necessary, a course of action that varies from recommendations must be undertaken.
Video capsule endoscopy (VCE) is a useful tool in investigating small bowel pathology. However, the role of bowel preparation is controversial. Therefore, the aim of this study was to explore the ...role of bowel preparation and in particular its consequences on diagnostic yield in a meta-analysis of all relevant studies.
Extensive English-language medical literature searches were performed up to February 2008, using suitable keywords, looking for human studies that compared different modes of small bowel preparation (purgative vs. clear liquids diet). We examined the effects of this preparation on the following three primary end points, diagnostic yield (DY), small bowel visualization quality (SBVQ), and VCE completion rate (CR) by meta-analysis of relevant studies.
A total of 12 eligible studies (6 prospective, 6 retrospective) were identified, including 16 sets of data relevant to our primary end points. There were significant differences between patients prepared with purgative vs. those prepared with clear liquids diet in DY (263 vs. 213 patients, respectively; OR (95% CI)=1.813 (1.251-2.628), P=0.002) and SBVQ (404 vs. 249 patients, respectively; OR (95% CI)=2.113 (1.252-3.566), P=0.005). There was no statistically significant difference regarding CR rate. Purgatives did not affect VCE gastric transit time (GTT) or VCE small bowel transit time (SBTT).
Pooled data showed that in comparison to clear liquids diet, purgative bowel cleansing, before VCE, improves the SBVQ and increases the DY of the examination, but does not affect the VCE completion rate.
Aliment Pharmacol Ther 2010; 32: 425–442
Summary
Background Guidelines and practice standards for sedation in endoscopy have been developed by various national professional societies. No attempt has ...been made to assess consensus among internationally recognized experts in this field.
Aim To identify areas of consensus and dissent among international experts on a broad range of issues pertaining to the practice of sedation in digestive endoscopy.
Methods Thirty‐two position statements were reviewed during a 1 ½‐day meeting. Thirty‐two individuals from 12 countries and four continents, representing the fields of gastroenterology, anaesthesiology and medical jurisprudence heard evidence‐based presentations on each statement. Level of agreement among the experts for each statement was determined by an open poll.
Results The principle recommendations included the following: (i) sedation improves patient tolerance and compliance for endoscopy, (ii) whenever possible, patients undergoing endoscopy should be offered the option of having the procedure either with or without sedation, (iii) monitoring of vital signs as well as the levels of consciousness and pain/discomfort should be performed routinely during endoscopy, and (iv) endoscopists and nurses with appropriate training can safely and effectively administer propofol to low‐risk patients undergoing endoscopic procedures.
Conclusions While the standards of practice vary from country to country, there was broad agreement among participants regarding most issues pertaining to sedation during endoscopy.
Purpose
Non-alcoholic fatty liver disease (NAFLD) is a complex disease, resulting from a variety of genetic and environmental factors. The aim of this case–control study was to evaluate the effect of ...selected genetic polymorphisms, nutrition aspects and their interaction on the risk of NAFLD.
Methods
The sample consisted of 134 patients with NAFLD and 217 controls. Disease was diagnosed by liver ultrasound and volunteers were clinically and nutritionally assessed. Food groups were extracted from a 172 food-item FFQ questionnaire. Three genetic polymorphisms were assessed: PNPLA3 rs738409, TM6SF2 rs58542926 and GCKR rs780094.
Results
We replicated the effect of previously reported risk factors for NAFLD, such as elevated liver enzymes, obesity and metabolic syndrome. Food groups rich in simple sugars, fat and especially saturated fat were positively associated with NAFLD risk, whereas food groups rich in polyunsaturated fatty acids were reversely associated with the possibility of developing the disease (
p
< 0.05). Only the PNPLA3 genetic variant was statistically significantly associated with the disease (
p
additive
= 0.015). However, it was found that a one-portion increase in fish intake increased the risk of NAFLD in carriers of the risk allele of TM6SF2 rs58542926 polymorphism compared to non-carriers, after adjusting for age, gender, energy intake, pack-years, PAL, TM6SF2 genotype and fish consumption (OR
dominant
= 1.503, 95% CI 1.094–2.064).
Conclusions
Fish intake exerts an additive effect on NAFLD risk for carriers of the TM6SF2 polymorphism. This novel finding provides further rationale on the need for personalized nutritional advice, based on the genetic background of NAFLD patients.
The optimal treatment of bleeding due to radiation proctitis is still controversial. Although argon plasma coagulation (APC) has been recently reported as an effective treatment, its efficacy in ...relation to disease severity is unknown. The study aims were to prospectively evaluate (i) the efficacy of APC in endoscopically mild and severe radiation proctitis, and (ii) the recurrence rate following successful treatment.
56 patients (mean age 68.4 years) with radiation proctitis after radiotherapy for prostate cancer were studied. All presented with rectal bleeding, occurring a median 21.5 months after radiotherapy. Using an established scoring system, patients were classified into two groups, with mild or severe disease. We also examined the correlation between endoscopic severity and hemoglobin level as a more objective measure of bleeding activity. Success was defined either as cessation of bleeding or a significant reduction so that further treatment was not required.
Proctitis was classified as mild in 27 patients (48%) and severe in 29 (52%). Endoscopically judged severity and hemoglobin level showed good correlation (R = 0.58). All patients with mild proctitis and 23/29 (79%) with severe disease were successfully treated (P < 0.05). During a follow-up of a mean of 17.9 months (range 6-33), 34/38 patients (89.5%) remained in clinical remission. Recurrence was higher in those using anticoagulant or aspirin (P = 0.02).
APC is highly effective in all patients with mild radiation proctitis and in the majority of those with severe disease, providing long-lasting clinical remission.
Abstract Background Small intestine video-capsule endoscopy examination in patients with diabetes mellitus may be incomplete due to delayed gastric emptying. Aim To measure video-capsule endoscopy ...gastric and small bowel transit time and to assess the completeness of the examination in diabetes mellitus patients. Methods In this retrospective, case-control study, we examined capsule endoscopy videos from 29 consecutive diabetes mellitus patients. Fifty-eight matched for sex, type of preparation, age and reason for referral non-diabetic controls were selected from our video-capsule endoscopy database. Two independent experienced investigators measured transit times and assessed examinations’ completeness. Results Video-capsule endoscopy gastric transit time was significantly longer in diabetes mellitus (87, 1–478 min) compared to non-diabetic patients (24, 4–108 min, p < 0.001). The caecum was visualized in 20/29 (69%) diabetes mellitus and 52/58 (89.6%) non-diabetic controls ( p = 0.02). In 16 diabetes mellitus patients that video-capsule endoscopy reached the caecum, small bowel transit time was significantly shorter (261.2 ± 55.5 min) compared to their 32 non-diabetic matched controls (302 ± 62.7 min, p = 0.03). Conclusions Patients with type 2 diabetes mellitus have prolonged video-capsule endoscopy gastric transit time compared to non-diabetic patients. Prospective studies are required to complete our understanding of video-capsule endoscopy transit times in the setting of diabetes mellitus.
Our aim study was to compare 12 and 24-month results of intravitreal ranibizumab therapy in the management of choroidal neovascularization (CNV) secondary to angioid streaks (ST). This could be of ...clinical importance helping us planning optimal dosing strategies.
Over a 7-year period, a consecutive series of treatment-naïve eyes with macular CNV due to AS were treated with intravitreal ranibizumab (0.5 mg). The main outcome measure was changed in best-corrected visual acuity (BCVA) at 12 and 24 months as compared to baseline.
Twenty eyes completed 24-month therapy and regular follow-up visits. BCVA improved at 12 (0.42±0.26 logMAR) and 24 months (0.44±0.22 logMAR) as compared to baseline (0.75±0.26 logMAR) (p<0.001), but did not change between the 12 and 24-month follow-up (p=0.48). BCVA improved in 15 (75%) and 16 (80%) of the eyes, but in 5 (25%) and 4 eyes (20%) remained unchanged (p=0.71) at 12 and 24 months, respectively.
These results suggest that during the first year of intravitreal ranibizumab therapy for patients with macular CNV due to AS, BCVA improved in most of the eyes, and was maintained during the second year.
Background. Inflammation mediators related to radiation proctitis are partially elucidated, and neovascularization is thought to play a key role. Objectives. To investigate the expression of vascular ...endothelial growth factor (VEGF) and CD31 as angiogenetic markers in postradiation rectal tissue. Methods. Rectal mucosa biopsies from 11 patients who underwent irradiation for prostate cancer were examined immunohistochemically for the expression of VEGF and CD31 at three time settings—before, at the completion of, and 6 months after radiotherapy. VEGF expressing vascular endothelial cells and CD31 expressing microvessels were counted separately in 10 high-power fields (HPFs). VEGF vascular index (VEGF-VI) and microvascular density (MVD) were calculated as the mean number of VEGF positive cells per vessel or the mean number of vessels per HPF, respectively. Histological features were also evaluated. Results. VEGF-VI was significantly higher at the completion of radiotherapy (0.17±0.15 versus 0.41±0.24, P=0.001) declining 6 months after. MVD increased significantly only 6 months after radiotherapy (7.3±3.2 versus 10.5±3.1, P<0.005). The histopathological examination revealed inflammatory changes at the completion of radiotherapy regressing in the majority of cases 6 months after. Conclusions. Our results showed that in postradiation rectal biopsy specimens neoangiogenesis seems to be inflammation-related and constitutes a significant postradiation component of the tissue injury.
Physical examination revealed only mild diffuse epigastric and abdominal tenderness, and no signs of systemic vasculitis or connective tissue disease were present. Gastric biopsies showed H pylori ...infection and dense eosinophilic infiltration (29 eosinophils per high power field) of the gastric mucosa, but biopsies from the 2nd-3rd parts of the duodenum were normal.
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