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Volume 70 - 2007 - Fasc.4 - Case series

Transanal endoscopic microsurgery (TEM) vs radical surgery (RS) in the treat- ment of rectal cancer : Indications, limitations, prospectives. A review

Background and study aims : Principal goal in the management of any patient with rectal cancer is to provide an optimal chance for cure while maintaining their quality of life. Transanal endo- scopic microsurgery (TEM) is a minimal invasive procedure that allows full thickness local excision or rectal tumors. The role or TEM in the treatment of rectal cancer remains controversial. The aim of this study was to review the evidence related to the role of TEM compared to radical surgery in the treatment of rectal can- cer. Patients and methods : We reviewed 5 studies (two controlled randomized and three non-randomized) comparing outcome after TEM vs. radical surgery (RS), either open or laparoscopic, in patients with rectal cancer. We evaluated the results in terms of safety of the procedure as well as its efficacy. Results : Hospital stay, complication rate and overall morbidity and mortality were lower in the TEM groups in all studies. With the exception of one study, recurrence was slightly (but non-sig- nificantly) increased in the TEM groups. No difference for T2 tumors with TEM vs. laparoscopic resection was seen though. Overall survival was not statistically different. Conclusions : TEM is a safe, effective minimal invasive method for treatment of T1 rectal carcinomas and possibly T2 carcinomas in selected patients after neoadjuvant chemoradiation. Its role in advanced tumor stages should be further defined. (Acta gastro- enterol. belg., 2007, 70, 374-380).


Statins in hepatobiliary diseases : effects, indications and risks

Background and study aims : Statins are among the most fre- quently used medications. Our aim was to study their indications or contraindications in hepatobiliary diseases. Patient and Methods : This study was stimulated by a patient with PBC, marked hypercholesterolemia and cardiac problems. Results : Besides a lipid lowering effect, statins have other ben- efits, such as prevention of arterosclerosis, reduction of the risk of developing diabetes and inhibition of fibrogenesis. The effects depend on the type of statin, the genetic and acquired characteris- tics of the patient and the interaction with other medications. Side effects such as myopathy and liver toxicity are rather rare but should be monitored. The use of statins in liver disease is not clear- ly defined. Hyperlipidaemia is a risk factor for arteriosclerosis in NAFLD (Non Alcoholic Fatty Liver Disease), but fibrates might constitute the treatment of choice. Preliminary data suggest that biochemical and histological improvement in NAFLD might be obtained with atorvastatin or pravastatin. The use of statins in the medical therapy of gallstones remains unclear. Combination ther- apy might have a beneficial effect in cases of stones with mixed composition. Patients with Primary Biliary Cirrhosis or with chronic cholestasis in general have high HDL-cholesterol levels but a large amount of Lipoprotein X particles, which have a protective effect. As such, statin therapy is often not really indicated. Conclusion : When cardiovascular problems arise in patients with chronic cholestasis, an underlying factor should be looked for. The lipid abnormalities depend also on the stage of the PBC. (Acta gastroenterol. belg., 2007, 70, 381-388).


Management and treatment of chronic hepatitis B virus : Belgian Association for the Study of the Liver (BASL) 2007 guidelines

Chronic hepatitis B virus (HBV) infection currently affects about 400 million people and is responsible for 500,000 to 1,000,000 deaths annually worldwide from cirrhosis and hepatocellular carcinoma (HCC) (1). For this reason, screening high risk populations to identify HBV infected persons is important so that guidelines for treatment and prevention of transmission can be given in this specific group. Recently, new drugs became available for HBV and new insights in resistance and definitions came up. SO. the purpose of this paper is providing an update of the recent literature and guidelines concerning 1. screening for chronic hepatitis B (CHB) 2. management of patients with CHB 3. treatment of CHB in mono-infected patients and in special patient populations (co-infected, transplanted and immunosuppressed patients). The recommendations are based on published infor- mation and the level of evidence is reported with each recommendation. The level of evidence is graded as : grade I : randomized controlled trials ; grade II-1 : con- trolled trials without randomization ; grade II-2 : cohort or case-control analytic study ; grade II-3 : multiple time series, dramatic uncontrolled experiments ; grade III : descriptive epidemiology, expert opinions.