Volume 79 - 2016 - Fasc.2 - Original articles
The efficacy of intravenous hyoscine-N-butylbromide during colonoscopy : a prospective, randomized, double-blind, placebo-controlled study
Background and study aims : Colonic spasm makes colonoscope advancement difficult. This prospective, randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of hyoscine- N-butylbromide as an antispasmodic during colonoscopy.
Patients and methods : Patients referred for elective colonoscopy were randomized into the study and placebo groups. Before the procedure, the study and placebo groups received 20 mg intra- venous hyoscine-N-butylbromide and intravenous saline solution of the same amount, respectively. Demographic and procedure- related data were recorded and compared between the groups.
Results : Of 198 patients referred for elective colonoscopy, 121 were included (study group = 60, placebo group = 61). No differ- ences were observed between the study and placebo groups in terms of demographic data, pre-procedure characteristics, and colonoscopic characteristics including the cecal intubation time, total procedure time, bowel preparation, sedation doses, hemo- dynamic findings, endoscopist satisfaction, patient comfort, and polyp detection rate. The only difference was an increase in the heart rate by 32% in the study group after hyoscine-N-butyl- bromide administration (p < 0.001).
Usefulness of IT knife nano for endoscopic submucosal dissection of large colorectal lesions
Aim: Endoscopic submucosal dissection (ESD) is currently widely conducted for the treatment of early gastrointestinal cancers. Due to the characteristic anatomy of the large intestine, needle-tip type devices such as Dual knife are mainly used in colorectal ESD. On the other hand, the non needle-tip type IT knife is a unique device with an insulated tip, and has been reported to be safe, efficacious and speedy when used in gastric ESD. A new model of IT knife, IT knife nanO. anticipated to be useful for esophageal and colorectal ESD has become available, but its usefulness has not been reported. Therefore, we performed this study to evaluate the usefulness of IT knife nano for ESD of large colorectal lesions.
Fragmented QRS is associated with cirrhotic cardiomyopathy in patients with decompensated cirrhosis
Background/Aim : It has been reported that the fragmented QRS (fQRS) is related to left ventricular systolic dysfunction and dia- stolic dysfunction.The aim of this study was to determine the fre- quency of fragmented QRS (fQRS) in patients with decompensated cirrhosis and to evaluate the relationship between the presence of fQRS and systolic and diastolic dysfunction.
Methods : The study included consecutive 189 patients with de- compensated cirrhosis. fQRS pattern was described as presence of RSR' manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. Conventional echocardiog- raphy and tissue doppler echocardiography were performed in all patients.
CDX2 as a prognostic marker in gastric cancer
Background : There is considerable evidence in the literature to suggest a role for CDX2 in intestinal metaplasia and development of gastric cancer, but its impact on the prognosis of gastric cancer continues to be a matter of debate.
Objective : We conducted this study to assess the prognostic implications of CDX2 in gastric cancer.
Methods : We retrospectively reviewed our database for gastric carcinoma cases diagnosed at our hospital from 2004 to 2008. His- topathology slides of these were subsequently stained with CDX2 immuno-histochemical stain. CDX2 positive and negative groups were then compared for overall survival.
Results : A total of 101 patients (mean age 50y ; 60% male) were included in the study. 31/101 (30.7%) cases were CDX2 positive. Of these, 23/31 (74%) patients underwent curative surgical resection. In the CDX2 negative group, only 12/70 (17%) patients underwent curative surgery (p = .0001). Of those who underwent surgical re- section, 9% had stage I, 37% had stage II, 43% had stage III, and 11% had stage IV tumours on TNM staging of post-surgical histo- logical specimens. Mean overall survival of CDX2 positive group was 17 months, compared to 6 months in the CDX2 negative group (p = 0.0001).
Anemia Outcome After Laparascopic Mini Bypass : Analysis of 107 Consecutive Patients
Background : The prevalence of obesity has dramatically in- creased globally. Weight loss procedures are known to be an effec- tive and reliable method with relatively low complication rate and satisfactory results. Laparoscopic mini-gastric bypass (LMGB) is known as a modified Mason loop procedure with compatible re- sults to laparoscopic Roux-en-Y gastric bypass (LRYGB), and is believed to have even less complication rate. Despite adequate and meticulous supplement therapy, anemia is one of the challenges in patients undergoing LMGB. Thus, we aimed to review the preva- lence and severity of anemia in patients undergoing LMGB.
Method : A prospectively-maintained database of patients refer- ring to Hazrat Rasoul Akram hospital who underwent LMGB from December 2013 to October 2014 was reviewed retrospective-
Polymorphisms in the IL28B gene (rs12979860, rs8099917) and the virological response to pegylated interferon therapy in hepatitis D virus patients
Aim : Few data are available regarding the effects of interleukin 28B (IL28B) polymorphisms in chronic hepatitis D (CHD) patients. This study investigated the relationship between IL28B polymorphisms and the response of patients with CHD infections to pegylated interferon (PEG-IFN) therapy.
Materials and methods : A total of 101 CHD patients were selected,-80-of-whom-(46-males-;-median-age-41-years)-satisfied-the inclusion criteria and were enrolled in the study. Thirty-seven patients were treated with peg IFNa for-at-least-12-months-and-were followed for a median of 18 months (range, 12-30 months). The primary treatment endpoint was the suppression of HDV replication, as documented by the loss of detectable HDV RNA in serum. Geno-typing was used to analyse the IL28B polymorphisms rs12979860 and rs8099917 according to the virological response.
Results : After treatment, a sustained viral response (SVR) was achieved in 19 (51%) of the patients treated with PEG-INF. The IL28B genotypes in the 80 patients were as follows : CC in 36 (45%), CT in 33 (41%) and TT in 11 (14%) for rs12979860, and GG in 4 (5%), GT in 27 (34%) and TT in 49 (61%) for rs8099917. SVR was achieved in 5 (26%), 10 (53%) and 4 (21%) patients with CC, CT and TT at rs12979860, respectively, and one (5%), nine (47%) and nine (47%) patients with GG, GT and TT at rs8099917, respectively. There were differences in the SVR among genotypes (rs12979860 and rs8099917 ; chi-squared test, p = 0.047).
Conclusion : IL28B predicts the PEG-IFN response in patients with CHD infection. (Acta gastroenterol. belg., 2016, 79, 206-210).
Post progression survival analysis of metastatic gastric and gastroesophageal junction cancer patients after second-line treatment
Purpose : The aim of this study was to define the factors that affect response and post-progression survival of metastatic gastric cancer (MGC) and gastroesophageal junction cancer (GEJ) patients treated with second-line chemotherapy.
Methods : We retrospectively reviewed the data of 59 patients with MGC or GEJ adenocarcinoma who received second-line treatment.
Results : The median age was 54 years old (26-77). Response to second-line treatment was strongly associated with disease control with first-line treatment (p < 0.01). Median progression-free sur- vival (PFS), overall survival (OS) and post-progression survival (PPS) were 3.2 (95% CI : 2.63-3.80), 6.5 (95% CI : 3.78-9.35) and 2.7 months (95% CI : 1.89-3.68), respectively. PFS (r = 0.55, p < 0.01) and PPS (r = 0.89, p < 0.01) were correlated with OS. Response to second-line treatment was independently related to PFS (HR : 0.12 95%CI : 0.53-0.26, p < 0.001). Having an ECOG 0 performance status (HR : 0.42 ; 95%CI : 0.21-0.86, p = 0.02) and response to second-line therapy (HR : 0.47 ; 95%CI : 0.25-0.85, p = 0.01) were independently associated with OS.
Conclusion : PPS and PFS were correlated with OS after second- line treatment of MGC. Response to second-line treatment pro- longed OS by increasing PFS, and having an ECOG 0 PS prolonged OS by increasing PPS. (Acta gastroenterol. belg., 2016, 79, 211-215).
Comparing the type and severity of inflammatory bowel disease in relation to IgG4 immunohistochemical staining
Background and study aim : The role of immunoglobulin (Ig) G4 in the etiopathogenesis of inflammatory bowel disease (IBD) and its association with endoscopic and pathological activity are not yet completely understood. The purpose of this study was to determine the possible relationship between IgG4 status and IBD.
Patients and methods : Endoscopic colon biopsies of 55 patients with ulcerative colitis (UC) and of 17 patients with Crohn's disease (CD) were examined. Numbers of IgG4-positive plasma cells stained immunohistochemically were counted in a minimum of 5 high power fields (HPFs) for each specimen. The presence of > 10 cells/HPF IgG4-positive PCs was considered positive.
Results : The prevalence of IgG4-positive plasma cells in the lamina propria of the colonic mucosa was significantly higher in patients with UC than in those with CD (p :0.01). Additionally, the prevalence of IgG4-positive plasma cells increased in line with en- doscopic and pathological activity in UC patients. Conversely, we determined no significant correlation between IgG4 positivity and pathological activity in the CD group. IgG4-positive UC patients also exhibited findings of more severe disease compared to IgG4- negative UC patients.
Conclusions : Immunohistochemical IgG4 staining may predict disease severity in UC and may be a useful marker for distinguish- ing between UC and CD. (Acta gastroenterol. belg., 2016, 79, 216- 221).
Achieving WHO recommendations for Hepatitis C Virus Elimination in Belgium
Background : The World Health Organization (WHO) released updated guidelines for the screening, care and treatment of pa- tients with chronic hepatitis C virus (HCV) infection.
Methods : A previously described HCV disease burden model was used to develop a "WHO scenario" to achieve the WHO rec- ommendations of a 90% reduction in incidence and 65% reduction in liver-related deaths. After determining the steps necessary to achieve this goal, the impact of realistic constraints was modeled.
Results : In 2015, there were 66.200 viremic infections, with 43% diagnosed and 1.350 treated. In order to reduce new infections, treatment must be extended to = F0 patients, including people who inject drugs and other individuals at risk of transmitting HCV. Additionally, diagnosis and treatment of 3.030 and 4.060 patients, respectively, would be required. The largest attenuation of the WHO scenario would occur if no new cases were diagnosed after 2018 (300% more viremic infections by 2030). Limiting treatment to = F2 patients or treating fewer patients (3.000) would result in 220% or 140% more viremic cases, respectively, compared with the WHO scenario.
Mitigating the burden of hepatitis C virus among people who inject drugs in Belgium
Background and Aims : In 2010, there were an estimated 10 100 PWID in Belgium and 43% (34%-57%) were HCV infected. Un- derstanding HCV transmission dynamics in high-risk populations and assessing the potential impact of improved HCV treatment strategies requires robust epidemiological data and mathematical modeling.
Methods : HCV transmission was modeled using cohorts to track HCV incidence and prevalence among active PWID in the general PWID population, OST and NSP. Model assumptions were derived from published literature and expert consensus. The relative im- pact of increasing the number of PWID treated with new oral DAAs was considered.
Results : If the current transmission paradigm continues, there will be 2645 HCV-infected PWID in 203O.Annually treating 30 (1% of 2015 population) or 120 (4% of 2015 population) HCV-in- fected PWID with oral DAAs will result in 5% and 25% reductions, respectively, in HCV-infected PWID by 203O.Treating 370 PWID annually (12.5% of 2015 population) will result in a > 90% reduc- tion by 2030.