Volume 82 - 2019 - Fasc.4 - Case series
Efficacy and safety of magnetic guided capsule gastroscopy in gastric diseases
The current mainstay of screening and diagnosis for gastric diseases is conventional standard gastroscopy. However, it is invasive and uncomfortable procedure for the patients especially in case of non-sedative procedures and other adverse effects related to conscious sedation anesthesia. Recently, a magnetic guided capsule gastroscopy (MGCG) was introduced to overcome these challenges. It is a safe and pleasant procedure with no involvement of sedation and no risks of cross-infection between patients. In addition, this method is anticipated to be an alternative tool for screening and diagnosis of gastric diseases with similar gastric visualization as one achieved through standard gastroscopy. In this narrative review, we focused on the recent advances in MGCG including technical issues, ideal gastric preparation, indications and contraindications, available evidences regarding the use of magnetic guided capsule gastroscopy in clinical practice and highlighted further technical advancements which are needed to make MGCG as a potential diagnostic tool. After reviewing the literature, we concluded that the magnetic guided capsule gastroscopy is a safe tool and would be a promising alternative examination equipment for gastric diseases. (Acta gastroenterol. belg., 2019, 82, 507-513).
Potential clinical scenarios of tumour budding in colorectal cancer
Tumour budding, defined as single tumour cells or clusters of 4 tumour cells or less detached from the main tumour body, is a well- established indicator of aggressive tumour biology in colorectal cancer. As a marker of tumour dissemination, evidence points towards tumour budding as a morphological correlate of epithelial- mesenchymal type changes in the tumour microenvironment. Despite many studies in the literature going back decades, tumour budding has not been systematically integrated in colorectal cancer reporting protocols. The recently published proceedings of the International Tumour Budding Consensus Conference (ITBCC) have sparked the systematic implementation of tumour budding in routine reporting of colorectal cancer. Tumour budding may be particularly relevant to patient management in endoscopically resected pT1 colorectal cancer, stage II tumour and pre-operative biopsies. The present review focuses mainly on these three potential clinical scenarios with the aim to provide a concise and updated overview on tumour budding in CRC. (Acta gastroenterol. belg., 2019, 82, 515-518).
Fecal microbiota transplantation in ulcerative colitis
Background/study aims: Fecal microbiota transplantation (FMT), a treatment aiming to restore dysbiosis by transferring stool from a healthy donor into the patient, has cure rates up to 90% in the management of recurrent Clostridium difficile (C. difficile) diarrhea. This paper tries to determine whether FMT is safe and effective in the treatment of ulcerative colitis, and what the potential characteristics could be of a 'super donor'.
Methods : The PubMed database was searched using the term fecal microbiota transplantation inflammatory bowel disease. Only articles discussing the use of FMT in the treatment of ulcerative colitis were withheld. Finally, 31 original studies (10 case reports, 17 open label trials, 4 randomized controlled trials (RCTs)) and 1 meta-analysis were included.
Results : So far 4 RCTs have investigated the effectiveness of FMT in treating UC. Three RCTs reported a significant difference between FMT and a control group, achieving clinical remission in 24 to 44% of patients (vs. 5 to 20% of patients in control groups). The meta-analysis confirms that significantly more patients in the FMT-group achieve clinical remission in comparison to patients in the control group (p=0,01) : 42,1% vs. 22,6%. The composition of the gut microbiota plays an important role in the success of FMT- treatment.
Conclusion : FMT seems to be a promising and safe therapy in the management of UC. Further research, with larger cohorts, will be needed to confirm this and to determine the optimal FMT procedure. (Acta gastroenterol. belg., 2019, 82, 519-528).