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Volume 83 - 2020 - Fasc.1 - Case series

Guidelines for an optimal management of a malignant colorectal polyp. What is essential in a pathology report ?

Colorectal cancer (CRC) has become the most common malignancy in our country. Routine screening colonoscopy is on the rise. With the recent advances in endoscopic treatment, many T1 colorectal carcinomas are now found and their percentage amenable to endoscopic resection has increased. Endoscopists and pathologists dealing with the steadily increasing number of excised colorectal polyps have to collaborate closely to optimize patient care. Therapeutic management of patients after endoscopic resection is based on precise histological criteria that determine the risk of metastasis and the need for complementary surgery. This paper summarizes the procedures for the macroscopic management of endoscopic excisions and presents the identified risk factors which should be included in a standardized pathology report. (Acta gastroenterol. belg., 2020, 83, 53-59).


Foreign rectal body – Systematic review and meta-analysis

Background : Self-inserted foreign rectal bodies are an infrequent occurrence, however they present a serious dilemma to the surgeon, due to the variety of objects, and the difficulty of extraction. The purpose of this study is to give a comprehensive review of the literature regarding the epidemiology, diagnostic tools and therapeutic approaches of foreign rectal body insertion. Methods : A comprehensive systematic literature review on Pubmed/ Medline and Google for ‘foreign bodies’ was performed on January 14th 2018. A meta-analysis was carried out to evaluate the epidemiology, diagnostics and therapeutic techniques. 1,551 abstracts were identified, of which 54 articles were included. Results : The motivation of foreign rectal body insertion is mostly sexual stimulation. Patients are typically young and predominantly male, with a male to female ratio of 6:1. Sexual devices (35.7%, n=108) and glass objects (17.5%, n=53) are the most commonly self-inserted rectal foreign bodies. Patient history should be taken sensitively after diagnostic evaluation and identification of the object. Removal was performed under general anesthesia in 45.2% (n=95) and sedation in 29.0% (n=61). The total complication rate was described to be 30.4%. Conclusions : Diagnostics must be performed with caution in order to rule out perforation and establish a treatment algorithm. Manual transanal extraction under sedation or general anesthesia may be performed in conjunction with cautious abdominal compression. Because of the variety of objects, i.e. in form and material, each case must be treated individually. Sometimes creativity and surgeon imagination may be required, although different algorithms have been established. (Acta gastroenterol. belg., 2020, 83, 61-65).


Treatment of recurrent severe hepatic encephalopathy in patients with large porto-collaterals shunts or transjugular portosystemic shunt

Patients with hepatic encephalopathy (HE) do not systematically receive priority on the waiting list for liver transplantation. In some patients with cirrhosis, excessive amounts of gut derived ammonia can bypass the liver parenchyma due to large spontaneous portosystemic shunts (SPSS) induced by portal hypertension. A similar but iatrogenic condition can occur after transjugular portosystemic shunt (TIPS) insertion. In these situations HE may develop and can become refractory to standard management. In patients with preserved liver function, embolization of large SPSS has been shown to control HE mostly without aggravation of other portal hypertensive complications. In case of post-TIPS HE endovascular shunt reduction is able to control refractory post-TIPS HE in the majority of the patients. New strategies to prevent post–TIPS, such as the use of controlled expansion endoprosthesis, are currently explored. (Acta gastroenterol. belg., 2020, 83, 67-71).