Volume 77 - 2014 - Fasc.4 - Reviews
Long-lasting tumour response to sorafenib therapy in advanced hepatocellular carcinoma
The multi-kinase inhibitor sorafenib still remains the only -approved- agent- for- advanced- HCC.- Its- benefits- typically- involve disease stabilisation, whereas an induction of response is rare.
We-report-a-series-of-five-cases-with-extraordinary-response-to sorafenib.
For two patients complete response to sorafenib was reported with a recurrence-free survival of 51 and 21 months. In another HCC patient pretreated with transarterial chemoembolisation (TACE) sorafenib treatment resulted in a complete response with no-evidence-of-disease-18-months-after-first-diagnosis.-In-patient-4 with unresectable HCC and sorafenib therapy secondary resect- ability and subsequent liver transplantation was achieved. Patient 5-had-stabilised-disease-for-48-months-after-TACE-and-sorafenib treatment.
Sorafenib- may- be- very- potent- in- individual- patients.- Excellent interdisciplinary strategies are required to achieve best results. There is an urgent need of predictive biomarkers to identify HCC patients-that-will-benefit-the-most. (Acta gastroenterol. belg., 2014, 77, 386-388).
A new technique for endoscopic treatment of gastric phytobezoars : fragmentation using guidewire
Background and Study Aims : Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often oc- cur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure.
Patients and Methods : Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endo- scope. PBs were surrounded by a loop in the guidewire and de- stroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness.
Results : PB fragmentation time was 5-11 minutes. In five pa- tients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients addi- tionally treated with enzymatic degradation after the breaking pro- cedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure.
Conclusions : The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzy- matic degradation, PBs can be managed quickly and effectively. (Acta gastroenterol. belg., 2014, 77, 389-392).
