Volume 78 - 2015 - Fasc.1 - Case series
How to handle esophageal metaplasia in 2014 : a practical guide
Metaplasia of the esophagus is a precursor of esophageal adeno- carcinoma, a cancer with a poor prognosis and an increasing inci- dence. Guidelines for surveillance are proposed by all professional societies with small differences in timing. However, there is still no consensus on the definition of Barrett's esopaghus (only intestinal metaplasia or all subtypes). The goal of surveillance of esophageal metaplasia has evolved from early detection of cancer to early detection of pre-cancerous metaplasia to allow endoscopic therapy. The endoscopic therapy has the intention to stage, to cure, to pre- vent progression and to prevent metachronous lesions to develop. Firm indications for endoscopic therapy are high rade dysplasia and mEAC. The actual treatment is EMR/ESD for all visual abnor- malities and areas of cancer on biopsies, followed by RFA for the remaining metaplasia. For low grade dysplasia (LGD), surveillance versus RFA is still under discussion. The main reason for this is the wide interobserver variability with large differences in evolution between confirmed and unconfirmed LGD. The endoscopic treat- ment allows complete remission of dysplasia in most cases and of metaplasia in the majority of cases, with low complication rates and acceptable morbidity (treatable stenosis). However, a median of 3 treatments is usually required to achieve remission, and recur- rence is as high as 15% in the following 5 years. Strategies to reduce recurrence like chemotherapy or anti-reflux surgery need to be explored better and can actually not decrease or replace surveil- lance. (Acta gastroenterol. belg., 2015, 78, 30-37).
Diverticulitis : new insights on the traditional point of view
Diverticulosis of the colon is a common disease with an increasing incidence in Western countries. Recent literature has shown some changes in the traditional approach of this disease. The theory that diverticulosis is caused by a reduced intake of dietary fibre, is doubtful.
There might be some chemical and histological overlap between diverticulitis, inflammatory bowel disease and irritable bowel disease. High quality clinical study found no effect for antibiotics in acute, uncomplicated diverticulitis. Cyclic administration of mesalazine and rifaximin result in reduced symptoms of diverticular disease. For the treatment of diverticular abscesses, percutaneous drainage shows promising results.
Recurrence of acute diverticulitis is rare and most serious complications are linked to the first episode. Recent evidence does not support the traditional recommendation for elective surgery after two episodes of acute diverticulitis any more.
This review summarizes the last evidence in diverticular disease and diverticulitis. (Acta gastroenterol. belg., 2015, 78, 38-48).
