Volume 82 - 2019 - Fasc.4 - Original articles
Comparison between tunneling and standard endoscopic submucosal dissection for treatment of large esophageal superficial neoplasm
Background and study aims : Endoscopic submucosal dissection (ESD) has been established as a standard endoscopic method for treating esophageal superficial neoplasms, and it can be performed using a conventional or a tunneling method. The aim of the present study was to compare the safety and efficacy of tunneling ESD (t-ESD) and standard ESD (s-ESD) for treating large esophageal superficial neoplasms and to explore the risk factors for postoperative strictures.
Patients and methods: Fifty-five consecutive patients with large esophageal superficial neoplasms were treated by t-ESD or s-ESD. Demographics, lesion characteristics, procedure-related parameters, and follow-up results were retrospectively collected to compare the efficacy and safety of these procedures. Multivariate analyses were conducted to determine the potential risk factors for postoperative strictures.
Results : Of the 55 patients, 13 underwent t-ESD and 42 underwent s-ESD. The dissection speed of t-ESD was significantly faster than that of s-ESD (7.42±1.99 min/cm2 vs. 9.01±2.11 min/cm2, P <0.05). En bloc resection was achieved in 98.2% (54/55) of the cases, while R0 resection was achieved in 92.7% (51/55). Curative resection was achieved in 78.2% (43/55) of the cases. Fourteen patients (25.5%) had postoperative strictures, which resolved with endoscopic dilation and/or stent insertion. Circumferential involvement of >3/4 and lesion length of >3 cm were independent risk factors for strictures.
Conclusions : T-ESD is a safe and effective method for treating large esophageal superficial neoplasms with a faster dissection speed than s-ESD, but postoperative strictures may be encountered for lesions involving more than three-fourths of the circumference or longer than 3 cm. (Acta gastroenterol. belg., 2019, 82, 469-474).
Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm. A retrospective series
Background and aims : Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (> 10 mm).
Patients and methods : This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated > 10 mm, underwent CSP.
Results : A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%), > 30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haemostasis occurred. In only one patient haemostatic clipping was required (in order to achieve hemostasis). Preventive clipping was used in 3 patients.
There were no complications.
Seventy-two patients (with 87 lesions) had a follow-up colono- scopy. Of these 87 lesions, 9 had residual adenomatous tissue (10.3 %). According to the size of the original polyp, the distribution was as follows : 11-19 mm : 2/36 (5.5 %), 20-29 mm : 4/32 (12.5 %), > 30 mm : 3/19 (15.7%).
Conclusion : CSP for advanced, non-pedunculated lesions is feasible, effective and extremely safe. (Acta gastroenterol. belg., 2019, 82, 475-478).
Hepatitis C virus (HCV) prevalence estimation in the adult general population in Belgium : a meta-analysis
Background and study aims : Although multiple HCV prevalence studies were recently performed in the general population from Belgium, they suffer from a lack of geographical representativeness, an insufficient number of participants or a lack of inclusion of high prevalence groups. The aim of this study is to provide robust information on the HCV burden.
Methods : Recently performed HCV prevalence studies in the general, adult population were included in this study, based on well-defined selection criteria. A meta-analysis was performed to estimate the seroprevalence, the prevalence of participants with viremia and the prevalence estimation for people with viremia which were unaware of their status.
Results : Eight studies fulfilled the criteria for inclusion of the quantitative prevalence estimation. Based on the meta-analysis on these 8 studies, we estimated an HCV seroprevalence of 1.01% [95% CI : 0.66-1.42%], representing a total of 90,722 adult, HCV seropositives of which 64,412 individuals (0.71%) were confirmed seropositive. Based on the RNA presence, an estimated viremic prevalence of 0.33% [95% CI : 0.21-0.47 %] was determined, corresponding with 29,642 individuals. This is 46,0% of the true HCV seropositive residents. Further, based on the availability of patient information in 5 out of the 8 studies, a prevalence of 0.18% [95% CI : 0.07-0.33] representing 16,168 individuals from the adult Belgian population are unaware of their HCV status.
Conclusions : We believe that the quantitative measurement by the meta-analysis will be more reliable for their use in the design of a screening strategy or in the development of prevention campaigns as compared to the prevalence estimations performed at local level. (Acta gastroenterol. belg., 2019, 82, 479-485).
Von-Willebrand factor as a predictor of three-month mortality in patients with liver cirrhosis compared to MELD score
Introduction and aim : Endothelial dysfunction is involved in the pathogenesis of portal hypertension and in the progression of liver disease. As an indicator of endothelial dysfunction, von Willebrand factor (vWF-Ag) can be a useful mortality predictor in patients with liver cirrhosis. The aim of the study is to compare the predictive value of vWF-Ag with the predictive value of MELD score regarding the three-month mortality in patients with liver cirrhosis.
Materials and methods : In 70 patients with cirrhosis and portal hypertension we measured the vWF-Ag concentration and we followed the patients for 90 days. We registered all manifestations and complications of liver cirrhosis and the three-month mortality was the main end-point.
Results : We registered mean vWF-Ag of 341.9±155.8%, median 312%, IQR (214-410), vWF-Ag significantly correlated with MELD score (R=0.3713 ; p<0.05) and vWF-Ag median was higher in the uncensored compared to the median in the censored patients (p<0.0067). vWF-Ag and MELD score were significantly associated with three-month mortality, with no significant difference in the diagnostic performance between the two parameters [AUC=0.735, p=0.007 for vWF-Ag ; AUC=0.885, p=0.000 for MELD score], (Z=- 1.473, p=0.1407).
Conclusion : In patients with liver cirrhosis vWF-Ag is a relevant predictor of three-month mortality that equals the MELD score. (Acta gastroenterol. belg., 2019, 82, 487-493).
Role of computed tomography in prediction of gastrointestinal fistula in patients with acute pancreatitis
Aim : To identify computed tomography (CT) features that predict gastrointestinal fistula (GIF) in patients with acute pancreatitis (AP).
Methods: This retrospective study comprised consecutive patients with AP and GIF from June 2017 to June 2018. The diagnosis of GIF was based on upper gastrointestinal endoscopy, colonoscopy or surgery. A cohort of 19 matched patients from a prospective database of AP served as control group. Measures of severity, and clinical outcome were evaluated. CT parameters were compared between the groups to assess the features that could predict the development of GIF.
Results : There was no difference between the two groups in terms of disease etiology, severity, drainage, and mortality. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of bowel wall thickening (P=0.005), maximum thickness of the bowel wall (P=0.007), presence of air foci in extra pancreatic necrosis/ collection (P=0.013), discontinuity of the bowel wall (P=0.046) and the displacement/ compression of bowel by fluid collection (P=0.014). On multivariate analysis, all the above-mentioned CT findings except discontinuity of bowel wall were found to be statistically significant.
Conclusion : CT is helpful in predicting GIF in patients with AP. (Acta gastroenterol. belg., 2019, 82, 495-500).
Can the matrix metalloproteinases 2 and 9 predict the course of acute pancreatitis in previously healthy patients?
Background : It was confirmed that during the inflammatory process development, granulocytes are among the main groups of cells responsible for the course of acute pancreatitis. One of these substances produced by them are extracellular matrix enzymes- metalloproteinases. In the presented study, we undertook an attempt to investigate whether they may be used as an instrument to predict the course of acute pancreatitis in previously healthy patients.
Methods : The study included 72 patients with the first-time episode of acute pancreatitis. The 2012 Atlanta classification was used in order to divide them into 3 groups. The patients were assessed according to the most popular multifactor scoring systems and single laboratory markers. The levels of metalloproteinases 2 and 9 were determined by the ELISA method. The diagnostic value of the commonly applied scoring systems and single diagnostic markers was compared with the value of matrix metalloproteinases levels.
Results : A mild form of AP developed in 42 patients, a moderate form in 16, and severe in 14. All multifactor prognostic systems have high specificity and rather low sensitivity. Single laboratory markers have higher sensitivity but lower specificity than multi- factor tools. The determination of the level of MMP-2 shows specificity of 98.3%, while MMP-9-100%.
Conclusion : The determination of a single laboratory marker, which is the level of metalloproteinase-2 or metalloproteinase-9, is characterized by sensitivity and specificity comparable to that of multifactor prognostic scoring systems. (Acta gastroenterol. belg., 2019, 82, 501-505).
