GastroHep最新文献

Background/Aims

Colorectal endoscopic full-thickness resection using the full-thickness resection device is an emerging endoscopic therapy for non-lifting adenomas and subepithelial lesions. We aim to describe our initial experience and examine the outcomes of colorectal endoscopic full-thickness resection in our centre.

Methods

All colorectal endoscopic full-thickness resection performed from 2016 to 2021 were reviewed retrospectively. Demographic data, indication of endoscopic full-thickness resection, lesion size and location were collected. Outcomes assessed included technical success, complete resection, adverse events and need for surgery.

Results

Thirteen patients were included in the study. Four patients had recurrent/ residual adenoma and nine had rectal neuroendocrine tumours (NETs). The resected specimens measured 20-mm. Mean lesion size was 9.77 mm. All but one lesions were located in rectum. Technical success and complete resection rates were 100%. One patient underwent right hemicolectomy for unsuspected T1 adenocarcinoma with deep submucosal invasion. Four patients had minor post-procedure bleeding. No major adverse events were identified.

Conclusions

Colorectal endoscopic full-thickness resection with full-thickness resection device for treatment of residual/recurrent colorectal adenoma and rectal NET is efficacious and safe. It had a significant positive impact on management as it could definitively establish the adequacy of endoscopic resection by histology and confirm the feasibility of curative resection.

Introduction

Helicobacter pylori infection in dyspepsia is an important clinical problem with increasing antibiotic resistance.

Aim

To evaluate the efficacy of levofloxacin-based triple therapy compared with clarithromycin-based triple therapy for Helicobacter pylori eradication in chronic dyspepsia.

Methods

This was a prospective, single-blinded randomized trial. Rapid urease test and histology were performed in patients with chronic dyspepsia who underwent gastroscopy. H pylori-infected patients were randomly allocated into two equal groups prescribing 10-day course of levofloxacin-based or clarithromycin-based regime. Endoscopic responses and eradication status of both regimes were rechecked with gastroscopy 4 weeks after therapies.

Result

Two hundred and ninety-one treatment-naïve patients were enrolled. Eradication rates were 40% vs 47.5% on intention to treat (ITT) analysis and 43.7% vs 50.8% on per-protocol (PP) for clarithromycin group vs levofloxacin group, respectively. In levofloxacin arm, eradication occurred in 62.5% (ITT) & 71.4% (PP) of ulcer dyspepsia and 43.2% (ITT) and 46.6% (PP) of nonulcer dyspepsia.

Among ulcer dyspepsia, 58.3% healed in clarithromycin group and 64.3% in levofloxacin group. In nonulcer dyspepsia, gastritis was resolved in 21% of clarithromycin group and 10% of levofloxacin group. Adverse effects occurred in 30% of clarithromycin group and 27.6% of levofloxacin group.

Conclusion

In the study, eradication rates of both therapies were very low to unacceptable level. Levofloxacin was not effective in both ulcer and nonulcer dyspepsia. The emergence of primary levofloxacin resistant strains due to widespread usages in various infections might be the reason.

Background

Treatment adherence remains a potential barrier to achieving population-level hepatitis C virus (HCV) elimination by 2030. We aimed to understand barriers to and facilitators of HCV treatment adherence pre- and post-direct-acting antiviral (DAA) treatment.

Methods

A cohort of US Veterans who were initiating DAA treatment completed pre- and post-treatment surveys assessing demographic information, psychological symptoms and perceived barriers to adherence. DAA adherence was assessed through self-report and pharmacy records. Sustained virologic response (SVR) was evaluated using the medical record. Mann-Whitney U, Fisher's exact tests, and logistic regression were employed to evaluate associations of patient characteristics and survey responses with adherence and SVR.

Results

Of 97 participants, the majority were male (98%), white (62%), low-income (less than 35 000/y; 82%), and had a history of self-reported prior substance use (93%). The most common anticipated adherence barrier prior to treatment was having side effects (21%). Over follow-up, 62% of participants missed doses and 84% achieved SVR. Decreased pain (OR 0.32, 95% CI 1.06-1.72), agreeing with ‘the medication will improve my health’ (OR 4, 95% CI 1.22-15.8) and disagreeing with being ‘worried about my liver disease getting worse’ (OR 0.2, 95% CI 0.05, 0.59) predicted successfully achieving SVR. After treatment, the most commonly reported barriers to adherence were being busy (13%) and being away from home (13%). Veterans reported non-significantly decreased substance use after treatment (38% vs 28%, P = .18).

Conclusion

In this population of Veterans with high rates of substance use, most participants missed doses but still achieved SVR. HCV treatment may also serve as an opportunity for substance use treatment.