Acta gastro-enterologica Belgica最新文献

Background and study aims: Monitoring the symptoms of inflammatory bowel diseases (IBD) patients is now frequently made in the form of patient reported outcomes (PRO), rather than historical clinical activity scores. Unlike several chronic diseases, the role of telemonitoring in IBD has not yet been defined, particularly in terms of patient compliance with remote monitoring; the aim of our study was to assess patient compliance with digital monitoring of PRO as part of routine medical follow-up.

Patients and methods: we performed a monocentric prospective study in the Gastroenterology Unit of Liège's University Hospital between May 2023 and February 2024. Adherence was considered optimal if 50% of the recordings planned for the duration of the follow-up were carried out.

Results: 31% of the patients included achieved at least 50% total encoding of their PRO over the 9 months of follow-up. The main cause of failure cited by patients was technical difficulties, well ahead of poor motivation. The overall satisfaction of practitioners and patients was generally good. Male gender was the only factor associated with adherence.

Conclusion: Overall adherence to PRO telemonitoring in IBD was around 40% and was mainly impaired by technical difficulties. Despite this, both patients and healthcare professionals found this type of monitoring relevant.

Background: Pancreatic ductal adenocarcinoma (PDAC) has a known poor prognosis. For a select group, those with BRCA mutations, frontline platinum-based therapy and poly (ADPribose) polymerase inhibitors are options that can potentially lead to survival benefit.

Patients and methods: We present 2 cases of patients with BRCAmutated pancreatic cancer with liver metastases that achieved a remarkable long-term complete remission on platinum-based chemotherapy.

Conclusion: Germline testing for BRCA is important in PDAC because it influences treatment choices that impact survival. Complete responses with chemotherapy alone are rarely observed in metastatic PDAC, but may be seen upon treatment with platinum-based therapy.

Budd-Chiari syndrome (BCS) is a rare, potentially lifethreatening condition characterised by obstruction of the hepatic venous outflow tract due to thrombosis. Treatment typically involves lifelong anticoagulation and relieving the obstruction. This case report introduces hepatic venous thromboaspiration as an additional endovascular technique to achieve recanalisation.

Acute gastric variceal bleeding is a rare but serious complication of portal hypertension. Initial therapy for bleeding gastric varices focuses on acute hemostasis. In this regard, endoscopic cyanoacrylate injection (ECI) is the first-line approach. Cyanoacrylate diluted with Lipiodol acts as a tissue adhesive that polymerizes on contact with blood. Glue-induced pulmonary embolism is a very rare but severe complication of ECI. This paper describes a case of fatal glue pulmonary embolism during ECI for prevention of bleeding from gastric fundal varices in a patient with polycythemia vera and the presence of portosystemic shunts.

Background and study aims: Crohn's disease (CD) is often complicated by perianal fistulas or abscesses that worsen patient's quality of life, with 52-88% of CD-related perianal fistulas (CPFs) being complex. This retrospective study describes sociodemographic characteristics, treatment patterns and outcomes of patients with complex CPFs in five European countries.

Patients and methods: PREFACE is a multi-national medical chart review study of CD patients who started medical or surgical treatment for a new episode of complex CPFs between September 2011 and September 2014 (index date). Effectiveness outcomes were assessed as fistula remission rates based on fistula drainage assessment. The most recent assessments prior to each timepoint were used to calculate fistula remission rates.

Results: In total, 372 patients (51.3% male, mean age at index date 37.8 years) with 498 complex CPFs between index date and end of data collection were included. A quarter of patients with CPF already had perianal fistulas at CD diagnosis. Of the complex index CPFs, 39.8% were treated with antitumour necrosis factor, 33.3% with antibiotics and 16.3% with immunosuppressants. At least one surgery was performed for 93.8% of complex CPFs. By end of follow-up (median (IQR) 6.0 (5.2, 6.9) years), 61.2% of complex CPFs were not draining anymore. Fistula remission rate at patient level was 28.0% after 6 months, 35.2% after 12 months and 64.8% overall.

Conclusions: Current therapeutic algorithms for CPFs are not successful in a considerable proportion of patients. Improved therapeutic strategies and new treatment options are required to achieve better outcomes in complex CPFs.

Background and study aim: The ESGE curriculum guideline on training in ESD advises an extensive experience in animal models before commencing ESD training on humans. However, the evidence on which this recommendation is based, is rather limited. In this study we evaluate the performance of novices in ESD during their one-year training period; with continuous supervision of an endoscopist with extensive experience in ESD.

Patients and methods: During a 6.5 years period, all ESD procedures performed by an expert endoscopist (eESD) or by one of the 3 novices (sESD), in a single non-academic center, were retrospectively collected. Primary outcome parameters were rate of en-bloc resection and clinically relevant adverse events. The secondary outcome was R0 resection, recurrence rate and delayed adverse events.

Results: In total 210 ESD procedures were included. Of these 97 sESD (46.2%), were performed by a novice endoscopist under supervision and 113 eESD (53,8%) by an expert. En-bloc resection rate was 99.1% vs 99% (p = ns), R0 resection rate was 80.5 % vs 79.4 % (p=ns). Clinically relevant complications 14.2% vs 6.2 % (p = 0.04) and severe complications 4.4% vs 2.1% (p=ns). Perforation was the most frequent reported serious complication. Three patients in the eESD group versus one in the other group needed additionally surgery due to a complication (p=ns). Recurrence rate was 2.2% for eESD and 1.3 % for sESD (p=ns).

Conclusion: This retrospective analysis demonstrates that learning ESD in humans without extensive prior animal model training is safe and feasible, on the condition that continuous supervision by an expert is provided.

We report the case of a 59-year-old patient with a history of peripheral T-cell lymphoma, not otherwise specified (PTCLNOS) presenting with profuse diarrhea 3 months after completing lymphoma treatment. After exhaustive workup a recurrence of the peripheral T-cell lymphoma in the gastrointestinal tract was diagnosed. Predominant gastrointestinal recurrence is a unique presentation of relapse of PTCL-NOS. To the best of our knowledge, no other case reports have covered predominant gastrointestinal recurrence of PTCL-NOS so far.

Background and study aim: There are several studies comparing patients treated with lamivudine and those not given antiviral therapy in acute hepatitis B. Some of these studies showed that antiviral treatment significantly contributed to survival, whereas one other study suggested that antiviral treatment had no effect. The aim of this study was to investigate the efficacy of tenofovir disoproxil fumarate (TDF) therapy and its effect on HBsAg seroconversion in patients with acute viral hepatitis B.

Patients and methods: The files of 126 patients who were under follow-up for acute HBV infection in the Department of Gastroenterology were analyzed retrospectively. Demographic data, molecular, ELISA, and biochemistry tests at the time of diagnosis and in the follow-up, period were evaluated using the hospital automation system.

Results: The rate of chronicity of HBV was found to be higher in the TDF group than in the group without antiviral treatment. The rate of protective anti-HBs acquisition was found to be lower in the TDF group (p<0.05).

Conclusion: Antiviral treatment with TDF in acute HBV infection may increase the rate of chronicity. It may reduce the development of natural immunity. Further studies are warranted.