Acta gastro-enterologica Belgica最新文献

A 71-year old male patient with myelodysplastic syndrome presented with severe signs of portal hypertension. There was no underlying cirrhosis nor portal vein thrombosis. Despite liver stiffness being high, hepatic vein catheterisation failed to show an increased hepatic venous pressure gradient compatible with clinically significant portal hypertension. Finally, a liver biopsy showed enlarged fibrotic portal tracts with multiple dilated immature bile ducts compatible with congenital hepatic fibrosis - there was no macroscopic biliary disease. Mostly presenting in childhood or adulthood, congenital hepatic fibrosis is an uncommon cause of non-cirrhotic portal hypertension that can also have a late presentation. Treatment is supportive with management of portal hypertension (and its complications); liver transplantation is curative but is reserved for cases with liver failure or recurrent cholangitis (mostly in Caroli syndrome).

A Meckel's diverticulum (MD) is the most prevalent congenital anomaly of the gastro-intestinal tract and the life-long risk for complications is estimated to be around 4%, mostly resulting in bleeding, obstruction, diverticulitis or intussusception. Although rare, about 3.1-5.1% of the complications are due to malignant evolution of the MD. Case: We present a 50-year old patient with progressive subobstructive symptoms leading the diagnosis of a complicated MD. Peroperative findings were suggestive for malignancy and the histopathological samples confirmed the presence of a metastatic adenocarcinoma, arising from the MD. Conclusion: This case illustrates a rare, malignant complication of a MD. This finding is of utmost clinical importance because the diagnosis may be challenging and early detection may improve the outcome of these patients. The clinician should be aware that malignant evolution of a MD exists and should be excluded in complicated cases.

Background: Sarcopenia is common in patients with cirrhosis and lower limb muscle strength could represent a factor of morbidity. A systematic review with meta-analysis on knee extension muscle strength in patients with cirrhosis was performed.

Methods: Literature was reviewed in electronic databases from inception until March 2023. Two independent researchers applied the inclusion criteria to assess the eligibility of articles. Of the 28 retrieved articles; 21 of them met the eligibility requirements.

Results: Muscle strength was impaired in patients with cirrhosis versus age-matched control (standardized mean difference, SMD: 3.48, 95% CI 2.35-4.61, I² = 96.5%, p<0.001) and was negatively influenced by increasing disease severity, with Child-Pugh A and B superior to C (SMD: 2.62, 95% CI 0.54-4.71, p<0.014; SMD 0.71, 95% CI 0.29-1.13, p<0.001, respectively). Exercise training tended to increase (SMD: 1.21, 95% CI 0.16-2.59, p=0.085), while liver transplantation decreased knee extension strength (SMD: -0.45, 95% CI -0.88 -0.01, p=0.045).

Conclusion: The negative impact of liver cirrhosis on knee extension strength is worsened by the severity of the disease. Transplantation leads to impaired knee extension strength. Conversely, exercise training tends to be beneficial, making rehabilitation pre and post-transplantation an attractive strategy to prevent muscle mass and strength loss.

Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients is challenging. We analyzed ERCP procedures after gastric surgery with maintained Vater's papilla: total/partial gastrectomy Roux-en-Y, Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy.

Methods: Monocentric retrospective analysis of prospective ERCP cohort in surgically altered gastric anatomy (SAGA) patients with maintained Vater's papilla between 2006 and 2024.

Results: 186 ERCP procedures in 110 patients with SAGA proportions: 37% total gastrectomy Roux-en-Y, 32% Billroth II partial gastrectomy, 15% partial gastrectomy Roux-en-Y, 11% gastrojejunostomy, 4% sleeve gastrectomy and 1% less common reconstructions. ERCP indications were mainly biliary (87%). Total technical success was 82% with lower technical success in Roux-en-Y gastric surgery (73%) vs gastric surgery without Rouxen- Y (92%). 13 adverse events (GRADE II - IV) were encountered (7%) with 1 mortality due to perprocedural cardiac arrest. Sleeve gastrectomy allowed the use of conventional duodenoscopes with 100% technical success. In Billroth II patients both duodenoscopes, gastroscopes and colonoscopes as well as balloon-assisted enteroscopes were used with high technical success (94-100%), as well as in gastrojejunostomy patients (57-100%). For Roux-en-Y reconstructions, only single-balloon enteroscopes were used with acceptable success (75% in partial and 74% in total gastrectomy Roux-en-Y).

Conclusions: ERCP in SAGA patients is challenging requiring different types of endoscopes, especially after Roux-en-Y total or partial gastrectomy with lower technical success as compared tods Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy. Adverse event rates are comparable to ERCP procedures in patients with normal anatomy.

Introduction: Medical malpractice litigations represent a reality for clinical physicians. However, no data are available about the impact on gastroenterologists in Belgium.

Aim: We estimated the number of malpractice litigations against gastroenterologists in Belgium based on the annual reports of the Fund for Medical Accidents (FMA), residing under the Belgian national social security service (RIZIV-INAMI).

Methods: FMA annual reports are available online in the public domain from 2012 onwards. We reviewed all available annual reports, focussing on results within the fields of Gastroenterology and Cardiology.

Results: From 2010 to 2023 a total of 6884 applications for malpractice litigations were filed resulting in a final decision for 3185 care providers between 2014 and 2023. In this 10 years period claims were filed against 92 gastroenterologists, placing them in the top 10 of care providers at risk for malpractice litigations in Belgium. There are currently 777 practicing gastroenterologists in Belgium, indicating that over 10 years time the cumulative risk of malpractice litigation through the FMA alone is as high as 12%. The subject of the claims is not mentioned in the FMA reports, and therefore remains unknown. Compared to Cardiology, another interventional speciality within the field of Internal Medicine, gastroenterologists are more prone to malpractice litigations. Only 73 (6%; p<0.001 Chi-square) on a total of 1237 practicing cardiologists faced malpractice litigations through the FMA.

Conclusion: Based on the FMA annual reports, Belgian gastroenterologists are considerably at risk of malpractice litigations reaching 12% over a 10 years time period, as compared to only 6% cumulative risk of practicing cardiologists. Endoscopy-related complications are supposedly the most common reason of malpractice litigation and Belgian gastroenterologists should be aware of this risk.

We report the case of a 24-year-old patient with abdominal discomfort and weight loss. On imaging, a large unilocular cystic lesion originating from the pancreatic body and tail was seen. Endoscopic fine needle aspiration revealed a slightly elevated lipase, suggesting a connection with the pancreatic duct. Furthermore, the liquid appeared chylous, and markedly elevated triglycerides were noted. A transgastric drainage and biopsies of the cyst wall were performed. The diagnosis of a pancreatic cystic lymphangioma was made. Our patient was successfully managed conservatively by an echoendoscopic transgastric drainage.

Background: The clinical management of functional dyspepsia (FD) is challenging. This study evaluated the efficacy and safety of Aurantii Fructus Immaturus flavonoid (AFIF) tablets vs. domperidone for FD.

Methods: This multicenter, randomized, double-blind, doubledummy, positive-controlled trial recruited FD patients, who were randomized 1:1 to the AFIF (AFIF and domperidone placebo) and domperidone (domperidone and AFIF placebo) groups. The primary endpoint was the rate of disappearance of all four FD symptoms (postprandial feeling of fullness, early satiety, upper abdominal pain, and upper abdominal burning sensation) after 4 treatment weeks.

Results: Totally 120 and 119 patients were included in the AFIF and domperidone groups, respectively. The rates of disappearance of all four symptoms after 4 treatment weeks were 28.33% and 31.93% in the AFIF and domperidone groups, respectively (p=0.5748). The rate of disappearance of all four symptoms 4 weeks after treatment discontinuation was significantly higher in the AFIF (21.05%) compared with the domperidone group (4.39%, p=0.0002). The gastric emptying rates 2h after a meal were significantly increased in both AFIF (7.58%, p<0.0001) and domperidone (6.95%, p=0.0121) groups versus baseline, without a significant between-group difference (p=0.8457). Twenty-two (1 moderate) and 43 (3 moderate) adverse events occurred in the AFIF (19.17%) and domperidone (36.13%) groups, respectively.

Conclusion: The efficacy of AFIF tablets is similar to that of domperidone after 4 treatment weeks, while AFIF tablets may have a better safety profile than domperidone. Additionally, AFIF tablets have a significant advantage over domperidone in the rate of symptom disappearance 4 weeks after treatment discontinuation.

Gastroparesis is a condition with a growing incidence and few effective treatments. In recent years, GPOEM has demonstrated its superiority to other existing treatments. We report here on our experience in which 34 patients underwent GPOEM, with 23 patients assessed for symptoms and quality of life before and after the procedure. We measured an average clinical success rate of 73.92% and an excellent risk profile with only two minor complications. The procedure was very well accepted by patients as all would be willing to undergo it again. Patients for whom GPOEM was successful saw a major improvement in their quality of life, which returned to normal, and, for those suffering from reflux, a significant reduction in their PPI treatment. As for the patients for whom the procedure was not a success, we found that they were at high risk of somatization, so screening questionnaires should be considered pre-intervention to screen these patients and avoid unnecessary procedures.

Eosinophilic esophagitis (EoE) is a chronic disorder characterized by eosinophilic inflammation of the oesophagus triggered by food allergens and possibly aeroallergens. We present a boy with the diagnosis of EoE at the age of 4 years and the disease responded to topical steroids. When he turned 7 years old he had the concomitant diagnose of grass pollen allergy. A clear difference between both histological (October 2019: 0 eosinophils (Eo's)/High Power Field (HPF), April 2022: 80 Eo's/ HPF) and clinical signs (October 2019: pediatric eoe symptom score (PEESS) 3/100, April 2022: PEESS 31/100) is evident when comparing winter to spring. The boy is currently only using topical budesonide during grass pollen season. There are increasing arguments in favour of aeroallergens as a trigger for EoE. This information is important for determining the timing of endoscopic follow-up. And it may be beneficial to consider upgrading treatment during allergy season, or exclusively administering treatment during allergy season.