Acta gastro-enterologica Belgica最新文献

Colorectal cancer (CRC) is the second and third leading cause of cancer death in men and women respectively worldwide. Colonoscopy is the gold standard screening test to detect premalignant lesions with endoscopic polypectomy preventing evolution to CRC. Endoscopic polypectomy is effective with a higher safety profile and is less costly as compared to surgery. Bestpractice polypectomy technique is crucial, as 10% of polyps <2 cm are incompletely resected and may therefore play a significant role in the development of post colonoscopy colorectal cancer (PCCRC). Hot snare polypectomy (HSP) has traditionally been the technique of choice for endoscopic polypectomy but is associated with a small but appreciable risk of adverse events, primarily postpolypectomy bleeding and perforation. Recent high-quality studies have demonstrated the similar efficacy and superior safety profile of cold snare polypectomy (CSP) for polyps less than 10 mm in size. In daily clinical practice, the vast majority of colorectal polyps encountered by gastroenterologists are less than 10 mm, making CSP the technique of choice. Widespread use of CSP over HSP may therefore significantly reduce the number of adverse events associated with endoscopic polypectomy. The indication for CSP may be extended to larger lesions, including large, non-dysplastic sessile serrated lesions and small pedunculated polyps with a thin stalk. In addition, the risk-benefit ratio of CSP is favourable in patients in whom interruption of anticoagulants is a concern in terms of thromboembolic risk. In this review, the focus will be on safety of hot versus cold snare polypectomy as a technique for the resection of diminutive and small polyps.

Small intestinal neuroendocrine tumors (SI-NETs) typically follow an indolent disease course and are often accompanied by mesenteric lymph node metastases upon diagnosis. These tumors can incite a fibroblastic reaction within the mesenteric root. Here, we present two cases of patients with symptomatic small bowel obstruction due to such mesenteric involvement. These patients underwent peptide receptor radionuclide therapy (PRRT), resulting in the stabilization of the mesenteric mass and remarkable improvements in obstructive symptoms. They experienced a return to oral intake and were able to discontinue parenteral nutrition. Despite some controversies, PRRT emerges as a promising tool in managing the mesenteric mass and achieving a reversal of debilitating complications such as obstruction and mesenteric ischemia.

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.

Background and study aims: The COVID-19 pandemic substantially impacted the healthcare system and society in 2020. This study assessed its possible impact on occurrence and stage of colorectal cancer diagnoses in Belgium.

Methods: Population-based data from the Belgian Cancer Registry were used to extrapolate 2017-2019 trends in incidence and stage distribution to expected counts for 2020 that were subsequently compared to the observed values. Stage-specific predictions were corrected to account for the overall decline in diagnoses.

Results: In 2020, 705 fewer than expected invasive and 255 fewer in situ colorectal cancers were diagnosed. For colon cancer, significant declines were observed in all genders and regions, mainly in the screening age group and in age 75+. For rectal cancers, there was only a significant decline in the latter two groups. Colon cancer pStage distribution did not change significantly. In situ rectal tumors showed a relative decline in Flanders and in the screening age group. In the latter group, more than expected cStage III rectal cancers were observed in women.

Conclusions: The excess decline in in situ rectal cancers is likely attributable to the temporary suspension of the colorectal screening program during the first pandemic wave. The overall decline in colon and rectal cancer incidence in Belgium in 2020 was not accompanied by a stage shift. Longer-term effects or impact on clinically relevant outcomes cannot be excluded.

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.

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.