Acta gastro-enterologica Belgica最新文献

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.

Small bowel obstruction is a relatively prevalent surgical condition, with the most common underlying cause being postoperative adhesions. However, in patients with no previous history of abdominal surgery, one needs to think more outside the box. In this case study, we have a young and athletic man who presented to the emergency department with an acute abdomen, shortly after binge eating a large amount of food. Obstruction due to food impaction, such as in our case, should always be on the differential list, especially in those without significant medical history and with binge eating pattern where uncontrolled and extreme amounts of food are eaten alternating with restrictive dieting.

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.

Mirizzi syndrome is a rare complication of chronic gallstone disease characterised by the compression of the common bile duct due to an impacted lithiasis in the infundibulum of the gallbladder or cystic duct. In this case study, we discuss an 85-yearold patient who presented with Mirizzi syndrome associated with septic shock. She was not eligible for cholecystectomy due to her advanced age and frailty, requiring a less invasive alternative. Gallbladder drainage was initiated by endoscopic ultrasoundguided cholecystoduodenostomy with a lumen-apposing metal stent (LAMS). Utilising this bulbo-cholecystic stent, SpyGlassguided electrohydraulic lithotripsy (SGEHL) was then performed, resulting in successful extraction of multiple bile stones, including a 20 mm lithiasis that was lodged in the cystic infundibulum. Subsequently, serum bilirubin levels and inflammatory markers were significantly reduced, consistent with resolution of Mirizzi syndrome. The combination of SGEHL and LAMS, designated as SLAMS, represents a novel, minimally invasive intervention for this potentially life-threatening disease.

Fibrogenesis is initially performed during tissue damage to protect the remaining tissues from the progressive death of epithelial cells, infiltration of immune and inflammatory cells, and local degrading enzymes. Inflammation can lead to excessive extracellular matrix deposition by fibroblasts and the induction of fibrosis in many organs, such as the liver. MiRNAs are small noncoding RNAs that mediate mRNA repression or destabilization, leading to translational repression. Owing to the wide range of roles of miRNAs in the development of fibrosis, especially liver fibrosis, many studies have focused on their diagnostic, regulatory, and therapeutic roles. In this study, we used medical science and general databases, including PubMed, Elsevier, Scopus, Nature, and Google Scholar, to find valid studies on the different roles of miRNAs in liver fibrosis. Because a large number of miRNAs with regulatory, diagnostic, and therapeutic roles in diseases associated with liver fibrosis have been identified and reported in this study, special attention to these elements is needed in the future of healthcare systems.

Background: Bile acid malabsorption (BAM) is a common entity in patients experiencing chronic watery diarrhea. However, literature suggests that BAM is underdiagnosed and undertreated. In many countries 75SeHCAT is the gold standard for diagnosing BAM (1-5). The aim of this retrospective study was to investigate the frequency of BAM using 75SeHCAT scintigraphy and the response to treatment with bile acid sequestrants.

Methods: We retrospectively evaluated the clinical data of 420 patients who had a 75SeHCAT scan from January 2016 to January 2023. Electronic medical records were investigated for risk factors of BAM. BAM was defined as a 75SeHCAT retention of less than 15%. Response to bile acid sequestrants was evaluated based on outpatient clinical reports.

Results: Median age at the time of 75SeHCAT test was 47 years (range 14-87). Out of 420 patients, 192 (46%) had a positive result for BAM. Cholecystectomy and ileal resection were significant predictors for BAM (p<0.001). BAM type 1 is statistically more likely to be more severe compared to type 2 (p<0.0001) and compared to type 3 (p=0.0021). In patients who fulfilled Rome IV criteria for IBS-D or functional diarrhea, 75 out of 121 (38%) tested positive for BAM. Overall, treatment with bile acid binders was effective in 76%.

Conclusions: This retrospective study of patients who underwent SeHCAT scanning confirms that about 1/3 patients presenting with therapy-resistant chronic diarrhea in secondary care suffer from BAM. Including the test in clinical management protocols of chronic diarrhea allows early and quantitative diagnosis and treatment of BAM.

Background and objectives: Metabolic dysfunction-associated fatty liver disease (MAFLD) has been reported as a complication after pancreatic surgery. The aim of this study is to assess this phenomenon in a Belgian population, specifically in a period in time when less perioperative chemotherapy was given.

Methods: We performed a retrospective monocentric cohort study with 124 selected patients who underwent pancreatic surgery - pancreaticoduodenectomy (PD), distal pancreatectomy (DP) or total pancreatectomy - between 2005 and 2014. Steatosis was assessed radiologically, using Hounsfield units on liver and spleen. Data on imaging, liver function, weight and other relevant parameters were gathered preoperatively as well as 2 and 6 months, 1 and 2 years after surgery.

Results: Thirty-eight (31%) out of 124 patients developed liver steatosis at least at one point in time in the two years following surgery, with a prevalence of 21.0% at 2 months, 28.6% at 6 months, 16.4% at 1 year and 20.8 % at 2 years. A statistically significant association with preoperative AST and ALT values, administration of pancreatic enzyme supplementation as a surrogate for pancreatic exocrine insufficiency (PEI) and weight loss at 2 years was detected.

Conclusion: MAFLD is seen in 31% of patients with PD or DP pancreatic resection in this retrospective analysis of a monocentric Belgian cohort. Both early and late onset of MAFLD was observed, implying that long-term follow-up is necessary. Clinical impact as well as a direct correlation with patients' weight and oral enzyme supplements needs to be further investigated.