Prolonged retention of prophylactic pancreatic stents is not associated with increased complications

Objectives

The risk of post-ERCP pancreatitis (PEP) can be reduced effectively by the placement of a self dislodging pancreatic stent. The present study analyzed whether a prolonged interval until stent passage evaluation and removal of retained stents is associated with an increased risk for clinically relevant complications.

Effectiveness of antiviral therapy in patients with chronic hepatitis C treated by private practice gastroenterologists

The standard treatment for patients with chronic hepatitis C consists of pegylated interferon (PegIFN) alpha in combination with ribavirin. Information on treatment effectiveness outside clinical trials is sparse. To study community-based health care, a regional network supported by the German network of competence for hepatitis (Hep-Net) was created between gastroenterologists in private practice and a tertiary referral centre. A treatment register containing evidence-based guidelines was established and 212 consecutive patients who were treated with either PegIF Nalpha 2a/ribavirin (n = 126) or PegIFNalpha2b/ribavirin (n = 86) for 24 weeks (HCV genotype 2, 3) and 48 weeks (HCV genotype 1, 4, 5), respectively, were included and followed prospectively. Twenty-four weeks after cessation of antiviral treatment a sustained virological response was achieved in 54 % of the patients. By univariate analyses, infection with HCV genotypes 2 or 3 (p < 0.0001), younger age (p < 0.0001), normal gamma-glutamyltransferase levels before initiation of treatment (p = 0.003), and absence of language communication problems (p = 0.023) were associated with a sustained virological response. The presence of liver cirrhosis in patients with HCV genotype 1, 4, 5 infection was associated with lower sustained response rates (p = 0.025). Patients infected with HCV genotype 1 in whom the PegIFNalpha dose was reduced had higher virological relapse rates (p = 0.049). With regard to the treating physician, sustained virological response rates ranged from 26 - 67 % in patients infected with HCV genotype 1. Our study shows that virological response rates similar to those in international randomised clinical trials can be achieved by private practice gastroenterologists. The presented network allows characterization of the treatment outcome in chronic hepatitis C not only with regard to virus- and host-related factors but also on an individual physician basis.     

Early duodenal adenocarcinoma arising in gastric metaplasia treated by endoscopic resection

Early duodenal carcinoma is a rare entity. Most duodenal carcinomas are diagnosed at a more advanced stage. This report describes the case of a 59-year-old lady with an early duodenal adenocarcinoma diagnosed at check-up gastroduodenoscopy in an outpatient clinic who was referred to us for further investigation and management. The initial upper endoscopy at our department revealed a type IIa+c lesion in the proximal duodenum (10 - 12 mm diameter, flat elevated lesion with central depression). Using chromoendoscopy and magnification endoscopy the lesion could be well demarcated and neoplastic changes in the architecture of the intestinal villi could be detected. After submucosal epinephrine-saline injection, the lesion was removed by endoscopic resection without complications. Histopathological examination revealed the rare entity of an early duodenal carcinoma arising from incomplete-type gastric metaplasia in the duodenum. In summary, the presented paper describes a case of successful endoscopic treatment of an early duodenal carcinoma arising from incomplete gastric metaplasia.     

The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis

Objectives

Acoustic radiation force impulse (ARFI) imaging is an ultrasound-based elastography method that is integrated into a conventional ultrasound machine. A meta-analysis based on original and abstract publications was performed to evaluate the overall performance of ARFI for the diagnosis of liver fibrosis.

Methods

Literature databases and conference abstracts were searched from 2007 up to February 2012. A random effects meta-analysis of the area under the receiver operating characteristic (ROC) curve (AUROC) and the diagnostic odds ratio (DOR) was performed as well as summary ROC curve techniques. Quality analyses were conducted to assess sources of heterogeneity.

Results

The systematic literature search revealed 36 studies, with 3,951 patients overall. The mean diagnostic accuracy of ARFI expressed as the AUROC was 0.84 (DOR, 11.54) for the diagnosis of significant fibrosis (F?≥?2), 0.89 (DOR, 33.54) for the diagnosis of severe fibrosis (F?≥?3) and 0.91 (DOR, 45.35) for the diagnosis of liver cirrhosis (F?=?4). Subgroup analyses showed sources of heterogeneity between the different underlying liver diseases for F?≥?3 and F?=?4. The mean body mass index had a significant influence for F?≥?2.

Conclusions

The meta-analysis revealed good diagnostic accuracy of the ARFI imaging for the staging of F?≥?2 and F?≥?3, and excellent diagnostic accuracy for F?=?4.

Key Points

? Acoustic radiation force impulse (ARFI) imaging adds important information over conventional ultrasound. ? ARFI imaging provides good diagnostic performance for assessing significant/severe hepatic fibrosis. ? ARFI imaging shows excellent diagnostic accuracy and odds ratio for cirrhosis staging. ? Body mass index significantly influences the assessment of significant fibrosis.