BACKGROUND Pancreatic exocrine insufficiency(PEI)is said to be associated with numerous conditions both within and outside the gastrointestinal(GI)system.The majority of research has been concerned with conditions tha...BACKGROUND Pancreatic exocrine insufficiency(PEI)is said to be associated with numerous conditions both within and outside the gastrointestinal(GI)system.The majority of research has been concerned with conditions that reduce the volume of functioning pancreatic tissue or prevent adequate drainage to the small bowel,such as chronic pancreatitis,cystic fibrosis,pancreatic cancer and pancreatic resection.However,the evidence base supporting an association with extrapancreatic conditions,such as coeliac disease,diabetes mellitus and congestive cardiac failure,is heterogeneous.AIM To strengthen the evidence base by studying all previously reported associations with PEI in a large cohort of outpatients.METHODS A single-centre retrospective study was performed.General gastroenterology outpatients tested for PEI with faecal elastase-1(FE1)were identified and information retrieved from the electronic patient record.PEI was defined as FE1<200μg/g.Patients already taking pancreatic enzyme replacement therapy were excluded.Multiple imputation was used to handle missing data.Univariable logistic regression was used to study which presenting symptoms predicted PEI.Multivariable logistic regression was used to explore the relationship between all previously reported associations and PEI.RESULTS Of 1027 patients were included.182 patients(17.7%)were diagnosed with PEI.Steatorrhoea[odds ratios(OR):2.51,95%confidence intervals(CI):1.58-3.98]and weight loss(OR:1.49,95%CI:1.08-2.06)were the only presenting symptoms that predicted PEI.Chronic pancreatitis(OR:7.98,95%CI:3.95-16.15),pancreatic cancer(OR:6.58,95%CI:1.67-25.98),upper GI surgery(OR:2.62,95%CI:1.32-5.19),type 2 diabetes(OR:1.84,95%CI:1.18-2.87),proton pump inhibitor therapy(OR:1.87,95%CI:1.25-2.80)and Asian ethnicity(OR:2.11,95%CI:1.30-3.42)were significantly associated with PEI in the multivariable analysis.None of the other historically reported associations with PEI were significant after adjustment for the other variables included in our multivariable analysis.CONCLUSION PEI is common in patients with chronic pancreatitis,pancreatic cancer,upper GI surgery and type 2 diabetes.Proton pump inhibitor therapy may also be associated with PEI or a false positive FE1.展开更多
Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,a...Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,and the majority of post-colonoscopy colorectal cancers are thought to arise from these.Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa.However,these topographic features are not enhanced by white light colonoscopy,and the endoscopist must infer these from two-dimensional cues.This may contribute to the number of missed lesions.A variety of optical imaging technologies have been developed commercially to enhance surface topography.However,existing techniques enhance surface topography indirectly,and in two dimensions,and the evidence does not wholly support their use in routine clinical practice.In this narrative review,co-authored by gastroenterologists and engineers,we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate,and review the development of photometric stereo(PS)for colonoscopy.PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography.This imaging technique has several potential clinical applications in colonoscopy,including adenoma detection,polyp classification,and facilitating polypectomy,an inherently three-dimensional task.However,the development of PS for colonoscopy is at an early stage.We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.展开更多
文摘BACKGROUND Pancreatic exocrine insufficiency(PEI)is said to be associated with numerous conditions both within and outside the gastrointestinal(GI)system.The majority of research has been concerned with conditions that reduce the volume of functioning pancreatic tissue or prevent adequate drainage to the small bowel,such as chronic pancreatitis,cystic fibrosis,pancreatic cancer and pancreatic resection.However,the evidence base supporting an association with extrapancreatic conditions,such as coeliac disease,diabetes mellitus and congestive cardiac failure,is heterogeneous.AIM To strengthen the evidence base by studying all previously reported associations with PEI in a large cohort of outpatients.METHODS A single-centre retrospective study was performed.General gastroenterology outpatients tested for PEI with faecal elastase-1(FE1)were identified and information retrieved from the electronic patient record.PEI was defined as FE1<200μg/g.Patients already taking pancreatic enzyme replacement therapy were excluded.Multiple imputation was used to handle missing data.Univariable logistic regression was used to study which presenting symptoms predicted PEI.Multivariable logistic regression was used to explore the relationship between all previously reported associations and PEI.RESULTS Of 1027 patients were included.182 patients(17.7%)were diagnosed with PEI.Steatorrhoea[odds ratios(OR):2.51,95%confidence intervals(CI):1.58-3.98]and weight loss(OR:1.49,95%CI:1.08-2.06)were the only presenting symptoms that predicted PEI.Chronic pancreatitis(OR:7.98,95%CI:3.95-16.15),pancreatic cancer(OR:6.58,95%CI:1.67-25.98),upper GI surgery(OR:2.62,95%CI:1.32-5.19),type 2 diabetes(OR:1.84,95%CI:1.18-2.87),proton pump inhibitor therapy(OR:1.87,95%CI:1.25-2.80)and Asian ethnicity(OR:2.11,95%CI:1.30-3.42)were significantly associated with PEI in the multivariable analysis.None of the other historically reported associations with PEI were significant after adjustment for the other variables included in our multivariable analysis.CONCLUSION PEI is common in patients with chronic pancreatitis,pancreatic cancer,upper GI surgery and type 2 diabetes.Proton pump inhibitor therapy may also be associated with PEI or a false positive FE1.
文摘Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,and the majority of post-colonoscopy colorectal cancers are thought to arise from these.Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa.However,these topographic features are not enhanced by white light colonoscopy,and the endoscopist must infer these from two-dimensional cues.This may contribute to the number of missed lesions.A variety of optical imaging technologies have been developed commercially to enhance surface topography.However,existing techniques enhance surface topography indirectly,and in two dimensions,and the evidence does not wholly support their use in routine clinical practice.In this narrative review,co-authored by gastroenterologists and engineers,we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate,and review the development of photometric stereo(PS)for colonoscopy.PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography.This imaging technique has several potential clinical applications in colonoscopy,including adenoma detection,polyp classification,and facilitating polypectomy,an inherently three-dimensional task.However,the development of PS for colonoscopy is at an early stage.We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.
