Background & Aims: Patients with Barrett’s esophagus (BE)- have a risk of esophageal adenocarcinoma of approximately 0.5% per year. Patients may have difficulty understanding this risk. This study assessed the pe...Background & Aims: Patients with Barrett’s esophagus (BE)- have a risk of esophageal adenocarcinoma of approximately 0.5% per year. Patients may have difficulty understanding this risk. This study assessed the perceived risk of cancer in patients with BE, and correlated their risk estimates with their health care use behaviors. Methods: We performed a survey of patients with BE participating in an endoscopic surveillance program at 2 sites: a university teaching hospital and a Veterans’ Administration hospital. A questionnaire also elicited their demographics as well as their sources of health information. Health care behaviors, including physician visits and endoscopic surveillance behaviors, were assessed. Patients were classified as either overestimators or nonoverestimators of risk. Characteristics of overestimators, as well as health care use patterns, were assessed. Results: One hundred eighteen patients met entry criteria, and 92 (78% ) completed all the questionnaires. Sixty-eight percent of patients overestimated their 1-year risk of cancer, with a mean estimated 1-year cancer risk being 13.6% . The lifetime risk also was overestimated by 38% of patients. Patients who overestimated risk were more likely to be Veterans’ Administration medical center patients, have more symptomatic reflux, and were more likely to use the Internet to get health care information. There was no significant difference in physician visits between overestimators and nonestimators (1.2 visits per year vs 1.0, P = .20), nor in endoscopy use (5.7 endoscopies per 5-year period vs 5.0, P = .42). Conclusions: The majority of patients with prevalent BE participating in an endoscopic surveillance program overestimated their chances of developing adenocarcinoma of the esophagus. Efforts to improve education of such patients with BE are warranted.展开更多
Background and aims:Endoscopic surveillance of Barrett’s oesophagus currently relies on multiple random biopsies.This approach is time consuming,has a poor diagnostic yield,and significant interobserver variability.E...Background and aims:Endoscopic surveillance of Barrett’s oesophagus currently relies on multiple random biopsies.This approach is time consuming,has a poor diagnostic yield,and significant interobserver variability.Elastic scattering spectroscopy is a real time in vivo optical technique which detects changes in the physical properties of cells.The aim of this study was to assess the potential for elastic scattering to detect high grade dysplasia or cancer within Barrett’s oesophagus.Methods:Elastic scattering spectroscopy measurements collected in vivo were matched with histological specimens taken from identical sites within Barrett’s oesophagus.All biopsies were reviewed by three gastrointestinal pathologists and defined as either “ low risk”(non-dysplastic or low grade dysplasia) or “ high risk”(high grade dysplasia or cancer) .Two different statistical approaches(leave one out and block validation) were used to validate the model.Results:A total of 181 matched biopsy sites from 81 patients,where histopathological consensus was reached,were analysed.There was good pathologist agreement in differentiating high grade dysplasia and cancer from other pathology(kappa = 0.72) .Elastic scattering spectroscopy detected high risk sites with 92% sensitivity and 60% specificity and differentiated high risk sites from inflammation with a sensitivity and specificity of 79%.If used to target biopsies during endoscopy,the number of low risk biopsies taken would decrease by 60% with minimal loss of accuracy.A negative spectroscopy result would exclude high grade dysplasia or cancer with an accuracy of >99.5%.Conclusions:These preliminary results show that elastic scattering spectroscopy has the potential to target conventional biopsies in Barrett’s surveillance saving significant endoscopist and pathologist time with consequent financial savings.This technique now requires validation in prospective studies.展开更多
Background and aims: The role of antibiotic treatment in early stage gastric mucosa associated lymphoid tissue (MALT) lymphoma not associated with Helicobacter pylori infection has not been investigated. Patients and ...Background and aims: The role of antibiotic treatment in early stage gastric mucosa associated lymphoid tissue (MALT) lymphoma not associated with Helicobacter pylori infection has not been investigated. Patients and methods: Six patients with localised gastric MALT lymphoma underwent antibiotic treatment with clarithromycin, metronidazole, and pantoprazole. Staging, including endosonography plus gastroscopy,computed tomography of the thorax and abdomen, colonoscopy,magnetic resonance imaging of the salivary glands, and bone marrow biopsy were performed to rule out distant spread of the disease. In addition, MALT specific genetic changes, including reverse transcriptase- polymerase chain reaction for t(11;18)(q21;q21), were tested in all patients. H pylori infection was ruled out by histology, urease breath test, serology, and stool antigen testing. Results: All six patients had MALT lymphoma restricted to the stomach, and no evidence of infection with H pylori was found. Only one patient tested positive for t(11;18)(q21;q21) while the remaining five displayed no genetic aberrations. Following antibiotic treatment, endoscopic controls were performed every three months. Five patients responded with lymphoma regression between three and nine months following antibiotic treatment (one partial remission and four complete responses). One patient had stable disease for 12 months and was then referred for chemotherapy. Conclusions: Patients with early stage gastric MALT lymphoma negative for H pylori might still benefit from antibiotic treatment as the sole treatment modality.展开更多
Background: Many patients with high-grade dysplasia and localized adenocarcinoma in Barrett’s esophagus have localized disease but are either unfit for major surgery or decline esophagectomy. Photodynamic therapy wit...Background: Many patients with high-grade dysplasia and localized adenocarcinoma in Barrett’s esophagus have localized disease but are either unfit for major surgery or decline esophagectomy. Photodynamic therapy with the powerful photosensitizer m-tetrahydroxyphenyl chlorinmay be a nonsurgical therapeutic option. Methods: This is a pilot study to evaluate the efficacy and complications of m-tetrahydroxyphenyl chlorin photodynamic therapy. The design is a case series of 19 consecutive patients at a tertiary referral unit with a special interest in photodynamic therapy. The study included 7 patients with high-grade dysplasia and 12 with early esophageal cancer, who had refused or were unfit for esophagectomy. Three days after photosensitization with 0.15 mg/kg m-tetrahydroxyphenyl chlorin, red or green light was delivered endoscopically when using either a bare fiber or a diffuser device. Results were assessed by endoscopic surveillance. Results: By using red light via the diffuser, 4/6 patients with cancer and 3/4 with high-grade dysplasia were successfully treated with photodynamic therapy alone. When using the bare-tipped fiber, there was one procedure- related death and only 1/5 patients with cancers were successfully treated. Two others were downgraded to high-grade dysplasia. With green light delivered via a diffuser, 0/3 patients with high-grade dysplasia are in long-term remission. Two serious complications arose (including one death) from taking multiple biopsy specimens too soon after therapy. Two esophageal strictures occurred. Conclusions: Photodynamic therapy with m-tetrahydroxyphenyl chlorin is, potentially, a valuable therapeutic option for localized esophageal neoplasia. Red light via a diffuser device appears to be the most effective light-delivery technique. Biopsy specimens should not be taken for at least 2 months after treatment.展开更多
AIM:To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Fifty-nine consecutive patients ...AIM:To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010. This was a randomized cross-over study, in which each patient underwent ERCP twice, once with BIS monitoring and once with control monitoring. Whether BIS monitoring was done during the first or second ERCP procedure was random. Patients were intermittently administered a mixed regimen including midazolam, pethidine, and propofol by trained nurses. The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring. The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups. RESULTS:The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9 ± 30.8 mg in the control group (P = 0.673). The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P = 0.103). The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups. The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor. No significant differences in the frequency of < 80% oxygen saturation, hypotension (< 80 mmHg), or bradycardia (< 50 beats/min) were observed between the two study groups. Four cases of poor cooperation occurred, in which the procedure should be stopped to add the propofol dose. After adding the propofol, the procedure could be conducted successfully (one case in the BIS group, three cases in the control group). The endoscopist rated patient sedation as excellent for all patients in both groups. All patients in both groups rated their level of satisfaction as high (no discomfort). During the post-procedural follow-up in the recovery area, no cases of clinically significant hypoxic episodes were recorded in either group. No other postoperative side effects related to sedation were observed in either group. CONCLUSION:BIS monitoring trend to slighlty reduce the mean propofol dose. Nurse-administered propofol sedation under the supervision of a gastroenterologist may be considered an alternative under anesthesiologist.展开更多
AIM: Consecutive monitoring of intragastric pH using the Bravo? capsule. METHODS: We put threads through a Bravo? capsule and then affixed it to the gastric wall by endoscopic hemoclipping in seven subjects. Study dat...AIM: Consecutive monitoring of intragastric pH using the Bravo? capsule. METHODS: We put threads through a Bravo? capsule and then affixed it to the gastric wall by endoscopic hemoclipping in seven subjects. Study data were uploaded to a computer via Datalink every 48 h. In this way,repeated monitoring of intragastric pH was undertaken. RESULTS: All subjects were able to monitor gastric pH over a 1-wk period,and five for > 2 wk. No complications were encountered during the monitoring. After pH monitoring,we safely retrieved the capsule endoscopically. CONCLUSION: Clipping a Bravo? capsule onto the gastric wall enabled long-term intragastric pH monitoring. This is a methodological report of pH monitoring over a period of > 2 wk.展开更多
Colitis-associated colorectal cancer(CACC)is one of the most serious complications of inflammatory bowel disease(IBD),particularly in ulcerative colitis(UC);it accounts for approximately 15%of all-causes mortality amo...Colitis-associated colorectal cancer(CACC)is one of the most serious complications of inflammatory bowel disease(IBD),particularly in ulcerative colitis(UC);it accounts for approximately 15%of all-causes mortality among IBD patients.Because CACC shows a worse prognosis and higher mortality than sporadic colorectal cancer,early detection is critical.Colonoscopy is primarily recommended for surveillance and several advanced endoscopic imaging techniques are emerging.In addition,recent studies have reported on attempts to develop clinically relevant biomarkers for surveillance using various biosamples,which may become high-performance screening tools in the future,so the best approach and technique for cancer surveillance in long-standing UC patients remain under debate.This review gives a comprehensive description and summary about what progress has been made in terms of early CACC detection.展开更多
This article analyses the literature regarding the value of computer-assisted systems in esogastroduodenoscopy-quality monitoring and the assessment of gastric lesions.Current data show promising results in upper-endo...This article analyses the literature regarding the value of computer-assisted systems in esogastroduodenoscopy-quality monitoring and the assessment of gastric lesions.Current data show promising results in upper-endoscopy quality control and a satisfactory detection accuracy of gastric premalignant and malignant lesions,similar or even exceeding that of experienced endoscopists.Moreover,artificial systems enable the decision for the best treatment strategies in gastriccancer patient care,namely endoscopic vs surgical resection according to tumor depth.In so doing,unnecessary surgical interventions would be avoided whilst providing a better quality of life and prognosis for these patients.All these performance data have been revealed by numerous studies using different artificial intelligence(AI)algorithms in addition to white-light endoscopy or novel endoscopic techniques that are available in expert endoscopy centers.It is expected that ongoing clinical trials involving AI and the embedding of computer-assisted diagnosis systems into endoscopic devices will enable real-life implementation of AI endoscopic systems in the near future and at the same time will help to overcome the current limits of the computer-assisted systems leading to an improvement in performance.These benefits should lead to better diagnostic and treatment strategies for gastric-cancer patients.Furthermore,the incorporation of AI algorithms in endoscopic tools along with the development of large electronic databases containing endoscopic images might help in upper-endoscopy assistance and could be used for telemedicine purposes and second opinion for difficult cases.展开更多
文摘Background & Aims: Patients with Barrett’s esophagus (BE)- have a risk of esophageal adenocarcinoma of approximately 0.5% per year. Patients may have difficulty understanding this risk. This study assessed the perceived risk of cancer in patients with BE, and correlated their risk estimates with their health care use behaviors. Methods: We performed a survey of patients with BE participating in an endoscopic surveillance program at 2 sites: a university teaching hospital and a Veterans’ Administration hospital. A questionnaire also elicited their demographics as well as their sources of health information. Health care behaviors, including physician visits and endoscopic surveillance behaviors, were assessed. Patients were classified as either overestimators or nonoverestimators of risk. Characteristics of overestimators, as well as health care use patterns, were assessed. Results: One hundred eighteen patients met entry criteria, and 92 (78% ) completed all the questionnaires. Sixty-eight percent of patients overestimated their 1-year risk of cancer, with a mean estimated 1-year cancer risk being 13.6% . The lifetime risk also was overestimated by 38% of patients. Patients who overestimated risk were more likely to be Veterans’ Administration medical center patients, have more symptomatic reflux, and were more likely to use the Internet to get health care information. There was no significant difference in physician visits between overestimators and nonestimators (1.2 visits per year vs 1.0, P = .20), nor in endoscopy use (5.7 endoscopies per 5-year period vs 5.0, P = .42). Conclusions: The majority of patients with prevalent BE participating in an endoscopic surveillance program overestimated their chances of developing adenocarcinoma of the esophagus. Efforts to improve education of such patients with BE are warranted.
文摘Background and aims:Endoscopic surveillance of Barrett’s oesophagus currently relies on multiple random biopsies.This approach is time consuming,has a poor diagnostic yield,and significant interobserver variability.Elastic scattering spectroscopy is a real time in vivo optical technique which detects changes in the physical properties of cells.The aim of this study was to assess the potential for elastic scattering to detect high grade dysplasia or cancer within Barrett’s oesophagus.Methods:Elastic scattering spectroscopy measurements collected in vivo were matched with histological specimens taken from identical sites within Barrett’s oesophagus.All biopsies were reviewed by three gastrointestinal pathologists and defined as either “ low risk”(non-dysplastic or low grade dysplasia) or “ high risk”(high grade dysplasia or cancer) .Two different statistical approaches(leave one out and block validation) were used to validate the model.Results:A total of 181 matched biopsy sites from 81 patients,where histopathological consensus was reached,were analysed.There was good pathologist agreement in differentiating high grade dysplasia and cancer from other pathology(kappa = 0.72) .Elastic scattering spectroscopy detected high risk sites with 92% sensitivity and 60% specificity and differentiated high risk sites from inflammation with a sensitivity and specificity of 79%.If used to target biopsies during endoscopy,the number of low risk biopsies taken would decrease by 60% with minimal loss of accuracy.A negative spectroscopy result would exclude high grade dysplasia or cancer with an accuracy of >99.5%.Conclusions:These preliminary results show that elastic scattering spectroscopy has the potential to target conventional biopsies in Barrett’s surveillance saving significant endoscopist and pathologist time with consequent financial savings.This technique now requires validation in prospective studies.
文摘Background and aims: The role of antibiotic treatment in early stage gastric mucosa associated lymphoid tissue (MALT) lymphoma not associated with Helicobacter pylori infection has not been investigated. Patients and methods: Six patients with localised gastric MALT lymphoma underwent antibiotic treatment with clarithromycin, metronidazole, and pantoprazole. Staging, including endosonography plus gastroscopy,computed tomography of the thorax and abdomen, colonoscopy,magnetic resonance imaging of the salivary glands, and bone marrow biopsy were performed to rule out distant spread of the disease. In addition, MALT specific genetic changes, including reverse transcriptase- polymerase chain reaction for t(11;18)(q21;q21), were tested in all patients. H pylori infection was ruled out by histology, urease breath test, serology, and stool antigen testing. Results: All six patients had MALT lymphoma restricted to the stomach, and no evidence of infection with H pylori was found. Only one patient tested positive for t(11;18)(q21;q21) while the remaining five displayed no genetic aberrations. Following antibiotic treatment, endoscopic controls were performed every three months. Five patients responded with lymphoma regression between three and nine months following antibiotic treatment (one partial remission and four complete responses). One patient had stable disease for 12 months and was then referred for chemotherapy. Conclusions: Patients with early stage gastric MALT lymphoma negative for H pylori might still benefit from antibiotic treatment as the sole treatment modality.
文摘Background: Many patients with high-grade dysplasia and localized adenocarcinoma in Barrett’s esophagus have localized disease but are either unfit for major surgery or decline esophagectomy. Photodynamic therapy with the powerful photosensitizer m-tetrahydroxyphenyl chlorinmay be a nonsurgical therapeutic option. Methods: This is a pilot study to evaluate the efficacy and complications of m-tetrahydroxyphenyl chlorin photodynamic therapy. The design is a case series of 19 consecutive patients at a tertiary referral unit with a special interest in photodynamic therapy. The study included 7 patients with high-grade dysplasia and 12 with early esophageal cancer, who had refused or were unfit for esophagectomy. Three days after photosensitization with 0.15 mg/kg m-tetrahydroxyphenyl chlorin, red or green light was delivered endoscopically when using either a bare fiber or a diffuser device. Results were assessed by endoscopic surveillance. Results: By using red light via the diffuser, 4/6 patients with cancer and 3/4 with high-grade dysplasia were successfully treated with photodynamic therapy alone. When using the bare-tipped fiber, there was one procedure- related death and only 1/5 patients with cancers were successfully treated. Two others were downgraded to high-grade dysplasia. With green light delivered via a diffuser, 0/3 patients with high-grade dysplasia are in long-term remission. Two serious complications arose (including one death) from taking multiple biopsy specimens too soon after therapy. Two esophageal strictures occurred. Conclusions: Photodynamic therapy with m-tetrahydroxyphenyl chlorin is, potentially, a valuable therapeutic option for localized esophageal neoplasia. Red light via a diffuser device appears to be the most effective light-delivery technique. Biopsy specimens should not be taken for at least 2 months after treatment.
文摘AIM:To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010. This was a randomized cross-over study, in which each patient underwent ERCP twice, once with BIS monitoring and once with control monitoring. Whether BIS monitoring was done during the first or second ERCP procedure was random. Patients were intermittently administered a mixed regimen including midazolam, pethidine, and propofol by trained nurses. The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring. The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups. RESULTS:The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9 ± 30.8 mg in the control group (P = 0.673). The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P = 0.103). The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups. The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor. No significant differences in the frequency of < 80% oxygen saturation, hypotension (< 80 mmHg), or bradycardia (< 50 beats/min) were observed between the two study groups. Four cases of poor cooperation occurred, in which the procedure should be stopped to add the propofol dose. After adding the propofol, the procedure could be conducted successfully (one case in the BIS group, three cases in the control group). The endoscopist rated patient sedation as excellent for all patients in both groups. All patients in both groups rated their level of satisfaction as high (no discomfort). During the post-procedural follow-up in the recovery area, no cases of clinically significant hypoxic episodes were recorded in either group. No other postoperative side effects related to sedation were observed in either group. CONCLUSION:BIS monitoring trend to slighlty reduce the mean propofol dose. Nurse-administered propofol sedation under the supervision of a gastroenterologist may be considered an alternative under anesthesiologist.
文摘AIM: Consecutive monitoring of intragastric pH using the Bravo? capsule. METHODS: We put threads through a Bravo? capsule and then affixed it to the gastric wall by endoscopic hemoclipping in seven subjects. Study data were uploaded to a computer via Datalink every 48 h. In this way,repeated monitoring of intragastric pH was undertaken. RESULTS: All subjects were able to monitor gastric pH over a 1-wk period,and five for > 2 wk. No complications were encountered during the monitoring. After pH monitoring,we safely retrieved the capsule endoscopically. CONCLUSION: Clipping a Bravo? capsule onto the gastric wall enabled long-term intragastric pH monitoring. This is a methodological report of pH monitoring over a period of > 2 wk.
基金supported by the National Natural Science Foundation of China(No.81570502)and Research Fund for the Doctoral Program of Higher Education of China(No.20130181120041)Scientific Research Foundation for the Returned Overseas Chinese Scholars,State Education Ministry(No.201416851110)。
文摘Colitis-associated colorectal cancer(CACC)is one of the most serious complications of inflammatory bowel disease(IBD),particularly in ulcerative colitis(UC);it accounts for approximately 15%of all-causes mortality among IBD patients.Because CACC shows a worse prognosis and higher mortality than sporadic colorectal cancer,early detection is critical.Colonoscopy is primarily recommended for surveillance and several advanced endoscopic imaging techniques are emerging.In addition,recent studies have reported on attempts to develop clinically relevant biomarkers for surveillance using various biosamples,which may become high-performance screening tools in the future,so the best approach and technique for cancer surveillance in long-standing UC patients remain under debate.This review gives a comprehensive description and summary about what progress has been made in terms of early CACC detection.
文摘This article analyses the literature regarding the value of computer-assisted systems in esogastroduodenoscopy-quality monitoring and the assessment of gastric lesions.Current data show promising results in upper-endoscopy quality control and a satisfactory detection accuracy of gastric premalignant and malignant lesions,similar or even exceeding that of experienced endoscopists.Moreover,artificial systems enable the decision for the best treatment strategies in gastriccancer patient care,namely endoscopic vs surgical resection according to tumor depth.In so doing,unnecessary surgical interventions would be avoided whilst providing a better quality of life and prognosis for these patients.All these performance data have been revealed by numerous studies using different artificial intelligence(AI)algorithms in addition to white-light endoscopy or novel endoscopic techniques that are available in expert endoscopy centers.It is expected that ongoing clinical trials involving AI and the embedding of computer-assisted diagnosis systems into endoscopic devices will enable real-life implementation of AI endoscopic systems in the near future and at the same time will help to overcome the current limits of the computer-assisted systems leading to an improvement in performance.These benefits should lead to better diagnostic and treatment strategies for gastric-cancer patients.Furthermore,the incorporation of AI algorithms in endoscopic tools along with the development of large electronic databases containing endoscopic images might help in upper-endoscopy assistance and could be used for telemedicine purposes and second opinion for difficult cases.
