Efficacy and safety of radiofrequency ablation of Barrett's esophagus in the absence of reimbursement: a multicenter prospective Belgian registry.

BACKGROUND: Radiofrequency ablation (RFA), combined with endoscopic resection, can be used as a primary treatment for low grade dysplasia, high grade dysplasia, and early esophageal adenocarcinoma (EAC) in Barrett's esophagus (BE). The aim of the Belgian RFA registry is to capture the real-life outcome of endoscopic therapy for BE with RFA and to assess efficacy and safety outside study protocols, in the absence of reimbursement. PATIENTS AND METHODS: Between February 2008 and January 2017, data from 7 different expert centers were prospectively collected in the registry. Efficacy outcomes included complete remission of intestinal metaplasia (CR-IM), complete remission of dysplasia (CR-D), and durability of remission. Safety outcomes included immediate and late adverse events. RESULTS: 684 RFA procedures in 342 different patients were registered. Of these, 295 patients were included in the efficacy analysis, with CR-IM achieved in 88 % and CR-D in 93 %, in per-protocol analysis; corresponding rates in intention-to-treat analysis were 82 % and 87 %, respectively. Sustained remission was seen in 65 % with a median (interquartile range) follow-up of 25 (12 - 47) months. No risk factors for recurrent disease were identified. Immediate complications occurred in 4 % of all procedures and 6 % of all patients, whereas late complications occurred in 9 % of all procedures and in 20 % of all patients. CONCLUSIONS: Data from the Belgian registry confirm that RFA in combination with endoscopic resection is an efficient treatment for BE with dysplasia or early EAC. In the absence of reimbursement, more rescue treatments are used, not compromising outcome. Since there is recurrent disease after CR-IM in 35 %, surveillance endoscopy remains necessary.

Molecular detection of Helicobacter pylori and clarithromycin resistance in gastric biopsies: a prospective evaluation of RIDA®GENE Helicobacter pylori assay.

Background: Empirical treatment of Helicobacter pylori (HP) depends on the local prevalence of clarithromycin resistance but data are lacking and culturing of HP is time-consuming. We evaluated RIDA®GENE Helicobacter pylori assay (r-biopharm), a quantitative PCR assay for detecting HP and clarithromycin resistance mutations in gastric biopsies.Material/methods: Gastric biopsies were obtained from each of 436 consecutive patients referred for gastroscopic investigation and results of qPCR were compared to culture and immunohistochemical staining (IHCS).Results: Of 436 samples, 47 were positive for HP by PCR (11%), 42 by culture (9.7%) and 44 by IHCS (10%). Compared to culture, sensitivity and specificity of the qPCR were 100% and 99%, respectively, and 96% and 99% compared to IHCS. The sensitivity and specificity for clarithromycin resistance detection were 92% and 97%, respectively.Conclusions: RIDA®GENE Helicobacter pylori assay reliably and rapidly detects HP and its resistance to clarithromycin in human gastric biopsies.

Correction of the Scimitar syndrome, a rare cardiac venous anomaly, leading to Budd-Chiari syndrome: a case report.

INTRODUCTION: Scimitar syndrome is a congenital heart disease characterized by an abnormal drainage of the right lung into the inferior vena cava, the right atrium or a variety of venous connections from the anomalous pulmonary vein to a systemic vein. This left-to-right shunt induces pulmonary hypertension and is an indication for surgical repair in cases of a history of recurrent pneumonia or significant left-to-right shunting. A corrective approach, which consists of rerouting the anomalous pulmonary flow to the left atrium, is usually performed. Complications of scimitar repair are stenosis, thrombosis and occlusion of the scimitar vein and its deviation. CASE PRESENTATION: This case report describes a 53-year-old Caucasian woman with known scimitar syndrome, undergoing surgical repair due to invaliding symptoms of dyspnoea, and presenting with postoperative Budd-Chiari syndrome due to anomalous drainage of her right hepatic vein into the left atrium. It is an interesting cause of liver pathology caused by Budd-Chiari that never has been described before. CONCLUSIONS: This case report emphasizes the importance of a thorough preoperative evaluation, and the importance of antecedents in newly presenting pathology. It is an interesting cause of a known hepatic syndrome, the Budd-Chiari syndrome. This case report is of interest to many specialties, including Hepatology, Cardiology, Radiology and Cardiovascular Surgery. It exposes a new interesting anatomic variation of the scimitar syndrome with significant postoperative implications.

Comparison of six different calprotectin assays for the assessment of inflammatory bowel disease.

BACKGROUND AND OBJECTIVES: Faecal calprotectin is a valuable noninvasive marker for inflammatory bowel disease (IBD). The aim of our study was to determine the correlation between six different calprotectin assays and compare their performance for diagnosis and follow up of IBD. METHODS: Thirty-one patients with suspected IBD and 31 patients in follow up were included. We determined calprotectin by means of three rapid immmunochromatographic tests, two enzyme-linked immunosorbent assays, and one automated fluoroimmunoassay. Results were correlated with endoscopic and histological findings. RESULTS: Although all methods correlated significantly, slopes and intercepts differed extensively, with up to 5-fold quantitative differences between assays. Sensitivity and specificity for diagnosis of IBD were 82-83 and 84-89%, respectively. For follow up, sensitivity in detecting mild ulcerative colitis was 71-100%. In moderate-to-severe ulcerative colitis, sensitivity was 100% for all assays. Specificity was 67-86% in both subgroups. In Crohn's disease, only moderate-to-severe disease could be differentiated from remission, with sensitivity 83-86% and specificity 75% for all tests. CONCLUSIONS: All calprotectin assays showed comparable clinical performance for diagnosis of IBD. For follow up, performance was acceptable, except for mild Crohn's disease. Because of the large quantitative differences, further efforts are needed to standardize calprotectin assays.

Endoscopic trimming of metallic stents with the use of argon plasma.

BACKGROUND: The endoscopic placement of metallic stents for palliation of malignant obstruction of the GI or biliary tract is an established practice and as such is often applied. Use of these stents, however, has its problems. Stent migration may cause obstruction of the bowel lumen. Migration of a biliary stent into the contralateral duodenal wall may cause difficulty in gaining access to the biliary tract, as will the placement of a duodenal stent across the ampulla. OBJECTIVE: We report on 6 patients in whom trimming of the metallic nitinol stent was performed. DESIGN: Single-center, retrospective case series. SETTING: Secondary referral center. PATIENTS: Of 6 patients included, 2 patients each had an uncovered duodenal stent, 2 had an uncovered biliary stent each, 1 had an uncovered colorectal stent, and 1 had a covered gastroduodenal stent. INTERVENTIONS: Under direct endoscopic vision, an argon plasma beam was used to cut self-expandable metallic stents, as appropriate. MAIN OUTCOME MEASUREMENT: The main objective was relief of the obstruction to the bowel lumen or bile duct, facilitating successful passage of an endoscope or biliary canulation, respectively. RESULTS: In all 5 patients with uncovered metallic stents, we were able to re-establish access to the obstructed bowel lumen or the biliary tree, as indicated. An attempt to tailor the length of a covered metallic gastroduodenal stent failed. No complications were observed and no hemorrhage or perforation occurred. LIMITATIONS: The study was limited by retrospective design and small sample size. CONCLUSIONS: The endoscopic cutting and tailoring of an uncovered metallic prosthesis, by means of an argon plasma beam, is feasible, effective, and safe. Trimming of covered stents is not advocated.

Cytomegalovirus colitis in an apparently immunecompetent host after biliopancreatic diversion for obesity.

CMV colitis in an immunocompetent host is a rare occurrence. We report a case of CMV colitis after biliopancreatic diversion surgery. The diagnosis of primary CMV infection with CMV colitis was based on histological examination of tissues biopsies obtained at colonoscopy, serology positive for CMV-IgM and CMV-IgG antibodies and a good response to systemic gancyclovir treatment. Malnutrition and colonic mucosal damage, both consequences of biliopancreatic diversion surgery, were thought to be predisposing factors. To our knowledge this is the first report in the English language literature of an association between CMV colitis and status following biliopancreatic diversion surgery.