Relationship of aging and tobacco use with the development of aberrant crypt foci in a predominantly African-American population.

BACKGROUND AND AIMS: In clinical studies, diminished folate availability appears to increase the risk for colorectal neoplasms. Additionally, alcohol and tobacco use are associated with an increased risk for colon cancer, but the early pathologic events by which these agents promote neoplastic transformation are not well understood. Aberrant crypt foci (ACF) are potential precursors of adenoma and cancer, and can be visualized by magnification endoscopy. We hypothesized that folate depletion is linked to ACF formation and therefore studied the association between tissue folate, dietary habits, and ACF number in patients undergoing screening colonoscopy. METHODS: Eighty-three patients, undergoing screening colonoscopy at an urban Veterans Affairs and university hospital, completed a questionnaire concerning alcohol, nonsteroidal anti-inflammatory drug (NSAID), and tobacco use. Folate intake was calculated from food frequency questionnaires. Rectal ACFs were scored using magnification chromoendoscopy (magnification, 35 x) by methylene blue staining. Folate concentrations in rectal biopsy specimens were determined by microtiter bioassay. RESULTS: ACF number increased with age and with increasing tobacco intake. Decreased colonic folate level was associated with increased homocysteine levels and lower dietary folate intake but did not correlate with ACF number. CONCLUSIONS: Increasing age and tobacco use were linked independently to the presence of colonic ACF in this predominantly African-American population. Folate, alcohol, and acetylsalicylic acid (ASA) use did not influence the prevalence of these lesions.

Selective intrahepatic ductal cannulation during ERCP with a sphincterotome.

BACKGROUND: Selective intrahepatic ductal cannulation during ERCP remains difficult, particularly when strictures involve the bifurcation and/or secondary intrahepatic branches. METHODS: A retrospective review was conducted of a cohort of 16 patients (stones 5, cholangiocarcinoma 5, primary sclerosing cholangitis 4, hepatoma 1, bile leak 1) in whom selective cannulation of the intrahepatic ducts with conventional techniques was unsuccessful and who underwent ERCP with a sphincterotome and a hydrophilic coated guidewire to achieve intrahepatic ductal access. RESULTS: The procedure was technically successful in 15 patients and clinically successful in 12. In the 5 patients with bile duct stones, clearance was obtained in 3 and stents were placed in the other 2 patients; one died of cholangitis within 30 days and the other underwent surgery. The procedure was technically successful in 3 of the 5 patients with cholangiocarcinoma. One patient died and the procedure was technically unsuccessful in another. For all patients with primary sclerosing cholangitis, the endoscopic therapy was technically successful and clinical outcomes satisfactory. The patient with a hepatoma was treated successfully and subsequently died of hepatic failure. CONCLUSION: Use of a sphincterotome and hydrophilic-coated guidewire can significantly enhance the success rate for selective intrahepatic ductal access.