A new type of rendezvous: introduction of laparo-endoscopy in selected patients.

OBJECTIVE: The aim of this work is to demonstrate the introduction of laparo-endoscopy and to investigate the year-long experience with its use. PATIENTS AND METHODS: In a subgroup of patients with cholecystolithiasis, concomitant lithiasis of the common bile duct may also be present. When the preoperative endoscopic cholangiopancreatography, performed as a result of a suspected choledocholithiasis, was unsuccessful, a "rendezvous" ERCP, laparo-endoscopy, is performed. After a survey of the international literature on the method, and a description of its technique, the authors give a review of the cases of their own 10 patients, which were all successful. RESULTS: These findings emphasise the advantages of the new method in a certain subgroup of patients over the conventional, sequential approach (preoperative ERCP followed by laparoscopic cholecystectomy), and also give technical hints obtained during their performance of the operations up to now. CONCLUSIONS: These results underline the importance of team work that involves the cooperation of a gastroenterologist, a surgeon and an anaesthesiologist in the indication, organisation and implementation of the intervention.

Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease.

BACKGROUND: Adalimumab is a fully human monoclonal antibody targeting tumour necrosis factor with proven efficacy in the treatment of Crohn's disease (CD). AIM: To investigate the predictors of medium-term clinical efficacy and mucosal healing during adalimumab therapy, in patients with CD, in specialised centres approved for biological therapy in Hungary. METHODS: Data capture of the 201 CD patients was standardised and prospective (male/female: 112/89, median age: 33.0 years, duration: 8 years). Previous infliximab therapy had been administered in 48% of patients, concomitant steroids in 41%, azathioprine in 69% and combined therapy in 27% of patients. RESULTS: Overall clinical response and remission rates at 24 weeks were 78% and 52%, respectively; at 52 weeks were 69% and 44%, respectively. Endoscopic improvement and healing were achieved in 43% and 24% of patients. In a logistic regression model, clinical efficacy and CRP at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, whereas CRP at week 12, clinical remission at week 24, inflammatory parameters and nonsmoking were associated to endoscopic improvement/healing. Intensification to weekly dosing was needed in 16% of patients. Parallel azathioprine therapy and clinical remission at week 12 were inversely associated with dose escalation. CONCLUSIONS: Clinical efficacy and normalised CRP at week 12 (early deep clinical remission) are associated with medium-term clinical efficacy and mucosal healing during adalimumab therapy, whereas need for combined immunosuppression at induction and smoking status are predictors for non-response. Parallel azathioprine therapy may decrease the probability for dose escalation.