Is narrow-band imaging a useful tool in screening colonoscopy performed by an experienced endoscopist? A prospective randomised study on 533 patients.

INTRODUCTION: The detection of adenomas is the basic goal for colorectal cancer screening programs; therefore, every possibility to improve the adenoma detection rate is valuable. AIM: To answer the question of whether narrow-band imaging (NBI) can enhance detection quality in screening for colonoscopy. MATERIAL AND METHODS: A group of 533 patients (202 men: 331 women; average age: 56.1 years) included in a colorectal cancer screening program were randomised into two groups (NBI n = 266 and white light (WL) n = 267). Five hundred and twenty-seven patients were finally included in the assessment. Examinations were performed by three experienced colonoscopists. The NBI was used only at the withdrawal of the instrument. RESULTS: Comparing WL and NBI colonoscopies, differences in the mean number of detected polyps per patient (1.36 ±2.79 WL vs. 1.65 ±2.11 NBI; p = 0.012), polyp detection rate (PDR) (48.5% WL vs. 57.2% NBI; p = 0.049), PDR for polyps ≤ 5 mm (44.7% WL vs. 54% NBI; p = 0.033), and PDR for left-sided polyps (43.3% WL vs. 52.7% NBI; p = 0.033) were observed. The difference in adenoma detection rate (ADR) as well as in adenomas/patient was not significant. Narrow-band imaging enhanced significantly one of three operators' ADR (15.6% WL vs. 25.7% NBI; p = 0.038). CONCLUSIONS: It seems that NBI improves only detection of hyperplastic polyps, especially those that are diminutive and left-sided. However, after analysis of particular endoscopists, it can clearly be seen that some of them may benefit from NBI.

Cogan's Syndrome in Patients With Inflammatory Bowel Disease--A Case Series.

BACKGROUND: Cogan's syndrome (CSy) is a very rare autoimmune disorder, mainly affecting the inner ear and the eye, and is associated with inflammatory bowel disease (IBD). METHODS: This was a European Crohn's and Colitis Organisation (ECCO) retrospective observational study, performed as part of the CONFER project. A call to all ECCO members was made to report concomitant CSy and inflammatory bowel disease (IBD) cases. Clinical data were recorded in a standardized questionnaire. RESULTS: This international case series reports on 22 concomitant CSy-IBD cases from 14 large medical centres. Mean duration of IBD until diagnosis of CSy was 8.7 years (range 0.0-38.0) and mean age at CSy diagnosis was 44.6 years (range 9.0-67.0). Six patients had underlying ulcerative colitis (UC) and 16 had Crohn's disease. Eleven patients (50%) had active disease at CSy diagnosis. Sixteen patients were under IBD treatment at the time of CSy diagnosis, of whom 6 (37.5%) were on anti-tumour necrosis factor (TNF). Seven out of 10 patients, who were treated for CSy with immunomodulators (mostly with corticosteroids), demonstrated at least partial response. CONCLUSION: This is the largest CSy-IBD case series so far. Although CSy is considered to be an autoimmune disease and is associated with IBD, immunomodulatory IBD maintenance treatment and even anti-TNF therapy do not seem to prevent disease onset. Moreover, IBD disease activity does not seem to trigger CSy. However, vigilance may prompt early diagnosis and directed intervention with corticosteroids at inception may potentially hinder audiovestibular deterioration. Finally, vigilance and awareness may also offer a better setting to study the pathophysiological mechanisms of this rare but debilitating phenomenon.

A microRNA-based test improves endoscopic ultrasound-guided cytologic diagnosis of pancreatic cancer.

BACKGROUND & AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in combination with cytopathology is the optimal method for diagnosis and staging of pancreatic ductal adenocarcinoma (PDAC) and other pancreatic lesions. Its clinical utility, however, can be limited by high rates of indeterminate or false-negative results. We aimed to develop and validate a microRNA (miRNA)-based test to improve preoperative detection of PDAC. METHODS: Levels of miRNAs were analyzed in a centralized clinical laboratory by relative quantitative polymerase chain reaction in 95 formalin-fixed paraffin-embedded specimens and 228 samples collected by EUS-FNA during routine evaluations of patients with solid pancreatic masses at 4 institutions in the United States, 1 in Canada, and 1 in Poland. RESULTS: We developed a 5-miRNA expression classifier, consisting of MIR24, MIR130B, MIR135B, MIR148A, and MIR196, that could identify PDAC in well-characterized, formalin-fixed, paraffin-embedded specimens. Detection of PDAC in EUS-FNA samples increased from 78.8% by cytology analysis alone (95% confidence interval, 72.2%-84.5%) to 90.8% when combined with miRNA analysis (95% confidence interval, 85.6%-94.5%). The miRNA classifier correctly identified 22 additional true PDAC cases among 39 samples initially classified as benign, indeterminate, or nondiagnostic by cytology. Cytology and miRNA test results each were associated significantly with PDAC (P < .001), with positive predictive values greater than 99% (95% confidence interval, 96%-100%). CONCLUSIONS: We developed and validated a 5-miRNA classifier that can accurately predict which preoperative pancreatic EUS-FNA specimens contain PDAC. This test might aid in the diagnosis of pancreatic cancer by reducing the number of FNAs without a definitive adenocarcinoma diagnosis, thereby reducing the number of repeat EUS-FNA procedures.

[Comparison of technical aspects of colonoscopy in various gastroenterologic centres]. / Porównanie aspektów technicznych kolonoskopii w róznych osrodkach gastrologicznych.

There are ongoing multicenter European trials analyzing, among other factors, technical aspects of colonoscopy in various countries. The aim of the study was to compare the techniques of preparation and performance of colonoscopy in the Department of Gastroenterology at Medical University of Silesia in Katowice and other gastroenterology centers throughout Europe. The trial was conducted between January 1st 2001 and May 30th 2001 in 18 centers in 9 European countries. 307 consecutive patients, who signed consent forms, were recruited in Katowice, while 5697 patients were enrolled in other centers. The data were collected in a dedicated sheet, prepared in the coordinating center in Lausanne (Switzerland). The part concerning methods of bowel preparation was filled in before colonoscopy and the remaining questions (sedation, number of persons involved, duration, completeness, diagnosis, complications) were answered after the procedure. The data from all centers were analyzed in Lausanne and the results were sent back to the participants. The comparison of results from Katowice and other centers was performed in Katowice. We found out, that the type of cleansing the gut did not influence the quality of bowel preparation. Colonoscopy was performed under deep sedation (in the presence of anesthesiologist and anesthesiology nurse) more frequently in Katowice than in other centers. Differences between Katowice and the rest of centers in the other technical aspects of colonoscopy were of minor importance.

[Estimation of appropriateness of colonoscopy using RAND/UCLA method]. / Ocena zasadnosci przeprowadzania kolonoskopii z wykorzystaniem metody RAND/UCLA.

Multicenter European trials estimating appropriateness of colonoscopy are one of the hot topics in gastroenterology. The aim of the study was the estimation of appropriateness of colonoscopy and usefulness of panel experts criteria (elaborated according to RAND/UCLA method) in Department of Gastroenterology of Medical University of Silesia in Katowice and other gastroenterology centers throughout Europe. The trial was conducted between January 1st 2001 and May 30th 2001 in 18 centers in 9 European countries. 307 patients, who signed informed consent, were recruited in Katowice, while 5697 patients were enrolled in the other centers. The data have been collected in a prospective manner on a dedicated sheet, prepared in the coordinating centre in Lausanne (Switzerland). The part of the sheet with evaluation of appropriateness of colonoscopy was filled in before the procedure. The endoscopic (and histopathologic if necessary) diagnosis was collected after the procedure. The data from all centers were analyzed in Lausanne and the results were sent to the participants. The comparison of results from Katowice and of all the other centers was performed in Katowice. We found out, that self-estimation (made by colonoscopist), but also what is much more important the estimation done according to objective criteria of the panel of experts were significantly higher in our department, than in the other participating centers. The overestimation of self-judgment has been significantly higher in the other centers, than in our department. The higher percentage of therapeutic colonoscopies in our department can be responsible for such results.

[Evaluation of probability of bile duct stone presence by using of non-invasive procedures]. / Ocena prawdopodobienstwa wystepowania kamicy zólciowej przewodowej oparta na badaniach nieinwazyjnych.

Precise evaluation of bile duct stones presence in particular moment, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound--US) but also more sophisticated imaging methods (CT or MRI) are frequently useless. The "gold standards" of bile duct stones diagnosis are still endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and surgical choledochotomy. However, the ERCP expose the patients to the risk of some serious complications. The aim of the study was to evaluate the diagnostic capabilities of patients case history data and non-invasive tests (such as biochemistry, ultrasound data) in order to establish a risk scale in cases suspected for common bile duct stones. The investigated group comprised of 135 patients treated from January 1996 through March 1997 in the Department of Gastroenterology Silesian Medical Academy. In patients prospectively enrolled to the study case history and a set of blood biochemical examinations were completed. In following, US was performed. The verification of the biliary tree (done with ERCP with endoscopic sphincterotomy or surgical choledochotomy) was performed. Examiners (US, ERCP) were blind to the other results of a patient. Case history data, laboratory blood tests and US results were used to select parameters significantly differing between patients with and without bile duct stones. Thirteen parameters were tested using Mann-Whitney's and chi 2 tests and four parameters were finally selected. For every selected parameter cut off values (i.e. values best differentiating patients with and without stones) were chosen on the basis of the chi 2 value, 95% confidence interval of risk ratio and Youden's index (gamma-GTP, alanine transaminase, enlarged bile ducts on US, bile duct stones on US). In the next step a set of different combinations of selected parameters was tested to find out the best waged scale for bile duct stones risk diagnosis. Finally, diagnostic efficacy of the best constructed scales and US alone were compared. Constructed risk scales can not be employed in the primary selection of patients, as their positive predictive value is quite high, but negative predictive value is low. US is also not valuable in evaluation of patients suspected for common bile duct stones.

[Digestive tract hemorrhage and recurrent ileus. Peutz-Jeghers syndrome-case report]. / Krwawienie z przewodu pokarmowego i nawrotowa niedroznosc--opis przypadku zespolu Peutz-Jeghersa.

Authors describe a case of 24 years old woman with recurrent lower GI bleeding and mechanical obstruction. Crohn's disease was diagnosed at the beginning. It was impossible to treat the patient's profound anemia with blood transfusions due to her religion believes. The diagnosis of Peutz-Jeghers syndrome was made postoperatively. During operation mechanical obstruction (invagination of terminal ileum into ascending colon) was released. The invagination was caused by 3 cm large polyp localized in terminal ileum. Subsequently, 8 polyps (varying in size between 0.5 and 3 cm) in the small intestine were localized using intraoperative upper GI endoscopy and enteroscopy and finally surgically removed. Typical hamartomas were found on histopathological examination of removed polyps. Authors present modern attitude to Peutz-Jeghers syndrome--its diagnostics, treatment and follow-up.