Endoscopic full thickness resection (EFTR) of colorectal neoplasms with the Full Thickness Resection Device (FTRD): Clinical experience from two tertiary referral centers in Switzerland.

BACKGROUND: Endoscopic full thickness resection (EFTR) by the Full Thickness Resection Device (FTRD) has recently been introduced as a method to allow resection of certain lesions such as adenomatous polyps that would not be resectable by standard polypectomy techniques. We report our clinical experience with FTRD procedures, assessing technical success, completeness of resection (R0 status), rate of histologically proven FTR and safety. PATIENTS AND METHODS: We conducted a retrospective analysis of 33 consecutive patients with colonic polyps treated with FTRD from May 2015 to November 2016. RESULTS: Indications mainly were adenoma recurrence or residual adenoma with nonlifting sign after previous polypectomy. In the 31 cases amenable to EFTR, resection was en bloc and histologically complete (R0) in 87.9% (29/33) of patients. Histologically confirmed complete full thickness resection (FTR) was achieved in 80.6% (25/31). Three post-procedure bleedings and one perforation were seen. CONCLUSION: FTRD offers an additional endoscopic approach to treat nonlifting colorectal lesions. EFTR by FTRD appears to be feasible and efficacious in the resection of benign neoplasms of up to 30 mm in diameter and may be an alternative to surgery in selected patients. Given a significant rate of complications, safety is a concern and needs to be assessed in larger prospective studies.

Acute Herpes Simplex Viral Esophagitis Occurring in 5 Immunocompetent Individuals With Eosinophilic Esophagitis.

Herpes simplex esophagitis (HSE) is an acute, severe viral infection of the esophagus, rarely occurring in immunocompetent individuals. Eosinophilic esophagitis (EoE) is a rare immune-mediated esophageal disorder. We recently observed 5 severe HSE cases in diagnosed EoE patients. Four of the 5 patients had active, untreated EoE at the time of infection, so HSE is not likely a side effect of swallowed topical corticosteroids, the first-line medical treatment of EoE. However, this coincidence of these 2 rare conditions raises the question of a causal relationship between these 2 forms of esophagitis, and whether active EoE might predispose to HSE infection.

[Imaging studies in the diagnosis of functional abdominal disorders]. / Bildgebung bei unspezifischen Abdominalbeschwerden.

Functional abdominal disorders are predominantly diagnosed on the basis of a thorough history and clinical examination. It is a challenge to clinicians to define the adequate place of imaging studies in order to rule out relevant organic disease. In functional dyspepsia, oesphago-gastroduodensoscopy and abdominal ultrasound are widely used as first line studies. Although irritable bowel syndrome is mainly diagnosed on clinical grounds, in patients over 50 years of age colonoscopy is almost mandatory, taking into account the importance of screening for colorectal cancer. In constipation-dominant irritable bowel syndrome, a marker study to determine colonic transit time will be helpful to differentiate this disorder from true slow transit constipation. Chronic or recurrent abdominal pain often warrants abdominal CT scan. Select cases are referred for laparoscopy.

Accuracy of four fecal assays in the diagnosis of colitis.

PURPOSE: This study was designed to evaluate the accuracy of four different fecal markers in discriminating between irritable bowel syndrome, inflammatory bowel disease, and other forms of colitis and to examine the feasibility of collecting fecal samples in outpatients. METHODS: We prospectively included 20 patients with irritable bowel syndrome, 36 with inflammatory bowel disease (24 Crohn's disease, 12 ulcerative colitis), and 18 with other forms of colitis (8 infectious colitis, 5 ischemic colitis, 5 medication-induced colitis). Diagnosis was established by clinical, laboratory, and endoscopic workup. Blinded fecal samples were measured for calprotectin (PhiCal-Test, ELISA), lactoferrin (IBD-SCAN, ELISA), Hexagon OBTI (immunochromatographic test for detection of human hemoglobin), and LEUKO-TEST (lactoferrin latex-agglutination test). RESULTS: Overall accuracy for discriminating irritable bowel syndrome from inflammatory bowel disease or other forms of colitis was recorded, respectively: IBD-SCAN 91/100 percent, PhiCal-Test 89/100 percent, LEUKO-TEST 83/89 percent, Hexagon OBTI 77/84 percent, C-reactive protein 71/79 percent, and blood leukocytes 63/68 percent. Differentiation of inflammatory bowel disease from other forms of colitis with fecal markers was as follows: range of overall accuracy from 43 to 50 percent. Overall accuracy (in percent) for discrimination of irritable bowel syndrome from patients with Crohn's disease in remission (CDAI<150) was: IBD-SCAN 90, PhiCal-Test 90, LEUKO-TEST 85, Hexagon OBTI 77. Calprotectin and lactoferrin were significantly elevated in patients with Crohn's disease with CDAI>150 compared with those in remission. Fecal sampling feasibility in outpatients was high (acceptance rate 95 percent). CONCLUSIONS: IBD-SCAN and PhiCal-Test have the best overall accuracy for detection of colitis, followed by LEUKO-TEST, Hexagon OBTI, C-reactive protein, and blood leukocytes. Accuracy of fecal markers is high even in patients with Crohn's disease in remission. Fecal sampling feasibility was high in outpatients. Because fecal markers are unspecific, endoscopic workup remains crucial to determine the underlying cause of colitis.

Herbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products.

BACKGROUND/AIMS: Herbal agents are popular and perceived as safe because they are supposedly 'natural'. We report 10 cases of toxic hepatitis implicating Herbalife products. METHODS: To determine the prevalence and outcome of hepatotoxicity due to Herbalife products. A questionnaire was sent to all public Swiss hospitals. Reported cases were subjected to causality assessment using the CIOMS criteria. RESULTS: Twelve cases of toxic hepatitis implicating Herbalife preparations (1998-2004) were retrieved, 10 sufficiently documented to permit causality analysis. Median age of patients was 51 years (range 30-69) and latency to onset was 5 months (0.5-144). Liver biopsy (7/10) showed hepatic necrosis, marked lymphocytic/eosinophilic infiltration and cholestasis in five patients. One patient with fulminant liver failure was successfully transplanted; the explant showed giant cell hepatitis. Sinusoidal obstruction syndrome was observed in one case. Three patients without liver biopsy presented with hepatocellular (2) or mixed (1) liver injury. Causality assessment of adverse drug reaction was classified as certain in two, probable in seven and possible in one case(s), respectively. CONCLUSIONS: We present a case series of toxic hepatitis implicating Herbalife products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable.