The efficacy of a computer alert programme for increasing HBV screening rates before starting immunosuppressive therapy.

BACKGROUND AND AIM: Hepatitis B Virus (HBV) screening before starting immunosuppressive treatment is of vital importance in order to prevent HBV reactivation and its associated clinical consequences. Despite all recommendations by international organizations, screening rates are far below desired. The aim of this study was to assess the efficacy of a computer alert programme 'HBVision' for increasing HBV screening rates. MATERIAL AND METHODS: 'HBVision' identifies patients at risk of HBV reactivation by specific ICD-10 codes and immunosuppressive medication reports and sends sequential alert messages to screen for HBsAg, anti-HBc IgG and consult a specialist if one of them is positive. The demographic variables, treatment protocols, HBV screening and consultation rates of oncology and hematology patients who started immunosuppressive treatments within one year before (control group) and after "HBVision" (study group) were retrospectively compared. RESULTS: HBsAg and anti-HBc IgG screening rates (68.6% and 13.1%, respectively) were significantly higher in the study group (n=602) compared to control group (n=815) (55% and 4.3%, respectively) (p<0.001, for both). Subgroup analysis revealed significant improvements in the screening rates of HBsAg (65.8%) and anti-HBc IgG (5.1%) in oncology patients (p<0.001), anti-HBc IgG (89.1%) in hematology patients (p<0.001). CONCLUSION: The computer alert programme significantly increased HBV screening rates before starting immunosuppressive treatments, however the results were still below ideal. Additional efforts, such as modifying the computer programme according to feedbacks, are probably needed.

Long term efficacy of pegylated interferone in the treatment of delta hepatitis: a single center experience.

BACKGROUND AND AIM: Currently there is no satisfactory treatment of chronic HDV. We aimed to evaluate the long term efficacy of PEG-interferones. PATIENTS METHODS: Patients who received PEG-interferone for chronic delta hepatitis during a 7-year period were retrospectively analysed. End of treatment response, virologic response at 6 months after treatment, and long term efficacy were evaluated. Predictors of treatment response were determined. RESULTS: The study group consisted of 31 patients. Twenty-three patients received either PEG-interferone alfa-2a (n=8) or PEG-interferone alfa-2b (n=15) for at least 48 weeks. Thirteen patients had an end of treatment virologic response (ITT:56.5%, PP:68.4%). HDV RNA negativity after 6 months off PEG-interferone treatment was achieved in 12 patients (ITT:52.1%, PP:63.1%). The patients were followed for a median duration of 36 months after PEG-interferone treatment (min-max:12-120 months). Four patients (33.3%) relapsed during the follow-up. Sustained virologic response (ITT) was 34.8% in the long term. Undetectable HDV RNA level at week 24 of treatment and biochemical response were independent predictors of end of treatment response and sustained virologic response in the long term, respectively. CONCLUSION: PEG-interferones have an unsatisfactory efficacy on the treatment of HDV because of a considerable relapse in the long term. (Acta gastro-enterol. belg., 2016, 79, 329-335).

Prevalence of advanced histologic features in diminutive colon polyps.

BACKGROUND/AIMS: Accurate in vivo differentiation of colon polyp histology may serve to prevent the resection of diminutive hyperplastic polyps in the distal colon or the need for histologic assesment of diminutive polyps after resection. The clinical implementation of these strategies depends on the prevalence of advanced histologic findings among diminutive polyps. We aimed to determine the prevalence of advanced histologic features (villous features, high-grade dysplasia, and adenocarcinoma) in diminutive colon polyps and compare it to small and larger polyps. PATIENTS/METHODS: The data of patients who had undergone elective colonoscopy at a tertiary-care referral center were retrospectively reviewed. The size, morphology, and location of all polyps were recorded. Polyps were divided into 3 groups according to their size: diminutive (≤ 5 mm), small (6-9 mm), and large (≥ 10 mm). RESULTS: A total of 7160 polyps in 3226 eligible patients were evaluated. The mean diameter of the polyps were 6.7 ± 4.9 mm. Histopathologic diagnosis were adenomatous in 4548 (63.5%) and non-adenomatous in 2612 (36.5%). Out of 7160 polyps, 4902 (68.5%) were diminutive (1-5 mm), 1360 (19%) were small (6-9 mm), and 898 (12.5%) large (≥ 10 mm) polyps. Among the diminutive polyps 2739 (55.9%) had adenomatous histology. There were 66 polyps (1.3%) with advanced histology in the diminutive group, 72 (5.2%) in the small group, 263 (29.2%) in the large polyp group. Diminutive polyps had a lower frequency of advanced histology compared to small and large polyps (p = 0.001). When the histology of the polyps were evaluated based on the size of the largest polyp the patient has, 2202 patients had polyp(s) ≤ 5 mm. The frequency of advanced histology was 2.2% in these patients. CONCLUSIONS: The prevalence of advanced histology in diminutive polyps is quite low (1.3%) which supports the clinical implementation of discard, resect and discard strategies in diminutive polyps.

Retrograde dilation of a complex radiation-induced esophageal stricture through percutaneous gastrostomy.

Upper esophageal strictures occur in approximately 3-4% of patients who receive radiotherapy for head and neck cancers. The standart initial treatment is dilation by using bougie or through-the-scope balloon dilators. Endoscopic treatment requires the passage of a guidewire through the stricture which cannot be accomplished in some of the patients with complex strictures. Retrograde dilation of esophageal strictures through a mature percutaneous gastrostomy tract have been reported in a limited number of cases and small case series up to date and can be considered as a rescue treatment before considering surgery in such patients. Herein we report retrograde dilatation of a radiation-induced complex esophageal stricture through the percutaneous gastrostomy tract in a patient with operated larynx cancer.

Spontaneous abdominal esophageal perforation in a patient with mitochondrial neurogastrointestinal encephalomyopathy.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive multisystem disorder caused by thymidine phosphorylase deficiency. Severe denutrition is almost constant during the course of the disease which leads to severe malnutrition and requires long-term parenteral nutrition in most cases. Patients with MNGIE syndrome and chronic intestinal pseudo-obstruction have a particularly poor prognosis and they usually die around 40 years of age. Gastrointestinal perforation associated with MNGIE is extremely rare. Herein we present our unique case with MNGIE associated abdominal esophageal perforation.

Endoscopic treatment of pancreatic fistulas.

BACKGROUND: Pancreatic fistulas are managed primarily by conservative treatment. Surgery is performed in cases of conservative treatment failure. Endoscopic treatment is reported to be both effective and safe as an alternative treatment method. METHODS: A total of 26 patients underwent endoscopic treatment after failure of conservative treatment between January 2002 and November 2004. The mean time between the onset of fistula and the endoscopic retrograde cholangiopancreatography (ERCP) procedure was 95 days. The mean fistula output volume was 400 ml per day. Four patients had pancreatic ascites. The aim of the endoscopic treatment was to bypass the ductal disruption by placing stents or drains where the origin of fistulous tract could be identified, and to lower the pancreatic duct pressure by performing pancreatic sphincterotomy or by placing stents where the site of the leak could not be identified. RESULTS: Pancreatography could be performed in all the patients except one. Partial duct disruption occurred in 16 patients. All of the fistulas closed after the ductal disruption was bypassed. Pancreatic sphincterotomy or endoprothesis placement was effective for eight of the remaining nine patients in whom the ductal disruption originated from the tail of the pancreas and hence could not be bypassed. The overall success rate was 94% for the patients with partial duct disruption. Four patients had side branch leaks. All of them closed after placement of an endoprothesis. Fistulas closed in only one (20%) of the five patients with complete duct disruption. Pancreatic ascites resolved in two of the four patients after endoscopic treatment. No serious complications resulted from endoscopic treatment other than proximally migrated stents in two patients. CONCLUSIONS: Endoscopic treatment is an effective and safe method for patients with pancreatic fistulas unresponsive to conservative treatment. The success rate is very high, especially for patients with partial and side branch duct disruption.