Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer.

BACKGROUND: Self-expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used. OBJECTIVE: The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy. METHODS: Single centre, retrospective analysis of all patients (n = 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo-radiotherapy, treated with SEMS (n = 160) or APC (n = 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan-Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log-rank test. RESULTS: Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13-1.65 of SEMS over APC, p: 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p = 0.02 and 0.05 respectively). CONCLUSIONS: APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo-radiotherapy. A randomized controlled trial will be needed to confirm those results.

Update of endoscopy in liver disease: more than just treating varices.

The management of complications in liver disease is often complex and challenging. Endoscopy has undergone a period of rapid expansion with numerous novel and specialized endoscopic modalities that are of increasing value in the investigation and management of the patient with liver disease. In this review, relevant literature search and expert opinions have been used to provide a brief overview and update of the current endoscopic management of patients with liver disease and portal hypertension. The main areas covered are safety of endoscopy in patients with liver disease, the use of standard endoscopy for the treatment of varices and the role of new endoscopic modalities such as endoscopic ultrasound, esophageal capsule, argon plasma coagulation, spyglass and endomicroscopy in the investigation and treatment of liver-related gastrointestinal and biliary pathology. It is clear that the role of the endoscopy in liver disease is well beyond that of just treating varices. As the technology in endoscopy expands, so does the role of the endoscopist in liver disease.

Chromoendoscopy in small bowel capsule endoscopy: Blue mode or Fuji Intelligent Colour Enhancement?

INTRODUCTION: Virtual chromoendoscopy is used to enhance surface patterns and colour differences. One type of virtual chromoendoscopy is the Fuji Intelligent Colour Enhancement (FICE). Although widely applied in conventional endoscopy, data on FICE application in capsule endoscopy are limited. Furthermore, the validity of Blue filter (feature of RAPID(®) software) has not been examined. AIM/S: We aimed to qualitatively evaluate the use of FICE and Blue filter enhancement, in images of lesions obtained during small bowel capsule endoscopy, comparing them with similar, conventional (white light) images. METHODS: A total of 167 images (6 different lesion categories) obtained from 200 capsule endoscopy examinations. Two gastroenterologists examined the images with white light, FICE and Blue filter in regards to the visibility of blood vessels, the contrast of the mucosal surface, and the demarcation of lesion borders. The agreed scores were: improved, similar, worse. Inter-observer agreement was calculated. RESULTS: For all lesion categories, Blue filter provided image improvement (compared to white light) in 83%, (inter-observer agreement: 0.786). With FICE 1, improvement was observed in 34%, worse image in 55.9%, (inter-observer agreement: 0.646). With FICE 2, improvement was observed in 8.6%, worse in 77.5%, (inter-observer agreement: 0.617). With FICE 3, improvement was seen in 7.7%, worse in 79.9% (inter-observer agreement: 0.669). CONCLUSION: Comparing with FICE, Blue filter offers better image enhancement in capsule endoscopy.