[Experimental study on the resistance to intraluminal pressure between handsewn and stapled anastomosis. In vitro experimental study]. / A bélrendszer kézi és gépi anastomosisainak nyomással szembeni ellenálló képességének felmérése. In vitro kísérletes tanulmány.

Intoduction and aim: The aim of the study was to compare the resistance to pressure of stapled and manually handsewn intestinal suture lines on in vitro pig intestine model. METHOD: We performed different types of stapled and manual sutures and the pressure level was measured using a differential pressure manometer. RESULTS: Although the hand-sewn end-to-end suture turned out to be the most resistant to pressure, statistical analysis revealed no significant differences compared to stapled suture (p = 0.49). In stump closure techniques, we observed a statistically high significance in resistance to pressure in the favour of manual stump closure (p = 0.004).Regarding side-to-side sutures we did not find any statistically significant differences in resistance to pressure between the techniques (p = 0.06). CONCLUSION: We can conclude that regarding the stump closure, the most resistant to pressure is the hand-sewn procedure, but in the other types of anastomosis, no significant differences was found between the stapled and hand-sewn techniques. Orv Hetil. 2017; 158(42): 1674-1680.

A preliminary feasibility study: Narrow-band imaging targeted versus standard white light endoscopy non-targeted biopsies in a surveillance Barrett's population.

BACKGROUND: Narrow band imaging (NBI) is used in the detection of intestinal metaplasia (IM) and dysplasia in patients with Barrett's oesophagus (BE). AIMS: The study compared the usefulness of NBI with white-light standard endoscopy (WLSE) for the detection of dysplasia and IM in BE and determined the prediction of the histological diagnosis according to the mucosal and vascular patterns obtained by NBI. PATIENTS AND METHODS: A total of 84 patients were prospectively enrolled in the study. Every patient underwent a WLSE with random biopsies and after 4-6 weeks, a NBI examination was performed. RESULTS: NBI detected significant more IM positive biopsies than WLSE (74.5% vs. 35.9%; p<0.0001) and significant more patients with low grade dysplasia (LGD) (7.1% vs. 0%; p=0.03). Taking biopsy samples from the villous pattern determined the diagnosis of IM (80%) and biopsies from the area covered by the irregular pattern lead to the identification of LGD in 45.4% of the cases and indefinite dysplasia (ID) in 18.2% of the cases. CONCLUSION: A thorough analysis of NBI patterns may lead to real-time IM diagnosis in the absence of the histological examination and may require targeted biopsies from the areas with an irregular pattern for diagnosing dysplasia.

Indications of a Defunctioning Stoma in Colorectal Anastomosis--Our Experience and Review of the Literature.

BACKGROUND: Defunctioning stomas can prevent consequences of anastomotic leakage, but they are not free of complications. OBJECTIVES: The identification of high-risk patients to establish criteria for strong and relative indications for the formation of a defunctioning stoma. METHODS: Two hundred fifty consecutive colorectal anastomoses were performed between 2004 and 2015; 95.2% of these were for colorectal cancer. In 130 cases, mechanical anastomosis was used. A protective stoma was performed in only 15 cases. The incidence of anastomotic leakage was evaluated according to multiple parameters, as were the postoperative complications related to protective stomas. The outcomes were compared to those reported in the literature. RESULTS: Symptomatic anastomotic leakage occurred in six patients (2.4%) and resulted in four deaths. None of the patients with a protective stoma developed serious complications related to the colorectal anastomosis. However, serious ileostomy-related complications occurred in two cases (15.38%). CONCLUSIONS: Protective stomas should be used only according to the risk criteria of the patients. Strong indications are: anastomotic imperfections, anastomosis under tension, previous pelvic irradiation, ultralow anastomosis in patients older than 70 years, patients over 80 years, and significant co-morbidities.

Barrett's esophagus and intestinal metaplasia of gastric cardia: prevalence, clinical, endoscopic and histological features.

BACKGROUND & AIMS: Over the past few decades, the incidence of adenocarcinomas of the gastroesophageal junction has rapidly increased. Barrett's esophagus is a risk factor for esophageal adenocarcinoma, but the role of intestinal metaplasia of the gastric cardia as a precursor in cardia-related cancer is controversial. The aims of the present study were to examine the prevalence of intestinal metaplasia in the gastroesophageal junction and to evaluate the clinical, endoscopical and histological features of patients with intestinal metaplasia in the gastric cardia and patients with Barrett's esophagus. METHODS: 286 consecutive patients undergoing gastroduodenoscopy were enrolled in a prospective study. Biopsy specimens were performed in the distal esophagus, squamocolumnar junction, gastric cardia, gastric corpus and antrum. RESULTS: We identified 44 patients (15.3%) with intestinal metaplasia in biopsies from gastric cardia and 24 patients (8.3%) with Barrett's esophagus. Cardia intestinal metaplasia was significantly associated with older age (p=0.03), with intestinal metaplasia in the antrum (p=0.017) and H. pylori infection (p<0.0001). Severe chronic cardia inflammation increased the presence of cardia intestinal metaplasia 6.2 fold (OR=6.288; p<0.0001). Patients with Barrett's esophagus were predominantly men. Barrett's esophagus presence significantly correlated with reflux symptoms(p<0.0001), endoscopic esophagitis (p<0.0001) and hiatal hernia >2 cm (p=0.002). No patient had dysplasia in the gastroesophageal region. CONCLUSIONS: Presence of intestinal metaplasia at the gastroesophageal region correlated with reflux symptoms and endoscopic signs of reflux disease in patients with Barrett's esophagus and with H.pylori infection and distal intestinal metaplasia in patients with cardia intestinal metaplasia.