AIM:To investigate the potential benef it of Fujinon in-telligent chromo endoscopy(FICE)-assisted small bowel capsule endoscopy(SBCE)for detection and character-ization of small bowel lesions in patients with obscure ...AIM:To investigate the potential benef it of Fujinon in-telligent chromo endoscopy(FICE)-assisted small bowel capsule endoscopy(SBCE)for detection and character-ization of small bowel lesions in patients with obscure gastroenterology bleeding(OGIB).METHODS:The SBCE examinations(Pillcam SB2,Giv-en Imaging Ltd)were retrospectively analyzed by two GI fellows(observers)with and without FICE enhance-ment.Randomization was such that a fellow did not assess the same examination with and without FICE enhancement.The senior consultant described f indings as P0,P1 and P2 lesions(non-pathological,intermedi-ate bleed potential,high bleed potential),which were considered as reference f indings.Main outcome mea-surements:Inter-observer correlation was calculated using kappa statistics.Sensitivity and specif icity for P2 lesions was calculated for FICE and white light SBCE.RESULTS:In 60 patients,the intra-class kappa cor-relations between the observers and reference f indings were 0.88 and 0.92(P2),0.61 and 0.79(P1),for SBCE using FICE and white light,respectively.Overall 157 le-sions were diagnosed using FICE as compared to 114 with white light SBCE(P = 0.15).For P2 lesions,the sensitivity was 94% vs 97% and specif icity was 95% vs 96% for FICE and white light,respectively.Five(P2 le-sions)out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE.Significantly more P0 lesions were diagnosed when FICE was used as compared to white light(39 vs 8,P < 0.001).CONCLUSION:FICE was not better than white light for diagnosing and characterizing signif icant lesions on SBCE for OGIB.FICE detected signif icantly more non-pathological lesions.Nevertheless,some vascular le-sions could be more accurately characterized with FICE as compared to white light SBCE.展开更多
AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digest...AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digestive endoscopy.RESULTS:The response rate was 24.5%.Fewer than half the respondents(66/142,46.5%)were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy,and 4.2%of respondents were actually using CO2 as the insufflation agent.Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice(84%and 49%of answers,respectively;two answers were permitted for this item).CONCLUSION:Based on this survey,adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional.A majority of endoscopists were not aware of this possibility,while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is the fourth leading cause of cancer-related death in the industrialized world.Despite progress in the understanding of the molecular and genetic basis of this disease,the5-year ...Pancreatic ductal adenocarcinoma(PDAC)is the fourth leading cause of cancer-related death in the industrialized world.Despite progress in the understanding of the molecular and genetic basis of this disease,the5-year survival rate has remained low and usually does not exceed 5%.Only 20%-25%of patients present with potentially resectable disease and surgery represents the only chance for a cure.After decades of gemcitabine hegemony and limited therapeutic options,more active chemotherapies are emerging in advanced PDAC,like 5-Fluorouracil,folinic acid,irinotecan and oxaliplatin and nab-paclitaxel plus gemcitabine,that have profoundly impacted therapeutic possibilities.PDAC is considered a systemic disease because of the high rate of relapse after curative surgery in patients with resectable disease at diagnosis.Neoadjuvant strategies in resectable,borderline resectable,or locally advanced pancreatic cancer may improve outcomes.Incorporation of tissue biomarker testing and imaging techniques into preoperative strategies should allow clinicians to identify patients who may ultimately achieve curative benefit from surgery.This review summarizes current knowledge of adjuvant and neoadjuvant treatment for PDAC and discusses the rationale for moving from adjuvant to preoperative and perioperative therapeutic strategies in the current era of more active chemotherapies and personalized medicine.We also discuss the integration of good specimen collection,tissue biomarkers,and imaging tools into newly designed preoperative and perioperative strategies.展开更多
文摘AIM:To investigate the potential benef it of Fujinon in-telligent chromo endoscopy(FICE)-assisted small bowel capsule endoscopy(SBCE)for detection and character-ization of small bowel lesions in patients with obscure gastroenterology bleeding(OGIB).METHODS:The SBCE examinations(Pillcam SB2,Giv-en Imaging Ltd)were retrospectively analyzed by two GI fellows(observers)with and without FICE enhance-ment.Randomization was such that a fellow did not assess the same examination with and without FICE enhancement.The senior consultant described f indings as P0,P1 and P2 lesions(non-pathological,intermedi-ate bleed potential,high bleed potential),which were considered as reference f indings.Main outcome mea-surements:Inter-observer correlation was calculated using kappa statistics.Sensitivity and specif icity for P2 lesions was calculated for FICE and white light SBCE.RESULTS:In 60 patients,the intra-class kappa cor-relations between the observers and reference f indings were 0.88 and 0.92(P2),0.61 and 0.79(P1),for SBCE using FICE and white light,respectively.Overall 157 le-sions were diagnosed using FICE as compared to 114 with white light SBCE(P = 0.15).For P2 lesions,the sensitivity was 94% vs 97% and specif icity was 95% vs 96% for FICE and white light,respectively.Five(P2 le-sions)out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE.Significantly more P0 lesions were diagnosed when FICE was used as compared to white light(39 vs 8,P < 0.001).CONCLUSION:FICE was not better than white light for diagnosing and characterizing signif icant lesions on SBCE for OGIB.FICE detected signif icantly more non-pathological lesions.Nevertheless,some vascular le-sions could be more accurately characterized with FICE as compared to white light SBCE.
文摘AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digestive endoscopy.RESULTS:The response rate was 24.5%.Fewer than half the respondents(66/142,46.5%)were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy,and 4.2%of respondents were actually using CO2 as the insufflation agent.Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice(84%and 49%of answers,respectively;two answers were permitted for this item).CONCLUSION:Based on this survey,adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional.A majority of endoscopists were not aware of this possibility,while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.
基金Supported by Grants from Fonds Erasme,ULB,Brussels(to Francesco Puleo)
文摘Pancreatic ductal adenocarcinoma(PDAC)is the fourth leading cause of cancer-related death in the industrialized world.Despite progress in the understanding of the molecular and genetic basis of this disease,the5-year survival rate has remained low and usually does not exceed 5%.Only 20%-25%of patients present with potentially resectable disease and surgery represents the only chance for a cure.After decades of gemcitabine hegemony and limited therapeutic options,more active chemotherapies are emerging in advanced PDAC,like 5-Fluorouracil,folinic acid,irinotecan and oxaliplatin and nab-paclitaxel plus gemcitabine,that have profoundly impacted therapeutic possibilities.PDAC is considered a systemic disease because of the high rate of relapse after curative surgery in patients with resectable disease at diagnosis.Neoadjuvant strategies in resectable,borderline resectable,or locally advanced pancreatic cancer may improve outcomes.Incorporation of tissue biomarker testing and imaging techniques into preoperative strategies should allow clinicians to identify patients who may ultimately achieve curative benefit from surgery.This review summarizes current knowledge of adjuvant and neoadjuvant treatment for PDAC and discusses the rationale for moving from adjuvant to preoperative and perioperative therapeutic strategies in the current era of more active chemotherapies and personalized medicine.We also discuss the integration of good specimen collection,tissue biomarkers,and imaging tools into newly designed preoperative and perioperative strategies.
