Falk Gastro Info 1/2014

Video

ERCP with ballon dilation of the papilla and subsequent cholangioscopy with electro-hydraulic lithotripsy of the bile duct stone

Live endoscopy from the HSK Dr. Horst Schmidt Hospitals in Wiesbaden in collaboration with „Video Journal and Encyclopedia of GI Endoscopy“. Recording in the context of the Falk Symposium 185 „Interfaces and Controversies in Gastroenterology“ on October 3rd – 4th, 2012.

Presented by:

Jürgen Pohl, HSK Dr. Horst-Schmidt-Kliniken Wiesbaden, Germany;

Chris Mulder, Vrieje Universiteit Amsterdam, The Netherlands

Summary:

This is the case of a 69-year-old woman with jaundice and intermittent abdominal pain. ERCP in this patient showed an impacted bile duct stone that could not be retrieved. An attempt to capture the stone with a lithotripsy basket also failed.

In a next step, ERCP with balloon dilation of the papilla is performed to obtain adequate access for direct cholangioscopy and subsequent electrohydraulic lithotripsy of the stone.

Take home messages:

Direct cholangioscopy is an easy and attractive technique for evaluation and treatment of pathologies in the common bile duct. It is also very useful for electrohydraulic lithotripsy of bile duct stones under direct visualization.
To reduce the potential risk of common bile duct injury there are a few important advices:The first is: Always keep intraductal gas insufflation at an absolute minimum.
Moreover, it is strongly advised to perform a decent sphincterotomy that might be combined with balloon dilation up to 10 mm prior to cholangioscopy.
This allows adequate efflux of the gas and might prevent a ventile effect with subsequent gas embolization.

Please switch on your loudspeakers!

Link to Falk Mediacenter:

http://media.falkfoundation.de/index.php?id=84&L=1

Link to the video directly:

http://media.drfalkpharma.de/fileadmin/media/130502_EHL_FINAL.mp4

Preview images:

580 x 350 pixels

http://www.drfalkpharma.de/fileadmin/media/Video/ERCP_Ballondilatation_580.png

Latest research in brief:

Description field (to be displayed at the end of the structural element):

Editor: Prof. W. Kreisel, Medical University Hospital, 79106 Freiburg, Germany

Bowel

http://www.drfalkpharma.de/fileadmin/media/logos_falk/abstracts/Bowel-Logo-FGR.gif

Text:

Lutgens MWMD et al, Inflamm Bowel Dis. 2013;19(4):789–99

The risk of colorectal cancer in patients with inflammatory bowel disease is declining. However, the risk of colorectal cancer is significantly higher in patients with longer disease duration, extensive disease, and inflammatory bowel disease diagnosis at young age.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24218

Text:

Casanova MJ et al, Am J Gastroenterol. 2013;108(3):433–40

The treatment with thiopurines and anti-TNF-antibodies does not seem to increase the risk of complications during pregnancy and does seem to be safe for the newborn.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24219

Text:

van Schaik FDM et al, Gut. 2013;62(5):683–8

A panel of serological markers is able to predict the development of Crohn’s disease and ulcerative colitis in individuals from a low-risk population.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24222

Liver
Biliary Tracts

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Text:

Kumada T et al, J Hepatol. 2013;58(3):427–33

Nucleos(t)ide analogue therapy reduces the risk of hepatocellular carcinoma in patients with chronic hepatitis B.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24220

Text:

Ogawa E et al, J Hepatol. 2013;58(3):495–501

Sustained virological response and complete viral suppression during treatment with relapse (transient virological response) were associated with a lower risk of hepatocellular carcinoma development when compared with non-virological response.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24217

Text:

Terrault NA et al, Hepatology. 2013;57(3):881–9

Among monogamous heterosexual couples the risk of HCV transmission is extremely low, it amounts to 0.07% per year.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24221

Oesophagus

Stomach

Duodenum

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Text:

Chan FKL et al, Gastroenterology. 2013;144(3):528–35

The long-term incidence of recurrent ulcer bleeding with low-dose aspirin (ASA) use is low after Helicobacter pylori infection is eradicated. ASA users without current or past Helicobacter pylori infections who develop ulcer bleeding have a high risk of recurrent bleeding. Tests for Helicobacter pylori infection can be used to assign high-risk ASA users to groups that require different gastroprotective strategies.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24213

Text:

Zhou X et al, Eur J Gastroenterol Hepatol. 2013;25(4):460–8

These data suggest that asthmatics have a significantly lower rate of Helicobacter pylori infection. Further studies should be carried out to determine the relation between this bacterium and allergic disorders.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24223

Text:

Kastelein F et al, Clin Gastroenterol Hepatol. 2013;11(4):382–8

In this multicenter prospective cohort study, proton-pump inhibitor use was associated with a reduced risk of neoplastic progression in patients with Barrett’s esophagus.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24216

Pancreas

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Text:

Sadr-Azodi O et al, JAMA Intern Med. 2013;173(6):444–9

Current oral glucocorticoid use is associated with a slightly increased risk of acute pancreatitis.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18004#c24215

Current Falk literature:

Diet and Nutrition in

Crohn’s Disease and