Falk Gastro Info 3/2014

Video

Endoscopic resection of Barrett’s early carcinoma with a ligation device

Live endoscopy from the HSK Dr. Horst-Schmidt-Kliniken 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: Hendrik Manner, HSK Dr. Horst-Schmidt-Kliniken Wiesbaden, Germany; Pradeep Bhandari, Queen Alexandra Hospital Cosham, Great Britain

This is a case of a 64-year-old patient with long standing reflux disease. At an upper endoscopy, a circumscribed early Barrett’s neoplasia was detected. Subsequent endosonography did not show any involvement of lymph nodes.

Here, an endoscopic resection of the Barrett’s neoplasia with a ligation device is performed. In this case, the final histological diagnosis of the specimen was a moderately differentiated neoplasia extending to the edge of the submucosa without any lymph vessel invasion. Therefore, the endoscopic resection is regarded to be curative in this case.

Take home messages:

Indeed, endoscopic resection is the treatment of choice for most early Barrett’s neoplasias that do not invade deeper than the upper layer of the submucosa.
Some neoplasias are very subtle and hard to demarcate and in these cases auxiliary techniques like chromoendoscopy are highly recommended, in particular chromoendoscopy with acetic acid as it highlights the mucosal details of both, the non-neoplastic and the neoplastic mucosa.
For prediction of local infiltration depth macroscopic evaluation is superior to endosonography.
However, before proceeding to endoscopic resection a complete staging of the tumor is mandatory. This certainly includes endosonographic evaluation of a possible lymph node involvement.

Please switch on your loudspeakers!

Link to Falk Mediacenter:

http://media.falkfoundation.de/index.php?id=69&L=1

Link to the video directly:

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

Preview images:

180 x 116 pixels

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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

Text:

Reinisch W et al, Inflamm Bowel Dis. 2013;19(8):1700–9

In this open-label study, adalimumab was effective for maintaining clinical remission in anti-tumor necrosis factor-naive patients with moderately to severely active ulcerative colitis who did not adequately respond to conventional therapy. Remission rate after 2 weeks treatment is about 30%, response rate about 50%.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24839

Text:

Parikh A et al, Inflamm Bowel Dis. 2013;19(8):1691–9

Vedolizumab, a gut selective antibody to the α4β7-integrin complex, shows efficacy in ulcerative colitis.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24840

Text:

Khan N et al, Inflamm Bowel Dis. 2013;19(6):1123–9

When starting a patient on mesalamine for remission maintenance in ulcerative colitis, there is no difference in the long-term flare risk between low versus high average daily dose as long as the patients have a high to moderate level of adherence.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24841

Text:

Miehlke S et al, Gastroenterology. 2014. DOI: 10.1053/j.gastro.2014.01.019

Oral budesonide (9 mg once daily) is effective and safe for short-term treatment of collagenous colitis, whereas short-term treatment with oral mesalamine (3 g once daily) appears to be ineffective.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24842

Liver
Biliary Tracts

Text:

Lawitz E et al, J Hepatol. 2013;59(1):11–7

An interferon-free 12-week regimen of ABT-450/r and ABT-072 with ribavirin was well tolerated in this pilot study and achieved high sustained viral response rate through 36 weeks of post-treatment observation.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24844

Text:

Kowdley KV et al, Lancet. 2013;381(9883):2100–7

This study suggest that sofosbuvir, an uridine nucleotide analogue selective inhibitor of hepatitis C virus (HCV) NS5B polymerase, is well tolerated and shows promising efficacy in a 12 weeks treatment period in patients with chronic hepatitis C virus genotype-1 infection, including those with cirrhosis.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24845

Text:

Lawitz E et al,J Hepatol. 2013;59(1):18–23

Patients treated with MK-7009 (vaniprevir), a non-covalent competitive inhibitor of the hepatitis C virus (HCV) NS3/4A protease, plus peginterferon-α2a and ribavirin (P/R) experienced significant improvement in sustained viral response compared to P/R control in a population of HCV genotype 1 interferon-experienced patients.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24846

Oesophagus

Stomach

Duodenum

Text:

Solaymani-Dodaran M et al,Gastroenterology. 2013;144(7):1375–83

Among patients with Barrett’s esophagus, approximately 2% will die of esophageal cancer within 10 years. However, patients with Barrett’s esophagus died more frequently of other causes, such as ischemic heart disease.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24847

Text:

Rizzato C et al, Int J Cancer. 2013;133(2):315-22

Single nucleotide polymorphisms in the ABO gene, predictive of ABO blood groups, are associated with risk of advanced precancerous gastric lesions in individuals infected with Helicobacter pylori, but the assessment of the risk is strictly dependent on cagA status.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24848

Text:

Thrift AP et al, Am J Gastroenterol. 2013;108(6):915–22

Risk of Barrett’s esophagus increased linearly with earlier age at onset of frequent gastroesophageal reflux disease (GERD) symptoms. Age at symptom onset may help practitioners decide which patients with GERD symptoms to refer for endoscopic screening for Barrett’s esophagus.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24849

Pancreas

Text:

Oskarsson V et al, Gut. 2013;62(8):1187–92

Vegetable consumption, but not fruit consumption, may play a role in the prevention of non-gallstone-related acute pancreatitis.

Link:

http://www.drfalkpharma.de/index.php?L=1&id=18248#c24850

Current Falk literature:

NEW

Azathioprine in Daily Practice

The Basis of Immunosuppressive Therapy