US_Gastro_PaperAbs.qxp 15/10/07 5:09 pm Page 13
Paper Abstracts
A Selection of Significant Papers from the Past Year as
Recommended by the Advisory Panel
Impact of Surgeon Volume and Narrow-band Imaging Compared with patient values were 53 and 38%, respectively,
Specialization on Short-term Outcomes Conventional Colonoscopy for the whereas the values for agreement within a 2cm
in Colorectal Cancer Surgery Detection of Dysplasia in Patients with interval were 97 and 95%, respectively. The
Borowski DW, et al. Longstanding Ulcerative Colitis overall RC for endoscopic recognition of BE ≥1cm
Br J Surg, 2007;94(7):880–89. Dekker E was 0.72, whereas for BE <1cm it was 0.22. The
This study examined a population-based audit of Endoscopy, 2007;39:216–21. RCs for recognizing the location of the
8,219 patients with colorectal cancer managed Forty-two patients with long-standing ulcerative gastroesophageal junction and the diaphragmatic
by surgeons between 1998 and 2002. It aimed to colitis underwent narrow-band imaging (NBI) hiatus were 0.88 and 0.85, respectively. ■
determine the impact of surgeon volume and and conventional colonoscopy with at least three
specialization on primary tumor resection rate, weeks between the procedures. The number of Long-term Proton Pump Inhibitor
restoration of bowel continuity following rectal patients with neoplasia detected by targeted Therapy and Risk of Hip Fracture
cancer resection, anastomotical leakage, and biopsies was used to assess the sensitivity of Yang YX, et al.
peri-operative mortality. Tumor resection was each technique. With NBI, 52 suspicious lesions JAMA, 2006;296:2947–53.
performed in 6,949 of 7,411 patients (93.8%). were detected in 17 patients compared with 28 Proton pump inhibitors (PPIs) may interfere with
High-volume surgeons with an annual caseload suspicious lesions in 13 patients detected during calcium absorption through induction of
of at least 18.5 (odds ratio (OR) 1.53, 95% conventional colonoscopy. Histopathological hypochlorhydria, but they also may reduce bone
confidence interval (CI) 1.10–2.12; p=0.012) and evaluation of targeted biopsies revealed 11 resorption through inhibition of osteoclastic
colorectal specialists (OR 1.42, 95% CI patients with neoplasia: in four patients the vacuolar proton pumps. This study was conducted
1.06–1.90; p=0.018) were more likely to perform neoplasia was detected by both techniques; in to determine the association between PPI therapy
elective sphincter-saving rectal surgery. In elective four patients neoplasia was detected only by and risk of hip fracture. The study cohort consisted
surgery, the risk of peri-operative death was NBI; and in three patients neoplasia was of users of PPI therapy and non-users of acid-
lower for high-volume surgeons (OR 0.58, 95% detected only by conventional colonoscopy. The suppression drugs who were over 50 years of age.
CI 0.44–0.76; p<0.001), but this was not the sensitivity of the studied first-generation NBI Cases included all patients with an incident hip
case in emergency surgery. The study concluded system for the detection of patients with fracture. Controls were selected using incidence
that high-volume surgeons had lower peri- neoplasia seems to be comparable to density sampling, matched for sex, index date,
operative mortality rates for elective surgery. ■ conventional colonoscopy, although more year of birth, and both calendar period and
suspicious lesions were found during NBI. ■ duration of up-to-standard follow-up before the
Curative Endoscopic Resection of index date. The results showed that the risk of hip
Early Esophageal Adenocarcinomas The Development and Validation of an fracture was significantly increased among
(Barrett’s Cancer) Endoscopic Grading System for Barrett’s patients prescribed long-term high-dose PPIs. ■
Ell C, et al. Esophagus: the Prague C & M Criteria
Gastrointest Endosc, 2007;65(1):3–10. Sharma P, et al. Ileal Pouch–Anal Anastomosis
A single-center prospective study was conducted Gastroenterology, 2006;131(5):1392–9 McGuire BB, et al.
to evaluate the efficacy and safety of endoscopic An international working group agreed on criteria Br J Surg, 2007;7:812–23(12).
resection in patients undergoing surgery for for the endoscopic diagnosis and grading of Construction of an ileal pouch reservoir is now
adenocarcinoma in Barrett’s esophagus. A total of Barret’s esophagus (BE). The group developed standard. For restorative proctocolectomy with
100 patients (mean age: 62.1±10.9 years; range: materials for their formal evaluation using video- ileoanal anastomosis, this is usually in the form of a
31–86 years) with low-risk adenocarcinoma of the endoscopic recordings gathered in a standardized J pouch (ileal pouch–anal anastomosis, IPAA). The
esophagus arising in Barrett’s metaplasia were manner in 29 patients. The criteria included authors of this report reviewed literature on the
included. Complete local remission was achieved assessment of the circumferential (C) and clinical indications, surgical technique, morbidity,
in 99 of the 100 patients after 1.9 months (range: maximum (M) extent of the endoscopically complications, and outcome following ileoanal
1–18 months) and a maximum of three visualized BE segment, as well as endoscopic anastomosis (IAA) and IPAA. The functional results
resections. During a mean follow-up period of landmarks. The overall reliability coefficients of IPAA are good. Pouchitis, irritable pouch
36.7 months, recurrent or metachronous (RCs) for the assessment of the C & M extent syndrome, and cuffitis are specific long-term
carcinomas were found in 11% of the patients, of the endoscopic BE segment above the complications, but rarely result in failure. Pouch
but successful repeat treatment with endoscopic gastroesophageal junction were 0.95 and 0.94, salvage is possible in selected patients with poor
resection was possible in all of these cases. The respectively. The rates of exact agreement (for C functional outcomes. One-stage operations are
calculated five-year survival rate was 98%. ■ & M values) for pairwise comparisons of individual increasingly being performed. ■
US GASTROENTEROLOGY REVIEW 2007
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