- 1 How sensitive is fecal immunochemical testing in detecting colorectal neoplasms
The fecal immunochemical test (FIT) is increasingly being
adopted as the preferred testing strategy for the prevention
of colorectal cancer (CRC). The FIT has a userfriendly
design, and previous studies conducted in Taiwan
have confirmed that it is effective in detecting CRC with a
sensitivity of about 80% [1]. In addition, because the FIT
result is not affected by upper gastrointestinal lesions, its
specificity is high [2], which can substantially decrease
the risk of false-positive results and unnecessary colonoscopy
[3]. Considering both sensitivity and specificity,
the area under the receiver operating characteristic curve
in predicting CRC has been estimated to be 83%, which
can be improved only minimally by adding conventional
risk factors into the prediction model [4]. Furthermore, a
recent meta-analysis including 19 diagnostic accuracy
studies on asymptomatic, average-risk adults from
different countries has shown consistently that the pooled
sensitivity, specificity, positive likelihood ratio, and
negative likelihood ratio of the FITs for CRC are 79%, 94%,
13.10, and 0.23, respectively, with an overall diagnostic
accuracy of 95% [5].
- 2 Accuracy of immunochemical fecal occult blood test for detecting colorectal neoplasms in individuals undergoing health check-ups
In Taiwan, the prevalence of colorectal cancer has been increasing in
recent decades. As a result, the fecal occult blood test (FOBT) has been advocated and widely
used for colorectal cancer screening in areas with limited colonoscopy capacity. The goal of
this study was to analyze the sensitivity of a single immunochemical FOBT (I-FOBT) and correlate
it with the results of colonoscopy for detecting colorectal neoplasia in the asymptomatic
Taiwanese population.
Methods: Data were collected from the results of health examinations conducted on asymptomatic
adults older than 40 years and who simultaneously underwent one-time I-FOBT and colonoscopy
examinations between January 01, 2008 and June 30, 2009. The sensitivity and
specificity of the I-FOBT were calculated in correlation to age, size, and pathologic result.
Results: A total of 6096 patients were analyzed, including 3418 men and 2678women, aged 40e87
years. I-FOBT result was positive in 229 patients (3.8%); the sensitivity of detection of total colorectal
neoplasia and advanced neoplasia were 6.98% and 22.1%, respectively. A total of 13 participants
were found to have invasive cancer in this study, and the sensitivity and specificity of the
I-FOBT in this group were 69.2% and 96.4%, respectively.
- 3 Multipolar radiofrequency ablation with non-touch technique for hepatocellular carcinoma £ 3 cm A preliminary report
Conventional monopolar radiofrequency ablation (RFA) bears the
risks of incomplete ablation and tumor seeding. This study aimed to evaluate the effectiveness
and safety of multipolar RFA with non-touch technique for hepatocellular carcinoma (HCC)
3 cm.
Methods: Fifteen cirrhotic patients (9 men, 6 women; age 51e83 years, mean 64.4 years,
Child-Pugh score: A Z 10 and B Z 5) with 17 HCCs of 3 cm (mean: 26 mm), which were diagnosed
based on typical radiologic findings were enrolled. Two or three Celon Prosurge Bipolar
electrodes with 3-cm active tip were deployed with non-touch technique via percutaneous
approach under ultrasound guidance.
Results: Complete ablation was achieved in all 17 lesions. This is defined as no enhanced part
around the ablated index tumors according to dynamic computed tomography or magnetic
resonance imaging at least 1 month after ablation. No local tumor progression was detected
at follow-up (range, 3e21.5 months; mean, 10 months). No track seeding was observed. There
was one distant recurrence 15.4 months after ablation. One patient had procedure-related
biliary stricture and died of pneumonia 3.5 months after tumor ablation.
- 4 Liver cirrhosis as a predisposing factor for esophageal candidiasis
Esophageal candidiasis (EC) often occurs in human immunodeficiency
virus (HIV)-infected patients, but is uncommon in non-HIV-infected patients. It is known that
malignancy, diabetes mellitus, previous gastric surgery, and medications (antibiotics, proton
pump inhibitors, and steroids) are risk factors for esophageal candidiasis in non-HIV-infected
patients. However, the relationship between liver cirrhosis and esophageal candidiasis was unclear.
This study aimed to elucidate the role of liver cirrhosis in esophageal candidiasis.
Methods: A retrospective chart review study was conducted on non-HIV-infected patients with
esophageal candidiasis who presented to Tri-Service General Hospital from January 2009 to
December 2012. The diagnosis of EC was primarily based on endoscopic findings. The incidence
of EC in cirrhotic and noncirrhotic patients was compared. Furthermore, differences in baseline
characteristics, clinical variables, and mortality after antifungal treatment between the
two groups were analyzed.
Results: In this study, 43,217 non-HIV-infected patients were enrolled, 3017 of whom had liver
cirrhosis. The incidence of EC in cirrhotic patients was higher than that in noncirrhotic patients
(0.8% vs. 0.36%; relative risk Z 2.2; p < 0.001). Multivariate logistic regression analysis identified
liver cirrhosis as an independent risk factor for EC (odds ratio, 1.74; 95% confidence interval,
1.06e2.87; p Z 0.029). Moreover, cirrhotic patients tended to be asymptomatic
compared with noncirrhotic patients (45.8% vs. 9%; p < 0.01). The most common coexisting
endoscopic finding was reflux esophagitis (83.9%). However, antifungal treatment did not
decrease the mortality of patients with EC during hospitalization.
- 5 Acute hepatitis with nontyphoidal salmonella and hepatitis E virus coinfection
A 65-year-old Taiwanese man presented with dark urine for 5 days before admission
to hospital and with fever on the 2nd day of admission to hospital. Laboratory studies
showed acute hepatitis with hyperbilirubinemia. Acute hepatitis with nontyphoidal salmonella
and hepatitis E virus coinfection was diagnosed. The fever subsided after treatment with ceftriaxone
and cefepime. His serum bilirubin reached its peak value on the 3rd week after admission
to hospital and then gradually returned to the normal range. To the best of our knowledge,
acute hepatitis E coinfection with nontyphoidal salmonella has not been reported previously.
Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society
of Taiwan. Published by Elsevier Taiwan LLC.
Introduction
Hepatitis E is an important public health issue in many
developing countries, especially in Asia and Africa [1].
Hepatitis E virus (HEV) spreads mainly through the fecal
contamination of water supplies or food; person-to-person
transmission is uncommon. However, autochthonous
hepatitis E in developed countries is far more common than
previously recognized and might be more common than
hepatitis A [2]. Hepatitis E is thought to be a zoonotic disease
because animals are known to be a source of infection;
both deer and pigs have been implicated as potential reservoirs
of the virus. Outbreaks of acute hepatitis E have
never occurred in Taiwan and only sporadic cases of acute
hepatitis E have been reported to the Centers for Disease
Control (CDC) Taiwan [3].Nontyphoidal salmonella (NTS)
species are important food-borne pathogens, with acute
gastroenteritis being the most common clinical manifestation
[4]. The most common manifestation of nontyphoidal
salmonellosis is acute enterocolitis, but the organism can
cause focal infection, bacteremia, and meningitis, as well
* Corresponding author. Department of Internal Medicine, E-Da
Hospital/I-Shou University, Number 1, Yi-Da Road, Jiasou Village,
Yanchao District, Kaohsiung 824, Taiwan.
E-mail address: moleinray@yahoo.com.tw (L.-R. Mo).
http://dx.doi.org/10.1016/j.aidm.2013.09.006
2351-9797/Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society of Taiwan. Published by
Elsevier Taiwan LLC.
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.aidm-online.com
Advances in Digestive Medicine (2014) 1, 92e94
Open access under CC BY-NC-ND license.
Open access under CC BY-NC-ND license.
- 6 Gallbladder perforation in cholecystitis with liver abscess formation and septic thrombophlebitis of portal vein mimicking presentation of liver malignancy
Gallbladder perforation is a rare complication of cholecystitis. Similarly, septic
thrombophlebitis of the portal vein, also called pylephlebitis, is another rare complication
of intra-abdominal infections including cholecystitis. Both gallbladder perforation and pylephlebitis
are associated with significantly higher morbidity and mortality. Herein, we report a
patient with an atypical presentation of gallbladder perforation and liver abscess formation.
A 68-year-old man suffered from malaise, poor appetite, and body weight loss for 1 month.
Liver mass lesion and portal vein thrombosis were detected by ultrasound at a local clinic.
He was referred to our institution under the tentative diagnosis of hepatocellular carcinoma.
He underwent abdominal ultrasound and computed tomography examinations at our hospital.
Cholecystitis with gallbladder perforation was highly suspected. Broad-spectrum antibiotics
were administered immediately. Percutaneous transhepatic gallbladder drainage was
performed in this case, and pigtail drainage for liver abscess was done later. The patient’s
conditiondcholecystitis, liver abscess, and pylephlebitis (followed by ultrasound)dimproved
after treatment. Furthermore, the patient recovered his appetite and his body weight
increased.
Copyright ª
- 7 Gastritis cystica polyposa in an unoperated stomach
Gastritis cystica polyposa is relatively rare and characterized by polypoid hyperplasia
and cystic dilatation of the gastric glands in stomach. Most cases are related to previous
gastric surgeries, but a few cases have been reported in unoperated stomachs. We present a
34-year-old man who had anemic symptoms with melena and exertional dyspnea for 3 weeks.
He denied any surgical history. An esophagogastroduodenoscopy revealed diffuse giant folds
extending from the lower to the upper body of the stomach with nodularity and no obvious
bleeding site. A pathologic diagnosis of a punch biopsy specimen from the giant folds revealed
only moderately active chronic inflammation with a high Helicobacter pylori density. After serial
studies, the patient received a whole layer gastric biopsy during a laparoscopy. Gastritis
cystica polyposa was diagnosed on the pathology report. Our present case highlights the rare
clinical and endoscopic condition of gastritis cystica polyposa in an unoperated stomach.
Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society
of Taiwan. Published by Elsevier Taiwan LLC.
* Corresponding author. Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Number 280, Jen-Ai
Road, Section 4, Taipei 106, Taiwan.
E-mail address: cghleecl@hotmail.com (C.-L. Lee).
http://dx.doi.org/10.1016/j.aidm.2013.09.008
2351-9797/Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society of Taiwan. Published by
Elsevier Taiwan LLC.
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.aidm-online.com
Advances in Digestive Medicine (2014) 1, 100e103
Open access under CC BY-NC-ND license.
Open access under CC BY-NC-ND license.
- 8 Liver cirrhosis as a predisposing risk factor for esophageal candidiasis Bystander or culprit
Candida esophagitis is the most common infectious disease of
the esophagus and the most common gastrointestinal opportunistic
disorder among individuals infected with human immunodeficiency
virus (HIV). Ou et al [1] conducted a study
using a retrospective chart review of non-HIV-infected patients
with esophageal candidiasis and particularly aimed to
elucidate the role of liver cirrhosis in esophageal candidiasis. I
have long thought that retrospective chart reviewsare usually
poorly done and are subject to all sorts of biases and confounding
issues. The editorial allowed me to review the
article presented by Ou et al [1] and feel that it shared many
of these problems. Actually, most of the clinical relevant data
of esophageal candidiasis were gathered from HIV-infected
patients. Fungal infections have not been adequately studied
in patients with liver cirrhosis [2]. The main interest had
been focused on acute liver failure and liver transplantation
[3,4]. Thecurrent study is a unique one to focus on esophageal
candidiasis in patients with liver cirrhosis thus far and did
identify discussion-worthy issues regarding specific risks in
cirrhotic patients.
