- 1 Oral sodium phosphate for bowel preparation in endoscopic submucosaldissection training in a pig model A pilot study
The technical complexity of endoscopic submucosal dissection (ESD)
demands adequate training to lower the surgical risks. The diameter and mucosal structure of
the porcine colon is similar to the human colon making the pig a good animal for colonoscopic
procedure training. However, a standardized animal bowel preparation used in colonic ESD
training has not been established.
Methods: Colonoscopic procedures were performed in 12 pigs, divided into four groups. The
control group (Group 1) fasted and received no preprocedure preparation. Group 2 received
a single dose of sodium phosphate 2 mL/kg; Group 3 and Group 4 received split doses of sodium
phosphate (2 mL/kg and 4 mL/kg, respectively). An experienced endoscopist, blinded to the
preparation method, assigned a score from excellent (4 points) to poor (1 point) at five regions
of the colon. The final mean bowle cleansing score was calculated from five regions in each
pig. Serum biochemistry and electrolyte levels were analyzed.
- 2 Different schedules of bowel preparation with sodium phosphate lead to different bowel cleansing effects and adenoma detection rates at colonoscopy
Adequate bowel preparation is an important quality indicator of colonoscopy.
This study validated whether the bowel cleansing quality and adenoma detection
rate (ADR) could be different between two bowel preparation schedules in individuals
receiving health examinations.
Methods: We enrolled individuals who had received a colonoscopy as part of the regimen for
their health checkup program with split-dose phosphosoda for bowel preparation. Prior to
December 31, 2012, the second dose of phosphosoda was administered at 10:00 PM before
the day of the colonoscopy and the individuals were defined as the 10-PM group. After January
1, 2013, the schedule was changed to 4:00 AM the same day as the colonoscopy and was
defined as the 4-AM group. The bowel cleansing quality was assessed using the Aronchick
scale.
Results: A total of 431 individuals were included, 259 in the 10-PM group and 172 in the 4-AM
group. The 4-AM group individuals had a higher rate of excellent or good bowel cleansing quality
as compared with the 10-PM group (77.3% vs. 22%, respectively; p < 0.001). The ADR was
also higher in the 4-AM group than in the 10-PM group (36% vs. 25.5%, respectively; p Z 0.019).
- 3 Risk factors of incomplete response to proton pump inhibitor therapy in patients with mild erosive esophagitis
Incomplete symptom resolution to proton pump inhibitor (PPI) therapy
is a common problem in the treatment of gastroesophageal reflux disease (GERD). The
aims of this study were (1) to examine the rate of incomplete symptom response following
8-week PPI therapy in patients with mild erosive esophagitis (Los Angeles Grade A/B erosive
esophagitis) and (2) to determine the independent factors predicting incomplete symptom
response in patients with mild erosive esophagitis.
- 4 Impact of interleukin-28B polymorphism on HCV-1 infected patients treated with response-guided therapy
Single nucleotide polymorphisms (SNPs) of interleukin-28B (IL28B)
were associated with sustained virological response (SVR) in hepatitis C virus genotype 1
(HCV-1) infected patients treated with a standard 48-week regimen of peginterferon and ribavirin
combination. Whether IL28B SNP genotype would be the influential prognosticator for patients
treated with response-guided therapy (RGT) is still not well understood.
Aims: To investigate the impact of IL28B rs809917 genotype on HCV-1 infected patients treated
with RGT.
Methods: A total of 128 consecutive treatment-naı¨ve HCV-1 infected patients between July
2006 and July 2011 were analyzed. For rapid virological response (RVR) patients, we allowed
an abbreviated 24-week regimen regardless of baseline viral loads; otherwise, a 48-week
regimen was implemented (for patients with early virological response). The IL28B
rs8099917 SNP genotypes were determined accordingly.
Results: A total of 117 patients (91.4%) were of rs8099917 TT genotype and 11 (8.6%) were of
GT/GG genotype. Eighty-two of the 128 (64.1%) patients achieved SVR, occurring in 54 of 67
RVR patients (80.6%) and 28 of 61 non-RVR patients (45.9%, p < 0.001). Compared to the
GT/GG genotype, patients with the TT genotype had significantly higher SVR rates (67.5%
vs. 27.3%; p Z 0.008) and low relapse rates (28.2% vs. 70.0%; p Z 0.006). The multivariate
analysis showed that RVR (odds ratio, 4.51; 95% confidence interval, 1.87e10.90; p Z 0.001)
and rs8099917 TT genotype (odds ratio, 6.91; 95% confidence interval, 1.53e31.17;
p Z 0.012) were independent factors associated with SVR.
- 5 Primary duodenal Burkitt lymphoma presenting as sessile, button-like bleeding polyps
Primary gastrointestinal (GI) lymphoma accounts for 30e50% of all extranodal non-
Hodgkin’s lymphomas, making the GI tract the most common site of extranodal non-Hodgkin’s
lymphomas. Most GI lymphomas belong to the B cell lineage. Burkitt lymphoma (BL) is a highly
aggressive mature B cell neoplasm that occurs in three forms: endemic, sporadic, and
immunodeficiency-associated. Sporadic BL accounts for 1e2% of all adult lymphomas and usually
presents as an abdominal manifestation of extranodal disease involving the distal ileum or
cecum. Primary BL of the duodenum is rare. However, this report emphasizes the importance
of awareness of the malignancy potential of duodenal polyps. We report the case of a 70-yearold
woman admitted to our ward with upper GI bleeding due to duodenal polyps. An upper GI
endoscopic examination showed button-like polyps with central depression, and an immunohistochemical
study of the polyps revealed a high-grade B cell malignancy (BL). Consequently,
the patient was treated with aggressive chemotherapy. The tumors regressed after chemotherapy.
Although primary duodenal Burkitt lymphoma is very rare, the possibility of malignancy
should be considered if a patient presents with duodenal button-like polyps with a
central depressed surface.
Copyright ª 2014, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society
of Taiwan and Taiwan Association for
- 6 An unusual polynodular liver disease Multiple biliary hamartoma
We report a 73-year-old male patient who suffered from right upper abdominal
dull pain, fever, and chills for 2 days. Gall bladder stones and acute cholecystitis were diagnosed,
and parenteral antibiotics were used. The abdominal ultrasonography showed multiple
tiny hyperechoic nodules over both lobes of the liver. His computed tomography scan revealed
low-density lesions without contrast enhancement. Magnetic resonance imaging and magnetic
resonance cholangiopancreatography further revealed lesions that were hypointense on T1-
weighted images and hyperintense on T2-weighted images. Laparoscopic cholecystectomy
and liver biopsy were performed, and biliary hamartoma was diagnosed based on the pathology.
This report describes an unusual case of multiple biliary hamartomas and reviews the
literature regarding the incidence, pathogenesis, and diagnosis of this disease.
Copyright ª 2014, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society
of Taiwan and Taiwan Association for the Study of the Liver. Published by Elsevier Taiwan LLC.
Introduction
Multiple biliary hamartomas, also known as von Meyenburg
complexes, were first described by von Meyenburg in 1918.
They are rare, benign malformations consisting of multiple
well-circumscribed collections of duct-like structures lined
by the biliary epithelium and surrounded by the fibrous
stroma [1]. Multiple biliary hamartomas are asymptomatic
and usually found incidentally. Their clinical significance is
that they may be easily confused with liver metastasis,
microabscess, and other cystic liver diseases [2]. In this
report, we present a patient with this unusual intrahepatic
bile duct malformation.
Case report
A 73-year-old male patient was admitted to the Gastroenterology
Department of Cheng-Ching General Hospital,
* Corresponding author. Division of Gastroenterology, Department
of Internal Medicine, Cheng Ching Hospital, Number 118,
Section 3, Taichung-Kang Road, Taichung 407, Taiwan.
E-mail address: guthuang@yahoo.com.tw (J.-C. Huang).
http://dx.doi.org/10.1016/j.aidm.2014.03.008
2351-9797/Copyright ª 2014, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association
for the Study of the Liver. Published by Elsevier Taiwan LLC.
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.aidm-online.com
Advances in Digestive Medicine (2015) 2, 37e40
Open access under CC BY-NC-ND license.
- 7 Toward individualized therapy with peginterferon aribavirin for chronic hepatitis C
The evolution of treatment for chronic hepatitis C (CHC)
has improved over the past 2 decades. Peginterferon a
(PEG-IFN)/ribavirin combination therapy has become the
standard regimen, even with rapid development of novel
direct-acting antivirals (DAAs), and remains the major
standard of care for CHC, especially in Asian countries.
Genotype-guide therapy was first introduced in 2004 in a
multicenter randomized clinical trial, with a recommended
regimen for CHC patients of weekly PEG-IFN 180 mg plus
ribavirin 1000e1200 mg or 800 mg daily, for either 48 weeks
in patients infected with hepatitis C virus (HCV) genotype
1/4, or 24 weeks in patients infected with HCV genotype 2/
3 [1]. Compared to Western countries, an even better
response to the recommended regimen in Asian countries
has been observed.
- 8 Optimizing bowel preparation for colonoscopyTiming is the key
Along with the trend of increasing incidence of colorectal
cancer (CRC) and the launch of a population-screening
program, colonoscopy has become one of the most common
and important procedures in gastrointestinal endoscopy,
not only in many developed countries, but also in Taiwan.
According to an unofficial estimate, at present, nearly
160,000 colonoscopies are performed in Taiwan annually,
including procedures performed for diagnostic, therapeutic,
and screening purposes. Previous studies have shown
that colonoscopy and polypectomy could effectively reduce
both the incidence of and mortality from CRC; however, a
growing body of evidence also suggests that substandard
quality may decrease the effectiveness of colonoscopy
