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Best Practice & Research. Clinical Gastroenterology

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https://www.readbyqxmd.com/read/28842058/distribution-of-colorectal-polyps-implications-for-screening
#1
REVIEW
Carlo Senore, Cristina Bellisario, Nereo Segnan
BACKGROUND: During the last decades data from different studies reported modifications of the topographic distribution of colorectal cancers (CRCs), with an increased frequency of tumours in proximal colonic segments. Given the documented link between adenomas and CRC, a proximal migration of adenomas over time could be expected as well. AIM: To evaluate available evidence about the prevalence of adenomas and of sessile serrated polyps across colonic segments, the changing trends in their distribution across the colon and the diagnostic performance of screening tests currently adopted in population based screening programs for lesions located in different colonic segments...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842057/colorectal-endoscopic-submucosal-dissection-esd
#2
REVIEW
Lorenzo Fuccio, Thierry Ponchon
Endoscopic submucosal dissection (ESD) is an interventional procedure for en-bloc resection of gastrointestinal lesions. ESD is a challenging and can involve a reasonable degree of risk, therefore case selection is of crucial importance, especially in the colo-rectum. This procedure should be mainly used for dissection of lesions when there is a high suspicion of superficial malignant invasion; several classifications have been proposed in order to better identify lesions suitable for ESD. However, case selection is still an issue, since only about 8-10% of dissected lesions are superficially invading cancer and most of cases involve benign or massively invading cancer...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842056/colorectal-endoscopic-mucosal-resection-emr
#3
REVIEW
Pujan Kandel, Michael B Wallace
Colonoscopy has the benefit of detecting and treating precancerous adenomatous polyps and thus reduces mortality associated with CRC. Screening colonoscopy is the keystone for prevention of colorectal cancer. Over the last 20 years there has been increased in the management of large colorectal polyps from surgery to endoscopic removal techniques which is less invasive. Traditionally surgical resection was the treatment of choice for many years for larger polyps but colectomy poses significant morbidity of 14-46% and mortality of up to 7%...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842055/standardisation-of-polypectomy-technique
#4
REVIEW
Alan Moss, Kumanan Nalankilli
There are several approaches to polypectomy for sessile polyps <20 mm and for pedunculated polyps. Recent evidence is leading towards standardisation of polypectomy technique. Key recent polypectomy developments include: 1. Use of cold snare polypectomy (CSP) for sessile polyps <10 mm; 2. Use of hot snare polypectomy (HSP) following submucosal injection for sessile polyps sized 10-19 mm; 3. Piecemeal cold snare polypectomy (PCSP), with or without prior submucosal injection, for select sessile polyps sized 10-19 mm, where the potential risk for an adverse event is increased (e...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842054/adenoma-detection-rate-and-risk-of-colorectal-cancer
#5
REVIEW
P Wieszczy, J Regula, M F Kaminski
GOALS: The aim of this paper was to discuss association between adenoma detection rate (ADR) and interval colorectal cancer risk. BACKGROUND: Adenoma detection rate is being used as a benchmark quality measure for colonoscopy. There are three studies showing inverse association between ADR and interval colorectal cancer risk. One recent study reports significant impact of increased ADR on decreasing interval colorectal cancer risk. STUDY: We discussed evidence for using ADR as a quality measures in colonoscopy and flexible sigmoidoscopy...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842053/polyp-characterization-at-colonoscopy-clinical-implications
#6
REVIEW
James E Allen, Prateek Sharma
Although advancements in endoscopic imaging of colorectal mucosa have outstripped the pace of research in the field, the potential clinical applications of these novel technologies are promising. Chief among these is the ability to diagnose colorectal polyps in vivo. This feature appears most applicable to diminuitive polyps, which have very little malignant potential yet represent over 70% of resected polyps. In an ideal application, the capability to predict diminutive hyperplastic polyp histology in vivo precludes the need for excision whereas dimunitive adenomas do require excision, but not necessarily histopathologic analysis if the diagnosis is made in vivo with adequate confidence...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842052/polyp-detection-at-colonoscopy-endoscopist-and-technical-factors
#7
REVIEW
Douglas K Rex
The adenoma detection rate (ADR) has emerged as the most important quality measure in colonoscopy, as it predicts the risk of interval cancer after colonoscopy. Measuring and improving ADR is the central focus of the current quality movement in colonoscopy. High ADRs can be achieved by a colonoscopist with a thorough understanding of the wide range of endoscopic appearances of precancerous lesions in the colorectum, effective bowel preparation, and meticulous technique using high definition colonoscopes. The knowledgeable and effective examiner needs no adjunctive devices or techniques to achieve master level ADRs...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842051/epidemiology-and-risk-factors-of-colorectal-polyps
#8
REVIEW
Mari Øines, Lise M Helsingen, Michael Bretthauer, Louise Emilsson
The lifetime risk of colorectal cancer (CRC) in the Western world is around 5%. CRC commonly develops from precursor lesions termed polyps, classified as adenomatous or serrated polyps according to growth pattern. Despite the well-known connection between polyps and cancer, most polyps will never develop into CRC. For those that do, the time until CRC development is generally thought of as >10 years. This gives opportunity for interventional strategies to prevent transformation into cancer. This article aims to provide an overview of the epidemiology of and risk factors for colorectal polyps in the average risk population, and will encompass the effect of age, gender, ethnicity, smoking, obesity, alcohol, physical activity, NSAIDs and dietary factors on colorectal polyps...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842050/hereditary-or-sporadic-polyposis-syndromes
#9
REVIEW
Gianluca Basso, Paolo Bianchi, Alberto Malesci, Luigi Laghi
Polyposis syndromes are encountered in endoscopy practice, and are considered rare entities, accounting for ≤1% of colorectal cancer. Polyposis can occur within inherited syndromes or as "sporadic" cases of unknown etiology. Their proper characterization is relevant for patient management, and should nowadays drive appropriate genetic tests which have a key role in clinical practice for driving surveillance and colorectal cancer prevention, enlarged to relatives. Polyposis classification is based upon polyp number and histology, familial and personal history...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842049/management-of-small-bowel-polyps-a-literature-review
#10
REVIEW
Rabia A de Latour, Saikiran M Kilaru, Seth A Gross
Despite the small bowel comprising 90% of the mucosal surface area of the gastrointestinal tract, it is a rare site for neoplasia and only accounts for a little over 3% of the tumors that arise in the digestive tract. Benign small bowel lesions include lipomas, lymphangiomas, leiomyomas, neurofibromas, nodular lymphoid hyperplasia and adenomas, many of which are precursors to malignant lesions. Several polyposis syndromes are associated with small bowel polyps as well, including familial adenomatous polyposis syndrome, lynch syndrome, Peutz-Jeghers syndrome, Cowden syndrome and juvenile polyposis syndrome...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842048/management-of-duodenal-polyps
#11
REVIEW
Michael X Ma, Michael J Bourke
Duodenal adenomas are the most common type of polyp arising from the duodenum. These adenomas can occur within and outside of genetic syndromes, and are broadly classified as non-ampullary or ampullary depending on their location. All adenomas have malignant potential and are therefore appropriately treated by endoscopic resection. However, the unique anatomical properties of the duodenum, namely its relatively thin and vascular walls, narrow luminal diameter and relationship to the ampulla and its associated pancreatic and biliary drainage, pose an increased degree of complexity for any endoscopic interventions in this area...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842047/evaluation-and-management-of-gastric-epithelial-polyps
#12
REVIEW
R Castro, P Pimentel-Nunes, M Dinis-Ribeiro
Gastric polyps include a wide spectrum of lesions with different histology and neoplastic potential. They are found in up to 6% of upper gastrointestinal endoscopy and are usually asymptomatic and incidentally diagnosed, being in the vast majority epithelial gastric polyps. Hyperplastic, fundic gland and adenomas are the most common types of gastric polyps and, although each type may have typical endoscopic appearances, they all must be sampled at the initial endoscopy for histological assessment. Also, the normal appearing gastric mucosa should be sampled to stage atrophic changes, rule out endoscopically non-visible dysplasia and to diagnose Helicobacter pylori...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842046/histological-and-molecular-classification-of-gastrointestinal-polyps
#13
REVIEW
Franziska Haumaier, William Sterlacci, Michael Vieth
Endoscopic diagnosis and treatment for gastrointestinal polyps became widely available within the last decades. Exact terminology is important for further therapeutic steps, follow up or treatment. Gastroenterologists, Oncologists, Surgeons and Pathologists need to be aware of the most recent terminology to ensure proper risk assessment and subsequent treatment if necessary. This manuscript aims to list the variety of gastrointestinal polyps and the molecular background where appropriate.
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842045/morphological-classifications-of-gastrointestinal-lesions
#14
REVIEW
Jasper L A Vleugels, Yark Hazewinkel, Evelien Dekker
In the era of spreading adoption of gastrointestinal endoscopy screening worldwide, endoscopists encounter an increasing number of complex lesions in the gastrointestinal tract. For decision-making on optimal treatment, precise lesion characterization is crucial. Especially the assessment of potential submucosal invasion is of utmost importance as this determines whether endoscopic removal is an option and which technique should be used. To describe a lesion and stratify for the risk of submucosal invasion, several morphological classification systems have been developed...
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28842044/preface-to-gastrointestinal-polyps
#15
EDITORIAL
C Hassan, A Repici
No abstract text is available yet for this article.
August 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28774417/treatment-of-hepatitis-b-virus-with-combination-therapy-now-and-in-the-future
#16
REVIEW
Joel S Emery, Jordan J Feld
Chronic Hepatitis B continues as a significant public health problem despite the availability of safe and effective antivirals and a highly effective protective vaccine. Current therapy, however rarely leads to cure and lifelong therapy is often required, contributing to poor uptake and ongoing morbidity. New insights into the hepatitis B viral life cycle and the host immune response have expanded the potential targets for drug therapies with interesting antiviral candidates and novel immunotherapeutic approaches in early stage development...
June 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28774416/new-treatments-to-reach-functional-cure-rationale-and-challenges-for-emerging-immune-based-therapies
#17
REVIEW
Adam J Gehring
The landscape for chronic HBV therapy is rapidly evolving. The latest generation of antiviral drugs provide robust virus suppression with a high barrier to resistance that facilitates long-term treatment. However, low rates of HBsAg loss demonstrate that additional strategies are needed to consistency achieve a functional cure. The immune system can clear HBV and establish long-term control over the virus. Sufficiently boosting HBV immunity in chronic patients has been very difficult due to immune exhaustion, immune dysregulation, and inhibitory pathways suppressing the immune response...
June 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28774415/new-treatments-to-reach-functional-cure-virological-approaches
#18
REVIEW
David Durantel
Current therapies of chronic hepatitis B (CHB) remain limited to pegylated-interferon-alpha (pegIFN-α) or any of the five approved nucleos(t)ide analogues (NA). If viral suppression can be achieved in the majority of patients with the high-barrier-to-resistance new-generation of NA, i.e. entecavir and tenofovir, HBsAg loss is achieved by PEG-IFN-α and/or NA in only 10% of patients, after a 5-year follow-up. Attempts to improve the response by administering two different NA or a combination of NA and PEG-IFN-α have not provided a dramatic increase in the rate of "functional cure"...
June 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28774414/hepatitis-delta-infection-current-and-new-treatment-options
#19
REVIEW
Menashe Elazar, Christopher Koh, Jeffrey S Glenn
In humans, hepatitis D virus (HDV) infection only occurs in the presence of a concomitant hepatitis B virus (HBV) infection, and induces the most severe form of human viral hepatitis. Even though HDV is spread worldwide and is endemic in some regions, screening and treatment has been often neglected in part due to the lack of an effective therapy. Moreover, HDV prevalence rates are increasing in many countries driven by immigration from areas of high endemicity. Currently, no FDA-approved anti-HDV therapy is available, although interferon (IFN) alpha therapy has demonstrated benefit in a minority of patients...
June 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28774413/management-of-hepatitis-b-in-special-populations
#20
REVIEW
Kali Zhou, Norah Terrault
Special populations infected with chronic HBV include those with decompensated cirrhosis, coinfections (HIV, HCV, HDV), hemodialysis and renal failure, immunosuppressed including transplant patients, children and women in pregnancy. These populations differ in their natural history and risk for liver-related complications, the indications for anti-HBV therapy as well as the recommendations regarding the HBV drugs used, duration of therapy and anticipated endpoints. Reflecting the special populations with substantive changes in management in recent years, this review focuses on HBV-HIV coinfected patients, immunosuppressed patients at risk for reactivation, liver transplant recipients and pregnant women...
June 2017: Best Practice & Research. Clinical Gastroenterology
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