Cheng Ju Yu

Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis

Background and Aim:  To compare the efficacy and safety of endoscopic variceal ligation (EVL) with propranolol in prophylaxis on the rate of first esophageal variceal bleeding in patients with cirrhosis.

Rather than interleukin-27, interleukin-6 expresses positive correlation with liver severity in naïve hepatitis B infection patients

Effective cytokines can drive the commitment of naive T cells to regulate immune response after antigen‐mediated activation. Aims are to elucidate the clinical role of serum IL‐27 and IL‐6 in the different stages of naïve hepatitis B virus (HBV)‐infected patients.

Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors

BACKGROUND GI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial. OBJECTIVE The aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs. DESIGN Prospective case series. SETTING Academic medical center. PATIENTS Eight patients with submucosal gastric tumors <2 cm in diameter suspected to be GISTs. INTERVENTIONS Endoscopic ligation and resection. MAIN OUTCOME MEASUREMENTS Clinical/technical feasibility, success, and adverse events. RESULTS Seven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred. LIMITATIONS Small number of patients (n = 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign. CONCLUSIONS Endoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method.

IL-6, through p-STAT3 rather than p-STAT1, activates hepatocarcinogenesis and affects survival of hepatocellular carcinoma patients: a cohort study

BackgroundBiologic activities of functional mediators activate downstream transducers regulating inflammation and carcinogenesis. Correlation among mediators (IL-6, IL-27, TNF-α, and VEGF) with STAT proteins at diverse clinical-pathologic stages of hepatocellular carcinoma (HCC) remains limited.MethodsSerum mediators assayed from 147 untreated HCC cases (HCC-total group) included 70 HBV-infected (HCC-HBV group), 64 HCV-infected (HCC-HCV group), and 13 without HBV-/HCV-infection (HCC-NBNC group). Another 156 non-HCC individuals comprised 54 healthy individuals (HG) and 102 chronic hepatitis patients (CH-total group) as control group. To correlate with serum mediators, 86-paired liver tissues (CH: 52 and HCC: 34 cases) served for p-STATs proteins immunostain.ResultsAlthough four mediators (IL-6, IL-27, TNF-α, and VEGF) significantly over-expressed, IL-6 presented the strongest correlation in HCC-total versus CH-total or HG groups (HCC-total versus CH-total: P < 0.001; HCC-total versus HG: P < 0.001). Over-expressed IL-6 concentration linked with poor liver function (Albumin: r = −0.383, P < 0.001; Bilirubin: r = 0.280, P = 0.001; INR: r = 0.299, P < 0.001; AST: 0.212, P = 0.016), tumor progression (TNM system: r = 0.370; P < 0.001), clinical condition severity (BCLC system: r = 0.471; P < 0.001; terminal- versus early-stage HCC, P = 0.001; advanced- versus early-stage HCC, P = 0.007; terminal- versus intermediate- stage HCC P = 0.003; advanced- versus intermediate-stage HCC P = 0.019), and 6-month mortality (P = 0.024). Likewise, serum IL-6 (r = 0.501, P = 0.003) as compared to IL-27 (r = 0.052, P = 0.770), TNF-α (r = 0.019, P = 0.917), and VEGF (r = 0.096, P = 0.595) expression reflected positive correlation with activation of tissues p-STAT3 rather than p-STAT1.ConclusionsSerum IL-6, through p-STAT3 rather than p-STAT1 signal pathway, affected hepatic function, tumor progression, and determine HCC patient survival.

Phlebosclerotic colitis with nonsurgical treatment

Dear editor: Colonic ischemia is the most common entity of ischemic bowel disease clinically, but phlebosclerotic colitis is a relatively rare form of colonic ischemia. We describe a rare case of phlebosclerotic colitis in a 56-year-old Chinese man presenting with abdominal pain and diarrhea. He had a medical history of acute pancreatitis at the age of 30 years. There was no history of chronic pancreatitis, cirrhosis, hypercoagulability, systemic collagen, or inflammatory vascular disease. The laboratory tests were initially unremarkable except for a white blood cell count of 19,460/μL. The stool was significantly positive for occult blood (4+). Physical examination showed diffuse tenderness without marked rebound tenderness. A plain abdominal radiograph demonstrated multiple linear and threadlike calcifications at the site of the ascending colon. An abdominal computed tomography (CT) revealed wall thickening and linear calcification of the vasculature of the ascending and transverse colon. The inferior mesenteric venous territories were mostly spared. A colonoscopy demonstrated edematous and dark purple-blue mucosa, luminal narrowing, and several small round ulcers in the ascending colon. Histopathologic examination from the colonoscopic biopsies showed ulceration with acute and chronic inflammatory cell infiltration in lamina propria. Barium enema study showed multiple diverticula, disappearance of the semilunar folds, irregular contours and rigid walls, and luminal narrowing of the ascending colon. Based on these pathognomonic findings, the diagnosis of phlebosclerotic colitis was made. His symptoms subsided after conservative treatment with bowel rest, and then he was discharged and followed up regularly at our outpatient clinic. Repeated colonoscopy was performed 1 month and 1 year later and revealed stationary mucosal appearances despite the obviously improved symptoms. Two years later, a conventional angiography disclosed mild tortuosity of vasa recta and marginal arteries of the ascending and transverse colon, which was thought to be compatible with phlebosclerotic colitis. During the 4-year follow-up, the patient remained in good health, and there has been no need of surgical intervention for the patient. The pathogenesis of phlebosclerotic colitis remains undetermined currently. Speculations concerning its predisposing factors implicate water-soluble irritants, thrombotic phlebitis, increased intraluminal pressure of the right-side colon, and calcinosis, Raynaud phenomenon, esophageal involvement, sclerodactyly, and telangiectasia (CREST syndrome). Clinically, phlebosclerotic colitis may manifest abdominal pain, diarrhea, and bloody stools. Koyama et al. first reported 19 cases of phlebosclerotic colitis, who were all Japanese. The symptoms were gradual in onset, and the lesions were uniformly in the right colon. However, Ikehata et al. reported that the lesions in two cases gradually extended to the distal colon over a period of 5 years. The Int J Colorectal Dis (2009) 24:1241–1242 DOI 10.1007/s00384-009-0707-1

A clinical survey of Klebsiella pneumoniae virulence and genotype in pyogenic liver abscess.

PrimaryKlebsiella pneumoniae liver abscess with metastatic complications is a globally emerging infectious disease and is the leading cause of liver abscess in Taiwan. Host immunity and bacterial virulence, especially of the capsular polysaccharide type, are important in determining clinical manifestations. Investigators retrospectively studied theK pneumoniae genotype and capsular serotype from patients with 37 strains of liver abscess; no correlation was noted with genotype, and many genetically different strains caused liver abscess. AlthoughK pneumoniae is prevalent in patients with diabetes, it can attack healthy or alcoholic people as well. Additional studies are needed to explore the mechanisms of bacterial virulence and to optimize treatment strategies. Physicians should be alert to the illness and its complications.