Dimitrios Xinopoulos

Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis

Background: The aim of the present study was to compare the efficacy, safety, and cost of endoscopic palliative treatment with selfexpanding metallic stents with that of stoma creation in the management of inoperable malignant colonic obstructions. Methods: A total of 30 patients with inoperable malignant partial obstruction (due to metastases, hemodynamic instability, or pulmonary instability) in the left colon unsing from colorectal or ovarian cancer were included in the study. Fifteen were randomized to undergo palliative metallic colonic stent placement and 15 to undergo stoma creation. The efficacy and safety of the two methods was compared. A cost-effectiveness analysis was also performed, including the cost of postinterventional care. Results: Stents were placed successfully in 14 of 15 patients. In one patient with obstruction of a tortuous rectosigmoid flexure colon, stenting was not possible; this patient was excluded from the study. During the follow-up period, a moderate, nonocclusive ingrowth of tumor into the stent lumen was observed in six patients; they were all treated with internal laser ablation. The cost-effectiveness analysis showed that although the stoma creation procedure was less expensive, the total difference in average costs for the two methods was 6.9% (132 Euros). Conclusions: Self-expanding metallic stent placement is a palliative alternative to colostomy for patients with inoperable malignant colonic strictures. This treatment option provides a better quality of life for the patient, without the psychological repercussions of a colostomy, and it appears to be cost-effective.

Natural course of inoperable esophageal cancer treated with metallic expandable stents: Quality of life and cost-effectiveness analysis

Background and Aim:  The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with self‐expanding metallic endoprostheses in the management of malignant esophageal obstruction or stenosis and the cost‐effectiveness of the method in patients suffering from primary esophageal carcinoma. All patients with inoperable esophageal cancers treated with either laser palliation or endoprosthesis insertion were studied retrospectively.

Peginterferon/ribavirin treatment achieves a higher compliance rate than interferon/ribavirin combination in patients chronically infected with HCV on methadone maintenance.

Introduction Chronic hepatitis C virus infection (HCV) is the most common infectious disease among intravenous drug users. Aims To determine and compare compliance rates between two groups of chronic HCV patients from the methadone substitution program of the National Greek Organization Against Drugs treated with either pegylated interferon &agr;-2b/ribavirin or with interferon &agr;-2b/ribavirin during 48 weeks of therapy and 24 weeks of follow-up. Furthermore, to evaluate the efficacy of each treatment modality. Methods Forty-five consecutive methadone maintenance (MM) patients (group A, 36 males, nine females) were treated with pegylated interferon &agr;-2b (weight-based dosing 1.5 μg/kg/week) and ribavirin 1000–1200 mg/day orally. Sixty-five consecutive MM patients (group B, 52 males, 13 females) were treated with interferon &agr;-2b (6 MIU, three times/week) and ribavirin with the doses reported above. During the study, all patients were followed up periodically by hepatologists, internists, and psychiatrists. Results Baseline characteristics were similar between the two groups. Thirty-four out of 45 patients (75.6%) from group A and 31 of 65 patients (47.7%) from group B completed therapy (P=0.006). Thirty-two (71.1%) patients from group A and 27 patients (41.5%) from group B were followed-up until the end of week 72 (P=0.004). At the end of the follow-up, sustained virologic response was achieved in 23 of 45 (51.1%) patients from group A and 21 of 65 patients (32.3%) from group B (P=0.075). Conclusion Pegylated interferon &agr;-2b/ribavirin treatment achieved a significantly higher compliance rate than interferon &agr;-2b/ribavirin in MM patients with chronic HCV infection. After 24 weeks of follow-up, response rates were similar for patients who were compliant to treatment for both groups.

Synchronous occurrence of colorectal adenocarcinoma and colonic gastrointestinal stromal tumor.

SUMMARY The synchronous occurrence of GIST and other primary gas- trointestinal malignancies has been rarely reported. We re - port the case of an 84 year-old female who presented with a rectal blood loss. Total coloscopy revealed a stenotic lesion at casespermi ll ionandanestimated� 5-yearsurvivalrateof� 45-65%,�Giststypicallypresentinolderindividualsand� aremostcommoninthestomach� (60%),�followedbysmall� intestine� (15%),�colonandrectum� (5%),�esophagus,� mes- enteryandomentum 5,6 . thesynchronousoccurrenceofGistandotherprima - rygastrointestinal� malignancieshasbeenrarelyreported.� inthesecasesstomachandsmallintestinewerethemost� commonlocationsfortheGist . 7-11

Sa1944 Immunohistochemical Localisation of Kallikrein-Related Protease 14 (KLK14) in Colon Tissues During Cancer Development: Expression and Clinical Evaluation

variability in the sequence quality, reads generated, or basic coverage metrics. To assess the fidelity of variant calls in the EUS FNA exome data, results were compared to mutations previously detected by a 50 gene cancer panel. Results: The sequencing study was successful with a sufficient/expected number of reads per sample generated (Table 1). The mean percent duplicate reads per sample was 12.9% (range 4.8-38.6%). Exome coverage varied between samples; 50-85% of the exome was covered at 50x, and 20-50% of the exome was covered at 100x. The 50 gene panel comparator set comprised of 87 mutations across 12 samples. Comparison revealed that 86 of 87 mutations reported by the panel were also detected by exome sequencing. Conclusion: This is the first report to demonstrate the success of EUS FNA exome-sequencing. There was sufficient coverage in all samples and the variant identification between the 50 gene panel and the exome sequencing was highly concordant. The findings reveal the potential clinical utility of this method when applied to routine clinical cytology specimens to identify potential therapeutic targets which could be readily applied in a clinical research trial and eventually direct clinical care. Table 1