Eva Martinez-Bauer

OVESCO: un sistema prometedor de cierre endoscópico de las perforaciones del tracto digestivo

Perforations of the gastrointestinal tract are a significant source of morbidity in clinical practice. Surgery has been the standard of care. However, endoscopic treatment with clips can be used when perforations are small. The development of natural orifice transluminal endoscopic surgery (NOTES) has substantially contributed to research in this field, such as the over the scope clip (OVESCO or OTSC). This system is one of the most promising technologies for closure of perforations of the gastrointestinal tract because of its efficacy, safety and rapidity. Other indications include severe gastrointestinal bleeding, fistulae, anastomotic leaks, and bariatric surgery anastomosis remodelling. This article describes the OVESCO system from its initial design to its introduction in clinical practice.

Usefulness of indirect noninvasive methods in predicting progression to cirrhosis in chronic hepatitis C.

Background and aims The ability of noninvasive methods to predict the development of cirrhosis has not been established. We evaluated the ability of three noninvasive methods [the Forns index, the aspartate aminotransferase-to-platelet ratio index (APRI), and the Non-Invasive Hepatitis-C-related Cirrhosis Early Detection (NIHCED) score] to determine the risk of developing cirrhosis in chronic hepatitis C. Methods Consecutive patients with chronic hepatitis C who had undergone liver biopsy between 1998 and 2004 were eligible. We used the three methods to evaluate patients at baseline and at follow-up (4–10 years later). When these methods yielded discordant or indeterminate results, a second liver biopsy was performed. Logistic regression models were fitted for each method to predict whether cirrhosis would appear and to predict long-term mortality from cirrhosis. Results We included 289 patients in our study. The mean scores at baseline and at follow-up, respectively, were as follows: Forns, 5.47±1.95 and 6.56±2.02; APRI, 1.1±2.33 and 1.4±1.53; and NIHCED, 7.79±11.45 and 15.48±15.28. The area under the receiver operating characteristic curve for predicting cirrhosis was 0.83 for Forns, 0.79 for APRI, and 0.76 for NIHCED. The sensitivity and specificity for predicting cirrhosis, respectively, were 75 and 71% for Forns (cutoff 4.7), 86 and 42% for APRI (cutoff 0.48), and 41 and 82% for NIHCED (cutoff 0). The area under the receiver operating characteristic curve for predicting mortality was 0.86 for Forns, 0.79 for APRI, and 0.84 for NIHCED. Conclusion Indirect noninvasive markers could help identify patients with chronic hepatitis C at risk of progression to cirrhosis.

Inter and intra-observer concordance for the diagnosis of portal hypertension gastropathy

INTRODUCTION At present there is no fully accepted endoscopic classification for the assessment of the severity of portal hypertensive gastropathy (PHG). Few studies have evaluated inter and intra-observer concordance or the degree of concordance between different endoscopic classifications. OBJECTIVES To evaluate inter and intra-observer agreement for the presence of portal hypertensive gastropathy and enteropathy using different endoscopic classifications. METHODS Patients with liver cirrhosis were included into the study. Enteroscopy was performed under sedation. The location of lesions and their severity was recorded. Images were videotaped and subsequently evaluated independently by three different endoscopists, one of whom was the initial endoscopist. The agreement between observations was assessed using the kappa index. RESULTS Seventy-four patients (mean age 63.2 years, 53 males and 21 females) were included. The agreement between the three endoscopists regarding the presence or absence of PHG using the Tanoue and McCormack classifications was very low (kappa scores = 0.16 and 0.27, respectively). CONCLUSIONS The current classifications of portal hypertensive gastropathy have a very low degree of intra and inter-observer agreement for the diagnosis and assessment of gastropathy severity.

HEMOSPRAY: EXPERIENCIA INICIAL EN HEMORRAGIA DIGESTIVA ALTA NO VARICOSA

Introduccio: Hemospray es un nou agent hemostatic pel tractament endoscopic de lesions sagnants no varicoses del tracte gastrointestinal. Es tracta d’una pols inorganica que provoca una barrera mecanica sobre la lesio sagnant i activa la via intrinseca de la coagulacio. Dos estudis pilot realitzats a Hong Kong i Canada i un multicentric europeu han mostrat la seva eficacia en pacients amb ulcera peptica i en pacients amb sagnat d’ origen tumoral.