Kuo-Liang Wei

Routine blood tests to predict liver fibrosis in chronic hepatitis C.

AIM To verify the usefulness of FibroQ for predicting fibrosis in patients with chronic hepatitis C, compared with other noninvasive tests. METHODS This retrospective cohort study included 237 consecutive patients with chronic hepatitis C who had undergone percutaneous liver biopsy before treatment. FibroQ, aspartate aminotransferase (AST)/alanine aminotransferase ratio (AAR), AST to platelet ratio index, cirrhosis discriminant score, age-platelet index (API), Pohl score, FIB-4 index, and Loks model were calculated and compared. RESULTS FibroQ, FIB-4, AAR, API and Loks model results increased significantly as fibrosis advanced (analysis of variance test: P < 0.001). FibroQ trended to be superior in predicting significant fibrosis score in chronic hepatitis C compared with other noninvasive tests. CONCLUSION FibroQ is a simple and useful test for predicting significant fibrosis in patients with chronic hepatitis C.

Outcomes of endoscopic submucosal dissection for early gastric cancer and precancer lesion: Experience from a center in Southern Taiwan

Limited data are available on the interval of disease‐free status after endoscopic submucosal dissection (ESD) for early gastric cancer and precancer lesion in Taiwan. In this long‐term (2–105 months) follow‐up study, we analyzed the risk factors that affect the local recurrence and noncurative resection (non‐CR) of these lesions.

Gastrointestinal metastasis from primary sarcomatoid carcinoma of the lung: a case report and review of the literature

Gastrointestinal metastases in lung cancer are extremely rare. The report presents a rare case of primary lung sarcomatoid carcinoma with both gastric and colonic metastases, and reviews the literature about endoscopic presentation of colonic metastases.

Successful Endoscopic Treatment of Mirizi Syndrome after Short-term Stenting: Report of a Case

Mirizzi syndrome (MS) is a very uncommon complication that develops in patients with gallbladder stones, with an incidence rate of approximately 1%. The standard treatment for MS is surgical intervention with either a laparoscopic or an open approach. In patients who cannot undergo surgery, an endoscopic approach with long-term stenting, mechanical lithotripsy, extracorporeal shockwave lithotripsy, electrohydraulic lithotripsy, and laser lithotripsy are alternatives to surgery. However, mechanical lithotripsy is technically challenging, and long-term stenting is associated with high complication and mortality rates. Here, we report a patient with MS who was successfully treated using endoscopic mechanical lithotripsy after short-term stenting.

Antibiotic Strategy for Pyogenic Liver Abscess: One Medical Center Experience in Taiwan

Background and Aim: There is currently no consensus on antibiotic treatment for pyogenic liver abscess. This retrospective study intends to verify the equivalent effects between the step-up antimicrobial strategy and indiscriminate broad-spectrum antibiotic treatment for this disease. Methods: One hundred twenty-two consecutive patients with pyogenic liver abscess were retrospectively analyzed. In addition to abscess drainage, they were preferentially treated with a conservative regimen of parenteral antibiotics with cefazolin plus gentamicin at presentation. The mortality rate was compared with that of studies published in English-language medical literature. The complicated group, with mortality, metastatic infections, relapsed diseases, and involuntary surgeries, was compared with its contrary uncomplicated group to identify the risk factors for unfavorable clinical courses and outcomes. Results: The mortality rate was 10% (12/122), which was comparable to results documented in the English-language literature. There were 38 patients in the complicated group and 84 patients in the uncomplicated group. Seventy- three patients (60%) did not require modification of their cefazolin plus gentamicin regimen. Univariate analysis revealed that liver cirrhosis (OR=5.643, P=0.004), biliary disease (OR=3.440, P=0.006), pleural effusion (OR=3.556, P=0.003) and abscess rupture (OR=43.160, P=0.0001) were risk factors for complicated outcomes. Clinical jaundice (2.67±2.45 νs. 1.67±1.82 mg/dL, P=0.013) and anemia (11.6±2.43 νs. 12.53±1.88 g/dL, P=0.024) also reached the statistical significance. Multivariate logistic regression analysis revealed that liver cirrhosis (P=0.004), abscess rupture (P=0.0001) and biliary disease (P=0.0001) were independent risk factors. Conclusion: Cefazolin plus gentamicin suffices for most patients with pyogenic liver abscess. Liver cirrhosis, biliary disease, and abscess rupture are independent risk factors for a complicated disease course.

Paraesophageal Hernia Complicated with Mediastinal Abscess: Report of a Case

Paraesophageal hiatal hernia is an uncommon hiatal hernia which can lead to life-threatening complications, developing in approximately 30% of patients if left untreated. We described an extremely rare and previously undocumented case of paraesophageal hiatal hernia with complication of mediastinum abscess. The diagnosis was confirmed by chest X-ray, upper gastrointerstinal barium study, computed tomography (CT) scan and endoscopy. Prompt surgical intervention prevented further severe complications, and no recurrence was observed at one-year follow-up.

Pancreatic Ascites Treated by Endoscopic Pancreatic Duct Stenting: Report of a Case

Pancreatic ascites is an uncommon complication of pancreatitis. In essence this condition involves a fistula from the pancreas to the peritoneal cavity. The most common underlying cause is chronic pancreatitis secondary to alcohol abuse. Traditional conservative therapy requires surgery in up to 50% of patients. However, surgery is associated with a high recurrence rate as well as with morbidity and mortality. Endoscopic management has emerged as a treatment option for pancreatic ascites during the past two decades. This work describes a case of pancreatic ascites successfully managed by endoscopic retrograde pancreatography (ERP) with stent placement in the pancreatic duct.