Srdjan Djuranovic

Therapeutic Double-Balloon Enteroscopy: A Binational, Three-Center Experience

Background/Aims: There are few reports focusing on therapeutic small bowel endoscopy. The aim of this study was to analyze the results of therapeutic small bowel endoscopy in a large cohort of patients. Methods: A retrospective study of a prospectively collected database comprising all patients undergoing diagnostic and therapeutic small bowel endoscopy in three centers. Results: A total of 614 double-balloon enteroscopies were performed in 534 patients. The most common pathological findings were angiodysplasias and vascular lesions (n = 98, 18%), mucosal ulcers and erosions (n = 95, 17.8%), polyps and tumors (including patients with familiar polyposis syndrome such as Peutz-Jeghers syndrome, familiar adenomatous polyps syndrome, neurofibromatosis, adenocarcinoma, neuroendocrine tumors and gastrointestinal stromal tumors) (n = 52, 9.7%), and strictures (Crohn’s disease, ischemia, tumors) (n = 12, 2.2%). The mean duration of therapeutic small bowel enteroscopy was 67 min (range 30–115) compared to 50 min (range 25–105) for diagnostic procedures (p < 0.05). A therapeutic small bowel endoscopy was performed in 121 patients (22%). Therapeutic procedures included argon plasma coagulation of vascular lesions (n = 73), polypectomy (n = 49), mucosectomy (n = 5), stricture dilation (n = 7), foreign body extraction (n = 7), injection of fibrin glue (n = 10), and clip placement (n = 5). There were a total of 5 complications (0.9%; paralytic ileus, n = 2, pancreatitis, n = 1, bleeding n = 2). No perforations or deaths occurred. Conclusion: Endoscopists performing double-balloon enteroscopy should be trained and prepared to provide therapeutic interventions for small bowel disorders including argon plasma coagulation, injection, hemoclipping, polypectomy, mucosectomy and foreign body extraction. Therapeutic small bowel endoscopy, albeit associated with complications in about 1% of cases, can be considered a relatively safe procedure.

The Polymorphism rs3024505 (C/T) Downstream of the IL10 Gene Is Associated with Crohn’s Disease in Serbian Patients with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), manifesting as Crohns disease (CD) and ulcerative colitis (UC), is characterized by recurring episodes of inflammation in gastrointestinal tract, in which aberrant production of regulatory cytokine interleukin-10 (IL-10) presumably plays important role. Single nucleotide polymorphisms (SNPs) that affect IL-10 production, such as rs1800896 (G/A) at position -1082 and rs1800871 (C/T) at position -819 in the promoter region of the IL10 gene, have been associated with CD and/or UC, but the results were inconsistent. Another SNP that may alter IL-10 production, rs3024505 (C/T) located immediately downstream of the IL10 gene has been recently identified. T allele of rs3024505 was associated with both UC and CD in Western populations, but the studies from East European countries are lacking. Therefore, our aim was to assess the association of rs3024505, rs1800896 and rs1800871 with Serbian IBD patients. To this end, 107 CD and 99 UC patients and 255 healthy controls were genotyped. As a result, T allele of rs3024505 was associated with CD at allelic, genotypic (GT genotype) and haplotypic (GCCT haplotype) level, suggesting potential role of this variant in susceptibility to CD. In contrast, CD patients carrying C allele of rs3024505 had significantly increased risk of anemia and stricturing/penetrating behavior. No association was observed between rs3024505 and UC or SNPs in IL10 promoter region and any form of IBD. In conclusion, rs3024505 SNP flanking the IL10 gene is associated with susceptibility and severity of disease in Serbian CD patients, further validating its role as a potential biomarker in IBD.

Significance of color Doppler ultrasonography in the assessment of pancreatic carcinoma vascular invasion

BACKGROUND/AIM It is highly appreciated to provide exact data on vascular invasion of pancreatic carcinoma relying as much as possible on non-invasive diagnostic procedures. Color Doppler ultrasonography has been proven as an efficient method for clinical staging of pancreatic carcinoma essential for therapeutic decisions. The aim of this study was to provide an analysis of the sensitivity and specificity for color Doppler ultrasonography in patients suffering from pancreatic carcinoma. METHODS We performed color Doppler ultrasonography examination in 43 patients with pancreatic carcinoma prior to the surgery. The findings of ultrasonography on neoplasm vascular invasion were correlated to the findings obtained during the subsequent surgical procedures. An estimation of neoplastic invasion of certain blood vessels including portal vein, celiac trunk, and superior mesenteric artery and vein is critical for decision making regarding surgical treatment. The patients with metastases of pancreatic carcinoma were excluded from the study. RESULTS Comparing color Doppler and the surgical findings we estimated the sensitivity for detection of neoplastic vascular invasion ranging from 79-93%, whereas the specificity range was from 83-93%. CONCLUSION Color Doppler ultrasonography is a sufficiently sensitive and specific method for evaluation of vascular invasion in pancreatic carcinoma patients. Since color Doppler ultrasonography is a non-invasive, radiation free, and inexpensive diagnostic tool, considering also the results of this and similar studies we could strongly recommend its use for an initial presurgical evaluation of vascular invasion in pancreatic carcinoma patients.

MDR1 gene polymorphisms are associated with ulcerative colitis in a cohort of Serbian patients with inflammatory bowel disease

Background Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology in which genetic factors contribute to development of disease. Single nucleotide polymorphisms (SNPs) in multidrug resistance 1 (MDR1) gene encoding transporter P-glycoprotein have been associated with IBD, but their role in disease susceptibility remains unclear. Therefore, the aim of this study was to investigate the association of three MDR1 polymorphisms, C1236T (rs1128503), G2677T/A (rs2032582) and C3435T (rs1045642), with Serbian IBD patients. Methods A total of 206 IBD patients, 107 Crohns disease (CD) and 99 ulcerative colitis (UC), and 255 healthy controls were included in the study. All subjects were genotyped using TaqMan SNP genotyping assays. Comparisons between the groups were performed using the Pearson Chi-square test. False discovery rate according to Benjamini-Hochberg procedure was applied to adjust for multiple comparisons. Results Carriers of T allele of all three MDR1 SNPs were more common in UC patients compared to healthy controls, suggesting predisposing role of T allele of these SNPs in UC pathogenesis. Consistently, TT genotype of C1236T and TTT haplotype were also found more frequently in UC patients. On the other hand, C allele and CC genotype of C1236T and C3435T, as well as G allele and GG genotype of G2677T/A were more frequent in healthy subjects, implying protective role of these variants in UC. Likewise, CGC haplotype and CGC/CGC diplotype were more frequent in controls. Contrary to UC, no statistical difference was observed between CD patients and controls in any of the SNPs analyzed. Conclusion MDR1 gene variants and haplotypes were associated with UC in Serbian IBD patients, further supporting their potential role in susceptibility to UC.

Colorectal cancer screening methods

Colorectal cancer (CRC) is an important social and medical problem. Complete recovery can be achieved only if the disease is diagnosed in the early stages, most common by screening methods. Studies have shown that screening methods reduce the incidence and mortality of colorectal cancer. The methods for colorectal screening can be divided into tests that allow the detection of cancer (fecal occult blood test and fecal DNA test) and morphological tests that allow diagnosis of cancer or adenomatous polyps (flexible sigmoidoscopy, colonoscopy, double contrast barium enema, CT colography ). In people with average risk of disease, screening begins at 50 years and performed on one of the following: fecal occult blood test (every year), flexible sigmoidoscopy (every 5 years), colonoscopy (every 10 years), double contrast barium enema (every 5 years) or CT colography (every 5 years). Colonoscopy is the preferred method, and is used as a confirmatory method, if the any other methods was positive.

[Acute lead intoxication--a rare cause of abdominal pain].

Abdominal pain is a common symptom of various diseases and conditions of different aetiology. The aim of the interpretation of abdominal pain is to reach an early and accurate diagnosis, thereby enabling appropriate treatment. Acute abdominal pain may be the result of a number of abdominal, as well as extra-abdominal causes, lead poisoning being one such extra-abdominal cause. Here, we report the case of a 73-year-old male patient, admitted for clinical investigation of a suspected tumour of the colon, due to the presence of acute convulsive abdominal pain, without propagation, constipation, and anaemia. A history provided by the patients family indicated his exposure to lead. The absence of any abdominal pathology, increased levels of lead in the blood (5.249 micromol/l), the presence of basophilically punctuated red blood cells, as well as a ring of sideroblasts, all indicated that the patients symptoms (abdominal pain, constipation, and anaemia) were the result of acute lead intoxication. The patients case history, including lead exposure, the absence of pathological findings via endoscopic and x-ray examination, laboratory findings (normocytic anaemia, an increased serum lead concentration, basophilically punctuated red blood cells, and the presence of an abundant ring of sideroblasts), all indicated that his symptoms were the result of lead intoxication. After six months of chelation therapy (EDTA), his symptoms completely disappeared, and his laboratory findings returned to normal. This presentation aims to underscore the importance of meticulous history taking, as well as of the selection of suitable laboratory and other auxiliary diagnostic methods in the correct diagnosis of this rare condition.