Gaining competence in needle - knife fistulotomy - can I begin on my own?

BACKGROUND: While there are guidelines for appropriate training in ERCP, these are non-existent for needle-knife precut. The aim of this study was: (1) evaluate the experience curve of three endoscopists in needle-knife fistulotomy (NKF); (2) propose a minimum number of NKF procedures to attest proficiency. METHODS: Between November 1997 and March 2011, the first 120 consecutive NKF performed by three endoscopists (A, B, and C) were selected (360 patients) from three centers. Each group of 120 patients was chronologically ordered into three subgroups of 40.?The main outcomes were: NKF use, NKF success, and post-ERCP adverse events. RESULTS: The need for NKF did not decrease over time. The NKF success rate in the first attempt for endoscopist A and C in each of the three subgroups was 85?%/85?%, 87.5?%/87.5?%, and 87.5 %/90?%, respectively. Furthermore, both demonstrated a high NKF success in their initial 20 NKFs (85?% and 80?%, respectively). Endoscopist B however presented a different pattern as the success rate initiated at 60?%, then rose to 82.5?% and 85?% for the last group (P?=?0.03). Adverse events were mild (28 of the 32 occurrences) with no clear reduction with increased experience. CONCLUSIONS: A skillful endoscopist may expect to master NKF easily with few adverse events. While some endoscopists could begin on their own because of their innate skills, a minimal training is needed for all, as we cannot predict skills in advance. We propose a minimum of 20 NKF precuts to attest a trainee's competence in this procedure.info:eu-repo/semantics/publishedVersio

Predictive biomarkers of bacillus calmette-guérin immunotherapy response in bladder cancer : where are we now?

The most effective therapeutic option for managing nonmuscle invasive bladder cancer (NMIBC), over the last 30 years, consists of intravesical instillations with the attenuated strain Bacillus Calmette-Gu´erin (the BCG vaccine). This has been performed as an adjuvant therapeutic to transurethral resection of bladder tumour (TURBT) and mostly directed towards patients with highgrade tumours, T1 tumours, and in situ carcinomas. However, from 20% to 40% of the patients do not respond and frequently present tumour progression. Since BCG effectiveness is unpredictable, it is important to find consistent biomarkers that can aid either in the prediction of the outcome and/or side effects development. Accordingly, we conducted a systematic critical review to identify themost preeminent predictive molecular markers associated with BCG response. To the best of our knowledge, this is the first review exclusively focusing on predictive biomarkers for BCG treatment outcome. Using a specific query, 1324 abstracts were gathered, then inclusion/exclusion criteria were applied, and finally 87 manuscripts were included. Several molecules, including CD68 and genetic polymorphisms, have been identified as promising surrogate biomarkers. Combinatory analysis of the candidate predictive markers is a crucial step to create a predictive profile of treatment responseThe first author has a PhD grant from Fundação para a Ciência e Tecnologia /FCT (SFRH/BD/43399/2008), cofinanced by European Social Fund (ESF) underHuman Potential Operation Programme (POPH) from National Strategic Reference Framework (NSRF)

MicroRNAs biomarkers for early screening of colorectal cancer

Colorectal cancer (CRC) is the most incident neoplasia in Portugal. When diagnosed early, the 5-year cancer survival rate increases to 90% [2]. However, the current noninvasive screening method for CRC, Fecal Immunochemical Test (FIT), has low sensitivity and specificity for detecting precancerous lesions. Therefore, it is necessary to develop a new screening method for CRC. MicroRNAs (miRs) play a role in genetic events associated with carcinogenesis, and their disrupted expression in tumors can be readily detected in biological fluids [5-8]. This characteristic offers a promising tool for CRC screening. Review the existing literature to assess the advancements made in recent years in the potential use of miRs as a biomarker to improve the CRC screening. A comprehensive literature review was conducted, analyzing a total of 54 studies that investigated miRs expression in stool and blood samples and evaluated is potential as biomarkers for CRC identification. In our search, we identified a total of 104 miRs with potential relevance to CRC screening in both stool and blood samples. Among these miRs, miR-21-5p and miR-92a-3p, along their cluster including miR-29a-3p, miR-20a-5p, and miR-18-5p, emerged as the most frequently mentioned and promising candidates. Furthermore, is reported a differential expression of miR-135b-5p, miR-223-3p, and miR-451 only in stool specimens, while miR-139-3p and miR-4516 exhibit this altered expression in blood samples. Other notable miRs, including miR-146a-5p, miR-199a-5p, miR-421, miR-27a-3p, and miR-221-3p, have shown promising results in detecting advanced adenomas, exhibiting a better performance compared to FIT. However, these findings require further validation in a larger patient cohort and across different biological samples to confirm their significance for CRC and precancerous lesions detection. Therefore, miRs are regarded as a promising approach for enhancing the detection of CRC, particularly in the identification of precancerous lesions. Nevertheless, further studies are required to assess the accuracy of these molecules as biomarkers.info:eu-repo/semantics/publishedVersio

Linking dysbiosis to precancerous stomach through inflammation: Deeper than and beyond imaging

Upper gastrointestinal endoscopy is considered the gold standard for gastric lesions detection and surveillance, but it is still associated with a non-negligible rate of missing conditions. In the Era of Personalized Medicine, biomarkers could be the key to overcome missed lesions or to better predict recurrence, pushing the frontier of endoscopy to functional endoscopy. In the last decade, microbiota in gastric cancer has been extensively explored, with gastric carcinogenesis being associated with progressive dysbiosis. Helicobacter pylori infection has been considered the main causative agent of gastritis due to its interference in disrupting the acidic environment of the stomach through inflammatory mediators. Thus, does inflammation bridge the gap between gastric dysbiosis and the gastric carcinogenesis cascade and could the microbiota-inflammation axis-derived biomarkers be the answer to the unmet challenge of functional upper endoscopy? To address this question, in this review, the available evidence on the role of gastric dysbiosis and chronic inflammation in precancerous conditions of the stomach is summarized, particularly targeting the nuclear factor-κB (NF-κB), toll-like receptors (TLRs) and cyclooxygenase-2 (COX-2) pathways. Additionally, the potential of liquid biopsies as a non-invasive source and the clinical utility of studied biomarkers is also explored. Overall, and although most studies offer a mechanistic perspective linking a strong proinflammatory Th1 cell response associated with, but not limited to, chronic infection with Helicobacter pylori, promising data recently published highlights not only the diagnostic value of microbial biomarkers but also the potential of gastric juice as a liquid biopsy pushing forward the concept of functional endoscopy and personalized care in gastric cancer early diagnosis and surveillance

Training in endoscopic mucosal resection and endoscopic submucosal dissection: face, content and expert validity of the live porcine model

Introduction: Endoscopic mucosal resection and endoscopic submucosal dissection are demanding procedures. This study aims to establish face, content and expert validity of the live porcine model in performing endoscopic mucosal resection, endoscopic submucosal dissection, complication management and to assess it as a training tool. Material and methods: Tutors and trainees participating in live porcine model endoscopic mucosal resection and endoscopic submucosal dissection workshops filled out a questionnaire regarding the realism of the model compared to human setting and its role as a learning tool. A 10-point Likert scale was used. Results: Ninety-one endoscopists (13 tutors; 78 trainees) were involved in four workshops. Median global classifications for the realism of the life porcine model ranged between 7.0–8.0 (interquartile range 5.0–9.0). Procedures resembled human cases with a median of 9.0 (8.0–9.0) for oesophageal multiband endoscopic mucosal resection; 8.5 (8.0–9.0) for oesophageal endoscopic submucosal dissection; 9.0 (8.0–10.0) for gastric endoscopic submucosal dissection; and 9.0 (8.5–9.75 and 8.0–9.69) for complication detection and management. The animal model as a learning tool had median scores of 9.0 (7.0–10.0) considering how procedures are performed; 9.0–9.5 (8.0–10.0) for usefulness for beginners; and 9.0–10.0 (5.0–10.0) regarding it a prerequisite. Conclusions: Training in a live porcine model was considered very realistic compared to the human setting and was highly appreciated as a learning tool. This is the first study to establish face, content and expert validity of the live porcine model in performing multiband endoscopic mucosal resection, oesophageal and gastric endoscopic submucosal dissection. The validation of this model provides the rationale to incorporate it into formal teaching programmes.info:eu-repo/semantics/publishedVersio

Participation in clinical trials increases the detection of pre-malignant lesions during colonoscopy

BACKGROUND: colorectal adenoma detection has been associated with the effectiveness of cancer prevention. Clinical trials have been designed to determine the role of several interventions to increase the detection of pre-malignant lesions. We hypothesized that colonoscopy in the setting of clinical trials has a higher pre-malignant lesion detection rate. METHODS: a cross-sectional study was performed that compared the detection of pre-malignant lesions in 147 randomly sampled non-research colonoscopies and 294 from the control group of two prospective trials. Outpatients aged 40-79 years, with no personal history of colorectal cancer (CRC) were included. RESULTS: baseline characteristics were similar between the two groups. The pre-malignant lesion detection rate in the trial vs control group was 65.6 % vs 44.2 % (OR 2.411; 95 % CI: 1.608-3.614; p < 0.001), the polyp detection rate was 73.8 % vs 59.9 % (OR 1.889; 95 % CI: 1.242-2.876; p = 0.003), the adenoma detection rate was 62.6 % vs 44.2 % (OR 2.110; 95 % CI: 1.411-3.155; p < 0.001) and the sessile serrated lesion detection rate was 17 % vs 4.1 % (OR 4.816; 95 % CI: 2.014-11.515; p < 0.001). The mean number of pre-malignant and sessile serrated lesions was 1.70 vs 1.06 (p = 0.002) and 0.32 vs 0.06 (p = 0.001) lesions per colonoscopy, respectively. There was no significant change in any of the study outcomes according to the multivariate analysis with each single potential confounder. CONCLUSIONS: patients involved in colonoscopy trials may benefit from higher quality examinations, as shown by the higher detection rates. Institutions should consider supporting clinical research in colonoscopy as a simple means to improve colonoscopy quality and colorectal cancer prevention.publishersversionpublishe