Gastrointestinal cancer screening and surveillance programmes : a worldwide perspective : part 2

Part 1 of this article can be found through this link: https://www.um.edu.mt/library/oar//handle/123456789/12879Part 2 of this article. Cancer is a leading cause of death worldwide and such deaths are projected to continue to rise, creating significant morbidity and mortality. Devising programmes to detect early cancer, aiming to achieve complete cure, has been high on the agenda of various professional bodies. This paper focuses on the various screening and surveillance programmes around the world, aiming at detecting early gastrointestinal malignancies. Starting with Barretts’ oesophagus, we shall see the different surveillance programmes across countries to detect premalignant stages of oesophageal cancer, while at the same time reviewing the only country in the world, China, which has an oesophageal cancer mass screening programme. Moving to gastric cancer, we shall review Japan’s screening programme, followed by other countries’ measures in surveilling premalignant gastric conditions. Colorectal cancer is the only gastrointestinal cancer where mass screening has been employed in various countries. This will be discussed in detail, with particular emphasis on the British and American systems. We shall also be discussing the surveillance programmes for moderate and high risk patients of colorectal cancer. Finally, we shall also review the different recommendations with regards to screening for hepatocellular carcinoma.peer-reviewe

Gastrointestinal cancer screening and surveillance programmes : a worldwide perspective : part 1

Part 2 of this article can be found through this link: https://www.um.edu.mt/library/oar//handle/123456789/13101Cancer is a leading cause of death worldwide and such deaths are projected to continue to rise, creating significant morbidity and mortality. Devising programmes to detect early cancer, aiming to achieve complete cure, has been high on the agenda of various professional bodies. This paper focuses on the various screening and surveillance programmes around the world, aiming at detecting early gastrointestinal malignancies. Starting with Barretts’ oesophagus, we shall see the different surveillance programmes across countries to detect premalignant stages of oesophageal cancer, while at the same time reviewing the only country in the world, China, which has an oesophageal cancer mass screening programme. Moving to gastric cancer, we shall review Japan’s screening programme, followed by other countries’ measures in surveilling premalignant gastric conditions. Colorectal cancer is the only gastrointestinal cancer where mass screening has been employed in various countries. This will be discussed in detail, with particular emphasis on the British and American systems. We shall also be discussing the surveillance programmes for moderate and high risk patients of colorectal cancer. Finally, we shall also review the different recommendations with regards to screening for hepatocellular carcinoma.peer-reviewe

Accidental severe bronchial aspiration of barium uncovers diagnosis of bronchiectasis

A 77-year-old man, with a history of chronic obstructive pulmonary disease (COPD) and radiotherapy-treated laryngeal malignancy diagnosed 15 years prior, presented with a 1-year history of intermittent dysphagia. As a part of his investigations, a barium swallow was obtained; but during the initial phases of the procedure, the patient aspirated the contrast agent of barium sulphate. A chest radiograph (Fig. 1a), taken few minutes after the aspiration, showed barium within the different segments and subsegments of the bronchial tree bilaterally, and uncovered features, such as irregular dilatation of the bronchial tree, non-tapering of the bronchi, luminal filling defects and lack of bronchial side branches, characteristic of bronchiectasis. This incident precipitated an exacerbation of COPD with type II respiratory failure, requiring bronchodilators, intravenous antibiotics and non-invasive ventilation using a bilevel positive airway pressure machine. On recovery, direct laryngoscopy revealed post-radiotherapy changes but no evidence of tumour recurrence.peer-reviewe

Recurrent urinary tract infections in a patient with Crohn’s disease

A 62-year-old male smoker was diagnosed with ileocolonic Crohn’s disease 1 year previously, which was complicated by an asymptomatic terminal ileal stricture diagnosed on contrast radiology. Clinical and biochemical remission were induced initially by steroids and then maintained by mesalazine (1 g three times a day) and azathioprine (2 mg/kg daily). Six months following diagnosis, the patient complained of recurrent urinary tract infections and haematuria, and was found to have raised inflammatory markers, hypoalbuminaemia and anaemia.peer-reviewe

Giant gastric folds in a patient with hypoalbuminaemia

A 70-year-old man presented with a 3-month history of persistent epigastric pain, 8 kg weight loss and lower limb swelling. Examination revealed a normal abdomen and bilateral lower limb oedema. Blood results were unremarkable except for hypoalbuminaemia (23 g/l) and peripheral eosinophilia (1.06×109/l). Urinalysis and CT of the abdomen were negative. An oesophagogastroduodenoscopy (OGD) revealed large gastric folds involving the fundus and the body of the stomach (figure 1), and a small antral polyp. Histology showed marked reactive mucosal changes, pronounced foveolar hyperplasia and cystic dilatation (figure 2), compatible with a diagnosis of Ménétrier’s disease. Helicobacter pylori was absent and the antral polyp was adenomatous. He was given omeprazole and prednisolone (20 mg daily), which was tailed down after 2 months. Subsequently, his symptoms improved significantly. He regained 10 kg in weight and his albumin levels normalised. OGD done post therapy and 1 year later still showed prominent, but less pronounced, gastric folds, and histological evidence of hyperplastic gastropathy.peer-reviewe

Anti-endomysial antibody may predict a second endoscopy in coeliac-suspected patients with false negative index duodenal biopsies

Background/aims: A subset of coeliac-suspected patients requires 2 Oesophagogastroduodenoscopies (OGDs) to achieve histological confirmation. Their index OGD would fail to reach diagnosis despite 4 duodenal biopsies suggested by guidelines. We compared this subgroup of patients with other coeliac patients requiring 1 endoscopy and recognize any predictors to identify the former group.Methods: Coeliac-suspected patients at our department underwent an OGD. Clinical, serological and histological data were retrieved from medical notes. Group 1 comprised patients who achieved diagnosis with 1 OGD. Group 2 required 2 OGDs.Results: 178 patients underwent an OGD (mean age 47 years; 73.6% females). 12 patients (6.7%) required 2 OGDs. Both groups had the same mean number of duodenal biopsies at their index endoscopy (4.6 vs 4.5, P=0.76). In Group 2, the number of biopsies was higher at the second endoscopy (6.4 vs 4.5, P=0.028). Group 2 showed a negative or lower positivity for anti-EMA (P=0.039) and a lower anti-tTG IgA level (P=0.06) than Group 1.Conclusion: Anti-EMA seronegativity or low positivity in coeliac-suspected patients indicates the need for more duodenal biopsies to achieve diagnosis and avoiding subsequent OGDs. This finding makes anti-EMA testing crucial in coeliac diagnostics.peer-reviewe

Endoscopic snare polypectomy of a pedunculated adenocarcinoma of the duodenal bulb arising from a hyperplastic polyp

Primary non-ampullary adenocarcinoma of the duodenum is a rare occurrence, arising mainly from adenomatous polyps [1].We report the first case of a pedunculated adenocarcinoma of the duodenal bulb, arising from a hyperplastic polyp, treated with endoscopic snare polypectomy.peer-reviewe

Tenofovir as rescue therapy following clinical failure to lamivudine in severe acute hepatitis B

Acute hepatitis B (AHB) is a self-limiting condition in more than 95% of cases. Treatment is however recommended in patients with severe AHB (<1% of cases), aiming to prevent liver failure and death. Various nucleos(t)ide analogues (NA) have been found to be effective in severe AHB, although NA-resistant strains causing AHB have been also recently reported. The use of tenofovir in severe AHB has only been described in 3 cases (1 adult and 1 infant with HBV mono-infection, 1 adult with HBV/HIV co-infection). We hereby report a 47-year-old treatment-naïve male, who developed severe AHB and was initially treated with lamivudine (LMV). Initial rapid biochemical response was followed by biochemical breakthrough after 9 days, suggesting LMV resistance. Rescue therapy with ‘add-on’ tenofovir brought about a sustained improvement in biochemical, serological and virological markers until HBsAg was lost after 4 months. Thus, this is the second adult HBV mono-infected patient, who responded successfully to tenofovir in severe AHB.peer-reviewe