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Objective Acquiring adequate tissue for immunohistochemical (IHC) analysis is important in the differential diagnosis of subepithelial tumors (SETs). In this study, we aimed to compare the diagnostic yield based on IHC analysis between endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and EUS-guided fine needle biopsy (EUS-FNB) after on-site cytological evaluation for cellularity in gastric SETs. Methods In 22 patients with gastric SETs, EUS-guided tissue sampling was performed on the same SET in a randomized sequence, with EUS-FNA followed by EUS-FNB, or vice versa. After on-site cytological evaluation for cellularity, the cytological and histological examinations were performed. Results There was a significant difference in the median number of needle passes to obtain adequate cellularity in the on-site cytological evaluation (2.0 for EUS-FNA vs 1.0 for EUS-FNB, P = 0.008). The proportion of adequate cellularity on the first needle pass was significantly higher in the EUS-FNB than in the EUS-FNA group (68.2% vs 31.8%, P = 0.034). However, diagnosis based on IHC examination was established in 15 (68.2%) and 18 (81.8%) cases by EUS-FNA and EUS-FNB, respectively ( P = 0.488). Conclusions EUS-FNB decreases the number of needle passes to obtain adequate cellularity and yields a higher proportion of adequate cellularity during the first needle pass compared with EUS-FNA in gastric SETs. However, there was no significant difference in diagnostic yield with IHC stain between the two procedures after on-site cytological evaluation for adequate cellularity. [ABSTRACT FROM AUTHOR]

Objectives: The PAGE‐B model consists of variables at the initiation of antiviral therapy (AVT), whereas the SAGE‐B and CAGE‐B models consist of variables after 5 years of AVT. We aimed to compare the predictive accuracy of three risk prediction models for hepatocellular carcinoma (HCC) development after 5 years of AVT in patients with chronic hepatitis B (CHB). Methods: A total of 1335 patients who initiated entecavir (ETV) treatment between 2006 and 2011 and were followed up for more than 5 years were enrolled in the study. Results: At ETV initiation, the median age was 49 years and the median score of the PAGE‐B model was 14. After 5 years of ETV treatment, the median SAGE‐B and CAGE‐B scores were 6 and 6. During the study period, 93 (7.0%) patients developed HCC after 5‐year treatment. In multivariate analysis, PAGE‐B (hazard ratio [HR] 1.151, 95% confidence interval [CI] 1.087–1.219), SAGE‐B (HR 1.340, 95% CI 1.228–1.463), and CAGE‐B (HR 1.327, 95% CI 1.223–1.440) models independently predicted HCC development after 5 years of treatment (all P < 0.001). The high‐risk groups of the three risk prediction models showed a significantly higher risk of HCC development compared to the medium‐ and low‐risk groups (both P < 0.05). The AUROC of the SAGE‐B (0.772–0.844) and CAGE‐B (0.785–0.838) models was significantly higher than those of the PAGE‐B model (0.696–0.745) in predicting HCC development after 5 years of treatment (both P < 0.05). Conclusion: The SAGE‐B and CAGE‐B models might be better than the PAGE‐B model in predicting HCC development after 5 years of ETV treatment. [ABSTRACT FROM AUTHOR]

Objective: Surgicel (Fibrillar), i.e. oxidized regenerated cellulose, is used to control oozing bleeding after surgery, but few studies have assessed its effect on complications after endoscopic treatment. The aim of this study was to evaluate the efficacy of Surgicel for preventing bleeding after endoscopic submucosal dissection (ESD) for gastric epithelial tumors. Methods: From November 2012 to December 2013 patients scheduled for ESD of gastric epithelial tumors were prospectively enrolled in this study. Patients were assigned randomly to monotherapy with a proton pump inhibitor (PPI) (the MT group) or combination therapy with Surgicel and histamine‐2 receptor antagonist (H2RA) (the CT group) for preventing bleeding after ESD. Major bleeding rates and changes in hemoglobin at 1 and 7 days after ESD were evaluated. Results: Among the 157 patients enrolled (111 men, 46 women), 78 were assigned to the MT group and 79 to the CT group; finally, 72 and 74 patients were included in the MT and CT groups. The major bleeding rate was lower in the CT group (6/74, 8.1%) than in the MT group (12/72, 16.7%), but the difference was not significant (P = 0.354). The change in hemoglobin was significantly less marked in the CT group than the MT group 1 day after ESD ([−6.2 ± 9.0] g/L vs [−8.9 ± 6.2] g/L, P = 0.045). Conclusions: Combination therapy with Surgicel and an H2RA decreased the rate of bleeding similarly to PPI. Adding Surgicel to H2RA could be considered for patients with bleeding tendencies, or who require continuous antiplatelet therapy to prevent bleeding after ESD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Limited evidence is available on rebleeding due to nonsteroidal anti‐inflammatory drugs (NSAIDs)‐induced enteropathy. Previous studies have primarily analyzed endoscopic findings. Therefore, there is a need to evaluate their clinical implications for patients. This study aimed to evaluate the rebleeding rate and its related risk factors in patients with NSAIDs‐induced enteropathy. METHODS: Of 402 patients with obscure gastrointestinal bleeding who were evaluated with capsule endoscopy, 49 were diagnosed with NSAIDs‐induced enteropathy. The clinical characteristics of the patients were retrospectively analyzed. The Charlson comorbidity index was used to stratify the comorbidities. For patients who used additional drugs that influenced their tendency to bleeding, the odds ratio was calculated and used for a quantitative comparison. RESULTS: The rebleeding rate in patients with NSAIDs‐induced enteropathy was 20.4%, within a mean duration of 23.4 months. Age ≥65 years (hazard ratio [HR] 8.628, 95% confidence interval [CI] 1.152–64.625), no additional use of mucoprotective agents (HR 11.712, 95% CI 1.278–76.098) and the continuation of NSAIDs after the first bleeding episode (HR 9.861, 95% CI 1.395–98.344) were independently related to rebleeding due to NSAIDs‐induced enteropathy. The underlying comorbidities, drug‐related rebleeding risk scores and therapeutic use of proton pump inhibitors were not significantly different (P = 0.209, 0.212 and 0.720, respectively). CONCLUSIONS: Approximately one‐fifth of patients with NSAIDs‐induced enteropathy showed rebleeding within 2 years. A careful long‐term follow‐up should be offered to elderly patients with NSAIDs‐induced enteropathy who need continuous NSAID treatment without the additional use of mucoprotective medications. [ABSTRACT FROM AUTHOR]

Objective We aimed to validate a new scoring system for the differential diagnosis of gastric subepithelial tumors ( SET) based on endoscopic ultrasonography (EUS) findings, and to determine its diagnostic yield for different gastric SET. Methods Data of patients with gastric SET treated with endoscopic mucosal resection, endoscopic submucosal dissection or surgical resection from April 2001 to October 2012 at the Soonchunhyang University Hospital ( Bucheon, Korea) were retrospectively reviewed. Four variables, including location, shape, layer of origin and echogenicity of the tumor on EUS were used to validate the new scoring system. Results Among the 226 patients with gastric SET, 69 (30.5%) had gastrointestinal stromal tumors ( GIST), 68 (30.1%) had ectopic pancreas and 35 (15.5%) had leiomyoma. Most GIST were located at the fundus and body (79.7%), whereas most leiomyomas were found at the cardia (80.0%). Ectopic pancreas was mostly found at the antrum (88.2%). GIST were mainly irregular and round in shape, while ectopic pancreas and lipoma were oval and leiomyomas were irregularly shaped on EUS. With a score range of 0-1 for leiomyoma, 2-3 for GIST, 4-6 for ectopic pancreas and 7-8 for lipoma, the sensitivity and specificity of the scoring system were 75.8% and 85.4% for GIST, 84.6% and 73.1% for ectopic pancreas, 75.9% and 99.5% for leiomyoma and 91.7% and 96.7% for lipoma, respectively. Conclusions The new scoring system was simple and relatively useful for predicting the histology of gastric SET without acquiring tissues. Prospective studies with large sample sizes are needed in the future. [ABSTRACT FROM AUTHOR]