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Aris Chronis, Konstantinos Thomopoulos, Apostolos Sapountzis, Christos Triantos, Maria Kalafateli, Charalampos Kalofonos, Vassiliki NikolopoulouDepartment of Internal Medicine, Division of Gastroenterology, University Hospital, Patras, GreecePurpose: Adiposity has been thought to be related to colorectal carcinogenesis. The aim of this study was to explore any association between obesity factors and the presence of colorectal adenoma, a potential precancerous lesion.Patients and methods: Two hundred and six consecutive patients undergoing colonoscopy without colorectal cancer were enrolled in the study. Anthropometric measures and other adiposity-related laboratory variables including insulin resistance and serum adiponectin levels were recorded and correlated with the presence of adenoma.Results: Colorectal adenoma was detected in 68/206 patients (33%), tubular adenoma(s) in 38 patients, and tubulovillous or villous in 30 patients. Twenty-one patients (10.2%) had at least one proximal polyp. The size of the largest adenoma was ≤10 mm in 40 patients and >10 mm in 28 patients. No statistically significant difference was observed in body mass index, waist circumference, fasting plasma glucose concentration, insulin, homeostatic metabolic assessment, cholesterol, low-density lipoproteins, high-density lipoprotein, or triglycerides between patients with and without adenoma. In addition, there was no difference in plasma adiponectin between patients with adenoma (11.1 ± 6 µg/mL) and controls (10.2 ± 7.8 µg/mL). Furthermore, no significant difference in any parameter was found between patients with advanced adenoma and no advanced adenoma, nor between patients with proximal or distal tumors.Conclusion: This study found that the presence of colorectal adenoma is not correlated with any adiposity factor. Moreover, obesity does not appear to be associated with the site or the presence of more advanced lesions.Keywords: adiposity, colorectal adenoma, polyp, adiponectin

This article, published in the journal Endoscopy, explores the risk factors associated with delayed post polypectomy bleeding, which is a common complication of endoscopic polypectomy. The study suggests that endoscopic hemostasis is usually not necessary for low-risk stigmata, such as flat pigmented stigma or a clean base. However, for high-risk stigmata, such as active bleeding or visible vessels, endoscopic hemostasis may be warranted. The study also highlights potential risk factors for high-risk stigmata, including hemodynamic instability, the need for transfusion, shock index, polyp size, and the use of prophylactic hemostatic clips. The authors conclude that further research is needed to determine which patients with delayed post polypectomy bleeding can be treated conservatively. [Extracted from the article]

This article, published in the journal Endoscopy, discusses a case of caustic injury to the rectum in a 21-year-old male with a history of hemorrhoidal disease. The patient presented with acute bloody diarrhea and was found to have marked edema, erythema, and erosions of the rectosigmoid mucosa. It was later revealed that the patient had been using hydrogen peroxide as a cleaning aid. The article emphasizes the importance of a high suspicion index and thorough medical history in diagnosing and managing such cases. [Extracted from the article]

This article, titled "How we spray. TC-325 survival guide: Tips and tricks," aims to provide a comprehensive guide on the application of TC-325 hemostatic powder in clinical practice. The authors present various tips, techniques, and pitfalls to avoid when using TC-325 based on existing literature and their own experience. The article outlines a four-phase process for using the hemostatic powder, including selecting the appropriate hemostatic method, suctioning, preparation, and spraying. The authors emphasize the importance of following these steps carefully to improve the effectiveness of the technique and prevent mistakes. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the successful treatment of anorectal variceal bleeding in a 76-year-old female patient with a history of hepatitis B virus-related liver cirrhosis. The patient experienced multiple episodes of hematochezia and underwent sigmoidoscopy, which revealed enlarged anorectal varicose veins. The bleeding vessels were treated successfully with the injection of a sclerosing agent called ethanolamine, commonly used in sclerotherapy of varicose veins in the lower extremities. Anorectal varices are a significant cause of bleeding in patients with portal hypertension. The article includes a video demonstrating the procedure. [Extracted from the article]

This article, titled "Parastomal variceal bleeding successfully treated with tissue adhesive injection (cyanoacrylate)," discusses the case of a 48-year-old female patient with a history of gastric bypass surgery and portal hypertension. The patient presented with hematemesis and was found to have bleeding from a parastomal varicose vein. The bleeding was successfully treated with cyanoacrylate glue injection. The article highlights the clinical challenge of managing ectopic parastomal varices and emphasizes the need for case-dependent treatment in the absence of general management guidelines. The authors of the article are C. Sotiropoulos, C. Konstantakis, O. Ampazis, G. Theocharis, C. Triantos, and K. Thomopoulos. [Extracted from the article]

This article, titled "Over-the-scope clip for recurrent peptic ulcer hemorrhage: Use of a novel tool as a rescue treatment," discusses the use of an over-the-scope clip system as a rescue treatment for persistent or recurrent bleeding caused by peptic ulcers. The article presents a case study of an 83-year-old patient who experienced in-hospital melena and was initially treated with epinephrine injection and a through-the-scope clip placement. However, the bleeding recurred and the patient underwent a repeat endoscopy, during which an active hemorrhage was detected and treated with the over-the-scope clip system. The article concludes that the over-the-scope clip is an effective and safe treatment for persistent or recurrent bleeding. [Extracted from the article]

This article discusses a case of upper gastrointestinal bleeding in a patient who had previously undergone laparoscopic gastric plication bariatric surgery. The patient presented with symptoms of melena and fainting, and was treated with intravenous fluids, transfusions, and proton pump inhibitors. During a gastroscopy, ulcers were discovered in the stomach mucosa. The article highlights the potential complications associated with gastric plication surgery. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the case of a 79-year-old man who was intubated in the intensive care unit due to a severe exacerbation of chronic obstructive pulmonary disease (COPD). The patient experienced melena, or black, tarry stools, while in the hospital. During a gastroscopy, two ulcers were found in the second part of the duodenum and were treated with adrenaline injection and through the scope clips. However, after 72 hours and the initiation of anticoagulant therapy, the patient experienced a recurrence of bleeding. Another endoscopy was performed, and an actively oozing duodenal ulcer was successfully treated with adrenaline injection and the placement of an Over-The-Scope Clip. The authors of the article are C. Sotiropoulos, C. Konstantakis, G. Theocharis, C. Triantos, and K. Thomopoulos. [Extracted from the article]

The article titled "The 'colonic single-stripe' sign: An evidence clue of ischemic colitis" discusses a case study of a 58-year-old female patient who presented with abdominal pain and rectal bleeding. After ruling out other potential causes, a colonoscopy revealed a linear ulcer on the colonic wall, which is referred to as the "colonic single-stripe" sign. Microscopic evaluation of the biopsied tissue confirmed the diagnosis of ischemic colitis. The article emphasizes that the presence of the "colonic single-stripe" sign during colonoscopy is highly indicative of colonic ischemia. [Extracted from the article]

This article discusses the use of TC-325 hemostatic powder in the management of bleeding upper gastrointestinal (GI) malignancy. The authors present three cases where the powder was successfully used to control bleeding in patients with different types of GI cancer. The powder not only provides hemostasis but also offers palliative benefits and can serve as a bridge to more definitive treatments like radiotherapy or surgery. The use of TC-325 can improve transfusion needs and overall quality of life for patients with upper GI malignancy. [Extracted from the article]

This article discusses the treatment of Mirizzi syndrome, a rare complication of gallstone disease. The traditional approach to treating this condition is through surgery, but the authors present a case series where endoscopic treatment was used instead. The cases involved patients who had previously undergone cholecystectomy, and different types of Mirizzi syndrome were successfully managed using single operator cholangioscopy and lithotripsy. The authors suggest that this endoscopic approach may be a feasible, effective, and safe alternative to surgery, particularly considering the high risk of complications associated with surgical treatment. [Extracted from the article]

This article, published in the journal Endoscopy, examines the incidence of multi-drug resistant (MDR) infections following endoscopic retrograde cholangiopancreatography (ERCP) procedures. The study compares data collected before and after the COVID-19 pandemic outbreak to identify potential risk factors for MDR infections. The results show a significant increase in post-ERCP MDR infections in the period following the pandemic, with 63.4% of cases occurring after COVID-19. The study highlights the complex and multifaceted factors contributing to the development of MDR infections, including the overuse of antibiotics, increased use of corticosteroids, and reallocation of antimicrobial stewardship resources. [Extracted from the article]

Background: The effectiveness of a submucosal injection of adrenaline solution in endoscopic haemostasis is well documented in patients suffering from peptic ulcer bleeding. After treatment, however, a significant number of patients continue to bleed or rebleed, and require emergency surgical intervention. The aim of this study was to define factors associated with the failure of endoscopic injection haemostatic therapy in peptic ulcer bleeding. Methods: In the period 1992 to 1998, we prospectively studied all patients suffering from peptic ulcer bleeding and identified endoscopically as being either bleeding actively or carrying a visible vessel. A total of 427 patients (343 men and 84 women; mean age 58.6 ± 16.6 years) were all subjected to endoscopic injection with adrenaline solution on an emergency basis. Patients who eventually required surgical intervention for permanent haemostasis were considered as endoscopic haemostasis failures, whereas those who did not were considered as endoscopic treatment successes. We evaluated all clinical and endoscopic parameters that might have been related to failure of endoscopic injection therapy. Results: Endoscopic injection haemostasis was successful in 341 patients (79.9%) and a failure in 86 (20.1%) who finally underwent emergency surgical haemostasis. On analysing the examined parameters, failure was significantly related to shock on admission (OR 2.31, 95% CI 1.33, 6.97), spurt bleeding at endoscopy (OR 2.45, 95% CI 1.51, 3.98), posteriorly located duodenal ulcer (OR 2.48, 95% CI 1.37, 7.01) and anastomotic ulcer (OR 3.39, 95% CI 1.37, 7.29). Endoscopic injection haemostasis therapy was less effective in patients with chronic ulcers compared to those who had acute NSAID-related ulcers. A history of peptic ulcer (OR 1.57, 95% CI 1.14, 3.05), previous peptic ulcer bleeding (OR 2.45, 95% CI 1.51, 3.98) or non-use of NSAIDs (OR 2.81, 95% CI 1.33, 4.62) were negative predictors for the outcome of endoscopic haemostasis. Conclusion: With the use of specific clinical and endoscopic characteristics it is possible to define a subgroup of high-risk patients for continued bleeding or rebleeding despite endoscopic injection therapy. These patients may be candidates for intensive monitoring, early surgical intervention or possibly complementary endoscopic haemostatic methods. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the prevalence of intrapulmonary vascular dilatations (IPVD) in normoxaemic patients with early liver cirrhosis and to compare their occurrence in progressive alcoholic versus postviral hepatic insufficiency. Methods: Pulmonary function tests and arterial blood gas measurements were performed in 75 consecutive patients with cirrhosis of alcoholic and postviral aetiology. Contrast-enhanced echocardiography was used to identify IPVD. Results: All patients were grade A or B in accordance with the Child-Pugh modified classification. Arterial blood gas analyses showed normoxaemia in all patients. Eight of 75 patients (10.7%) had a positive contrast echocardiogram, all with a decreased diffusion capacity (Dl[sub CO] < 75% of the expected value). The abnormality was more prominent with advancing stage of liver failure (4.5% in grade A versus 19.4% in grade B; P < 0.05) and more common in patients with alcoholic cirrhosis (17.5% in alcoholic versus 2.9% in postviral cirrhosis; P < 0.05). Conclusion: In normoxaemic patients with early liver cirrhosis subclinical pulmonary vasodilatation, as assessed with contrast echocardiography, can occur. The finding is more prominent in alcoholic cirrhosis and possibly reflects an advancing degree of liver insufficiency. [ABSTRACT FROM AUTHOR]

Endoscopic hemostasis is the treatment of choice for bleeding gastroduodenal ulcers. Forest IIA gastroduodenal ulcers (non-bleeding visible vessel-NBVV) are related to high risk of rebleeding, which often necessitates surgical hemostasis for permanent control. The aim of this study was to define factors that would predict failure of endoscopic hemostasis in patients with NBW. During a four-year period (1997-2001), 1113 patients were treated at our hospital due to benign peptic ulcer bleeding, among them 191 with NBVV. Within 24 hours from admission they all underwent emergency endoscopic hemostasis with adrenaline injection, and were then followed intensively. In case of rebleeding, a second attempt for endoscopic hemostasis was carried out.