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Hepatocellular carcinoma (HCC) is the fifth most common cancer, with an increasing incidence in recent years. The prognosis is unfavorable, representing the third most frequent cause of cancer-related death worldwide. This is because it generally develops in patients with pre-existing liver pathology, thus limiting therapeutic options. The role of ablative therapies is well-established in nodules smaller than 3 cm, but for nodules from 3 to 5 cm, the best therapeutic management is not well defined. Recent studies reported that combining minimally invasive procedures like transarterial chemoembolization (TACE) with microwave ablation (MWA) or radiofrequency ablation is superior to each alone. However, there is no consensus regarding the timing and the order in which each procedure should be performed. We report a case of an 86 years old male with HCV-related compensated hepatic cirrhosis and multiple cardiac comorbidities diagnosed with a 47/50 mm HCC. Pre-surgical evaluation of the associated pathologies determined that the risk for the surgical approach outweighs the benefits, so the committee decided to treat it in a less invasive manner. We performed MWA and TACE in a single session with technical success according to the modified Response Evaluation Criteria in Solid Tumors (m-RECIST). This case illustrates the first case of simultaneous MWA and TACE performed in our center. This new approach of hepatocellular carcinoma appears to be a good alternative to more invasive methods, with good results even in older people that are unfit for surgery. [ABSTRACT FROM AUTHOR]

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Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus Infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and transfusions of blood but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6g/dl.The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies were taken from esophageal ulcers and normal mucosa. We suspected viral esophagitis with CMV and we started treatment with Valganciclovir for 21 days with favorable clinical course. The infection was then confirmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and blood transfusions but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6 g/dl. The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies from esophageal mucosa were taken. We suspected viral esophagitis with CMV and we started empiric treatment with valganciclovir for 21 days with favorable clinical course. The infection was then confirmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus Infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and transfusions of blood but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6g/dl.The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies were taken from esophageal ulcers and normal mucosa. We suspected viral esophagitis with CMV and we started treatment with Valganciclovir for 21 days with favorable clinical course. The infection was then confi rmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Difficile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium difficile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Difficile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients significantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. difficile and differentiate CDI symptoms from a disease flare. Special care to rule out C. difficile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A definitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anemia is the most common cause of anemia worldwide. The differential diagnosis of this entity remains one of the most encountered problems: from thalassemia, neoplasia, malabsorbtion syndrome to chronic kidney disease under hemodialysis. Case report: This case report describes clinical and paraclinical features of a 75-year-old patient with multiple comorbidities and iron deficiency anemia. We emphasize on the importance of endoscopic videocapsule examination for the accurate diagnosis of iron deficiency anemia when other methods fail (endoscopy and colonoscopy), thus revealing the source of bleeding in a small bowel benign polyp. Thus, tumors of the small intestine present as a unique challenging diagnosis. Conclusion: Endoscopic videocapsule, even if expensive, should remain an important tool in the diagnosis of iron deficiency anemia with normal upper GI endoscopy and colonoscopy. Small bowel tumors are seldom considered as a diagnostic hypothesis, but should not be overlooked, especially when alarm symptoms are present (weight loss, melena, hematochesia). [ABSTRACT FROM AUTHOR]

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A defi nitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Diffi cile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium diffi cile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Diffi cile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients signifi cantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. diffi cile and differentiate CDI symptoms from a disease flare. Special care to rule out C. diffi cile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) has increased exponentially in recent years in Western European countries, where the number of hepatitis of viral etiology has been declining, and it is thought to be the most common cause of chronic liver disease in the near future (1). Currently, NAFLD is both the second most common cause of hepatocellular carcinoma (HCC) and the second most common indication for liver transplantation (2-4). This problem is very serious, as cases of NAFLDs are increasingly in children, a population with a long life ahead, and in whom the disease has all the time to progress to cirrhosis and HCC (5, 6). Objectives: The goal of this prospective study is to determine the effect of an original formula consisting in silymarin, organic selenium and alpha lipoic acid, in reducing liver damage in patients with chronic liver disease. Material and methods: The study started in March 2018, initially with a group of patients from Bucharest, integrated in the study at St. Mary's Hospital. In October 2018 it was expanded at the national level to 1 718 patients, monitored by 145 investigating physicians from 134 centers, with an average of 11.8 patients per investigating physician. Outcomes: Taking each stage of fatty liver disease (FLD) at T0 moment (the beginning of the study), we observed that 25% of patients with grade I FLD had no sign of disease at the end of the study, 74% of those with grade II FLD recovered or improved their health, and 83% of patients with grade III FLD recovered or improved their health. There were 149 patients with no FLD detected at the end of the study (recovered). Conclusions: Based on triple antioxidant therapy, the original formula improved the evolution and prognosis of patients with chronic liver disease. [ABSTRACT FROM AUTHOR]

Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs). Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort. Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort. Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs., Competing Interests: Conflict of Interest Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, and mdconsgroup. Michel Kahaleh is a consultant for Boston Scientific, Interscope Med, and Abbvie; grant recipient from Boston Scientific, Conmed, Gore, Pinnacle, Merit Medical, Olympus Medical, and Ninepoint Medical; chief executive officer and founder of Innovative Digestive Health Education & Research Inc. Issac Raijman is a speaker for BostonScientific, ConMed, Medtronic, and GI Supplies; advisory board member for Micro-Tech; co-owner of EndoRx. The other authors declare no conflicts of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)