journal
Journals Best Practice & Research. Clin...

Best Practice & Research. Clinical Gastroenterology

https://read.qxmd.com/read/38522882/curative-criteria-for-endoscopic-treatment-of-gastric-cancer
#21
REVIEW
João A Cunha Neves, Pedro G Delgado-Guillena, Patrícia Queirós, Diogo Libânio, Enrique Rodríguez de Santiago
Endoscopic treatment, particularly endoscopic submucosal dissection, has become the primary treatment for early gastric cancer. A comprehensive optical assessment, including white light endoscopy, image-enhanced endoscopy, and magnification, are the cornerstones for clinical staging and determining the resectability of lesions. This paper discusses factors that influence the indication for endoscopic resection and the likelihood of achieving a curative resection. Our review stresses the critical need for interpreting the histopathological report in accordance with clinical guidelines and the imperative of tailoring decisions based on the patients' and lesions' characteristics and preferences...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522881/curative-criteria-for-endoscopic-treatment-of-colorectal-cancer
#22
REVIEW
Lucille Quénéhervé, Mathieu Pioche, Jérémie Jacques
As endoscopic treatment enables en bloc resection of T1 colorectal cancers, the risk of recurrence, often assimilated to the risk of lymph node metastases, must be assessed in order to offer patients an additional treatment if this risk is deemed significant. The curative criteria currently used by most guidelines are depth of invasion <1 mm, well or moderately differentiated tumour, absence of lympho-vascular invasion, absence of significant budding and tumour-free resection margins. However, these factors must be assessed by qualified pathologists, as they are difficult to evaluate...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38522880/management-of-high-risk-t1-esophageal-adenocarcinoma-following-endoscopic-resection
#23
REVIEW
Philippe Leclercq, Raf Bisschops, Jacques J G H M Bergman, Roos E Pouw
High-risk T1 esophageal adenocarcinoma (HR-T1 EAC) is defined as T1 cancer, with one or more of the following histological criteria: submucosal invasion, poorly or undifferentiated cancer, and/or presence of lympho-vascular invasion. Esophagectomy has long been the only available treatment for these HR-T1 EACs and was considered necessary because of a presumed high risk of lymph node metastases up to 46%. However, endoscopic submucosal disscection have made it possible to radically remove HR-T1 EAC, irrespective of size, while leaving the esophageal anatomy intact...
February 2024: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103932/prognostic-models-and-autoimmune-liver-diseases
#24
REVIEW
Daphne D'Amato, Marco Carbone
Autoimmune liver diseases (AILDs) are complex diseases with unknown causes and immune-mediated pathophysiology. In primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) disease modifying drugs are available which improve patient quality and quantity of life. In primary sclerosing cholangitis (PSC) no medical therapy is available and the only accepted treatment is liver transplantation (LT). PBC, PSC and AIH possess features that describe the archetype of patients within each disorder. On the other hand, the classical disorders are not homogeneous, and patients within each diagnosis may present with a range of clinical, biochemical, serological, and histological findings...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103931/prognostic-models-in-alcohol-related-liver-disease-and-alcohol-related-hepatitis
#25
REVIEW
Jessica Ann Musto, Michael Ronan Lucey
Alcohol-associated liver disease (ALD) and alcohol-associated hepatitis (AH) are dynamic disorders whose prognosis can be challenging to determine. A number of prognostic models have been developed to determine likelihood of death, when to refer for liver transplant (LT) and the role for glucocorticoids. Often these models were created with a specific application in mind but were found to have additional applications with further study. Those prognostic models that have stood the test of time are easy to use, have clear interpretations and employ objective parameters...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103930/prognostic-models-their-use-and-abuse
#26
EDITORIAL
James Neuberger, Lorenzo Fuccio
No abstract text is available yet for this article.
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103929/prognostic-modelling-in-ibd
#27
REVIEW
Peter Rimmer, Tariq Iqbal
In the ideal world prognostication or predicting disease course in any chronic condition would allow the clinician to anticipate disease behaviour, providing crucial information for the patient and data regarding best use of resources. Prognostication also allows an understanding of likely response to treatment and the risk of adverse effects of a treatment leading to withdrawal in any individual patient. Therefore, the ability to predict outcomes from the onset of disease is the key step to developing precision personalised medicine, which is the design of medical care to optimise efficiency or therapeutic benefit based on careful profiling of patients...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103928/prognostic-models-what-the-statistician-wants-the-clinician-to-know
#28
REVIEW
Elisa Allen, Matthew L Robb
Prognostic model building is a process that begins much earlier than data analysis and ends later than when a model is reached. It requires careful delineation of a clinical question, methodical planning of the approach and attentive exploration of the data before attempting model building. Once following these important initial steps, the researcher may postulate a model to describe the process of interest and build such model. Once built, the model will need to be checked, validated and the exercise may take the researcher back a few steps - for instance, to adapt the model to fit a variable that displays a 'curved' pattern - to then return to check and validate the model again...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103927/scoring-systems-for-risk-stratification-in-upper-and-lower-gastrointestinal-bleeding
#29
REVIEW
Franco Radaelli, Simone Rocchetto, Alessandra Piagnani, Alberto Savino, Dhanai Di Paolo, Giulia Scardino, Silvia Paggi, Emanuele Rondonotti
Several scoring systems have been developed for both upper and lower GI bleeding to predict the bleeding severity and discriminate between low-risk patients, who may be suitable for outpatient management, and those who would likely need hospital-based interventions and are at high risk for adverse outcomes. Risk scores created to identify low-risk patients (namely the Glasgow Blatchford Score and the Oakland score) showed very good discriminative performances and their implementation has proven to be effective in reducing hospital admissions and healthcare burden...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103926/prognostic-models-in-end-stage-liver-disease
#30
REVIEW
A Ferrarese, M Bucci, A Zanetto, M Senzolo, G Germani, M Gambato, F P Russo, P Burra
Cirrhosis is a major cause of death worldwide, and is associated with significant health care costs. Even if milestones have been recently reached in understanding and managing end-stage liver disease (ESLD), the disease course remains somewhat difficult to prognosticate. These difficulties have already been acknowledged already in the past, when scores instead of single parameters have been proposed as valuable tools for short-term prognosis. These standard scores, like Child Turcotte Pugh (CTP) and model for end-stage liver disease (MELD) score, relying on biochemical and clinical parameters, are still widely used in clinical practice to predict short- and medium-term prognosis...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103925/models-and-scores-to-predict-adequacy-of-bowel-preparation-before-colonoscopy
#31
REVIEW
Romane Fostier, Georgios Tziatzios, Antonio Facciorusso, Apostolis Papaefthymiou, Marianna Arvanitakis, Konstantinos Triantafyllou, Paraskevas Gkolfakis
Adequate bowel preparation is of paramount importance for the effectiveness of preventive colonoscopy as it allows visualization of the mucosal surface and adenomas detection, the pre-malignant lesions leading to colon cancer. Still, a considerable portion of patients fail to achieve adequate bowel cleansing, with predictors of inadequate bowel preparation being at the focal point of several studies, so far. Incorporation of these factors within predictive models has been implemented in an effort to promptly identify patients at risk for inadequate bowel preparation and thus, timely adopt practices that have the potential to improve bowel cleansing...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/38103924/predictive-models-in-eus-ercp
#32
REVIEW
Barbara Lattanzi, Daryl Ramai, Paraskevas Gkolfakis, Antonio Facciorusso
Predictive models (PMs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) have the potential to improve patient outcomes, enhance diagnostic accuracy, and guide therapeutic interventions. This review aims to summarize the current state of predictive models in ERCP and EUS and their clinical implications. To be considered useful in clinical practice a PM should be accurate, easy to perform, and may consider objective variables. PMs in ERCP estimate correct indication, probability of success, and the risk of developing adverse events...
December 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852716/lights-and-shadows-in-the-early-onset-colorectal-cancer-management-and-research-an-integrative-perspective-physician-scientist-with-patient-advocates
#33
REVIEW
José Perea, Phuong Gallagher, Annie Delores
Early-onset colorectal cancer (age under 50 years) (EOCRC) is an entity of undeniable importance, both because of its growing incidence, and the population it affects. Other current reviews emphasize the essential points regarding the clinical management and knowledge of its molecular bases. However, we intend to go one step further. With the increased significance of patient participation and disease experience in mind, we have integrated the voice of the patient to show the weaknesses and the needs, and next steps in the advancement of knowledge and management of EOCRC...
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852715/colorectal-cancer-in-symptomatic-patients-how-to-improve-the-diagnostic-pathway
#34
REVIEW
William Hamilton, Sarah E R Bailey
Even in countries with national screening programmes for colorectal cancer, most cancers are identified after the patient has developed symptoms. The patients present these symptoms usually to primary care, or in some countries to specialist care. In either healthcare setting, the clinician has to consider cancer to be a possibility, then to perform triage investigations, followed by definitive investigation, usually by colonoscopy. This apparently simple pathway is not simple: most symptoms of colorectal cancer are more likely to represent benign disease than cancer, and each of these stages represents selection of patients into a higher-risk pool...
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852714/preventive-strategies-in-familial-and-hereditary-colorectal-cancer
#35
REVIEW
Zachariah H Foda, Pooja Dharwadkar, Bryson W Katona
Colorectal cancer is a leading cause of cancer-related deaths worldwide. While most cases are sporadic, a significant proportion of cases are associated with familial and hereditary syndromes. Individuals with a family history of colorectal cancer have an increased risk of developing the disease, and those with hereditary syndromes such as Lynch syndrome or familial adenomatous polyposis have a significantly higher risk. In these populations, preventive strategies are critical for reducing the incidence and mortality of colorectal cancer...
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852713/colorectal-cancer-diagnostic-biomarkers-beyond-faecal-haemoglobin
#36
REVIEW
A Krishnamoorthy, R Arasaradnam
Colorectal cancer (CRC) is the third most common cancer worldwide, and the second commonest cause of cancer deaths worldwide. One of the most important prognostic factors, and thus a potential target for improving cancer care, is the stage of cancer at diagnosis. Earlier stage diagnosis is associated with better prognosis and longer survival times after treatment. At the same time, the use of targeted therapies and immunotherapy is improving CRC outcomes. Diagnostic biomarkers are key to both early detection and prediction of treatment responses...
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852712/colorectal-cancer-from-prevention-to-treatment
#37
EDITORIAL
Joaquín Cubiella, Cristina Regueiro-Expósito
No abstract text is available yet for this article.
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852711/pt1-colorectal-cancer-a-treatment-dilemma
#38
REVIEW
Angelo Brunori, Maria Daca-Alvarez, Maria Pellisé
The implementation of population screening programs for colorectal cancer (CRC) has led to a considerable increase in the prevalence pT1-CRC originating on polyps amenable by local treatments. However, a high proportion of patients are referred for unnecessary oncological surgeries without a clear benefit in terms of survival. Selecting the appropriate endoscopic resection technique in the moment of diagnosis becomes crucial to provide the best treatment alternative to each individual polyp and patient. For this, it is imperative to increase the optical diagnostic skill for differentiating pT1-CRCs and decide the appropriate initial therapy...
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852710/surveillance-after-colorectal-polyp-resection
#39
REVIEW
Sandra Baile-Maxía, Rodrigo Jover
Post-polypectomy surveillance has proven to reduce colorectal cancer (CRC) incidence in patients with high-risk polyps, but it implies a major burden on colonoscopy units. Therefore, it should be targeted to individuals with a higher risk. Different societies have published guidelines on surveillance after resection of polyps, with notable discrepancies among them, and many recommendations come from low-quality evidence based on surrogate measures, such as risk of advanced adenoma, and not CRC risk. In this review, we aimed to summarize the evidence supporting post-polypectomy surveillance, compare the recently updated major guidelines, and discuss the existing discrepancies on this topic...
October 2023: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/37852709/rationale-for-organized-colorectal-cancer-screening-programs
#40
REVIEW
Carlo Senore, Iris Lansdorp-Vogelaar, Lucie de Jonge, Linda Rabeneck
Colorectal cancer (CRC) is a major health problem and it is expected that the number of persons diagnosed with CRC and CRC-related deaths will continue to increase. However, recent years have shown reductions in CRC incidence and mortality particularly among individuals aged 50 years and older which can be attributed to screening, improvements in patients' management, closer adherence to treatment guideline recommendations and a higher utilization of curative surgery, chemotherapy and radiotherapy. The International Agency for Research on Cancer has concluded that there has been sufficient evidence that biennially screening using a stool-test or once-only endoscopy screening reduces CRC-related mortality...
October 2023: Best Practice & Research. Clinical Gastroenterology
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