INTRODUCTION: Esophageal achalasia is a primary motility disorder. Although the exact pathogenesis is unknown, autoimmune, and neurodegenerative processes seem to be involved similarly to neurodegenerative and/or demyelinating disorders (NDDs). We hypothesized that the prevalence of NDD may be higher among patients with achalasia and vice versa as the background pathogenetic mechanisms are similar. METHODS: This was a prospective, comparative questionnaire-based study. Patients with achalasia and patients with NDD were enrolled. Selected patients with achalasia were thoroughly examined by a neurologist and selected patients with NDD were examined by a gastroenterologist to confirm or rule out NDD or achalasia. We assessed the prevalence of both achalasia and NDD and compared them with their prevalence in general population. RESULTS: A total of 150 patients with achalasia and 112 patients with NDD were enrolled. We observed an increased prevalence of NDD among patients with achalasia (6.0% (9/150); 95% CI (confidence interval): 3.1-11.2%) as compared to the estimated 2.0% prevalence in general population (p = 0.003). Although 32 out of 112 patients (28.6%) with NDD reported dysphagia, we did not observe significantly increased prevalence of achalasia in these patients (1.8% (2/112) vs 0.8% in general population, p = 0.226). CONCLUSION: The prevalence of NDD was significantly higher among patients with achalasia (6.0%) compared to general population (2.0%), suggesting an association of these disorders. Large-volume studies are necessary to confirm this finding.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• dopisy MeSH

Background/Aims: Several studies have reported partial recovery of peristalsis in patients with achalasia after myotomy. The aim of our study is to analyze esophageal motility patterns after peroral endoscopic myotomy (POEM) and to assess the potential predictors and clinical impact of peristaltic recovery. Methods: We performed a retrospective analysis of prospectively collected data of consecutive patients with achalasia undergoing POEM at a tertiary center. High-resolution manometry (HRM) studies prior to and after POEM were reviewed and the Chicago classification was applied. Results: A total of 237 patients were analyzed. The initial HRM diagnoses were achalasia type I, 42 (17.7%); type II, 173 (73.0%); and type III, 22 (9.3%). Before POEM, peristaltic fragments were present in 23 (9.7%) patients. After POEM the Chicago classification diagnoses were: 112 absent contractility, 42 type I achalasia, 15 type II, 11 type III, 26 ineffective esophageal motility, 18 esophagogastric junction outflow obstruction, 10 fragmented peristalsis, and 3 distal esophageal spasm. Altogether 68 patients (28.7%) had signs of contractile activity, but the contractions newly appeared in 47 patients (47/214, 22.0%). Type II achalasia showed a trend for appearance of contractions (P = 0.097). Logistic regression analysis did not identify any predictors of peristaltic recovery. The post-POEM Eckardt score did not differ between patients with and without contractions nor did the parameters of timed barium esophagogram. Conclusions: More than 20% of achalasia patients have signs of partial recovery of esophageal peristalsis after POEM. It occurs predominantly in type II achalasia but the clinical relevance seems to be negligible.

• Publikační typ
• časopisecké články MeSH

BACKGROUND AND AIMS: Patients after endoscopic treatment of Barrett's esophagus (BE) related neoplasia (BORN) should enter endoscopic surveillance with biopsies to detect persistent or recurrent neoplasia or intestinal metaplasia (IM). Probe-based confocal laser endomicroscopy (pCLE) serves as a virtual biopsy and could replace standard biopsies. However, the role of pCLE in patients after endoscopic treatment of BORN has not been systematically assessed. The aim of this study was to compare pCLE with biopsies in detecting persistent/recurrent IM/neoplasia. METHODS: A single center, prospective and pathologist-blinded study was performed. Patients after endoscopic treatment of BORN (endoscopic resection or dissection, radiofrequency ablation) underwent surveillance endoscopy with pCLE followed by biopsies. RESULTS: A total of 56 patients were enrolled: initial diagnoses were low-grade dysplasia (LGD) in 24 patients (43%), high-grade dysplasia (HGD) in 12 patients (21%) and early adenocarcinoma (EAC) in 20 patients (36%). Only one patient (2%) experienced recurrent neoplasia (LGD), which was diagnosed by pCLE only. Twenty patients (35.7%) experienced persistent/recurrent IM, diagnosed by both pCLE and biopsies in 17 patients (17/30, 85%) and by pCLE only in 3 pts (3/30, 15%). Sensitivity, specificity, positive and negative predictive values to diagnose recurrent/persistent IM did not differ significantly between pCLE and biopsies; diagnostic accuracy was 100% (95%CI 93.6-100) for pCLE and 94.6 (95%CI 85.1-98.9%) for biopsies, p=0.25. In patients with IM detected by both tested methods, pCLE detected significantly more goblet cells (median 43 per patient) than biopsies (median 12 per patient), p=0.01. CONCLUSION: pCLE is at least as effective as standard biopsies in the detection of persistent/recurrent IM after endoscopic treatment of BORN.

• MeSH
• Barrettův syndrom patologie   chirurgie   MeSH
• biopsie MeSH
• časové faktory MeSH
• dospělí MeSH
• ezofagektomie * škodlivé účinky   MeSH
• ezofágoskopie * škodlivé účinky   MeSH
• konfokální mikroskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru * MeSH
• nádory jícnu patologie   chirurgie   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• radiofrekvenční ablace * MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň nádoru MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Úvod: Histopatologická diagnostika indeterminovaných biliárních stenóz a pankreatických lézí má svá úskalí, např. nedostatečnou kvalitu vzorků tkáně odebraných při ERCP (kartáčkový stěr), cholangioskopii (biopsie) nebo endosonografii (EUS, punkční cytologie − FNAB). Konfokální laserová endomikroskopie (CLE) umožňuje virtuální histopatologickou diagnostiku a mohla by nahradit nebo zpřesnit standardní diagnostiku biliárních a pankreatických lézí. Cílem prospektivní pilotní studie bylo jednak srovnat výtěžnost standardní histopatologické diagnózy s CLE u pacientů, kteří byli indikováni k cholangioskopii nebo k EUS vyšetření pankreatu. Dalším cílem bylo zhodnotit finanční náročnost metody. Metody: Zařazení pacienti nejprve podstoupili CLE (buď s cholangioskopií, nebo s EUS) a následně byl proveden odběr tkáně. Histopatologická diagnostika na základě CLE byla srovnána se standardní histopatologickou diagnózou. U cholangioskopie byla CLE sonda zavedena skrze pracovní kanál cholangioskopu, v případě EUS byla CLE sonda zavedena skrze punkční jehlu. Výsledky: Do studie bylo zařazeno celkem 23 pacientů (12 žen, průměrný věk 61 let), 13 pacientů podstoupilo cholangioskopii, 10 pacientů EUS pankreatu. Cholangioskopie: U cholangioskopie CLE diagnostikovala všechny 4 maligní striktury (histologie pouze dvě, u 2 pacientů byly biopsie nevýtěžné). Shoda mezi standardní diagnostikou a CLE byla dosažena v 85 %. EUS: CLE i FNAB správně diagnostikovaly všechny (n=3) karcinomy pankreatu. Ostatní premaligní i benigní léze byly správně diagnostikovány oběma metodami. CLE je finančně náročnější oproti FNAB, je však cenově srovnatelná s tkáňovou analýzou při digitální cholangioskopii. Závěr: CLE je spolehlivou metodou poskytující histopatologickou diagnózu u pacientů s biliárními či pankreatickými lézemi, která by mohla zlepšit výtěžnost nebo i nahradit standardní histopatologickou diagnostiku.

Introduction: An accurate histopathological diagnosis of indeterminate biliary strictures and pancreatic lesions is challenging because of insufficient quality of tissue specimen taken during ERCP (brush cytology), cholangioscopy (biopsies) or endosonography (EUS, FNAB). Confocal laser endomicroscopy (CLE) allows virtual histopathological diagnosis with the potential to either replace or increase the diagnostic yield of standard histopathological diagnosis in patients presenting with biliary strictures and pancreatic lesions. The aims of our prospective pilot study were to: 1. Assess the diagnostic yield of standard histopathology compared to CLE in patients referred for cholangioscopy or for EUS of the pancreas; 2. Evaluate the cost of CLE in these indications. Methods: CLE was performed (during cholangioscopy or EUS), followed by standard tissue sampling. CLE-based diagnosis was compared with standard histopathology/cytology. CLE probe was introduced through the working channel of the cholangioscope or through the FNAB needle. Results: A total of 23 patients were enrolled (12 women, mean age 61 years); 13 patients underwent cholangioscopy and 10 patients underwent EUS. Cholangioscopy: CLE diagnosed correctly all 4 malignant strictures (histology 2 of them only as 2 patients had insufficient quality of the tissue specimen). Agreement between standard histopathology and CLE was achieved in 85 %. EUS: All 3 cases of pancreatic cancer were correctly diagnosed by both CLE and FNAB. All remaining (premalignant and benign) lesions were also correctly diagnosed by both methods. The cost of CLE examination is higher compared to FNAB but comparable with tissue sampling during digital cholangioscopy. Conclusion: CLE demonstrated sufficient diagnostic accuracy in patients with indeterminate biliary strictures or pancreatic lesions and, therefore, might improve diagnostic accuracy or even replace standard histopathology in these indications.

• Klíčová slova
• biliární striktura, cystické léze pankreatu,
• MeSH
• konfokální mikroskopie metody   MeSH
• lidé MeSH
• nemoci slinivky břišní * diagnóza   MeSH
• nemoci žlučových cest * diagnóza   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Úvod: Endoskopická pyloromyotomie (G-POEM) je nová terapeutická metoda v léčbě gastroparézy (GP). Doposud byly publikovány pouze omezené série případů prokazující její účinnost. Cílem naší studie bylo vyhodnotit účinnost G-POEM u pacientů s refrakterní GP. Metody: G-POEM byl nabídnuta pacientům s těžkou a refrakterní GP. Abnormální vyprazdňování žaludku (GES) bylo nezbytným kritériem zařazení. Hlavním výstupem byl léčebný efekt, definovaný snížením celkového skóre GSCI o >40 % proti vstupním hodnotám ve 3, 6, 12 a 24M.Výsledky: G-POEM se realizovala u 9 pacientů (5 žen, věk 56,3), 5 post-chirurgických, 2 diabetických, 1 idiopatické a 1 kombinované post-chirurgické/diabetické GP. Medián sledování byl 23M (12−31). Všechny G-POEM byly ukončené úspěšně. U jednoho pacienta se objevilo opožděné krvácení ze žaludečního vředu, které bylo úspěšně ošetřeno endoskopicky, přičemž zbylé výkony byly bez komplikací. Úspěšnost léčby dosáhla u 8/9 pacientů (88,9 %) ve 3, 6 a 12M a 3/4 (75 %) ve 24M. GSCI se snížilo z 3,16 na 0,86 (p=0,008), 0,74 (p=0,008), 1,07 (p=0,008) a 1,31 (p=0,11) ve 3, 6, 12 a 24M. Index kvality života se zlepšil ze vstupní hodnoty 77 (48−102) na 113 (86−138, p=0,03) a 96 (50−124, p=0,4) ve 12 a 24 M. U pacientů s léčebným efektem se doposud neobjevila recidiva závažné GP. GES se zlepšilo/normalizovalo u všech pacientů. Závěr: G-POEM byl efektivní u 88,9 % pacientů s refrakterní GP a zdá se, že její účinnost je dlouhotrvající.

Introduction: Endoscopic pyloromyotomy (G-POEM) is an emerging therapeutic method for the treatment of gastroparesis (GP). So far, only limited case-series suggesting its effectivity have been published. The aim of our study was to assess the effectivity of G-POEM in patients with refractory GP.Methods: Consecutive patients with severe and refractory GP were offered the procedure. An abnormal gastric emptying study (GES) was necessary for inclusion. The main outcome was treatment success defined as a decrease of the total GSCI symptom score by at least 40% from baseline at 3, 6, 12 and 24 months.Results: G-POEM was performed in 9 patients (5 women, mean age 56.3): 5 post-surgical, 2 diabetic, 1 idiopathic and 1 combined post-surgical and diabetic. The median follow-up was 23M (range 12–31). All procedures were successfully completed. One patient experienced delayed bleeding from gastric ulceration, which was successfully treated endoscopically; all remaining patients recovered uneventfully. Treatment success was achieved in 8/9 patients (88.9%) at 3, 6 and 12M and in 3/4 (75%) at 24M. The mean GSCI decreased from 3.16 to 0.86 (p=0.008), 0.74 (p=0.008), 1.07 (p=0.008) and 1.31 (p=0.11) at 3, 6, 12 and 24M after the procedure. The Quality of Life Index improved from the baseline value of 77 (range 48−102) to 113 (86–138, p=0.03) and 96 (50–124, p=0.4) at 12 and 24M. In patients with treatment success, no recurrences have occurred so far. GES improved/normalized in all the patients.Conclusion: G-POEM was effective in 88.9% of patients with refractory GP and the effect seems to be long-lasting.

• MeSH
• dospělí MeSH
• gastroparéza * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• pyloromyotomie * metody   MeSH
• radioisotopová scintigrafie metody   MeSH
• senioři MeSH
• vyprazdňování žaludku MeSH
• žaludek chirurgie   diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND AND AIM: Probe-based confocal laser endomicroscopy (pCLE) provides real-time microscopic visualisation. Our aim was to compare the diagnostic accuracy of pCLE with standard biopsies in patients with visible oesophageal or gastric lesions. METHODS: This was a single-centre, prospective, pathologist-blinded study. Patients underwent high-resolution endoscopy, and lesions were examined by pCLE followed by standard biopsies. A definitive diagnosis was determined from resection specimen. Main outcomes were overall diagnostic accuracy, sensitivity, specificity and positive and negative predictive values. RESULTS: We examined 74 lesions in 67 patients. Definitive diagnoses revealed 34 malignant and 40 non-malignant lesions. pCLE diagnosis was correct in 89.2% (66/74), while diagnosis based on biopsy was correct in 85% (57/67; p = 0.6). The overall diagnostic accuracy of biopsies was 85% (76-94%) and that of pCLE was 89% (79-96%). pCLE correctly diagnosed malignant lesions, comprising oesophageal adenocarcinoma, oesophageal squamous-cell cancer or gastric adenocarcinoma, in 88.2% (30/34) of cases, while biopsy was correctly diagnosed in 75.9% (22/29; p = 0.3). Sensitivity and specificity to diagnose a malignant lesion were 75.9% (95% confidence interval (CI) 56-89%) and 100% (95% CI 90-100%) for biopsies and 88.2% (95% CI 72-97%) and 92% (95% CI 79-98%) for pCLE. No differences between biopsies and pCLE were found with regard to sensitivity, specificity to diagnose dysplastic and benign lesions (p > 0.2). CONCLUSION: pCLE provides satisfactory diagnostic accuracy comparable with standard biopsies in patients with oesophageal or gastric lesions. ClinicalTrials.gov identifier: NCT0292049).

• MeSH
• adenokarcinom diagnóza   patologie   MeSH
• biopsie statistika a číselné údaje   MeSH
• dospělí MeSH
• gastrointestinální endoskopie přístrojové vybavení   metody   statistika a číselné údaje   MeSH
• konfokální mikroskopie přístrojové vybavení   metody   statistika a číselné údaje   MeSH
• lasery MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory jícnu diagnóza   patologie   MeSH
• nádory žaludku diagnóza   patologie   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• sliznice jícnu diagnostické zobrazování   patologie   MeSH
• spinocelulární karcinom diagnóza   patologie   MeSH
• žaludeční sliznice diagnostické zobrazování   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• Publikační typ
• úvodníky MeSH

BACKGROUND AND AIMS: Radiofrequency ablation (RFA) with/without endoscopic resection (ER) is the standard endoscopic treatment modality for Barrett's esophagus (BE) related neoplasia (BORN). The main aim of this study was to assess the long-term outcomes of RFA in patients with BORN. METHODS: We retrospectively analyzed the prospectively collected data from the Czech national database. Main outcomes were: complete remission of neoplasia (CR-N), complete remission of intestinal metaplasia (CR-IM), recurrence of both neoplasia and IM, and safety. RESULTS: From a total of 170 patients with BORN treated with RFA, 136 patients were analyzed. They were followed up for a median of 27.5 months. Fifty-six patients (41%) had low-grade intraepithelial neoplasia (LGIN), 46 (34%) had high-grade intraepithelial neoplasia (HGIN) and 34 (25%) had early adenocarcinoma (EAC). RFA was combined with previous ER in 65 patients (48%). CR-IM and CR-N were achieved in 77.9% (95% CI 70.0-84.6%) and 98.5% (95% CI 94.8-99.8%). Among 30 patients without CR-IM, 22 (73%) did not have macroscopic signs of BE. Recurrent neoplasia was detected in 4.5% of patients (6/134) and 15% (16/106) experienced a recurrence of IM at the level of the neo-Z-line. Diagnosis of cancer was an independent risk factor for recurrent IM after RFA (OR 7.0, 95% CI 1.6-30.9, p<0.0005). CONCLUSION: RFA is highly effective in achieving remission in patients with BORN. A significant proportion of patients did not achieve CR-IM or had a recurrence of IM despite macroscopically absent BE. Recurrence of neoplasia was infrequent but not negligible, thus, patients after successful RFA still require endoscopic surveillance.

• MeSH
• Barrettův syndrom chirurgie   MeSH
• databáze faktografické MeSH
• dospělí MeSH
• indukce remise MeSH
• Kaplanův-Meierův odhad MeSH
• karcinom in situ chirurgie   MeSH
• katetrizační ablace škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• mladý dospělý MeSH
• nádory jícnu chirurgie   MeSH
• následné studie MeSH
• prekancerózy chirurgie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

• Publikační typ
• abstrakt z konference MeSH