Effects of Posture and Swallow Volume on Esophageal Motility Morphology and Probability of Bolus Clearance: A Study Using High-Resolution Impedance Manometry.

The Chicago classification diagnostic criteria of esophageal motility disorders are based on 5-ml water swallows in the supine position and have not been analyzed for the correlation between the morphology and bolus transit in the upright position and larger volume swallow conditions. This study aimed to evaluate the effect of posture and swallow volume on peristaltic morphology and the probability of bolus clearance in patients with nonspecific esophageal disorder. A total of 139 patients (4,214 swallows) were included for high-resolution impedance manometry analysis in the right lateral recumbent and upright positions, as well as 5- and 10-ml liquid swallows.

Bacterial infections in cirrhosis: A critical review and practical guidance.

Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death.

Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer.

Radiation therapy has an important role in the treatment of locally advanced or metastatic pancreatic cancer and can be used alone or in conjunction with surgery and/or systemic chemotherapy. Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting. Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy.

Management of patients with hepatitis C infection and renal disease.

Hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is associated with more rapid liver disease progression and reduced renal graft and patients' survival following kidney transplantation. Evaluations and management of HCV in patients with renal disease are challenging. The pharmacokinetics of interferons (IFN), ribavirin (RBV) and some direct acting antiviral (DAA), such as sofosbuvir, are altered in patients with ESRD.

Complications of enteroscopy: how to avoid them and manage them when they arise.

Deep small bowel enteroscopy is a safe procedure that has revolutionized the strategy for diagnosis and treatment of small bowel diseases. However, enteroscopy-associated adverse events are more common compared with standard endoscopy. Prevention, early detection, and effective intervention are crucial in reducing the adverse event severity and improving outcomes.

Unexpected anomaly of the common bile duct and pancreatic duct.

Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy.

Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the treatment of biliary and pancreatic ductal diseases. It is essential for the endoscopist carrying out the ERCP to have a thorough understanding of the potential adverse events. Typically, endoscopists are well familiar with common adverse events such as post-ERCP pancreatitis, cholangitis, post-sphincterotomy bleeding, post-sphincterotomy perforation, and sedation-related cardiopulmonary compromises.

Hepatitis C genotype 6: A concise review and response-guided therapy proposal.

Hepatitis C genotype 6 is endemic in Southeast Asia [prevalence varies between 10%-60% among all hepatitis C virus (HCV) infection], as well as also sporadically reported outside the area among immigrations. The diagnosis of HCV genotype can be inaccurate with earlier methods of genotyping due to identical 5'-UTR between genotype 6 and 1b, hence the newer genotyping methods with core sequencing are preferred. Risk factors and clinical course of HCV genotype 6 do not differ considerably from other genotypes.

Effectiveness and safety of endoscopic treatment of benign biliary strictures using a new fully covered self expandable metal stent.

Background. In patients with benign biliary strictures, the use of fully covered self-expandable metal stents (SEMS) has been proposed as an alternative to plastic stenting, but high quality prospective data are sparse. This study was performed to evaluate the long-term effectiveness and safety of a new fully covered SEMS for benign biliary strictures.

Air embolism complicating gastrointestinal endoscopy: A systematic review.

Gastrointestinal endoscopy has become an important modality for the diagnosis and treatment of various gastrointestinal disorders. One of its major advantages is that it is minimally invasive and has an excellent safety record. Nevertheless, some complications do occur, and endoscopists are well aware and prepared to deal with the commonly recognized ones including bleeding, perforation, infection, and adverse effects from the sedative medications.

Evaluation of a new endoscopic ultrasound-guided multi-fiducial delivery system: a prospective non-survival study in a live porcine model.

Background: Endoscopic ultrasound (EUS) is an excellent tool for implanting fiducials for gastrointestinal malignancies, but a dedicated delivery system for EUS-guided fiducial placement is not available. The aim of the present study was to evaluate the performance characteristics of a new dedicated EUS-guided multi-fiducial delivery system.

Methods: This was a prospective live porcine study using prototype 22-G EUS needles preloaded with four fiducials.

Bacterial infections other than spontaneous bacterial peritonitis in cirrhosis.

Cirrhotic patients are immunocompromised with a high risk of infection. Proinflammatory cytokines and hemodynamic circulation derangement further facilitate the development of serious consequences of infections. Other than spontaneous bacterial peritonitis, bacteremia and bacterial infections of other organ systems are frequently observed.

Pancreatoblastoma: a rare tumor still evolving in clinical presentation and histology.

Context: Pancreatoblastoma is a rare neoplasm in adults with a total of only 24 cases that have been reported in the literature. Adult pancreatoblastomas are large tumors and majority are larger than 8 cm at the time of diagnosis. Metastasis is seen in 26% of adults and usually involves the liver and then the lymph nodes.

Endoscopic ultrasound-guided biliary drainage.

Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression.

Ischemic colitis as a cause of severe hematochezia: risk factors and outcomes compared with other colon diagnoses.

Background: Risk factors and outcomes of severe hematochezia from ischemic colitis compared with other colonic diagnoses have not been well studied.

Objective: Our purposes were (1) to compare demographics and outcomes of patients hospitalized with severe hematochezia from ischemic colitis compared with other colonic diagnoses, (2) to compare inpatient and outpatient start of bleeding from ischemic colitis, and (3) to describe potential risk factors.

Design: Prospective cohort study.

Felty's syndrome as an initial presentation of rheumatoid arthritis: a case report.

Introduction: Felty's syndrome is an uncommon but severe extra-articular manifestation of rheumatoid arthritis. Felty's syndrome is characterized by the triad of rheumatoid arthritis, neutropenia, and splenomegaly. The lifetime risk of Felty's syndrome for a rheumatoid arthritis patient is less than 1% and there are only few case reports of Felty's syndrome with neutropenia preceded clinical evidence of arthritis.

Survival in Asian Americans after treatments for hepatocellular carcinoma: a seven-year experience at UCLA.

Background/rationale: Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC.

Results: Between September 2000 and December 2007, 278 patients, mean age 61.