Volume 6 Issue 12, December 2009

The treatment of primary sclerosing cholangitis is a major challenge. Complications such as dominant bile duct stenoses and biliary infections are associated with poor outcomes. Data from a new prospective study with a follow-up of 20 years now show that dominant stenosis and fungal, but not bacterial infections reduce survival free of liver transplantation.

Endoscopic band ligation (EBL) and nonselective β-blockade are two effective strategies in the primary prevention of variceal bleeding. Meta-analyses have shown an advantage of EBL over propranolol with regard to bleeding rates but not mortality. By contrast, a recent randomized, controlled trial shows less bleeding associated with the use of carvedilol compared with EBL.

The management of chronic anal fissure has received renewed interest and has been re-evaluated over the past 20 years. The use of botulinum toxin seems to be a promising and safe approach, particularly in patients at high risk for incontinence. A recent meta-analysis investigated the efficacy of botulinum toxin injection compared with lateral internal sphincterotomy for the management of this condition.

A Markov model using data from a randomized, controlled trial has demonstrated that laparoscopic fundoplication is a cost-effective intervention for the management of chronic GERD. However, there are some limitations of the model, discussed below, which suggest that the results should be viewed cautiously until longer follow-up is reported.

The Bordeaux group has made major progress in the genotyping and phenotyping of hepatocellular adenomas. Their efforts have allowed the classification of hepatocellular adenomas into subtypes, which enhances our understanding of this benign liver lesion. The clinical relevance of their findings is open to debate.

Pancreatic cancer, although infrequent, has an extremely high mortality rate. The epidemiologic features of this rare cancer are still poorly known. In this Review Raimondi and colleagues discuss the environmental, lifestyle and genetic factors that increase or decrease the probability of developing pancreatic cancer and that may explain the different incidence rates observed in distinct subpopulations.

Intestinal anastomoses are frequently performed to remove tumors or diseased tissue. They have clear benefits but they can also lead to serious complications such as dehiscences and strictures. This Review discusses the surgical techniques, healing factors and perioperative and postoperative strategies to minimize complications when performing anastomoses of the lower gastrointestinal tract.

A repeat endoscopic evaluation of a bleeding lesion on subsequent follow-up is commonly called second-look endoscopy. Tsoi and colleagues review the findings from five randomized, controlled trials and consider whether second-look endoscopy can be recommended as routine practice, and which groups of patients might benefit most. The cost-effectiveness of second-look endoscopy and the use of PPIs versus second-look endoscopy are also discussed.

Stem cells are primitive, relatively unspecialized cells that can self-renew and are multipotent. In this Review, Quante and Wang discuss potential types of stem cells found within the gastrointestinal tract, the susceptibility of these stem cells for malignant transformation, and their potential for use in restoring tissue function to treat gastrointestinal disorders.

The use of CT has been increasing exponentially over the past decade. Unfortunately, there is little cognizance among health-care providers (or their patients) about the relative latent cancer risks associated with repetitive exposure to ionizing radiation. Given the exposure of a relatively high proportion of the population to these tests, it is incumbent on health-care providers to have an improved understanding of these risks and discuss them accordingly with their patients.