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Open access

Alina Boeriu, Ofelia Pascarenco, Olga Brusnic, Danusia Onisor, Cristian Boeriu and Daniela Dobru

Abstract

Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field. The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria.

Open access

Alina Boeriu, Olga Brusnic, Danusia Onișor, Ofelia Pascarenco, C. Boeriu and Daniela Dobru

Abstract

The diagnosis of dysplasia and early neoplasia in Barrett’s esophagus by conventional endoscopy is based on a four- quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett’s esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems.

Open access

Danusia Onişor, Alina Boeriu, Ofelia Pascarenco, Olga Brusnic and Daniela Dobru

Abstract

Background: The clinical utility of non-invasive markers in the diagnosis and monitoring of ulcerative colitis (UC) has been intensively studied. The aim of our study was to evaluate the value of fecal calprotectin (FC) in differentiating between UC and irritable bowel syndrome (IBS), and in estimating inflammatory activity in UC.

Method: A total number of 140 patients were included in the study. All patients underwent ileocolonoscopy with biopsies, quantitative determination of FC, and blood tests (white blood cell count, CRP, ESR). The severity of UC was assessed by using the Ulcerative Colitis Disease Activity Index (UCDAI) and Mayo endoscopic score.

Results: In patients with active UC the mean values of FC were 373.8 +/- 146.3 μg/g, significantly higher than those in the inactive UC (mean values 36.04 +/- 13.25 μg/g), and in IBS (42.9 +/- 16.00 μg/g). In univariate regression analysis, elevated FC levels strongly correlated with pancolitis (p=0.0001), UCDAI and Mayo scores (p=0.0001), and elevated CRP levels. In multivariate regression model, FC was positively associated with severe pancolitis, and elevated CRP. The optimal cutoff value of FC for the prediction of severe pancolitis (Mayo score˃ 3) was 540 μg/g. We obtained 71.4% sensitivity (CI95%: 41.95-91.6) and 96.1% specificity (CI95%: 89.2 -99.2) of FC in assessing the severity of inflammation in UC patients.

Conclusion: FC is a promising marker that can be used in clinical practice to select patients with organic intestinal disorders, compared with those with functional disorders. It also correlates very well with the extent of lesions and the severity of clinical symptoms in UC, with increased sensitivity and specificity.

Open access

Crina Pop, B. Kozma, Silvia Drasovean, Daniela Dobru and Alina Boeriu

Abstract

Background and aim: Hepatocellular carcinoma (HCC) is one of the most important health problem, with an increasing incidence worldwide. The aim of the present study was to determine the factors that predict HCC occurrence in a group of patients with liver cirrhosis developed on various etiologies.

Material and Methods: A total of 282 consecutive patients with liver cirrhosis seen between January 1, 2013 and July 31, 2014 were enrolled in a prospective study. Data from patient’s history, physical exams, laboratory tests and abdominal ultrasound were collected.

Results: 282 patients were included in the study with a median age of 59.6 and a male/female ratio of 1.38/1; 12.41% (35) were diagnosed with HCC. Alcohol consumption was documented in 19 cases (54.28%), without statistical association (p=0.621), and 7 (20%) were smokers (p=0.403). According to etiological factors of liver cirrhosis: 7 (20%) had background B virus infection, 15 (42.85%) HCV infection and 11 (31.42%) cases incriminated other causes of cirrhosis (alcohol). Chi2 test identified a statistically significant association between the occurrence of HCC and viral etiology of cirrhosis (p = 0.001, r = 18,830). No statistical association was found between Child Pugh scoring of cirrhosis and HCC (p=0.774) and a statistically significant association but inversely proportional was identified between neoplasia and obesity (p=0.008, r= -0.157).

Conclusion: In conclusion the viral etiology of liver cirrhosis is found to be an important risk factor for HCC, and liver cancer was inversely associated with nutritional status.

Open access

Diana Aniela Moldovan, Maria Despina Baghiu, Alina Balas, Emese Rozalia Fabian-Frast and Cristian Boeriu

Abstract

Objectives: Our study aimed to evaluate and compare the accuracy of C-reactive protein, Procalcitonin and Interleukine-6 in identifying serious bacterial infections (SBI) in children with fever without source.

Methods: 139 children, aged 7 days to 36 months, addressing the Emergency Department from a Romanian university hospital, were prospectively enrolled during 2013. C-reactive protein, Procalcitonin and Interleukin-6 were determined for every patient. SBI diagnosis was based on cultures results and chest radiographs.

Results: 31 patients (22.3%) had SBI. C-reactive protein [AUC: 0.87 (95%CI: 0.81-0.92)] and Procalcitonin [AUC: 0.83 (95%CI: 0.76-0.89)] proved strong prediction value for SBI and performed better than Interleukin-6 [AUC: 0.77 (95%CI: 0.69-0.84)]. For the group of children with the duration of fever less than 8 hours, Interleukin- 6 was the best predictor [AUC: 0.88 (0.76-0.95)].

Conclusions: Both C-reactive protein and Procalcitonin are strong and similar predictors for SBI, and Interleukin- 6 might be a better SBI screening tool for children with shorter duration of fever.

Open access

Diac Andreea Raluca, Brusnic Olga, Gabos Gabriella, Onisor Danusia, Drasoveanu Silvia Cosmina, Boeriu Alina and Dobru Daniela Ecaterina

Abstract

Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps.

Methods. This paper is a descriptive retrospective study on 52 pacients reffered for colonoscopy in Gastroenterology Clinic – Clinical County Hospital Targu Mures from January until September 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE (Narrow Band Imaging International Colorectal Endoscopic) classification and corroboration of the histology prediction and pathological assessment.

Results. Polyp detection rate was 48,58%, given the quality of bowel preparation in hospital fair in 84,5%. The predominant histological type was the tubular adenoma (46,25%), and 40% of the polyps were located in the sigmoid. Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real –time prediction of the histology of the colorectal polyps using NBI established: NICE 1: 19 polpyps, histology- 16 hyperplastic, (p<0,0001, sensitivity: 100%, specificity: 95%), NICE 2: 59 polyps, histology- 53 adenomatous, (p<0,0001, sensitivity: 96%, specificity: 76%), NICE 3: 2 polyps- histology-cancer.

Conclusions. We did not observe any distribution pattern in the topography of the diminutive polyps. Histologicaly the predominant type was the hyperplastic type. NBI was accurate in real-time prediction of the histology of the colo-rectal polyps. The results are relevant for application of the new strategies in the managment of the diminutive polyps.

Open access

Silvia Cosmina Drasovean, Diana Elena Morărașu, Ofelia Daniela Pascarenco, Olga Brsunic, Danusia Maria Onișor, Boeriu Alina and Daniela Ecaterina Dobru

Abstract

Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pilory infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia.

Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings.

Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19).

Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.