Source: Clinical Gastroenterology and Hepatology 2014;12:1514-1521
Comment
Colonic cleansing with sodium phosphate (SPH) preparations is effective, however, an increased risk of acute kidney injury (AKI) has been reported, secondary to the abrupt increase in blood phosphate levels. In healthy volunteers, it was found that about 50% of the preparation is absorbed in the intestine and 14% is excreted by the kidneys. The retained phosphate could have systemic effects by being deposited in different tissues after binding with calcium. It is not yet clear what consequences this deposit could have, especially in populations considered to be at risk for kidney damage. Most of the published works are inconclusive, or have a low power as a major limitation, secondary to an insufficient number of patients. On the other hand, they do not discriminate between those who undergo studies on an outpatient or inpatient basis, which implies populations that are not always comparable. The FDA advised against the use of FTS in patients with kidney disorders in 2008.
This study is a retrospective cohort, from a secondary database, which listed the reasons for patient care demand towards their health coverage plans in the United States. Patients between 50 and 75 years of age who had undergone surveillance video colonoscopy (CCV) on an outpatient basis from January 2000 to November 2008 were analyzed. The exposure period was considered to be 30 days prior to the CCV, period during which colonic preparation had been prescribed, either with FTS or with polyethylene glycol (PEG). Follow-up began on the day of the CCV and continued for 6 months. Those patients who had presented acute kidney injury, kidney failure of unknown etiology, rhabdomyolysis, on dialysis or in pre-transplant evaluation were excluded. The main event was acute kidney injury (AKI), defined according to the codes of the nomenclator of the 9th revision of the International Classification of Diseases. The covariates considered, in addition to the demographic data of the population, were risk factors for kidney damage, regular medication and that started during the exposure period. Hazard ratios (HR) for the development of AKI were estimated using a Cox proportional hazards regression model. A propensity score for treatment was generated, using all potential confounders, and the analysis was matched to detect inequalities between groups. A sensitivity analysis was performed in which patients operated on before 2005 (no reports of kidney damage due to FTS) and between that year and 2008 (the FDA advised against the use of FTS in patients at risk of AKI) were evaluated separately. ).
A total of 550,696 patients were analyzed, 429,430 had received PEG and 121,266 FTS. There was a slight predominance of women in both groups. In the group that received PEG, the mean age and drug use were higher, as was the prevalence of co-morbidities, such as diabetes, chronic renal failure, hypertension, and cardiovascular disorders. The frequency of hypercalciuria and recent kidney stones was similar in both groups. The mean follow-up was 170.7 days (SD 32 d). A total of 1,595 AKI episodes were recorded, 241 (0.2%) in the FTS-prepared group and 1,354 (0.3%) in the PEG-prepared group. Other events such as kidney failure or dialysis requirement did not show differences between both groups. The crude HR of AKI for the FTS group compared to the PEG group was 0.63 (95% CI 0.55-0.72) and the HR adjusted for comorbidities (CKD, >60 years, diabetics, stones, hypercalciuria, NSAIDs and with thiazide treatment) was 0.86 (95% CI 0.75-0.99). The analysis using the propensity score showed that both groups, FTS and PEG, are comparable. The matched HR was 0.85 (95% CI 0.72-1.01). Likewise, the sensitivity analysis by periods (until 2004 and from 2005 to 2008) did not show significant differences either.
Since previous evidence has not been conclusive regarding the possible risk of complications from FTS, and considering that conducting a clinical trial would be unethical given that the FDA has discouraged its use in this group of patients, this cohort has certain advantages over previously published studies. It analyzes patients exclusively from the outpatient setting and defines the follow-up period. It is innovative, by using a propensity score that makes it possible to homogenize both groups and make them comparable. This is a useful tool in observational studies, since it allows estimating a causal effect of the treatments studied. It also performs an analysis adjusted for numerous risk factors, as well as concurrent medication.
Within limitations, the fact that the exposure factor (FTS or PEG) is determined by the dispensing records in pharmacies and that the detection of patients with ARI has been based on the coding of the social coverage pathologies stands out, which lowers the sensitivity of the data. Like all observational studies, there is the possibility that co-variables that could be directly associated with the ARI event have not been considered. The secondary database used may not be generalizable to other populations outside of the United States.
Based on the aforementioned results, this study did not find an increased risk of AKI associated with the use of FTS, even in the highest-risk subgroups.
Carried out by: Dr. María Julieta Argüero
2nd Course on Diagnostic and Therapeutic Endoscopic Techniques-Upper Digestive Endoscopy
2 months – 23 teaching hours
General objective
– Offer a continuing education program in Upper Digestive Endoscopy.
– Promote updating in endoscopic techniques, which facilitate the diagnosis, monitoring and treatment of pathology of the upper digestive tract.
Specific objectives
– Review the updated contents on diagnostic and therapeutic endoscopic techniques and their practical application from the point of view of the medical specialist.
– Knowledge of specific therapeutic techniques, oriented according to pathology and endoscopic findings.
– Promote the correct handling and application of these techniques.
Target audiences
– Gastroenterologists.
– Digestive Endoscopist Surgeons.
– Pediatricians Gastroenterologists endoscopists.-
– Scholarship recipients in digestive endoscopic training in the aforementioned specialties.
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Sodium phosphate would not increase the risk of acute renal failure after routine colonoscopy compared with polyethylene glycol
Source: Clinical Gastroenterology and Hepatology 2014;12:1514-1521
Comment
Colonic cleansing with sodium phosphate (SPH) preparations is effective, however, an increased risk of acute kidney injury (AKI) has been reported, secondary to the abrupt increase in blood phosphate levels. In healthy volunteers, it was found that about 50% of the preparation is absorbed in the intestine and 14% is excreted by the kidneys. The retained phosphate could have systemic effects by being deposited in different tissues after binding with calcium. It is not yet clear what consequences this deposit could have, especially in populations considered to be at risk for kidney damage. Most of the published works are inconclusive, or have a low power as a major limitation, secondary to an insufficient number of patients. On the other hand, they do not discriminate between those who undergo studies on an outpatient or inpatient basis, which implies populations that are not always comparable. The FDA advised against the use of FTS in patients with kidney disorders in 2008.
This study is a retrospective cohort, from a secondary database, which listed the reasons for patient care demand towards their health coverage plans in the United States. Patients between 50 and 75 years of age who had undergone surveillance video colonoscopy (CCV) on an outpatient basis from January 2000 to November 2008 were analyzed. The exposure period was considered to be 30 days prior to the CCV, period during which colonic preparation had been prescribed, either with FTS or with polyethylene glycol (PEG). Follow-up began on the day of the CCV and continued for 6 months. Those patients who had presented acute kidney injury, kidney failure of unknown etiology, rhabdomyolysis, on dialysis or in pre-transplant evaluation were excluded. The main event was acute kidney injury (AKI), defined according to the codes of the nomenclator of the 9th revision of the International Classification of Diseases. The covariates considered, in addition to the demographic data of the population, were risk factors for kidney damage, regular medication and that started during the exposure period. Hazard ratios (HR) for the development of AKI were estimated using a Cox proportional hazards regression model. A propensity score for treatment was generated, using all potential confounders, and the analysis was matched to detect inequalities between groups. A sensitivity analysis was performed in which patients operated on before 2005 (no reports of kidney damage due to FTS) and between that year and 2008 (the FDA advised against the use of FTS in patients at risk of AKI) were evaluated separately. ).
A total of 550,696 patients were analyzed, 429,430 had received PEG and 121,266 FTS. There was a slight predominance of women in both groups. In the group that received PEG, the mean age and drug use were higher, as was the prevalence of co-morbidities, such as diabetes, chronic renal failure, hypertension, and cardiovascular disorders. The frequency of hypercalciuria and recent kidney stones was similar in both groups. The mean follow-up was 170.7 days (SD 32 d). A total of 1,595 AKI episodes were recorded, 241 (0.2%) in the FTS-prepared group and 1,354 (0.3%) in the PEG-prepared group. Other events such as kidney failure or dialysis requirement did not show differences between both groups. The crude HR of AKI for the FTS group compared to the PEG group was 0.63 (95% CI 0.55-0.72) and the HR adjusted for comorbidities (CKD, >60 years, diabetics, stones, hypercalciuria, NSAIDs and with thiazide treatment) was 0.86 (95% CI 0.75-0.99). The analysis using the propensity score showed that both groups, FTS and PEG, are comparable. The matched HR was 0.85 (95% CI 0.72-1.01). Likewise, the sensitivity analysis by periods (until 2004 and from 2005 to 2008) did not show significant differences either.
Since previous evidence has not been conclusive regarding the possible risk of complications from FTS, and considering that conducting a clinical trial would be unethical given that the FDA has discouraged its use in this group of patients, this cohort has certain advantages over previously published studies. It analyzes patients exclusively from the outpatient setting and defines the follow-up period. It is innovative, by using a propensity score that makes it possible to homogenize both groups and make them comparable. This is a useful tool in observational studies, since it allows estimating a causal effect of the treatments studied. It also performs an analysis adjusted for numerous risk factors, as well as concurrent medication.
Within limitations, the fact that the exposure factor (FTS or PEG) is determined by the dispensing records in pharmacies and that the detection of patients with ARI has been based on the coding of the social coverage pathologies stands out, which lowers the sensitivity of the data. Like all observational studies, there is the possibility that co-variables that could be directly associated with the ARI event have not been considered. The secondary database used may not be generalizable to other populations outside of the United States.
Based on the aforementioned results, this study did not find an increased risk of AKI associated with the use of FTS, even in the highest-risk subgroups.
Carried out by: Dr. María Julieta Argüero
Idiopathic acute pancreatitis
Endosonography vs cholangiopancreatoresonance in patients with idiopathic acute pancreatitis
Source: Digestive Diseases and Sciences
Comment
Despite progress in diagnostic imaging, many patients with acute pancreatitis remain without an etiologic diagnosis. According to reports, 25-30% of cases of acute pancreatitis are diagnosed as idiopathic due to lack of clear evidence of biliary lithiasis or other cause.
The efficacy of endosonography (EUS) in the diagnosis of idiopathic acute pancreatitis (IAP) is already known, because it is able to detect small (=or<4mm) occult biliary lithiasis in the gallbladder or bile duct. It also contributes to the diagnosis of chronic pancreatitis, or small tumors responsible for PAI such as IPMN. Cholangiopancreatoresonance (CPRMN) has advanced in the last 10 years and is also able to detect small stones in the bile duct and abnormalities in the pancreatic ducts.
A prospective study was developed to compare these two techniques in the etiological diagnosis of the disease, performed after the acute phase of the disease.
During 2008 and 2010, 128 patients diagnosed with acute pancreatitis were included in the study. After the first-line studies (serology, abdominal ultrasound and computed tomography), if the etiology was not found, second-line studies (EUS and MRCP) were performed after two months (or more if the pancreatitis was severe).
With the first-line studies, etiological diagnosis was made in 83 cases of acute pancreatitis. Of the 45 patients diagnosed with PAI, 38 underwent EUS and CPRMN.
EUS and MRCP were able to identify the etiology in 19 patients (50%). The diagnostic yield of EUS was higher (29 vs 10.5%). EUS more accurately detected gallstones and MRCP better identified ductal abnormalities, IPMN.
In conclusion, EUS is more efficient than MRCP in the diagnosis of PAI, however the use of both methodologies is valid. EUS better characterizes parenchymal lesions and MRCP gives a better global visualization of the ducts. NMRCP is less invasive and less expensive than EUS, although the performance of the latter is higher.
Considering the high incidence of microlithiasis as a cause of IAP, it is difficult to replace EUS due to its greater ability to recognize microlithiasis over MRCPNM.
Therefore according to this study, from a practical and economic point of view, one could start by performing the diagnosis with EUS, and if this is negative or doubtful, follow by CPRMN.
Carried out by: Dr. Inés Oría
Original article:
Endoscopic Ultrasound and Magnetic Resonance Cholangiopancreatography in patients with Idiopathic Acute Pancreatitis.
Aldine Thevenot, Barbara Bournet et al.
Dig Dis Sci 2013. 58 (8):2361-2368.
Resection of small colonic polyps in anticoagulated patients: prospective randomized study comparing conventional polypectomy versus cold loop resection
Source: Gastrointestinal Endoscopy
Comment
Currently, the ASGE (American Society of Gastrointestinal Endoscopy) guidelines consider conventional or cold loop polypectomy as a high-risk procedure in anticoagulated patients, and therefore recommend the suspension of anticoagulation before the procedure is performed.
This recommendation is based on the available evidence that establishes that the risk of post-polypectomy bleeding in anticoagulated patients is approximately 10%. However, the risk of thromboembolic events after discontinuation of anticoagulation is approximately 3%.
In this study published in the journal Gastrointestinal Endoscopy by a Japanese group, the risk of conventional polypectomy versus cold loop polypectomy in anticoagulated patients without suspension of anticoagulation is raised as a question.
This is a prospective randomized study carried out in a single center in Japan, in which patients over 20 years of age who were anticoagulated and who presented polyps smaller than 10 mm in a screening colonoscopy were included for 10 months. Exclusion criteria were: pregnant women, ASA III or IV, obesity (>100 kg), allergy to propofol or insufficient preparation that prevented observation of at least 90% of the colon. The primary outcome was delayed bleeding (bleeding within the first 2 weeks of the procedure that would have required endoscopic intervention) and the secondary outcome was immediate bleeding (oozing bleeding during the procedure for more than 30 seconds that would have required hemostatic clip placement).
The estimated sample calculation was 53 patients in each group; however, an intermediate analysis was performed during the course of the study which showed a high rate of bleeding with conventional polypectomy (40%) and the study was stopped. Finally, 77 patients were prospectively included, of which 7 were excluded because they presented lesions larger than 10 mm. All patients were randomized, leaving 35 patients in the conventional group (CG) and another 35 in the cold loop group (GF). Both groups were similar with respect to demographic characteristics.
In the GF group 78 polyps were resected with an average size of 6.5 mm and in the CG group 81 polyps were resected with an average size of 6.8 mm. Regarding delayed bleeding, a significant difference was observed between both groups, being 14% (5/35) in the GF vs. 0% (0/15) in the GF; P=0.027. Immediate bleeding was 5.7% (2/35) vs. 23% (8/35) respectively; P=0.042. The Odds ratio for post-polypectomy bleeding in the GF was 6.5 (95% CI, 1.9-22.5). Regarding the histopathological study of the polyps, there was no difference in the rate of complete resection between the two groups. A statistically significant difference was observed in the presence of submucosal arteries in the samples analyzed: GC 47% vs GF 32%, P=0.049. Likewise, the presence of injured submucosal arteries was also higher in the GC: 22% vs 39%, P=0.023.
In conclusion, this study shows that cold loop polypectomy seems to be a useful and safe resource in anticoagulated patients, since immediate bleeding could be effectively controlled with hemostatic clips or other methods. As for delayed bleeding, it would appear to be much less than that estimated with conventional polypectomy, making it a safe method that could avoid the suspension of anticoagulation, thus avoiding possible thromboembolic events. A possible explanation for the differences observed between both techniques could be linked to the injury of submucosal arteries, a situation more frequently observed in conventional polypectomy. Although this is a small sample study, future larger and multicenter studies could be important to corroborate these results.
Carried out by: Dr. Ramiro C. González Sueyro
Original article:
Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy.
Akira Horiuchi, MD,1 Yoshiko Nakayama, MD,1,2 Masashi Kajiyama, MD,1 Naoki Tanaka, MD,1 Kenji Sano, MD,3 David Y. Graham, MD.
Gastrointest Endosc. 2014 Mar;79(3):417-23.
Therapeutic update in eosinophilic esophagitis
Eosinophilic esophagitis is a chronic disease characterized clinically by symptoms of esophageal malfunction and histologically by infiltration of…
Eosinophilic esophagitis is a chronic disease characterized clinically by symptoms of esophageal malfunction and histologically by dense infiltration by eosinophilic leukocytes. Its etiology is immunoallergic and is triggered in most cases by a non-IgE mediated food allergy. It is now a common disease in Europe, the United States and Australia, and emerging in South America and Asia. During the last decade there have been substantial improvements in the therapeutic algorithm of the disease, from the inclusion of proton pump inhibitors as an anti-inflammatory drug, the emergence of new topical corticosteroids designed specifically for the disease, the simplification and optimization of elimination diets and the acceptance of endoscopic dilatation as a highly effective and safe adjuvant treatment. This review attempts to update and imbricate, from a practical point of view, the main therapeutic options available for this new and intriguing disease.
Keywords. Eosinophilic esophagitis, proton pump inhibitor, corticosteroids, diet, dilatation.
Javier Molina-Infante, Rodolfo Corti, Judith Doweck, Alfredo J Lucendo
Acta Gastroenterol Latinoam 2018;48(3):242-252
Publisher: Revista Acta Gastroenterológica Latinoamericana.
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Covid-19, Coronavirus, SARS-CoV-2 and the small bowel
Although SARS-CoV-2 may primarily enter the cells of the lungs, the small bowel may also be an important entry or interaction site…
ABSTRACT – Although SARS-CoV-2 may primarily enter the cells of the lungs, the small bowel may also be an important entry or interaction site, as the enterocytes are rich in angiotensin converting enzyme (ACE)-2 receptors. The initial gastro- intestinal symptoms that appear early during the course of Covid-19 support this hypothesis. Furthermore, SARS- CoV virions are preferentially released apically and not at the basement of the airway cells. Thus, in the setting of a productive infection of conducting airway epithelia, the apically released SARS-CoV may be removed by mucocil- iary clearance and gain access to the GI tract via a luminal exposure. In addition, post-mortem studies of mice infected by SARS-CoV have demonstrated diffuse damage to the GI tract, with the small bowel showing signs of enterocyte desquamation, edema, small vessel dilation and lympho- cyte infiltration, as well as mesenteric nodes with severe hemorrhage and necrosis. Finally, the small bowel is rich in furin, a serine protease which can separate the S-spike of the coronavirus into two “pinchers” (S1 and 2).The sep- aration of the S-spike into S1 and S2 is essential for the attachment of the virion to both the ACE receptor and the cell membrane. In this special review, we describe the inter- action of SARS-CoV-2 with the cell and enterocyte and its potential clinical implications.
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Prevalence of small intestine bacterial overgrowth in patients with gastrointestinal symptoms
Carolina Piedade MARTINS, Caio Henrique Amorim CHAVES, Maurício Gustavo Bravim de CASTRO, Isabel Cristina GOMES3 and Maria do Carmo Friche PASSOS
ABSTRACT – Background – Small intestine bacterial overgrowth is a heterogeneous syndrome characterized by an increase in the number and/or the presence of atypical microbiota in the small intestine. The symptoms of small intestine bacterial overgrowth are unspecific, encompassing abdominal pain/distension, diarrhea and flatulence. Due to the increased cost and complexity for carrying out the jejunal aspirate, the gold standard for diagnosis of the syndrome, routinely the hydrogen (H2) breath test has been used, utilizing glucose or lactulose as substrate, which is able to determine, in the exhaled air, the H2 concentration produced from the intestinal bacterial metabolism. However, due to a number of individuals presenting a methanogenic microbiota, which does not produce H2, the testing on devices capable of detecting, concurrently, the concentration of exhaled H2 and methane (CH4) is justified. Objective – This study aimed to determine the prevalence of small intestine bacterial overgrowth in patients with digestive symptoms, through a comparative analysis of breath tests of H2 or H2 and CH4 associated, using glucose as substrate. Methods – A total of 200 patients of both sexes without age limitation were evaluated, being directed to a Breath Test Laboratory for performing the H2 test (100 patients) and of exhaled H2 and CH4 (100 patients) due to gastrointestinal complaints, most of them patients with gastrointestinal functional disorders. Results – The results indicated a significant prevalence of small intestine bacterial overgrowth in the H2 test and in the test of exhaled H2 and CH4 (56% and 64% respectively) in patients with gastrointestinal symptoms, and higher prevalence in females. It found further that methane gas was alone responsible for positivity in 18% of patients. Conclusion – The data found in this study is consistent with the findings of the current literature and underscores the need for using devices capable of capturing the two gases (exhaled H2 and CH4) to improve the sensitivity and hence the accuracy of small intestine bacterial overgrowth diagnosis in daily medical practice.
HEADINGS – Bacterial growth. Small intestine. Breath tests. Hydrogen. Methane.
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Crédits:
Maurício Gustavo Bravim de Castro – CRM MG: 29.496
Cirurgião do aparelho digestivo do Hospital Lifecenter (2002 – 2017)
Formado em medicina pela UFMG (1995)
Residência de cirurgia geral e do trauma pelo Hospital Felício Rocho e Hospital João XXIII da Fundação Hospitalar da Estado de Minas Gerais (1998)
Membro titular do Colégio Brasileiro de Cirurgia Digestiva (CBCD)
Membro efetivo da Federação Brasileira de Gastroenterologia (FBG)
Membro do conselho consultivo da Sociedade Brasileira de Motilidade Digestiva e Neurogastroenterologia (SBMDN)
Diretor técnico do CEMAD – Centro de Motilidade do Aparelho Digestivo – Belo Horizonte
Long-term tolerability of the combination naproxen and esomeprazole magnesium in fixed dose
Gastrointestinal risk factors have been extensively studied. During the last CNS Latin American Forum on pain, Dr. Angel Lanas explained that in the last 10 years there has been an important reduction of complications in the upper gastrointestinal tract, although complications in the lower gastrointestinal tract have increased.
In view of this situation, Lanas considered that it is essential to define an ideal strategy to achieve the protection of both digestive tracts. At the same time, special attention should be paid to those patients who may develop an ulcer.
In line with the above, it is pertinent to mention a study published in Current Medical Research and Opinion. The objective of this study was to assess the long-term tolerability of the combination of enteric-coated naproxen at a dose of 500 mg and immediate-release esomeprazole magnesium at a fixed dose of 20 mg (FDC) in patients at risk of NSAID-related gastric ulcers.
This was an open-label, multicenter, phase III study involving Helicobacter pylori-negative patients aged ≥50 50 years or 18 to 49 years with a history of uncomplicated ulcer in the past five years. Patients in turn had osteoarthritis, rheumatoid arthritis, or other disorder requiring daily NSAIDs for ≥12 months, received naproxen/esomeprazole twice daily for 12 months.
The primary endpoints consisted of adverse effects, vital signs, physical examination, and laboratory tests. Subgroup analyses included use of low-dose acetylsalicylic acid (LDA) and age.
Adverse effects of NSAID-related gastric ulcer and predefined cardiovascular adverse effects were analyzed.
Of 239 treated patients (tolerability population), 135 completed ≥ 348 days of treatment (those who completed 12 months). The frequency of adverse effects was approximately 70%; dyspepsia, constipation, upper respiratory infections, nausea, dorsalgia, and contusion were most frequent (≥ 5 patients, in each population).
Treatment-related adverse effects occurred in 28.0% and 23.7% of patients in the tolerability and 12-month completion populations, respectively; 18.8% of patients discontinued medication as a result of adverse effects (tolerability population).
There were few serious adverse effects and no deaths. In the tolerability population, the frequency of adverse effects was 71.4% and 76.9% in patients <65 years of age (n = 161) and ≥65 years (n = 78), respectively, and 67.6% and 75.8% in LDA users (n = 74) and nonusers (n = 165), respectively.
High digestive and cardiovascular adverse effects were observed in 18.8% and 6.3% of patients, respectively, in the tolerability population and 16.3% and 5.2%, respectively, in those concluding 12 months of treatment. Dyspepsia and hypertension were more frequent. Additional assessments showed no unexpected findings.
Based on these endpoints, long-term treatment with FDX naproxen/esomeprazole was not associated with any new tolerability issues, including predefined UGI and cardiovascular adverse effects, in patients requiring NSAID therapy who were at risk for upper gastrointestinal complications.
Source: Medcenter Medical News
Metabolic fingerprinting of tumors useful in bowel cancer patients
It is possible to assess how advanced a bowel cancer is by analyzing its metabolic fingerprint, according to new research.
Bowel cancer is the third most common type of cancer worldwide and more than 1 million new cases are diagnosed each year. Pinpointing the exact stage a tumor has reached is critical in determining which treatments to offer.
When determining the metabolic fingerprint, a blood, urine or tissue sample is analyzed for the concentrations of many different metabolites, which are the products of chemical reactions in the body’s cells. This mixture of metabolites alters as cancer occurs and grows. The researchers who collaborated on the new study, from Imperial College London, point out that clinicians could use metabolic fingerprinting in conjunction with available imaging techniques to perform the most accurate analysis of a tumor possible. This research is published in the journal Annals of Surgery. Physicians currently use a combination of CT, MRI, and ultrasound to assess how advanced a tumor is, but because these tests rely on visual estimates of the size and location of a tumor, they are not always as sensitive or specific. Previous studies have shown that these techniques regularly indicate that a tumor is more advanced or less advanced than it actually is.
Dr. Reza Mirnezami, lead author of the study from the Department of Surgery and Cancer at Imperial College London, said, “Investigating the stage of a tumor is critical in planning a patient’s treatment. It is becoming increasingly common that before we carry out surgical resection of a tumor we give treatments to try to shrink its mass, but the kinds of treatments we offer depend on our assessment of how advanced the tumor is. The more precise we can be, the better the patient’s chances of survival.
“Our research indicates that using metabolic fingerprinting techniques in addition to assessment with imaging studies could give us the clearest possible picture of how the cancer is progressing.”
For the new study, the researchers analyzed the metabolic fingerprint of 44 intestinal tumor tissue samples, provided by patients seen at Imperial College Healthcare NHS Trust, using high-resolution magic angle spinning nuclear magnetic resonance spectroscopy (HR-MAS NMR). Their results for determining the stage the cancer had reached were as accurate as existing radiological methods.
Lord Ara Darzi, Paul Hamlyn Chair of Surgery at Imperial College London, and lead author of the study, said, “We know that even with the impressive scanning technology we have available so far, it is not always possible to correctly verify the local stage of a cancer. Our study seems to indicate that if used in conjunction with medical imaging, metabolic fingerprinting could allow us to obtain more accurate information. This could give us more certainty about the correct treatment to administer to patients, and spare some of them from invasive treatment when they do not need it.”
The research also indicates that tumors adopt unique metabolic properties as they progress further, opening up new avenues for treatment. The researchers hope that it will ultimately be possible to identify different metabolic targets when the cancer is at different stages, in order to render the tumor impossible or slow it down. Professor Jeremy Nicholson, Head of the Department of Surgery and Cancer at Imperial College London and corresponding author of the study, said, “This study represents one part of our program to develop advanced technology to improve patient tolerability in the surgical setting and shows the enormous potential of using metabolic models to stratify patients and optimize treatment.”
Source: Medical News Today