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Elastic band ligation of hemorrhoids:Flexible gastroscope or rigid proctoscope?

World Journal of Gastroenterology 2007年第4期13卷 585-587页

作者： M Cazemier RJF Felt-Bersma MA Cuesta cjj mulder Department of Gastroenterology and Hepatology VU University Medical Center Amsterdam The Netherlands Department of Gastrointestinal Surgery VU University Medical Center Amsterdam The Netherlands Department of Gastroenterology and Hepatology VU University Medical Center.Amsterdam The Netherlands

AIM： To compare dgid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids. METHODS： Patients between 18 and 80 years old, with chronic complaints （blood loss, pain, itching or prolapse） of internal hemorrhoids of grade 1-91, were randomized to elastic band ligation by rigid proctoscope or flexible endoscope （preloaded with 7 bands）. Patients were retreated every 6 wk until the cessation of complaints. Evaluation by three-dimensional anal endosonography was performed. RESULTS： Forty-one patients were included （median age 52.0, range 27-79 years, 20 men）. Nineteen patients were treated with a rigid proctoscope and twenty two with a flexible endoscope. Twenty-nine patients had grade I hemorrhoids, 9 patients had grade 11 hemorrhoids and 3 patients had grade 91 hemorrhoids. All patients needed a minimum of 1 treatment and a maximum of 3 treatments. A median of 4.0 bands was used in the rigid proctoscope group and a median of 6.0 bands was used in the flexible endoscope group （P 〈 0.05）. Pain after ligation tended to be more frequent in patients treated with the flexible endoscope （first treatment： 3 vs 20 patients, P 〈 0.05）. Three- dimensional endosonography showed no sphincter defects or alterations in submucosal thickness. CONCLUSION： Both techniques are easy to perform, well tolerated and have a good and fast effect. It is easier to perform more ligations with the flexible endoscope. Additional advantages of the flexible scope are the maneuverability and photographic documentation. However, treatment with the flexible endoscope might be more painful and is more expensive.

关键词： Hemorrhoids Barron ligation Rigid scope Endoscope Anal endosonography

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On attitudes about colorectal cancer screening among gastrointestinal specialists and general practitioners in the Netherlands

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World Journal of Gastroenterology 2006年第32期12卷 5201-5204页

作者： JS Terhaar sive Droste GDN Heine ME Craanen H Boot cjj mulder Department of Gastroenterology and Hepatology VU University Medical Centre AmsterdamThe Netherlands Department of Gastroenterology and Hepatology Antoni van Leeuwenhoek Hospital AmsterdamThe Netherlands

AIM： To find out whether there are differences in attitudes about colorectal cancer （CRC） screening among gastrointestinal （GI） specialists and general practitioners （GPs） and which method is preferred in a national screening program METHODS： Four hundred and twenty Dutch GI specialists in the Netherlands and 400 GPs in Amsterdam were questioned in 2004. Questions included demographics, affiliation, attitude towards screening both for the general population and themselves, methods of screening, family history and individual risk. RESULTS： Eighty-four percent of the GI specialists returned the questionnaire in comparison to 32% of the GPs （P〈0.001）. Among the GI specialists, 92% favoured population screening whereas 51% of GPs supported population screening （P〈0.001）. Of the GI specialists 95% planned to be screened themselves, while 30% of GPs intended to do so （P〈0.001）. Regarding the general population, 72% of the GI specialists preferred colonoscopy as the screening method compared to 27% of the GPs （P〈0.001）. The method preferred for personal screening was colonoscopy in 97% of the GI specialists, while 29% of the GPs favoured colonoscopy （P〈0.001）. CONCLUSION： Screening for CRC is strongly supported by Dutch GI specialists and less by GPs. The major health issue is possibly misjudged by GPs. Since GPs play a crucial role in a successful national screening program, CRC awareness should be realized by increasing knowledge about the incidence and mortality, thus increasing awareness of the need for screening among GPs.

关键词： Colorectal cancer General practitioner Screening Colonoscopy Awareness

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Nonalcoholic fatty liver disease: An overview of current insights in pathogenesis, diagnosis and treatment

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World Journal of Gastroenterology 2008年第16期14卷 2474-2486页

作者： Tim CMA Schreuder Bart J Verwer Carin MJ van Nieuwkerk Chris JJ mulder Department of Gastroenterology and Hepatology VU University Medical Center

Estimates of people suffering from overweight (one billion) and obesity (300 million) are increasing. The accumulation of triglycerides in the liver, in the absence of excess alcohol intake, has been described in the early sixties. It was not until 1980, however, that Ludwig et al named this condition nonalcoholic steatohepatitis (NASH). Subsequently, nonalcoholic fatty liver disease (NAFLD) has been used as a general name for conditions ranging from simple steatosis through steatohepatitis to end-stage liver disease (cirrhosis). Many studies have demonstrated the significant correlation with obesity and insulin resistance. Other studies have revealed a signifi- cant correlation between hepatic steatosis, cardiovascu- lar disease and increased intima-media thickness. WHO estimated that at least two million patients will develop cirrhosis due to hepatic steatosis in the years to come. Longitudinal cohort studies have demonstrated that those patients with cirrhosis have a similar risk to devel- op hepatocellular carcinoma as those with other causes of cirrhosis. Taken all together, NAFLD has become the third most important indication for liver transplantation. There- fore, training programmes in internal medicine, gastroen- terology and hepatology should stress the importance of diagnosing this entity and treat properly those at risk for developing complications of portal hypertension and con- comittant cardiovascular disease. This review will focus on the clinical characteristics, pathophysiology, imaging tech- niques and the readily available therapeutic options.

关键词： Non-alcoholic fatty liver disease Non-alcoholicsteatohepatitis Insulin resistance Liver Obesity Steatosis

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