Journal of Gastroenterology and Hepatology

Lee, Shou‐Dong

doi: 10.1046/j.1440-1746.2000.02239.xpmid: 11101002

Abstract Recent decades have witnessed a marked decline in the prevalence of hepatitis A virus (HAV) infection in Asian populations, especially in children. This is attributable to general improvements in socio‐economic status and hygiene, which have, in turn, made a large population of young adults susceptible to the disease. The HAV infection rarely results in death and mortality is age‐dependent. According to previous reports, it may be more severe in persons with underlying chronic liver disease (CLD). Because most parts of Asia are areas of endemic hepatitis B and C virus infection, where chronic hepatitis B and C are the most important causes of CLD, it is therefore imperative for patients with CLD to be protected against HAV infection. Several studies have been conducted into the success of immunization against HAV in different risk groups. Given the increasing potential for HAV epidemics and the success and safety of the HAV vaccines, mass immunization against the infection seems possible and rational in Asia.

Tandon, Rakesh K

doi: 10.1046/j.1440-1746.2000.02268.xpmid: 11100996

Abstract A worldwide concern has emerged with regard to endoscope disinfection and many gastrointestinal endoscopy associations have developed guidelines for proper disinfection of endoscopes and endoscopic accessories. A working party was convened to formulate guidelines for the Asia–Pacific region, pertaining to any setting in which gastrointestinal endoscopy is performed. Endoscope reprocessing that meets the established standard of practice helps to ensure a microbial‐free endoscope for all patients, reduces the risk of disease transmission and helps to prolong the life of the endoscope. The recommendations included mechanical cleaning as the first and most important step followed by immersion in 2% glutaraldehyde for a minimum period of 10 min. Automated disinfectors have been recommended for busy endoscopy centres to ensure better compliance. Reuse of endoscopic accessories meant for ‘single use’ remains a controversial issue. Strict quality assurance programmes are a must to preclude lack of compliance with these guidelines.

Haber, GB

doi: 10.1046/j.1440-1746.2000.02272.xpmid: 11101000

Abstract The key issues that determine the decision between reusable versus disposable accessories are cost and functionality. In most health‐care systems the availability and dissemination of endoscopic services relates directly to the resources (i.e. budget) of that system. Given the limitations of health‐care budgets, access to endoscopic services will depend upon the cost efficiency of endoscopic practice. The onus on endoscopists and health‐care providers, therefore, is to meticulously evaluate the necessary steps for safe reutilization of accessories. This paper addresses the principles of reuse, quality assurance and particularly disinfection practices. Any change to a more costly disposable accessory policy must bear the responsibility of denied access to endoscopic services in a system with finite resources.

Leung, Joseph W

doi: 10.1046/j.1440-1746.2000.02269.xpmid: 11100997

Abstract Proper reprocessing of endoscopes prevents the risk of transmission of infection between patients. Meticulous mechanical cleaning is the most important step as it removes the majority of the contaminating bacteria. It should be performed before manual or automatic disinfection. High‐level disinfection involves total immersion of the endoscope in a liquid chemical germicide (LCG) at a preset temperature and concentration for a pre‐determined period of time. Subsequent rinsing and drying are essential steps to remove the chemical solution and prevent bacterial colonization during storage. Endoscopy units that are used for more than 50 procedures per week may benefit from cleaning in an automatic endoscope reprocessor (AER). This allows automated exposure of the endoscope to the LCG with subsequent flushing and drying of the channels, and minimizes staff exposure to the LCG. Reprocessing should be performed by trained and accredited personnel according to written guidelines or standards of practice as defined by professional societies. Regular monitoring of the reprocessing process is important for quality control and in ensuring patients' safety.

Sung, Jjy; Russell, Ri; Yeomans, N; Chan, Fkl; Chen, Sl; Fock, Km; Goh, Kl; Kullavanijaya, P; Kimura, K; Lau, Cs; Louw, J; Sollano, J; Triadiafalopulos, G; Xiao, Sd; Brooks, Peter

Brennan, Murray F

doi: 10.1046/j.1440-1746.2000.02259.xpmid: 11100987

Abstract The incidence of pancreatic adenocarcinoma in the USA remains stable. Advances in management are confined to more accurate preoperative diagnosis and staging, and decreased operative mortality. Long‐term survival in the absence of resection remains poor.

Cotton, Peter B

doi: 10.1046/j.1440-1746.2000.02263.xpmid: 11100991

Abstract The developments of minimally invasive surgery and therapeutic endoscopy have blurred the traditional distinctions between surgical and medical disciplines. Maintenance of the time‐honoured separation of surgery and medicine now hinders the full flowering of innovative interventions. Patient care, clinical research and education in digestive disorders require structural realignment, as is being attempted in the Digestive Disease Center at the Medical University of South Carolina.

Schlemper, Ronald J; Kato, Yo; Stolte, Manfred

doi: 10.1046/j.1440-1746.2000.02266.xpmid: 11100994

Abstract Background: Large differences have been found between Western and Japanese pathologists in their diagnosis of adenoma/dysplasia and early carcinoma for gastric, colorectal and oesophageal epithelial neoplastic lesions. Common worldwide terminology based on clinical usefulness, that is, on neoplastic severity and depth of invasion, is needed. Methods: Thirty‐one pathologists from 12 countries reviewed 35 gastric, 20 colorectal and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints was assessed by kappa statistics. Results: Suspected or definite carcinoma was diagnosed in 17–66% of gastric, in 5–40% of colorectal, and in 10–67% of oesophageal slides by pathologists with a Western viewpoint, but in 77–94% of gastric, in 45–75% of colorectal and in 81–100% of oesophageal slides by pathologists with a Japanese viewpoint (from Japan, Germany, Austria and UK). Overall, there was poor agreement between the conventional Western and Japanese diagnoses (kappa values lower than 0.3 for gastric, colorectal and oesophageal lesions). There was much better agreement among the pathologists (kappa values higher than 0.5 for gastric and colorectal lesions) when the original assessments of the slides were regrouped into the five categories of the following classification of GI epithelial neoplasia we hereby propose: C1, negative for neoplasia; C2, indefinite for neoplasia; C3, mucosal low‐grade neoplasia (low‐grade adenoma/dysplasia); C4, mucosal high‐grade neoplasia (high‐grade adenoma/dysplasia plus mucosal carcinoma); C5, submucosal invasion of neoplasia. Conclusions: The intercountry differences in the diagnoses of adenoma/dysplasia and early carcinoma can, in large part, be resolved by adopting terminology based on neoplastic severity and depth of invasion. Problems with defining intramucosal invasion are thus avoided. Moreover, grouping high‐grade adenoma/dysplasia and mucosal carcinoma together in one category is clinically useful, as patients with small mucosal neoplastic lesions can be cured by endoscopic local resection.

Tytgat, Gnj

doi: 10.1046/j.1440-1746.2000.02262.xpmid: 11100990

Abstract Much has been achieved in Helicobacter pylori research, to the point that the growth of new knowledge is bound to slow down. However, expectations for further developments remain high. Knowledge about the characteristic organism and behaviour is already extensive. Particularly intriguing are the differences in genetic make‐up in the various geographical regions. Sadly, detailed knowledge on how the organism spreads is still lacking. The spectrum of clinical presentation in humans is largely known. Helicobacter pylori is disappearing worldwide, allowing the relative frequency of H. pylorin‐egative ulcer disease to increase. The extent to which H. pylori disappearance and eradication is responsible for decreasing prevalence of gastric cancer remains speculative. Antimicrobial therapy is dominated by proton pump inhibitor triple therapy as first line therapy, with quadruple therapy as second rescue line therapy. The long‐term consequences of the rising resistance to the ‘key’ antimicrobials are so far unknown, because few data are available on therapeutic outcomes in routine practice outside pharmaceutical trials.

Locarnini, Stephen

doi: 10.1046/j.1440-1746.2000.02265.xpmid: 11100993

Abstract The global burden of chronic liver disease caused by persistent infection with hepatitis B and C viruses has meant the urgent development of therapeutic strategies designed to control active replication and therefore prevent subsequent clinical sequelae. Advances in these therapeutic strategies are now clearly happening, mainly as a consequence of a better understanding of the viral life cycle and the unique pathogenesis of each disease. Further progress should continue as further insights into the virus–cell relationship are derived, which will sharpen attention on specific viral targets as well as shift and enhance host cytokine responses.