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Background/Aims Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients. Methods We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development. Results Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P

Reprocessing of gastrointestinal (GI) endoscopes and accessories is an essential part of patient safety and quality control in GI endoscopy centers. However, current endoscopic reprocessing guidelines or procedures are not adequate to ensure patient-safe endoscopy. Approximately 5.4 % of the clinically used duodenoscopes remain contaminated with high-concern microorganisms. Thus, the Digestive Endoscopy Society of Taiwan (DEST) sets standards for the reprocessing of GI endoscopes and accessories in endoscopy centers. DEST organized a task force working group using the guideline-revision process. These guidelines contain principles and instructions of step-by-step for endoscope reprocessing. The updated guidelines were established after a thorough review of the existing global and local guidelines, systematic reviews, and health technology assessments of clinical effectiveness. This guideline aims to provide detailed recommendations for endoscope reprocessing to ensure adequate quality control in endoscopy centers.

Background/Purpose: Small bowel (SB) accounts for the majority of gastrointestinal tract but its tumors are rare and always overlooked. In this study, we aimed to evaluate the epidemiology of SB tumors. Methods: This multicenter retrospective study utilized endoscopy database from 2006/11 to 2016/07. Baseline demographic characteristics, clinical, radiologic and endoscopic findings were collected. Results: Totally 103 (34 benign, 69 malignant lesions) patients with SB tumors in 1070 enteroscopic examinations were enrolled. There were male preponderance (56.3% males, 43.7% females), both in benign (52.9%, 49.1%) and malignant (58.0%, 42.0%) lesions, except for subtype gastrointestinal stromal tumors (GISTs) (31.6%, 68.4%). The age (mean ± SD) at diagnosis in malignant SB tumors (62.2 ± 15.6) was older than those with benign tumors (50.7 ± 21.4) (p 60-year-old, 77.8%) were older than lymphomas (60%) and GISTs (50%). Proximally location rates of lymphomas, GISTs, adenocarcinomas were 25.0% (5/20), 84.2% (16/19), and 88.9% (16/18), respectively. Conclusion: This endoscopy-based study revealed the most common histology of benign SB tumors were hamartoma and adenoma, and malignant ones were lymphomas, GISTs, adenocarcinomas and metastatic cancers. Most of them were male gender, except for GISTs, and with proximal location, except for lymphomas. Further large-scale investigation efforts are warranted to elucidate the epidemiology of SB tumors. Keywords: Small intestine, Small bowel, Tumors, Enteroscopy

Summary: Background: Endoscopic ultrasound guided fine needle aspiration has become a standard procedure in diagnosis of pancreatic neoplasms with a high diagnosis yield. However, the clinical application focusing on the elderly population is scanty. Methods: Consecutive procedures for EUS-FNA diagnosis of pancreatic neoplasms at a tertiary referral center from March 2014 to December 2015 were analyzed retrospectively. The procedures were divided into two groups according to their age, the control group consisted of patients ≤60 years old and the elderly groups consisted of patients >60 years old. The primary outcome is the accuracy of the diagnosis in the two groups. The secondary outcome is the safety during the procedure. Results: A total of 28 EUS-FNA procedures were performed. The mean age of the control group was 48.7 years (n = 14) versus 70.2 years (n = 14) for the elderly cohort. Diagnostic accuracy of the EUS-FNA procedure in detecting malignant (true positive) and benign (true negative) lesions were higher in the control group (nonelderly: 85.7% vs. elderly: 50%; P = 0.046). There were two mild acute pancreatitis associated to the EUS-FNA procedures in the control group. Conclusion: Although EUS-FNA is safe and well tolerated in the elderly patients, our study showed a lower EUS-FNA diagnosis accuracy in this group. Focal fibrotic changes in the pancreas associated with the elderly patients resembled that of chronic pancreatitis microscopically. Keywords: EUS-FNA, pancreatic neoplasms, elderly, endoscopy, diagnosis

Background: laparoscopic cholecystectomy (LC) following endoscopic sphincterotomy (ES) in elderly patients with concomitant gallbladder stones remains a matter of debate. Methods: We retrospectively collected data from 84 patients aged >65 years who had common bile duct stones (CBDS) with cholangitis and had undergone successful ES between July 2007 and October 2010. We divided the patients into 2 groups: the cholecystectomy and wait-and-see groups. We also compared two age groups, namely, the young-old (65–74 years) and old (>75 years) groups. The endpoint was the presence of symptoms indicating recurrence of biliary events. Results: The recurrence rate was lower in patients who underwent subsequent cholecystectomy than in patients in the wait-and-see group. However, among the patients in the old group, the time to recurrence did not significantly differ between the cholecystectomy and wait-and-see groups. Univariate analysis showed that the presence of a juxtapapillary diverticulum (JPD) was an independent factor predicting recurrence. Conclusion: Cholecystectomy after ES is recommended for patients with CBDS aged

Summary: An 88-year-old man was admitted because of right upper quadrant abdominal pain and diagnosed as having acute cholecystitis. He underwent endoscopic retrograde cholangiography for jaundice and showed common hepatic duct narrowing with external compression compatible with Mirizzi syndrome. Owing to his age and fragility, he received only internal drainage with a plastic stent instead of operation. The right upper quadrant abdominal pain recurred with bloody stool and decreased hemoglobin level. Colonoscopy revealed a 4- × 3-cm colonic tumor over the hepatic flexure, and colonoscopic biopsy revealed necrosis and inflammation. Abdominal computed tomography (CT) revealed ruptured acute cholecystitis and abscess formation. Surgical intervention was performed, and the operative finding showed a cholecystocolonic fistula. The patient was discharged after cholecystectomy and partial colectomy, and the period of secondary hospitalization was 46 days. Keywords: acute cholecystitis, cholecystocolonic fistula, colonic tumor, Mirizzi syndrome

Pancreatic cancer is the eighth leading cause of cancer-related deaths in Taiwan. Pancreatic cancer has a poor prognosis. Diagnosis of early-stage pancreatic cancer, which can be defined based on resectability, size, or curability, will improve survival. Diagnostic tools for pancreatic cancer include transabdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS). We report the case of a 48-year-old man who presented with progressively yellowing skin. An CT imaging study did not reveal the pancreatic lesion. Further imaging with EUS was performed to search for the organic lesion causing an abrupt distal common bile duct stricture, and a heterogeneous hypoechoic tumor located at the uncinate process was identified. The patient underwent a Whipple operation because malignancy could not be ruled out. The final pathological result was moderate to poorly differentiated adenocarcinoma.

Emergency cholecystectomy for acute cholecystitis (AC) is associated with high morbidity and mortality rates in elderly patients with significant comorbidities. The aim of this study was to evaluate percutaneous cholecystostomy for AC in elderly patients with various coexisting diseases. We retrospectively reviewed the records of 4311 patients with AC treated in Mackay Memorial Hospital between the years 2000 and 2015. The clinical course of AC was compared between nonelderly (age ≤70 years) and elderly patients (age>70 years). In total, 67 elderly patients and 32 nonelderly patients received percutaneous cholecystostomy. The rate of percutaneous cholecystostomy increased between the years 2011 and 2015 (from 2.5% to 12.2%) and this procedure was more common in the elderly group (p=0.009). In addition, the comorbidities of ischemic heart disease and chronic kidney disease were higher in elderly than in nonelderly patients (p=0.014 and p=0.015, respectively). The American Society of Anesthesiologists' classification was higher in the elderly patients (p=0.001). The overall survival-free rate of recurrent cholecystitis in patients who did not receive cholecystectomy was not significantly different in the two groups. When compared with emergent cholecystectomy in high-risk elderly patients, percutaneous cholecystostomy resulted in reduced hospital stay and morbidity (p=0.002 and p=0.013, respectively). Our results demonstrate that percutaneous cholecystostomy has become a common and early treatment for AC in high-risk elderly patients with ischemic heart disease or chronic kidney disease. Identifying such patients will possibly improve clinical outcomes, reduce hospital stay and morbidity, and facilitate delayed laparoscopic cholecystectomy.

Crohn's disease (CD) and ulcerative colitis are the principal types of inflammatory bowel disease, which has a bimodal age distribution, with ∼10–15% of the affected population older than 60 years. The management of CD in the elderly population is more complex due to comorbidities, polypharmacy, impaired mobility, and surgical candidacy criteria. Further difficulty exists in the data and experience from clinical trials, which often exclude the elderly. Therefore, few data are available that directly compare treatment efficacies in younger and older patients. Recognizing prescribed medications and natural disease history in this population is the first step in preventing complications and improving quality of care delivered to older individuals with CD. This review focuses on the CD-related treatment, associated complications, and limitations in the elderly population.

Background: Single-balloon enteroscopy (SBE) is an effective tool in management of small-bowel disease. However, data on SBE in elderly patients are limited. In this study, we aimed to evaluate the safety, efficacy, and diagnostic and therapeutic utility of SBE in elderly patients. Methods: A retrospective review was performed at a tertiary referral hospital. A total of 168 patients who underwent 265 SBE procedures from December 2009 to October 2016 were included. Patients were divided into 2 groups based on age: young (

Adjuvant 5-fluorouracil (5-FU)-based chemotherapy, including FOLFOX (5-FU, leucovorin, and oxaliplatin), is recommended for colorectal cancer. However, intestinal mucositis remains a common adverse effect for which no effective preventive strategies are available. To develop a convenient and novel way to alleviate mucositis, we investigated the effect of Lactobacillus casei variety rhamnosus (Lcr35) on FOLFOX-induced mucosal injury. BALB/c mice subcutaneously injected with syngeneic CT26 colorectal adenocarcinoma cells were orally administered Lcr35 daily before, during, and after 5-day injection of FOLFOX regimen, for 14 days. The following methods were used: diarrhea score for toxicity, ELISA for cytokine production, histopathology for intestinal injury, immunohistochemistry for apoptosis/proliferation and regulatory proteins, RT-PCR for cytokine mRNA expression, and DNA sequencing for fecal gut microbiota. FOLFOX administration to colorectal cancer-bearing mice significantly inhibited tumor growth and the accompanying marked diarrhea and intestinal injury histologically characterized by the shortening of villi and destruction of intestinal crypts. Preventive administration of Lcr35 dose-dependently reduced the severity of diarrhea and intestinal mucositis without affecting the anti-tumor effect of FOLFOX. The numbers of apoptotic, NF-κB-, and BAX-activated cells increased after FOLFOX, and these responses were mitigated by Lcr35. TNF-α and IL-6 upregulation by FOLFOX treatment was attenuated by Lcr35. The fecal gut microbiota composition of Firmicutes and Bacteroidetes disturbed by FOLFOX was significantly reversed by Lcr35 toward a preferential profile. In conclusion, the oral probiotic Lcr35 prevented FOLFOX-induced intestinal mucositis in colorectal cancer-bearing mice. The putative mechanism might involve modulation of gut microbiota and proinflammatory responses with suppression of intrinsic apoptosis in intestinal injury.

Lamivudine, telbivudine, and entecavir are the first-line drugs covered by the Taiwan National Health Insurance as 3-year treatments for patients with chronic hepatitis B virus (HBV), but the optimal treatment duration of each remains unclear. We aimed to detect HBV treatment-cessation durability, and compare the predictors in patients with and without clinical relapse. In this retrospective cohort study, 210 patients with chronic HBV who tested hepatitis B e-antigen positive or hepatitis B e-antigen negative were treated for 3 years with a nucleos(t)ide analogue. Of these, 102 patients continued therapy after 3 years, while 88 patients stopped treatment and were followed for 1 year due to financial difficulties. Efficacy was assessed in terms of alanine aminotransferase (ALT) level normalization, HBV DNA clearance, virus breakthrough, clinical relapse, and liver decompensation. The durability predictors were evaluated by host factors, HBV DNA, and drug differences. Eighty patients (14 on lamivudine, 19 on telbivudine, and 47 on entecavir) were recruited. There was no difference in clinical-relapse rate among lamivudine, telbivudine, and entecavir (35.7% vs. 36.8% vs. 31.9%, respectively; p = 0.916), and liver decompensated hepatitis was absent. In baseline clinical characteristics, there were no differences between the clinical-relapse and nonrelapse groups in age, sex, cirrhosis, prior treatment, HBV DNA, pretreatment ALT, or hepatitis B e-antigen (HBeAg). The mean 3rd year serum ALT level differed significantly between clinical-relapse and nonrelapse patients (37.5 U/L vs. 27.7 U/L, respectively; p = 0.044). The 3-year nucleos(t)ide analogue off-treatment in patients with chronic HBV delivered according to the Taiwan National Health Insurance guidelines had an overall 33.8% 1-year clinical-relapse rate without any decompensated hepatitis flare-ups.

Lymphoepithelioma-like cholangiocarcinoma (LELCC) is a rare variant of intrahepatic cholangiocarcinoma. We herein have reported an unusual case of LELCC in a 71-year-old Taiwanese women with cirrhotic liver disease and chronic hepatitis C. The patient's liver tumor was unexpectedly discovered during a regular abdominal ultrasound exam without obvious clinical symptoms and signs; she thereafter received surgical resection. Histologically, the liver tumor showed lymphoepithelial-like appearance and features of cholangiocarcinoma without association with Epstein-Barr virus (EBV). We maintained regular follow-up with the patient for 3 years, who at that time was alive without tumor recurrence.

Malignant peritoneal mesothelioma (MPM) is rare. It is difficult to diagnose early and responds poorly to treatment. There is no optimal and effective treating consensus so far. We report three patients of MPM treated at Mackay Memorial Hospital in recent 3 years. They were two men and one woman without asbestos exposure related to their occupations. Due to failure in early diagnosis of MPM, none of them survived for more than 5 months. We make a brief review from the previous literature. These three cases were compared with the reviewing data in many aspects including the risk factor, clinical presentation, diagnostic options, and management. Besides, some latest clinical trials are introduced in this report.

Background/purpose: Nonalcoholic fatty liver disease (NAFLD) is a common condition comprising a wide spectrum of liver damage strongly associated with type 2 diabetes, obesity, and hyperlipidemia. The pathogenesis of fatty liver is multifactorial, and it has been suggested that the presence of insulin resistance (IR) is an essential requirement for the accumulation of hepatocellular fat. Although NAFLD may affect people of any age, in general, increasing age is associated with increasing prevalence. The aim of this study was to determine the prevalence of fatty liver and its influence on age and sex; and to assess the association of different degrees of fatty liver to IR and metabolic syndrome. Materials and methods: The study was performed in 8350 alcohol- and virus-negative individuals who underwent routine physical check-up at the health evaluation centre of Mackay Memorial Hospital, from February 2004 to May 2009. They underwent clinical examination, anthropometry, biochemical tests including serum fasting insulin, and routine liver ultrasonography. Steatosis was graded as absent, mild, moderate, or severe. Results: The overall prevalence of fatty liver was 34.40% with the prevalence of fatty liver being significantly higher in males than in females (22.34 vs. 12.06%, p = 0.015). A progressive increase in the means of a homeostasis model assessment of IR (HOMA-IR), body mass index, systolic blood pressure, plasma triglyceride, alanine aminotransferase, low-density lipoprotein-cholesterol and glucose level and decrease in high-density lipoprotein-cholesterol (p

Background: The average age of patients with hepatocellular carcinoma (HCC) has been increasing worldwide. This study aimed to clarify the aged-specific clinical characteristics of HCC among elderly patients. Materials and methods: We retrospectively analyzed 1123 patients with HCC treated between 2003 and 2006 at the Mackay Memorial Hospital in Taiwan. Patients aged more than 75 years of age at the time of diagnosis of HCC were defined as the elderly group. According to the Kaplan–Meier method, survival curves were compared between patients receiving treatment and those receiving supportive care. Results: A total of 169 patients (16.9%) were included in the elderly group. The mean age of the patients at the time of diagnosis was 80 ± 3.6 years. The sex ratio (male to female) was 1:0.72. The proportion of patients positive for hepatitis C virus antibody (HCVAb) and hepatitis B surface antigen (HBsAg) were 49.1% and 19.5%, respectively. The percentages of patients in the Cancer of the Liver Italian Program (CLIP) score categories 0–1, 2–3, and 4–6 were 44%, 39%, and 17 %, respectively. Of the 169 patients, 114 patients (67.5%) underwent treatment—transcatheter arterial embolization (TAE, n = 52, 45.7%), being the predominant treatment method—while 55 patients (32.5%) received supportive care. There cumulative survival curves of the treated group and the supportive care group differed significantly for HCC patients in the CLIP score categories 0–1 (p < 0.001) and 2–3 (p = 0.021), while there was no difference in these survival curves for HCC patients in the CLIP score category 4–6. Conclusion: Most elderly patients at the time of diagnosis of HCC were in CLIP score category 0–1. Transcatheter arterial embolization was the predominant treatment method at our hospital. Aggressive treatment for HCC, especially in CLIP score category 0–3, might improve the survival rate.

Discharge planning is an interdisciplinary approach to provide continuity of care; it is a process that includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation. Discharge planning has been viewed as a major way to enhance a smooth transition for patients from the hospital to home or other chronic care units and as a solution to solve problems associated with postdischarge care. The promotion of discharge planning began in the United States in the 1960s. Nursing scholars from Taiwan learned about the concept of discharge planning from the United States in the early 1980s and subsequently introduced it to Taiwanese medical institutions in 1985. A policy to promote discharge planning in Taiwan was announced by the Executive Yuan, Department of Health in 1993. Following the healthcare reforms in 1995, discharge planning has since been strongly promoted. Studies concerning discharge planning in Taiwan showed some promising results, including increased satisfaction of patients and their families, improved preparation of caregivers, and improved quality of life for patients. However, patients receiving interdisciplinary discharge planning services were still in the minority. There was no standard evaluation procedure for interdisciplinary discharge planning, and a high percentage of patients thought that hospitals handled the postdischarge long-term care services referral procedure inadequately. Despite the positive attitudes toward discharge planning, many physicians still demonstrate an unsatisfactory level of knowledge and behaviors with regard to discharge planning. To enhance the implementation of discharge planning, a standard evaluation procedure for interdisciplinary discharge planning and improved physician awareness concerning the importance of discharge planning are needed. In Taiwan, the improvement of discharge planning in the foreseeable future is promising with the accreditation of the procedure and the participation of doctors in efforts to ensure the continuity of postdischarge care for patients.

Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6%) patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029), end-stage renal disease (P = 0.038), previous antiplatelet drug use (P

Ulcerative colitis (UC) is a chronic inflammation of the large bowel characterized by diarrhea and a negative stool culture. However, several enteropathogens have been implicated as causative agents in UC. The differentiation between chronic infectious colitis (IC) and UC with concurrent infection is difficult owing to their similar clinical presentations. The study aimed to explore the presentations and diagnostic clues that enable differentiation between UC with concomitant infections and chronic IC. The study included 17 UC patients with a bacterial infection and 46 with chronic IC. The UC patients (47 ± 19 years) were younger than the chronic IC patients (58 ± 20 years) (P = 0.022). Bloody diarrhea was more common in UC than in chronic IC (58.8% vs 10.9%, P < 0.001). Previous antibiotic usage was a risk factor for chronic IC (5.9% vs 32.6%, P = 0.031). Malignancy was a common comorbidity of chronic IC (5.9% vs 34.8%, P = 0.022). UC patients had lower antibiotic response rates than chronic IC patients (60.0% vs 87.2%, P = 0.026). Aeromonas species and Clostridium difficile were common in both groups. Histological features of cryptitis and crypt abscess were useful in the diagnosis of UC (P = 0.052 and P = 0.016, respectively). Bloody diarrhea in a young adult, decreased response to antibiotic treatment, and results of endoscopy with biopsy are important features in the diagnosis of UC with bacterial infection.

Discharge planning is an interdisciplinary approach to continuity of care and a process that includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation. Effective discharge planning supports the continuity of health care; it is described as “the critical link between treatment received in hospital by the patient, and post-discharge care provided in the community.” The structure of discharge planning is classified into: (1) informal (ordinary) discharge planning and (2) formal (specialized, structured) discharge planning. Many studies showed that discharge planning may increase patient satisfaction, and some studies showed reduced hospital length of stay and reduced readmission to hospital, but no evidence that it reduced health-care costs. A structured discharge planning tailored to the individual patient probably reduces hospital length of stay and readmission rates for older people admitted to hospital with a medical condition, but the impact of discharge planning on mortality, health outcomes, and cost remains uncertain.

Background: Capsule endoscopy (CE) is a highly sensitive examination for the detection of small bowel lesions. However, there are few clinical studies on obscure gastrointestinal bleeding (OGIB) among elderly patients. This study reports the risk factors of angiodysplasia with CE in the elderly. Methods: To ascertain the predictive clinical associations for angiodysplastic lesions as a cause of OGIB in the elderly, we retrospectively analyzed CE results in consecutive cases over a period of 4 years and 9 months (March 2004 to November 2008). Data were collected regarding patient demographics and potential risk factors. Risk factors were analyzed by the χ2 test and binary logistic regression analyses. Results: From March 2004 to November 2008, a total of 121 consecutive patients (71 male and 50 female; mean age and standard deviation, 57.9 ± 17.9 years) were referred to our department for CE evaluation of OGIB. All cases had undergone standard investigation with negative results within the 3 months prior to CE. Angiodysplastic lesions of the small bowel, the most common cause of OGIB in the elderly, were found in 52% of cases. Clinical associations with angiodysplastic lesions as a cause of OGIB were examined. One risk factor was increased age (≥ 65 years) (odds ratio, 2.76; 95% confidence interval, 1.20–6.35; p = 0.02). Conclusion: The use of CE in the elderly is a simple and safe diagnostic tool in the evaluation of OGIB. CE affords great precision while avoiding radiation, and should thus be the preferred method of investigation in this population.

Capsule endoscopy is a highly sensitive method for the detection of small bowel lesions. False-positive findings are important confounding factors. This study reports on a scoring system for evaluating the role of capsule endoscopy in small bowel tumors. Methods: Ten men and two women (age, 23–79 years) with suspected small bowel tumors were included from 120 patients referred for capsule endoscopy between March 2004 and March 2008. The indications were gastrointestinal bleeding (n = 9), melanoma workup (n = 1), physical checkup (n = 1), and iron deficiency anemia (n = 1). The proposed tumor score was composed of five components: bleeding, mucosal disruption, an irregular surface, color, and white villi. These can be scored for probability of mass lesions seen at capsule endoscopy. Small bowel mass lesions were probably present in those with a score of ≥ 4, and a score of ≤ 2 indicated a low probability of a small bowel mass lesion. Results: Capsule endoscopy showed probable small bowel mass lesions in six patients, and a low lesion probability in the other six. Capsule endoscopy showed that new lesions were not detected by esophagogastroduodenoscopy or colonoscopy. All six patients with probable small bowel tumors were found to have pathological findings upon capsule endoscopy: two with lymphangioma, and one each with ileal ectopic pancreas, with melanoma metastasis, gastrointestinal lymphoma, and gastrointestinal stromal tumor. Conclusion: Capsule endoscopy may detect small bowel tumors more reliably by using the scoring system outlined. It should be considered in suspected cases of small bowel tumor.

Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1–4% of all intestinal obstructions. In patients with cholelithiasis, only 0.3–0.5% reportedly develop gallstone ileus. However, the condition causes 25% of cases of non-strangulated small bowel obstruction in those over the age of 65 years. We report a patient with gallstone ileus who presented with small bowel obstruction that was initially misdiagnosed. The correct diagnosis was made based on finding an ectopic gallstone on plain abdominal radiography, a cholecystoduodenal fistula, and gallstone impaction in a small bowel follow-through study. [International Journal of Gerontology 2008; 2(1): 18–21]

Background and study aims: The proportion of outpatients with inadequate bowel preparation before colonoscopy is high owing to patient unawareness of its importance and poor adherence to instructions. This meta-analysis aimed to determine the effect of educational intervention on the quality of bowel preparation before colonoscopy. Patients and methods: A comprehensive literature review identified randomized controlled trials measuring the effect of educational intervention on the quality of bowel preparation. Two reviewers independently screened relevant articles, extracted data, and assessed the risk of bias. The primary outcome was the quality of each bowel preparation before colonoscopy, using a particular assessment scale. The secondary outcomes were polyp detection rates during the procedure and the need for a repeat colonoscopy due to incomplete examination. Results: Nine randomized controlled trials were included in this meta-analysis. In all, 2885 patients were enrolled, with 1458 receiving education and 1427 assigned to the control group. An educational intervention before colonoscopy significantly improved bowel preparation (relative risk [RR] = 1.22; 95 % confidence interval [CI], 1.10 – 1.36), however, no significant differences were identified in polyp detection rates (RR = 1.14; 95 %CI 0.87 – 1.51) or the need for repeat colonoscopy (RR = 0.52; 95 %CI 0.25 – 1.04) between the groups. Asymmetry in the appearance of the funnel plot and the result of Egger test (P

Background: Extrahepatic cholangiocarcinoma (eCCA) poses a significant clinical challenge, particularly in older individuals. This retrospective study, conducted atMacKayMemorial Hospital, evaluates the clinical efficacy of biliary drainage in older patients with eCCA, focusing specifically on its impact on survival. Methods: We retrospectively reviewed 36 older patients diagnosed with eCCA via pathology between 2015 and 2022. Biliary drainage was categorized as either endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic cholangial drainage (PTCD).We compared survival curves and basic characteristics between patients who received biliary drainage and those who did not, using the Kaplan-Meier method, t-tests, and Chi-square analysis. Results: Of the 36 patients, 28 had received biliary drainage prior to any anti-cancer treatment. Of these 28 patients, 20 underwent ERBD, whereas the remaining eight received PTCD. The mean age of the eCCA cohort was 74.1 years. The mean and median survival times for the non-drainage group were 4.3 months and 4 months, respectively. In contrast, the mean and median survival times for patients who had received biliary drainage were 10.4 months and 12 months, respectively. The difference in mean survival was statistically significant (p = 0.024). Conclusion: Biliary drainage may benefit older patients with eCCA. The extended survival observed in patients who underwent biliary drainage highlights the importance of this intervention in the context of a challenging malignancy. [ABSTRACT FROM AUTHOR]