79 Vitamin D Receptor Inactivation Alters the Colonic Microbiome and Increases Secondary Bile Acids and Colonic Tumorigenesis

Abstract

BACKGROUND AND AIM: Endoscopy is the first level procedure in the diagnosis of gastrointestinal (GI) masses. However gastro-duodenal or colonic lesions which mainly involve submucosa or subserosa as well as small bowel's lesions may be difficult to diagnose. The present study aimed to evaluate the role of ultrasound (US)-guided percutaneous biopsy in diagnosing GI tract lesions. PATIENTS AND METHODS: 114 patients (63 male 51 female patients, age range 55-80 years, median age 68 years) underwent US-guided biopsy of GI lesions from 2000 to 2012. In 36 patients the lesion was in the small bowel, thus endoscopically inaccessible; in 50 patients previous histology of endoscopic biopsies was repeatedly negative; in 18 patients, stenosis did not allow bioptic sampling and in 10 patients age, severe cardiological disease and sepsis prevented endoscopy. We used multi-frequency convex probes with side adapters and 18G cutting needle for histological sampling. After biopsy, patients were monitored by measuring blood pressure and pulse rate during the following 3-4 hours to evaluate possible complications. Histology was compared with postsurgery histological evaluation in 73 cases. In the remaining, histology of US-guided biopsy was the only clue to diagnosis. RESULTS: Biopsy specimens were taken from stomach in 38 cases, small bowel in 36 cases and colon-sigma in 40 cases. Final diagnosis was malignant lesions in all but three cases. One case was intestinal endometriosis, the second was bowel duplication, whereas in the third case it was a false-negative result, the correct diagnosis being gastric adenocarcinoma. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of biopsy were respectively 99%, 100%, 100%, 66%, 99%.We observed no mortality and one complication: A case of melena due to bleeding from gastric gastrointestinal stromal tumor that was effectively controlled by positioning of metal clips. CONCLUSION: US-guided percutaneous biopsy of GI tract lesions may be an alternative, safe and effective procedure for diagnosis of GI tract lesions in those cases where conventional diagnostic approach is not feasible or successful.