- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
Citation: YI Xin, LUO Shiqiao. Treatment for gastrointestinal stromal tumor with liver metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 774-780. doi: 10.7507/1007-9424.201910062 Copy
1. | Ducimetière F, Lurkin A, Ranchère-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PLoS One, 2011, 6(8): e20294. |
2. | Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology, 2014, 46(2): 95-104. |
3. | Wada R, Arai H, Kure S, et al. “Wild type” GIST: clinicopathological features and clinical practice. Pathol Int, 2016, 66(8): 431-437. |
4. | DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastro-intestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000, 231(1): 51-58. |
5. | Pawlik TM, Vauthey JN, Abdalla EK, et al. Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg, 2006, 141(6): 537-543. |
6. | Nunobe S, Sano T, Shimada K, et al. Surgery including liver resection for metastatic gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Jpn J Clin Oncol, 2005, 35(6): 338-341. |
7. | DeMatteo RP, Shah A, Fong Y, et al. Results of hepatic resection for sarcoma metastatic to liver. Ann Surg, 2001, 234(4): 540-548. |
8. | Xia L, Zhang MM, Ji L, et al. Resection combined with imatinib therapy for liver metastases of gastrointestinal stromal tumors. Surg Today, 2010, 40(10): 936-942. |
9. | Chen Q, Li C, Yang H, et al. Resection combined with TKI Therapy for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. J Gastrointest Surg, 2019, [Epub ahead of print]. |
10. | Brudvik KW, Patel SH, Roland CL, et al. Survival after resection of gastrointestinal stromal tumor and sarcoma liver metastases in 146 patients. J Gastrointest Surg, 2015, 19(8): 1476-1483. |
11. | Turley RS, Peng PD, Reddy SK, et al. Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era. Cancer, 2012, 118(14): 3571-3578. |
12. | Xiao B, Peng J, Tang J, et al. Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center. Cancer Manag Res, 2018, 10: 6121-6127. |
13. | Kanda T, Masuzawa T, Hirai T, et al. Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese Study Group on GIST. Jpn J Clin Oncol, 2017, 47(4): 369-372. |
14. | Ang C, Maki RG. Contemporary management of metastatic gastrointestinal stromal tumors: systemic and locoregional approaches. Oncol Ther, 2016, 4(1): 1-16. |
15. | Shima Y, Horimi T, Ishikawa T, et al. Aggressive surgery for liver metastases from gastrointestinal stromal tumors. J Hepatobiliary Pancreat Surg, 2003, 10(1): 77-80. |
16. | Gomez D, Al-Mukthar A, Menon KV, et al. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience. HPB (Oxford), 2007, 9(1): 64-70. |
17. | de la Fuente SG, Deneve JL, Parsons CM, et al. A comparison between patients with gastrointestinal stromal tumours diagnosed with isolated liver metastases and liver metastases plus sarcomatosis. HPB (Oxford), 2013, 15(9): 655-660. |
18. | Cheung TT, Chok KS, Chan AC, et al. Analysis of long-term survival after hepatectomy for isolated liver metastasis of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(11): 827-831. |
19. | Cananzi FC, Belgaumkar AP, Lorenzi B, et al. Liver surgery in the multidisciplinary management of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(12): E1-E8. |
20. | Vassos N, Agaimy A, Hohenberger W, et al. Management of liver metastases of gastrointestinal stromal tumors (GIST). Ann Hepatol, 2015, 14(4): 531-539. |
21. | Seesing MF, Tielen R, van Hillegersberg R, et al. Resection of liver metastases in patients with gastrointestinal stromal tumors in the imatinib era: a nationwide retrospective study. Eur J Surg Oncol, 2016, 42(9): 1407-1413. |
22. | Shi YN, Li Y, Wang LP, et al. Gastrointestinal stromal tumor (GIST) with liver metastases: an 18-year experience from the GIST cooperation group in North China. Medicine (Baltimore), 2017, 96(46): e8240. |
23. | von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563. |
24. | Inaba CS, Dosch A, Koh CY, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc, 2019, 33(3): 923-932. |
25. | Stanek M, Pisarska M, Rzepa A, et al. Laparoscopic treatment of large gastrointestinal stromal tumors (>5 cm). Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 170-175. |
26. | Sato S, Tsujinaka T, Masuzawa T, et al. Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry. Surg Today, 2017, 47(1): 58-64. |
27. | Mussi C, Ronellenfitsch U, Jakob J, et al. Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol, 2010, 21(2): 403-408. |
28. | Machairas N, Prodromidou A, Molmenti E, et al. Management of liver metastases from gastrointestinal stromal tumors: where do we stand? J Gastrointest Oncol, 2017, 8(6): 1100-1108. |
29. | Bauer S, Rutkowski P, Hohenberger P, et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib–analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol, 2014, 40(4): 412-419. |
30. | Keung EZ, Fairweather M, Raut CP. The role of surgery in metastatic gastrointestinal stromal tumors. Curr Treat Options Oncol, 2016, 17(2): 8. |
31. | Antonescu CR, Besmer P, Guo T, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res, 2005, 11(11): 4182-4190. |
32. | Zhu J, Yang Y, Zhou L, et al. A long-term follow-up of the imatinib mesylate treatment for the patients with recurrent gastrointestinal stromal tumor (GIST): the liver metastasis and the outcome. BMC Cancer, 2010, 10(1): 199. |
33. | Lin JX, Chen QF, Zheng CH, et al. Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up. J Cancer Res Clin Oncol, 2017, 143(4): 727-734. |
34. | Zhang X, Zhou Y, Wu X, et al. Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi–center cohort study. Eur J Surg Oncol, 2019, 45(3): 318-323. |
35. | Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol, 2012, 13(3): 265-274. |
36. | Gaitanidis A, Alevizakos M, Tsaroucha A, et al. Incidence and predictors of synchronous liver metastases in patients with gastrointestinal stromal tumors (GISTs). Am J Surg, 2018, 216(3): 492-497. |
37. | Cavnar MJ, Seier K, Curtin C, et al. Outcome of 1 000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre and post-imatinib eras. Ann Surg, 2019, [Epub ahead of print]. |
38. | Yamanaka T, Takaki H, Nakatsuka A, et al. Radiofrequency ablation for liver metastasis from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2013, 24(3): 341-346. |
39. | Yoon IS, Shin JH, Han K, et al. Ultrasound-guided intraoperative radiofrequency ablation and surgical resection for liver metastasis from malignant gastrointestinal stromal tumors. Korean J Radiol, 2018, 19(1): 54-62. |
40. | Chen Q, Li C, Yang H, et al. Radiofrequency ablation versus resection for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. Clin Res Hepatol Gastroenterol, 2019, 43(3): 317-323. |
41. | Hakimé A, Le Cesne A, Deschamps F, et al. A role for adjuvant RFA in managing hepatic metastases from gastrointestinal stromal tumors (GIST) after treatment with targeted systemic therapy using kinase inhibitors. Cardiovasc Intervent Radiol, 2014, 37(1): 132-139. |
42. | Jones RL, McCall J, Adam A, et al. Radiofrequency ablation is a feasible therapeutic option in the multi modality management of sarcoma. Eur J Surg Oncol, 2010, 36(5): 477-482. |
43. | Jung JH, Won HJ, Shin YM, et al. Safety and efficacy of radio-frequency ablation for hepatic metastases from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2015, 26(12): 1797-1802. |
44. | Maluccio MA, Covey AM, Schubert J, et al. Treatment of metastatic sarcoma to the liver with bland embolization. Cancer, 2006, 107(7): 1617-1623. |
45. | Kobayashi K, Gupta S, Trent JC, et al. Hepatic artery chemo-embolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors. Cancer, 2006, 107(12): 2833-2841. |
46. | Cao G, Li J, Shen L, et al. Transcatheter arterial chemoembolization for gastrointestinal stromal tumors with liver metastases. World J Gastroenterol, 2012, 18(42): 6134-6140. |
47. | Cao G, Zhu X, Li J, et al. A comparative study between Embosphere(®) and conventional transcatheter arterial chemoembolization for treatment of unresectable liver metastasis from GIST. Chin J Cancer Res, 2014, 26(1): 124-131. |
48. | Takaki H, Litchman T, Covey A, et al. Hepatic artery embolization for liver metastasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer, 2014, 45(4): 494-499. |
49. | Omari J, Drewes R, Matthias M, et al. Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy. Brachytherapy, 2019, 18(1): 63-70. |
50. | Rathmann N, Diehl SJ, Dinter D, et al. Radioembolization in patients with progressive gastrointestinal stromal tumor liver metastases undergoing treatment with tyrosine kinase inhibitors. J Vasc Interv Radiol, 2015, 26(2): 231-238. |
51. | Joensuu H, Eriksson M, Collan J, et al. Radiotherapy for GIST progressing during or after tyrosine kinase inhibitor therapy: a prospective study. Radiother Oncol, 2015, 116(2): 233-238. |
52. | Radkani P, Ghersi MM, Paramo JC, et al. A multidisciplinary approach for the treatment of GIST liver metastasis. World J Surg Oncol, 2008, 6(1): 46. |
53. | Iesari S, Mocchegiani F, Nicolini D, et al. Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: report of a first case. Am J Transplant, 2019, 19(10): 2939-2943. |
54. | Serralta AS, Sanjuan FR, Moya AH, et al. Combined liver transplantation plus imatinib for unresectable metastases of gastrointestinal stromal tumours. Eur J Gastroenterol Hepatol, 2004, 16(11): 1237-1239. |
- 1. Ducimetière F, Lurkin A, Ranchère-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PLoS One, 2011, 6(8): e20294.
- 2. Jo VY, Fletcher CD. WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology, 2014, 46(2): 95-104.
- 3. Wada R, Arai H, Kure S, et al. “Wild type” GIST: clinicopathological features and clinical practice. Pathol Int, 2016, 66(8): 431-437.
- 4. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastro-intestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000, 231(1): 51-58.
- 5. Pawlik TM, Vauthey JN, Abdalla EK, et al. Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg, 2006, 141(6): 537-543.
- 6. Nunobe S, Sano T, Shimada K, et al. Surgery including liver resection for metastatic gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Jpn J Clin Oncol, 2005, 35(6): 338-341.
- 7. DeMatteo RP, Shah A, Fong Y, et al. Results of hepatic resection for sarcoma metastatic to liver. Ann Surg, 2001, 234(4): 540-548.
- 8. Xia L, Zhang MM, Ji L, et al. Resection combined with imatinib therapy for liver metastases of gastrointestinal stromal tumors. Surg Today, 2010, 40(10): 936-942.
- 9. Chen Q, Li C, Yang H, et al. Resection combined with TKI Therapy for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. J Gastrointest Surg, 2019, [Epub ahead of print].
- 10. Brudvik KW, Patel SH, Roland CL, et al. Survival after resection of gastrointestinal stromal tumor and sarcoma liver metastases in 146 patients. J Gastrointest Surg, 2015, 19(8): 1476-1483.
- 11. Turley RS, Peng PD, Reddy SK, et al. Hepatic resection for metastatic gastrointestinal stromal tumors in the tyrosine kinase inhibitor era. Cancer, 2012, 118(14): 3571-3578.
- 12. Xiao B, Peng J, Tang J, et al. Liver surgery prolongs the survival of patients with gastrointestinal stromal tumor liver metastasis: a retrospective study from a single center. Cancer Manag Res, 2018, 10: 6121-6127.
- 13. Kanda T, Masuzawa T, Hirai T, et al. Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese Study Group on GIST. Jpn J Clin Oncol, 2017, 47(4): 369-372.
- 14. Ang C, Maki RG. Contemporary management of metastatic gastrointestinal stromal tumors: systemic and locoregional approaches. Oncol Ther, 2016, 4(1): 1-16.
- 15. Shima Y, Horimi T, Ishikawa T, et al. Aggressive surgery for liver metastases from gastrointestinal stromal tumors. J Hepatobiliary Pancreat Surg, 2003, 10(1): 77-80.
- 16. Gomez D, Al-Mukthar A, Menon KV, et al. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience. HPB (Oxford), 2007, 9(1): 64-70.
- 17. de la Fuente SG, Deneve JL, Parsons CM, et al. A comparison between patients with gastrointestinal stromal tumours diagnosed with isolated liver metastases and liver metastases plus sarcomatosis. HPB (Oxford), 2013, 15(9): 655-660.
- 18. Cheung TT, Chok KS, Chan AC, et al. Analysis of long-term survival after hepatectomy for isolated liver metastasis of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(11): 827-831.
- 19. Cananzi FC, Belgaumkar AP, Lorenzi B, et al. Liver surgery in the multidisciplinary management of gastrointestinal stromal tumour. ANZ J Surg, 2014, 84(12): E1-E8.
- 20. Vassos N, Agaimy A, Hohenberger W, et al. Management of liver metastases of gastrointestinal stromal tumors (GIST). Ann Hepatol, 2015, 14(4): 531-539.
- 21. Seesing MF, Tielen R, van Hillegersberg R, et al. Resection of liver metastases in patients with gastrointestinal stromal tumors in the imatinib era: a nationwide retrospective study. Eur J Surg Oncol, 2016, 42(9): 1407-1413.
- 22. Shi YN, Li Y, Wang LP, et al. Gastrointestinal stromal tumor (GIST) with liver metastases: an 18-year experience from the GIST cooperation group in North China. Medicine (Baltimore), 2017, 96(46): e8240.
- 23. von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.
- 24. Inaba CS, Dosch A, Koh CY, et al. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc, 2019, 33(3): 923-932.
- 25. Stanek M, Pisarska M, Rzepa A, et al. Laparoscopic treatment of large gastrointestinal stromal tumors (>5 cm). Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 170-175.
- 26. Sato S, Tsujinaka T, Masuzawa T, et al. Role of metastasectomy for recurrent/metastatic gastrointestinal stromal tumors based on an analysis of the Kinki GIST registry. Surg Today, 2017, 47(1): 58-64.
- 27. Mussi C, Ronellenfitsch U, Jakob J, et al. Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol, 2010, 21(2): 403-408.
- 28. Machairas N, Prodromidou A, Molmenti E, et al. Management of liver metastases from gastrointestinal stromal tumors: where do we stand? J Gastrointest Oncol, 2017, 8(6): 1100-1108.
- 29. Bauer S, Rutkowski P, Hohenberger P, et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib–analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol, 2014, 40(4): 412-419.
- 30. Keung EZ, Fairweather M, Raut CP. The role of surgery in metastatic gastrointestinal stromal tumors. Curr Treat Options Oncol, 2016, 17(2): 8.
- 31. Antonescu CR, Besmer P, Guo T, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res, 2005, 11(11): 4182-4190.
- 32. Zhu J, Yang Y, Zhou L, et al. A long-term follow-up of the imatinib mesylate treatment for the patients with recurrent gastrointestinal stromal tumor (GIST): the liver metastasis and the outcome. BMC Cancer, 2010, 10(1): 199.
- 33. Lin JX, Chen QF, Zheng CH, et al. Is 3-years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up. J Cancer Res Clin Oncol, 2017, 143(4): 727-734.
- 34. Zhang X, Zhou Y, Wu X, et al. Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi–center cohort study. Eur J Surg Oncol, 2019, 45(3): 318-323.
- 35. Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol, 2012, 13(3): 265-274.
- 36. Gaitanidis A, Alevizakos M, Tsaroucha A, et al. Incidence and predictors of synchronous liver metastases in patients with gastrointestinal stromal tumors (GISTs). Am J Surg, 2018, 216(3): 492-497.
- 37. Cavnar MJ, Seier K, Curtin C, et al. Outcome of 1 000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre and post-imatinib eras. Ann Surg, 2019, [Epub ahead of print].
- 38. Yamanaka T, Takaki H, Nakatsuka A, et al. Radiofrequency ablation for liver metastasis from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2013, 24(3): 341-346.
- 39. Yoon IS, Shin JH, Han K, et al. Ultrasound-guided intraoperative radiofrequency ablation and surgical resection for liver metastasis from malignant gastrointestinal stromal tumors. Korean J Radiol, 2018, 19(1): 54-62.
- 40. Chen Q, Li C, Yang H, et al. Radiofrequency ablation versus resection for resectable liver metastases of gastrointestinal stromal tumours: results from three national centres in China. Clin Res Hepatol Gastroenterol, 2019, 43(3): 317-323.
- 41. Hakimé A, Le Cesne A, Deschamps F, et al. A role for adjuvant RFA in managing hepatic metastases from gastrointestinal stromal tumors (GIST) after treatment with targeted systemic therapy using kinase inhibitors. Cardiovasc Intervent Radiol, 2014, 37(1): 132-139.
- 42. Jones RL, McCall J, Adam A, et al. Radiofrequency ablation is a feasible therapeutic option in the multi modality management of sarcoma. Eur J Surg Oncol, 2010, 36(5): 477-482.
- 43. Jung JH, Won HJ, Shin YM, et al. Safety and efficacy of radio-frequency ablation for hepatic metastases from gastrointestinal stromal tumor. J Vasc Interv Radiol, 2015, 26(12): 1797-1802.
- 44. Maluccio MA, Covey AM, Schubert J, et al. Treatment of metastatic sarcoma to the liver with bland embolization. Cancer, 2006, 107(7): 1617-1623.
- 45. Kobayashi K, Gupta S, Trent JC, et al. Hepatic artery chemo-embolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors. Cancer, 2006, 107(12): 2833-2841.
- 46. Cao G, Li J, Shen L, et al. Transcatheter arterial chemoembolization for gastrointestinal stromal tumors with liver metastases. World J Gastroenterol, 2012, 18(42): 6134-6140.
- 47. Cao G, Zhu X, Li J, et al. A comparative study between Embosphere(®) and conventional transcatheter arterial chemoembolization for treatment of unresectable liver metastasis from GIST. Chin J Cancer Res, 2014, 26(1): 124-131.
- 48. Takaki H, Litchman T, Covey A, et al. Hepatic artery embolization for liver metastasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer, 2014, 45(4): 494-499.
- 49. Omari J, Drewes R, Matthias M, et al. Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy. Brachytherapy, 2019, 18(1): 63-70.
- 50. Rathmann N, Diehl SJ, Dinter D, et al. Radioembolization in patients with progressive gastrointestinal stromal tumor liver metastases undergoing treatment with tyrosine kinase inhibitors. J Vasc Interv Radiol, 2015, 26(2): 231-238.
- 51. Joensuu H, Eriksson M, Collan J, et al. Radiotherapy for GIST progressing during or after tyrosine kinase inhibitor therapy: a prospective study. Radiother Oncol, 2015, 116(2): 233-238.
- 52. Radkani P, Ghersi MM, Paramo JC, et al. A multidisciplinary approach for the treatment of GIST liver metastasis. World J Surg Oncol, 2008, 6(1): 46.
- 53. Iesari S, Mocchegiani F, Nicolini D, et al. Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: report of a first case. Am J Transplant, 2019, 19(10): 2939-2943.
- 54. Serralta AS, Sanjuan FR, Moya AH, et al. Combined liver transplantation plus imatinib for unresectable metastases of gastrointestinal stromal tumours. Eur J Gastroenterol Hepatol, 2004, 16(11): 1237-1239.