Certainly

some strictures which initially appear malignant may later be found to be due to treatable causes such as chronic pancreatitis or autoimmune pancreatitis. If endoscopic ultrasound with fine-needle aspiration and on-site cytologic Wnt mutation review is available, then this dilemma can often be solved at the time of the procedure. However, EUS is not at widespread at ERCP and many endoscopists (particularly in community settings) will Inhibitors,research,lifescience,medical have to rely on a high index of suspicion for placing a metallic stent across a presumed malignant stricture. The concern about removal of the stent in cases of benign disease would seem to be addressed by the use of a covered metallic stent. At this time there is no data specifically on the performance of covered metallic stents in patients undergoing neoadjuvant therapy, though the main factor which makes metallic stents preferable (i.e., Inhibitors,research,lifescience,medical larger diameter) is still present. In summary, the study by Adams et al. lends further support to the notion that SEMS are a superior device

for management of malignant obstruction in pancreatic cancer patients undergoing neoadjuvant therapy. This patient population is likely to grow as more centers embrace neoadjuvant therapy, so this kind of knowledge is critical Inhibitors,research,lifescience,medical to providing the best outcomes for patients facing this life-threatening illness. It seems increasingly clear that plastic stents are now an obsolete device for management of strictures in pancreatic cancer, and that it is time to embrace metallic stents for all patients with this disease who are not sent immediately to curative surgery, or expected to survive less than six months. Acknowledgements Disclosure: The author declares no conflict of interest.
To

the Editor, We would like to thank Dr. Kapetanakis and his Inhibitors,research,lifescience,medical colleagues for their interest in our article Inhibitors,research,lifescience,medical (1). We specifically appreciate the attention they brought to the importance of environmental factors, particularly Helicobacter pylori (H. pylori) infection, in the development of sporadic colorectal carcinoma (CRC). While the focus of our article was on the pathologic aspects (2), we would like to take this opportunity to extend our discussion to H. pylori as a others potential etiopathogenetic factor in colorectal tumorigenesis. As mentioned by Dr. Kapetanakis and his colleagues, the development of sporadic CRC is associated with a variety of environmental factors including diet and lifestyle. Given that the colon harbors the largest number of microorganisms in the body, it is natural to assume that certain microbial species may play a role in colorectal tumorigenesis. The first reports connecting intestinal microflora with CRC were published back in the early 1950s. Streptococcus bovis septicemia was reported to be associated with carcinoma of the sigmoid colon (3). This association was subsequently supported by several publications (4-6). Animal studies have shown that S.