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Lai JH, Lee KH, Chang CW, Chen MJ, Lin CC. Predicting Factors for Pancreatic Malignancy with Computed Tomography and Endoscopic Ultrasonography in Chronic Pancreatitis. Diagnostics (Basel) 2022; 12:diagnostics12041004. [PMID: 35454052 PMCID: PMC9030339 DOI: 10.3390/diagnostics12041004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023] [Imported: 08/29/2023] Open
Abstract
Diagnosing pancreatic malignancy is challenging, especially in patients with chronic pancreatitis (CP). Endoscopic ultrasonography (EUS) is a promising diagnostic procedure for discriminating between malignancy and CP. We aimed to investigate the predictive factors and reliability of computed tomography (CT) and EUS for differentiating pancreatic mass lesions and the diagnostic accuracy of EUS-FNA or FNB in patients with CP. Forty patients with CP, receiving CT and EUS-FNA or FNB for pancreatic mass lesion evaluation, were enrolled in the study. Patients’ data, CT and EUS characteristics, image-based diagnosis, cytopathology, and final diagnosis were recorded. EUS was superior to CT in terms of diagnostic accuracy (92.5% vs. 82.5%, p = 0.02). Both CT and EUS showed significant predictive factors (all p < 0.05) with the tumor image hypoattenuation pattern or vessel invasion on CT and pancreatic duct dilatation, or distal pancreatic atrophy on EUS. EUS imaging is a reliable modality for evaluating pancreatic lesions, even with a CP background. The EUS image has a higher diagnostic accuracy than CT. Predicting factors, including hypoechoic pattern, pancreatic duct dilatation, and distal pancreas atrophy, may help to differentiate benign or malignant in patients with CP.
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Chang CW, Lee HC, Li LH, Chiang Chiau JS, Wang TE, Chuang WH, Chen MJ, Wang HY, Shih SC, Liu CY, Tsai TH, Chen YJ. Fecal Microbiota Transplantation Prevents Intestinal Injury, Upregulation of Toll-Like Receptors, and 5-Fluorouracil/Oxaliplatin-Induced Toxicity in Colorectal Cancer. Int J Mol Sci 2020; 21:ijms21020386. [PMID: 31936237 PMCID: PMC7013718 DOI: 10.3390/ijms21020386] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/18/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin), a 5-fluorouracil (5-FU)-based chemotherapy regimen, is one of most common therapeutic regimens for colorectal cancer. However, intestinal mucositis is a common adverse effect for which no effective preventive strategies exist. Moreover, the efficacy and the safety of fecal microbiota transplants (FMT) in cancer patients treated with anti-neoplastic agents are still scant. We investigated the effect of FMT on FOLFOX-induced mucosal injury. BALB/c mice implanted with syngeneic CT26 colorectal adenocarcinoma cells were orally administered FMT daily during and two days after five-day injection of FOLFOX regimen for seven days. Administration of FOLFOX significantly induced marked levels of diarrhea and intestinal injury. FMT reduced the severity of diarrhea and intestinal mucositis. Additionally, the number of goblet cells and zonula occludens-1 decreased, while apoptotic and NF-κB-positive cells increased following FOLFOX treatment. The expression of toll-like receptors (TLRs), MyD88, and serum IL-6 were upregulated following FOLFOX treatment. These responses were attenuated following FMT. The disrupted fecal gut microbiota composition was also restored by FMT after FOLFOX treatment. Importantly, FMT did not cause bacteremia and safely alleviated FOLFOX-induced intestinal mucositis in colorectal cancer-bearing mice. The putative mechanism may involve the gut microbiota TLR-MyD88-NF-κB signaling pathway in mice with implanted colorectal carcinoma cells.
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Chang CW, Tu CH, Chou JW, Huang TY, Hsu WH, Wang YP, Chen CC, Chung CS, Lin CP, Lin WC, Tai CM, Wang HY, Chen MJ. Endoscopic management of strictures in patients with Crohn's disease - A multi-center experience in Taiwan. J Formos Med Assoc 2020; 119:1500-1505. [PMID: 31917065 DOI: 10.1016/j.jfma.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/11/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND/PURPOSE Inflammatory bowel disease (IBD) is a chronic gastrointestinal (GI) disorder that causes relapsing inflammation and severe mucosal damage in the intestine. Crohn's disease (CD)-related stricturing complications are a major cause of surgery, disability, and reduced quality of life. Endoscopic balloon dilation (EBD) has been shown to reliably delay or prevent surgery in patients with stricturing CD. However, cases of EBD performed for stricture in CD in Taiwan are rare. In this study, we want to evaluate the experiences regarding EBD for stricturing CD in Taiwan. METHODS We conducted a retrospective analysis of 9 medical centers in Taiwan. Patients with CD-related strictures who were treated with EBD were included and analyzed. RESULTS In nine medical centers, a total of 26 CD patients (19 male, 7 female, mean disease duration 75.4 ± 65.2 months) underwent 42 EBD procedures during the study period. Among the subjects, an 83.3% (35/42) EBD success rate was seen, but 26.9% (7/26) patients underwent surgery after ineffective EBD. In the surgery group, the the small bowel strictures was high compared with the non-surgery group (p = 0.01). There were no significant differences in disease phenotype, disease duration or history of fistulizing disease. In the surgery group, immunosuppressant use was high, and 5-aminosalicylic acid (5-ASA) use was low compared with the non-surgery group. After EBD, the physicians tended to change the drugs, especially increasing the use of biologic agents. CONCLUSION EBD is a safe and effective procedure for CD-related stricture, with a 83.3% success rate in Taiwan.
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Chang CW, Chang CW, Lin WC, Wu CH, Wang HY, Wang TE, Chu CH, Chen MJ. Efficacy and Safety of Single-Balloon Enteroscopy in Elderly Patients. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] [Imported: 08/29/2023] Open
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Lin YS, Shih SC, Wang HY, Lin CC, Chang CW, Chen MJ. Comparison of telbivudine and entecavir on the change of off- treatment eGFR after 3 years of treatment in non-cirrhotic chronic hepatitis B patients. BMC Gastroenterol 2017; 17:22. [PMID: 28137301 PMCID: PMC5282840 DOI: 10.1186/s12876-017-0582-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 01/27/2017] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
Background The change of estimated glomerular filtration rate (eGFR) with off-treatment nucleos(t)ide analogues (NA) in chronic hepatitis B patients (CHB) is unclear. This study is aimed to evaluate the off-treatment eGFR after 3 years of therapy with telbivudine (LdT) or entecavir (ETV) and to assess predictive factors for eGFR improvement. Methods From January 2009 to December 2011, we identified NA-naïve patients who were at least 20 years of age diagnosed with compensated CHB. All patients received a 3-year NA treatment and 1 year off-treatment follow-up; the initial selection of patients for LdT or ETV treatment was at the physicians’ discretion. An increase of more than 10% in eGFR from the baseline was identified as an improvement. The change of chronic kidney disease stages were recorded and compared with baseline at year 3 and year 4, respectively. Results This study included two groups consisting of 46 patients each (each with3 years of treatment with LdT or ETV). In LdT-treated patients, the mean eGFR increased from 94.3 ± 28.3 to 104.0 ± 31.2 mL/min/1.73 m2 in year 3 (p = 0.01) and from 104.0 ± 31.2 to 104.0 ± 28.8 mL/min/1.73 m2 in year 4 (p = 0.99). However, in ETV-treated patients, the mean eGFR decreased from 93.1 ± 26.1 to 85.5 ± 25.1 mL/min/1.73 m2 in year 3 (p = 0.0009) and from 85.5 ± 25.1 to 87.7 ± 24.8 mL/min/1.73 m2 in year 4 (p = 0.2). After a multivariate analysis, the predictors for the off-treatment eGFR improvement were the LdT treatment (odds ratio [OR], 3.97 (1.37–11.5), p = 0.01) and pre-treated eGFR (OR, 0.98 (0.95–1.00), p = 0.04). Conclusions At year 4, 48.8 and 21.3% patients had an improved eGFR from baseline in LdT and ETV patients, respectively. Telbivudine may have a protective renal effect that can last for one year after treatment in non-cirrhotic CHB patients without a virological breakthrough.
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Wong MW, Bair MJ, Shih SC, Chu CH, Wang HY, Wang TE, Chang CW, Chen MJ. Using typical endoscopic features to diagnose esophageal squamous papilloma. World J Gastroenterol 2016; 22:2349-2356. [PMID: 26900297 PMCID: PMC4735009 DOI: 10.3748/wjg.v22.i7.2349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/12/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
AIM: To better understand some of the superficial tiny lesions that are recognized as squamous papilloma of the esophagus (SPE) and receive a different pathological diagnosis.
METHODS: All consecutive patients with esophageal polypoid lesions detected by routine endoscopy at our Endoscopy Centre between October 2009 and June 2014 were retrospectively analysed. We enrolled patients with SPE or other superficial lesions to investigate four key endoscopic appearances (whitish color, exophytic growth, wart-like shape, and surface vessels) and used narrow band imaging (NBI) to distinguish their differences. These series endoscopic images of each patient were retrospectively reviewed by three experienced endoscopists with no prior access to the images. All lesion specimens obtained by forceps biopsy were fixed in formalin and processed for pathological examination. The following data were collected from patient medical records: gender, age, indications for esophagogastroduodenoscopy, and endoscopic characteristics including lesion location, number, color, size, surface morphology, surrounding mucosa, and surface vessels under NBI. Clinicopathological features were also compared.
RESULTS: During the study period, 41 esophageal polypoid lesions from 5698 endoscopic examinations were identified retrospectively. These included 24 patients with pathologically confirmed SPE, 11 patients with squamous hyperplasia, three patients with glycogenic acanthosis, two patients with ectopic sebaceous glands, and one patient with a xanthoma. In the χ2 test, exophytic growth (P = 0.003), a wart-like shape (P < 0.001), and crossing surface vessels under NBI (P = 0.001) were more frequently observed in SPE than in other lesion types. By contrast, there was no significant difference regarding the appearance of a whitish color between SPE and other lesion types (P = 0.872). The most sensitive characteristic was wart-like projections (81.3%) and the most specific was exophytic growth (87.5%). Promising positive predictive values of 84.2%, 80.8%, and 82.6% were noted for exophytic growth, wart-like projections, and surface vessel crossing on NBI, respectively.
CONCLUSION: The use of three key typical endoscopic appearances - exophytic growth, a wart-like shape, and vessel crossing on the lesion surface under NBI - has a promising positive predictive value of 88.2%. This diagnostic triad is useful for the endoscopic diagnosis of SPE.
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Chang CW, Shih SC, Wang HY, Chu CH, Wang TE, Hung CY, Shieh TY, Lin YS, Chen MJ. Meta-analysis: The effect of patient education on bowel preparation for colonoscopy. Endosc Int Open 2015; 3:E646-52. [PMID: 26716129 PMCID: PMC4683152 DOI: 10.1055/s-0034-1392365] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] [Imported: 08/29/2023] Open
Abstract
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 < 0.001) suggested that publication bias existed. CONCLUSIONS Evidence from these randomized controlled trials shows that a brief counseling session with patients before colonoscopy ensures better bowel preparation. However, evidence is insufficient to assess improvements in polyp detection rate and avoidance of a repeat colonoscopy. Despite these encouraging observations, this meta-analysis had some limitations, including potential publication bias and significant heterogeneity of the types of bowel purgatives. These results should be interpreted with caution.
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Tsai SJ, Lin CC, Chang CW, Hung CY, Shieh TY, Wang HY, Shih SC, Chen MJ. Benign esophageal lesions: Endoscopic and pathologic features. World J Gastroenterol 2015; 21:1091-1098. [PMID: 25632181 PMCID: PMC4306152 DOI: 10.3748/wjg.v21.i4.1091] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/23/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the lesion causes symptoms. We suggest endoscopic resection of all granular cell tumors and squamous papillomas because, while rare, these lesions have malignant potential. Dysphagia aortica should be considered in the differential diagnosis of dysphagia in the elderly.
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Wang HY, Shih SC, Hung CY, Liu CY, Shieh TY, Chen MJ. The feasibility of using simulated targets in the stomachs of live pigs for full endoscopic submucosal dissection training. Gut Liver 2014; 8:619-24. [PMID: 25368749 PMCID: PMC4215447 DOI: 10.5009/gnl13327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/13/2013] [Accepted: 10/14/2013] [Indexed: 12/22/2022] [Imported: 08/29/2023] Open
Abstract
Background/Aims In endoscopic submucosal dissection (ESD) training, only a flat target lesion can usually be simulated in the normal mucosa. This study aimed to evaluate the feasibility of simulated targets in the stomachs of live pigs for complete training. Methods Six trained endoscopists with hands-on experience with ex vivo, isolated pig stomachs were enrolled in this pilot study. An endoscopic banding device was used to create a polyp that was snared, leaving an ulcerated lesion. This simulated target model was used to perform ESD in pigs. The en bloc resection rate, procedure time, complications, quality of resection, and participants’ opinions on the simulated targets were compared with the conventional model. Results En bloc resections were achieved in all six simulated targets and six conventional models. The mean size of the resected specimens was 32.2 mm (range, 20 to 39 mm) in the simulated target group and 23.5 mm (range, 11 to 40 mm) in the conventional group. The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking. Conclusions Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.
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Lin YS, Chen MJ, Shih SC, Bair MJ, Fang CJ, Wang HY. Management of Helicobacter pylori infection after gastric surgery. World J Gastroenterol 2014; 20:5274-82. [PMID: 24833857 PMCID: PMC4017042 DOI: 10.3748/wjg.v20.i18.5274] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/30/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori (H. pylori) in patients with previous gastric neoplasia who have undergone gastric surgery. However, the guidelines do not mention optimal timing, eradication regimens, diagnostic tools, and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H. pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy. The purpose of this review is to provide an update which may help physicians to properly manage H. pylori infection in patients who have undergone gastric surgery. This review focuses on (1) the microenvironment change in the stomach after gastrectomy; (2) the phenomenon of spontaneous clearance of H. pylori after gastrectomy; (3) the effects of H. pylori on gastric atrophy and intestinal metaplasia after gastrectomy; (4) incidence and clinical features of ulcers developing after gastrectomy; (5) does eradication of H. pylori reduce the risk of gastric stump cancer in the residual stomach? (6) does eradication of H. pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach? and (7) optimal timing and regimens for H. pylori eradication, diagnostic tools and follow-up strategies for patients undergoing gastrectomy.
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Wang HY, Shih SC, Hung CY, Shieh TY, Chen YB, Chen MJ. Use of artificial tissue to practice endoscopic submucosal dissection. Endoscopy 2014; 45 Suppl 2 UCTN:E175-6. [PMID: 23801289 DOI: 10.1055/s-0032-1326497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Chen CJ, Shih SC, Wang HY, Sun FJ, Lu SC, Chu CH, Wang TE, Chen MJ. Clinical application of total parenteral nutrition in patients with peritoneal carcinomatosis. Eur J Cancer Care (Engl) 2013; 22:468-73. [PMID: 23730735 DOI: 10.1111/ecc.12052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2013] [Indexed: 01/19/2023] [Imported: 08/29/2023]
Abstract
Cancer patients with terminal stage peritoneal carcinomatosis are often unable to eat, rendering total parenteral nutrition (TPN) as the only option to avoid starvation. In this retrospective study, we reviewed the medical records of 46 patients with peritoneal carcinomatosis and compared them to the records of 51 patients who had gastrointestinal malignancy without evidence of peritoneal carcinomatosis. The factors evaluated include demographic data, cause of primary malignancy, ascites formation, anthropometric measurements, laboratory tests, and outcome measurements as well as factors associated with greater than 90-day survival. In-hospital mortality was observed in 31 of the 46 patients with peritoneal carcinomatosis, with a median survival time of 40 days (4-148 days) for all 46 patients. The median duration of TPN administration in the peritoneal carcinomatosis group was 24.1 ± 27.4 days (3-68 days). Severe infection related to TPN application was seen in 5/46 (10.7%) patients with peritoneal carcinomatosis and 6/51 (9.8%) patients without peritoneal carcinomatosis. The length of survival varied widely among terminal patients with peritoneal carcinomatosis. The average survival time in peritoneal carcinomatosis patients receiving TPN was short, indicating that the nutrition support of TPN was relatively suboptimal. Ascites was not a prognostic factor for peritoneal carcinomatosis, while body mass index was a predictor for 90-day survival.
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Shieh TY, Lin CC, Yang FS, Chang WH, Chen MJ. Azygoesophageal fistula successfully treated with endoscopic injection of N-butyl-2-cyanoacrylate. Endoscopy 2011; 43 Suppl 2 UCTN:E168-9. [PMID: 21563066 DOI: 10.1055/s-0030-1256270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Lee YK, Wang HY, Shyung LR, Chang CW, Chen MJ. Inflammatory myofibroblastic tumor: an unusual submucosal lesion of the stomach. Endoscopy 2011; 43 Suppl 2 UCTN:E151-2. [PMID: 21563057 DOI: 10.1055/s-0030-1256257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Simulating a target lesion for endoscopic submucosal dissection training in an ex vivo pig model. Gastrointest Endosc 2011; 74:398-402. [PMID: 21679942 DOI: 10.1016/j.gie.2011.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 04/08/2011] [Indexed: 01/24/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND Currently, there is no training model that simulates the target lesion encountered during endoscopic submucosal dissection. OBJECTIVE To develop a novel method simulating a target lesion for endoscopic submucosal dissection. DESIGN Training program with the use of an ex vivo porcine stomach model. SETTING Clinical skills training center. INTERVENTION A pseudopolyp was created by using an esophageal variceal ligation device to simulate a protruding (0-Ip) lesion, and the pseudopolyp was transected with a snare cautery to simulate a depressed (0-IIc) lesion. MAIN OUTCOME MEASUREMENTS Evaluate the histological depth of the target lesions and resected specimens. RESULTS Histological findings of the simulated targets showed artificial ulcerative or polypoid lesions involving the muscularis mucosa or superficial submucosa. The resected specimen was limited to the submucosal layer, and no perforation was noted. LIMITATIONS Pilot study in an ex vivo porcine stomach model. CONCLUSION The most important advantage of the model is to simulate realistic target lesions like those encountered in clinical practice in endoscopic submucosal dissection training. It allows trainees to practice how to make proper markings, delineate adequate safety margins, and properly manage different subtypes of early gastric cancer.
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Chang WH, Shih SC, Wang HY, Chang CW, Chen CJ, Chen MJ. Acquired hyperplastic gastric polyps after treatment of ulcer. J Formos Med Assoc 2010; 109:567-73. [PMID: 20708507 DOI: 10.1016/s0929-6646(10)60093-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/06/2009] [Accepted: 10/28/2009] [Indexed: 01/12/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND/PURPOSE Healing of gastric ulcers requires repair by epithelial migration and proliferation. We have found a small proportion of patients with acquired hyperplastic polyps at the healed ulcer site. The aim of this study was to identify clinical characteristics that might be associated with the development of hyper-plastic polyps at the site of healed gastric ulcers. METHODS This was a retrospective review of 86 patients with gastric ulcers from April 2006 to September 2008. After initial endoscopy, the patients were all treated with proton pomp inhibitors, after which a second endoscopy was performed. Demographic data, polyp characteristics (endoscopic and histological), Helicobacter pylori status, and duration of treatment were analyzed. RESULTS A total of 24 hyperplastic gastric polyps were found in 18 patients; all at the site of the healed ulcer (20 in the antrum and 4 in the corpus). The mean size of the ulcers prior to treatment was 14.5 +/- 9.1 mm. Hyperplastic gastric polyps were more likely to occur at the site of ulcers larger than 10 mm (odds ratio = 9.57, 95% confidence interval =2.50-36.65). Age, sex, H. pylori status, ulcer location and duration of treatment did not differ significantly between patients with and without polyps. CONCLUSION Hyperplastic polyps that develop after healing of gastric ulcers are likely to be extensive mucosal injury. A gastric ulcer larger than 10 mm is associated with a significantly increased risk of hyperplastic polyps.
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Hung CY, Chen MJ, Shih SC, Liu TP, Chan YJ, Wang TE, Chang WH. Gastric carcinoid tumor in a patient with a past history of gastrointestinal stromal tumor of the stomach. World J Gastroenterol 2008; 14:6884-7. [PMID: 19058321 PMCID: PMC2773889 DOI: 10.3748/wjg.14.6884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract. It may coexist with other type of cancers, and if so, the tumors usually involve the stomach. The most common associated cancers are gastrointestinal carcinomas. We report a 65-year-old woman with a history of gastric gastrointestinal stromal tumor who had undergone subtotal segmental gastrectomy. New polypoid lesions were detected on a follow-up gastroscopy one year later. The lesions were biopsied and found to be carcinoid tumors. There was serum hypergastrinemia, and type 1 gastric carcinoid tumor was diagnosed. A total gastrectomy was performed. Pathologic examination revealed both carcinoid tumors and a recurrent gastrointestinal stromal tumor.
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Chen MJ, Shih SC, Wang TE, Chan YJ, Chen CJ, Chang WH. Endoscopic patterns and histopathological features after eradication therapy in Helicobacter pylori-associated nodular gastritis. Dig Dis Sci 2008; 53:1893-7. [PMID: 18080192 DOI: 10.1007/s10620-007-0097-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 10/27/2007] [Indexed: 01/02/2023] [Imported: 08/29/2023]
Abstract
The endoscopic finding of nodular gastritis (NG) is highly associated with presence of Helicobacter pylori infection. How the endoscopic patterns and histopathology of NG change after eradication of H. pylori is unclear. Twenty-one adults (3 men and 18 women) with H. pylori-associated NG found on endoscopy were enrolled for this study. The histological findings included gastritis activity, bacterial colonization, and lymphoid follicles. Repeat endoscopy for the endoscopic as well as histopathological features of gastric biopsy specimens was performed 2 months later after eradication treatment. H. pylori was successfully eradicated in 19 patients. Endoscopic NG disappeared in 12, improved in 5, and was unchanged in 4. After treatment, there was significant improvement in scores for gastritis activity [P < 0.001, 95% confidence interval (CI) 1.31-1.91], bacterial colonization (P < 0.001, 95% CI 0.71-1.14) and follicular gastritis (P = 0.047, 95% CI 0.04-0.52), primarily among patients whose endoscopic pattern resolved completely. The disappearance of nodularity on endoscopy was accompanied by a decrease in follicular gastritis score.
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Chen MJ, Wang TE, Chang WH, Liao TC, Lin CC, Shih SC. Nodular gastritis: an endoscopic indicator of Helicobacter Pylori infection. Dig Dis Sci 2007; 52:2662-6. [PMID: 17417730 DOI: 10.1007/s10620-006-9281-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 03/01/2006] [Indexed: 12/31/2022] [Imported: 08/29/2023]
Abstract
We prospectively assessed the relationship between nodular gastritis and Helicobacter pylori infection. Of 1409 adults who underwent endoscopy for persistent dyspepsia between June 2004 and August 2005, 41 (2.9%) patients were diagnosed with nodular gastritis (11 [27%] men and 30 [73%] women). The mean age was 45.9 years. A control group of 65 patients without nodular gastritis was also evaluated. The prevalence of H. pylori infection was higher in patients with nodular gastritis than in controls (38/41 [93%] vs. 33/65 [51%]). Of 21 patients treated to eradicate H. pylori, the nodular gastritis pattern resolved or improved in 16 patients on subsequent endoscopy. This study suggests that a nodular pattern of the gastric mucosa on endocscopy is a good indicator for H. pylori infection in adults, with the high positive predictive value of 92.7%.
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Chen MJ, Chang WH, Chu CH, Wang TE, Lin SC, Shih SC. Rapid response of Henoch-Schönlein purpura to corticosteroids: correlation between skin and gastric mucosal lesions. Dig Dis Sci 2007; 52:1706-8. [PMID: 17404873 DOI: 10.1007/s10620-006-9568-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 08/10/2006] [Indexed: 12/09/2022] [Imported: 08/29/2023]
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Chen MJ, Lin CC, Chang WH, Yang FS. Biloma following repeated transcatheter arterial embolization and complicated by intrahepatic duct stones: A case report. World J Gastroenterol 2005; 11:4764-5. [PMID: 16094727 PMCID: PMC4615428 DOI: 10.3748/wjg.v11.i30.4764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases, we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.
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Chen MJ, Wang TE, Chang WH, Tsai SJ, Liao WS. Endoscopic findings in a patient with Henoch-Schönlein purpura. World J Gastroenterol 2005; 11:2354-6. [PMID: 15818753 PMCID: PMC4305826 DOI: 10.3748/wjg.v11.i15.2354] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Henoch-Schönlein purpura (HSP) is a systemic vasculitis of the small vessels of the skin, joints, GI tract, and kidney. It preferentially affects children but may also occur in adults. We report a 60-year-old man with HSP who prese-nted with colicky abdominal pain, bloody diarrhea, arth-ralgia, and skin rash. The gastrointestinal tract was viewed by upper endoscopy and colonoscopy. We found charac-teristic endoscopic findings in the stomach, cecum and sigmoid colon, the combination of which has rarely been demonstrated in one patient. Histologic examination of skin biopsy specimens revealed leukocytoclastic vasculitis with positive staining for IgA in the capillaries. Endoscopy appears to have substantial diagnostic utility in patients suspected of having HSP, especially when abdominal symptoms precede the cutaneous lesions.
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