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Yu T, Hou S, Du H, Zhang W, Tian J, Hou Y, Yao J, Hou S, Zhang L. Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy. Gastroenterol Rep (Oxf) 2024; 12:goae056. [PMID: 38933338 PMCID: PMC11199342 DOI: 10.1093/gastro/goae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background Endoscopic ultrasound (EUS)-guided transhepatic antegrade stone removal (TASR) has been reserved for choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP) in recent years. The aim of this study was to evaluate the techniques, feasibility, and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA). Methods A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed. Results During the study period, 13 patients underwent simplified single-session EUS-TASR as a rescue procedure (8 males, median age, 64.0 [IQR, 48.5-69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four gastrectomy with Roux-en-Y anastomoses, and four hepaticojejunostomy with Roux-en-Y anastomoses. The technical success rate was 100% and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively. Conclusions Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. But further evaluation of this technique is still needed, preferably through prospective multicenter trials.
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Affiliation(s)
- Tingting Yu
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Suning Hou
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Haiming Du
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Wei Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Jiao Tian
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Yankun Hou
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Jun Yao
- Jinan University of Second Clinical Medical Sciences, Shenzhen People’s Hospital, Shenzhen, Guangdong, P. R. China
| | - Senlin Hou
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Lichao Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
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152
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Sbeit W, Shahin A, Basheer M, Khoury T. The additive diagnostic value of cytology in fine needle biopsy of pancreatic adenocarcinoma: A tertiary center experience. Diagn Cytopathol 2024. [PMID: 38923863 DOI: 10.1002/dc.25376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Endoscopic ultrasound guide fine needle biopsy (EUS-FNB) is the main diagnostic tool for pancreatic adenocarcinoma. In most instances, only histology is obtained via FNB, without sending cytological slides. The aim of our study was to assess the additive diagnostic yield of cytology performed through FNB. METHODS We conducted a retrospective study of all patients with histological diagnosis of pancreatic adenocarcinoma who were diagnosed by EUS-FNB. RESULTS Overall, 80 patients were included in the study period. The overall concordance between cytology and histology all FNB needles was 78.2%. Notably, cytological assessment improved the diagnostic yield for malignancy by 12.8%. The overall kappa coefficient correlation between histology and cytology was .501, 95% CI 0.361-0.641. However, the kappa correlation for suspicious of malignancy and malignant was excellent of .872, 95% CI 0.733-1, suggesting that cytology is crucial when histology is inconclusive. Further analysis showed that the Acquire and Sharkcore needles outperformed the Procore needle in term of concordance between cytology and histology (kappa correlation of .527, 95% CI 0.331-0.724, .515, 95% CI 0.265-0.764, and .297, 95% CI -0.051-0.646), respectively. CONCLUSION Performing cytology specimen when using FNB improves the diagnostic yield in pancreatic adenocarcinoma.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee medical center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee medical center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maamoun Basheer
- Department of Gastroenterology, Galilee medical center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee medical center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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153
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Huang P, Hou R, Zhang F, Yin H. Simple nylon rope lithotripsy for the management of giant gastric and duodenal bulbar bezoars complicated with obstruction: A case report. Asian J Surg 2024:S1015-9584(24)01211-9. [PMID: 38926063 DOI: 10.1016/j.asjsur.2024.05.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Pengjie Huang
- Ningxia Medical University (School of Clinical Medicine), Yinchuan, Ningxia, 750004, PR China
| | - Ruirui Hou
- General Hospital of Ningxia Medical University (Department of Gastroenterology), Yinchuan, Ningxia, 750004, PR China
| | - Feixiong Zhang
- General Hospital of Ningxia Medical University (Department of Gastroenterology), Yinchuan, Ningxia, 750004, PR China
| | - Hua Yin
- General Hospital of Ningxia Medical University (Department of Gastroenterology), Yinchuan, Ningxia, 750004, PR China.
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154
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Amil-Dias J, Oliva S, Papadopoulou A, Thomson M, Gutiérrez-Junquera C, Kalach N, Orel R, Auth M, Nijenhuis-Hendriks D, Strisciuglio C, Bauraind O, Chong S, Ortega GD, Férnandez SF, Furman M, Garcia-Puig R, Gottrand F, Homan M, Huysentruyt K, Kostovski A, Otte S, Rea F, Roma E, Romano C, Tzivinikos C, Urbonas V, Velde SV, Zangen T, Zevit N. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2024. [PMID: 38923067 DOI: 10.1002/jpn3.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary. METHODS A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations. RESULTS A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline. CONCLUSION Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE.
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Affiliation(s)
- Jorge Amil-Dias
- Pediatric Gastroenterology, Hospital Lusíadas, Porto, Portugal
| | - Salvatore Oliva
- Maternal and Child Health Department, University Hospital - Umberto I, Sapienza - University of Rome, Rome, Italy
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, Children's hospital Agia Sofia, University of Athens, Athens, Greece
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, UK
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Spain
| | - Nicolas Kalach
- Department of Pediatrics, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France
| | - Rok Orel
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marcus Auth
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery of the University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Sonny Chong
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - Gloria Dominguez Ortega
- Pediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sonia Férnandez Férnandez
- Pediatric Gastroenterology Unit, Department of Pediatrics, Severo Ochoa University Hospital, Madrid, Spain
| | - Mark Furman
- Royal Free London NHS Foundation Trust, London, UK
| | - Roger Garcia-Puig
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain
| | | | - Matjaz Homan
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Koen Huysentruyt
- Kindergastro-enterologie, hepatologie en nutritie, Brussels Centre for Intestinal Rehabilitation in Children (BCIRC), Belgium
| | - Aco Kostovski
- University Children's Hospital Skopje, Faculty of Medicine, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Sebastian Otte
- Childrens' Hospital, Helios Mariahilf Hospital, Hamburg, Germany
| | - Francesca Rea
- Endoscopy and Surgey Unit, Bambino Gesu Children's Hospital, Rome, Italy
| | - Eleftheria Roma
- First Department of Pediatrics, University of Athens and Pediatric Gastroenterology Unit Mitera Children's Hospital, Athens, Greece
| | - Claudio Romano
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Christos Tzivinikos
- Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, UAE
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Vaidotas Urbonas
- Vilnius University Medical Faculty Clinic of Children's Diseases, Vilnius, Lithuania
| | | | - Tsili Zangen
- Pediatric Gastroenterology Unit, Wolfson Medical Center, Holon, Israel
| | - Noam Zevit
- Eosinophilic Gastrointestinal Disease Clinic, Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Israel
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155
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Lima Capela T, Arieira C, Xavier S, Cúrdia Gonçalves T, Boal Carvalho P, Rosa B, Cotter J. TOP 100 and detection of colorectal lesions in colon capsule endoscopy: more than meets the eye. Eur J Gastroenterol Hepatol 2024:00042737-990000000-00373. [PMID: 38916233 DOI: 10.1097/meg.0000000000002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Colon capsule endoscopy (CCE) is a well-known method for the detection of colorectal lesions. Nevertheless, there are no studies reporting the accuracy of TOP 100, a CCE software tool, for the automatic detection of colorectal lesions in CCE. We aimed to evaluate the performance of TOP 100 in detecting colorectal lesions in patients submitted to CCE for incomplete colonoscopy compared with classic reading. A retrospective cohort study including adult patients submitted to CCE (PillCam COLON 2; Medtronic) for incomplete colonoscopy. Blinded for each other's evaluation, one experienced reader analyzed the TOP 100 images and the other performed classic reading to identify colorectal lesions. Detection of colorectal lesions, namely polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions was assessed and TOP 100 performance was evaluated compared with the gold standard (classic reading). A total of 188 CCEs were included. Prevalence of colorectal lesions, polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions were 77.7, 54.3, 8.5, 1.6, 50.0, 0.5, 0.5, and 1.1%, respectively. TOP 100 had a sensitivity of 92.5%, specificity of 69.1%, negative predictive value of 72.5%, positive predictive value of 91.2%, and accuracy of 87.2% for detecting colorectal lesions. TOP 100 had a sensitivity of 89.2%, specificity of 84.9%, negative predictive value of 86.9%, positive predictive value of 87.5%, and accuracy of 87.2% in detecting polyps. All colorectal lesions other than polyps were identified with 100% accuracy by TOP 100. TOP 100 has been shown to be a simple and useful tool in assisting the reader in the prompt identification of colorectal lesions in CCE.
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Affiliation(s)
- Tiago Lima Capela
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Cátia Arieira
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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156
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Sacco M, Gesualdo M, Staiano MT, Dall'Amico E, Caronna S, Dibitetto S, Canalis C, Caneglias A, Mediati F, Stasio RC, Gaia S, Saracco GM, Bruno M, De Angelis CG. Direct Single-Operator Cholangioscopy and Intraductal Ultrasonography in Patients with Indeterminate Biliary Strictures: A Single Center Experience. Diagnostics (Basel) 2024; 14:1316. [PMID: 39001208 PMCID: PMC11240807 DOI: 10.3390/diagnostics14131316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
The evaluation of biliary strictures poses a challenge due to the low sensitivity of standard diagnostic approaches, but the advent of direct single-operator cholangioscopy (DSOC) has revolutionized this paradigm. Our study aimed to assess the diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal ultrasound (IDUS), and standard brush cytology in patients with indeterminate biliary strictures (IBS). We reviewed patients who underwent advanced diagnostic evaluation for IBS at our endoscopy unit from January 2018 to December 2022, all of whom had previously undergone at least one endoscopic attempt to characterize the biliary stricture. Final diagnoses were established based on surgical pathology and/or clinical and radiological follow-up spanning at least 12 months. A total of 57 patients, with a mean age of 67.2 ± 10.0 years, were included, with a mean follow-up of 18.2 ± 18.1 months. The majority of IBS were located in the distal common bile duct (45.6%), with malignancy confirmed in 35 patients (61.4%). DSOC and IDUS demonstrated significantly higher accuracies (89.5% and 82.7%, respectively) compared to standard cytology (61.5%, p < 0.05). Both DSOC visualization and IDUS exhibited optimal diagnostic yields in differentiating IBS with an acceptable safety profile.
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Affiliation(s)
- Marco Sacco
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marcantonio Gesualdo
- Endoscopy Unit, Gastroenterology Department, Section of Gastroenterology II, National Institute of Research IRCCS "Saverio De Bellis", 70013 Castellana Grotte, Italy
| | - Maria Teresa Staiano
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Eleonora Dall'Amico
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Stefania Caronna
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Simone Dibitetto
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Chiara Canalis
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Alessandro Caneglias
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Federica Mediati
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Rosa Claudia Stasio
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Gaia
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Giorgio Maria Saracco
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Mauro Bruno
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Claudio Giovanni De Angelis
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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157
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Elahee M, Domsic RT. Managing Symptoms of Systemic Sclerosis for the Allergist-Immunologist. Curr Allergy Asthma Rep 2024:10.1007/s11882-024-01155-9. [PMID: 38904933 DOI: 10.1007/s11882-024-01155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW Systemic sclerosis (SSc) is a chronic, multisystem, autoimmune disease characterized by fibrosis, vasculopathy and immune system dysregulation. We provide a comprehensive review of features of systemic sclerosis that can potentially present to the allergist. RECENT FINDINGS A thorough understanding of the management options is crucial for clinicians involved in the care of patients with SSc to optimize clinical outcomes. Management of systemic sclerosis has drastically changed in the last decade and continues to evolve. This review provides an overview of management strategies for the various symptoms including skin, upper and lower airway, gastrointestinal and vascular manifestations. Institution of treatment early in the disease, including referral to rheumatology or specialized scleroderma centers, can help to both prevent and manage disease complications, and improve patient quality-of-life. While the landscape of systemic sclerosis management has evolved, we continue to recognize that there is still a need for better biomarkers and targeted therapies.
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Affiliation(s)
- Mehreen Elahee
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Robyn T Domsic
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
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158
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Heo S, Huh J, Kim JK, Lee KM. Delayed Perforation After Endoscopic Resection of Upper Gastrointestinal Tumors: CT Findings to Identify Patients Requiring Surgery. J Clin Gastroenterol 2024:00004836-990000000-00308. [PMID: 38896425 DOI: 10.1097/mcg.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To determine the clinical and imaging factors associated with surgical treatment in patients with delayed perforation after endoscopic resection of upper gastrointestinal tumors. METHODS We retrospectively included patients with delayed perforation after endoscopic tumor resection for gastric or duodenal tumors between January 2007 and December 2021 in a tertiary hospital. We compared the clinical, endoscopic, and CT findings of the surgical and conservative treatment groups. Univariable and multivariable analyses were performed to identify significant factors associated with surgery. RESULTS Among 10,423 patients who had undergone endoscopic tumor resection, 52 (0.50%) experienced delayed perforation, with 20 patients (35.5%) treated surgically and 32 patients (64.5%) treated conservatively. The CT findings of gross perforation (adjusted odds ratio [OR]=6.75, 95% confidence interval [CI], 1.04-43.89; P=0.045) and presence of peritonitis (OR=34.26, 95% CI, 5.52-212.50; P<0.001) were significantly associated with surgical treatment. Other clinical factors as well as CT-measured amount of pneumoperitoneum were not significant factors. CONCLUSIONS CT findings of gross perforation and peritonitis are significant factors associated with surgery in delayed perforation after endoscopic tumor resection. These factors can aid in guiding the patients towards an appropriate treatment plan.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Jimi Huh
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Yeongtong-gu, Suwon
| | - Jai Keun Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Yeongtong-gu, Suwon
| | - Ki Myung Lee
- Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Yeongtong-gu, Suwon, Republic of Korea
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159
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Gonzalez-Gonzalez L, Iborra I, Fortuny M, Mañosa M, Calm A, Colan J, Cañete F, Caballero N, Calafat M, Domènech E. External validation of the SHA 2PE score and its comparison to the Oakland score for the prediction of safe discharge in patients with lower gastrointestinal bleeding. Surg Endosc 2024:10.1007/s00464-024-10953-1. [PMID: 38902406 DOI: 10.1007/s00464-024-10953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The growing incidence of lower gastrointestinal bleeding (LGIB) is leading to a rise in-hospital admissions even though most LGIB episodes are self-limiting. The Oakland and SHA2PE scores were designed to identify patients best suited to outpatient care. Our aim is explore the validity of the SHA2PE score and compare both of these scores in terms of predictiveness of safe discharge. METHODS Retrospective observational study of LGIB patients admitted to a tertiary hospital between June 2014 and June 2019. Safe discharge was defined as the absence of all the following: blood transfusion, haemostatic intervention, re-bleeding, in-hospital death, and re-admission due to LGIB within 28 days after discharge. RESULTS From 595 hospital admissions for LGIB, 398 episodes were included. Fifty-four per cent met safe discharge criteria, with these cases being younger, with a lower score in the Charlson's index and significantly higher haemoglobin concentration upon arrival. The performance of both scores was good, with an AUC for the Oakland score of 0.85 (95% CI 0.82-0.89) and of 0.797 (95% CI 0.75-0.84) for the SHA2PE score. The Oakland score performed better in terms of prediction of safe discharge, with a positive predictive value and specificity of 100% when a cut-off value of ≤ 8 points was used; however, only a minority of patients might benefit from its implementation given its low sensitivity. CONCLUSIONS Almost half of the patients admitted for LGIB met criteria for safe discharge. However, the available indexes only allow for the identification of a small proportion of those patients candidates for outpatient care.
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Affiliation(s)
- Laura Gonzalez-Gonzalez
- PhD program, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
| | - Ignacio Iborra
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
| | - Marta Fortuny
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
| | - Míriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Anna Calm
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
| | - Juan Colan
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
| | - Fiorella Cañete
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Noemí Caballero
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
| | - Margalida Calafat
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Catalonia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
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160
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Wu H. Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas: a narrative review. Front Oncol 2024; 14:1409197. [PMID: 38962271 PMCID: PMC11220528 DOI: 10.3389/fonc.2024.1409197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024] Open
Abstract
Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOGCP) is a rare pancreatic tumor that accounts for less than 1% of all pancreatic malignancies. The characteristic pathological manifestation of UCOGCP is the presence of osteoclast-like giant cells (OGCs) distributed among pleomorphic undifferentiated tumor cells. UCOGCP can occur either alone or in association with other types of pancreatic tumors. At present, there is no unified consensus or guideline for the diagnosis and treatment of UCOGCP, and most of the literature are individual case reports. With the accumulation in the number of clinical cases and the development of precision medicine technology, the understanding of UCOGCP is also deepening. Researchers have begun to recognize that UCOGCP is a pancreatic tumor with distinctive clinical and molecular characteristics. In this review, we focus on the latest research status and future exploration directions in the diagnosis, treatment, and prognosis of UCOGCP.
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Affiliation(s)
- Haoxiang Wu
- Fudan University Shanghai Cancer Center, Shanghai, China
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161
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Xin S, Liu X, He C, Gao H, Wang B, Hua R, Gao L, Shang H, Sun F, Xu J. Inflammation accelerating intestinal fibrosis: from mechanism to clinic. Eur J Med Res 2024; 29:335. [PMID: 38890719 PMCID: PMC11184829 DOI: 10.1186/s40001-024-01932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024] Open
Abstract
Intestinal fibrosis is a prevalent complication of IBD that that can frequently be triggered by prolonged inflammation. Fibrosis in the gut can cause a number of issues, which continue as an ongoing challenge to healthcare systems worldwide. The primary causes of intestinal fibrosis are soluble molecules, G protein-coupled receptors, epithelial-to-mesenchymal or endothelial-to-mesenchymal transition, and the gut microbiota. Fresh perspectives coming from in vivo and in vitro experimental models demonstrate that fibrogenic pathways might be different, at least to some extent, independent of the ones that influence inflammation. Understanding the distinctive procedures of intestinal fibrogenesis should provide a realistic foundation for targeting and blocking specific fibrogenic pathways, estimating the risk of fibrotic consequences, detecting early fibrotic alterations, and eventually allowing therapy development. Here, we first summarize the inflammatory and non-inflammatory components of fibrosis, and then we elaborate on the underlying mechanism associated with multiple cytokines in fibrosis, providing the framework for future clinical practice. Following that, we discuss the relationship between modernization and disease, as well as the shortcomings of current studies. We outline fibrosis diagnosis and therapy, as well as our recommendations for the future treatment of intestinal fibrosis. We anticipate that the global review will provides a wealth of fresh knowledge and suggestions for future fibrosis clinical practice.
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Affiliation(s)
- Shuzi Xin
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Xiaohui Liu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Chengwei He
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Han Gao
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
- Department of Clinical Laboratory, Aerospace Clinical Medical College, Aerospace Central Hospital, Beijing, 100039, China
| | - Boya Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Rongxuan Hua
- Department of Clinical Medicine, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Lei Gao
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
| | - Hongwei Shang
- Experimental Center for Morphological Research Platform, Capital Medical University, Beijing, 100069, China
| | - Fangling Sun
- Department of Laboratory Animal Research, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Jingdong Xu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
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162
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Malik S, Tenorio BG, Moond V, Dahiya DS, Vora R, Dbouk N. Systematic review of machine learning models in predicting the risk of bleed/grade of esophageal varices in patients with liver cirrhosis: A comprehensive methodological analysis. J Gastroenterol Hepatol 2024. [PMID: 38886175 DOI: 10.1111/jgh.16645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/08/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
Esophageal varices (EV) in liver cirrhosis carry high mortality risks. Traditional endoscopy, which is costly and subjective, prompts a shift towards machine learning (ML). This review critically evaluates ML applications in predicting bleeding risks and grading EV in patients with liver cirrhosis. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of studies using ML to predict the risk of variceal bleeding and/or grade EV in liver disease patients. Data extraction and bias assessment followed the CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies) checklist and PROBAST (Prediction model Risk Of Bias Assessment Tool) tool, respectively. Due to the heterogeneity of the study, a meta-analysis was not feasible; instead, descriptive statistics summarized the findings. Twelve studies were included, highlighting the use of various ML models such as extreme gradient boosting, artificial neural networks, and convolutional neural networks. These studies demonstrated high predictive accuracy, with some models achieving area under the curve values above 99%. However, significant heterogeneity was noted in input variables, methodologies, and outcome measures. Moreover, a substantial portion of the studies exhibited unclear or high risk of bias, mainly due to insufficient participant numbers, unclear handling of missing data, and a lack of detailed reporting on endoscopic procedures. ML models show significant promise in predicting the risk of variceal bleeding and grading EV in patients with cirrhosis, potentially reducing the need for invasive procedures. Nonetheless, the current literature reveals considerable heterogeneity and methodological limitations, including high or unclear risks of bias. Future research should focus on larger, prospective trials and the standardization of ML assessment criteria to confirm these models' practical utility in clinical settings.
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Affiliation(s)
- Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | | | - Vishali Moond
- Department of Internal Medicine, St. Peter's University Medicine School, Jersey City, New Jersey, USA
| | - Dushyant Singh Dahiya
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Ravi Vora
- Department of Gastroenterology and Hepatology, Emory School of Medicine, Atlanta, Georgia, USA
| | - Nader Dbouk
- Department of Gastroenterology and Hepatology, Emory School of Medicine, Atlanta, Georgia, USA
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163
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Klimza H, Maćkowiak B, Zagaja K, Jackowska J, Banaszewski J, Wierzbicka M. The usefulness of narrow-band Imaging (NBI) in nasopharyngeal lesions-Validation of the Ni NBI classification dedicated for vascular pattern in the nasopharynx. PLoS One 2024; 19:e0302043. [PMID: 38885230 PMCID: PMC11182514 DOI: 10.1371/journal.pone.0302043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/27/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND This study aims to explore the applicability of narrow-band imaging (NBI) involving the Ni classification for the diagnosis of nasopharyngeal mucosal lesions in order to distinguish malignant tumours (NPT) from non-malignant lesions. METHODS Each patient (n = 53) with a suspected nasopharyngeal lesion underwent a trans-nasal flexible video endoscopy with an optical filter for NBI. We assessed the suspected area using white light imaging (WLI) in terms of location and morphology as well as the vascular pattern (using Ni classification of nasopharyngeal microvessels) and surrounding tissue by using NBI. Based on the results of the NBI and WLI, patients were classified into "positive" or "negative" groups. All lesions of the nasopharynx were biopsied and submitted for final histological evaluation. RESULTS NBI showed higher sensitivity, specificity, and accuracy than WLI. There was a significant correlation between the final histological result and the NBI pattern of the NPT: Chi2(1) = 31.34; p = 0.000001 and the WLI assessment of the NPT: Chi2(1) = 14.78; p = 0.00012. CONCLUSIONS The assessment of the NPT in NBI using Ni NBI classification proved valuable in suspected mucosa assessment. NBI not only confirms the suspicious areas in WLI, but it also shows microlesions beyond the scope of WLI and allows for proper sampling.
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Affiliation(s)
- Hanna Klimza
- Regional Specialist Hospital Wroclaw, Research & Development Centre, Wrocław, Poland
| | - Bartosz Maćkowiak
- Department of Otolaryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kacper Zagaja
- Department of Otolaryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Jackowska
- Department of Otolaryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Banaszewski
- Department of Otolaryngology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Regional Specialist Hospital Wroclaw, Research & Development Centre, Wrocław, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
- Wroclaw University of Science and Technology, Wroclaw, Poland
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164
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Veras Ayres da Silva PH, So Taa Kum A, Logetto Caetité Gomes I, Miyajima NT, Moraes Bestetti A, Cadena Aguirre DP, Mansilla Gallegos MM, Menezes Nascimento Filho H, Gomes de Sousa IV, Marques Bernardo W, Guimarães Hourneaux de Moura E. Scissor-assisted vs. conventional endoscopic submucosal dissection for colorectal lesions: Systematic review and meta-analysis. Dig Endosc 2024. [PMID: 38886902 DOI: 10.1111/den.14829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/07/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Colorectal endoscopic submucosal dissection (ESD) is a technically complex procedure. The scissor knife mechanism may potentially provide easier and safer colorectal ESD. The aim of this meta-analysis is to evaluate the efficacy and safety of scissor-assisted vs. conventional ESD for colorectal lesions. METHODS A search strategy was conducted in MEDLINE, Embase, and Lilacs databases from January 1990 to November 2023 according to PRISMA guidelines. Fixed and random-effects models were used for statistical analysis. Heterogeneity was assessed using I2 test. Risk of bias was assessed using the ROBINS-I and RoB-2 tools. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS A total of five studies (three retrospective and two randomized controlled trials, including a total of 1575 colorectal ESD) were selected. The intraoperative perforation rate was statistically lower (risk difference [RD] -0.02; 95% confidence interval [CI] -0.04 to -0.01; P = 0.001; I2 = 0%) and the self-completion rate was statistically higher (RD 0.14; 95% CI 0.06, 0.23; P = 0.0006; I2 = 0%) in the scissor-assisted group compared with the conventional ESD group. There was no statistical difference in R0 resection rate, en bloc resection rate, mean procedure time, or delayed bleeding rate between the groups. CONCLUSION Scissor knife-assisted ESD is as effective as conventional knife-assisted ESD for colorectal lesions with lower intraoperative perforation rate and a higher self-completion rate.
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Affiliation(s)
| | - Angelo So Taa Kum
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Igor Logetto Caetité Gomes
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Nelson Tomio Miyajima
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Alexandre Moraes Bestetti
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Diego Paul Cadena Aguirre
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | - Igor Valdeir Gomes de Sousa
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil
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165
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Houlden R, Crichton F. Want doctors to use VR simulation? Make it mandatory, accessible, educationally valuable, and enjoyable! MEDEDPUBLISH 2024; 14:8. [PMID: 38932994 PMCID: PMC11200059 DOI: 10.12688/mep.20040.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background Virtual reality (VR) simulation training is mandatory for postgraduate year 1-2 doctors at the author's hospital trust. Despite this, a preceding quantitative study demonstrated uptake below required levels. While the educational value of VR simulation has been highlighted, little attention has been paid to participant utilisation in postgraduate curricula. With the increasing development and incorporation of VR-based clinical education, it is essential to understand the factors influencing how frequently postgraduate doctors utilise it so that its potential can be maximised. Methods A qualitative study design was employed. All 108 postgraduate year 1-2 doctors from the 2020-21 training year were invited for a semi-structured interview. Interviews continued until data saturation was reached in the form of informational redundancy. Reflexive thematic analysis was conducted. Results A total of 17 interviews were conducted. Four main themes that influenced participation in VR simulation were identified: (1) the mandatory nature encouraged participation but led to negative perceptions as a tick-box exercise; (2) there were multiple challenges to accessing the resource; (3) the scenarios were felt to have limited educational value; and (4) there was untapped potential in drawing benefits from VR as an enjoyable leisure activity. Conclusions Recommendations from these findings include: (1) VR simulation should be mandatory but with a degree of learner autonomy; (2) sessions should be integrated into doctors' rotas as protected time; (3) more challenging scenarios ought to be created aligned with postgraduate courses, examinations, and specialty training, and (4) presented as a difficulty level system akin to gaming experiences.
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Affiliation(s)
- Riki Houlden
- University of Dundee, Dundee, Scotland, UK
- East and North Hertfordshire NHS Trust, Stevenage, England, UK
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166
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Cobb W, Harris S, Xavier J, de la Fuente SG. Systematic review of long-term effectiveness of endoscopic gastrojejunostomy in patients presenting with gastric outlet obstruction from periampullary malignancies. Surg Endosc 2024:10.1007/s00464-024-10943-3. [PMID: 38886233 DOI: 10.1007/s00464-024-10943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Recently, endoscopic ultrasound-guided (EUS) gastrojejunostomy (GJ) has emerged as an alternative option to surgical palliation and endoscopic duodenal stenting for malignant gastric outlet obstruction (GOO). Although early success rates are commonly reported with the technique, there is a paucity of data regarding the long-term efficacy of this approach. In this study, we investigated long-term outcomes in patients that underwent EUS-guided GJ for palliation of periampullary malignancies. METHODS From a total of 192 studies that were reviewed, 6 studies with a follow-up time frame of a minimum of 5 months were analyzed, totaling 238 patients. Outcome variables included technical success rate, clinical success rate, adverse events, symptom recurrence, and re-intervention rates. RESULTS The cohort of 238 patients had a technical success rate of 93.7% and a clinical success rate of 92.9%. A total of 25 patients (10.5%) experienced adverse events associated with EUS-GJ. A total of 14 patients (5.9%) experienced recurrence of GOO symptoms within 5 months. A total of 14 patients (5.9%) underwent re-intervention with the first 5 months. CONCLUSIONS This systematic review shows that data are scarce regarding long-term effectiveness of EUS-guided GJ. Even though early success rates have been reported, further studies are needed to focus on long-term efficacy of this approach. Until such studies become available, surgical palliation should continue to be the treatment of choice for patients with malignant GOO with a prolonged life expectancy.
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Affiliation(s)
- William Cobb
- Department of Surgery, AdventHealth Orlando, Orlando, FL, USA
| | - Shelby Harris
- Department of Surgery, AdventHealth Orlando, Orlando, FL, USA
| | - Jonathan Xavier
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Sebastian G de la Fuente
- Department of Surgery, AdventHealth Orlando, Orlando, FL, USA.
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.
- Department of Surgical Oncology, 2415 N. Orange Ave, Suite 400, Orlando, FL, 32804, USA.
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Bergeron E, Pichette M, Boisvert G, Manière T, Désilets É. Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy: A case report and review of literature. World J Clin Cases 2024; 12:3161-3167. [PMID: 38898841 PMCID: PMC11185380 DOI: 10.12998/wjcc.v12.i17.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Pneumatosis cystoides intestinalis (PCI), characterized by a collection of gas-filled cysts in the intestinal wall, is an uncommon but well-known condition in gastroenterology. Abdominal pain is the most frequent symptom associated with PCI. Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation. However, the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood. CASE SUMMARY A 52-year-old male, known with idiopathic PCI, presented seventeen months after initial diagnosis with a new right upper quadrant pain. A computed tomography-scan demonstrated a colonic intussusception at the hepatic flexure. PCI did not progress compared with initial investigation. The patient underwent an emergency right hemicolectomy. CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause. Surgery allowed to address the underlying pathology, the potential relapse of intussusception, and the likely cause of recurrent abdominal pain, either invagination or PCI itself.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Maude Pichette
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Geneviève Boisvert
- Department of Medical Imaging, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
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168
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蓝 益, 张 静, 冉 永, 李 博, 蔡 晓, 江 涛, 薛 德. [Preparation and in vivo osteogenesis of acellular dermal matrix/dicalcium phosphate composite scaffold for bone repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:755-762. [PMID: 38918199 PMCID: PMC11190677 DOI: 10.7507/1002-1892.202403059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/21/2024] [Indexed: 06/27/2024]
Abstract
Objective To investigate the physicochemical properties, osteogenic properties, and osteogenic ability in rabbit model of femoral condylar defect of acellular dermal matrix (ADM)/dicalcium phosphate (DCP) composite scaffold. Methods ADM/DCP composite scaffolds were prepared by microfibril technique, and the acellular effect of ADM/DCP composite scaffolds was detected by DNA residue, fat content, and α-1,3-galactosyle (α-Gal) epitopes; the microstructure of scaffolds was characterized by field emission scanning electron microscopy and mercury porosimetry; X-ray diffraction was used to analyze the change of crystal form of scaffold; the solubility of scaffolds was used to detect the pH value and calcium ion content of the solution; the mineralization experiment in vitro was used to observe the surface mineralization. Twelve healthy male New Zealand white rabbits were selected to prepare the femoral condylar defect models, and the left and right defects were implanted with ADM/DCP composite scaffold (experimental group) and skeletal gold ® artificial bone repair material (control group), respectively. Gross observation was performed at 6 and 12 weeks after operation; Micro-CT was used to detect and quantitatively analyze the related indicators [bone volume (BV), bone volume/tissue volume (BV/TV), bone surface/bone volume (BS/BV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), bone mineral density (BMD)], and HE staining and Masson staining were performed to observe the repair of bone defects and the maturation of bone matrix. Results Gross observation showed that the ADM/DCP composite scaffold was a white spongy solid. Compared with ADM, ADM/DCP composite scaffolds showed a significant decrease in DNA residue, fat content, and α-Gal antigen content ( P<0.05). Field emission scanning electron microscopy showed that the ADM/DCP composite scaffold had a porous structure, and DCP particles were attached to the porcine dermal fibers. The porosity of the ADM/DCP composite scaffold was 76.32%±1.63% measured by mercury porosimetry. X-ray diffraction analysis showed that the crystalline phase of DCP in the ADM/DCP composite scaffolds remained intact. Mineralization results in vitro showed that the hydroxyapatite layer of ADM/DCP composite scaffolds was basically mature. The repair experiment of rabbit femoral condyle defect showed that the incision healed completely after operation without callus or osteophyte. Micro-CT showed that bone healing was complete and a large amount of new bone tissue was generated in the defect site of the two groups, and there was no difference in density between the defect site and the surrounding bone tissue, and the osteogenic properties of the two groups were equivalent. There was no significant difference in BV, BV/TV, BS/BV, Tb.Th, Tb.N, and BMD between the two groups ( P>0.05), except that the Tb.Sp in the experimental group was significantly higher than that in the control group ( P<0.05). At 6 and 12 weeks after operation, HE staining and Masson staining showed that the new bone and autogenous bone fused well in both groups, and the bone tissue tended to be mature. Conclusion The ADM/DCP composite scaffold has good biocompatibility and osteogenic ability similar to the artificial bone material in repairing rabbit femoral condylar defects. It is a new scaffold material with potential in the field of bone repair.
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Affiliation(s)
- 益南 蓝
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
- 浙江大学丽水医院骨科(浙江丽水 323000)Department of Orthopedics, Lishui Hospital of Zhejiang University, Lishui Zhejiang, 323000, P. R. China
| | - 静逸 张
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
| | - 永峰 冉
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
| | - 博 李
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
| | - 晓斌 蔡
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
| | - 涛 江
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
| | - 德挺 薛
- 浙江大学医学院附属第二医院骨科(杭州 310009)Department of Orthopedics, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Zhejiang, 310009, P. R. China
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Moreno Pimentel C, Galindo García C, Ariza Estepa M, Naranjo Llamas ME, Palomar Ávila C, Castro Fernández M, Fobelo Lozano MJ. "Cap polyposis", refractory to drug treatment, including infliximab. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38873995 DOI: 10.17235/reed.2024.10297/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum and sigmoid. It presents with tenesmus, mucous stools and rectorrhagia. There is currently no standardized treatment, having been treated empirically with aminosalicylates, oral or rectal steroids, metronidazole, H. pylori eradication therapy and infliximab with variable results. In refractory cases, endoscopic resection of polyps may be used and surgery may even be necessary. We present the case of a 36-year-old patient diagnosed in our center with cap polyposis, refractory to both pharmacological and endoscopic treatment, and therefore treatment with infliximab was decided out of indication. The case we present is the fourth case of cap polyposis treated with infliximab available in the current literature and highlights the difficulty of achieving a clinical response with pharmacological treatment, including biologic drugs such as infliximab.
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170
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Xi Y, Min Z, Liu M, Li X, Yuan ZH. Role and recent progress of P2Y12 receptor in cancer development. Purinergic Signal 2024:10.1007/s11302-024-10027-w. [PMID: 38874752 DOI: 10.1007/s11302-024-10027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
P2Y12 receptor (P2Y12R) is an adenosine-activated G protein-coupled receptor (GPCR) that plays a central role in platelet function, hemostasis, and thrombosis. P2Y12R activation can promote platelet aggregation and adhesion to cancer cells, promote tumor angiogenesis, and affect the tumor immune microenvironment (TIME) and tumor drug resistance, which is conducive to the progression of cancers. Meanwhile, P2Y12R inhibitors can inhibit this effect, suggesting that P2Y12R may be a potential therapeutic target for cancer. P2Y12R is involved in cancer development and metastasis, while P2Y12R inhibitors are effective in inhibiting cancer. However, a new study suggests that long-term use of P2Y12R inhibitors may increase the risk of cancer and the mechanism remains to be explored. In this paper, we reviewed the structural and functional characteristics of P2Y12R and its role in cancer. We explored the role of P2Y12R inhibitors in different tumors and the latest advances by summarizing the basic and clinical studies on the effects of P2Y12R inhibitors on tumors.
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Affiliation(s)
- Yanni Xi
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Republic of China
- The Second Clinical Medical College, Nanchang University, Nanchang, 330006, Republic of China
| | - Zhenya Min
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Republic of China
- The Second Clinical Medical College, Nanchang University, Nanchang, 330006, Republic of China
| | - Mianxue Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Republic of China
- The Second Clinical Medical College, Nanchang University, Nanchang, 330006, Republic of China
| | - Xueqin Li
- Department of Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Republic of China
| | - Zhao-Hua Yuan
- Department of General Surgery, Jiujiang Hospital of Traditional Chinese Medicine, Jiujiang, Jiangxi, 332007, People's Republic of China.
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171
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Profitiliotis T, Koltsakidis S, Tsongas K, Tzetzis D. Innovative Design of a 3D Printed Esophageal Stent Inspired by Nature: Mitigating Migration Challenges in Palliative Esophageal Cancer Therapy. Biomimetics (Basel) 2024; 9:359. [PMID: 38921239 PMCID: PMC11201459 DOI: 10.3390/biomimetics9060359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Esophageal cancer is a complex and challenging tumor to treat, with esophageal stenting being used as a palliative measure to improve the quality of life of patients. Self-expandable metal stents (SEMS), self-expandable plastic stents (SEPS), and biodegradable stents are the most commonly used types of stents. However, complications can arise, such as migration, bleeding, and perforation. To address issues of migration, this study developed a novel 3D printed bioinspired esophageal stent utilizing a highly flexible and ductile TPU material. The stent was designed to be self-expanding and tubular with flared ends to provide secure anchorage at both the proximal and distal ends of the structure. Suction cups were strategically placed around the shaft of the stent to prevent migration. The stent was evaluated through compression-recovery, self-expansion, and anti-migration tests to evaluate its recovery properties, self-expansion ability, and anchoring ability, respectively. The results indicated that the novel stent was able to recover its shape, expand, keep the esophagus open, and resist migration, demonstrating its potential for further research and clinical applications. Finite element analysis (FEA) was leveraged to analyze the stent's mechanical behavior, providing insights into its structural integrity, self-expansion capability, and resistance against migration. These results, supported by FEA, highlight the potential of this innovative stent for further research and its eventual application in preclinical settings.
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Affiliation(s)
- Thomas Profitiliotis
- Digital Manufacturing and Materials Characterization Laboratory, School of Science and Technology, International Hellenic University, 57001 Thermi, Greece
| | - Savvas Koltsakidis
- Digital Manufacturing and Materials Characterization Laboratory, School of Science and Technology, International Hellenic University, 57001 Thermi, Greece
| | - Konstantinos Tsongas
- Department of Industrial Engineering and Management, School of Engineering, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Dimitrios Tzetzis
- Digital Manufacturing and Materials Characterization Laboratory, School of Science and Technology, International Hellenic University, 57001 Thermi, Greece
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172
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Brooks SG, Yosipovitch G. Unmet needs in treating itch: reaching beyond eczema. J DERMATOL TREAT 2024; 35:2351487. [PMID: 38945542 DOI: 10.1080/09546634.2024.2351487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Pruritus is an unpleasant sensation that creates the urge to scratch. In many chronic conditions, relentless pruritus and scratching perpetuates a vicious itch-scratch cycle. Uncontrolled itch can detrimentally affect quality of life and may lead to sleep disturbance, impaired concentration, financial burden, and psychological suffering. Recent strides have been made to develop guidelines and investigate new therapies to treat some of the most common severely pruritic conditions, however, a large group of diseases remains underrecognized and undertreated. The purpose of this article is to provide a comprehensive review of the challenges hindering the treatment of pruritus. METHODS An online search was performed using PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov from 1994 to 2024. Included studies were summarized and assessed for quality and relevance in treating pruritus. RESULTS Several barriers to treating pruritus emerged, including variable presentation, objective measurement of itch, and identifying therapeutic targets. Itch associated with autoimmune conditions, connective tissue diseases, genodermatoses, cutaneous T-cell lymphoma, and pruritus of unknown origin were among the etiologies with the greatest unmet needs. CONCLUSION Treating pruritus poses many challenges and there are many itchy conditions that have no yet been addressed. There is an urgent need for large-scale controlled studies to investigate potential targets for these conditions and novel therapies.
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Affiliation(s)
- Sarah G Brooks
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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173
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Toyoshima O, Nishizawa T, Hiramatsu T, Matsuno T, Yoshida S, Mizutani H, Ebinuma H, Matsuda T, Saito Y, Fujishiro M. Colorectal adenoma detection rate using texture and color enhancement imaging versus white light imaging with chromoendoscopy: a propensity score matching study. J Gastroenterol Hepatol 2024. [PMID: 38872367 DOI: 10.1111/jgh.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/07/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND AIM Few studies have evaluated the adenoma detection rate (ADR) of colonoscopy with texture and color enhancement imaging (TXI), a novel image-enhancing technology. This study compares the detection of colorectal polyps using TXI to that using white light imaging (WLI). METHODS This single-center retrospective study used propensity-matched scoring based on the patients' baseline characteristics (age, sex, indication, bowel preparation, endoscopist, colonoscope type, and withdrawal time) to compare the results of patients who underwent chromoendoscopy using WLI or TXI at the Toyoshima Endoscopy Clinic. The differences in polyp detection rates and the mean number of detected polyps per colonoscopy were determined between the TXI and WLI groups. RESULTS After propensity score matching, 1970 patients were enrolled into each imaging modality group. The mean patient age was 57.2 ± 12.5 years, and 44.5% of the cohort were men. The ADR was higher in the TXI group than in the WLI group (55.0% vs 49.4%, odds ratio: 1.25). High-risk ADR were more common in the TXI group than in the WLI group (17.6% vs 12.8%; OR: 1.45). The mean number of adenomas per colonoscopy (APC) was higher in the TXI group than in the WLI group (1.187 vs 0.943, OR: 1.12). APC with a flat morphology (1.093 vs 0.848, OR: 1.14) and APC of <6 mm (0.992 vs 0.757, OR: 1.16) were higher in the TXI group than in the WLI group. CONCLUSION Compared to WLI, TXI improved the ADR in patients who underwent chromoendoscopy based on actual clinical data.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Takuma Hiramatsu
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Matsuno
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Internal Medicine, Yoshida Clinic, Fukaya, Japan
| | - Hiroya Mizutani
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sakurai Y, Karaki H, Nakamura Y, Fukuda H, Okaya T, Oheda Y, Yokoyama Y, Hirai F, Abe M, Sugano I. A case of early-stage type 3 gastric neuroendocrine tumor in the upper body of the stomach: is endoscopic resection feasible? Clin J Gastroenterol 2024:10.1007/s12328-024-01999-8. [PMID: 38865017 DOI: 10.1007/s12328-024-01999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
Although gastric neuroendocrine tumors (NETs) are uncommon compared with gastric carcinomas, the incidence of NETs has been recently increasing. Gastric NETs are classified into three subgroups, and among these, gastrin-independent sporadic type 3 gastric NETs have a poor prognosis because of frequent lymph node or distant metastasis. We experienced a case of an early-stage type 3 gastric NET associated with lymphovascular and submucosal invasion. In a 54 year-old woman, esophagogastroduodenoscopy performed during a health screening identified an elevated lesion of the upper body of the stomach. The results of immunohistochemical analyses of endoscopic biopsy specimens obtained from the lesion were positive for chromogranin A and synaptophysin, indicating an NET. Because the patient's serum gastrin level was normal and she had no predisposing conditions for NET development, the tumor was diagnosed as a type 3 gastric NET. The patient underwent local resection of the tumor and regional lymph node dissection. The resected specimen indicated a diagnosis of type 3 gastric NET with invasion into the submucosa and lymphatic duct. This is an extremely rare case of an early-stage type 3 gastric NET. Our discussion provides insight into the pathogenesis and development of these tumors and the appropriate therapeutic strategy.
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Affiliation(s)
- Yoichi Sakurai
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-1 1-Chome Izumi-Cho, Narashino City, Chiba, 275-8580, Japan.
| | - Hirokazu Karaki
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-1 1-Chome Izumi-Cho, Narashino City, Chiba, 275-8580, Japan
| | - Yusuke Nakamura
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-1 1-Chome Izumi-Cho, Narashino City, Chiba, 275-8580, Japan
| | - Hiroyuki Fukuda
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-1 1-Chome Izumi-Cho, Narashino City, Chiba, 275-8580, Japan
| | - Tomohisa Okaya
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-1 1-Chome Izumi-Cho, Narashino City, Chiba, 275-8580, Japan
| | - Yoshio Oheda
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-1 1-Chome Izumi-Cho, Narashino City, Chiba, 275-8580, Japan
| | - Yuya Yokoyama
- Department of Gastroenterology, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Narashino City, Chiba, Japan
| | - Futoshi Hirai
- Department of Gastroenterology, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Narashino City, Chiba, Japan
| | - Michikazu Abe
- Department of Gastroenterology, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Narashino City, Chiba, Japan
| | - Isamu Sugano
- Pathology Division, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Narashino City, Chiba, Japan
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175
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Hu Y, Zhou M, Liu D, Gong J. Risk Factors for Rebleeding After Endoscopic Injection of Cyanoacrylate Glue for Gastric Varices: A Systematic Review and Meta-Analysis. Dig Dis Sci 2024:10.1007/s10620-024-08482-x. [PMID: 38864930 DOI: 10.1007/s10620-024-08482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/06/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients. AIM This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding. METHODS Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included. RESULTS The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I2 = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I2 = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I2 = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I2 = 91.6%], 3% [95% CI - 2 to 8, I2 = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I2 = 0%], all-cause mortality rate was 17% [95% CI 12-22, I2 = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor. CONCLUSIONS Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.
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Affiliation(s)
- Yihuan Hu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, 410011, Hunan, China
| | - Mei Zhou
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, 410011, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, 410011, Hunan, China
| | - Jian Gong
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China.
- Clinical Research Center of Digestive Diseases of Hunan Province, Changsha, 410011, Hunan, China.
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Yamazaki T, Kamata K, Hyodo T, Im SW, Tanaka H, Yoshida A, Fukunaga T, Omoto S, Minaga K, Takenaka M, Kudo M. Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography to Diagnose Pancreaticobiliary Maljunction. Dig Dis Sci 2024:10.1007/s10620-024-08505-7. [PMID: 38864928 DOI: 10.1007/s10620-024-08505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Detection of a common channel outside the duodenal wall is important in diagnosing pancreaticobiliary maljunction (PBM). The present study evaluated the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in diagnosing PBM. METHODS This single-center retrospective study enrolled 45 patients who were diagnosed with PBM or high confluence of pancreatobiliary ducts (HCPBD) between January 2007 and December 2021. The diagnostic sensitivities of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI), and CH-EUS for diagnosing PBM were analyzed. Imaging findings were evaluated by two reviewers blinded to the clinicopathological results. RESULTS Based on diagnostic criteria, 33 patients were diagnosed with PBM and 12 with HCPBD. Compared with the patients with HCPBD, those with PBM had significantly longer common channel (12.5 mm vs. 8.1 mm, P = 0.018) and common bile duct (13.0 mm vs. 8.6 mm, P = 0.049) lengths. The κ-coefficients for differentiating PBM and HCPBD were 0.871 between CE-CT and MRI, 0.330 between CE-CT and CH-EUS, and 0.611 between MRI and CH-EUS. The diagnostic sensitivity of CH-EUS (95.2%) was higher than that of CE-CT (83.3%) and MRI (82.8%), although the differences were not statistically significant. CONCLUSION CH-EUS may be useful for the diagnosis of PBM.
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Affiliation(s)
- Tomohiro Yamazaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
| | - Tomoko Hyodo
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sung-Woon Im
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hidekazu Tanaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Akihiro Yoshida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Tomohiro Fukunaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
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Abboud Y, El Helou MO, Meza J, Samaan JS, Bancila L, Randhawa N, Park KH, Mehdizadeh S, Gaddam S, Lo SK. Esophageal Self-Expandable Metal Stents Can Fracture in the Distal Third When Used for Post-Bariatric Surgery Complications: A Single Center Experience and Review of the Literature with Video. J Clin Med 2024; 13:3419. [PMID: 38929948 PMCID: PMC11204956 DOI: 10.3390/jcm13123419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Esophageal self-expandable metal stents (SEMS) are an important endoscopic tool. These stents have now been adapted successfully to manage post-bariatric surgery complications such as anastomotic leaks and strictures. In centers of expertise, this has become the primary standard-of-care treatment given its minimally invasive nature, and that it results in early oral feeding, decreased hospitalization, and overall favorable outcomes. Self-expandable metal stents (SEMS) fractures are a rare complication of unknown etiology. We aimed to investigate possible causes of SEMS fractures and highlight a unique endoscopic approach utilized to manage a fractured and impaled SEMS. Methods: This is a retrospective study of consecutive patients who underwent esophageal SEMS placement between 2015-2021 at a tertiary referral center to identify fractured SEMS. Patient demographics, stent characteristics, and possible etiologies of fractured SEMS were identified. A comprehensive literature review was also conducted to evaluate all prior cases of fractured SEMS and to hypothesize fracture theories. Results: There were seven fractured esophageal SEMS, of which six were used to manage post-bariatric surgery complications. Five SEMS were deployed with their distal ends in the gastric antrum and proximal ends in the distal esophagus. All stents fractured within 9 weeks of deployment. Most stents (5/7) were at least 10 cm in length with fractures commonly occurring in the distal third of the stents (6/7). The wires of a fractured SEMS were embedded within the esophagogastric junction in one case, prompting the use of an overtube that was synchronously advanced while steadily extracting the stent. Discussion: We suggest the following four etiologies of SEMS fractures: anatomical, physiological, mechanical, and chemical. Stent curvature at the stomach incisura can lead to strain- and stress-related fatigue due to mechanical bending with exacerbation from respiratory movements. Physiologic factors (gastric body contractions) can result in repetitive squeezing of the stent, adding to metal fatigue. Intrinsic properties (long length and low axial force) may be contributing factors. Lastly, the stomach acidic environment may cause nitinol-induced chemical weakness. Despite the aforementioned theories, SEMS fracture etiology remains unclear. Until more data become available, it may be advisable to remove these stents within 6 weeks.
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Affiliation(s)
- Yazan Abboud
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mohamad Othman El Helou
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
- Department of General Surgery, Yale University, New Haven, CT 06510, USA
| | - Joseph Meza
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
| | - Jamil S. Samaan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
| | - Liliana Bancila
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
| | - Navkiran Randhawa
- Division of Gastroenterology and Hepatology, Augusta University, Augusta, GA 30912, USA;
| | - Kenneth H. Park
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
| | - Shahab Mehdizadeh
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
| | - Srinivas Gaddam
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
| | - Simon K. Lo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (M.O.E.H.); (J.M.); (J.S.S.); (L.B.); (K.H.P.); (S.M.); (S.G.)
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Priego-Parra BA, Triana-Romero A, Inurreta-Vásquez A, Laffitte-García H, Violante-Hernández GA, Jiménez-Rodríguez SS, Martínez-Pérez GP, Meixueiro-Daza A, Grube-Pagola P, Remes-Troche JM. Colorectal cancer screening program implementation: biennial adherence and participation patterns. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024:S2255-534X(24)00048-3. [PMID: 38862361 DOI: 10.1016/j.rgmxen.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/26/2023] [Indexed: 06/13/2024]
Abstract
INTRODUCTION AND AIM Adherence to colorectal cancer (CRC) screening is essential for the effectiveness of screening programs. Even though organized screening programs can improve the quality of the process and adherence, there are still challenges to overcome. The aim of the present study, in which we implemented a biennial organized screening program for CRC, was to describe adherence and participation patterns. MATERIALS AND METHODS A longitudinal, descriptive study was conducted, in which a team of trained patient navigators carried out interventions, with reminders via cellphone communication, to follow a cohort of 301 subjects eligible for CRC screening, utilizing a fecal immunochemical test (FIT). All the follow-up subjects received a FIT kit. RESULTS A total of 747 cellphone calls were made and divided into three interventions. From the initial cohort, 126 subjects completed their biennial screening process through the FIT, indicating a consistent adherence rate of 41.8% to our program. The participation patterns were: 126 consistent participants (41.8%), 160 inconsistent participants (53.2%), and 15 participants that were never contacted (5%). CONCLUSIONS In conclusion, our study underlines the importance of organized screening programs in the early detection of CRC. The implementation of follow-up interventions, through reminders and the training of patient navigators, can improve adherence, but there is a need for examining new strategies, to overcome barriers to communication via cellphone.
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Affiliation(s)
- B A Priego-Parra
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico.
| | - A Triana-Romero
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - A Inurreta-Vásquez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - H Laffitte-García
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - G A Violante-Hernández
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - S S Jiménez-Rodríguez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - G P Martínez-Pérez
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - A Meixueiro-Daza
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - P Grube-Pagola
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - J M Remes-Troche
- Departamento de Fisiología y Motilidad Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
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179
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Issa MA, Clementsen PF, Laursen CB, Christiansen IS, Crombag L, Vilmann P, Bodtger U. Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer. Eur Clin Respir J 2024; 11:2362995. [PMID: 38859948 PMCID: PMC11164041 DOI: 10.1080/20018525.2024.2362995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
Background Bronchoscopy and EBUS are standard procedures in lung cancer work-up but have low diagnostic yield in lesions outside the central airways and hilar/mediastinal lymph nodes. Growing evidence on introducing the EBUS endoscope into the oesophagus (EUS-B) in the same session as bronchoscopy/EBUS gives access to new anatomical areas that can be safely biopsied. Objective To summarize the current evidence of the added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in lung cancer work-up. Methods A narrative review. Results Few randomized trials or prospective studies are available. Prospective studies show that add-on EUS-B-FNA increases diagnostic yield when sampling abnormal mediastinal lymph nodes, para-oesophageal lung and left adrenal gland. A large retrospective series on EUS-B-FNA from retroperitoneal lymph nodes suggests high diagnostic yield without safety concerns, as do casuistic reports on EUS-B-FNA from mediastinal pleural thickening, pancreatic lesions, ascites fluid and pericardial effusions. No study has systematically assessed both diagnostic yield, safety, patient reported outcomes, adverse events and costs. Conclusion The diagnostic value of add-on EUS-B to standard bronchoscopy and EBUS in lung cancer work-up appears very promising without safety concerns, giving the pulmonologist access to a variety of sites out of reach with other minimally invasive techniques. Little is known on patient-reported outcomes and costs. Future and prospective research should focus on effectiveness aspects to clarify whether overall benefits of add-on EUS-B sufficiently exceed overall downsides.
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Affiliation(s)
- Mohammad A. Issa
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
| | - Paul F. Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida S. Christiansen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Laurence Crombag
- Department of Respiratory Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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180
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Bashkin O, Boltean R, Ben-Lulu R, Aharon M, Elhayany R, Yitzhak A, Guterman R, Abu-Freha N. A Patient-Centered Approach to Communication during Endoscopic Procedures: The Importance of Providing Information to Patients. Eur J Investig Health Psychol Educ 2024; 14:1688-1699. [PMID: 38921077 PMCID: PMC11202659 DOI: 10.3390/ejihpe14060111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
The study aimed to explore patients' experiences and perceptions throughout the various stages of endoscopic procedures and examine the association between patient-centered communication and the patient's experience. A total of 191 patients responded to pre- and post-procedure surveys that inquired about fear and pain, patients' satisfaction regarding the information provided to them, perceptions and experience. Pain was associated with post-procedure fear (r = 0.63, p < 0.01) and negatively associated with reported patient experience at the end of the visit (r = -0.17, p < 0.01). Significant positive associations were found between patient experience and satisfaction from the information provided before (r = 0.47, p < 0.01) and the information provided after the procedure (r = 0.51, p < 0.001). A predictive model found that perceptions toward the physicians, satisfaction from information provided before discharge, and feelings of trust are predictors of the patient experience (F = 44.9, R2 = 0.61, p < 0.001). Patients' satisfaction with information provided before and after the procedure can positively affect the patients' experience, leading to a decrease in fear and anxiety and increasing compliance with medical recommendations. Strategies for PCC with endoscopic patients should be developed and designed in a participatory manner, taking into account the various aspects associated with the patient experience.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
| | - Rita Boltean
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
| | - Revaya Ben-Lulu
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
| | - Mor Aharon
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
| | - Ruhama Elhayany
- Assuta Medical Center, Beer-Sheva 8489507, Israel; (R.E.); (A.Y.); (R.G.)
| | - Avraham Yitzhak
- Assuta Medical Center, Beer-Sheva 8489507, Israel; (R.E.); (A.Y.); (R.G.)
| | - Revital Guterman
- Assuta Medical Center, Beer-Sheva 8489507, Israel; (R.E.); (A.Y.); (R.G.)
| | - Naim Abu-Freha
- Assuta Medical Center, Beer-Sheva 8489507, Israel; (R.E.); (A.Y.); (R.G.)
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181
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Iacucci M, Santacroce G, Majumder S, Morael J, Zammarchi I, Maeda Y, Ryan D, Di Sabatino A, Rescigno M, Aburto MR, Cryan JF, Ghosh S. Opening the doors of precision medicine: novel tools to assess intestinal barrier in inflammatory bowel disease and colitis-associated neoplasia. Gut 2024:gutjnl-2023-331579. [PMID: 38851294 DOI: 10.1136/gutjnl-2023-331579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/18/2024] [Indexed: 06/10/2024]
Abstract
Mounting evidence underscores the pivotal role of the intestinal barrier and its convoluted network with diet and intestinal microbiome in the pathogenesis of inflammatory bowel disease (IBD) and colitis-associated colorectal cancer (CRC). Moreover, the bidirectional association of the intestinal barrier with the liver and brain, known as the gut-brain axis, plays a crucial role in developing complications, including extraintestinal manifestations of IBD and CRC metastasis. Consequently, barrier healing represents a crucial therapeutic target in these inflammatory-dependent disorders, with barrier assessment predicting disease outcomes, response to therapy and extraintestinal manifestations.New advanced technologies are revolutionising our understanding of the barrier paradigm, enabling the accurate assessment of the intestinal barrier and aiding in unravelling the complexity of the gut-brain axis. Cutting-edge endoscopic imaging techniques, such as ultra-high magnification endocytoscopy and probe-based confocal laser endomicroscopy, are new technologies allowing real-time exploration of the 'cellular' intestinal barrier. Additionally, novel advanced spatial imaging technology platforms, including multispectral imaging, upconversion nanoparticles, digital spatial profiling, optical spectroscopy and mass cytometry, enable a deep and comprehensive assessment of the 'molecular' and 'ultrastructural' barrier. In this promising landscape, artificial intelligence plays a pivotal role in standardising and integrating these novel tools, thereby contributing to barrier assessment and prediction of outcomes.Looking ahead, this integrated and comprehensive approach holds the promise of uncovering new therapeutic targets, breaking the therapeutic ceiling in IBD. Novel molecules, dietary interventions and microbiome modulation strategies aim to restore, reinforce, or modulate the gut-brain axis. These advancements have the potential for transformative and personalised approaches to managing IBD.
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Affiliation(s)
- Marietta Iacucci
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Giovanni Santacroce
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Snehali Majumder
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jennifer Morael
- APC Microbiome Ireland, Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
| | - Irene Zammarchi
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Yasuharu Maeda
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
| | - David Ryan
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Maria Rescigno
- IRCSS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Maria R Aburto
- APC Microbiome Ireland, Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Ireland, Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, Cork, Ireland
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Fahmy SN, Khedr LH, Wahdan SA, Menze ET, Azab SS, El-Demerdash E. Effect of carvedilol on pharmacokinetics of sofosbuvir and its metabolite GS-331007: role of P-glycoprotein. J Pharm Pharmacol 2024:rgae070. [PMID: 38850570 DOI: 10.1093/jpp/rgae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
Sofosbuvir (SOF) is a P-glycoprotein (P-gp) substrate, and carvedilol (CAR) is an inhibitor of P-gp, suggesting that it may affect the oral pharmacokinetics and safety of SOF. The current study investigated the pharmacokinetic interaction of CAR with SOF and its metabolite, GS-331007, and the possible consequent toxicities in rats. To assess the pharmacokinetics of SOF and GS-331007, rats were divided into three groups; all received a single oral dose of SOF preceded with saline (SAL), verapamil (VER) as a standard P-gp inhibitor, or CAR, respectively. The serosal, plasma, and hepatic tissue contents of SOF and GS-331007 were assessed using LC-MS/MS. Renal and hepatic toxicities were assessed using biochemical and histopathological tests. Serosal and plasma concentrations of SOF and GS-331007 were increased in the presence of CAR, suggesting a significant inhibitory effect of CAR on intestinal P-gp. Simultaneously, the pharmacokinetic profile of SOF showed a significant increase in the Cmax, AUC(0-t), AUC (0-∞), t1/2, and a reduction in its apparent oral clearance. While the pharmacokinetic profile of GS-331007 was not significantly affected. However, this notable elevation in drug oral bioavailability was corroborated by a significant alteration in renal functions. Hence, further clinical investigations are recommended to ensure the safety and dosing of CAR/SOF combination.
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Affiliation(s)
- Salma N Fahmy
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
| | - Lobna H Khedr
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
| | - Sara A Wahdan
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
- Preclinical & Translational Research Center, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Esther T Menze
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Samar S Azab
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ebtehal El-Demerdash
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
- Preclinical & Translational Research Center, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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183
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Dương TQ, Soldera J. Virtual reality tools for training in gastrointestinal endoscopy: A systematic review. Artif Intell Gastrointest Endosc 2024; 5:92090. [DOI: 10.37126/aige.v5.i2.92090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/11/2024] [Accepted: 04/07/2024] [Indexed: 05/11/2024] Open
Abstract
BACKGROUND Virtual reality (VR) has emerged as an innovative technology in endoscopy training, providing a simulated environment that closely resembles real-life scenarios and offering trainees a valuable platform to acquire and enhance their endoscopic skills. This systematic review will critically evaluate the effectiveness and feasibility of VR-based training compared to traditional methods.
AIM To evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. By examining the current state of the field, this review seeks to identify gaps, challenges, and opportunities for further research and implemen-tation of VR in endoscopic training.
METHODS The study is a systematic review, following the guidelines for reporting systematic reviews set out by the PRISMA statement. A comprehensive search command was designed and implemented and run in September 2023 to identify relevant studies available, from electronic databases such as PubMed, Scopus, Cochrane, and Google Scholar. The results were systematically reviewed.
RESULTS Sixteen articles were included in the final analysis. The total number of participants was 523. Five studies focused on both upper endoscopy and colonoscopy training, two on upper endoscopy training only, eight on colon-oscopy training only, and one on sigmoidoscopy training only. Gastro-intestinal Mentor virtual endoscopy simulator was commonly used. Fifteen reported positive results, indicating that VR-based training was feasible and acceptable for endoscopy learners. VR technology helped the trainees enhance their skills in manipulating the endoscope, reducing the procedure time or increasing the technical accuracy, in VR scenarios and real patients. Some studies show that the patient discomfort level decreased significantly. However, some studies show there were no significant differences in patient discomfort and pain scores between VR group and other groups.
CONCLUSION VR training is effective for endoscopy training. There are several well-designed randomized controlled trials with large sample sizes, proving the potential of this innovative tool. Thus, VR should be more widely adopted in endoscopy training. Furthermore, combining VR training with conventional methods could be a promising approach that should be implemented in training.
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Affiliation(s)
- Tuấn Quang Dương
- Department of Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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184
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Yi LZ, Zhao SB. Endoscopic band ligation or endoscopic tissue adhesive injection in the treatment of gastric varices: Which is better? World J Gastroenterol 2024; 30:2827-2828. [PMID: 38899333 PMCID: PMC11185297 DOI: 10.3748/wjg.v30.i21.2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024] Open
Abstract
The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies. Moreover, the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.
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Affiliation(s)
- Li-Zhi Yi
- Department of Gastroenterology, The People’s Hospital of Leshan, Leshan 614000, Sichuan Province, China
| | - Sheng-Bing Zhao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai 200433, China
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185
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Jangan A, Watts E, Pankhania M. Coin-cidence? Have cashless payments reduced the incidence of upper aerodigestive foreign body insertion? A study of UK Hospital Episode Statistics. Ann R Coll Surg Engl 2024. [PMID: 38836371 DOI: 10.1308/rcsann.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES Insertions of nasal and oral foreign bodies (FB) are common presentations in the emergency department, with coins frequently implicated among paediatric populations. Contactless payments were first introduced in the UK in 2007, and cash payments significantly declined from 2012. This study aims to explore the potential implications of increasing contactless payments on FB ingestion. METHODS UK Hospital Episode Statistics (HES) were reviewed between 2000 and 2022. All FB retrieval procedures involving the alimentary tract, respiratory tract and nasal cavity were included. Regression analysis was performed to assess trends in the incidence of FB ingestion before and following the transition to cashless payments in 2012. RESULTS Following the decline in cash payments in 2012, the frequency of alimentary tract FB removal procedures decreased significantly by 27.78 procedures per year (p < 0.001). Similarly, respiratory FB removal procedure decreased by 4.83 per year (p = 0.009) and nasal cavity FB removal procedures decreased by 52.82 per year (p < 0.001). CONCLUSIONS This study suggests a statistically significant decline in the number of procedures for removal of FB performed in the UK from 2012. Although this relationship is multifactorial, our data suggest an association between the introduction of contactless payments and a reduction in the number of FB retrieval procedures from the of upper aerodigestive tract.
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Affiliation(s)
- A Jangan
- Walsall Healthcare NHS Trust, UK
| | - E Watts
- University Hospitals Birmingham NHS Foundation Trust, UK
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186
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Neitzel E, Salahudeen O, Mueller PR, Kambadakone A, Srinivas-Rao S, vanSonnenberg E. Part 2: Current Concepts in Radiologic Imaging & Intervention in Acute Biliary Tract Diseases. J Intensive Care Med 2024:8850666241259420. [PMID: 38839242 DOI: 10.1177/08850666241259420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Acute cholangitis is encountered commonly in critically ill, often elderly, patients. The most common causes of cholangitis include choledocholithiasis, biliary strictures, and infection from previous endoscopic, percutaneous, or surgical intervention of the biliary tract. Rare causes of acute cholangitis in the United States include sclerosing cholangitis and recurrent pyogenic cholangitis, the latter predominantly occurring in immigrants of Asian descent. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, gastroenterologists, endoscopists, and infectious disease physicians typically involved in the care of these patients. In this paper intended for intensivists predominantly, we will review the imaging findings and radiologic interventional management of critically ill patients with acute cholangitis, primary and secondary sclerosing cholangitis, and recurrent pyogenic cholangitis.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
| | - Owais Salahudeen
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric vanSonnenberg
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States
- Departments of Radiology and Student Affairs, Phoenix, AZ, United States
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187
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Shen L, Aslan E, Cao JJ, Shen J, Tse JR. Gastrointestinal devices: common and uncommon foreign bodies. Abdom Radiol (NY) 2024:10.1007/s00261-024-04336-2. [PMID: 38831074 DOI: 10.1007/s00261-024-04336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 06/05/2024]
Abstract
Devices for the gastrointestinal tract are widely available and constantly advancing with less invasive techniques. They play a crucial role in diagnostic and therapeutic interventions and are commonly placed by interventional radiologists, gastroenterologists, and surgeons. These devices frequently appear in imaging studies, which verify their proper placement, identify any complications, or may be incidentally detected. Radiologists must be able to identify these devices at imaging and understand their intended purpose to assess their efficacy, detect complications such as incorrect positioning, and avoid misinterpreting them as abnormalities. Furthermore, many patients with these devices may require MRI, making assessing compatibility essential for safe patient care. This review seeks to provide a succinct and practical handbook for radiologists regarding both common and uncommon gastrointestinal devices. In addition to textual descriptions of clinical indications, imaging findings, complications, and MRI compatibility, the review incorporates a summary table as a quick reference point for key information and illustrative images for each device.
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Affiliation(s)
- Luyao Shen
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, United States
| | - Emre Aslan
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, United States
| | - Jennie J Cao
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, United States
| | - Jody Shen
- Department of Radiology, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, United States
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, United States.
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Cocomazzi F, Carparelli S, Labarile N, Capogreco A, Gentile M, Maselli R, Dhar J, Samanta J, Repici A, Hassan C, Perri F, Facciorusso A. Is there a best choice of equipment for colorectal endoscopic submucosal dissection? Expert Rev Med Devices 2024:1-17. [PMID: 38829122 DOI: 10.1080/17434440.2024.2364022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Endoscopic submucosal dissection (ESD) is a widely used technique to remove early neoplastic lesions. It was primarily used in the initial days to treat gastric lesions, but recently, the horizon of this endoscopic procedure has expanded, which has allowed us to manage other technically more complex locations, such as the colorectum. AREAS COVERED There has been an exponential growth regarding the wide range of devices available in the market for performing colorectal ESD. As a result, the aim of this review is to highlight the indication of this endoscopic technique, which device is best suited for which indication, as well as future trajectories in this field. EXPERT OPINION Although some devices have proven to be more advantageous than others in this area, very often the choice is still subjective, which is commonly attributed to individual preferences and experience. However, an accurate knowledge of the available tools and their functioning, with their pros and cons, is fundamental for any endoscopist venturing into the field of third space endoscopy. In this way, one can choose which device best suits a particular situation, along with simultaneously having the wealth of knowledge related to therapeutic armamentarium at our disposal in the endoscopy suite.
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Affiliation(s)
- Francesco Cocomazzi
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Nunzia Labarile
- Department of Gastroenterology, National Institute of Gastroenterology - IRCCS "Saverio de Bellis" - Castellana Grotte, Bari, Italy
| | - Antonio Capogreco
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
| | - Marco Gentile
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Jahnvi Dhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Francesco Perri
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
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Yarur AJ, Chiorean MV, Panés J, Jairath V, Zhang J, Rabbat CJ, Sandborn WJ, Vermeire S, Peyrin-Biroulet L. Achievement of Clinical, Endoscopic, and Histological Outcomes in Patients with Ulcerative Colitis Treated with Etrasimod, and Association with Faecal Calprotectin and C-reactive Protein: Results From the Phase 2 OASIS Trial. J Crohns Colitis 2024; 18:885-894. [PMID: 38245818 PMCID: PMC11147797 DOI: 10.1093/ecco-jcc/jjae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/20/2023] [Accepted: 01/19/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND AIMS Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator for the treatment of moderately to severely active ulcerative colitis [UC]. This post-hoc analysis of the phase 2 OASIS trial [NCT02447302] evaluated its efficacy for endoscopic improvement-histologic remission [EIHR] and assessed correlation between faecal calprotectin [FCP] and C-reactive protein [CRP] levels with efficacy outcomes. METHODS In total, 156 adults with moderately to severely active UC received once-daily etrasimod (1 mg [n = 52]; 2 mg [n = 50]) or placebo [n = 54] for 12 weeks. Clinical, endoscopic, and histologic variables were evaluated at baseline and Week 12. EIHR was defined as achievement of endoscopic improvement [endoscopic subscore ≤ 1, without friability] and histologic remission [Geboes score < 2.0]. Outcomes included the relationships between FCP and CRP concentration and clinical, endoscopic, and histologic variables. RESULTS Achievement of EIHR was significantly higher in patients who received etrasimod 2 mg versus placebo [19.5% vs 4.1%; Mantel-Haenszel estimated difference, 15.4%; p = 0.010]. In the etrasimod 2 mg group, median FCP and CRP levels at Week 12 were significantly lower in patients who achieved clinical remission, endoscopic improvement, histologic remission, and EIHR versus patients who did not [all p < 0.05]. An FCP concentration cutoff of 250 µg/g achieved optimum sensitivity and specificity for efficacy, including EIHR [0.857 and 0.786, respectively; κ coefficient, 0.3584]. Higher proportions of patients with FCP ≤ 250 µg/g achieved efficacy outcomes at Week 12 versus patients with FCP > 250 µg/g. CONCLUSIONS Etrasimod was effective for inducing EIHR in patients with UC. FCP and CRP may be useful, noninvasive biomarkers to monitor treatment response. CLINICALTRIALS.GOV NUMBER NCT02447302.
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Affiliation(s)
| | | | - Julián Panés
- Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - Jinkun Zhang
- Arena Pharmaceuticals, Inc, San Diego, CA, USA, a wholly owned subsidiary of Pfizer Inc, New York, NY, USA
| | - Christopher J Rabbat
- Arena Pharmaceuticals, Inc, San Diego, CA, USA, a wholly owned subsidiary of Pfizer Inc, New York, NY, USA
| | | | | | - Laurent Peyrin-Biroulet
- INSERM, NGERE, University of Lorraine, F54000 Nancy, France
- Groupe Hospitalier Privé Ambroise Paré - Hartmann, Paris IBD Center, 92200 Neuilly-sur-Seine, France
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190
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Chavoshi M, Zamani S, Kolahdoozan S, Radmard AR. Diagnostic value of MR and CT enterography in post-operative recurrence of Crohn's disease: a systematic review and meta-analysis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04394-6. [PMID: 38829393 DOI: 10.1007/s00261-024-04394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/17/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Post-operative recurrence is a critical issue in the surveillance of Crohn's disease after ileocecal resection. This meta-analysis aims to assess the diagnostic yield of enterography techniques in post-operative recurrence of Crohn's disease. A systematic electronic bibliographic databases search was conducted. The inclusion criteria of original articles were: Utilized MR enterography or CT enterography after ileocolonic resection; Documented recurrence by ileo-colonoscopy (Rutgeerts' score ≥ i2); Provided crude data of diagnostic performance. A random-effect method was used for analysis. Relative risk and diagnostic value of each imaging feature were calculated. Eleven studies (11 populations and 589 patients) were included (4 CTE and 7 MRE with 248 and 341 patients, respectively). The pooled sensitivity and specificity of the enterography were 91% (95% CI: 0.85-0.95) and 75% (95% CI: 0.56-0.87), respectively. The pooled sensitivity and specificity of CTE were 93% (95% CI: 0.87-0.96) and 67% (95% CI: 0.35-0.90), respectively. MRE revealed pooled sensitivity and specificity of 90% (95% CI: 0.78-0.96) and 78% (95% CI: 0.57-0.90), respectively. The inter-study heterogeneity was low for sensitivity (I2 = 29%, p-value = 0.17) and high for specificity (I2 = 85%, p-value < 0.01). Wall enhancement, anastomosis wall thickening, anastomosis stenosis, pre-anastomotic dilatation, penetrating lesion, comb sign, and perivisceral edema were significantly higher in POR patients. Wall thickening and penetrating lesion were the most sensitive (81%) and specific (97%) findings, respectively. MRE and CTE exhibit high sensitivity and acceptable specificity (especially MRE) for detection of recurrence in Crohn's disease which makes them an effective initial screening tool and reserves ileo-colonoscopy for those patients with inconclusive enterography results.
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Affiliation(s)
- Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Zamani
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Kolahdoozan
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Tehran University of Medical Sciences, Shariati Hospital, 14117, North Kargar St., Tehran, Iran.
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191
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Dai H, Xiao Y, Fu C, Grimm R, von Busch H, Stieltjes B, Choi MH, Xu Z, Chabin G, Yang C, Zeng M. Deep Learning-Based Approach for Identifying and Measuring Focal Liver Lesions on Contrast-Enhanced MRI. J Magn Reson Imaging 2024. [PMID: 38826142 DOI: 10.1002/jmri.29404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The number of focal liver lesions (FLLs) detected by imaging has increased worldwide, highlighting the need to develop a robust, objective system for automatically detecting FLLs. PURPOSE To assess the performance of the deep learning-based artificial intelligence (AI) software in identifying and measuring lesions on contrast-enhanced magnetic resonance imaging (MRI) images in patients with FLLs. STUDY TYPE Retrospective. SUBJECTS 395 patients with 1149 FLLs. FIELD STRENGTH/SEQUENCE The 1.5 T and 3 T scanners, including T1-, T2-, diffusion-weighted imaging, in/out-phase imaging, and dynamic contrast-enhanced imaging. ASSESSMENT The diagnostic performance of AI, radiologist, and their combination was compared. Using 20 mm as the cut-off value, the lesions were divided into two groups, and then divided into four subgroups: <10, 10-20, 20-40, and ≥40 mm, to evaluate the sensitivity of radiologists and AI in the detection of lesions of different sizes. We compared the pathologic sizes of 122 surgically resected lesions with measurements obtained using AI and those made by radiologists. STATISTICAL TESTS McNemar test, Bland-Altman analyses, Friedman test, Pearson's chi-squared test, Fisher's exact test, Dice coefficient, and intraclass correlation coefficients. A P-value <0.05 was considered statistically significant. RESULTS The average Dice coefficient of AI in segmentation of liver lesions was 0.62. The combination of AI and radiologist outperformed the radiologist alone, with a significantly higher detection rate (0.894 vs. 0.825) and sensitivity (0.883 vs. 0.806). The AI showed significantly sensitivity than radiologists in detecting all lesions <20 mm (0.848 vs. 0.788). Both AI and radiologists achieved excellent detection performance for lesions ≥20 mm (0.867 vs. 0.881, P = 0.671). A remarkable agreement existed in the average tumor sizes among the three measurements (P = 0.174). DATA CONCLUSION AI software based on deep learning exhibited practical value in automatically identifying and measuring liver lesions. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Haoran Dai
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyao Xiao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Robert Grimm
- MR Predevelopment, Siemens Healthineers AG, Erlangen, Germany
| | - Heinrich von Busch
- Innovation Owner Artificial Intelligence for Oncology, Siemens Healthineers AG, Erlangen, Germany
| | | | - Moon Hyung Choi
- Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Zhoubing Xu
- Technology Excellence, Digital Technology and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Guillaume Chabin
- Technology Excellence, Digital Technology and Innovation, Siemens Healthecare SAS, Paris, France
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
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192
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Lee S, Choi JW, Chung IS, Kim TJ, Sim WS, Park S, Ahn HJ. Comparison of high-flow nasal cannula and conventional nasal cannula during deep sedation for endoscopic submucosal dissection: a randomized controlled trial. J Anesth 2024:10.1007/s00540-024-03352-2. [PMID: 38824469 DOI: 10.1007/s00540-024-03352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE Adequate oxygenation and airway management during deep sedation can be challenging. We investigated the effect of high-flow nasal cannula (group HF) and conventional nasal cannula (group CO) during sedation for endoscopic submucosal dissection (ESD). METHODS Patients undergoing ESD with deep sedation were enrolled. The primary outcome was difference in lowest oxygen saturation (SpO2) between the groups. Incidence of hypoxia (SpO2 < 90%), patients with SpO2 < 95%, hypercapnia, and airway interventions; operator satisfaction; and adverse events were recorded. RESULTS Thirty-two patients in each group completed the study. The mean of minimum SpO2 values was significantly higher in group HF than in group CO (96.8% ± 4.2% vs. 93.3% ± 5.3%, p = 0.005). The incidence of hypoxia was comparable between the groups (4 [12.5%] vs. 6 [18.8%], p = 0.491); however, patients with SpO2 < 95% were significantly less in group HF (5 [15.6%] vs. 18 [56.3%], p = 0.003). Incidence of hypercapnia was higher in group HF than in group CO (14 [46.7%] vs. 5 [16.7%], p = 0.013). Airway rescue interventions were significantly less common in group HF. Satisfaction of operators and post-procedural complications were comparable between the two groups. In multivariable analysis, group CO and higher body mass index were risk factors for airway managements (odds ratio [95% confidence interval]: 6.204 [1.784-21.575], p = 0.004; 1.337 [1.043-1.715], p = 0.022, respectively). CONCLUSIONS Compared to conventional nasal cannula, high-flow nasal cannula maintained higher minimum SpO2 value during deep sedation with propofol-remifentanil for ESD. TRIAL REGISTRATION Clinical Trial Registry of the Republic of Korea (KCT0006618, https://cris.nih.go.kr ; registered September 29, 2021; principal investigator: Ji Won Choi).
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Affiliation(s)
- Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Tae Jun Kim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Seojin Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
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193
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Krige JE, Jonas EG, Bernon MM. The safety profile of endoscopic variceal ligation in patients with esophageal varices. Hepatol Int 2024; 18:1060-1061. [PMID: 38117408 DOI: 10.1007/s12072-023-10619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Jake E Krige
- Surgical Gastroenterology and HPB Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, and Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| | - Eduard G Jonas
- Surgical Gastroenterology and HPB Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, and Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Marc M Bernon
- Surgical Gastroenterology and HPB Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, and Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, 7925, South Africa
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194
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Canakis A, Gilman AJ, Baron TH. Management of biliary complications in liver transplant recipients using a fully covered self-expandable metal stent with antimigration features. Minerva Gastroenterol (Torino) 2024; 70:181-186. [PMID: 37162469 DOI: 10.23736/s2724-5985.23.03343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Following liver transplant (LT) with duct-to-duct anastomosis, biliary strictures and leaks are typically managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting. While multiple side-by-side plastic stents are typically used for management of anastomotic strictures, fully covered self-expandable metal stents (FCSEMS) can be used to decrease the number of ERCPs with longer periods of stent patency. The risk of migration can limit their use. FCSEMS with antimigration fins to manage benign biliary complications following LT may provide stricture resolution with limited adverse events (AEs). METHODS Single center retrospective study of LT patients who required FCSEMS from 1/2014 to 4/2022. Primary outcomes included stricture resolution and recurrence. Secondary outcomes were stent migration, occlusion, removability, and number of ERCPs. RESULTS Forty-three patients (mean age 55.5 years) with anastomotic strictures (N.=37), bile leaks (N.=4) or both (N.=2) were included. The median time from LT to FCSEMS placement was 125 days. Within one year of LT, 31 patients required intervention; early intervention at less than 30 and 90 days was needed in 7 and 19 patients, respectively. The median length of follow-up was 816.5 days. Stricture resolution was seen in 35 patients (81%) after a median stent dwell time of 130.5 days; recurrence occurred in 8 patients. There were three instances of partial stent migration that did not require reintervention or interfere with removability. The mean number of ERCPs required was 2.5. CONCLUSIONS The use of a FCSEMS with antimigration features yields effective stricture resolution with longer stent dwell times and fewer ERCPs.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew J Gilman
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA -
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195
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Maselli DB, Donnangelo LL, Jirapinyo P, Thompson CC, McGowan CE. Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting. Am J Gastroenterol 2024; 119:1047-1055. [PMID: 38634547 DOI: 10.14309/ajg.0000000000002821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous. As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. In this review, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.
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Affiliation(s)
| | | | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
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196
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Nabi Z, Reddy DN. Endoscopic full thickness resection: techniques, applications, outcomes. Expert Rev Gastroenterol Hepatol 2024; 18:257-269. [PMID: 38779710 DOI: 10.1080/17474124.2024.2357611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) represents a pivotal advancement in the minimally invasive treatment of gastrointestinal lesions, offering a novel approach for the management of lesions previously deemed challenging or unreachable through conventional endoscopic techniques. AREAS COVERED This review discusses the development, methodologies, applications, and clinical outcomes associated with EFTR, including exposed and device-assisted EFTR, the integration of endoscopic mucosal resection with EFTR in hybrid techniques, and the collaborative approach between laparoscopic and endoscopic surgery (LECS). It encapsulates a comprehensive analysis of the various EFTR techniques tailored to specific lesion characteristics and anatomical locations, underscoring the significance of technique selection based on the lesion's nature and situational context. EXPERT OPINION/COMMENTARY The review underscores EFTR's transformative role in expanding therapeutic horizons for gastrointestinal tumors, emphasizing the importance of technique selection tailored to the unique attributes of each lesion. It highlights EFTR's capacity to facilitate organ-preserving interventions, thereby significantly enhancing patient outcomes and reducing procedural complications. EFTR is a cornerstone in the evolution of gastrointestinal surgery, marking a significant leap forward in the pursuit of precision, safety, and efficacy in tumor management.
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Affiliation(s)
- Zaheer Nabi
- Department of Gastroenterology, Asian institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian institute of Gastroenterology, Hyderabad, India
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197
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Nijjar GS, Aulakh SK, Singh R, Chandi SK. Emerging Technologies in Endoscopy for Gastrointestinal Neoplasms: A Comprehensive Overview. Cureus 2024; 16:e62946. [PMID: 39044885 PMCID: PMC11265259 DOI: 10.7759/cureus.62946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/25/2024] Open
Abstract
Gastrointestinal neoplasms are a growing global health concern, requiring prompt identification and treatment. Endoscopic procedures have revolutionized the detection and treatment of gastrointestinal tumors by providing accurate, minimally invasive methods. Early-stage malignancies can be treated with endoscopic excision, leading to improved outcomes and increased survival rates. Precancerous lesions, like adenomatous polyps, can be prevented by removing them, reducing cancer occurrence and death rates. Advanced techniques like chromoendoscopy, narrow-band imaging, and confocal laser endomicroscopy improve the ability to see the mucosa surface and diagnose conditions. Artificial Intelligence (AI) applications in endoscopy can enhance diagnostic accuracy and predict histology outcomes. However, challenges remain in accurately defining lesions and ensuring precise diagnosis and treatment selection. Molecular imaging approaches and therapeutic modalities like photodynamic therapy and endoscopic ultrasonography-guided therapies hold potential but require further study and clinical confirmation. This study examines the future prospects and obstacles in endoscopic procedures for the timely identification and treatment of gastrointestinal cancers. The focus is on developing technology, limits, and prospective effects on clinical practice.
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Affiliation(s)
| | - Smriti Kaur Aulakh
- Internal Medicine, Sri Guru Ram Das University of Health Science and Research, Amritsar, IND
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198
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Rady NA, Parrish J. Perforation of the Terminal Ileum Secondary to Mucosal Damage of Enteroaggregative Escherichia coli and a Toothpick. Cureus 2024; 16:e62495. [PMID: 39022518 PMCID: PMC11253569 DOI: 10.7759/cureus.62495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) is a common form of E. coli that causes gastroenteritis and diarrhea worldwide. Biofilm formation on the intestinal mucosa initiates an inflammatory cascade in the gastrointestinal tissue, which has significant destructive effects on the mucosa of the small and large intestines. Small bowel obstruction and perforation due to a foreign body are uncommon, but the risk increases with pre-existing conditions such as the presence of intestinal strictures, inflammation, and mucosal ulceration. We present a unique case of acute enteritis from EAEC with mucosal ulceration and perforation because of co-ingestion of foreign body and impaction with the presence of stricture in the terminal ileum. This was treated with small bowel resection and primary anastomosis. The patient was successfully discharged from the hospital. The clinical features and pathological findings of enteric EAEC infection are described. To our knowledge, intestinal perforation and secondary peritonitis related to EAEC enteric infection, with mucosal ulceration and perforation secondary to co-ingestion of a foreign body with intestinal stricture, have not been documented. In this case, EAEC was associated with terminal ileum mucosal ulceration and complicated by perforation secondary to foreign body impaction along with ileal stricture. These compounding effects likely explain gastrointestinal tract perforation and secondary peritonitis.
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Affiliation(s)
- Nora A Rady
- Research, Edward Via College of Osteopathic Medicine - Louisiana Campus, Monroe, USA
| | - James Parrish
- Surgery, Christus St. Frances Cabrini Hospital, Alexandria, USA
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199
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Yasen A, Feng J, Dai TX, Zhu CH, Liang RB, Liao ZH, Li K, Cai YH, Wang GY. Management of anastomotic biliary stricture through utilizing percutaneous transhepatic cholangioscopy. Clin Radiol 2024; 79:e868-e877. [PMID: 38548547 DOI: 10.1016/j.crad.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/23/2024] [Accepted: 02/18/2024] [Indexed: 05/07/2024]
Abstract
AIM Occurrence of anastomotic biliary stricture (AS) remains an essential issue following hepatobiliary surgeries, and percutaneous transhepatic cholangioscopy (PTCS) has great therapeutic significance in handling refractory AS for patients with altered gastrointestinal anatomy after cholangio-jejunostomy. This present study aimed to investigate feasibility of PTCS procedures in AS patients for therapeutic indications. MATERIALS AND METHODS This study was a single-center, retrospective cohort study with a total number of 124 consecutive patients who received therapeutic PTCS due to AS. Clinical success rate, required number, and adverse events of therapeutic PTCS procedures as well as patients survival state were reviewed. RESULTS These 124 patients previously underwent choledochojejunostomy or hepatico-jejunostomy, and there was post-surgical altered gastrointestinal anatomy. Overall, 366 therapeutic PTCS procedures were performed for these patients through applying rigid choledochoscope, and the median time of PTCS procedures was 3 (1-11). Among these patients, there were 34 cases (27.32%) accompanied by biliary strictures and 100 cases (80.65%) were also combined with biliary calculi. After therapeutic PTCS, most patients presented with relieved clinical manifestations and improved liver functions. The median time of follow-up was 26 months (2-86 months), and AS was successfully managed through PTCS procedures in 104 patients (83.87%). During the follow-up period, adverse events occurred in 81 cases (65.32%), most of which were tackled through supportive treatment. CONCLUSION PTCS was a feasible, safe and effective therapeutic modality for refractory AS, which may be a promising alternative approach in clinical cases where the gastrointestinal anatomy was changed after cholangio-jejunostomy.
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Affiliation(s)
- Aimaiti Yasen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Jun Feng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Tian-Xing Dai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Can-Hua Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Run-Bin Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Zhi-Hong Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Kai Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Yu-Hong Cai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
| | - Guo-Ying Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China.
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Fukuda S, Hijioka S, Nagashio Y, Maruki Y, Ohba A, Agarie D, Hagiwara Y, Hara H, Okamoto K, Yamashige D, Yagi S, Kuwada M, Chatto M, Kondo S, Morizane C, Ueno H, Saito Y, Okusaka T. Feasibility and safety of a novel plastic stent designed specifically for endoscopic ultrasound-guided pancreatic duct drainage. Endosc Int Open 2024; 12:E715-E722. [PMID: 38841434 PMCID: PMC11150017 DOI: 10.1055/a-2294-8517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/15/2024] [Indexed: 06/07/2024] Open
Abstract
Background and study aims Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is emerging as an effective alternative treatment for obstructive pancreatitis after unsuccessful endoscopic retrograde pancreatography (ERP). However, the high incidence of adverse events associated with EUS-PD (approximately 20%) remains an issue. Recently, we developed a novel plastic stent for EUS-PD, with a radiopaque marker positioned at approximately one-third of the length from the distal end of the stent and side holes positioned exclusively distal to the marker. This study aimed to evaluate the feasibility and safety of using this stent in EUS-PD. Patients and methods We retrospectively reviewed data from 10 patients who underwent EUS-PD with the novel plastic stent at the National Cancer Center Hospital between March 2021 and October 2023. Technical and clinical success, procedure times, adverse events (AEs), recurrent pancreatic duct obstruction (RPO), and time to RPO were assessed. Results Of the 10 patients, five had postoperative benign pancreaticojejunal anastomotic strictures and five had malignant pancreatic duct obstruction. The technical and clinical success rates were both 100% (10/10). An AE (self-limited abdominal pain) occurred in one patient (10.0%). Two patients (20.0%) died of their primary disease during the follow-up period (median, 44 days; range, 25-272 days). The incidence of RPO was 10.0% (1/10), and the 3-month non-RPO rate was 83.3%. Conclusions The novel plastic stent shows potential as a useful and safe tool in EUS-PD.
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Affiliation(s)
- Soma Fukuda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Daiki Agarie
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuya Hagiwara
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hidenobu Hara
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Okamoto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Daiki Yamashige
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shin Yagi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaru Kuwada
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Mark Chatto
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Medicine, Makati Medical Center, Manila, Philippines
| | - Shunsuke Kondo
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
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