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Manthopoulou E, Ramai D, Dhar J, Samanta J, Ioannou A, Lusina E, Sacco R, Facciorusso A. Cholangiocarcinoma in the Era of Immunotherapy. Vaccines (Basel) 2023; 11:1062. [PMID: 37376451 DOI: 10.3390/vaccines11061062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Cholangiocarcinoma (CCA) is a rare malignancy of the gastrointestinal tract, with aggressive behavior, and portends a poor prognosis. Traditionally, it is classified according to its site of involvement as intrahepatic, perihilar, and distal cholangiocarcinoma. A host of genetic and epigenetic factors have been involved in its pathogenesis. Chemotherapy has remained the standard first-line treatment over the last decade, with a disappointing median overall survival of 11 months for locally advanced and metastatic CCA. The advent of immunotherapy has revolutionized the treatment of many pancreaticobiliary malignancies, offering durable responses with a safe therapeutic profile. To date, there have been no significant advances in the management of CCA. Novel immunotherapeutic methods, such as cancer vaccines, adoptive cell therapy, and combinations of immune checkpoint inhibitors with other agents, are currently under investigation and may improve prognosis with overall survival. Efforts to find robust biomarkers for response to treatment along with multiple clinical trials are also ongoing in this regard. In this review, we present an overview of the current advances and the future perspectives of immunotherapy in the management of CCA.
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Affiliation(s)
- Eleni Manthopoulou
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, 11522 Athens, Greece
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 801385, USA
| | - Jahnvi Dhar
- Department of Gastroenterology, Sohana Multi-Speciality Hospital, Mohali 140308, India
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Alexandros Ioannou
- Department of Gastroenterology, Alexandra General Hospital, Lourou 4-2, 11528 Athens, Greece
| | - Ekaterina Lusina
- Therapeutic Unit, Gastroenterology Department, Chaika Clinics, Lesnaya Street 9, 125196 Moscow, Russia
| | - Rodolfo Sacco
- Department Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Antonio Facciorusso
- Department Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy
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Manthopoulou E, Ramai D, Ioannou A, Gkolfakis P, Papanikolaou IS, Mangiavillano B, Triantafyllou K, Crinò SF, Facciorusso A. Endoscopic ultrasound-guided tissue acquisition beyond the pancreas. Ann Gastroenterol 2023; 36:257-266. [PMID: 37144012 PMCID: PMC10152811 DOI: 10.20524/aog.2023.0797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023] Open
Abstract
Endoscopic ultrasound (EUS) offers the ability to obtain tissue material via a fine needle under direct visualization for cytological or pathological examination. Prior studies have looked at EUS tissue acquisition; however, most reports have been centered around lesions of the pancreas. This paper aims to review the literature on EUS tissue acquisition in other organs (beyond the pancreas) such as the liver, biliary tree, lymph nodes, and upper and lower gastrointestinal tracts. Furthermore, techniques for obtaining tissue samples under EUS guidance continue to evolve. Specifically, some of the techniques that endoscopists employ are suction techniques (i.e., dry heparin, dry suction technique, wet suction technique), the slow pull technique, and the fanning technique. Apart from acquisition techniques, the type and size of the needle utilized play a major role in the quality of samples. This review describes the indications for tissue acquisition for each organ, and also describes and compares the various tissue acquisition techniques, as well as the different needles used according to their shape and size.
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Affiliation(s)
- Eleni Manthopoulou
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Greece (Eleni Manthopoulou)
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai)
| | - Alexandros Ioannou
- Gastroenterology Department, Alexandra General Hospital, Athens, Greece (Alexandros Ioannou)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium (Paraskevas Gkolfakis)
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA), Italy (Benedetto Mangiavillano)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy (Stefano Francesco Crinò)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy (Antonio Facciorusso)
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Kypraios D, Manthopoulou E, Dimitroulopoulos D, Plastiras A, Ioannou A, Katsinelos D, Tsamakidis K. A Modified "Rendezvous" Technique for EUS-guided Recanalization of a Rectal Anastomotic Stricture without Fluoroscopy and Stenting. J Gastrointestin Liver Dis 2021; 30:404-406. [PMID: 34551028 DOI: 10.15403/jgld-3792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/16/2021] [Indexed: 11/01/2022]
Abstract
Various endoscopic techniques have been described for the treatment of post-operative colonic strictures. Our aim is to report a solely EUS-guided recanalization procedure for a complete rectal stricture, without the use of fluoroscopy or stenting. A 66-year-old male was submitted to low anterior resection and protective ileostomy for rectal adenocarcinoma, complicated with complete anastomotic stricture 6 months later. The patient was treated with a modified EUS-guided rendezvous technique. A colonoscope was advanced through the ileostomy to the sigmoid colon, which was subsequently filled with water. A linear echoendoscope was advanced transanally to the distal part of the rectal anastomosis. The proximal colon was punctured with a 19G needle and a guidewire was advanced through the needle. The rectocolonic fistula tract was first dilated by graduated dilation catheters. Subsequently, progressive pneumatic dilatation was performed. There were no post-procedural complications. At 6-month follow-up the anastomosis was patent, with no significant stricture recurrence. In conclusion, a rendezvous technique for EUS-guided recanalization of complete rectal anastomotic strictures is feasible and safe in a non-radiology assisted setting. In selected cases of distal stenoses balloon dilation could effectively serve as the sole treatment, without the adjunct of stent placement.
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Affiliation(s)
- Dimitrios Kypraios
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Athens, Greece. .
| | - Eleni Manthopoulou
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Athens, Greece. .
| | | | - Aris Plastiras
- Department of Surgery, St. Savvas Oncology Hospital of Athens, Athens, Greece.
| | - Alexandros Ioannou
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Athens, Greece.
| | - Dimitrios Katsinelos
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Athens, Greece.
| | - Klisthenis Tsamakidis
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, Athens, Greece.
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Michalopoulou E, Manthopoulou E, Dimitroulopoulos D, Kypreos D, Katsinelos D, Marakis I, Sachtouris G, Tsamakidis X, Tsamakidis K. P-244 Demographic data, risk factors, and clinical aspects of hepatocellular carcinoma (HCC) in Southeastern Europe during the last decade. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Garas J, Maragoudakis S, Besbeas S, Gartsonis G, Manthopoulou E, Evangelou G, Schinas P, Tsiribas J, Kordiolis N, Bonotis S, Georgaka-Gara A. The management of advanced head and neck neoplasms by continuous intra-arterial infusion and irradiation. Panminerva Med 1975; 17:323-5. [PMID: 1230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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