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Skamnelos A, Lazaridis N, Vlachou E, Koukias N, Apostolopoulos P, Murino A, Christodoulou D, Despott EJ. The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021. Ann Gastroenterol 2021; 34:599-611. [PMID: 34475730 PMCID: PMC8375652 DOI: 10.20524/aog.2021.0652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
The impact of small-bowel (SB) capsule endoscopy and device-assisted enteroscopy on clinical practice, since their introduction 2 decades ago, has been remarkable. These disruptive technologies have transformed the investigation and management of SB pathology and now have a firmly established place in guidelines and clinical algorithms. Furthermore, recent years have witnessed innovations, driven by the demand of new goals in the management of inflammatory bowel disease (IBD), such as mucosal healing and evolving strategies based on tight monitoring and accelerated escalation of care. These developments in SB endoscopy have also been paralleled by refinement in dedicated radiological SB imaging technologies. This updated review highlights the current state of the art and more recent innovations with a focus on their role in IBD.
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Affiliation(s)
- Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Alexandros Skamnelos, Dimitrios Christodoulou)
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Genesis Hospital of Thessaloniki, Thessaloniki, Greece (Nikolaos Lazaridis)
| | - Erasmia Vlachou
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Army Share Funds Hospital (NIMTS), Athens, Greece (Erasmia Vlachou, Periklis Apostolopoulos)
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott).,Department of Gastroenterology, University Hospital of Patras, Patras, Greece (Nikolaos Koukias)
| | - Periklis Apostolopoulos
- Army Share Funds Hospital (NIMTS), Athens, Greece (Erasmia Vlachou, Periklis Apostolopoulos)
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott)
| | - Dimitrios Christodoulou
- Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Alexandros Skamnelos, Dimitrios Christodoulou)
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott)
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Costa D, Despott EJ, Lazaridis N, Woodward J, Kohout P, Rath T, Scovell L, Gee I, Hindryckx P, Forrest E, Hollywood C, Hearing S, Mohammed I, Coppo C, Koukias N, Cooney R, Sharma H, Zeino Z, Gooding I, Murino A. Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device. Gastrointest Endosc 2021; 93:1325-1332. [PMID: 33221321 DOI: 10.1016/j.gie.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Buried bumper syndrome (BBS) is a rare adverse event of percutaneous endoscopic gastrostomy (PEG) placement in which the internal bumper migrates through the stomal tract to become embedded within the gastric wall. Excessive tension between the internal and external bumpers, causing ischemic necrosis of the gastric wall, is believed to be the main etiologic factor. Several techniques for endoscopic management of BBS have been described using off-label devices. The Flamingo set is a novel, sphincterotome-like device specifically designed for BBS management. We aimed to evaluate the effectiveness of the Flamingo device in a large, homogeneous cohort of patients with BBS. METHODS A guidewire was inserted through the external access of the PEG tube into the gastric lumen. The Flamingo device was then introduced into the stomach over the guidewire. This dedicated tool can be flexed by 180 degrees, exposing a sphincterotome-like cutting wire, which is used to incise the overgrown tissue until the PEG bumper is exposed. A retrospective, international, multicenter cohort study was conducted on 54 patients between December 2016 and February 2019. RESULTS The buried bumper was successfully removed in 53 of 55 procedures (96.4%). The median time for the endoscopic removal of the buried bumper was 22 minutes (range, 5-60). Periprocedural endoscopic adverse events occurred in 7 procedures (12.7%) and were successfully managed endoscopically. A median follow-up of 150 days (range, 33-593) was performed in 29 patients (52.7%), during which no significant adverse events occurred. CONCLUSIONS Through our experience, we found this dedicated novel device to be safe, quick, and effective for minimally invasive, endoscopic management of BBS.
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Affiliation(s)
- Deborah Costa
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Jeremy Woodward
- Department of Gastroenterology and Clinical Nutrition Addenbrooke's Hospital, Cambridge, UK
| | - Pavel Kohout
- Department of Internal Medicine Thomayer Hospital, Prague, Czech Republic
| | - Timo Rath
- Division of Gastroenterology, Department of Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Louise Scovell
- Gastrointestinal and Liver services Ipswich Hospital, Ipswich, UK
| | - Ian Gee
- Department of Gastroenterology, Worcestershire Acute Hospital, Worcester, UK
| | - Pieter Hindryckx
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stephen Hearing
- Department of Gastroenterology and Hepatology, University Hospitals of Derby and Burton, Derby, UK
| | - Imtiyaz Mohammed
- Department of Gastroenterology Sandwell and West Birmingham Hospitals, Lyndon, West Bromwich, West Midlands, UK
| | - Claudia Coppo
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | - Hemant Sharma
- Gastrointestinal and Liver Services, Maidstone and Tunbridge Wells Hospital, Maidstone and Pembury, UK
| | - Zeino Zeino
- Department of Gastroenterology and Hepatology, North Bristol Trust, Bristol, UK
| | - Ian Gooding
- Department of Gastroenterology, Colchester General Hospital, Colchester, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
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Lazaridis N, Skamnelos A, Murino A, Chacchi Cahuin R, Koukias N, Despott EJ. Reply to Letter to the Editor, Reply to Yasri & Wiwanitkit. Endoscopy 2021; 53:97. [PMID: 33212521 PMCID: PMC7869036 DOI: 10.1055/a-1303-9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Edward J. Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
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Lazaridis N, Skamnelos A, Murino A, Chacchi Cahuin R, Koukias N, Despott EJ. "Double-surgical-mask-with-slit" method: reducing exposure to aerosol generation at upper gastrointestinal endoscopy during the COVID-19 pandemic. Endoscopy 2020; 52:928-929. [PMID: 32967022 PMCID: PMC7516391 DOI: 10.1055/a-1198-5471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Alexandros Skamnelos
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Rocio Chacchi Cahuin
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Edward J. Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
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Lazaridis N, Murino A, Koukias N, Kiparissi F, Despott EJ. Blue rubber bleb nevus syndrome in a 10-year-old child treated with loop ligation facilitated by double-balloon enteroscopy. VideoGIE 2020; 5:412-414. [PMID: 32954102 PMCID: PMC7482362 DOI: 10.1016/j.vgie.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Fevronia Kiparissi
- Great Ormond Street Hospital (GOSH) for Children and University College London Hospitals (UCLH), London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
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Affiliation(s)
- Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Andrea Telese
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
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Costa D, Despott EJ, Lazaridis N, Koukias N, Murino A. Minimally invasive endoscopic management of buried bumper syndrome by use of a novel dedicated resection device. VideoGIE 2019; 4:366-368. [PMID: 31388613 PMCID: PMC6675916 DOI: 10.1016/j.vgie.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Deborah Costa
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
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Despott EJ, May A, Lazaridis N, Vlachou E, Koukias N, Patch D, Planche K, Hayashi Y, Murino A. Double-balloon enteroscopy-facilitated cyanoacrylate-injection endotherapy of small-bowel varices: an international experience from 2 European tertiary centers (with videos). Gastrointest Endosc 2019; 90:302-306. [PMID: 30980796 DOI: 10.1016/j.gie.2019.03.1171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Small-bowel varices (SBVs) are an uncommon consequence of portal hypertension. Radiologic intervention is usually considered for first-line management. When radiologic intervention is not possible, management options become very limited. The aim of this study was to evaluate the usefulness of double-balloon enteroscopy (DBE)-facilitated cyanoacrylate-injection endotherapy of SBVs. METHODS This was a retrospective review of DBE-facilitated cyanoacrylate-injection endotherapy of SBVs (December 2015 to October 2016). RESULTS Ten DBEs were performed in 6 patients (4 women; median age, 68.5 years). No radiologic or surgical options were deemed feasible. Thirteen nests of SBVs were identified and injected with cyanoacrylate glue without hemorrhagic or embolic adverse events. At the 30-day follow-up after therapy, only 1 patient had experienced a mild recurrence of mid-gut bleeding; this was managed conservatively. One patient presented with acute GI bleeding 7 months later, and a repeat DBE with cyanoacrylate-injection endotherapy was successfully performed. One patient succumbed to his underlying advanced cholangiocarcinoma after 2 months. The remaining patients had a median follow-up of 12 months without any recurrent GI bleeding. CONCLUSIONS DBE-facilitated cyanoacrylate-injection endotherapy of SBVs appears to be a safe and effective option when other first-line options are not feasible.
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Affiliation(s)
- Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Andrea May
- Department of Gastroenterology, Sana Klinikum Offenbach GmbH and University of Mainz, Germany
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Erasmia Vlachou
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK; NIMTS Army Veterans Hospital, Athens, Greece
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - David Patch
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Katie Planche
- Department of Radiology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
| | - Yoshikazu Hayashi
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK; Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, Hampstead, London, UK
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Lowe DM, Smith PJ, Moreira F, Workman S, Braggins H, Koukias N, Buckland MS, Wylie P, Taylor SA, Murray CD. Chronic Granulomatous Disorder-Associated Colitis Can Be Accurately Evaluated with MRI Scans and Fecal Calprotectin Level. J Clin Immunol 2019; 39:494-504. [PMID: 31172380 PMCID: PMC6611758 DOI: 10.1007/s10875-019-00651-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
Purpose Colitis is a common and serious complication of chronic granulomatous disorder (CGD) and requires assessment. Colonoscopy is invasive and carries risks of serious complication. We therefore assessed non-invasive monitoring via magnetic resonance imaging (MRI). We also evaluated fecal calprotectin (FCP), the Harvey-Bradshaw index (HBI) clinical score, and serum cytokines. Methods We recruited 10 patients with CGD (8 males, mean age 29.6 years), scored a modified HBI, and obtained stool for FCP. The following day we took blood for cytokine measurement via Luminex, performed MR enterography (scored by two independent radiologists using three systems: London score, CDMI, and MaRIA) followed by colonoscopy with disease activity measurement via ulcerative colitis endoscopic index of severity (UCEIS). We assessed patient experience after each investigation and overall preference with follow-up questionnaires. Results MRI scores correlated well with colonoscopic gold standard (for London score R2 0.91, p < 0.0001; for CDMI R2 0.83, p = 0.0006; for MaRIA R2 0.89, p = 0.0002). MRI was better tolerated and generally preferred, quicker, and visualized the entire large bowel whereas colonoscopy did not reach the terminal ileum in 3 participants. Elevated FCP accurately differentiated patients with colitis from those without, and log(calprotectin) correlated well with disease activity (R2 0.71, p = 0.009). Serum interleukin (IL)-12 concentration correlated with colitis activity but IL-1β and TNF did not. Harvey-Bradshaw index did not correlate with colitis activity. Conclusions MRI and fecal calprotectin are useful methods for monitoring CGD colitis and should reduce the need for colonoscopy in these patients. IL-12 may represent an appropriate target for treatment. Electronic supplementary material The online version of this article (10.1007/s10875-019-00651-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David M Lowe
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK. .,Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
| | - Philip J Smith
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot St, Liverpool, L7 8XP, UK
| | - Fernando Moreira
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Sarita Workman
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Helen Braggins
- Department of Immunology, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Nikolaos Koukias
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Matthew S Buckland
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK.,Department of Clinical Immunology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London Hospital, University College London, Euston Road, London, NW1 2BU, UK
| | - Charles D Murray
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
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Murino A, Koukias N, Telese A, Lazaridis N, Despott EJ. First report of a secondary aortojejunal fistula diagnosed by double-balloon enteroscopy. Endoscopy 2019; 51:E53-E54. [PMID: 30634189 DOI: 10.1055/a-0665-4225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Andrea Telese
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
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Despott EJ, Hirayama Y, Lazaridis N, Koukias N, Telese A, Hayashi Y, Miura Y, Yamamoto H, Murino A. Saline immersion therapeutic endoscopy facilitated pocket-creation method for endoscopic submucosal dissection (with video). Gastrointest Endosc 2019; 89:652-653. [PMID: 30784510 DOI: 10.1016/j.gie.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom
| | - Yutaka Hirayama
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom
| | - Andrea Telese
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom
| | - Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshimasa Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Alberto Murino
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom
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Kalafateli M, Karatzas A, Tsiaoussis G, Koutroumpakis E, Tselekouni P, Koukias N, Konstantakis C, Assimakopoulos S, Gogos C, Thomopoulos K, Kalogeropoulou C, Triantos C. Muscle fat infiltration assessed by total psoas density on computed tomography predicts mortality in cirrhosis. Ann Gastroenterol 2018; 31:491-498. [PMID: 29991895 PMCID: PMC6033770 DOI: 10.20524/aog.2018.0256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 09/15/2017] [Accepted: 01/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Ongoing evidence suggests that sarcopenia adversely affects outcomes in cirrhosis. The aim of this study was to evaluate muscle fat infiltration as a component of sarcopenia and its prognostic value in this setting. Methods: In 98 consecutive patients with cirrhosis, muscle density was measured during a computed tomography scan at the level of the fourth to fifth lumbar (L4) vertebrae. Univariate and multivariate Cox regression analysis was used to determine predictors of survival. Results: Body mass index: median 26 (range 17-45.2); model for end-stage liver disease (MELD) score: median 11 (6-29); Child-Pugh (CP) score: median 7 (5-13), CP class: A=49 (50.5%), B=39 (40%), C=10 (9.5%); hepatocellular carcinoma: 14 (14.3%); follow up: median 45 (1-140) months. Median L4 total psoas area (TPA): 2022 (777-3806) mm2; L4 average total psoas density (ATPD): 42.52 (21.26-59.8) HU. ATPD was significantly correlated with age (r=-0.222, P=0.034), creatinine (r=-0.41, P<0.001), albumin (r=0.224, P=0.035), MELD score (r=-0.218, P=0.034), and TPA (r=0.415, P<0.001). Fifty-four patients (55.1%) died during follow up. In the multivariate analysis, higher CP score (hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.04-1.41), advanced age (HR 1.038, 95%CI 1.006-1.07) and lower ATPD (HR 0.967, 95%CI 0.937-0.997) were predictors of mortality. Conclusion: Muscle fat infiltration, as a result of sarcopenia, is a negative predictive factor of survival in cirrhosis, emphasizing the need for early identification of this subgroup of patients.
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Affiliation(s)
- Maria Kalafateli
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Andreas Karatzas
- Department of Radiology (Andreas Karatzas, Christina Kalogeropoulou), University Hospital of Patras, Patras, Greece
| | - Georgios Tsiaoussis
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Efstratios Koutroumpakis
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Paraskevi Tselekouni
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Nikolaos Koukias
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Christos Konstantakis
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Stelios Assimakopoulos
- Department of Internal Medicine (Stelios Assimakopoulos, Charalambos Gogos), University Hospital of Patras, Patras, Greece
| | - Charalambos Gogos
- Department of Internal Medicine (Stelios Assimakopoulos, Charalambos Gogos), University Hospital of Patras, Patras, Greece
| | - Konstantinos Thomopoulos
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
| | - Christina Kalogeropoulou
- Department of Radiology (Andreas Karatzas, Christina Kalogeropoulou), University Hospital of Patras, Patras, Greece
| | - Christos Triantos
- Department of Gastroenterology (Maria Kalafateli, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos), University Hospital of Patras, Patras, Greece
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Murino A, Koukias N, Gaeta L, Despott EJ. Emergency double-balloon enteroscopy for retrieval of an ingested dental-bridge, partially embedded within the wall of the jejunum. Dig Liver Dis 2018; 50:516. [PMID: 29426616 DOI: 10.1016/j.dld.2017.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Laura Gaeta
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom.
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Koukias N, Murino A, Despott EJ. Efficacy of Double-Balloon Colonoscopy in Technically Difficult Cases: Growing Evidence Favoring its Frontline Use. Clin Gastroenterol Hepatol 2018; 16:594. [PMID: 29555226 DOI: 10.1016/j.cgh.2017.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, Hampstead, London, United Kingdom
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15
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Gaeta L, Murino A, Koukias N, Hayee B, Haji A, Telese A, Despott EJ. A rare cause of small-bowel bleeding: haemorrhagic small-bowel lymphangioma diagnosed by antegrade double-balloon enteroscopy. Endoscopy 2018; 50:E86-E87. [PMID: 29351701 DOI: 10.1055/s-0043-123824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Laura Gaeta
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Bu'Hussein Hayee
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, United Kingdom
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, United Kingdom
| | - Andrea Telese
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
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16
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Woodland P, Shen Ooi JL, Grassi F, Nikaki K, Lee C, Evans JA, Koukias N, Triantos C, McDonald SA, Peiris M, Aktar R, Blackshaw LA, Sifrim D. Superficial Esophageal Mucosal Afferent Nerves May Contribute to Reflux Hypersensitivity in Nonerosive Reflux Disease. Gastroenterology 2017; 153:1230-1239. [PMID: 28734832 DOI: 10.1053/j.gastro.2017.07.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Little is known about the causes of heartburn in patients with gastro-esophageal reflux disease. Visible epithelial damage is seldom associated with symptom severity, evidenced by the significant symptom burden in patients with nonerosive reflux disease (NERD) compared with patients with erosive reflux disease (ERD) or Barrett's esophagus (BE). We studied the distribution of mucosal nerve fibers in patients with NERD, ERD, and BE, and compared the results with those of healthy subjects. METHODS We performed a prospective study of 13 patients with NERD, 11 patients with ERD, and 16 patients with BE undergoing endoscopic evaluation in the United Kingdom or Greece. Biopsies were obtained from the proximal and distal esophageal mucosa of patients with NERD, from the distal esophageal mucosa of patients with ERD, and the distal-most squamous epithelium of patients with BE. These were examined for the presence and location of nerve fibers that reacted with a labeled antibody against calcitonin gene-related peptide (CGRP), a marker of nociceptive sensory nerves. The results were compared with those from 10 healthy volunteers (controls). RESULTS The distribution of CGRP-positive nerves did not differ significantly between the distal esophageal mucosa of controls (median, 25.5 cell layers to surface; interquartile range [IQR], 21.4-28.8) vs patients with ERD (median, 23 cell layers to surface; IQR, 16-27.5), or patients with BE (median, 21.5 cell layers to surface; IQR, 16.1-27.5). However, CGRP-positive nerves were significantly more superficial in mucosa from patients with NERD-both distal (median, 9.5 cell layers to surface; IQR, 1.5-13.3; P < .0001 vs ERD, BE, and controls) and proximal (median, 5.0 cell layers to surface; IQR, 2.5-9.3 vs median 10.4 cell layers to surface; IQR, 8.0-16.9; P = .0098 vs controls). CONCLUSIONS Proximal and distal esophageal mucosa of patients with NERD have more superficial afferent nerves compared with controls or patients with ERD or BE. Acid hypersensitivity in patients with NERD might be partially explained by the increased proximity of their afferent nerves to the esophageal lumen, and therefore greater exposure to noxious substances in refluxate.
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Affiliation(s)
- Philip Woodland
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joanne Li Shen Ooi
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Federica Grassi
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kornilia Nikaki
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chung Lee
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - James A Evans
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Nikolaos Koukias
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | - Stuart A McDonald
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Madusha Peiris
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rubina Aktar
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - L Ashley Blackshaw
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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17
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Koukias N, Murino A, Telese A, Gaeta L, Power N, Rathbone M, Despott EJ. Management of a rare cause of significant acute upper gastrointestinal bleeding: gastric lipoma resected by hybrid endoscopic submucosal dissection. Endoscopy 2017; 49:E246-E247. [PMID: 28719931 DOI: 10.1055/s-0043-115002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Andrea Telese
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Laura Gaeta
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
| | - Niall Power
- Depatment of Radiology, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, United Kingdom
| | - Michael Rathbone
- Academic Department of Cellular Pathology, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, United Kingdom
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18
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Koukias N, Vlachou E, Wylie P, Despott EJ. Wide-field endoscopic mucosal resection in the small bowel: Management of a rare cause of jejunal intussusception by double-balloon enteroscopy. Dig Liver Dis 2017; 49:573. [PMID: 28274828 DOI: 10.1016/j.dld.2017.01.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Nikolaos Koukias
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL), Institute for Liver and Digestive Health, London, United Kingdom.
| | - Erasmia Vlachou
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL), Institute for Liver and Digestive Health, London, United Kingdom
| | - Peter Wylie
- Department of Radiology, The Royal Free Hospital and University College London (UCL), Institute for Liver and Digestive Health, London, United Kingdom
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL), Institute for Liver and Digestive Health, London, United Kingdom
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19
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Triantos C, Emmanuil A, Aggeletopoulou I, Tsolias C, Grigoropoulou X, Jelastopulu E, Koukias N, Assimakopoulos S, Gogos C, Labropoulou-Karatza C, Thomopoulos K. Anti-Xa activity in patients with hepatocellular carcinoma. J Gastrointestin Liver Dis 2017; 26:91-92. [PMID: 28338119 DOI: 10.15403/jgld.2014.1121.261.axa] [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] [Indexed: 11/01/2022]
Affiliation(s)
- Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
| | - Andreas Emmanuil
- Department of Hematology, University Hospital of Patras, Patras, Greece
| | | | | | | | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras,Patras, Greece
| | - Nikolaos Koukias
- Department of Gastroenterology, University Hospital of Patras, Patras, Greece
| | | | - Charalambos Gogos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
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Abstract
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and has a complex pathophysiology with multiple pathways of development and progression implicated. Intestinal hormones regulate multiple biological functions and may play a role in the pathogenesis of non alcoholic fatty liver disease (NAFLD) by affecting food intake, body weight and insulin resistance. Bacterial products can affect the secretion of these hormones and thus have an effect on metabolism. Gut microbiota are normally involved in the intestinal energy harvest and their role has been increasingly been implicated in the pathogenesis of obesity and NAFLD. The intestinal hormone pathways as well as the intestinal microbiota populations are potential therapeutic targets in the management of NAFLD. We review the evidence on the associations of the intestinal hormones and gut microbiota in the development, progression and treatment of NAFLD.
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Affiliation(s)
- Nikolaos Koukias
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Elena Buzzetti
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK -
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21
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Bertino G, Privitera G, Purrello F, Demma S, Crisafulli E, Spadaro L, Koukias N, Tsochatzis EA. Emerging hepatic syndromes: pathophysiology, diagnosis and treatment. Intern Emerg Med 2016; 11:905-16. [PMID: 27273018 DOI: 10.1007/s11739-016-1478-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/25/2016] [Indexed: 12/11/2022]
Abstract
Liver cirrhosis is a major cause of morbidity and mortality worldwide, mainly due to complications of portal hypertension. In this article, we review the current understanding on the pathophysiology, the diagnostic criteria and the available therapeutic options for patients with emerging hepatic syndromes in cirrhosis, namely the hepatorenal, hepato-adrenal and hepatopulmonary syndrome. The hepatorenal syndrome is a well-recognized complication of advanced cirrhosis and is usually associated with an accelerated course to death unless liver transplantation is performed. The hepatopulmonary syndrome is often missed in the evaluation of patients with cirrhosis; however, early recognition is essential for the efficient management of individual patients. The hepato-adrenal syndrome, although not fully characterized, offers an exciting field for research and potential therapeutic interventions.
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Affiliation(s)
- Gaetano Bertino
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - Graziella Privitera
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi-Nesima, Catania, Italy
| | - Francesco Purrello
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi-Nesima, Catania, Italy
| | - Shirin Demma
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - Emanuele Crisafulli
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy
| | - Luisa Spadaro
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi-Nesima, Catania, Italy
| | - Nikolaos Koukias
- UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK.
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Koukias N, Woodland P, Yazaki E, Sifrim D. Supragastric Belching: Prevalence and Association With Gastroesophageal Reflux Disease and Esophageal Hypomotility. J Neurogastroenterol Motil 2015; 21:398-403. [PMID: 26130635 PMCID: PMC4496903 DOI: 10.5056/jnm15002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 01/06/2015] [Revised: 03/17/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022] Open
Abstract
Background/Aims Supragastric belching (SGB) is a phenomenon during which air is sucked into the esophagus and then rapidly expelled through the mouth. Patients often complain of severely impaired quality of life. Our objective was to establish the prevalence of excessive SGB within a high-volume gastrointestinal physiology unit, and evaluate its association with symptoms, esophageal motility and gastresophageal reflux disease. Methods We established normal values for SGB by analyzing 24-hour pH-impedance in 40 healthy asymptomatic volunteers. We searched 2950 consecutive patient reports from our upper GI Physiology Unit (from 2010–2013) for SGB. Symptoms were recorded by a standardized questionnaire evaluating for reflux, dysphagia, and dyspepsia symptoms. We reviewed the predominant symptoms, 24-hour pH-impedance and high-resolution esophageal manometry results. Results Excessive SGB was defined as > 13 per 24 hours. We identified 100 patients with excessive SGB. Ninety-five percent of these patients suffered from typical reflux symptoms, 86% reported excessive belching, and 65% reported dysphagia. Forty-one percent of patients with excessive SGB had pathological acid reflux. Compared to the patients with normal acid exposure these patients trended towards a higher number of SGB episodes. Forty-four percent of patients had esophageal hypomotility. Patients with hypomotility had a significantly higher frequency of SGB compared to those with normal motility (118.3 ± 106.1 vs 80.6 ± 75.7, P = 0.020). Conclusions Increased belching is rarely a symptom in isolation. Pathological acid exposure and hypomotility are associated with more SGB frequency. Whether SGB is a disordered response to other esophageal symptoms or their cause is unclear.
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Affiliation(s)
- Nikolaos Koukias
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Philip Woodland
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Etsuro Yazaki
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Daniel Sifrim
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
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Triantos C, Koukias N, Karamanolis G, Thomopoulos K. Changes in the esophageal mucosa of patients with non erosive reflux disease: How far have we gone? World J Gastroenterol 2015; 21:5762-5767. [PMID: 26019440 PMCID: PMC4438010 DOI: 10.3748/wjg.v21.i19.5762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/13/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
The normal esophageal mucosa creates a protective epithelial barrier that constrains the acidic reflux in the esophageal lumen. Microscopic findings and functional studies indicate that this barrier might be impaired in patients with non erosive reflux disease (NERD) but not in patients with functional heartburn (FH). Whereas endoscopy and pH monitoring are the most important diagnostic tools in the diagnosis of NERD, recent studies suggest that esophageal biopsies might have a complementary role. Particularly in the differential diagnosis between NERD and FH, the application of histological severity scores showed very promising results. Further evaluation of the scores could lead to routine application of histology in specific NERD populations.
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Triantos C, Kourakli A, Kalafateli M, Giannakopoulou D, Koukias N, Thomopoulos K, Lampropoulou P, Bartzavali C, Fragopanagou H, Kagadis GC, Christofidou M, Tsamandas A, Nikolopoulou V, Karakantza M, Labropoulou-Karatza C. Hepatitis C in patients with β-thalassemia major. A single-centre experience. Ann Hematol 2013; 92:739-46. [PMID: 23412560 DOI: 10.1007/s00277-013-1692-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 01/30/2013] [Indexed: 01/19/2023]
Abstract
Chronic hepatitis C (CHC) and iron overload are the main causes of liver disease in β-thalassemia major (βTM). There is limited data regarding the course of CHC in this population. All patients (n=144) from the thalassemia centre of the University Hospital of Patras were evaluated (January 1981 to June 2012). Patients were classified into group A (n=57), which consisted of patients with CHC, who either had received antiviral treatment (n=49) or not (n=8), and group B which included 87 patients without CHC. Nineteen patients died during follow-up (median: 257.5 months (1-355)). Survival rates were 84.2 % and 88.5 % for group A and B, respectively. The causes of death were heart failure (63.2 %), accident (10.5 %), sepsis (5.3 %), liver failure (5.3 %), hepatocellular carcinoma (HCC) (5.3 %), non-Hodgkin lymphoma (5.3 %) and multiorgan failure (5.3 %). There were no differences in total survival between the two groups (p=0.524). In the multivariate analysis, survival was neither correlated with CHC (p=ns), nor with anti-HCV treatment (p=ns), whereas independent negative predictors were presence of heart failure (p<0.001), presence of malignancy other than HCC (p=0.001) and non-adherence to chelation treatment (p=0.013). Predictive factors for the development of cirrhosis were: CHC (p<0.001), age>35 years (p=0.007), siderosis grade 3/4 (p=0.029) and splenectomy (p=0.001); however, multivariately, only siderosis grade 3/4 was found to be significant (p=0.049). In this study, survival of patients with βTM was mainly associated with heart failure, presence of malignancy other than HCC and non-adherence to chelation treatment, rather than with liver disease. Multicentre studies need to be designed to define more accurately the indications of antiviral treatment in this population.
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Affiliation(s)
- Christos Triantos
- Department of Gastroenterology, University Hospital of Patras, Stamatopoulou 4, Rio, 26504, Patras, Greece.
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