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Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy

World Journal of Gastroenterology 2007年第22期13卷 3106-3111页

作者： F Mugica G Urdapilleta a castiella A Berbiela F Alzate E Zapata L Zubiaurre P Lopez JI Arenas Gastroenterology Department Donostia Hospital San Sebastian Spain Department Donostia Hospital San Sebastian Spain Gastroenterology Department Bajo Deva Hospital Spain Anaesthesia Department Donostia Hospital San Sebastian Spain

AIM: To analyze the indications, effi cacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the fi lling pressure. RESULTS: The indications included intradiverticular papilla in 26 patients (49/), stenosis of a previous sphincterotomy in 19 patients (35.8/), small size of the papilla in 4 patients (7.5/), Billroth Ⅱ gastrectomy in 3 patients (5.6/), and coagulopathy in one patient (1.9/). The efficacy was 97.8/, with all the calculi extracted from the common bile duct in 84.4/ of the patients, even though 21 of the patients (39.6/) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2/) presented complications: haemorrhage in 1 patient (1.9/) and mild pancreatitis in 6 patients (11.3/). The mean hospital stay in case of complications was of 3 ± 0.63 d. CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort tolithotripsy or rescue sphincterotomy.

关键词：括约肌切开术解剖学胆总管结石病急性胰腺炎乳头

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Liver steatosis in patients with rheumatoid arthritis treated with methotrexate is associated with body mass index

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World Journal of Hepatology 2023年第5期15卷 699-706页

作者： Agustin castiella Luis Lopez-Dominguez Maria J Sanchez-Iturri Iratxe Urreta Andrea De Diego Joaquin Belzunegui Eva Zapata Department of Gastroenterology Service Donostia University HospitalDonostia 20014Spain Department of Rheumatology Donostia University HospitalDonostia 20014Spain Department of Gastroenterology Donostia University HospitalDonostia 20014Spain Department of Clinical Epidemiology Donostia University HospitalDonostia 20014Spain

BACKGROUND Methotrexate(MTX)is the usual first-line treatment for rheumatoid arthritis(RA).Long-term use of MTX has been associated with liver steatosis(LS)and liver fibrosis(LF).AIM To determine if LS in patients treated with MTX for RA is associated with MTX cumulative dose(MTX-CD),metabolic syndrome(Mt S),body mass index(BMI),the male sex,or LF.METHODS A single-center,prospective study of patients receiving MTX for RA was performed from February 2019 to February 2020.The inclusion criteria were patients aged 18 years or older diagnosed with RA by a rheumatologist and being treated with MTX(without limitation on the duration of treatment).The exclusion criteria were previous diagnosis of liver disease(hepatitis B or C virus infection,known nonalcoholic fatty liver disease),alcohol consumption greater than 60 g/d in males or 40 g/d in females,human immunodeficiency virus infection on antiretroviral therapy,diabetes mellitus,chronic renal failure,congestive heart failure,or BMI greater than 30 kg/m^(2).Patients receiving leflunomide in the 3 years prior to the study were also excluded.Transient elastography(Fibro Scan,Echosens?,Paris,France)was used for fibrosis determination(LF>7 Kp A)and computer attenuation parameter(CAP)for LS(CAP>248 d B/m).Demographic variables,laboratory data,MTX-CD(>4000 mg),Mt S criteria,BMI(>25),transient elastography,and CAP scores were collected from all patients.RESULTS Fifty-nine patients were included.Forty-three were female(72.88%),and the mean age was 61.52 years(standard deviation:11.73).When we compared MTX-CD≤4000 mg(26 patients;14 with LS and 12 without)with>4000 mg(33 patients;12 with LS and 21 without),no statistical differences were found(P=0.179).We compared CAP scores stratified by Mt S,BMI,sex,and LF.There were no significant differences in CAP scores based on the presence of Mt S[CAP/Mt S:50 no Mt S(84.75%);9 Mt S(15.25%);P=0.138],the male sex(CAP/sex:8 male/18 female LS;8 male/25 female no LS;P=0.576),or LF[CAP/fibrosis:53 no LF(89.83%);6 LF(10.17%);P=0.239].LS determ

关键词： patients diagnosis index

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Non-invasive methods for liver fi brosis prediction in hemochromatosis:One step beyond

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World Journal of Hepatology 2010年第7期2卷 251-255页

作者： Agustin castiella Eva Zapata José M Alústiza Gastroenterology Service Mendaro Hospital Radiology Service Osatek Donostia

Advances in recent years in the understanding of, and the genetic diagnosis of hereditary hemochromatosis (HH) have changed the approach to iron overload he-reditary diseases. The ability to use a radiologic tool (MRI) that accurately provides liver iron concentration determination, and the presence of non-invasive sero-logic markers for fibrosis prediction (ser um ferritin, platelet count, transaminases, etc), have diminished the need for liver biopsy for diagnosis and prognosis of this disease. Consequently, the role of liv er biopsy in iron metabolism disorders is changing. Furthermore, the irruption of transient elastography to assess liver stiffness, and, more recently, the ability to determine liver f ibrosis by means of MRI elastography will change this role even more, with a potential drastic decline in hepatic biopsies in years to come. This review will provide a brief summary of the different non-invasive methods available nowadays for diagnosis and prognosis in HH, and point out potential new techniques that could come about in the next years for fibrosis prediction, thus avoiding the need for liver biopsy in a greater number of patients. It is possible that liver biopsy will remain useful for the diagnosis of associated diseases, where other non-invasive means are not po-ssible, or for those rare cases displaying discrepancies between radiological and biochemical markers.

关键词： Hemochromatosis Iron overload Liver fibrosis Non-invasive Magnetic resonance imaging Ultrasound elastography

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drug-induced autoimmune liver disease:a diagnostic dilemma of an increasingly reported disease

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World Journal of Hepatology 2014年第4期6卷 160-168页

作者： Agustin castiella Eva Zapata M Isabel Lucena Raúl J Andrade Gastroenterology Service Mendaro Hospital Clinical Pharmacology Universidad de Mál-agaInstituto de Investigación Biomédica de MálagaUniversity Hospital Virgen de la Victoria Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Liver Unit Universidad de MálagaInstituto de Investigación Biomédica de MálagaUniversity Hospital Virgen de la Victoria

The aetiology of autoimmune hepatitis(AIH) is uncer-tain but the disease can be triggered in susceptible patients by external factors such as viruses or drugs.AIH usually develops in individuals with a genetic back-ground mainly consisting of some risk alleles of the major histocompatibility complex(HLA).Many drugs have been linked to AIH phenotypes,which sometimes persist after drug discontinuation,suggesting that they awaken latent autoimmunity.At least three clini-cal scenarios have been proposed that refers to drug- induced autoimmune liver disease(DIAILD):AIH with drug-induced liver injury(DILI); drug induced-AIH(DI-AIH); and immune mediated DILI(IM-DILI).In addi-tion,there are instances showing mixed features of DI-AIH and IM-DILI,as well as DILI cases with positive autoantibodies.Histologically distinguishing DILI from AIH remains a challenge.Even more challenging is the differentiation of AIH from DI-AIH mainly relying in histological features; however,a detailed standard-ised histologic evaluation of large cohorts of AIH and DI-AIH patients would probably render more subtle features that could be of help in the differential diag-nosis between both entities.Growing information on the relationship of drugs and AIH is being available,being drugs like statins and biologic agents more fre-quently involved in cases of DIAILD.In addition,there is some evidence on the fact that patients diagnosed with DIAILD may have had a previous episode of hepa-totoxicity.Further collaborative studies in DIAILD will strengthen the knowledge and understanding of this intriguing and complex disorder which might represent different phenotypes across the spectrum of

关键词： Drug-induced liver injury Autoimmune hepatitis Drugs Drug-induced autoimmune hepatitis Drug-induced autoimmune liver disease

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肝脏铁质浓度MRI定量的推荐参数在临床实践中正确性的研究

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国际医学放射学杂志 2011年第2期 193-193页

作者： A.castiella J.M.Alústiza J.I.Emparanza E.M.Zapata B.Costero M.I.Díez 胡娟 Radiology Service Osatek DonostiaPaseo Dr.BeguiristainDonostiaSpain

目的评价雷恩大学(URennes)设计的MRI算法定量分析肝脏铁质浓度(LIC)的准确性。方法 1999年—2006年期间,共171例病人使用URennes模型计算LIC,其结果

关键词：血色病肝活检肝病 MRI 对照研究

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