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Could near focus endoscopy,narrow-band imaging,and acetic acid improve the visualization of microscopic features of stomach mucosa?

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 157-167页

作者： Admir Kurtcehajic enver zerem Tomislav Bokun Ervin Alibegovic Suad Kunosic Ahmed Hujdurovic Amir Tursunovic Kenana Ljuca Department of Gastroenterology and Hepatology Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Bosnia and Herzegovina Department of Gastroenterology and Hepatology University Clinical Hospital DubravaZagreb 10000Croatia Department of Gastroenterology and Hepatology University Clinical Center TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Surgery University Clinical Center TuzlaTuzla 75000Bosnia and Herzegovina School of Medicine University of TuzlaTuzla 75000Bosnia and Herzegovina

BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric *** To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional *** During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric *** the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI *** The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three *** images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same *** to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF *** the NF-NBI mode,the values were 0.378,0.471,and 0.553,*** AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,*** When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic

关键词： Gastric mucosa Endoscopic microanatomy Magnifying endoscopy Near focus Narrow-band imaging Acetic acid

Current trends in acute pancreatitis:Diagnostic and therapeutic challenges

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World Journal of Gastroenterology 2023年第18期29卷 2747-2763页

作者： enver zerem Admir Kurtcehajic Suad Kunosić Dina zerem Malkočević Omar zerem Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Bosnia and Herzegovina Department of Gastroenterology and Hepatology Plava Medical GroupTuzla 75000Bosnia and Herzegovina Department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Bosnia and Herzegovina Department of Internal Medicine Cantonal Hospital“Safet Mujić”MostarMostar 88000Bosnia and Herzegovina

Acute pancreatitis(AP)is an inflammatory disease of the pancreas,which can progress to severe AP,with a high risk of *** is one of the most complicated and clinically challenging of all disorders affecting the *** main causes of AP are gallstone migration and alcohol *** causes are uncommon,controversial and insufficiently *** disease is primarily characterized by inappropriate activation of trypsinogen,infiltration of inflammatory cells,and destruction of secretory *** to the revised Atlanta classification,severity of the disease is categorized into three levels:Mild,moderately severe and severe,depending upon organ failure and local as well as systemic *** methods have been used for predicting the severity of AP and its outcome,such as clinical evaluation,imaging evaluation and testing of various biochemical ***,AP is a very complex disease and despite the fact that there are of several clinical,biochemical and imaging criteria for assessment of severity of AP,it is not an easy task to predict its subsequent ***,there are existing controversies regarding diagnostic and therapeutic modalities,their effectiveness and complications in the treatment of *** main reason being the fact,that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied *** this editorial article,we discuss the efficacy of the existing diagnostic and therapeutic modalities,complications and treatment failure in the management of AP.

关键词： Pancreatitis Etiology and pathogenesis Diagnostic criteria Nutrition Antibiotics Management of complications

Portal vein aneurysm-etiology,multimodal imaging and current management

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World Journal of Clinical Cases 2023年第4期11卷 725-737页

作者： Admir Kurtcehajic enver zerem Ervin Alibegovic Suad Kunosic Ahmed Hujdurovic Jasmin A Fejzic Department of Gastroenterology and Hepatology Plava Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Bosnia and Herzegovina Department of Gastroenterology and Hepatology University Clinical Center TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine Plava Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina Department of Internal Medicine General Hospital TesanjTesanj 74260Bosnia and Herzegovina

Portal vein aneurysm(PVA)is a rare vascular abnormality,representing 3%of all venous aneurysms in the human body,and is not well *** can be congenital or acquired,located mainly at the level of confluence,main trunk,branches and bifurcation.A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner.A review from 2015 entitled“Portal vein aneurysm:What to know”considered fewer than 200 *** the last seven years,there has been an increase in the number of PVAs diagnosed thanks to routine abdominal *** aim of this review is to provide a comprehensive update of PVA,including aetiology,epidemiology,and clinical assessment,along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.

关键词： Aneurysm Portal vein Abdominal imaging Treatment Follow-up

Treatment of severe acute pancreatitis and its complications

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World Journal of Gastroenterology 2014年第38期20卷 13879-13892页

作者： enver zerem Department of Gastroenterology University Clinical Center Tuzla Department of Medical Sciences The Academy of Sciences and Arts of Bosnia and Herzegovina

Severe acute pancreatitis(SAP),which is the most serious type of this disorder,is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk,a pro-inflammatory response results in systemic inflammatory response syndrome(SIRS). If the SIRS is severe,it can lead to early multisystem organ failure(MOF). After the first 1-2 wk,a transition from a pro-inflammatory response to an anti-inflammatory response occurs;during this transition,the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue,which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However,despite the reduction in overall mortality in the last decade,SAP is still associated with high mortality. In the majority of cases,sterile necrosis should be managed conservatively,whereas in infected necrotizing pancreatitis,the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently,the step-up approach(delay,drain,and debride) may be considered as the reference standard intervention for this disorder.

关键词： Acute necrotizing pancreatitis Infection Sepsis Drainage Gastrointestinal endoscopy

Comments on the article about the treatment of peripancreatic infection

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World Journal of Gastroenterology 2010年第18期16卷 2321-2322页

作者： enver zerem Goran Imamovic The University Clinical Centre Tuzla

We read with great interest the article by Tang et al published in issue 4 of World Journal of Gastroenterology *** results of their study indicate that percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to severe acute ***,there are some points that need to be addressed,including data about the patients in the study and their clinical characteristics,data about infection and superinfection during the treatment and type of treatment of patients with acute necrotizing pancreatitis.

关键词： Acute pancreatitis Pancreatic necrosis Infection Non-surgical management

Ultrasound guided percutaneous treatment for splenic abscesses: The signifi cance in treatment of critically ill patients

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World Journal of Gastroenterology 2006年第45期12卷 7341-7345页

作者： enver zerem Jacob Bergsland Interventional Ultrasonography Department University Clinical Centar Tuzla Bosnia and Herzegovina

AIM: To analyze the results of ultrasound guided percu- taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was defi nitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses.

关键词： Interventional ultrasound Needle aspiration Catheter drainage Spleen preservation

What is the optimal treatment for appendiceal mass formed after acute perforated appendicitis?

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World Journal of Gastroenterology 2012年第15期18卷 1849-1850页

作者： enver zerem Goran Imamovi Farid Ljuca Jasmina Alidzanovi Department of Gastroenterology University Clinical Center TuzlaTrnovac bb75000 TuzlaBosnia and Herzegovina Medical School of Tuzla University of Tuzla75000 TuzlaBosnia and Herzegovina Department of Oncology University Clinical Center TuzlaTrnovac bb75000 TuzlaBosnia and Herzegovina

We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol *** article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal *** author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass,and might prove to be more cost-effective than conservative treatment,with no need for interval ***,we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass,with no need for appendectomy,too.

关键词： Appendiceal mass Percutaneous drainage Antibiotic therapy Interval appendectomy Laparoscopic appendectomy

Comments on the article about correlation between computerized tomography and surgery in acute pancreatitis

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World Journal of Gastroenterology 2011年第3期17卷 407-408页

作者： enver zerem Goran Imamovi Zoran Mavija Bahrija Harai Department of Gastroenterology University Clinical Center Tuzla Medical Division Fresenius Medical Care BHd.o.o. Sarajevo Department of Gastroenterology Clinical Center Banjaluka

We read with great interest the article by Vege et al published in issue 34 of World J Gastroenterol 2010. The article evaluates the ability of contrast-enhanced computerized tomography (CECT) to characterize the nature of peripancreatic collections found at surgery. The results of their study indicate that most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue and CECT has a limited role in differentiating various types of collections. However, there are some points that need to be addressed, including data about the stage of acute pancreatitis in which CECT was done and the time span between CECT examination and surgery.

关键词： Acute pancreatitis Pancreatic necrosis Peripancreatic fluid collection Contrast-enhanced computerized tomography Surgery

Preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: What can be done?

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World Journal of Gastroenterology 2015年第4期21卷 1069-1080页

作者： Goran Hauser Marko Milosevic Davor Stimac enver zerem Predrag Jovanovi? Ivana Blazevic Department of Internal Medicine Division of GastroenterologyClinical Hospital Centre Rijeka51000 RijekaCroatia Department of Anaesthesiology Clinical Hospital Centre Rijeka51000 RijekaCroatia Department of Gastroenterology University Clinical Center TuzlaTrnovac bb75000 TuzlaBosnia and Herzegovina Center for Emergency Medicine Clinical Hospital Centre Rijeka51000 RijekaCroatia

Post-endoscopic retrograde cholangiopancreatographypancreatitis(PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatictype abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation(wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis.

关键词： Endoscopic retrograde cholangiopancreatography Pos