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Endoscopic diagnosis and treatment of gastric dysplasia and early cancer:Current evidence and what the future may hold

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World Journal of Gastroenterology 2021年第31期27卷 5126-5151页

作者： Edward Young hamish philpott Rajvinder Singh Department of Gastroenterology Lyell McEwin HospitalElizabeth Vale 5112SAAustralia Faculty of Health and Medical Sciences University of AdelaideAdelaide 5000SAAustralia

Gastric cancer accounts for a significant proportion of worldwide cancer-related morbidity and mortality.The well documented precancerous cascade provides an opportunity for clinicians to detect and treat gastric cancers at an endoscopically curable stage.In high prevalence regions such as Japan and Korea,this has led to the implementation of population screening programs.However,guidelines remain ambiguous in lower prevalence regions.In recent years,there have been many advances in the endoscopic diagnosis and treatment of early gastric cancer and precancerous lesions.More advanced endoscopic imaging has led to improved detection and characterization of gastric lesions as well as superior accuracy for delineation of margins prior to resection.In addition,promising early data on artificial intelligence in gastroscopy suggests a future role for this technology in maximizing the yield of advanced endoscopic imaging.Data on endoscopic resection(ER)are particularly robust in Japan and Korea,with high rates of curative ER and markedly reduced procedural morbidity.However,there is a shortage of data in other regions to support the applicability of protocols from these high prevalence countries.Future advances in endoscopic therapeutics will likely lead to further expansion of the current indications for ER,as both technology and proceduralist expertise continue to grow.

关键词： Gastric cancer Endoscopy Endoscopic imaging Endoscopic mucosal resection Endoscopic submucosal dissection

Dysphagia: Thinking outside the box

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World Journal of Gastroenterology 2017年第38期23卷 6942-6951页

作者： hamish philpott Mayur Garg Dunya Tomic Smrithya Balasubramanian Rami Sweis Department of Gastroenterology Eastern Health Clinical School Monash University University College London

Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux(GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett's oesophagus, adeno-as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pretest probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.

关键词：咽下困难食道嗜曙红 Manometry Gastroesophageal 倒流渴望食物大丸药装紧

Food,fibre,bile acids and the pelvic floor: An integrated low risk low cost approach to managing irritable bowel syndrome

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World Journal of Gastroenterology 2015年第40期21卷 11379-11386页

作者： hamish philpott Sanjay Nandurkar John Lubel Peter R Gibson Monash University Eastern HealthThe Alfred Hospital

Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome,and medications may be used often without success. Advances in the understanding of the causes of the symptoms(including pelvic floor weakness and incontinence,bile salt malabsorption and food intolerance) mean that effective,safe and well tolerated treatments are now available.

关键词： Bile acids Pelvic floor Food intolerance Irritable

Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence

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World Journal of Gastrointestinal Endoscopy 2020年第11期12卷 408-450页

作者： Andrew Chan hamish philpott Amanda H Lim Minnie Au Derrick Tee Damian Harding Mohamed Asif Chinnaratha Biju George Rajvinder Singh Department of Gastroenterology Lyell McEwin HospitalAdelaide 5112South AustraliaAustralia School of Medicine The University of AdelaideAdelaide 5005Australia

The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently.This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding.Thus,there is now greater importance on optimal pre,peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding,without increasing the risk of a thromboembolic event as a consequence of therapy interruption.Currently,there are position statements and guidelines from the major gastroenterology societies.These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures,to ensure optimal patient safety.However,since the publication of these guidelines,there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices.Most notably and divergent from current position statements,is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding,suggestive that this practice should be avoided.In addition,there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps(<10 mm).

关键词： Endoscopy Anticoagulants Antiplatelets Antithrombotics Bleeding Gastrointestinal