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World Journal of Hepatology 2014年第8期6卷 559-569页

作者： mahesh kr goenka Usha goenka Institute of Gastro Sciences Apollo Gle-neagles Hospitals Kolkata 700054 India Department of Imaging and Interventional Radi-ology Apollo Gleneagles Hospitals Kolkata 700054 India

Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography(ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous bili-ary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hi-lar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as asegment Ⅲ bypass if, during a laparotomy for resec-tion, the tumor is found to be unresectable. Photody-namic therapy and, more recently, radiofrequency abla-tion have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the bili-ary involvement(Bismuth class) and the availability of local expertise.

关键词： Cholangiocarcinoma Hilar cholangiocarcinoma Klatskin’s tumor Palliation Biliary stenting

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Capsule endoscopy:Present status and future expectation

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World Journal of Gastroenterology 2014年第29期20卷 10024-10037页

作者： mahesh K goenka Shounak Majumder Usha goenka Institute of Gastro Sciences Apollo Gleneagles Hospitals Department of Internal Medicine University of ConnecticutFarmingtonCT 06269United States Department of Imaging and Interventional Radiology Apollo Gleneagles Hospitals

Video capsule endoscopy (CE) since its introduction 13 years back, has revolutionized our approach to small intestinal diseases. Obscure gastrointestinal bleed (OGIB) continues to be the most important indication for CE with a high sensitivity, specificity as well as positive and negative predictive values. It is best performed during ongoing bleed or immediately thereafter. Overt OGIB has a higher diagnostic yield than occult OGIB. However, even in iron deficiency anemia, CE is emerging as important investigation after initial negative work up. In suspected Crohn’s disease (CD), CE has been shown superior to traditional imaging and endoscopic technique and should be considered after a negative ileocolonoscopy. Although CE has also been used for evaluating established CD, a high capsule retention rate precludes its use ahead of cross-sectional imaging. Celiac disease, particularly where gastro-duodenoscopy cannot be performed or is normal, can also be investigated by CE. Small bowel tumor, hereditary polyposis syndrome, and non-steroidal anti-inflammatory drugs induced intestinal damage are other indications for CE. Capsule retention is the only significant adverse outcome of CE and occurs mostly in presence of intestinal obstruction. This can be prevented by use of Patency capsule prior to CE examination. Presence of cardiac pacemaker and intracardiac devices continue to be relative contraindications for CE, though data do not suggest interference of CE with these devices. Major limitations of CE today include failure to control its movement from outside, inability of CE to acquire tissue for diagnosis, and lack of therapeutic help. With ongoing interesting and exciting developments taking place in these areas, these issues would be solved in all probability in near future. CE has the potential to become one of the most important tools in diagnostic and possibly in the therapeutic field of gastrointestinal disorder.

关键词： Video capsule Small bowel Obscure gastrointestinal bleeding Celiac disease Crohn's disease Small bowel tumor

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Endotherapy of leaks and fistula

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World Journal of Gastrointestinal Endoscopy 2015年第7期7卷 702-713页

作者： mahesh Kumar goenka Usha goenka Institute of Gastro Sciences Apollo Gleneagles Hospitals Department of Imaging and Interventional Radiology Apollo Gleneagles Hospitals

Perforations, leaks and fistula involving gastrointestinal(GI) tract are increasing encountered in clinical practice. There is a changing paradigm for their management with surgical approach being replaced by conservative approach including endoscopic therapy. Clips(through the scope and over the scope) and covered stent are front runners for endotherapy for GI leaks and *** the scope clips introduced recently, can treat larger defects compared to through the scope clips. Covered stents are suited for larger defects and those associated with luminal narrowing. However cervical esophagus, gastro-esophageal junction, stomach and right colonic lesions may be better for clip therapy rather than stenting. Recent developments in this field include use of endovac therapy which consists of a sponge with suction device, biodegradable stent, use of fibrin glue and some endo-suturing device. Conservative therapy with no surgical or endoscopic intervention, may be suitable for a small subset of patients. An algorithm based on location, size of defect, associated stricture, infection and available expertise needs to be developed to reduce the mortality and morbidity of this difficult clinical problem.

关键词： Fistula Leak Perforation Post operative Endoscopy Endoscopic Surgery Stent Suture Endoclip Clip

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Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

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World Journal of Gastroenterology 2011年第6期17卷 774-778页

作者： mahesh Kumar goenka Shounak Majumder Sanjeev Kumar Pradeepta Kumar Sethy Usha goenka Institute of Gastroenterology Apollo Gleneagles Hospital

AIM:To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS:We identified patients who underwent CE at our institution from August 2003 to December *** medical records were reviewed to determine type of OGIB (occult,overt),CE results and complications,and timing of CE with respect to onset of ***:Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by *** 222 patients (58%),definite lesions were detected that could unequivocally explain *** bowel ulcer/erosions secondary to Crohn's disease,tuberculosis or non-steroidal anti-inflammatory agent use were the commonest lesions *** with overt GI bleeding for < 48 h before CE had the highest diagnostic yield (87%).This was significantly greater (P < 0.05) compared to that in patients with overt bleeding prior to 48 h (68%),as well as those with occult OGIB (59%).CONCLUSION:We established the importance of early CE in management of *** within 48 h of overt bleeding has the greatest potential for lesion detection.

关键词： Capsule endoscopy Gastrointestinal bleeding

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