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Mucosal healing in inflammatory bowel disease： Maintain orde-escalate therapy

World Journal of Gastrointestinal Pathophysiology 2016年第1期7卷 1-16页

作者： marcello cintolo Giuseppe Costantino Socrate Pallio Walter Fries Clinical Unit for Chronic Bowel Disorders Department of Clinical and Experimental MedicineUniversity of Messina98125 MessinaItaly Digestive Endoscopy Unit Department of Human PathologyUniversity of Messina98125 MessinaItaly

In the past decade, thanks to the introduction of biologic therapies, a new therapeutic goal, mucosal healing(MH), has been introduced. MH is the expression of an arrest of disease progression, resulting in minor hospitalizations, surgeries, and prolonged clinical remission. MH may be achieved with several therapeutic strategies reaching success rates up to 80% for both, ulcerative colitis(UC) and Crohn's disease(CD). Various scoring systems for UC and for the transmural CD, have been proposed to standardize the definition of MH. Several attempts have been undertaken to de-escalate therapy once MH is achieved, thus, reducing the risk of adverse events. In this review, we analysed the available studies regarding the achievement of MH and the subsequent treatment de-escalation according to disease type and administered therapy, together with non-invasive markers proposed as predictors for relapse. The available data are not encouraging since de-escalation after the achievement of MH is followed by a high number of clinical relapses reaching up to 50% within one year. Unclear is also another question, in case of combination therapies, which drug is more appropriate to stop, in order to guarantee a durable remission. Predictors of unfavourable outcome such as disease extension, perianal disease, or early onset disease appear to be inadequate to foresee behaviour of disease. Further studies are warranted to investigate the role of histologic healing for the further course of disease.

关键词： De-escalation Mucosal healing Biologicaltherapy Deep remission Discontinuation Ulcerativecolitis Crohn's disease Immunosuppressors

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Oldest biliary endoprosthesis in situ

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World Journal of Gastrointestinal Endoscopy 2013年第7期5卷 356-358页

作者： Pierluigi Consolo Giuseppe Scalisi Stefano F Crinò Andrea Tortora Giuseppa Giacobbe marcello cintolo Luigi Familiari Socrate Pallio Digestive Endoscopy Unit University Hospital98100 Messina Italy

The advantages of endoscopic retrograde cholangio-pancreatography over open surgery have made it the predominant method of treating patients with choledo-cholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing "irretrievable stones" include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ . To the best of our knowledge the examined endoprosthesis is the oldest endo-prosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ . Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.

关键词： Common bile duct stones Cholangitis Biliary endoprosthesis Endoscopic retrograde cholangio-pancreatography Endoscopic sphincterotomy

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