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Third-space endoscopy:the final frontier

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Gastroenterology Report 2023年第1期11卷 14-23页

作者： Maham Hayat Dennis Yang peter v.draganov Center for Interventional Endoscopy AdventHealthOrlandoFLUSA Division of Gastroenterology Hepatologyand NutritionUniversity of FloridaGainesvilleFLUSA

Over the years,our growing experience with endoscopic submucosal dissection along with technological advances has so-lidiﬁed our comfort and knowledge on working in the submucosa,also referred to as the“third space.”Per-oral endoscopic myotomy(POEM)was theﬁrst prototype third-space endoscopy(TSE)procedure,demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal *** launch of POEM accelerated the evolution of TSE from a vanguard concept to an expandingﬁeld with a wide range of clinical *** this review,we discuss the status and future directions of multiple TSE interventions.

关键词： endoscopy final frontier therapeutic endoscopy third-space endoscopy submucosal endoscopy

Endoscopic ultrasound-guided biliary drainage

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World Journal of Gastroenterology 2012年第6期18卷 491-497页

作者： Disaya Chavalitdhamrong peter v draganov Division of Gastroenterology Hepatology and NutritionUniversity of Flori-daGainesvilleFL 32610-0214United States

Endoscopic ultrasound(EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography(ERCP).EUSguided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and ***-guided biliary drainage is an attractive option because of its minimally invasive,single step procedure which provides internal biliary *** investigators have reported high success and low complication ***,high quality prospective data are still *** provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure.

关键词：胆管引流内镜引导超声透视成像调查报告内窥镜

Squamous cell cancer of the rectum

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World Journal of Gastroenterology 2009年第35期15卷 4380-4386页

作者： Tara Dyson peter v draganov Department of Gastro-enterology Hepatology and NutritionUniversity of Florida 1600 SW Archer RdRoom HD 602PO Box 100214 GainesvilleFlorida 32610United States

Squamous cell carcinoma of the rectum is a rare *** appears to be associated with chronic inflammatory conditions and *** clear association seen between Human Papilloma virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum. The presentation is nonspecific and patients tend to present with advanced stage *** relies on endoscopic examination with biopsy of the *** from squamous cell cancer of the anus can be difficult,but can be facilitated by immunohistochemical staining for *** of the cancer with endoscopic ultrasound and computed tomography provides essential information on prognosis and can guide *** present,surgery remains the main therapeutic option;however recent advances have made chemoradiation a valuable therapeutic addition. Squamous cell carcinoma of the rectum is a distinct entity and it is of crucial importance for the practicing Gastroenterologist to be thoroughly familiar with this *** to adenocarcinoma of the rectum and squamous cell cancer of the anal canal,squamous cell carcinoma of the rectum has different epidemiology, etiology,pathogenesis,and prognosis but,most importantly,requires a different therapeutic approach. This review will examine and summarize the available information regarding this disease from the perspective of the practicing gastroenterologist.

关键词：细胞角蛋白腺癌直肠乳头状瘤病毒免疫组化染色胃肠疾病恶性肿瘤流行病学

Paraneoplastic dermatological manifestation of gastrointestinal malignancies

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World Journal of Gastroenterology 2009年第35期15卷 4372-4379页

作者： Lyubomir A Dourmishev peter v draganov Dermatology and venereology Medical University Department of Gastroenterology Hepatology and NutritionUniversity of Florida

Numerous dermatological disorders have been associated with underlining malignancies of the gastrointestinal (GI)*** cutaneous manifestations might have an important diagnostic value if they are the sole expressions of otherwise asymptomatic *** recognition of some typical paraneoplastic dermatologic disorders can lead to the prompt diagnosis of the underlying malignancy,timely administration of therapy,and ultimately,better *** this review we discuss the most common paraneoplastic dermatological syndromes from the perspective of the practicing gastroenterologist. We also outline a comprehensive practical approach for the evaluation for occult malignancy in patients presenting with cutaneous findings potentially associated with GI cancers.

关键词：恶性肿瘤皮肤病胃肠道皮肤疾病诊断价值早期诊断评价结果消化道

Pancreatic pseudocyst

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World Journal of Gastroenterology 2009年第1期15卷 38-47页

作者： Samir Habashi peter v draganov Department of Gastroenterology Hepatology and Nutrition University of FloridaGainesville Florida 32610 United States

Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.

关键词：胰腺假性囊肿导管引流术超声内镜症状持续治疗方法慢性胰腺炎并发症初步诊断

Evaluation and management of patients with refractory ascites

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World Journal of Gastroenterology 2009年第1期15卷 67-80页

作者： Bahaa Eldeen Senousy peter v draganov Ain Shams University school of Medicine Abbassia Square 11566 Cairo Egypt University of Florida Gainesville Florida 32610 United States

Some patients with ascites due to liver cirrhosis become no longer responsive to diuretics. Once other causes of ascites such as portal vein thrombosis, malignancy or infection and non-compliance with medications and low sodium diet have been excluded, the diagnosis of refractory ascites can be made based on strict criteria. Patients with refractory ascites have very poor prognosis and therefore referral for consideration for liver transplantation should be initiated. Search for reversible components of the underlying liver pathology should be undertaken and targeted therapy, when available, should be considered. Currently, serial large volume paracentesis (LvP) and transjugular intrahepatic portasystemic stent-shunt (TIPS) are the two mainstay treatment options for refractory ascites. Other treatment options are available but not widely used either because they carry high morbidity and mortality (most surgical options) rates, or are new interventions that have shown promise but still need further evaluation. In this comprehensive review, we describe the evaluation and management of patients with refractory ascites from the prospective of the practicing physician.

关键词：顽固性腹水管理门静脉血栓形成治疗方法肝硬化腹水支架分流术低钠饮食肝脏病理

Cystic neoplasms of the pancreas: A diagnostic challenge

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World Journal of Gastroenterology 2009年第1期15卷 48-54页

作者： Grant F Hutchins peter v draganov Department of Gastroenterology Hepatology and Nutrition University of Florida1600 SW Archer Rd Room HD 602 PO Box 100214 Gainesville Florida 32610 United States

Cystic neoplasms of the pancreas are increasingly recognized due to the expanding use and improved sensitivity of cross-sectional abdominal imaging. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite signifi cant improvements in imaging technology and the advent of endoscopic-ultrasound (EUS)-guided fineneedle aspiration, the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge. The fi rst diagnostic step is to differentiate between pancreatic pseudocyst and cystic neoplasm. If a pseudocyst has been effectively excluded, the cornerstone issue is then to determine the malignant potential of the pancreatic cystic neoplasm. In the majority of cases, the correct diagnosis and successful management is based not on a single test but on incorporating data from various sources including patient history, radiologic studies, endoscopic evaluation, and cyst fluid analysis. This review will focus on describing the various types of cystic neoplasms of the pancreas, their malignant potential, and will provide the clinician with a comprehensive diagnostic approach.

关键词：临床诊断方法胰腺囊性病变胰腺囊性肿瘤胰腺假性囊肿内镜超声成像技术恶性潜能生物学行为

Indomethacin for post-endoscopic retrograde cholangiopancreatography pancreatitis prophylaxis:Is it the magic bullet?

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世界胃肠病学杂志：英文版 2012年第31期18卷 4082-4085页

作者： Dennis Yang peter v draganov Division of Gastroenterology Hepatology and NutritionDepartment of MedicineUniversity of FloridaGainesvilleFL 32610United States

Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography(ERCP).Pancreatic duct stent insertion after ERCP has been widely accepted as the standard of care for the prevention of this complication in high-risk ***,the placement of pancreatic stents requires higher level of endoscopic expertise and is not always feasible due to anatomic ***,effective non-invasive pharmacologic prophylaxis remains appealing,particularly if it is inexpensive,easily administered,has a low risk side effect profile and is widely *** have been multiple studies evaluating potential pharmacologic candidates for post-ERCP pancreatitis(PEP) prophylaxis,most of them yielding disappointing results.A recently published large,multicenter,randomized controlled trial reported that in high risk patients a single dose of rectal indomethacin administered immediately after the ERCP significantly decreased the incidence of PEP compare to placebo.

关键词：急性胰腺炎药物预防吲哚美辛内镜造影胆管随机对照试验知识水平

Eosinophilic esophagitis

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World Journal of Gastroenterology 2009年第1期15卷 17-24页

作者： Anand R Gupte peter v draganov Department of Gastroenterology Hepatology and Nutrition University of Florida1600 SW Archer Rd Room HD 602 PO Box 100214 Gainesville Florida 32610 United States

Eosinophilic esophagitis is increasingly recognized in adults. The diagnosis is based on the presence of both typical symptoms and pathologic findings on esophageal biopsy. Patients usually present with dysphagia, food impaction and/or reflux-like symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power fi eld. In addition, it is essential to exclude the presence of known causes of tissue eosinophilia such as gastroesophageal reflux disease, infections, malignancy, collagen vascular diseases, hypersensitivity, and inflammatory bowel disease. There are no standardized protocols for the therapy of eosinophilic esophagitis. A variety of therapeutic approaches including acid suppression, dietary modifications, topical corticosteroids and endoscopic dilation can be used alone or in combination.

关键词：嗜酸性粒细胞增多粒细胞性食管炎胃食管反流病胶原血管疾病病理活检典型症状治疗方法