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Role of endoscopic-ultrasound-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1981-1985页

作者： smit S deliwala Emad Qayed Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGA 30303United States

In this editorial,we discuss the article by Peng et al in the recent issue of the World Journal of Gastrointestinal Surgery,focusing on the evolving role of endoscopicultrasound-guided biliary drainage(EUS-BD)with electrocautery lumen apposing metal stent(LAMS)for distal malignant biliary *** endoscopy has rapidly advanced in decompression techniques,with growing evidence of its safety and efficacy surpassing percutaneous and surgical *** endoscopic retrograde cholangiopancreatography(ERCP)has been the gold standard for biliary decompression,its failure rate approaches 10.0%,prompting the exploration of alternatives like *** random-effects meta-analysis demonstrated high technical and clinical success of over 90.0% and an adverse event rate of 17.5%,mainly in the form of stent *** based on stent size were not reported but the majority used 6 mm and 8 mm *** the body of literature continues to demonstrate the effectiveness of this technique,the challenges of stent dysfunction need to be addressed in future *** strategy that has shown promise is placement of double-pigtail stents,only 18% received the prophylactic intervention in this *** expect this to improve with time as the technique continues to be refined and *** results above establish EUS-BD with LAMS as a reliable alternative after failed ERCP and considering EUS to ERCP upfront in the same session is an effective *** the promising results,studies must explore the role of EUS-BD as first-line therapy for biliary decompression.

关键词： Endoscopic-ultrasound Malignant biliary obstruction Lumen apposing metal stent Choledochoduodenostomy Hepaticogastrostomy

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Spontaneous bacterial empyema in cirrhosis:A systematic review and meta-analysis

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World Journal of Hepatology 2022年第6期14卷 1258-1268页

作者： William Reiche smit deliwala Saurabh Chandan Babu P Mohan Banreet Dhindsa Daryl Ramai Abhilash Perisetti Rajani Rangray Sandeep Mukherjee Department of Internal Medicine CHI Creighton University Medical CenterOmahaNE 68124United States Department of Internal Medicine Michigan State University at Hurley Medical CenterFlintMI 48503United States Division of Gastroenterology and Hepatology CHI Creighton University Medical CenterOmahaNE 68124United States Department of Gastroenterology University of UtahSalt Lake CityUT 84132United States Division of Gastroenterology and Hepatology University of Nebraska Medical CenterOmahaNE 68198United States Division of Gastroenterology Parkview HealthFort WayneIN 46845United States

BACKGROUND Spontaneous bacterial empyema(SBE)occurs when a hepatic hydrothorax becomes infected and runs a course similar to spontaneous bacterial peritonitis(SBP).It remains underdiagnosed as patients with cirrhosis do not routinely undergo diagnostic *** understanding is limited by small cohorts,while studies reporting its association with ascites/SBP are *** To explore the incidence of SBE,to determine its association with ascites,and to summarize what is known regarding treatment and outcomes for patients with *** Major databases were searched until June *** include the incidence of SBE in pleural effusions,SBP in peritoneal fluid,and SBE in patients without ascites within our cohort of patients with *** performed a meta-analysis using a randomeffects model with pooled proportions and 95%confidence intervals(CI).We assessed heterogeneity using I^(2)and classic fail-safe to determine *** Eight studies with 8899 cirrhosis patients were *** median age ranged between 41.2 to 69.7 *** majority of the patients were Child-Pugh B and *** MELD score was 18.6±8.09.A total of 1334 patients had pleural effusions and the pooled incidence of SBE was 15.6%(CI 12.6-19;I^(2)50).Amongst patients diagnosed with SBE,the most common locations included right(202),left(64),and bilateral(8).Amongst our cohort,a total of 2636 patients had ascites with a pooled incidence of SBP of 22.2%(CI 9.9-42.7;I^(2)97.8).The pooled incidence of SBE in patients with cirrhosis but without concomitant ascites was 9.5%(CI 3.6-22.8;I^(2)82.5).CONCLUSION SBE frequently occurs with concurrent ascites/SBP;our results suggest high incidence rates of SBE even in the absence of *** pleura can be an unrecognized nidus and our findings support the use of diagnostic thoracentesis in patients with decompensated cirrhosis after exclusion of other causes of pleural *** should be considered particularly in p

关键词： Spontaneous bacterial peritonitis Spontaneous bacterial peritonitis Postparacentesis circulatory dysfunction Refractory ascites Hepatic hydrothorax

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Acute pancreatitis in liver transplant hospitalizations:Identifying national trends,clinical outcomes and healthcare burden in the United States

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World Journal of Hepatology 2023年第6期15卷 797-812页

作者： Dushyant Singh Dahiya Vinay Jahagirdar Saurabh Chandan Manesh Kumar Gangwani Nooraldin Merza Hassam Ali smit deliwala Muhammad Aziz Daryl Ramai Bhanu Siva Mohan Pinnam Jay Bapaye Chin-I Cheng Sumant Inamdar Neil R Sharma Mohammad Al-Haddad Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48601United States Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64110United States Division of Gastroenterology and Hepatology CHI Creighton University Medical CenterOmahaNE 68131United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Internal Medicine East Carolina UniversityGreenvilleNC 27858United States Division of Digestive Diseases Emory University School of MedicineAtlantaGA 30322United States Division of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States Division of Gastroenterology and Hepatology The University of Utah School of MedicineSalt Lake CityUT 84112United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Statistics Actuarial and Data ScienceCentral Michigan UniversityMt.PleasantMI 48859United States Division of Gastroenterology and Hepatology University of Arkansas for Medical SciencesLittle RockAR 72205United States Interventional Oncology and Surgical Endoscopy Programs Parkview Cancer InstituteFort WayneIN 46845United States Division of Gastroenterology and Hepatology Indiana University School of MedicineIndianapolisIN 46202United States

BACKGROUND Acute pancreatitis(AP)in liver transplant(LT)recipients may lead to poor clinical outcomes and development of severe *** We aimed to assess national trends,clinical outcomes,and the healthcare burden of LT hospitalizations with AP in the United States(US).METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)LT hospitalizations with AP in the US from 2007–***-LT AP hospitalizations served as controls for comparative *** trends of hospitalization characteristics,clinical outcomes,complications,and healthcare burden for LT hospitalizations with AP were *** characteristics,clinical outcomes,complications,and healthcare burden were also compared between the LT and non-LT ***,predictors of inpatient mortality for LT hospitalizations with AP were *** P values≤0.05 were considered statistically *** The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in *** was a rising trend of Hispanic(16.5%in 2007 to 21.1%in 2018,P-trend=0.0009)and Asian(4.3%in 2007 to 7.4%in 2019,p-trend=0.0002)LT hospitalizations with AP,while a decline was noted for Blacks(11%in 2007 to 8.3%in 2019,P-trend=0.0004).Furthermore,LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index(CCI)score≥3 increased from 41.64%in 2007 to 62.30%in 2019(P-trend<0.0001).We did not find statistically significant trends in inpatient mortality,mean length of stay(LOS),and mean total healthcare charge(THC)for LT hospitalizations with AP despite rising trends of complications such as sepsis,acute kidney failure(AKF),acute respiratory failure(ARF),abdominal abscesses,portal vein thrombosis(PVT),and venous thromboembolism(VTE).Between 2007–2019,6863 LT hospitalizations with AP were compared to 5649980 non-LT AP *** hospitalizations with AP were slightly older(53.5 vs 52.6 years,P=0.017)and

关键词： Liver transplantation Pancreatitis Mortality Cost Length of stay

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