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Endoscopic salvage therapy after failed biliary cannulation using advanced techniques:A concise review

World Journal of Gastroenterology 2022年第29期28卷 3803-3813页

作者： yung-Kuan tsou Kuang-Tse Pan Mu Hsien Lee Cheng-Hui Lin Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333Taiwan Department of Medicine Chang Gung UniversityTaoyuan 333Taiwan Department of Medical Imaging and Intervention Chang Gung Memorial HospitalTaoyuan 333Taiwan

Therapeutic endoscopic retrograde cholangiopancreatography(ERCP)begins with successful biliary ***,it is not always be *** failure of the initial ERCP is attributed to two main aspects:the papilla/biliary orifice is endoscopically accessible,or it is *** the papilla/biliary orifice is accessible,bile duct cannulation failure can occur even with advanced cannulation techniques,including double guidewire techniques,transpancreatic sphincterotomy,needle-knife precut papillotomy,or *** is currently no consensus on the next steps of treatment in this ***,this review aims to propose and discuss potential endoscopic options for patients who have failed ERCP due to difficult bile duct *** options include interval ERCP,percutaneous-transhepatic-endoscopic rendezvous procedures(PTE-RV),and endoscopic ultrasound-assisted rendezvous procedures(EUS-RV).The overall success rate for interval ERCP was 76.3%(68%-79% between studies),and the overall adverse event rate was 7.5%(0-15.9% between studies).The overall success rate for PTE-RV was 88.7%(80.4%-100%between studies),and the overall adverse event rate was 13.2%(4.9%-19.2% between studies).For EUS-RV,the overall success rate was 82%-86.1%,and the overall adverse event rate was 13%-15.6%.Because interval ERCP has an acceptably high success rate and lower adverse event rate and does not require additional expertise,facilities,or other specialists,it can be considered the first choice for salvage ***-RV can also be considered if local experts are *** patients in urgent need of biliary drainage,PTE-RV should be considered.

关键词： Difficult biliary cannulation Endoscopic ultrasound Rendezvous Endoscopic retrograde cholangiopancreatography Percutaneous transhepatic biliary drainage Interval

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Hydrogel as a bioactive material to regulate stem cell fate

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Bioactive Materials 2016年第1期1卷 39-55页

作者： yung-Hao tsou Joe Khoneisser Ping-Chun Huang Xiaoyang Xu Department of Chemical Biologicaland Pharmaceutical EngineeringNew Jersey Institute of TechnologyNewarkNJ 07102USA

The encapsulation of stem cells in a hydrogel substrate provides a promising future in biomedical ***,communications between hydrogels and stem cells is complicated;various factors such as porosity,different polymer types,stiffness,compatibility and degradation will lead to stem cell survival or *** mimic the three-dimensional extracellular matrix to provide a friendly environment for stem *** the other hand,stem cells can sense the surroundings to make the next progression,stretching out,proliferating or just to *** such,understanding the correlation between stem cells and hydrogels is *** this Review,we first discuss the varying types of the hydrogels and stem cells,which are most commonly used in the biomedical fields and further investigate how hydrogels interact with stem cells from the perspective of their biomedical application,while providing insights into the design and development of hydrogels for drug delivery,tissue engineering and regenerative medicine *** addition,we compare the results such as stiffness,degradation time and pore size as well as peptide types of hydrogels from respected *** also discussed most recently magnificent materials and their effects to regulate stem cell fate.

关键词： Hydrogel Stem cell Biomaterial

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Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?

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World Journal of Clinical Cases 2023年第29期11卷 6984-6994页

作者： yung-Kuan tsou Yi-Tse Su Cheng-Hui Lin Nai-Jen Liu Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalTaoyuan 333TaiwanChina

BACKGROUND Whether clinical outcomes of acute cholangitis(AC)vary by etiology is *** To compare outcomes in AC caused by malignant biliary obstruction(MBO)and common bile duct stones(CBDS).METHODS This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)due to AC caused by MBO(MBO group,n=56)and CBDS(CBDS group,n=460).Clinical and laboratory parameters were compared between the *** score matching(PSM)created 55 matched *** used in the PSM analysis were age,sex,time to ERCP,and technical success of *** primary outcome comparison was 30-d *** secondary outcome comparisons were intensive care unit(ICU)admission rate,length of hospital stay(LOHS),and 30-d readmission *** Compared with the CBDS group,the MBO group had significantly lower body temperature,percentage of abnormal white blood cell counts,and serum levels of aspartate aminotransferase,alanine aminotransferase,and *** temperature,percent abnormal white blood cell count,and serum aspartate aminotransferase levels remained significantly lower in the MBO group in the PSM *** count,prothrombin time/international normalized ratio,and serum levels of alkaline phosphatase and total bilirubin were significantly higher in the MBO *** MBO group had a significantly higher percentage of severe AC(33.9%vs 22.0%,P=0.045)and received ERCP later(median,92.5 h vs 47.4 h,P<0.001).However,the two differences were not found in the PSM *** 30-d mortality(5.4%vs 0.7%,P=0.019),ICU admission rates(12.5%vs 4.8%,P=0.028),30-d readmission rates(23.2%vs 8.0%,P<0.001),and LOHS(median,16.5 d vs 7.0 d,P<0.001)were significantly higher or longer in the MBO ***,only LOHS remained significant in the PSM *** analysis revealed that time to ERCP and multiple organ dysfunction were independent factors associated with 30-d *** MBO patients underwent ERC

关键词： Malignant biliary obstruction Common bile duct stones Endoscopic retrograde cholangiopancreatography Acute cholangitis Mortality Etiology

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Pancreatic stent improves the success rate of needle-knife papillotomy in patients with difficult biliary cannulation

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World Journal of Gastroenterology 2025年第1期31卷 58-67页

作者： Mu-Hsien Lee Cheng-Hui Lin Chi-Huan Wu yung-Kuan tsou Kai-Feng Sung Sheng-Fu Wang Nai-Jen Liu Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuan 33305Taiwan School of Medicine Chang Gung UniversityTaoyuan 33305Taiwan

BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed ***,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of *** To explore whether PS placement improves the success rate of NKP in patients with difficult biliary *** This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary *** cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's *** primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event *** Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP *** the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.

关键词： Difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife papillotomy Pancreatic stent Selective biliary cannulation

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Residual common bile duct stones on direct peroral cholangioscopy using ultraslim endoscope

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World Journal of Gastroenterology 2013年第30期19卷 4966-4972页

作者： Shu-Wei Huang Cheng-Hui Lin Mu-Shien Lee yung-Kuan tsou Kai-Feng Sung Department of Gastroenterology and Hepatology Division of Digestive Therapeutic EndoscopyChang Gung Memorial HospitalChang Gung University College of Medicine

AIM:To detect and manage residual common bile duct(CBD)stones using ultraslim endoscopic peroral cholangioscopy(POC)after a negative balloon-occluded ***:From March 2011 to December 2011,a cohort of 22 patients with CBD stones who underwent both endoscopic retrograde cholangiography(ERC)and direct POC were prospectively enrolled in this *** patients who were younger than 20 years of age,pregnant,critically ill,or unable to provide informed consent for direct POC,as well as those with concomitant gallbladder stones or CBD with diameters less than 10 mm were *** POC using an ultraslim endoscope with an overtube balloon-assisted technique was carried out immediately after a negative balloon-occluded cholangiography was ***:The ultraslim endoscope was able to be advanced to the hepatic hilum or the intrahepatic bile duct(IHD)in 8 patients(36.4%),to the extrahepatic bile duct where the hilum could be visualized in 10 patients(45.5%),and to the distal CBD where the hilum could not be visualized in 4 patients(18.2%).The procedure time of the diagnostic POC was 8.2 ± 2.9 min(range,5-18 min).Residual CBD stones were found in 5(22.7%)of the *** was one residual stone each in 3 of the patients,three in 1 patient,and more than five in 1 *** diameter of the residual stones ranged from 2-5 *** 2 of the patients,the residual stones were successfully extracted using either a retrieval balloon catheter(n = 1)or a basket catheter(n = 1)under direct endoscopic *** the remaining 3 patients,the residual stones were removed using an irrigation and suction method under direct endoscopic *** were no serious procedure-related complications,such as bleeding,pancreatitis,biliary tract infection,or perforation,in this ***:Direct POC using an ultraslim endoscope appears to be a useful tool for both detecting and treating residual CBD stones after conventional ERC.

关键词： Balloon-occluded cholangiography Common bile duct stones Endoscopic retrograde cholangiography Peroral cholangioscopy Residual stones

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Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth Ⅱ gastrectomy

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World Journal of Gastroenterology 2010年第36期16卷 4594-4598页

作者： Jui-Hsiang Tang yung-Kuan tsou Hao-Tsai Cheng Mu-Hsien Lee Ching-Song Lee Nai-Jen Liu Division of Digestive Therapeutic Endoscopy Department of Gastroenterology and HepatologyChang Gung Memorial Hospital College of Medicine Chang Gung University

AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)***:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP *** all cases,the ERCP procedures were started using a *** intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success ***:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent *** DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully *** patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by *** were no complications related to the *** overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.

关键词： Double balloon endoscopy Endoscopic retrograde cholangiopancreatography BillrothⅡgastrectomy

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Esophagogastroduodenoscopy with conscious sedation does not interfere with catheter-based 24-h pH monitoring

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World Journal of Gastroenterology 2013年第11期19卷 1805-1810页

作者： yung-Kuan tsou Jau-Min Lien Chin-Kuo Chen Cheng-Hui Lin Hsing-Yu Chen Mu-Shien Lee Department of Gastroenterology and Hepatology Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuan 333Taiwan Department of Otolaryngology Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuan 333Taiwan Center for Traditional Chinese Medicine Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuan 333Taiwan

AIM:To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH ***:Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August *** of the data were collected prospectively and analyzed ***-six patients(72%,group A) underwent pH monitoring shortly after esophagogastroduodenoscopy(EGD) with conscious sedation,and 14 patients(28%,group B) underwent pH monitoring without conscious *** 24-h pH data from two time periods were analyzed:the first 4 h(Period Ⅰ) and the remaining time of the study(Period Ⅱ).RESULTS:The mean age of the patients was 49.6 ± 12.5 years;20 patients(40%) were *** baseline data,including age,sex,body mass index,reflux esophagitis,the Reflux Symptom Index,and the Reflux Findings Score,were comparable between the two *** percentage of total time with a pH < 4 and the frequency of acid reflux during Period Ⅰ were not significantly different between the two groups,as measured using both pharyngeal(0.03% ± 0.10% vs 0.07% ± 0.16%,P = 0.32;and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h,P = 0.33,respectively) and esophageal probes(0.96% ± 1.89% vs 0.42% ± 0.81%,P = 0.59;and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h,P = 0.49,respectively).The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and Ⅱ in group A patients,as measured using both pharyngeal(0.03% ± 0.10% vs 0.23% ± 0.85%,P = 0.21;and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h,P = 0.22,respectively) and esophageal probes(0.96% ± 1.89% vs 1.11% ± 2.57%,P = 0.55;and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h,P = 0.55,respectively).CONCLUSION:EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal

关键词： Esophagogastroduodenoscopy Conscious sedation pH monitoring Gastroesophageal reflux disease Extraesophageal symptoms

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Predictive role of XRCC5/XRCC6 genotypes in digestive system cancers

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World Journal of Gastrointestinal Oncology 2011年第12期3卷 175-181页

作者： Mei-Due Yang Chia-Wen Tsai Wen-Shin Chang yung-an tsou Cheng-Nan Wu Da-Tian Bau Terry Fox Cancer Research Laboratory China Medical University Hospital Graduate Institute of Basic Medical Science China Medical University Department of Medical Laboratory Science and Biotechnology Central Taiwan University of Science and Technology Graduate Institute of Clinical Medical Science China Medical University

Cancers are a worldwide concern;oral,esophageal and gastrointestinal cancers represent important causes of cancer-related mortality and contribute to a signif icant burden of human *** DNA repair systems are the genome caretakers,playing a critical role in the initiation and progression of ***,the association between the genomic variations of DNA repair genes and cancer susceptibility is not well *** review focuses on the polymorphic genotypes of the non-homologous end-joining DNA repair system,highlighting the role of two genes of this pathway,XRCC5 and XRCC6,in the susceptibility to digestive system cancers and discussing their potential contributions to personalized medicine.

关键词： XRCC5 XRCC6 Polymorphism Oral cancer Esophageal cancer Gastrointestinal cancer Colorectal cancer

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Link between pharyngeal acid reflux episodes and the effectiveness of proton pump inhibitor therapy

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World Journal of Gastroenterology 2024年第48期30卷 5162-5173页

作者： Yen-Yang Chen Chen-Chi Wang Chun-Yi Chuang yung-an tsou Yen-Chun Peng Chi-Sen Chang Han-Chung Lien Division of Gastroenterology Taichung Veterans General HospitalTaichung 402TaiwanChina Department of Otolaryngology Taichung Veterans General HospitalTaichung 402TaiwanChina School of Medicine National Yang Ming Chiao Tung UniversityTaipei 112TaiwanChina School of Speech Language Pathology and Audiology Chung Shan Medical UniversityTaichung 402TaiwanChina School of Medicine Chung Shan Medical UniversityTaichung 402TaiwanChina Department of Otolaryngology Chung Shan Medical University HospitalTaichung 402TaiwanChina Department of Otorhinolaryngology-Head and Neck Surgery China Medical University HospitalTaichung 400TaiwanChina Division of Gastroenterology and Hepatology Department of Internal MedicineTungs’Taichung Metro Harbor HospitalTaichung 435TaiwanChina Division of Gastroenterology Center for Functional Esophageal DisordersTaichung Veterans General HospitalTaichung 402TaiwanChina Department of Post-Baccalaureate Medicine College of MedicineNational Chung Hsing UniversityTaichung 402Taiwan

BACKGROUND Diagnosing laryngopharyngeal reflux(LPR)is challenging due to overlapping *** proton pump inhibitors(PPIs)are commonly prescribed,reliable predictors of their responsiveness are *** monitoring techno-server *** hypothesized that PAR episodes alone might also predict PPI *** To investigate whether PAR episodes alone predict a positive response to PPI *** Patients suspected of having LPR were prospectively recruited from otolaryngologic clinics in three Taiwan residents tertiary *** underwent a 24-hour esophagopharyngeal pH test using either 3-pH-sensor or hypopha-ryngeal MII-pH catheters while off medication,followed by a 12-week esomeprazole course(40 mg twice daily).Participants were categorized into four groups based on pH results:PAR alone,EAR alone,both pH(+),and both pH(-).The primary outcome was a≥50%reduction in primary laryngeal symptoms,with observers blinded to group *** A total of 522 patients(mean age 52.3±12.8 years,54%male)were *** these,190(mean age 51.5±12.4 years,61%male)completed the treatment,and 89(47%)responded to PPI *** rates were highest in the PAR alone group(73%,n=11),followed by EAR alone(59%,n=68),both pH(+)(56%,n=18),and both pH(-)(33%,n=93).Multivariate analysis adjusting for age,sex,body mass index,and endoscopic esophagitis showed that participants with PAR alone,EAR alone,and both pH(+)were 7.4-fold(P=0.008),4.2-fold(P=0.0002),and 3.4-fold(P=0.03)more likely to respond to PPI therapy,respectively,compared to the both pH(-)*** analyses using the definition of≥1 PAR episode were less *** In the absence of proven hypopharyngeal predictors,this post-hoc analysis found that baseline≥2 PAR episodes alone are linked to PPI responsiveness,suggesting the importance of hypopharyngeal reflux monitoring.

关键词： Pharyngeal acid reflux episodes Laryngopharyngeal reflux Hypopharyngeal multichannel intraluminal impedance-pH 3-pH-sensor Proton pump inhibitors

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Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding

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World Journal of Gastroenterology 2016年第11期22卷 3196-3201页

作者： Mu-Hsien Lee yung-Kuan tsou Cheng-Hui Lin Ching-Song Lee Nai-Jen Liu Kai-Feng Sung Hao-Tsai Cheng Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of Medicine

AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) ***: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic ***: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from ***: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding.

关键词： Delayed bleeding Endoscopic hemostasis Endoscopic sphincterotomy Predictors Re-bleeding

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