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Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents:a twelve-year experience

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World Journal of Pediatrics 2015年第2期11卷 154-159页

作者： Carlos O Kieling Cristiane Hallal Camila O Spessato Luciana M Ribeiro Helenice Breyer helena as goldani Ismael Maguilnik Post-Graduate Program of Sciences in Gastroenterology and Hepatology Universidade Federal do Rio Grande do Sul Pediatric Gastroenterology Unit Hospital de Clínicas de Porto AlegreFaculdade de MedicinaUniversidade Federal do Rio Grande do SulBrazil Endoscopy Service Hospital de Clínicas de Porto AlegreFaculdade de MedicinaUniversidade Federal do Rio Grande do SulBrazil

Background:There are few data regarding endoscopic retrograde cholangiopancreatography(ERCP)usefulness in children and *** reviewed the long-term experience with diagnostic and therapeutic ERCP in a tertiary single center in Southern ***:A retrospective chart review of patients aged 0-18 years who had undergone ERCPs from January 2000 to June 2012 was *** on demographics,indications,diagnosis,treatments,and complications were ***:Seventy-five ERCPs were performed in 60 *** median age of the patients at the procedure was 13.9 years(range:1.2-17.9).Of the 60 patients,47(78.3%)were *** all ERCPs,48(64.0%)were performed in patients above 10 years and 35(72.9%)of them were in *** was indicated for patients with bile duct obstruction(49.3%),sclerosing cholangitis(18.7%),post-surgery complication(12%),biliary stent(10.7%),choledochal cyst(5.3%),and pancreatitis(4%).The complication rate of ERCP was 9.7%involving mild bleeding,pancreatitis and *** who had therapeutic procedures were older(13.7±3.9 vs.9.9±4.9 years;P=0.001)and had more extrahepatic biliary abnormalities(82%vs.50%;P=0.015)than those who had diagnostic ERCPs.A marked change in the indications of ERCPs was found,i.e.,from 2001 to 2004,indications were more diagnostic and from 2005 therapeutic procedures were ***:Diagnostic ERCPs are being replaced by magnetic resonance cholangiopancreatography and also by endoscopic *** these procedures are complementary and ERCP still has a role for therapeutic purposes.

关键词： adolescents cholangiopancreatography endoscopic retrograde

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Contribution of endoscopy in the management of eosinophilic esophagitis

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World Journal of Gastrointestinal Endoscopy 2012年第8期4卷 347-355页

作者： Cristina Targa Ferreira helena as goldani Department of Pediatrics and Gastroenterology Unit Hospital de Clinicas de Porto Alegre Faculdade de Medicina da Universidade Federal do Rio Grande do Sul 90430-140 Porto Alegre RS Brazil

Eosinophilic esophagitis (EoE) is a clinicopathological entity characterized by a set of symptoms similar to gastroesophageal reflux disease and eosinophilic infi ltration of the esophageal epithelium. EoE is an emerging worldwide disease as documented in many countries. Recent reports indicate that EoE is increasingly diagnosed in both pediatric and adult patients although the epidemiology of this new disease entity remains unclear. It is unclear whether EoE is a new disease or a new classification of an old esophageal disorder. Esophagogastroduodenoscopy (EGD) and biopsies with histological examination of esophageal mucosa are required to establish the diagnosis of EoE, verify response to therapy, assess disease remission, document and dilate strictures and evaluate symptom recurrence of EoE. Repeated endoscopies with biopsies are necessary for monitoring of disease progression and treatment effi cacy. EGD has a fundamental role in the diagnosis and management of EoE, forming an essential part of the investigation and follow-up of this condition. EoE is now considered a systemic disorder and not only a local condition with an important immunological back-ground. One of the aims of research in EoE is to study non-invasive markers, such as immune indicators found in plasma, that correlate with local presence of EoE in esophageal tissues. Studies over the next few years will provide new information about diagnosis, pathogenesis, endoscopic/histologic criteria, non-invasive markers, novel and more eff icacious treatments, as well as establishing natural history. Randomized clinical trials are urgently called for to inform non-invasive diagnostic tests, hallmarks of natural history and more eff icacious treatment approaches for patients with EoE. The collaboration between pediatric and adult clinical and experimental studies will be paramount in the understanding and management of this disease.

关键词： Eosinophilic Esophagitis Atopy Endoscopy Pediatrics

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Managing gastroesophageal reflux disease in children: The role of endoscopy

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World Journal of Gastrointestinal Endoscopy 2012年第8期4卷 339-346页

作者： helena as goldani Daltro LA Nunes Cristina T Ferreira Department of Pediatrics and Gastroenterology Unit Hospital de Clinicas de Porto Alegre Faculdade de Medicina da Universidade Federal do Rio Grande do Sul 90035-903 Porto Alegre-RS Brazil

Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.

关键词： Endoscopy Gastroesophageal reflux Esophagitis Infants Children

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Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease

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世界胃肠病学杂志：英文版 2015年第29期21卷 8927-8934页

作者： Daniele Santetti Maria Inês de Albuquerque Wilasco Cristina Toscani Leal Dornelles Isabel Cristina Ribas Werlang Fernanda Urruth Fontella Carlos Oscar Kieling Jorge Luiz dos Santos Sandra Maria Goncalves Vieira helena Ayako Sueno goldani Post-Graduate Program of Child and Adolescent Health Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto Alegre Nutrition Service Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Laboratory of Translational Pediatrics-NESCA Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Pediatric Hepatology Unit Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Pediatric Gastroenterology Unit Hospital de Clínicas de Porto Alegre and Post-Graduate Program of Child and Adolescent HealthFaculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto Alegre

AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver ***: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease(MELD) and Pediatric End Stage Liver Disease(PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition(Z-score <-1.00) and malnutrition(Z-score <-2.00). Interleukin-1β(IL-1β), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. RESULTS: The median(25th-75 th centile) age of the study population was 60(17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease(72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values were increased in patients at nutritional risk(34.9%) compared with those who were well-nourished [7.12(0.58-34.23) pg/m L vs 1.63(0.53-3.43) pg/m L; P = 0.02], correlating inversely with triceps skinfold-for-age z-score(rs =-0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score(P = 0.001).

关键词： Cytokines Interleukin-6 Malnutrition Cirrhosis Child

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