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Primary sclerosing cholangitis:A review and update

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Liver Research 2017年第4期1卷 221-230页

作者： james h.tabibian Christopher L.Bowlus Division of Gastroenterology and hepatology University of California DavisSacramentoCAUSA Division of Gastroenterology Olive View-UCLA Medical CenterSylmarCAUSA

Primary sclerosing cholangitis(PSC)is a rare,chronic,cholestatic liver disease of uncertain etiology characterized biochemically by cholestasis and histologically and cholangiographically by fibroobliterative inflammation of the bile *** a clinically significant proportion of patients,PSC progresses to cirrhosis,end-stage liver disease,and/or hepatobiliary cancer,though the disease course can be highly *** clinical trials of numerous pharmacotherapies over several decades,safe and effective medical therapy remains to be *** transplantation is an option for select patients with severe complications of PSC,and its outcomes are generally *** surveillance testing for pre-as well as post-transplant patients is a cornerstone of preventive care and health *** we provide an overview of PSC,including its epidemiology,etiopathogenesis,clinical features,associated disorders,surveillance,and emerging potential therapies.

关键词： Bile duct diseases Primary sclerosing cholangitis(PSC) Cholestasis Cholangiocarcinoma Magnetic resonance imaging Cholangiography Natural history

Biliary endoscopy in the management of primary sclerosing cholangitis and its complications

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Liver Research 2019年第2期3卷 106-117页

作者： Brian M.Fung james h.tabibian University of California Los Angeles-Olive View Internal Medicine Residency Program SylmarCAUSA Division of Gastroenterology Department of MedicineOlive View-University of California Los Angeles Medical CenterSylmarCAUSA

Primary sclerosing cholangitis(PSC)is a chronic,idiopathic,cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile *** can affect individuals of all age groups and gender,has no established pharmacotherapy,and is associated with a variety of neoplastic(***)and non-neoplastic(*** strictures)hepatobiliary *** these considerations,endoscopy plays a major role in the care of patients with *** this review,we discuss and provide updates regarding endoscopic considerations in the management of hepatobiliary manifestations and complications of *** evidence is limited,we suggest pragmatic approaches based on currently available data and expert opinion.

关键词： Primary sclerosing cholangitis(PSC) Biliary tract disease Balloon dilation Cholangioscopy Dominant stricture Cholangiocarcinoma(CCA) Endoscopic retrograde cholangiopancreatography(ERCP)

Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

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World Journal of hepatology 2020年第11期12卷 908-918页

作者： Saroja Bangaru Jihane N Benhammou james h tabibian Internal Medicine GastroenterologyUniversity of California at Los AngelesLos AngelesCA 90025United States The Vatche and Tamar Manoukian Division of Digestive Diseases University of California at Los AngelesLos AngelesCA 90095United States Department of Medicine Olive View-University of California at Los Angeles Medical CenterSylmarCA 91342United States David Geffen School of Medicine at UCLA Los AngelesCA 90095United States

The primary purpose of variceal screening in patients with cirrhosis is to detect gastroesophageal varices at high risk of hemorrhage and implement preventative intervention(s).It was previously recommended that all patients with cirrhosis undergo initial and periodic longitudinal variceal screening via upper ***,there has been growing interest and methods to identify patients with cirrhosis who may not have clinically significant portal hypertension and therefore be unlikely to have varices requiring intervention or benefit from upper *** the population of patients with compensated advanced chronic liver disease continues to grow,it is neither beneficial nor cost-effective to perform endoscopic variceal screening in all ***,there is ongoing research into the development of methods to non-invasively risk stratify patients with cirrhosis for the presence of high-risk esophageal varices and effectively limit the population that undergoes endoscopic variceal *** is particularly important and timely in light of increasing healthcare reform and barriers to *** this review,we discuss and compare,with respect to test characteristics and clinical applicability,the available methods used to noninvasively predict the presence of esophageal varices.

关键词： Gastroesophageal varices Variceal screening Advanced chronic liver disease Cirrhosis Non-invasive screening Upper endoscopy

Gastro-gastric intussusception in the setting of a neuroendocrine tumor: A case report

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World Journal of Clinical Cases 2019年第21期7卷 3517-3523页

作者： Alex Zhornitskiy Long Le Serene Tareen Gezman Abdullahi Deepthi Karunasiri james h tabibian Department of Internal Medicine Olive View-UCLA Medical CenterSylmarCA 91342United States Department of Pathology and Laboratory Medicine Olive View-UCLA Medical CenterSylmarCA 91342United States Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCA 91342United States

BACKGROUND While in children intussusception is often idiopathic,in adults it is commonly caused by a pathologic condition functioning as a lead *** is important to note that a variety of pathologic conditions may trigger intussusception,with malignancy being a relatively frequent culprit in adults;this should be considered high on the differential diagnosis during *** SUMMARY This is a case of a 40-year-old female presenting to the emergency department(ED)with three days of acute on chronic,peri-umbilical abdominal pain described as waxing and waning,and pressure-like in *** computed tomography(CT)of the abdomen and pelvis with contrast in the ED(after her pain had resolved)re-demonstrated a previously noted 13 mm lesion in the gastric antrum but no clear cause of the *** ultrasound was pursued,and the mass lesion was sampled via fine needle ***-procedure the patient experienced another episode of severe pain which prompted a repeat stat CT abdomen and pelvis with contrast;this re-demonstrated the 13 mm antral lesion and in addition was remarkable for a gastro-gastric *** upper gastrointestinal gastrograffin series was ordered(completed only after the pain had subsided)and showed resolution of the *** was consistent with a diagnosis of low-grade neuroendocrine tumor(NET).Surgery was initially deferred during the hospitilization given the low grade pathology of the lesion;however further multidisciplinary discussion between Surgery,Oncology,and Gastroenterology recommended resection given the patient’s recurrent abdominal pain with the NET functioning as a lead point for further intussusception,and the patient thus underwent robotically-assisted wedge *** We present a unique case of severe,intermittent,peri-umbilical pain related to gastro-gastric intussusception caused by an antral NET lead *** case highlights the importance of considering neoplasms as t

关键词： Abdominal pain Gastro-gastric intussusception Neuroendocrine tumor Case report

Geoepidemiologic variation in outcomes of primary sclerosing cholangitis

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World Journal of hepatology 2020年第4期12卷 116-124页

作者： Tej I Mehta Simcha Weissman Brian M Fung james h tabibian Department of Medicine University of South Dakota Sanford School of MedicineSioux FallsSD 57108United States Department of Medicine Hackensack University-Palisades Medical CenterNorth BergenNJ 07047United States Department of Medicine Olive View-UCLA Medical CenterSylmarCA 91342United States Department of Medicine UCLA-Olive View Medical CenterSylmarCA 91342and Health Sciences Clinical Associate ProfessorDavid Geffen School of Medicine at UCLALos AngelesCA 90095United States

Primary sclerosing cholangitis(PSC)is a chronic,progressive,hepatobiliary disease characterized by inflammation and fibrosis of the intra-and extra-hepatic bile *** natural history is one that generally progresses towards cirrhosis,liver failure,cholangiocarcinoma,and ultimately disease-related death,with a median liver transplantation-free survival time of approximately 15-20 ***,despite its lethal nature,PSC remains a heterogenous disease with significant variability in outcomes amongst different regions of the *** are also many regions where the outcomes of PSC have not been studied,limiting the overall understanding of this disease *** this review,we present the geoepidemiologic variations in outcomes of PSC,with a focus on survival pre-and post-liver transplantation as well as the concurrence of inflammatory bowel disease and hepatobiliary neoplasia.

关键词： Cholangiocarcinoma Inflammatory bowel disease Liver transplantation Geography Biliary tract Autoimmune

Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices

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World Journal of Gastrointestinal Surgery 2022年第4期14卷 286-303页

作者： Anand Rajan Peerapol Wangrattanapranee Jonathan Kessler Trilokesh Dey Kidambi james h tabibian Department ofGastroenterology Olive View-UCLA Medical CenterSylmarCA 91342United States Department ofGastroenterology City of Hope Medical CenterDuarteCA 91010United States Department ofMedicine Keck School of Medicine of USCLos AngelesCA 90033United States Department ofInterventional Radiology City of Hope Medical CenterDuarteCA 91010United States Department ofGastroenterology UCLA-Olive View Medical CenterSylmarCA 91342United States

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication *** evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and ***,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is ***,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.

关键词： Gastrostomy Gastropexy Enterostomy Decompression Enteral nutrition Endoscopy

Ever-increasing diversity of drug-induced pancreatitis

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World Journal of Gastroenterology 2020年第22期26卷 2902-2915页

作者： Simcha Weissman Muhammad Aziz Ryan B Perumpail Tej I Mehta Rutwik Patel james h tabibian Department of Medicine Hackensack University-Palisades Medical CenterNorth BergenNJ 07047United States Department of Medicine University of Toledo Medical CenterToledoOH 43614United States Vatche and Tamar Manoukian Division of Digestive Diseases David Geffen School of Medicine at UCLALos AngelesCA 90095United States Department of Interventional Radiology Johns Hopkins University HospitalBaltimoreMD 21205United States Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCA 91342 and David Geffen School of Medicine at UCLALos AngelesCA 90095United States

With over 100000 hospital admissions per annum,acute pancreatitis remains the leading gastrointestinal cause of hospitalization in the United States and has farreaching impact well *** has become increasingly recognized that druginduced pancreatitis(DIP),despite accounting for less than 3%of all cases,represents an important and growing though often inconspicuous cause of acute ***,knowledge of DIP is often curtailed by the limited availability of evidence needed to implicate given agents,especially for nonprescription ***,the majority of available data is derived from case reports,case series,or case control ***,the mechanism of injury and causality for many of these drugs remain elusive as a definitive correlation is generally not established(have been proposed,but no single system has been widely adopted,and periodic updates are required in light of ongoing pharmacologic ***,infrequently prescribed medications or those available over-thecounter(including herbal and other alternative remedies)are often overlooked as a potential culprit of acute ***,we review the ever-increasing diversity of DIP and the potential mechanisms of injury with the goal of raising awareness regarding the nature and magnitude of this *** believe this manuscript will aid in increasing both primary and secondary prevention of DIP,thus ultimately facilitating more expedient diagnosis and a decrease in DIPrelated morbidity.

关键词： Drug-induced pancreatitis Acute pancreatitis Pharmacology Mechanism of action Inflammation Etiology

hemobilia: Etiology, diagnosis, and treatment

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Liver Research 2018年第4期2卷 200-208页

作者： Rani Berry james han Ani A.Kardashian Nicholas F.LaRusso james h.tabibian Department of Internal Medicine UCLA Ronald Reagan Medical CenterLos AngelesCAUSA Department of Internal Medicine University of California IrvineIrvineCAUSA UCLA Gastroenterology Fellowship Training Program Vatche and Tamar ManoukianDivision of Digestive DiseasesLos AngelesCAUSA Division of Gastroenterology and hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Department of MedicineOlive View-UCLA Medical CenterSylmarCAUSA

hemobilia refers to bleeding from and/or into the biliary tract and is an uncommon but important cause of gastrointestinal *** of hemobilia date back to the 1600s,but due to its relative rarity and challenges in diagnosis,only in recent decades has hemobilia been more critically *** majority of cases of hemobilia are iatrogenic and caused by invasive procedures involving the liver,pancreas,bile ducts and/or the hepatopancreatobiliary vasculature,with trauma and malignancy rep-resenting the two other leading causes.A classic triad of right upper quadrant pain,jaundice,and overt upper gastrointestinal bleeding has been described(***'s triad),but this is present in only 25%e30%of patients with ***,prompt diagnosis depends critically on having a high index of suspicion,which may be based on a patient's clinical presentation and having recently undergone(peri-)biliary instrumentation or other predisposing *** treatment of hemobilia depends on its severity and suspected source and ranges from supportive care to advanced endoscopic,interventional radiologic,or surgical *** we provide a clinical overview and update regarding the eti-ology,diagnosis,and treatment of hemobilia geared for specialists and subspecialists alike.

关键词： hemobilia Upper gastrointestinal hemmorhage Etiology Diagnosis Imaging hepatopancreatobiliary interventions

Preventative care in cholestatic liver disease: Pearls for the specialist and subspecialist

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Liver Research 2019年第2期3卷 118-127页

作者： Adnan Malik Ani A.Kardashian Kais Zakharia Christopher L.Bowlus james h.tabibian Department of Public health and Business Administration The University of Alabama at BirminghamBirminghamALUSA Department of Internal Medicine Beaumont HospitalDearbornMIUSA University of California Los Angeles Gastroenterology Fellowship Training Program Vatche and Tamar Manoukian Division of Digestive DiseasesLos AngelesCAUSA Division of Gastroenterology and hepatology University of IowaIowaIAUSA Division of Gastroenterology and hepatology University of California DavisSacramentoCAUSA Division of Gastroenterology Department of MedicineOlive View-University of California Los Angeles Medical CenterSylmarCAUSA

Cholestatic liver diseases(CLDs)encompass a variety of disorders of abnormal bile formation and/or *** often lead to progressive hepatic insult and injury and following the development of cirrhosis and associated *** such complications are clinically silent until they manifest with severe sequelae,including but not limited to life-altering symptoms,metabolic disturbances,cirrhosis,and hepatobiliary diseases as well as other *** sclerosing cholangitis(PSC)and primary biliary cholangitis(PBC)are the most common CLDs,and both relate to mutual as well as unique *** review provides an overview of PSC and PBC,with a focus on preventive measures aimed to reduce the incidence and severity of disease-related complications.

关键词： Biliary tract diseases Primary sclerosing cholangitis(PSC) Primary biliary cholangitis(PBC) Cirrhosis Inflammatory bowel disease(IBD) Metabolic bone disease Pruritus Prophylaxis