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Obesity and cholangiocarcinoma

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World Journal of Gastroenterology 2013年第4期19卷 457-462页

作者： mansour a parsi Center for Endoscopy and Pancreatobiliary Disorders Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

It is estimated that about half of the population in developed countries are either overweight or *** some developing nations obesity rates have increased to surpass those seen in Western *** rate increase in obesity has many implications as obesity has been associated with numerous negative health effects including increased risks of hypertension,diabetes,cardiovascular disease,stroke,liver disease,apnea,and some cancer *** is now considered to be one of the major public health concerns facing the ***(bile duct cancers) are malignant tumors arising from cholangiocytes inside or outside of the *** cholangiocarcinomas are relatively rare,they are highly *** low survival rate associated with cholangiocarcinoma is due to the advanced stage of the disease at the time of *** is therefore especially important in this cancer *** data suggest that the incidence of cholangiocarcinoma in the western world is on the *** rate of obesity may be one of the factors responsible for this *** whether obesity is a risk factor for cholangiocarcinoma has significant clinical and societal implications as obesity is both prevalent and *** paper seeks to provide a summary of the current knowledge linking obesity and cholangiocarcinoma,and encourage further research on this topic.

关键词： Cholangiocarcinoma Obesity Epidemiology Bile ducts Cancer

Endoscopic ultrasound for the diagnosis of chronic pancreatitis

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World Journal of Gastroenterology 2010年第23期16卷 2841-2850页

作者： Tyler Stevens mansour a parsi Digestive Disease Institute Cleveland Clinic Foundation

Endoscopic ultrasound(EUS) has become a well accepted test for the diagnosis of chronic *** include its ability to detect subtle and severe changes of the pancreatic duct and parenchyma,and its relative safety compared with endoscopic retrograde *** include inter-and intraobserver variability,operator dependence,and an incomplete understanding of its true *** Rosemont classif ication has recently been proposed as a weighted,standardized method that may improve EUS chronic pancreatitis *** paper reviews the published evidence regarding the accuracy of EUS in chronic pancreatitis diagnosis,and enumerates the emerging technologies that have been recently studied which may ultimately improve endosonographic imaging of the pancreas.

关键词： Chronic pancreatitis Contrast-enhanced endoscopic ultrasound Diagnosis Digital image analysis Elastography Endoscopic ultrasound Pancreatic function testing Rosemont classification

Peroral cholangioscopy in the new millennium

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World Journal of Gastroenterology 2011年第1期17卷 1-6页

作者： mansour a parsi Center for Endoscopy and Pancreatobiliary Disorders Department of Gastroenterology and HepatologyDigestive Disease InstituteCleveland ClinicClevelandOH 44195United States

Peroral cholangioscopy was first described in 1970s and has recently gained *** cholangioscopy is appealing to therapeutic endoscopists because a direct intraluminal view of the biliary duct system offers possibilities for diagnosis and interventions beyond that which other imaging or endoscopic modalities can *** the image quality of cholangioscopies improves,so too does their diagnostic capability,and as their durability and maneuverability increases,so too does their potential use for therapeutic *** editorial is intended to provide a brief review of recent developments in peroral cholangioscopy and current indications for its use.

关键词： Endoscopic retrograde cholangiopancreatography Cholangioscopy Peroral cholangioscopy Cholangiocarcinoma Biliary stricture Pancreatic cancer Biopsy Brush cytology

Common controversies in management of biliary strictures

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World Journal of Gastroenterology 2017年第7期23卷 1119-1124页

作者： mansour a parsi Center for Endoscopy and Pancreatobiliary Disorders Department of Gastroenterology and HepatologyCleveland ClinicClevelandOH 44195United States

Biliary strictures are caused by a heterogeneous group of benign and malignant conditions, each requiring a specific treatment approach. Management of biliary strictures often involves endoscopy either for definite treatment, as a bridge to surgery or for palliative purposes. Endoscopic treatment of various types of biliary strictures is not standardized and there are multiple areas of controversy regarding the best treatment options. These controversies are mainly due to lack of well-designed comparative studies to support a specific therapy. This paper reviews three common areas of controversy in the endoscopic management of biliary strictures. The areas discussed in this editorial include the role of biliary drainage in resectable malignant strictures and whether such drainage should be performed routinely prior to surgery, the best endoscopic palliation for unresectable hilar strictures and whether unilateral or bilateral stenting should be attempted, and the optimal endoscopic management for dominant strictures in patients with primary sclerosing cholangitis. The goal of this editorial is twofold. The first is to review the current literature on management of the aforementioned strictures and offer recommendations based on available evidence. The second goal is to highlight the gaps in our knowledge which in turn can encourage future research on these topics.

关键词： Biliary stricture Benign Primary sclerosing cholangitis Malignant Controversy Biliary drainage Preoperative Hilar stricture

Update on endoscopic pancreatic function testing

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World Journal of Gastroenterology 2011年第35期17卷 3957-3961页

作者： Tyler Stevens mansour a parsi Department of Gastroenterology and Hepatology Digestive Disease Institute The Cleveland Clinic FoundationCleveland OH 44195 United States

Hormone-stimulated pancreatic function tests (PFTs) are considered the gold standard for measuring pancreatic exocrine function. PFTs involve the administration of intravenous secretin or cholecystokinin, followed by collection and analysis of pancreatic secretions. Because exocrine function may decline in the earliest phase of pancreatic fibrosis, PFTs are considered accurate for diagnosing chronic pancreatitis. Unfortunately, these potentially valuable tests are infrequently performed except at specialized centers, because they are time consuming and complicated. To overcome these limitations, endoscopic PFT methods have been developed which include aspiration of pancreatic secretions through the suction channel of the endoscope. The secretin endoscopic pancreatic function test (ePFT) involves collection of duodenal aspirates at 15, 30, 45 and 60 min after secretin stimulation. A bicarbonate concentration greater than 80 mmol/L in any of the samples is considered a normal result. The secretin ePFT has demonstrated good sensitivity and specificity compared with various reference standards, including the "Dreiling tube" secretin PFT, endoscopic ultrasound, and surgical histology. Furthermore, a standard autoanalyzer can be used for bicarbonate analysis, which allows the secretin ePFT to be performed at any hospital. The secretin ePFT may complement imaging tests like endoscopic ultrasound (EUS) in the diagnosis of early chronic *** paper will review the literature validating the use of ePFT in the diagnosis of exocrine insufficiency and chronic pancreatitis. Newer developments will also be discussed, including the feasibility of combined EUS/ ePFT, the use of cholecystokinin alone or in combination with secretin, and the discovery of new protein and lipid pancreatic juice biomarkers which may complement traditional fluid analysis.

关键词： Endoscopic pancreatic function test Pancreatic function testing Chronic pancreatitis Pancreatic exocrine insufficiency

Diagnostic and therapeutic direct peroral cholangioscopy using an intraductal anchoring balloon

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World Journal of Gastroenterology 2012年第30期18卷 3992-3996页

作者： mansour a parsi Tyler Stevens John J Vargo Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

AIM:To report our experience using a recently introduced anchoring balloon for diagnostic and therapeutic direct peroral cholangioscopy(DPOC).METHODS:Consecutive patients referred for diagnostic or therapeutic peroral cholangioscopy were evaluated in a prospective cohort *** patients underwent DPOC using an intraductal anchoring balloon,which was recently introduced to allow consistent access to the biliary tree with an ultraslim upper *** device was later voluntarily withdrawn from the market by the ***:Fourteen patients underwent DPOC using the anchoring *** access with an ultraslim upper endoscope was accomplished in all 14 *** 12(86%) patients,ductal access required sphincteroplasty with a 10-mm dilating *** placement of the ultraslim upper endoscope allowed satisfactory visualization of the biliary mucosa to the level of the confluence of the right and left hepatic ducts in 13 of 14 patients(93%).Therapeutic interventions by DPOC were successfully completed in all five attempted cases(intraductal biopsy in one and DPOC guided laser lithotripsy in four).Adverse events occurred in a patient on immunosuppressive therapy who developed an intrahepatic biloma at the site of the anchoring *** required hospitalization and *** endoscopic retrograde cholangiopancreatography 8 wk after the index procedure showed resolution of the ***:Use of this anchoring balloon allowed consistent access to the biliary tree for performance of diagnostic and therapeutic DPOC distal to the biliary bifurcation.

关键词： Anchoring balloon Direct peroral cholangioscopy Cholangiocarcinoma Endoscopic retrograde cholangiopancreatography Choledocholithiasis

Endoscopic management of difficult common bile duct stones

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World Journal of Gastroenterology 2013年第2期19卷 165-173页

作者： Guru Trikudanathan Udayakumar Navaneethan mansour a parsi Department of Internal Medicine University of Connecticut Medical CenterFarmingtonCT 06269United States Digestive Disease Institute Cleveland ClinicClevelandOH 44195United States

Endoscopy is widely accepted as the first treatment option in the management of bile duct *** this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct *** biliary stones can be removed with an extraction balloon,extraction basket or mechanical lithotripsy after endoscopic *** papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected *** clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have *** stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.

关键词： Choledocholithiasis Mechanical lithotripsy Laser lithotripsy Electrohydra-ulic lithotripsy Difficult to remove biliary stones Endoscopic large balloon papillary dilation Peroral cholangioscopy

Aflatoxins,hepatocellular carcinoma and public health

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World Journal of Gastroenterology 2013年第10期19卷 1508-1512页

作者： Arvin Magnussen mansour a parsi Sandefjord High School 3228 SandefjordNorway Section for Therapeutic and Pancreatobiliary Endoscopy Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

Hepatocellular carcinoma(HCC) is one of the leading causes of cancer deaths worldwide,primarily affecting populations in the developing ***,a food contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus,is a known human carcinogen that has been shown to be a causative agent in the pathogenesis of *** can affect a wide range of food commodities including corns,oilseeds,spices,and tree nuts as well as milk,meat,and dried *** factors affect the growth of Aspergillus fungi and the level of aflatoxin contamination in *** stress is one of the factors that increase susceptibility of plants to Aspergillus and thus aflatoxin contamination.A recent drought is thought to be responsible for finding of trace amounts of aflatoxin in some of the corn harvested in the United *** it's too soon to know whether aflatoxin will be a significant problem,since United States is the world's largest corn producer and exporter,this has raised alarm *** regulations and testing of finished foods and feeds in the United States should prevent a major health scare,and prevent human exposure to deleterious levels of ***,such regulations and testing are not in place in many *** purpose of this editorial is to summarize the current knowledge on association of aflatoxin and HCC,encourage future research and draw attention to this global public health issue.

关键词： Aflatoxins Hepatocellular carcinoma Environmental health Food safety Public health

Pre-operative biliary drainage is associated with shortened survival time in patients with cholangiocarcinoma

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Gastroenterology Report 2019年第3期7卷 185-192,I0002页

作者： Udayakumar Navaneethan Xiang Zhu mansour A.parsi Shyam Varadarajulu Center for Interventional Endoscopy Florida Hospital601 E Rollins StOrlandoFL 32803USA Department of Gastroenterology The Cleveland Clinic9500 Euclid AveClevelandOH 44195USA

Background and objective:Although pre-operative biliary drainage(PBD)is frequently performed in patients with cholangiocarcinoma(CCA),its impact on patient survival is *** aim was to evaluate the impact of PBD on overall survival of patients with extra-hepatic ***:This was a retrospective study using the Surveillance,Epidemiology,and End Results(SEER)-Medicare *** who underwent biliary drainage within 3 months prior to and/or after diagnosis of CCA were included in the PBD *** who did not receive biliary drainage were included in the non-PBD *** proportional hazard regression was used to determine independent predictors of ***:Of 3862 patients with extra-hepatic CCA,433(11.2%)underwent curative surgical resection,with a median survival of 14 months(95%confidence interval[95%CI],10-21months)in the PBD cohort(n=126)vs 31 months(95%CI,26-39 months)in the non-PBD cohort(n=307)(P<0.001),during the median follow-up duration for the surgical cohort of 26 months(range,1-60 months).Among the 433 patients,126(29.1%)underwent PBD and had significantly higher Charlson comorbidity index and advanced SEER stage than those without PBD before *** multivariable analysis in patients who underwent curative surgical resection,after adjusting patient demographics,tumor characteristics,Charlson comorbidity index,radiotherapy and chemotherapy,PBD was significantly associated with shortened survival time(hazard ratio,2.35;95%CI,1.34-4.10;P=0.003).Conclusions:PBD appears negative impact on long-term survival in patients with potentially resectable CCA and should be avoided if possible.

关键词： Cholangiocarcinoma endoscopic retrograde cholangiopancreatography biliary drainage pre-operative mortality