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High-grade pancreatic intraepithelial lesions： prevalence and implications in pancreatic neoplasia

Hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 202-208页

作者： Jean R Park Feng Li Veeral M Oza Brett C Sklaw Kevin M Cronley michael wellner Benjamin Swanson Somashekar G Krishna Division of Hospital Medicine The Ohio State University Wexner Medical Center Columbus Ohio USA Division of Gastroenterology Hepatology and Nutrition The Ohio State University Wexner Medical Center Columbus Ohio USA Department of Pathology The Ohio State University Wexner Medical Center Columbus Ohio USA

BACKGROUND： High-grade pancreatic intraepithelial neoplasia（Pan IN-3）, a precursor of pancreatic ductal adenocarcinoma（PDAC）, is not universally detected in resected pancreatic neoplasms. We sought to determine the prevalence and prognostic relevance of Pan IN-3 lesions in primary surgical resections of PDACs and intraductal papillary mucinous neoplasms（IPMNs）.METHODS： A retrospective review of a tertiary care center pathology database（1/2000-6/2014） was performed. Demographics, imaging, pathology, disease-recurrence, and survival data were ***： A total of 458 patients who underwent primary pancreatic resection were included. “Pan IN-3” lesions were found in 74（16.2%） patients who either had PDAC（n=67） or main duct（MD）-IPMN（n=7）. Among IPMN-MDs, Pan IN-3 lesions were exclusively found in those with pathological evidence of chronic pancreatitis. For PDACs, the median overall survival（OS） for pancreata with Pan IN-3 lesions was significantly better than those without（OS 1.12 years, interquartile range [IQR] 0.72, 2.05 years vs OS 0.86 years, IQR 0.64,1.60 years respectively; P=0.04）. Multivariate Cox regression analysis demonstrated that the presence of Pan IN-3 lesions was associated with a reduced risk of death（HR=0.43; 95% CI： 0.23-0.82; P=0.01）.CONCLUSIONS： Following primary resection of pancreatic adenocarcinoma, the lower survival observed in patients without Pan IN-3 lesions might suggest a state of complete or accelerated transformation. Further investigations are necessary to validate these findings that might impact disease prognosis and management.

关键词： pancreatic intraepithelial neoplasia intraductal papillary mucinous neoplasms pancreatic neoplasia pancreatic ductal adenocarcinoma

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Rare cause of dysphagia after esophageal variceal banding: A case report

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World Journal of Gastrointestinal Endoscopy 2019年第4期11卷 292-297页

作者： Lindsay A Sobotka Mitchell L Ramsey michael wellner Sean G Kelly Department of Gastroenterology Hepatology and Nutrition The Ohio State University Wexner Medical Center

BACKGROUND Esophageal varices are a result of progressive liver disease and portal hypertension. Treatment can be performed with band ligation versus nonselective beta blockers depending on the size of varices, ability to tolerate medications and history of variceal bleeding. Band ligation is an effective intervention with rare but serious complications including bleeding, ulcers and rarely obstruction. Few cases of esophageal obstruction and necrosis caused by banding have been reported, each with varied management from conservative treatment to band *** SUMMARY An 89 years old woman with a past medical history of nonalcoholic steatohepatitis cirrhosis presented to the hospital with an inability to swallow one day after screening esophagogastroduodenoscopy where band ligation of esophageal varices was performed for primary prophylaxis. The patient was not able to tolerate her oral secretions. Initial blood work revealed a Model of End Organ Liver Disease score of 7. She was treated with sublingual nitroglycerin for esophageal spasm, a known complication after esophageal banding. When she failed to improve, esophagogastroduodenoscopy was performed and revealed the mucosa surrounding the banded varix was necrosed and blocking the lumen of the esophagus. The band was purposefully dislodged, revealing distal ulceration and stricturing. Within 72 h after band removal, she was tolerating an oral diet. Endoscopy performed 2 wk later revealed an intrinsic stenosis,measuring 8 mm in diameter by 1 cm in length, which was *** Esophageal obstruction is a complication of variceal banding that should be considered in patients with inability to tolerate oral diet after banding.

关键词： Case report Esophageal varices Band ligation Esophageal necrosis Esophageal obstruction

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Cystic fibrosis patients on cystic fibrosis transmembrane conductance regulator modulators have a reduced incidence of cirrhosis

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World Journal of Hepatology 2022年第2期14卷 411-419页

作者： Mitchell L Ramsey michael R wellner Kyle Porter Stephen E Kirkby Susan S Li Luis F Lara Sean G Kelly A James Hanje Lindsay A Sobotka Department of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Gastroenterology Hepatology and NutritionThe Ohio State Wexner Medical CenterColumbusOH 43210United States Department of Biostatistics The Ohio State UniversityColumbusOH 43210United States Department of Pulmonary and Critical Care Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Gastroenterology Hepatology and NutritionThe Ohio State UniversityColumbusOH 43210United States

BACKGROUND Cystic fibrosis transmembrane conductance regulator(CFTR)modulators significantly improve pulmonary function in patients with cystic fibrosis(CF)but the effect on hepatobiliary outcomes remains *** hypothesized that CF patients on CFTR modulators would have a decreased incidence of cirrhosis compared to patients not on CFTR modulators or on *** To investigate the effect of CFTR modulators on the development of cirrhosis in patients with *** A retrospective analysis was performed using Truven MarketScan from January 2012 through December 2017 including all patients with a diagnosis of *** were excluded if they underwent a liver transplantation or if they had other etiologies of liver disease including viral hepatitis or alcohol *** were grouped by use of CFTR modulators,ursodiol,dual therapy,or no *** primary outcome was development of ***-Meier curves estimated the incidence of cirrhosis and log-rank tests compared incidence curves between treatment *** A total of 7201 patients were included,of which 955(12.6%)used a CFTR modulator,529(7.0%)used ursodiol,105(1.4%)used combination therapy,and 5612(74.3%)used neither *** incidence of cirrhosis was 0.1%at 1 year and 0.7%at 4 years in untreated patients,5.9%and 10.1%in the Ursodiol group,and 1.0%and 1.0%in patients who received both *** patient treated with CFTR modulators alone developed *** on CFTR modulators alone had lower cirrhosis incidence than untreated patients(P=0.05),patients on Ursodiol(P<0.001),and patients on dual therapy(P=0.003).The highest incidence of cirrhosis was found among patients treated with Ursodiol alone,compared to untreated patients(P<0.001)or patients on Ursodiol and CFTR modulators(P=0.01).CONCLUSION CFTR modulators are associated with a reduction in the incidence of cirrhosis compared to other therapies in patients with CF.

关键词： Cirrhosis Ursodiol Transmembrane Cystic fibrosis Market scan Cystic fibrosis related liver disease

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Impact of postoperative TNM stages after neoadjuvant therapy on prognosis of adenocarcinoma of the gastro-oesophageal junction tumours

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World Journal of Gastroenterology 2018年第13期24卷 1429-1439页

作者： michael Thomaschewski Richard Hummel Ekaterina Petrova Juliana Knief Ulrich Friedrich wellner Tobias Keck Dirk Bausch Department of Surgery University Medical Center Schleswig-Holstein Campus Lübeck Department of Pathology University Medical Center Schleswig-Holstein Campus Lübeck

AIM To compare prognostic relevance of postoperative tumour/node/metastasis(TMN) stages between patients with and without neoadjuvant treatment. METHODS Data from patients with adenocarcinoma of the gastrooesophageal junction(AEG) who had undergone surgical resection at a single German university centre were retrospectively analysed. Patients with or without neoadjuvant preoperative treatment were selected by exact matching based on preoperative staging. Standard assessment of preoperative(c)TNM stage was based on endoscopic ultrasound and computed tomography of the thorax and abdomen, according to the American Joint Committee on Cancer/Union for International Cancer Control classification system. Patients with cT1cN0cM0 and cT2cN0cM0 stages were excluded from the study, as these patients are generally not recommended for pretreatment. Longterm survival among the various postoperative TNM stages was compared between the groups of patients with or without neoadjuvant treatment. For statistical assessments, a P-value of ≤ 0.05 was considered *** The study included a total of 174 patients. The group of patients who had received preoperative neoadjuvant treatment included more cases of AEG(Siewert) type 1 carcinoma(P < 0.001), and consequently oesophagectomy was performed more frequently among these patients(P < 0.001). The two groups(with or without preoperative neoadjuvant treatment) had comparable preoperative T stages, but the group of patients with preoperative neoadjuvant treatment presented a higher rate of preoperative N-positive disease(P = 0.020). Overall long-term survival was not different between the two groups of patients according to tumours of different AEG classifications, receipt of oesophagectomy or gastrectomy, nor between patients with similar postoperative TNM stage, resection margin and grading. However, an improvement of long-term survival was found for patients with nodal down-staging after neoadjuvant therapy(P = 0.053).CONCLUSI

关键词： Adenocarcinoma of the gastro-oesophageal junction American Joint Committee on Cancer/Union for International Cancer Control TNM system Neoadjuvant therapy Oesophageal cancer

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