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Endoscopic resection techniques for colorectal neoplasia:Current developments

World Journal of Gastroenterology 2019年第3期25卷 300-307页

作者： Franz Ludwig Dumoulin ralf hildenbrand Department of Medicine and Gastroenterology Gemeinschaftskrankenhaus Bonn Institute for Pathology Bonn Duisdorf

Endoscopic polypectomy and endoscopic mucosal resection(EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller(< 5 mm) polyps and is possibly also suitable for the removal of noncancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection(ESD)offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive *** latest addition to endoscopic resection techniques is endoscopic fullthickness resection with specifically developed devices for flexible *** method is very useful for the treatment of smaller difficult-to-resect lesions,e.g., recurrence with scar formation after previous endoscopic resections.

关键词： Colorectal neoplasia Colorectal cancer screening Cold snare resection Endoscopic polypectomy Endoscopic mucosal resection Endoscopic submucosal dissection Endoscopic full-thickness resection Adenoma recurrence rate

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Enhanced expression of interleukin-18 in serum and pancreas of patients with chronic pancreatitis

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World Journal of Gastroenterology 2006年第40期12卷 6507-6514页

作者： Alexander Schneider Stephan L Haas ralf hildenbrand Sren Siegmund Iris Reinhard Helmut Nakovics Manfred V Singer Peter Feick Department of Medicine II (Gastroenterology Hepatology and Infectious Diseases) Univer-sity Hospital of Heidelberg at Mannheim Mannheim Germany Institute of Pathology University Hospital of Heidelberg at Mannheim Mannheim Germany Central Institute of Mental Health Mannheim Germany

AIM： To investigate interleukin-18 （IL-18） in patients with chronic panreatitis （CP）. METHODS： We studied 29 patients with CP and 30 healthy controls. Peripheral blood mononuclear cells （PBMC） were isolated and incubated with 50 mmol/L ethanol, lipopolysaccharide （LPS）（doses 25 g/L, 250 g/L, 2500 g/L） and both agents for 24 h. Levels of IL-18 in the supernatants, and levels of IL-18, IL-12, interferon （IFN）-T and soluble CD14 in the serum were analysed by EI_ISA technique. Expression of IL-18 in PBMC was investigated by reverse-transcription （RT）-PCR. IL-18 protein levels in CP tissue and in normal pancreas were studied by ELISA technique. IL-18 levels in PBMC and pancreatic tissue were determined by Westernblot. Immunohistochemistry for pancreatic IL-18 expression was performed.RESULTS： In patients, IL-18 serum levels were significantly enhanced by 76% （mean： 289.9 ± 167.7 ng/L） compared with controls （mean： 165.2 ± 43.6 ng/L; P 〈 0.0005）. IL-12 levels were enhanced by 25% in patients （18.3 ± 7.3 ng/L） compared with controls （14.7 ± 6.8 ng/L, P = 0.0576） although not reaching the statistical significance. IFN-γ, and soluble CD14 levels were not increased. In vitro, LPS stimulated significantly and dosedependently IL-18 secretion from PBMC. Incubation with ethanol reduced LPS-stimulated IL-18 secretion by about 50%. The mRNA expression of IL-18 in PBMC and the response of PBMC to ethanol and LPS was similar in CP patients and controls. In PBMC, no significant differences in IL-18 protein levels were detected between patients and controls. IL-18 protein levels were increased in CP tissues compared to normal pancreatic tissues. IL-18 was expressed by pancreatic acinar cells and by infiltrating inflammatory cells within the pancreas. CONCLUSION： IL-18 originates from the chronically inflammed pancreas and appears to be involved in the fibrotic destruction of the organ.

关键词： Chronic pancreatitis Cytokines Interleukin- 18 Pancreatic fibrosis

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