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Evolving management of metaplasia and dysplasia in Barrett's epithelium

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World Journal of Gastroenterology 2016年第47期22卷 10316-10324页

作者： richard PT Evans Moustafa Mabrouk Mourad simon G Fisher simon r bramhall Department of Surgery the Wye Valley NHS Trust

Oesophageal cancer affects more than 450000 people worldwide and despite continued medical advancements the incidence of oesophageal cancer is increasing. Oesophageal cancer has a 5 year survival of 15%-25% and now globally attempts are made to more aggressively diagnose and treat Barrett's oesophagus the known precursor to invasive disease. Currently diagnosis the of Barrett's oesophagus is predominantly made after endoscopic visualisation and histopathological confirmation. Minimally invasive techniques are being developed to improve the viability of screening programs. The management of Barrett's oesophagus can vary greatly dependent on the presence and severity of dysplasia. There is no consensus between the major international medical societies to determine and agreed surveillance and intervention pathway. In this review we analysed the current literature to demonstrate the evolving management of metaplasia and dysplasia in Barrett's epithelium.

关键词： Barrett’s Oesophagus Dysplasia Metaplasia Oesophageal cancer

Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation

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World Journal of Gastroenterology 2014年第20期20卷 6159-6169页

作者： Moustafa Mabrouk Mourad Abdullah Algarni Christos Liossis simon r bramhall Liver Unit Queen Elizabeth Hospital Birmingham B15 2TH United Kingdom

Liver transplantation (LT) is the best treatment for end-stage hepatic failure, with an excellent survival rates over the last decade. Biliary complications after LT pose a major challenge especially with the increasing number of procured organs after circulatory death. Ischaemic cholangiopathy (IC) is a set of disorders characterized by multiple diffuse strictures affecting the graft biliary system in the absence of hepatic artery thrombosis or stenosis. It commonly presents with cholestasis and cholangitis resulting in higher readmission rates, longer length of stay, repeated therapeutic interventions, and eventually re-transplantation with consequent effects on the patient’s quality of life and increased health care costs. The pathogenesis of IC is unclear and exhibits a higher prevalence with prolonged ischaemia time, donation after circulatory death (DCD), rejection, and cytomegalovirus infection. The majority of IC occurs within 12 mo after LT. Prolonged warm ischaemic times predispose to a profound injury with a subsequently higher prevalence of IC. Biliary complications and IC rates are between 16% and 29% in DCD grafts compared to between 3% and 17% in donation after brain death (DBD) grafts. The majority of ischaemic biliary lesions occur within 30 d in DCD compared to 90 d in DBD grafts following transplantation. However, there are many other risk factors for IC that should be considered. The benefits of DCD in expanding the donor pool are hindered by the higher incidence of IC with increased rates of re-transplantation. Careful donor selection and procurement might help to optimize the utilization of DCD grafts.

关键词： Ischaemic cholangiopathy Biliary complications Orthotopic liver transplantation Donation after circulatory death reperfusion injury Cold ischaemia time

Pancreatitis: Preventing catastrophic haemorrhage

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World Journal of Gastroenterology 2017年第30期23卷 5460-5468页

作者： richard PT Evans Moustafa Mabrouk Mourad Gunraj Pall simon G Fisher simon r bramhall russel’s Hall Hospital Department of Surgery the Wye Valley NHS Trust

Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.

关键词： Complication of pancreatitis Splenicartery Pancreatitis Haemorrhage Pseudoaneurysm

Anticoagulation and antiplatelets as prophylaxis for hepatic artery thrombosis after liver transplantation

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World Journal of Hepatology 2015年第9期7卷 1238-1243页

作者： Abdullah A Algarni Moustafa M Mourad simon r bramhall Liver Unit Queen Elizabeth HospitalBirmingham B15 2TH United Kingdom General Surgery Department Wye Valley NHS Trust

Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.

关键词： Hepatic artery thrombosis Haemostasis Anticoagulation Liver transplantation Antiplatelets Heparin

Is there still a role for sucralfate in the treatment of gastritis?

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World Journal of Meta-Analysis 2020年第1期8卷 1-3页

作者： simon r bramhall Moustafa M Mourad Department of Surgery The County HospitalHereford HR12ERUnited Kingdom Worcester royal Infirmary Worcester WR40JBUnited Kingdom

The endoscopic diagnosis of gastritis is usually made when a patient develops symptoms and undergoes an upper gastrointestinal *** are often obvious aetiological causes such as smoking,alcohol Helicobacter pylori infection or drug *** changes can sometimes improve symptoms but often patients will be treated with a proton pump *** stomach mucosa produces a protective mucous to prevent damage cause by gastric acid and exogenous agents can disrupt this *** of this protective layer can be enhanced by reduction in gastric acid secretion using H2 receptor antagonist or proton pump inhibitors or by cytoprotective drugs such as misoprostol,sucralfate,aluminium ions or bismuth *** is a complex polymer which at a low pH changes its chemical configuration and binds to serum protein to form a protective layer protecting the mucosa against further *** drugs were the first line treatment for peptic disease including gastritis for many years but since the launch of cimetidine in 1976 and the subsequent launch of omeprazole in 1988,their use has slowly *** line treatment for patients with symptomatic gastritis after removal of potential causative factors is likely to be a proton pump inhibitor in *** is despite the fact that there is some evidence that sucralfate is superior than a H2 receptor antagonist in the endoscopic healing rates in patients with *** logical treatment choice in patients with resistance symptoms is a combination of a proton pump inhibitor and sucralfate but evidence is *** such evidence is available In the meantime,we would suggest that there is a role for sucralfate in the treatment of intransigent gastritis and that mucosal protection should be considered even ahead of acid suppression given its favourable safety and toxicity profile.

关键词： Sucralfate Enoscopy Gastritis Treatment Anti-acid

Current status and recent advances of liver transplantation from donation after cardiac death

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World Journal of Gastrointestinal Surgery 2011年第11期3卷 167-176页

作者： M Thamara Pr Perera simon r bramhall The Liver Unit Queen Elizabeth HospitalEdgbaston Birmingham B15 2TH United Kingdom

The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a signif icant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" of-fered without ideal donor management or even prior to brain death being established. The absolute benef its of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

关键词： Non-heart beating donor Liver graft Pri- mary non-function reperfusion injury Modulation

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分子技术在胰腺癌治疗中的应用

中国实用外科杂志 2003年第10期23卷 635-637页

作者： Zahir Soonawalla simon bramhall 黄昕英国伯明翰大学伊利沙白皇后医院

胰腺癌病人预后极差，治疗仍不尽人意。新近，随着对其细胞生长增殖的分子生物学的深层有了进一步了解，基因和分子技术的应用取得了快速发展，一些生物制剂正在进行临床试验。本文专为《中国实用外科杂志》撰写，综述了对胰腺癌的综合... 详细信息

胰腺癌病人预后极差，治疗仍不尽人意。新近，随着对其细胞生长增殖的分子生物学的深层有了进一步了解，基因和分子技术的应用取得了快速发展，一些生物制剂正在进行临床试验。本文专为《中国实用外科杂志》撰写，综述了对胰腺癌的综合治疗方法。

关键词：分子技术胰腺癌综合治疗分子生物学筛查