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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

Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

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World Journal of Gastroenterology 2017年第16期23卷 2883-2890页

作者： Mohamed Mortagy Neal Mehta Mansour A Parsi Seiichiro Abe tyler stevens John J Vargo Yutaka Saito Amit Bhatt Department of Internal Medicine Homer Stryker MD School of MedicineWestern Michigan UniversityKalamazooMI 49008United States Department of Internal Medicine Medicine InstituteCleveland ClinicClevelandOH 44195United States Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan

Endoscopic submucosal dissection(ESD) is a wellestablished, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection(MAGESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon's "second hand". Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.

关键词： Endoscopic submucosal dissection Gastric cancer Magnetic anchor guidance Esophageal cancer Magnets Traction Natural orifice transluminal endoscopic surgery

Clinical outcomes of endoscopic management of pancreatic fluid collections in cirrhotics vs non-cirrhotics: A comparative study

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World Journal of Gastrointestinal Endoscopy 2019年第6期11卷 403-412页

作者： Sobia Laique Matheus C Franco tyler stevens Amit Bhatt John J Vargo Prabhleen Chahal Internal Medicine Cleveland ClinicClevelandOH 44195United States Digestive Disease Institute Cleveland ClinicClevelandOH 44195United States

BACKGROUND Endoscopic management of symptomatic pancreatic fluid collections (PFCs) using self-expandable metal stents (SEMS) placement has emerged as an innovative therapeutic approach with excellent efficacy, safety, and relatively few adverse outcomes. However, their use has not been studied in patients with cirrhosis. Cirrhotics tend to be considered less than optimal candidates due to concern for portal hypertension and coagulopathy related complications. AIM To compare the efficacy and safety of using SEMS for drainage of symptomatic PFCs in cirrhotic vs non-cirrhotic patients. METHODS We conducted a retrospective comparative analysis of patients with symptomatic PFCs [pancreatic pseudocyst (PP) or walled-off necrosis (WON)] who underwent endoscopic ultrasound (EUS)-guided placement of fully covered self-expandable metals stents or lumen-apposing self-expandable metal stents. All patients were followed clinically until resolution of PFCs or death. Definition:(1) Technical success was defined as successful placement of SEMS;and (2) Clinical success was defined as complete resolution of the PFCs without additional interventions including interventional radiology or surgery. Number of procedures performed per patient, number of patients who achieved complete resolution of the PFCs without additional interventions and procedure related adverse events were *** From January 2012 to December 2017, a total of 88 patients underwent EUSguided drainage of symptomatic PFCs. Of these, 58 non cirrhotic patients underwent plastic stent insertion for management of PFC and 30 patients, 5 with cirrhosis and 25 without cirrhosis, underwent EUS-guided transmural drainage with SEMS, including 18 (60%) PP and 12 (40%) WON. Technical success was achieved in all 30 patients. Clinical success was achieved in 60% cirrhotic patients and 92% non-cirrhotics (P = 0.12). Procedure-related adverse events were 60% in cirrhotic and 28% non-cirrhotic (P = 0.62). Moreover, fatal adv

关键词： Endoscopic ultrasonography Pancreatic pseudocysts Liver cirrhosis

积极的师生互动有助于增强学生对学校的归属感

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中国德育 2017年第7期12卷 6-6页

作者： Kenneth M.tyler Ruby stevens-Morgan Lynda Brown-Wright

初中阶段是青少年开始清晰地认识自我并与他人建立联系的关键时期，这个时期的学生开始对学校产生归属感，而师生问的互动是促进学生产生归属感的关键因素，同时也影响着学生的各种适应性行为，例如学业表现。美国一项调查以776存仞中... 详细信息

初中阶段是青少年开始清晰地认识自我并与他人建立联系的关键时期，这个时期的学生开始对学校产生归属感，而师生问的互动是促进学生产生归属感的关键因素，同时也影响着学生的各种适应性行为，例如学业表现。美国一项调查以776存仞中阶段学生为样本．研究师生间的互动和家校间的差异在学生对学校的归属感中的影响，其中，家校间的差异主要指学饺文化和家庭文化在教育方式、价值观等方面所表现出的差异。研究表明，师生之间愉悦和正而的互动体验有助于学生对学校产生更强的归属感，

关键词：师生互动归属感学生学校家庭文化适应性行为认识自我初中阶段