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Ascending aortic DILATATION rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study

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World Journal of Emergency Medicine 2019年第4期10卷 197-204页

作者： Yu-xin He Jia-qi Fan Qi-feng Zhu Qi-jing Zhou Ju-bo Jiang Li-han Wang Stella Ng Xian-bao Liu Jian-an Wang Department of Cardiology the Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009China Department of Radiology the Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009China

BACKGROUND: Current data is lacking about the progression of ascending aortic DILATATION after transcatheter aortic valve replacement(TAVR) in aortic stenosis(AS) patients with bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV). This study aims to assess the ascending aortic DILATATION rate(mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography(MDCT) fol ow-up and to determine the predictors of ascending aortic DILATATION rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed,and the diameters of ascending aorta were measured. Study end point is ascending aortic DILATATION rate(mm/year). Furthermore,factors predicting ascending aortic DILATATION rate were also investigated.RESULTS: Two hundred and eight patients were included,comprised of 86 BAV and 122 TAV patients. Five,4,3,2,and 1-year MDCT follow-ups were achieved in 7,9,30,46,and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group(43.7±4.4 mm vs. 44.0±4.5 mm;PDILATATION rate was found between BAV and TAV group(0.2±0.8 mm/year vs. 0.3±0.8 mm/year,P=0.592). Multivariate linear regression revealed paravalvular leakage(PVL) grade was independently associated with ascending aortic DILATATION rate in the whole population and BAV group,but not TAV group. No aortic events occurred during follow-ups.CONCLUSION: Ascending aortic size continues to grow after TAVR in BAV patients,but the DILATATION rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic DILATATION rate in BAV patients post-TAVR.

关键词： Transcatheter aortic valve replacement Aortic DILATATION Bicuspid aortic valve

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Endoscopic papillary large balloon DILATATION with sphincterotomy is safe and effective for biliary stone removal independent of timing and size of sphincterotomy

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World Journal of Gastroenterology 2017年第48期23卷 8597-8604页

作者： Usman Iqbal Aujla Nimzing Ladep Laura Dwyer Stephen Hood Nicholas Stern Richard Sturgess Digestive Diseases Unit Aintree University Hospital

AIM To describe the efficacy and safety of endoscopic papillary large balloon DILATATION(EPLBD) in the management of bile duct stones in a Western population. METHODS Data was collected from the endoscopic retrograde cholangiopancreatography(ERCP) and Radiology electronic database along with a review of case notes over a period of six years from 1 st August 2009 to 31 st July 2015 and incorporated into Microsoft excel. Statistical analyses were performed using Med Calc for Windows,version 12.5(Med Calc Software,Ostend,Belgium). Simple statistical applications were applied in order to determine whether significant differences exist in comparison groups. We initially used simple proportions to describe the study populations. Furthermore,we used chi-square test to compare proportions and categorical variables. Non-parametric Mann-Whitney U-test was applied in order to compare continuous variables. All comparisons were deemed to be statistically significant if P values were less than 0.05.RESULTS EPLBD was performed in 229 patients(46 females) with mean age of 68 ± 14.3 years. 115/229(50%) patients had failed duct clearance at previous ERCP referred from elsewhere with standard techniques. Duct clearance at the Index* ERCP(1 st ERCP at our centre) was 72.5%. Final duct clearance rate was 98%. EPLBD after fresh sphincterotomy was performed in 81(35.4%). Median balloon size was 13.5 mm(10-18). In addition to EPLBD,per-oral cholangioscopy(POC) and electrohydraulic lithotripsy(EHL) was performed in 35(15%) patients at index* ERCP. 63(27.5%) required repeat ERCP for stone clearance. 28(44.5%) required POC and EHL and 11(17.4%) had repeat EPLBD for complete duct clearance. Larger stone size(12.4 mm vs 17.4 mm,P < 0.000001),multiple stones(2,range(1-13) vs 3,range(1-12),P < 0.006) and dilated common bile duct(CBD)(12.4 mm vs 18.3 mm,P < 0.001) were significant predictors of failed duct clearance at index ERCP. 47 patients(20%) had ampullary or peri-ampullary diverticula. Procedure related adverse events included 2 cases of

关键词： Endoscopic sphincterotomy endoscopic papillary large balloon DILATATION Endoscopic retrograde cholangiopancreatography Adverse events Common bile duct stones

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Cholangiocarcinoma after flow diversion surgery for congenital biliary DILATATION: A case report and review of literature

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World Journal of Hepatology 2019年第11期11卷 743-751页

作者： Ryo Ataka Takashi Ito Toshihiko Masui Satoru Seo Takamichi Ishii Satoshi Ogiso Shintaro Yagi Kojiro Taura Shinji Uemoto Department of Hepato-Biliary-Pancreatic Surgery and Transplantation Graduate School of Medicine Kyoto University

BACKGROUND Pancreaticobiliary maljunction(PBM)can be classified into two categories,PBM with congenital biliary DILATATION(CBD)or PBM without biliary DILATATION,and the management of PBM is often controversial.The treatment for PBM with CBD is prophylactic flow diversion surgery,and some authors have reported that the incidence of cancer after extrahepatic bile duct excision is less than 1%.A very rare case of intrahepatic cholangiocarcinoma 6 years after flow diversion surgery for PBM with CBD is reported.CASE SUMMARY A 30-year-old man was diagnosed as having PBM with CBD,Todani classification type IVA,because of abnormal liver enzyme profiles.He underwent flow diversion surgery and cholecystectomy,and the specimen showed adenocarcinoma foci,pT1,pStage IA.Five and a half years passed without any recurrence of bile duct cancer.However,6 years after his operation,computed tomography showed a gradually growing nodule in the bile duct.Fluorodeoxyglucose positron emission tomography showed high uptake,and magnetic resonance imaging showed restricted diffusion signals.On double balloon enteroscopy,the nodule at the posterior bile duct-jejunum anastomosis was directly visualized,and its biopsy specimen showed adenocarcinoma.The patient underwent right lobectomy and biliary reconstruction.The pathological diagnosis was intraductal papillary neoplasm with high-grade intraepithelial neoplasia,pTis,pN0,pStage 0.The patient’s postoperative course was uneventful,and he has had no recurrence up to the present time.CONCLUSION This case suggests the necessity of careful observation after flow diversion surgery,especially when PBM with CBD is detected in adulthood.

关键词： Congenital biliary DILATATION Pancreaticobiliary maljunction Cholangiocarcinoma Recurrence Metachronous neoplasm Case report

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Isolated hepatic non-obstructive sinusoidal DILATATION, 20-year single center experience

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World Journal of Hepatology 2018年第5期10卷 417-424页

作者： Dharma Budi Sunjaya Guilherme Piovezani Ramos Manuel Bonfim Braga Neto Ryan Lennon Taofic Mounajjed Vijay Shah Patrick Sequeira Kamath Douglas Alano Simonetto School of Graduate Medical Education Mayo Clinic Division of Biomedical Statistics and Informatics Mayo Clinic Laboratory Medicine and Pathology Mayo Clinic Gastroenterology and Hepatology Mayo Clinic

AIM To characterize isolated non-obstructive sinusoidal DILATATION(SD) by identifying associated conditions, laboratory findings, and histological patterns. METHODS Retrospectively reviewed 491 patients with SD between 1995 and 2015. Patients with obstruction at the level of the small/large hepatic veins, portal veins, or right-sided heart failure were excluded along with history of cirrhosis, hepatic malignancy, liver transplant, or absence of electrocardiogram/cardiac echocardiogram. Liver histology was reviewed for extent of SD, fibrosis, red blood cell extravasation, nodular regenerative hyperplasia, hepaticpeliosis, and hepatocellular plate atrophy(HPA). RESULTS We identified 88 patients with non-obstructive SD. Inflammatory conditions(32%) were the most common cause. The most common pattern of liver abnormalities was cholestatic(76%). Majority(78%) had localized SD to Zone Ⅲ. Medication-related SD had higher proportion of portal hypertension(53%), ascites(58%), and median AST(113 U/L) and ALT(90 U/L) levels. Nineteen patients in our study died within one-year after diagnosis of SD, majority from complications related to underlying diseases.CONCLUSION Significant proportion of SD and HPA exist without impaired hepatic venous outflow. Isolated SD on liver biopsy, in the absence of congestive hepatopathy, requires further evaluation and portal hypertension should be rule out.

关键词： Sinusoidal DILATATION Sinusoidal obstruction syndrome Hepatic plate atrophy

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Gastrojejunostomy for pyloric stenosis after acute gastric DILATATION due to overeating

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World Journal of Gastroenterology 2015年第5期21卷 1670-1674页

作者： Akiharu Kimura Norihiro Masuda Norihiro Haga Tomokazu Ito Kichirou Otsuka Jyunko Takita Hitoshi Satomura Yuji Kumakura Hiroyuki Kato Hiroyuki Kuwano Department of Surgery Utsunomiya National HospitalTochigi 329-1193Japan Department of General Surgical Science Gunma UniversityGraduate School of MedicineMaebashiGunma 371-8511Japan Department of Surgery I Dokkyo Medical UniversityTochigi 321-0293Japan

A 34-year-old woman presented at our hospital withabdominal distention due to overeating.Acute gastric DILATATION was diagnosed.The patient was hospitalized,and nasogastric decompression was initiated.On hospitalization day 3,she developed shock,and her respiratory state deteriorated,requiring intubation and mechanical ventilation.Nasogastric decompression contributed to the improvement in her clinical condition.She was discharged 3 mo after admission.During outpatient follow-up,her dietary intake decreased,and her body weight gradually decreased by 14 kg.An upper gastrointestinal series and endoscopy revealed pyloric stenosis; therefore,we performed gastrojejunostomy 18 mo after her initial admission.The patient was discharged from the hospital with no postoperative complications.Gastric necrosis and perforation due to overeating-induced gastric DILATATION are life-threatening conditions.Surgical intervention may be required if delayed pyloric stenosis occurs after conservative treatment.We report a case of pyloric stenosis due to overeating-induced gastric DILATATION treated by gastrojejunostomy 18 mo after the initial presentation.

关键词： Acute gastric DILATATION Bulimia Pyloric stenosis

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Is endoscopic papillary large balloon DILATATION without endoscopic sphincterotomy effective?

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World Journal of Gastroenterology 2015年第23期21卷 7289-7296页

作者： Shigefumi Omuta Iruru Maetani Michihiro Saito Hiroaki Shigoka Katsushige Gon Junya Tokuhisa Mieko Naruki Division of Gastroenterology and Hepatology Department of Internal Medicine Toho University Ohashi Medical Center

AIM: To evaluate the safety and efficacy of endoscopic papillary large balloon DILATATION(EPLBD) without endoscopic sphincterotomy in a prospective study.METHODS: From July 2011 to August 2013, we performed EPLBD on 41 patients with nae papillae prospectively. For sphincteroplasty of EPLBD,endoscopic sphincterotomy(EST) was not performed,and balloon diameter selection was based on the distal common bile duct diameter. The balloon was inflated to the desired pressure. If the balloon waist did not disappear, and the desired pressure was satisfied, we judged the DILATATION as complete. We used a retrieval balloon catheter or mechanical lithotripter(ML) to remove stones and assessed the rates of complete stone removal, number of sessions, use of ML and adverse events. Furthermore, we compared the presence or absence of balloon waist disappearance with clinical characteristics and endoscopic outcome.RESULTS: The mean diameters of the distal and maximum common bile duct were 13.5 ± 2.4 mm and16.4 ± 3.1 mm, respectively. The mean maximum transverse-diameter of the stones was 13.4 ± 3.4mm, and the mean number of stones was 3.0 ± 2.4.Complete stone removal was achieved in 97.5%(40/41)of cases, and ML was used in 12.2%(5/41) of cases.The mean number of sessions required was 1.2 ± 0.62.Pancreatitis developed in two patients and perforation in one. The rate of balloon waist disappearance was73.1%(30/41). No significant differences were noted in procedure time, rate of complete stone removal(100% vs 100%), number of sessions(1.1 vs 1.3, P= 0.22), application of ML(13% vs 9%, P = 0.71),or occurrence of pancreatitis(3.3% vs 9.1%, P =0.45) between cases with and without balloon waist disappearance.CONCLUSION: EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance.

关键词： Endoscopic papillary large balloon DILATATION Difficult bile duct stone Endoscopic sphincterotomy Distal common bile duct Perforation

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Short and long-term outcomes of endoscopic balloon DILATATION for Crohn's disease strictures

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World Journal of Gastroenterology 2013年第1期19卷 86-91页

作者： Katsuya Endo Seiichi Takahashi Hisashi Shiga Yoichi Kakuta Yoshitaka Kinouchi Tooru Shimosegawa Division of Gastroenterology Tohoku University Graduate School of MedicineSendai 980-8574Japan

AIM:To investigate the short and long-term outcomes of endoscopic balloon DILATATION(EBD) for Crohn's disease(CD) strictures.METHODS:Between January 1995 and December 2011,47 EBD procedures were performed in 30 patients(8 females and 22 males) with CD.All patients had strictures through which an endoscope could not pass,and symptoms of these strictures included abdominal pain,abdominal fullness,nausea,and/or vomiting.The 47 strictures included 17 anastomotic and 30 de novo strictures.Endoscopy and DILATATION were performed under conscious sedation with intravenous diazepam or flunitrazepam.The DILATATIONs were all performed using through-the-scope balloons with diameters from 8 mm to 20 mm on inflation and lengths of 30-80 mm.Each DILATATION session consisted of two to four,3-min multistep inflations of the balloon,repeated at intervals of 1 wk until adequate DILATATION(up to 15-20 mm in diameter) was achieved.The follow-up data were collected from medical records and analyzed retrospectively.Primary success was defined as passage of the scope through the stricture after EBD.Longterm outcomes were analyzed focusing on interventionfree survival and surgery-free survival demonstrated by the Kaplan-Meier method.(Intervention-free meant cases in which neither endoscopic balloon re-DILATATION nor surgery was needed after the first DILATATION during the observation period).The log rank test was used to evaluate the difference in long-term outcomes between anastomotic and de novo stricture cases.RESULTS:Primary success was achieved in 44 of the 47 strictures(93.6%).Balloon DILATATIONs failed in 3 cases(6.4%).In 1 case,EBD was a technical failure because the guide-wire could not be passed through the stricture which showed severe adhesion and was a flexural lesion of the intestine.In 2 cases,unexpected perforations occurred immediately after balloon DILATATION.Of the 47 treatments,complications occurred in 5(10.6%).All 5 patients had de novo strictures.One suffered bleeding,two high fever and there were colorectal perfor

关键词： Crohn’s disease Endoscopic balloon DILATATION Stricture Anastomotic De novo Outcome

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Endoscopic ultrasound in common bile duct DILATATION with normal liver enzymes

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World Journal of Gastrointestinal Endoscopy 2015年第8期7卷 799-805页

作者： Claudio De Angelis Milena Marietti Mauro Bruno Rinaldo Pellicano Mario Rizzetto Department of Gastroenterology and Digestive Endoscopy "Città della Salute e della Scienza"University of Turin

In recent years,the description of isolated bile duct DILATATION has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms,probably due to the widespread use of high-resolution imaging techniques.However,there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound(EUS)in the diagnostic work up.When noninvasive imaging tests(transabdominal ultrasound,computed tomography or magnetic resonance cholangiopancreatography)fail to identify the cause of DILATATION and clinical or biochemical alarm signs are absent,the probability of having biliary disease is considered low.In this setting,using EUS,the presence of pathologic findings(choledocholithiasis,strictures,chronic pancreatitis,ampullary or pancreatic tumors,cholangiocarcinoma),not always with a benign course,has been observed.The aim of this review has been to evaluate the prevalence of disease among nonjaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield.Data point out to a promising role of EUS in the identification of a potential biliary pathology.EUS is a low invasive technique,with high accuracy,that could play a double cost-effective role:identifying pathologic conditions with dismal prognosis,in asymptomatic patients with negative prior imaging tests,and excluding pathologic conditions and further follow-up in healthy subjects.

关键词： Unexplained common bile duct DILATATION Endoscopic ultrasound Normal liver enzymes

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Comparison of endoscopic papillary balloon DILATATION and endoscopic sphincterotomy for bile duct stones

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World Journal of Gastrointestinal Endoscopy 2016年第10期8卷 395-401页

作者： Yuji Sakai Toshio Tsuyuguchi Harutoshi Sugiyama Masahiro Hayashi Jun-ichi Senoo Yuko Kusakabe Shin Yasui Rintaro Mikata Osamu Yokosuka Department of Gastroenterology and Nephrology Graduate School of Medicine Chiba University

Endoscopic treatment for bile duct stones is low-invasive and currently considered as the first choice of the treatment. For the treatment of bile duct stones, papillary treatment is necessary, and the treatments used at the time are broadly classified into two types; endoscopic papillary balloon DILATATION where bile duct closing part is dilated with a balloon and endoscopic sphincterotomy(EST) where bile duct closing part is incised. Both procedures have advantages and disadvantages. Golden standard is EST, however, there are patients with difficulty for EST, thus we must select the procedure based on understanding of the characteristics of the procedure, and patient backgrounds.

关键词： bile duct stones endoscopic papillary balloon DILATATION endoscopic sphincterotomy Endoscopic retrograde cholangiopancreatography Post endoscopic retrograde cholangiopancreatography pancreatitis

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Valvular Heart Disease and Aortic DILATATION

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Cardiovascular Innovations and Applications 2018年第B01期2卷 425-429页

作者： Thoralf M.Sundt Division of Cardiac Surgery Massachusetts General Hospital55 Fruit StreetBostonMA 02114USA

The case presented here offers us an opportunity to discuss an increasingly commonly confronted clinical challenge.Two issues are raised:how best to manage the patient’s valvular heart disease,including both the indications for surgical intervention and the prosthetic options,and how best to manage his aortic DILATATION.Let us take them one at a time.The patient has severe aortic regurgitation but a normal ejection fraction.Although we do not have his ventricular dimensions,he has a class I indication for intervention given his symptoms.

关键词： Valvular Heart Disease Aortic DILATATION

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