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The new criteria for differential diagnosis of indeterminate biliary stricture under super minimally invasive peroral cholangioscopy

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Chinese Medical Journal 2024年第3期137卷 255-256页

作者： Wengang Zhang Ningli Chai Qingzhen Wu Enqiang Linghu Department of Gastroenterology Chinese PLA General HospitalBeijing 100853China

Indeterminate biliary stricture(IBS)refers to biliary stricture with an uncertain histological diagnosis^([1])and can be classified as non-neoplastic stricture or neoplastic stricture.The former is mainly caused by various inflammatory biliopancreatic diseases,congenital malformations,or postoperative bile duct injury,while the latter exists in neoplastic lesions such as cholangiocarcinoma,invasion from pancreatic cancer,and adenomas in the bile duct.Most non-neoplastic strictures can be relieved by endoscopic or conservative medical treatment,and only a few require surgical intervention.Nevertheless,radical surgery or palliative biliary drainage should be applied for neoplastic strictures according to the progression of the disease.Therefore,it is essential to obtain an accurate diagnosis for IBS in clinical work.

关键词： diagnosis stricture biliary

Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture

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World Journal of Gastrointestinal Surgery 2023年第5期15卷 799-811页

作者： Raja Kalayarasan Satish Durgesh Surgical Gastroenterology JIPMERPuducherry 605006India

Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life.Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture.Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit.Colon is the commonly used esophageal substitute,particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures.Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area,with adverse cosmetic outcomes and long-term complications like an incisional hernia.As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition.However,minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure.With advancements in laparoscopic skills and instrumentation,the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented.Initial series have mainly used a laparoscopic-assisted approach,whereas more recent studies have shown the safety of a total laparoscopic approach.The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse longterm outcomes.Also,well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture.The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.

关键词： Robotics Laparoscopy Surgery Caustics Bypass stricture

Expression and possible role of Smad3 in postnecrotizing enterocolitis stricture

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World Journal of Pediatric Surgery 2022年第1期5卷 30-39页

作者： Rui Chen Chengjie Lv Xiaoxia Zhao Dong Ma Dengming Lai Yun Zhao Luyin Zhang Jinfa Tou Department of Neonatal Surgery Zhejiang University School of Medicine Children's HospitalHangzhouPeople's Republic of China National Center for clinical medicine of children's health and disease HangzhouPeople's Republic of China Department of Pathology Zhejiang University School of Medicine Children's HospitalHangzhouPeople's Republic of China Pediatric Surgery Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouPeople's Republic of China

Objective To investigate the expression of Smad3(mothers against decapentaplegic homolog 3)protein in postnecrotizing enterocolitis stricture and its possible mechanism of action.Methods We used immunohistochemistry to detect the expression characteristics of Smad3 and nuclear factor kappa B(NF-κB)proteins in human postnecrotizing enterocolitis stricture.We cultured IEC-6(crypt epithelial cells of rat small intestine)in vitro and inhibited the expression of Smad3 using siRNA technique.Quantitative PCR,western blotting,and ELISA were used to detect the changes in transforming growth factor-β1(TGF-β1),NF-κB,tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VEGF),and zonula occludens-1(ZO-1)messenger RNA(mRNA)and protein expressions in IEC-6 cells.CCK8 kit and Transwell cellular migration were used to detect cell proliferation and migration.Changes in epithelial-mesenchymal transition(EMT)markers(E-cadherin and vimentin)in IEC-6 cells were detected by immunofluorescence technique.Results The results showed that Smad3 protein and NF-κB protein were overexpressed in narrow intestinal tissues and that Smad3 protein expression was positively correlated with NF-κB protein expression.After inhibiting the expression of Smad3 in IEC-6 cells,the mRNA expressions of NF-κB,TGF-β1,ZO-1,and VEGF decreased,whereas the mRNA expression of TNF-αdid not significantly change.TGF-β1,NF-κB,and TNF-αprotein expressions in IEC-6 cells decreased,whereas ZO-1 and intracellular VEGF protein expressions increased.IEC-6 cell proliferation and migration capacity decreased.There was no significant change in protein expression levels of EMT markers E-cadherin and vimentin and also extracellular VEGF protein expression.Conclusions We suspect that the high expression of Smad3 protein in postnecrotizing enterocolitis stricture may promote the occurrence and development of secondary intestinal stenosis.The mechanism may be related to the regulation of TGF-β1,NF-κB,TNF-α,ZO-1,and VEGF mRNA and protein expression.This may also be relate

关键词： Smad3 expression. stricture

Evaluation of the Quality of Micturition in Patients Who Underwent Anastomotic Urethroplasty at the Yaounde Central Hospital, Cameroon

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Open Journal of Urology 2024年第2期14卷 115-127页

作者： Achille Aurele Mbassi Landry Oriole Mbouche Junior Mekeme Mekeme Jean Crepin Eloundou Nkolo Bright Che Awondo Jean Cedrik Fouda Frantz Guy Epoupa Ngalle Cyril Kamadjou Pamela Anaba Laure Pierre Joseph Fouda Fru Forbuzshi III Angwafo Higher Institute of Medical Technology Yaounde Cameroon Higher Institute of Health Sciences Bangangte Cameroon Urology and Andrology Department Yaounde Central Hospital Yaounde Cameroon Department of Surgery and Subspecialties Faculty of Medicine and Biomedical Sciences University of Yaounde 1 Yaounde Cameroon Yaounde Gynecology Obstetrics and Pediatric Hospital Yaounde Cameroon

Introduction: Radiological investigation which is the gold standard to perform following anastomotic urethroplasty in order to evaluate the quality of micturition is costly. In our context, due to financial limitations, reconstructive urologists prefer to use the uroflowmetry in order to assess the micturition post-surgery. Therefore, the objective of the study was to assess the quality of micturition using the uroflowmetry after anastomotic urethroplasty. Methodology: We conducted an 11-year retrospective review (1st January 2006-31st December 2017) and a cross-sectional descriptive observational study for a period of 8 months (November 2017-June 2018) at the Urology and Andrology Department of the Yaounde Central Hospital (YCH) of patients who were diagnosed with urethral stenosis and underwent an anastomotic urethroplasty at the YCH. We excluded patients who had incomplete files, patients lost to follow-up and did not do pre-operative uroflowmetry. Quality of micturition was evaluated using a uroflowmetry. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: We had a sample of 60 patients. The mean age was 42 ± 5 years with extremes ranging from 20 to 76 years. Twenty-seven (27) patients, or 45%, had no post-operative complications, and those who did had a urinary tract infection (26.70%). In our series, we had 82% excellent results (patient satisfied with his urination with bell-shaped urinary stream and urinary flow greater than or equal to 15 ml/sec);15% good results (patient with moderate dysuria with average urinary stream and urinary flow between 10 and 14.9 ml/sec) and 3% poor results (severe dysuria with urinary flow less than 10 ml/sec, urinary retention or urinary incontinence). Based on these results we can say that the success rate in our series was 97%. 96.70% of patients were satisfied against 3.3% who were not. Conclusion: Anastomotic urethropl

关键词： Urethra stricture Anastomotic Urethroplasty

Urethroplasty in a post irradiation urethral stricture-a review

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Plastic and Aesthetic Research 2022年第1期9卷 133-139页

作者： Carlos Guerra Sergio Davila Slavica Pusica Predrag Aleksic Department of Urology Belgrade Center for Genitourinary Reconstructive SurgeryBelgrade 11000Serbia Department of Urology Hospital Universitario“Dr.JoséEleuterio González”MonterreyNuevo Leon 64460Mexico Department of Urology Medical Military AcademyBelgrade 11000Serbia

Radiotherapy-induced urethral strictures(RIUS)decrease quality of life and present a great challenge for surgical reconstruction,especially due to proximal location,compromised vascular supply,and poor wound healing.It is unclear whether urethroplasty is an option in cases with stricture resulting from exposure to pelvic radiation.We review the pathophysiology,diagnostic workup,and disease-specific aspects of RIUS.Furthermore,we discuss several management alternatives such as excision and primary anastomosis,as well as techniques for open reconstruction with flaps.The most extensive techniques in the treatment of strictures include,for example,those using gracilis muscle flaps,as they can involve periurethral tissue to provide sufficient vascularity for excellent post-surgery urethral healing.In brief,RIUS represent a significant challenge.In carefully chosen patients,urethroplasty should be considered as a feasible and durable treatment.However,medical practitioners should always take into consideration that the results of urethroplasty in RIUS are not comparable to urethroplasties without a radiation background.

关键词： Urethra stricture radiotherapy urethroplasty buccal mucosa graft gracilis muscle flap stricture

Effect of polyglycolic acid sheet plus esophageal stent placement in preventing esophageal stricture after endoscopic submucosal dissection in patients with earlystage esophageal cancer: A randomized, controlled trial

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World Journal of Gastroenterology 2018年第9期24卷 1046-1055页

作者： Ning-Li Chai Jia Feng Long-Song Li Sheng-Zhen Liu Chen Du Qi Zhang En-Qiang Linghu Department of Gastroenterology Chinese PLA General Hospital

AIM To assess the effect of polyglycolic acid(PGA) plus stent placement compared with stent placement alone in the prevention of post-endoscopic submucosal dissection(ESD) esophageal stricture in early-stage esophageal cancer(EC) patients. METHODS Seventy EC patients undergoing ESD were enrolled in this randomized, controlled study. Patients were allocated randomly at a 1:1 ratio into two groups as follows:(1) PGA plus stent group(PGA sheet-coated stent placement was performed); and(2) Stent group(only stent placement was performed). This study was registered on http://***(No. chictrinr-16008709). RESULTS The occurrence rate of esophageal stricture in the PGA plus stent group was 20.5%(n = 7), which was lower than that in the stent group(46.9%, n = 15)(P = 0.024). The mean value of esophageal stricture time was 59.6 ± 16.1 d and 70.7 ± 28.6 d in the PGA plus stent group and stent group(P = 0.174), respectively. Times of balloon dilatation in the PGA plus stent group were less than those in the stent group [4(2-5) vs 6(1-14), P = 0.007]. The length(P = 0.080) and diameter(P = 0.061) of esophageal strictures were numerically decreased in the PGA plus stent group, whereas no difference in location(P = 0.232) between the two groups was found. Multivariate logistic analysis suggested that PGA plus stent placement(P = 0.026) was an independent predictive factor for a lower risk of esophageal stricture, while location in the middle third(P = 0.034) and circumferential range = 1/1(P = 0.028) could independently predict a higher risk of esophageal stricture in EC patients after ESD. CONCLUSION PGA plus stent placement is more effective in preventing post-ESD esophageal stricture compared with stent placement alone in EC patients with earlystage disease.

关键词： Esophageal cancer Endoscopic submucosal dissection Polyglycolic acid plus stent placement Esophageal stricture

Transurethral resection of the prostate stricture management

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Asian Journal of Andrology 2020年第2期22卷 140-144页

作者： Jian-Wei Wang Li-Bo Man Department of Urology Beijing Jishuitan HospitalThe Fourth Medical College of Peking UniversityBeijing 100096China

For more than nine decades,transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction.The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty.Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate,the exact etiology of urethral stricture after TURP is still controversial.Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection,mechanical trauma,prolonged indwelling catheter time,use of local anesthesia,and electrical injury by a stray current.One single treatment option is not appropriate for all stricture types.The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods,including urethral dilation and direct visual incision,or open surgical procedures with varying urethroplasty techniques.Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse,we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

关键词： benign prostatic hyperplasia transurethral resection of the prostate urethral stricture

Silicone-covered biodegradable magnesium stent for treating benign esophageal stricture in a rabbit model

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World Journal of Gastroenterology 2019年第25期25卷 3207-3217页

作者： Kai Yang Jun Cao Tian-Wen Yuan Yue-Qi Zhu Bi Zhou Ying-Sheng Cheng Department of Radiological Intervention Shanghai Sixth People's Hospital East Campus Affiliated to Shanghai University of Medicine&Health SciencesShanghai 201306China Department of Radiological Intervention Shanghai Sixth People's Hospital East Campus Affiliated to Shanghai Jiao Tong UniversityShanghai 201306China Department of Tumor Intervention Dahua HospitalShanghai 200237China Department of Radiological Intervention Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong UniversityShanghai 200233China

BACKGROUND Stent insertion can effective alleviate the symptoms of benign esophageal strictures(BES).Magnesium alloy stents are a good candidate because of biological safety,but show a poor corrosion resistance and a quick loss of mechanical support in vivo.AIM To test the therapeutic and adverse effects of a silicone-covered magnesium alloy biodegradable esophageal stent.METHODS Fifteen rabbits underwent silicone-covered biodegradable magnesium stent insertion into the benign esophageal stricture under fluoroscopic guidance(stent group).The wall reconstruction and tissue reaction of stenotic esophagus in the stent group were compared with those of six esophageal stricture models(control group).Esophagography was performed at 1,2,and 3 weeks.Four,six,and five rabbits in the stent group and two rabbits in the control groups were euthanized,respectively,at each time point for histological examination.RESULTS All stent insertions were well tolerated.The esophageal diameters at immediately,1,2 and 3 wk were 9.8±0.3 mm,9.7±0.7 mm,9.4±0.8 mm,and 9.2±0.5 mm,respectively(vs 4.9±0.3 mm before stent insertion;Pstricture and normal rabbits(P>0.05).CONCLUSION Esophageal silicone-covered biodegradable magnesium stent insertion is feasible for BES without causing severe injury or tissue reaction.Our study suggests that insertion of silicone-covered magnesium esophageal stent is a promising approach for treating BES.

关键词： Benign esophageal stricture Biodegradable stent Magnesium Silicone membrane

Colon Interposition for Corrosive Esophageal stricture: Single Institution Experience with 119 Cases

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Current Medical Science 2019年第3期39卷 415-418页

作者： Wen-hui ZENG Wan-li JIANG Gan-jun KANG Xing-hua ZHANG Guo-hua FAN Qing GENG Song-ping XIE Jie HUANG Department of Thoracic Surgery Renmin Hospital of Wuhan University Wuhan 430060 China

The colon is an alternative graft organ for esophageal reconstruction.The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion,to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range:270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20,16.8%), the larynx (n=3,2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon).One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.

关键词： corrosive esophageal stricture colon interposition outcomes