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Endoscopic clipping of gastrojejunostomy leakage following Whipple procedure: A case report

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World Journal of Gastrointestinal Surgery 2024年第9期16卷 3041-3047页

作者： Bahtiyar Muhammedoğlu Oguzhan Fatih Ay Department of General Surgery Kahramanmaras Sutcuİmam University Medical FacultyKahramanmaras 46040Türkiye Department of General Surgery Kahramanmaras Necip Fazıl City HospitalKahramanmaras 46140Türkiye

BACKGROUND Currently,perioperative complications of classic Whipple surgery occur at a rate of approximately 40%.Common complications include delayed gastric emptying,pancreatic fistula,and bile leakage,whereas gastrojejunostomy(GJ)leakage is *** SUMMARY This case report will assess the management of a GJ leak in a 71-year-old male patient following the Whipple *** surgery,the patient was trans-ferred to the clinic after four days of intensive care,where vacuum therapy was used to handle a developing subcutaneous *** patient,who had bile in the drains and incision during follow-up,underwent endoscopic examination on the 21st day after the *** opening of approximately 4 mm was observed in the GJ anastomosis during *** titanium clips were used to close the *** drainage of bile decreased to less than 50 mL on the first day after the procedure,and the patient's oral intake was *** Current literature reports a GJ leakage rate of 0.54%following Whipple surgery,with clinical findings lasting on average between 4-34 *** was the main form of therapy for this case,with a success rate of 84%,and percutaneous drai-nage was also utilized as a treatment *** case report is the first to docu-ment endoscopic treatment of GJ leaks following the classic Whipple procedure.

关键词： pancreas cancer Whipple procedure Gastrojejunostomy Leakage Endos-copic management Case report

Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients:a systematic review and meta-analysis

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Gastroenterology Report 2021年第2期9卷 105-114,I0001页

作者： Pradeep K.Siddappa Fadi Hawa Larry J.Prokop MHassan Murad Barham K.Abu Dayyeh Vinay Chandrasekhara Mark D.Topazian Fateh Bazerbachi Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA Department of Internal Medicine St.Joseph Mercy Ann Arbor HospitalYpsilantiMIUSA Library Public Services Mayo ClinicRochesterMNUSA Robert D and Patricia E Kern Center for the Science of Health Care Delivery Mayo ClinicRochesterMNUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA

Background Abdominal pain is a debilitating symptom affecting-80%of pancreatic cancer(PC)*** duct(PD)decompression has been reported to alleviate this pain,although this practice has not been widely *** aimed to evaluate the role,efficacy,and safety of endoscopic PD decompression for palliation of PC post-prandial obstructive-type *** A systematic review until 7 October 2020 was *** independent reviewers selected studies,extracted data,and assessed the methodological *** We identified 12 publications with a total of 192 patients with PC presenting with abdominal pain,in whom PD decompression was attempted,and was successful in 167 patients(mean age 62.5 years,58.7%males).The use of plastic stents was reported in 159 patients(95.2%).All included studies reported partial or complete improvement in pain levels after PD stenting,with an improvement rate of 93%(95%confidence interval,79%-100%).The mean duration of pain improvement was 94616 *** retrograde cholangiopancreatography(ERCP)-related adverse events(AEs)were postsphincterotomy bleeding(1.8%),post-ERCP pancreatitis(0.6%),and hemosuccus pancreaticus(0.6%).AEs were not reported in two patients who underwent endoscopic ultrasound-guided PD *** the 167 patients with technical success,the stent-migration and stent-occlusion rates were 3.6%and 3.0%,*** AE-related mortality was *** methodological quality assessment showed the majority of the studies having low or unclear *** In this exploratory analysis,endoscopic PD drainage may be an effective and safe option in selected patients for the management of obstructive-type PC ***,a randomized–controlled trial is needed to delineate the role of this invasive practice.

关键词： cancer-associated pain Endoscopic retrograde cholangiopancreatography palliative therapy pancreas cancer systematic review meta-analysis

Pancreatic cancer,autoimmune or chronic pancreatitis,beyond tissue diagnosis:Collateral imaging and clinical characteristics may differentiate them

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 925-942页

作者： Ana I Tornel-Avelar Jose Antonio Velarde Ruiz-Velasco Mario Pelaez-Luna Department of Gastroenterology Hospital Civil of Guadalajara“Fray Antonio Alcalde”Guadalajara 44340JaliscoMexico Research Division School of Medicine/Department of Gastroenterology Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition“Salvador Zubiran”Tlalpan 14000Mexico CityMexico

Pancreatic ductal adenocarcinoma(PDAC)is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related ***,the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses,such as autoimmune pancreatitis(AIP)and massforming chronic pancreatitis(MFCP),making its diagnosis *** AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic *** diagnostic criteria and tools allow the precise differentiation of benign from malignant masses;however,the diagnostic accuracy is *** pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate *** is not unusual that after a thorough diagnostic evaluation,the clinician is confronted with a pancreatic mass with uncertain *** those cases,a re-evaluation must be entertained,preferably by an experienced multispecialty team including radiologists,pathologists,gastroenterologists,and surgeons,looking for disease-specific clinical,imaging,and histological hallmarks or collateral evidence that could favor a specific *** aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP,PDAC,and MFCP and to highlight those disease-specific clinical,radiological,serological,and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.

关键词： pancreas cancer Chronic pancreatitis Autoimmune pancreatitis pancreas mass Endoscopic ultrasound Diagnosis

HER2 aberrations and heterogeneity in cancers of the digestive system: Implications for pathologists and gastroenterologists

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World Journal of Gastroenterology 2016年第35期22卷 7926-7937页

作者： Nicola Fusco Silvano Bosari Division of Pathology Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico 20122 Milan Italy Department of Pathophysiology and Organ Transplantation University of Milan

Management of cancers of the digestive system has progressed rapidly into the molecular era. Despite the significant recent achievements in the diagnosis and treatment of these patients, the number of deaths for these tumors has currently plateaued. Many investigations have assessed the role of HER2 in tumors of the digestive system in both prognostic and therapeutic settings, with heterogeneous results. Novel testing and treatment guidelines are emerging, in particular in gastric and colorectal cancers. However, further advances are needed. In this review we provide a comprehensive overview of the current state-ofknowledge of HER2 alterations in the most common tumors of the digestive system and discuss the operational implications of HER2 testing.

关键词： HER2 Digestive system Gastrointestinal tract Gastric cancer Colon cancer Esophageal cancer Gastroesophageal junction cancer Biliary tract cancer Gallbladder cancer Liver cancer pancreas cancer

Clinical impact of chemotherapy to improve tumor microenvironment of pancreatic cancer

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World Journal of Gastrointestinal Oncology 2016年第11期8卷 786-792页

作者： Takahiro Tsuchikawa Shintaro Takeuchi Toru Nakamura Toshiaki Shichinohe Satoshi Hirano Department of Gastro-enterological Surgery Ⅱ Hokkaido University Graduate School of Medicine

A perioperative multimodal strategy including combination chemotherapy and radiotherapy, in addition to surgical resection, has been acknowledged to improve patient prognosis. However chemotherapy has not been actively applied as an immunomodulating modality because of concerns about various immunosuppressive effects. It has recently been shown that certain chemotherapeutic agents could modify tumor microenvironment and host immune responses through several underlying mechanisms such as immunogenic cell death, local T-cell infiltration and also the eradication of immune-suppressing regulatory cells such as regulatory T cells(Tregs) and myeloid-derived suppressor cells. With the better understanding of the cell components in the tumor microenvironment and the effect of chemotherapy to improve tumor microenvironment, it has been gradually clear that the chemotherapeutic agents is two-edged sword to have both immune promoting and suppressing effects. The cellular components of the tumor microenvironment include infiltrating T lymphocytes, dendritic cells, regulatory T cells, tumor associated macrophages, myeloid derived suppressor cells and cancer associated fibroblasts. Based on the better understanding of tumor microenvironment following chemotherapy, the treatment protocol could be modified as personalized medicine and the prognosis of pancreas cancer would be more improved utilizing multimodal chemotherapy. Here we review the recent advances of chemotherapy to improve tumor microenvironment of pancreatic cancer, introducing the unique feature of tumor microenvironment of pancreatic cancer, interaction between anti-cancer reagents and these constituting cells and future prospects.

关键词： pancreas cancer Microenvironment Chemotherapy Immune cells Immunomodulation

Resection of isolated liver oligometastatic disease in pancreatic ductal adenocarcinoma:Is there a survival benefit?A systematic review

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1512-1521页

作者： James M Halle-Smith Sarah Powell-Brett Keith Roberts Nikolaos A Chatzizacharias Department of HPB and Liver Transplant Queen Elizabeth HospitalUniversity of BirminghamBirmingham B152GWUnited Kingdom

BACKGROUND Presence of liver metastatic disease in pancreatic ductal adenocarcinoma(PDAC),either synchronous or metachronous after pancreatic resection,is a terminal diagnosis that warrants management with palliative intent as per all international practice ***,there is an increasing interest on any potential value of surgical treatment of isolated oligometastatic disease in selected *** To present the published evidence on surgical management of PDAC liver metastases,synchronous and metachronous,and compare the outcomes of these treatments to the current standard of *** A systematic review was performed in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to compare the outcomes of both synchronous and metachronous liver metastases resection to standard *** 356 studies were identified,31 studies underwent full-text review and of these 10 were suitable for *** synchronous resection of liver metastases was compared to standard care,most studies did not demonstrate a survival benefit with the exception of one study that utilised neoadjuvant ***,resection of metachronous disease appeared to confer a survival advantage when compared to treatment with chemotherapy *** A survival benefit may exist in resection of selected cases of metachronous liver oligometastatic PDAC disease,after disease biology has been tested with time and systemic *** survival benefit is less clear in synchronous cases;however an approach with neoadjuvant treatment and consideration of resection in some selected cases may confer some *** studies should focus on pathways for selection of cases that may benefit from an aggressive approach.

关键词： pancreas cancer Liver metastases Surgical resection Systematic review

Novel approaches to therapeutics in pancreatic adenocarcinoma: vitamin C and tumor treatment fields

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Journal of cancer Metastasis and Treatment 2021年第1期7卷 284-299页

作者： Laith Abushahin Travis Jones Jonathan Song Terence M.Williams Haseebah Shahzad Anne Noonan Arthur G.James Comprehensive cancer Center and Richard J.Solove Research Institute The Ohio State University Medical CenterColumbusOH 43210USA Department of Internal Medicine Division of Medical OncologyThe Ohio State UniversityColumbusOH 43210USA Department of Mechanical&Aerospace Engineering The Ohio State UniversityColumbusOH 43210USA Department of Radiation Oncology The Ohio State University Medical CenterColumbusOH 43210USA

Pancreatic ductal adenocarcinoma(PDAC)is a lethal disease with limited therapeutic *** extensive clinical research over the past several decades,meaningful improvements in care standards have been challenging to *** efforts are underway on several fronts,including cytotoxic chemotherapy combinations,immunotherapy,and targeted *** this review,we chose to focus less on mainstream avenues of clinical research in PDAC and highlight some novel and innovative research efforts that are typically outside the spotlight of *** of these novel approaches include pharmacologic vitamin C and electromagnetic *** review’s scope is to present the biological basis of the anti-cancer potential and the early clinical data,as well as the future landscape of these agents,including ongoing clinical trials in these therapeutic avenues.

关键词： pancreas cancer vitamin C ascorbate tumor treatment fields induced electromagnetic field electromagnetic field therapy

Role of(～(18)F)2-fluoro-2-deoxyglucose positron emission tomography in upper gastrointestinal malignancies

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World Journal of Gastroenterology 2011年第46期17卷 5059-5074页

作者： Elizabeth C Smyth Manish A Shah Department of Gastrointestinal Oncology Weill Cornell Medical CollegeMemorial Sloan-Kettering Cancer Center Department of Gastrointestinal Oncology Weill Cornell Medical CollegeNew York-Presbyterian Hospital

The role of whole-body FDG [(～(18)F)2-fluoro-2-deoxy-glucose] positron emission tomography(PET)scan-ning as an imaging modality in the management of patients with malignancy has evolved enormously over the past two ***-PET has demonstrated signifi cant effi cacy in the staging,prognostication and detection of occult metastatic disease in malignancies of the gastrointestinal tract,in addition to assessment of the response to cytotoxic chemotherapy in a more timely manner than has traditionally been possible by more conventional imaging *** sensitivity and specif icity of FDG-PET for the detection and staging of malignancy depend not only on the site and size of the primary tumor and metastases,but also on histologi-cal cell type,reflecting underlying disparities in glucose *** metabolic response to neo-adjuvant chemotherapy or to chemo-radiotherapy in cancers of the gastro-esophageal junction or stomach has been demonstrated in several prospective studies to correlate signifi cantly with both the histological tumor response to treatment and with consequent improvements in overall *** may offer a future paradigm ofpersonalized treatment based on the PET response to ***-PET has been less successful in efforts to screen for and detect recurrent upper gastro-intestinal malignancies,and in the detection of low vol-ume metastatic peritoneal *** to improve the accuracy of PET include the use of novel radiotrac-ers such as(～(18)F)FLT(3-deoxy-3-fluorothymidine)or 11C-choline,or fusion PET-CT with concurrent high-res-olution computed *** review focuses on the role of FDG-PET scanning in staging and response assessment in malignancies of the upper gastrointesti-nal tract,specif ically gastric,esophageal and pancreas carcinoma.

关键词： Positron emission tomography Gastric cancer Esophageal cancer pancreas cancer

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

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World Journal of Gastroenterology 2007年第22期13卷 3112-3116页

作者： José Celso Ardengh César Vivian Lopes Luiz Felipe Pereira de Lima Juliano Rodrigues de Oliveira Filadélfi o Venco Giulio Cesare Santo José Luiz Pimenta Módena Echoendoscopy and Pathology Units from 9 de Julho Hospital and Ribeiro Preto Medical School-USP So Paulo Brazil

AIM： To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration （EUS-FNA） for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions.METHODS： From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUSFNA. The final diagnosis was obtained either by surgery （356 cases） or after a mean clinical follow-up of 11.8 mo in the remaining patients.RESULTS： There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 （97.4%） cases. There were 352 （57.6%） malignancies and 259 （42.4%） benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67% of the lesions. Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4%, 99.2%, 99.3%, 77.2% and 87.2%. Specifically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8% ys 82.4%, 100% ys 98.4%, 100% vs 99%, 54.8% vs 74.1% and 83.1% vs 87.8%. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%.CONCLUSION： EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.

关键词： Diagnosis Endoscopic ultrasound Fineneedle-aspiration biopsy pancreas cancer Pancreatic disease Sampling