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World Journal of Gastroenterology 2023年第21期29卷 3222-3240页

作者： Nicolas Richard Guillaume Savoye Mathilde Leboutte Asma Amamou Subrata Ghosh Rachel Marion-Letellier University of Rouen Normandie INSERMADEN UMR 1073NutritionInflammation and Microbiota-Gut-Brain AxisRouen F-76000France CHU Rouen Department of GastroenterologyRouen University Hospital-Charles NicolleRouen F-76000France Institute for Research and Innovation in Biomedicine University of Rouen NormandieRouen F-76000France APC Microbiome Ireland Biosciences BuildingUniversity College CorkCork T12 YT20Ireland

Crohn’s disease(CD)is an inflammatory bowel disease characterized by immunemediated flares affecting any region of the intestine alternating with remission periods.In CD,the ileum is frequently affected and about one third of patients presents with a pure ileal type.Moreover,the ileal type of CD presents epidemiological specificities like a younger age at onset and often a strong link with smoking and genetic susceptibility genes.Most of these genes are associated with Paneth cell dysfunction,a cell type found in the intestinal crypts of the ileum.Besides,a Western-type diet is associated in epidemiological studies with CD onset and increasing evidence shows that diet can modulate the composition of bile acids and gut microbiota,which in turn modulates the susceptibility of the ileum to inflammation.Thus,the interplay between environmental factors and the histological and anatomical features of the ileum is thought to explain the specific transcriptome profile observed in CD ileitis.Indeed,both immune response and cellular healing processes harbour differences between ileal and non-ileal CD.Taken together,these findings advocate for a dedicated therapeutic approach to managing ileal CD.Currently,interventional pharmacological studies have failed to clearly demonstrate distinct response profiles according to disease site.However,the high rate of stricturing disease in ileal CD requires the identification of new therapeutic targets to significantly change the natural history of this debilitating disease.

关键词： Ileum Crohn’s disease Bile acids Paneth cells Diet Genetics strictures

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Development and validation of a model to determine risk of refractory benign esophageal strictures

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World Journal of Clinical Cases 2019年第13期7卷 1623-1633页

作者： Qing Lu Tian-Tian Lei Yi-Lan Wang Hai-Lin Yan Bo Lin Lin-Lin Zhu Hong-Sheng Ma Jin-Lin Yang Department of Gastroenterology West China Hospital of Sichuan University Chengdu 610041 Sichuan Province China Department of Day Surgery West China Hospital of Sichuan University Chengdu 610041 Sichuan Province China

BACKGROUND Current research has identified several risk factors for refractory benign esophageal strictures (RBES), but research is scarce on the prediction of RBES in benign esophageal strictures patients. Meanwhile, the long-term outcomes of RBES remain unclear. The aim of this study was to develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures. And we also explored the long-term outcomes and safety in patients with RBES. AIM To develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures, based on the demographic data and endoscopic findings. METHODS A total of 507 benign esophageal stricture patients treated by dilation alone or in combination with stenting were retrospectively enrolled between January 2009 and February 2018. The primary outcome was to establish a risk-scoring model predicting RBES in benign esophageal strictures. The secondary outcome was to explore the clinical effectiveness and adverse events in patients with RBES. RESULTS In the study, age, etiology, and number and length of strictures were the independent risk factors for the refractory performance of benign esophageal strictures. According to risk factors of benign esophageal strictures, a risk-scoring model for predicting RBES in benign esophageal strictures was established: The risk score ranged from 0 to 8 points, and the risk scores were divided into low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-8 points). The proportions of RBES in the corresponding risk categories were 1.0%, 12.2%, and 76.0%, respectively. Among 507 patients, 57 had RBES (39 males;median age, 60 years). The success rate of dilation treatment (51.2%, 21/41) was higher than that of stent placement (37.5%, 6/16). CONCLUSION In this study, 11.3%(57/507) patients had RBES at our hospital. The risk-scoring model predicting RBES in benign esophageal strictures could predict the longterm outcome of patients with strictures ahead.

关键词： Refractory benign esophageal strictures Esophageal dilation Esophageal stents Long-term outcomes Retrospective analysis

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Histopathological changes in the oesophageal mucosa in Egyptian children with corrosive strictures: A single-centre vast experience

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World Journal of Gastroenterology 2019年第7期25卷 870-879页

作者： Ayman EskANDer Carolyne Ghobrial Nabil A Mohsen Bahaa Mounir Dalia Abd EL-Kareem Sara Tarek Mortada HF El-Shabrawi Department of Paediatrics Kasr Alainy School of Medicine Cairo University Department of Pathology Kasr Alainy School of Medicine Cairo University

BACKGROUND The caustic ingestion continues to be a major problem worldwide especially in developing countries. The long-term complications include stricture and increased life time risk of oesophageal carcinoma. Patients suffered from corrosive induced oesophageal strictures have more than a 1000-fold risk of developing carcinoma of the oesophagus.AIM To determine the possibility of oesophageal mucosal dysplasia after prolonged dilatation in post corrosive stricture.METHODS This observational study was conducted at the Paediatric Endoscopy Unit in Cairo University Children's Hospital. It included children of both sexes older than 2 years of age who had an established diagnosis of post-corrosive oesophageal stricture and repeated endoscopic dilatation sessions for more than 6 mo. All patients were biopsied at the stricture site after 6 mo of endoscopic dilatation. A histopathological examination of an oesophageal mucosal biopsy was performed for the detection of chronic oesophagitis, inflammatory cellular infiltration and dysplasia.RESULTS The mean age of the enrolled children was 5.9 ± 2.6 years; 90% of the patients had ingested an alkaline corrosive substance(potash). The total number of endoscopic dilatation sessions were ranging from 16 to 100 with mean number of sessionswas 37.2 ± 14.9. Histopathological examination of the specimens showed that 85%of patients had evidence of chronic oesophagitis(group A) in the form of basal cell hyperplasia, hyperkeratosis and subepithelial fibrosis. Thirteen percent of the patients had evidence of reactive atypia(group B) in the form of severe neutrophilic intraepithelial inflammatory cellular infiltration, and 2 patients(2%)had mild squamous dysplasia(group C); we rebiopsied these two patients 6 mo after the initial pathological assessment, guided by chromoendoscopy by Lugol's iodine.CONCLUSION The histopathology of oesophageal mucosal biopsies in post-corrosive patients demonstrates evidence of chronic oesophagitis, intraepithelial inflammatory cellular infiltration and d

关键词： Children Endoscopic dilatation Dysplasia Oesophageal strictures Postcorrosive

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Biliary strictures complicating living donor liver transplantation:Problems,novel insights and solutions

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World Journal of Gastroenterology 2018年第19期24卷 2061-2072页

作者： Harshavardhan B Rao Arjun Prakash Surendran Sudhindran Rama P Venu Department of Gastroenterology Amrita Institute of Medical SciencesAmrita UniversityKochi 682041India Department of Transplant and Vascular Surgery Amrita Institute of Medical SciencesAmrita UniversityKochi 682041India

Biliary stricture complicating living donor liver transplantation(LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement(with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for

关键词： Biliary strictures Endoscopic management Stenting Self-expanding metal stents Living donor liver transplantation

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Radiofrequency and malignant biliary strictures:An update

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World Journal of Gastrointestinal Endoscopy 2019年第2期11卷 95-102页

作者： Francesco Auriemma Luca De Luca Mario Bianchetti Alessandro Repici Benedetto Mangiavillano Gastrointestinal Endoscopy Unit Humanitas Mater Domini Gastroenterology and Digestive Endoscopy Unit Ospedali Riuniti Marche Nord Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital Humanitas Huniversity

Malignant biliary strictures are usually linked to different types of tumors,mainly cholangiocarcinoma, pancreatic and hepatocellular carcinomas. Palliative measures are usually adopted in patients with nonresectable or borderline resectable biliary disease. Stent placement is a well-known and established treatment in patients with unresectable malignancy. Intraductal radiofrequency ablation(RFA) represents a procedure that involves the use of a biliary catheter device, via an endoscopic approach. Indications for biliary RFA described in literature are: Palliative treatment of malignant biliary strictures, avoiding stent occlusion, ablating ingrowth of blocked metal stents, prolonging stent patency,ablating residual adenomatous tissue after endoscopic ampullectomy. In this mini-review we addressed focus on technical success defined as deployment of the RF catheter, virtually succeeded in all patients included in the studies. About efficacy, three main outcome measures have been contemplated: Biliary decompression and stent patency, survival. Existing studies suggest a beneficial effect on survival and stent patency with RFA, but current impression is limited because most of studies have been performed using a retrospective design, on diminutive and dissimilar cohorts of patients.

关键词： Radiofrequency Ablation Endoscopic retrograde colangiopancreatography Malignant biliary strictures

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Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique

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World Journal of Gastrointestinal Endoscopy 2018年第11期10卷 367-377页

作者： Harpal S Dhaliwal Nitin Kumar Pradeep Kumar Siddappa Ripudaman Singh Jogeet Singh Sekhon Jaspal Masih Justin Abraham Sameer Garg Department of Gastroen-terology Christian Medical College and HospitalLudhiana 141012 Punjab India Department of Internal Medicine Christian Medical College and Hospital Department of Internal Medicine University of Connecticut Department of Radiodiagnosis and Imaging Fortis Hospital

AIM To investigate the role of a novel minimally invasive endoscopic technique in the management of tight neartotal corrosive strictures of the proximal esophagus involving the hypopharynx.METHODS Two patients with near-total corrosive strictures of the proximal esophagus involving the hypopharynx were managed with the novel endoscopic technique. The technique involved passing a 0.025-inch flexible guidewire across the stricture, and stricture dilatation, using 10 F coaxial diathermy and balloon dilators, followed byelectro-incision of the proximal aspect of the residual eccentric stricture by means of a novel approach using a wire-guided sphincterotome.RESULTS Both patients were successfully managed on an outpatient department basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No adverse events were seen during or after the procedure. There was no recurrence of symptoms at a follow-up of over a year in both cases. There was a significant improvement in the body mass index of both patients after the procedure.CONCLUSION We report a novel flexible endoscopic technique for the management of complex hypopharyngo-esophageal strictures. In experienced hands, the procedure is relatively simple, safe and effective with a durable response.

关键词： Cricopharyngeal strictures Electroincision Corrosive injury Benign esophageal strictures Stricture dilatation

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Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 53-61页

作者： Benedetto Mangiavillano Mouen A Khashab Ilaria Tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici Gastrointestinal Endoscopy Unit Humanitas-Mater Domini Humanitas Huniversity Division of Gastroenterology and Hepatology Johns Hopkins Hospital Gastroenterology and Endoscopy Unit Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT) Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center IRCCS Digestive Endoscopy Unit Istituto Clinico Humanitas Research Hospital Unit of Gastroenterology Department of Medical and Surgical Sciences S. Orsola-Malpighi Hospital University of Bologna Gastroenterology and Digestive Endoscopy Unit Ospedali Riuniti Marche Nord Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography(EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP). The advent of lumen-apposing metal stents(LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.

关键词： Malignant biliary strictures Malignant duodenal stenosis Bilio-duodenal stenosis Biliary self-expandable metal stent Duodenal self-expandable metal stent Lumen-apposing metal stents Gastro-jejunostomy

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Comparative analysis of ERCP,IDUS,EUS and CT in predicting malignant bile duct strictures

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World Journal of Gastroenterology 2014年第30期20卷 10495-10503页

作者： Hauke S Heinzow Sara Kammerer Carina Rammes Johannes Wessling Dirk Domagk Tobias Meister Department of Medicine B University of MünsterD-48149 MünsterGermany Department of Clinical Radiology University of MünsterD-48149 MünsterGermany Department of Radiology ClemenshospitalMünster University Teaching HospitalD-48153 MünsterGermany Department of Medicine Ⅱ HELIOS AlbertSchweitzer HospitalG?ttingen University Teaching HospitalD-37154 NortheimGermany

AIM:To compare endoscopic retrograde cholangio-pancreatography(ERCP),intraductal ultrasound(IDUS),endosonography(EUS),endoscopic transpapillary forceps biopsies(ETP)and computed tomography(CT)with respect to diagnosing malignant bile duct strictures.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS,ETP,EUS,and CT.The sensitivity,specificity,and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.For each of the diagnostic measures,the sensitivity,specificity,and accuracy rates were calculated.In all cases,the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo.A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and theχ2test as appropriate.A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar’s test.Differences were considered statistically significant if Pstrictures were included.A total of 161patients underwent operative exploration;thus,a surgical histopathological correlation was available for those patients.A total of 113 patients had malignant disease proven by surgery;in 48 patients,benign disease was surgically found.In these patients,the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics(ERCP,CT,or EUS).Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a followup of at least 12 mo;the median follow-up was 34 mo.Twenty-three patients had extended malignant disease,and thus were considered palliative.A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91%(ERCP/IDUS),59%(ETP),92%(IDUS+ETP

关键词： Intraductal ultrasound Bile duct strictures Endoso

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Intraductal ultrasound substantiates diagnostics of bile duct strictures of uncertain etiology

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World Journal of Gastroenterology 2013年第6期19卷 874-881页

作者： Tobias Meister Hauke S Heinzow Carina Woestmeyer Philipp Lenz Josef Menzel Torsten Kucharzik Wolfram Domschke Dirk Domagk Department of Medicine B University of Münster Department of Medicine Ⅱ HELIOS AlbertSchweitzer University Teaching Hospital Department of MedicineⅡ Klinikum IngolstadtD-85049 IngolstadtGermany Department of Medicine University Teaching Hospital Lüneburg

AIM:To report the largest patient cohort study investigating the diagnostic yield of intraductal ultrasound (IDUS) in indeterminate strictures of the common bile duct.METHODS:A patient cohort with bile duct strictures of unknown etiology was examined by IDUS.Sensitivity,specificity and accuracy rates of IDUS were calculated relating to the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery.Analysis of the endosonographic report allowed drawing conclusions with respect to the T and N staging in 147 patients.IDUS staging was compared to the postoperative histopathological staging data allowing calculation of sensitivity,specificity and accuracy rates for T and N stages.The endoscopic retrograde cholangio-pancreatography and IDUS procedures were performed under fluoroscopic guidance using a side-viewing duodenoscope (Olympus TJF 160,Olympus,Ltd.,Tokyo,Japan).All procedures were performed under conscious sedation (propofol combined with pethidine) according to the German guidelines.For IDUS,a 6 F or 8 F ultrasound miniprobe was employed with a radial scanner of 15-20 MHz at the tip of the probe (Aloka Co.,Tokyo,Japan).RESULTS:A total of 397 patients (210 males,187 females,mean age 61.43 ± 13 years) with indeterminate bile duct strictures were included.Two hundred and sixty-four patients were referred to the department of surgery for operative exploration,thus surgical histopathological correlation was available for those patients.Out of 264 patients,174 had malignant disease proven by surgery,in 90 patients benign disease was found.In these patients decision for surgical exploration was made due to suspicion for malignant disease in multimodal diagnostics (computed tomography scan,endoscopic ultrasound or magnetic resonance imaging).Twenty benign bile duct strictures were misclassified by IDUS as malignant while 14 patients with malignant strictures were initially misdiagnosed by IDUS as benign resulting in sensitivity,specificity and accuracy ratesof 93.2

关键词： Intraductal ultrasound Bile duct strictures Accuracy

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Structural and molecular features of intestinal strictures in rats with Crohn's-like disease

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World Journal of Gastroenterology 2016年第22期22卷 5154-5164页

作者： Petra Talapka Anikó Berkó Lajos István Nagy Lalitha Chandrakumar Mária Bagyánszki László Géza Puskás éva Fekete Nikolett Bódi Department of Physiology Anatomy and Neuroscience Faculty of Sciences and Informatics University of Szeged H-6726 Szeged Hungary Avidin Ltd. H-6726 Szeged Hungary

AIM: To develop a new rat model we wanted to gain a better understanding of stricture formation in Crohn's disease(CD).METHODS: Chronic colitis was induced locally by the administration of 2,4,6-trinitrobenzenesulfonic acid(TNBS). The relapsing inflammation characteristic to CD was mimicked by repeated TNBS treatments. Animals were randomly divided into control, once, twice and three times TNBS-treated groups. Control animals received an enema of saline. Tissue samples were taken from the strictured colonic segments and also adjacent proximally and distally to its 60, 90 or 120 d after the last TNBS or saline administrations. The frequency and macroscopic extent of the strictures were measured on digital photographs. The structural features of strictured gut wall were studied by light- and electron microscopy. Inflammation related alterations in TGF-beta 2 and 3, matrix metalloproteinases 9(MMP9) and TIMP1 m RNA and protein expression were determined by quantitative real-time PCR and western blot analysis. The quantitative distribution of caspase 9 was determined by post-embedding immunohistochemistry.RESULTS: Intestinal strictures first appeared 60 d after TNBS treatments and the frequency of them increased up to day 120. From day 90 an intact lamina epithelialis, reversible thickening of lamina muscularis mucosae and irreversible thickening of the muscularis externa were demonstrated in the strictured colonic segments. Nevertheless the morphological signs of apoptosis were frequently seen and excess extracellular matrix deposition was recorded between smooth muscle cells(SMCs). Enhanced caspase 9 expression on day 90 in the SMCs and on day 120 also in myenteric neurons indicated the induction of apoptosis. The m RNA expression profile of TGF-betas after repeated TNBS doses was characteristic to CD, TGF-beta 2, but not TGF-beta 3 was up-regulated. Overexpression of MMP9 and down-regulation of TIMP1 were demonstrated. The progressive increase in the amount of MMP9 protein in the strictures was also obvious betwee

关键词： Crohn’s disease Rat model TGF-beta Intestinal strictures MMP9 TIMP1

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