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Salvage Photodynamic Therapy Is an Effective and Safe Treatment for Patients with Local Failure after Definitive Chemoradiotherapy for Esophageal Squamous Cell Carcinoma

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Journal of Cancer Therapy 2014年第7期5卷 647-656页

作者： Yoko Mashimo Yasumasa Ezoe Kosuke Ueda Yoshinao Ozaki Yusuke Amanuma Ikuo Aoyama Takahiro Horimatsu Shuko Morita Shin’ichi Miyamoto Tomonori Yano Koji Higashino Tsutomu Chiba Manabu Muto Department of Experimental therapeutics Institute for Advancement of Clinical and Translational Science (iACT) Kyoto University Hospital Kyoto Japan Department of Gastroenterology and Hepatology Graduate School of Medicine Kyoto University Kyoto Japan Department of Gastrointestinal Oncology Osaka Medical Centre for Cancer and Cardiovascular Diseases Osaka Japan Department of therapeutic Oncology Graduate School of Medicine Kyoto University Kyoto Japan Division of Digestive endoscopy and Gastrointestinal Oncology National Cancer Center Hospital East Kashiwa Japan

Although chemoradiotherapy (CRT) is one curative treatment option for patients with esophageal squamous cell carcinoma (ESCC), local failure after CRT remains a major problem for patients’ curability. The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) as a salvage treatment for local failure. From August 2007 to March 2012, 193 consecutive ESCC patients were treated with definitive CRT in Kyoto University Hospital. Eighteen of the patients with T2 or earlier T-stage local failure after CRT underwent salvage PDT. After the salvage PDT, 11 patients (61.1%) achieved a complete response at the primary site. Over a median follow-up period of 28.3 months, the 1-year survival and progression-free survival rates were 77.8% and 38.9%, respectively;and the 2-year survival and progression-free survival rates were 60.6% and 33.3%, respectively. Adverse events were mild esophageal stricture in seven (38.9%), esophageal obstruction because of necrotic tissue in nine (50.0%), and photosensitivity in three (16.7%) patients. There were no severe complications or treatment-related deaths. Salvage PDT may be a promising treatment option for the patients with a local residual or recurrent tumor after CRT for ESCC when the lesion is suspected to be in T2 or earlier.

关键词： Esophageal Cancer Salvage Treatment Photodynamic Therapy Chemoradiotherapy Local Failure

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Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions

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World Journal of Gastrointestinal endoscopy 2011年第3期3卷 57-61页

作者： Juan J Vila Marcos Kutz Silvia Goi Miriam Ostiz Edurne Amorena Carlos Prieto Cristina Rodriguez Ignacio Fernández-Urien Francisco J Jiménez endoscopy Unit Gastroenterology DepartmentComplejo Hospitalario de Navarra

AIM:To discuss the feasibility of single session endoscopic ultrasonography(EUS) to discuss and endoscopic retrograde cholangiopancreatography(ERCP) ***:Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session(Group Ⅰ) versus performing each procedure in two different sessions(Group Ⅱ) was *** following variables were evaluated:epidemiological variables,American Society of Anesthesiologists Physical Status Classification(ASA) level,procedural time,propofol dose,anesthetic complications,endoscopic complications and diagnostic yield,and therapeutic procedures on both groups.T-student,ChiSquare and Fisher test were used for ***:We included 39 patients in Group Ⅰ(mean age:69.85 ± 9.25;27 men) and 46 in Group Ⅱ(mean age:67.46 ± 12.57;25 men).Procedural time did not differ significantly between both groups(Group Ⅰvs Group Ⅱ:93 ± 32.78 vs 98.98 ± 38.17;P >0.05) but the dose of propofol differed(Group Ⅰ vs Group Ⅱ:322.28 ± 250.54 mg vs 516.96 ± 289.06 mg;P = 0.001).Three patients had normal findings on both *** anesthetic complications [O2 desaturation(2),broncoaspiration(1)] and 9 endoscopic complications [pancreatitis(6),bleeding(1),perforation(1),cholangitis(1)] occurred without significant differences between both groups(P > 0.05).We did not find any significant difference regarding age,sex,ASA scale level,diagnostic yield or therapeutic maneuvers between both ***:The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield,does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session.

关键词： Endosonography Endoscopic Retrograde Cholangiopancreatography Feasibility Studies endoscopy Gastrointestinal Anesthesia

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Antagonizing adipose tissue-derived exosome miR-103-hepatocyte phosphatase and tensin homolog pathway alleviates autophagy in non-alcoholic steatohepatitis:A trans-cellular crosstalk

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World Journal of Gastroenterology 2023年第29期29卷 4528-4541页

作者： Miao-Miao Lu Yue Ren Yu-Wei Zhou Ling-Ling Xu Meng-Meng Zhang Lin-Ping Ding Wei-Xin Cheng Xi Jin endoscopy Center Children’s Hospital of Zhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina Department of Medicine Zhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina Department of Gastroenterology The Second People’s Hospital of Yuhang DistrictHangzhou 310003Zhejiang ProvinceChina Department of Gastroenterology Hangzhou Shangcheng District People’s HospitalHangzhou 310003Zhejiang ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Obesity plays a vital role in the occurrence and development of non-alcoholic steatohepatitis(NASH).However,the underlining mechanism is still unclear,where adipose tissue(AT)derived exosomes may actively ***(miRNAs)are commonly secreted from exosomes for cell *** the regulation of miR-103 on insulin sensitivity has been reported,the specific role of AT-derived exosomes miR-103 in NASH is still vague and further investigation may provide novel therapeutic *** To determine the specific role of AT-derived exosomes miR-103 in developing NASH through various *** The expression levels of miR-103 in the AT-derived exosomes and livers were detected and compared between NASH mice and *** effect of miR-103 on NASH progression was also explored by antagonizing miR-103,including steatosis and inflammation degree *** interaction between miR-103 and the autophagy-related gene phosphatase and tensin homolog(PTEN)was confirmed by dual-luciferase reporter *** role of the interaction between miR-103 and PTEN on autophagy was verified in NASH-like ***,the effects of miR-103 from adipose-derived exosomes on NASH and autophagy were analyzed through animal *** The expression of miR-103 was increased in NASH mice,compared to the control,and inhibition of miR-103 could alleviate *** results of the dual-luciferase reporter assay showed miR-103 could interact with ***-103-anta decreased p-AMPKa,p-mammalian target of rapamycin(mTOR),and p62 but increased the protein levels of PTEN and LC3-II/I and the number of autophagosomes in NASH *** results were also observed in NASH-like cells,and further experiments showed PTEN silencing inhibited the effect of *** derivedexosome miR-103 aggravated NASH and increased the expressions of p-AMPKa,p-mTOR,and p62 but decreased the protein levels of PTEN and LC3-II/I and the number of autophagosomes in ***

关键词： Non-alcoholic steatohepatitis Nonalcoholic fatty liver disease Exosomes Phosphatase and tensin homolog

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Management of acute esophageal variceal bleeding by endoscopic sclerotherapy in technically difficult endoscopic band ligation cases—A population based cohort study

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Open Journal of Gastroenterology 2013年第5期3卷 281-287页

作者： Gamal E. Esmat Iman M. Hamza Bahaa E. Abbas Ahmed M. Hashem Hossam S. Ghoneim Division of endoscopy Air Force Hospital Cairo Egypt Endemic Medicine Department Division of Endoscopy Cairo University Giza Egypt Tropical Medicine Department Beni Sweif University Cairo Egypt

Endoscopic band ligation is regarded as the main therapeutic option for acute esophageal variceal bleeding, while sclerotherapy may be used in the acute setting if ligation is technically difficult. The incidence of difficult-to-perform band ligation in acute esophageal variceal bleeding, as well as the outcome of patients subjected to injection sclerotherapy as an alternative treatment, has not been clearly investigated. Our aim is to study the outcome of patients subjected to injection sclerotherapy in the acute setting of esophageal variceal bleeding when endoscopic band ligation is technically difficult to perform. We included 151 patients with acute esophageal variceal bleeding originnating from medium or large sized varices. All patients were planned for EBL as the 1st treatment option (EBL group 61.6%), meanwhile, EIS using 5% ethanolamine oleate was reserved as the 2nd treatment option when EBL was technically difficult (EIS group 38.4%). The mean time to restore hemodynamic stability was significantly prolonged in the EIS group (11.5 ± 6.5 hrs versus 9.5 ± 5.0 hrs, p 0.05). Initial control of bleeding was significantly higher in the EBL group versus the EIS group (96.7% vs 84.5%, p 0.021). Re-bleeding was more among the EIS group (42.9% vs 24.2%, p 0.04). There were no significant differences as regarding mortality and duration of hospital stay. So, a considerable proportion of cases presenting with acute variceal bleeding will have difficulty in performing EBL. In these patients, sclerotherapy is not a waning procedure with an accepted success rate, without much additional complications and without deranging mortality.

关键词： Esophageal Varices Band Ligation Injection Sclerotherapy

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Partially covered vs uncovered sphincterotome and postendoscopic sphincterotomy bleeding

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World Journal of Gastroenterology 2010年第40期16卷 5077-5083页

作者： Panagiotis Katsinelos George Paroutoglou Jannis Kountouras Grigoris Chatzimavroudis Christos Zavos Sotiris Terzoudis Taxiarchis Katsinelos Kostas Fasoulas George Gelas George Tzovaras Ioannis Pilpilidis Department of endoscopy and Motility Unit Medical School Aristotle University of Thessaloniki G. Gennimatas General Hospital Department of Gastroenterology University Hospital of Thessaly 2nd Department of Internal Medicine Medical School Aristotle University of Thessaloniki Ippokration Hospital

AIM: To prospectively compare partially covered vs uncovered sphincterotome use on post-endoscopic biliary sphincterotomy (ES) hemorrhage and other complications. METHODS: All patients referred for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to undergo ES either with a partially covered or an uncovered sphincterotome. Both patient and technical risk factors contributing to the development of post-ES bleeding were recorded and analyzed. The characteristics of bleeding was recorded during and after ES. Other complications were also compared. RESULTS: Three-hundred and eighty-seven patients were recruited in this study; 194 patients underwent ES with a partially covered sphincterotome and 193 with conventional uncovered sphincterotome. No statistical difference was noted in the baseline characteristics and risk factors for post-ES induced hemorrhage between the 2 groups. No significant difference in the incidence and pattern of visible bleeding rates was found between the 2 groups (immediate bleeding in 24 patients with the partially covered sphincterotome vs 19 patients with the uncovered sphincterotome, P = 0.418). Delayed bleeding was observed in 2 patients with a partially covered sphincterotome and in 1 patient with an uncovered sphincterotome (P = 0.62). No statistical difference was noted in the rate of other complications. CONCLUSION: The partially covered sphincterotome was not associated with a lower frequency of bleeding. Also, there was no difference in the incidence of other significant complications between the 2 types of sphincterotome.

关键词： Sphincterotome Endoscopic sphincterotomy Hemorrhage Complications

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Impact of periampullary diverticula on the outcome and fluoroscopy time in endoscopic retrograde cholangiopancreatography

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Hepatobiliary & Pancreatic Diseases International 2013年第4期12卷 408-414页

作者： Panagiotis Katsinelos Grigoris Chatzimavroudis Kostas Tziomalos Christos Zavos Athanasios Beltsis Georgia Lazaraki Sotiris Terzoudis Jannis Kountouras Department of endoscopy and Motility Unit G. Gennimatas General Hospital School of Medicine Aristotle University of Thessaloniki Ippokration HospitalThessaloniki Greece Department of Internal Medicine School of Medicine Aristotle University of Thessaloniki Ippokration HospitalThessaloniki Greece

BACKGROUND: It is unclear whether the presence of periampullary diverticula (PAD) affects technical success and complication rates during endoscopic retrograde cholangio- pancreatography (ERCP). Moreover, the impact of PAD on fluoroscopy duration is still unknown. The present study aimed to investigate the success rate and difficulty of common bile duct (CBD) cannulation, post-procedure complications and fluoroscopy duration in patients with and without PAD. METHODS: Patients from January 2008 to December 2010 with PAD (group A) and without PAD (group B) and similar indications for therapeutic ERCP were prospectively compared. The comparison included patient characteristics, findings of ERCP, and details of procedure and fluoroscopy time. The influence of papilla’s location with respect to the diverticulum on procedure was also investigated. RESULTS: A total of 428 consecutive patients who had undergone therapeutic ERCP for similar indications were divided in two groups according to the presence (group A, 107 patients) or absence (group B, 321 patients) of PAD. The mean age and ASA score of the patients with PAD were significantly higher than those patients without PAD. The main indication was choledocholithiasis. Successful final CBD cannulation was achieved in 97.20% of the patients in group A vs 99.69% in group B (P=0.05). CBD diameter, number of stones and the largest stone size were significantly higher in group A thangroup B (P<0.001). Complete clearance of the CBD after the first attempt was achieved in 85.86% and 94.75% of the patients in groups A and B, respectively (P=0.03). In both groups, the time needed to complete the procedure and fluoroscopy time was significantly longer in patients with PAD (22.87 vs 18.99 minutes, P<0.001; 76.51 vs 47.42 seconds, P<0.001). There was no significant difference between the two groups in the complication rate. The type of papilla’s location with respect to the diverticulum did not influence the total cannulati

关键词： endoscopic retrograde cholangiopancreatography anatomy ampulla of Vater

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Comparative study of therapeutic effects of PPI and H2RA on ulcers during continuous aspirin therapy

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World Journal of Gastroenterology 2010年第42期16卷 5342-5346页

作者： Hiroaki Nema Mototsugu Kato Department of Internal Medicine Teishinkai HospitalNorth 44East 8Higashi-kuSapporoHokkaido 007-0844Japan Division of endoscopy Hokkaido University HospitalNorth 14West 5Kita-kuSapporoHokkaido 060-8468Japan

AIM:To compare the therapeutic effects of proton pump inhibitors(PPI) and histamine 2 receptor antagonists(H2RA) on gastroduodenal ulcers under continuous use of low-dose ***:Sixty patients who had a gastroduodenal ulcer on screening endoscopy but required continuous use of low-dose aspirin were randomly assigned to receive PPI(lansoprazole 30 mg,n = 30) or H2RA(famotidine 40 mg or if famotidine had been administered before assignment,ranitidine 300 mg,n = 30).The therapeutic effects were evaluated by endoscopy after 8-wk *** presence or absence of Helicobacter pylori(***) was determined by urea breath test before *** symptoms were compared with the gastrointestinal symptom rating scale(GSRS) questionnaire before and after ***:Twenty-six patients in the PPI group and 26 patients in the H2RA group,excluding dropouts,were *** were no significant differences in median age,sex,underlying disease,smoking status,*** infection,prevalence of ulcers before treatment,and lesion site between the two *** therapeutic effects were endoscopically evaluated as healed in 23 patients(88.5%) and not healed in 3 patients in the PPI group and as healed in 22 patients(84.6%) and not healed in 4 patients in the H2RA *** symptoms before treatment were uncommon in both groups;the GSRS scores were not significantly reduced after treatment as compared with before ***:The healing rate of gastroduodenal ulcers during continuous use of low-dose aspirin was greater than 80% in both the PPI group and the H2RA group,with no significant difference between the two groups.

关键词： Low-dose aspirin Proton pump inhibitors Histamine 2 receptor antagonists Gastric ulcer

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Comparison of early pre-cutting vs standard technique for biliary cannulation in endoscopic retrograde cholangiopancreatography: A personal experience

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World Journal of Gastroenterology 2007年第27期13卷 3734-3737页

作者： Kannikar Laohavichitra Thawatchai Akaraviputh Asada Methasate Somchai Leelakusolvong Udom Kachintorn Department of Surgery Siriraj GI Endoscopy center Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand Siriraj GI endoscopy center Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand

AIM: To compare the results and complications of early pre-cutting technique with standard technique. METHODS: From January 2003 to December 2004, a total of 416 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist (T.A.). Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures (70.4%) were done with standard technique (group A) and 123 procedures (29.6%) with early pre-cutting technique in case of difficult cannulation (group B). The results and complications of ERCP were compared. RESULTS: Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group B. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION: For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.

关键词：早期切除术胆汁导管插入术并发症胰腺炎个人经验

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Concise review on the comparative efficacy of endoscopic ultrasound-guided fine-needle aspiration vs core biopsy in pancreatic masses, upper and lower gastrointestinal submucosal tumors

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World Journal of Gastrointestinal endoscopy 2018年第10期10卷 267-273页

作者： Tawfik Khoury Wisam Sbeit Nicholas Ludvik Divya Nadella Alex Wiles Caitlin Marshall Manoj Kumar Gilad Shapira Alan Schumann Meir Mizrahi Department of Gastroenterology and Liver Unit Hadassah Hebrew University Medical Center Institute of Gastroenterology and Liver Diseases Galilee Medical Center Bar Ilan Faculty of Medicine Department of Internal Medicine Division of Gastroenterology Center for Advanced Endoscopy University of South Alabama

Endoscopic ultrasound(EUS)-guided fine needle aspiration with or without biopsy(FNA/FNB) are the primary diagnostic tools for gastrointestinal submucosal tumors. EUS-guided fine needle aspiration(EUS-FNA) is considered a first line diagnostic method for the characterization of pancreatic and upper gastrointestinal lesions, since it allows for the direct visualization of the collection of specimens for cytopathologic analysis. EUSFNA is most effective and accurate when immediate cytologic assessment is permitted by the presence of a cytopathologist on site. Unfortunately, the accuracy and thus the diagnostic yield of collected specimens suffer without this immediate analysis. Recently, a EUS-FNB needle capable of obtaining core samples(fine needle biopsy, FNB) has been developed and has shown promising results. This new tool adds a new dimension to the diagnostic and therapeutic utility of this technique. The aim of the present review is to compare the efficacy of EUS-FNA to that afforded by EUS-FNB in the characterization of pancreatic masses and of upper and lower gastrointestinal submucosal tumors.

关键词： Efficacy Safety Gastrointestinal masses Fine needle aspiration and biopsy

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Papillary fistulotomy vs conventional cannulation for endoscopic biliary access:A prospective randomized trial

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World Journal of Gastroenterology 2018年第16期24卷 1803-1811页

作者： Carlos Kiyoshi Furuya Paulo Sakai Fabio Ramalho Tavares Marinho Jose Pinhata Otoch Spencer Cheng Lívia Lemes Prudencio Eduardo Guimaraes Hourneaux de Moura Everson Luiz de Almeida Artifon Department of Gastrointestinal endoscopy Unit University of Sao PauloSao Paulo 05409001Brazil Department of Surgery University of Sao PauloSao Paulo 05403000Brazil Department of Gastroenterology and Radiology University of Sao PauloSao Paulo 04107-030Brazil

AIM To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard *** From July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire(Group Ⅰ) and papillary fistulotomy(Group Ⅱ). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications(pancreatitis, bleeding, perforation) were *** We included 102 patients(66 females and 36 males, mean age 59.11 ± 18.7 years). Group Ⅰ and Group Ⅱ had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively(P = 0.0002). Twelve patients(23.5%) in Group Ⅰ had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access(Failure Group). The complication rate was 13.7%(2 perforations and 5 mild pancreatitis) vs 2.0%(1 patient with perforation and pancreatitis) in Groups Ⅰ and Ⅱ, respectively(P = 0.0597). CONCLUSION Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.

关键词： Catheterization Complications Endoscopic retrograde cholangiopancreatography therapeutic use Common bile duct

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