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Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?

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World Journal of gastroenterology 2016年第26期22卷 5909-5916页

作者： Toshio Fujisawa Koichi Kagawa Kantaro Hisatomi Kensuke Kubota Atsushi Nakajima Nobuyuki Matsuhashi Department of gastroenterology NTT Medical Center Tokyo Department of gastroenterology and Hepatology Yokohama City University School of Medicine

Endoscopic papillary balloon dilatation(EPBD) is useful for decreasing early complications of endoscopic retrograde cholangio-pancreatography(ERCP), including bleeding, biliary infection, and perforation, but it is generally avoided in Western countries because of a relatively high reported incidence of post-ERCP pancreatitis(PEP). However, as the efficacy of endoscopic papillary largeballoon dilatation(EPLBD) becomes widely recognized, EPBD is attracting attention. Here we investigate whether EPBD is truly a risk factor for PEP, and seek safer and more effective EPBD procedures by reviewing past studies. We reviewed thirteen randomised control trials comparing EPBD and endoscopic sphincterotomy(EST) and ten studies comparing direct EPLBD and EST. Three randomized controlled trials of EPBD showed significantly higher incidence of PEP than EST, but no study of EPLBD did. Careful analysis of these studies suggested that longer and higher-pressure inflation of balloons might decrease PEP incidence. The paradoxical result that EPBD with small-calibre balloons increases PEP incidence while EPLBD does not may be due to insufficient papillary dilatation in the former. Insufficient dilatation could cause the high incidence of PEP through the use of mechanical lithotripsy and stress on the papilla at the time of stone removal. Sufficient dilation of the papilla may be useful in preventing PEP.

关键词： Endoscopic papillary balloon dilatation Post-endoscopic retrograde cholangio-pancreatography pancreatitis Endoscopic papillary large-balloon dilatation Endoscopic sphincterotomy Randomized controlled trial

Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife

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World Journal of gastroenterology 2018年第15期24卷 1632-1640页

作者： Toshio Kuwai Toshiki Yamaguchi Hiroki Imagawa Ryoichi Miura Yuki Sumida Takeshi Takasago Yuki Miyasako Tomoyuki Nishimura Sumio Iio Atsushi Yamaguchi Hirotaka Kouno Hiroshi Kohno Sauid Ishaq Department of gastroenterology National Hospital Organization Kure Medical Center and Chugoku Cancer Center Department of gastroenterology DGH SGU WI Birmingham City University

AIM To determine short-and long-term outcomes of endoscopic submucosal dissection(ESD) using the stag beetle(SB) knife, a scissor-shaped *** Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical center and Chugoku Cancer center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3-and 5-year cumulative overall metachronous cancer rates were also *** Eligible patients had dysplasia/intraepithelial neoplasia(22%) or early cancers(squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up(mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3-and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for noncurative resections. The 3-and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, *** ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short-and long-term outcomes.

关键词： Neoplasms Stag beetle knife Esophageal Endoscopic submucosal dissection Outcome measures

Safety and efficacy of self-expandable metallic stents in malignant small bowel obstructions

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World Journal of gastroenterology 2016年第40期22卷 9022-9027页

作者： Akiyoshi Tsuboi Toshio Kuwai Tomoyuki Nishimura Sumio Iio Takeshi Mori Hiroki Imagawa Toshiki Yamaguchi Atsushi Yamaguchi Hirotaka Kouno Hiroshi Kohno Department of gastroenterology National Hospital Organization Kure Medical Center and Chugoku Cancer Center

In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent(SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time(stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction.

关键词： Self-expandable metallic stents Malignant small bowel obstructions Endoscopy Case report Pancreatic cancer

Ensure preparation and capsule endoscopy:A two-center prospective study

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World Journal of gastroenterology 2013年第8期19卷 1264-1270页

作者： Eva Niv Baruch Ovadia Yulia Ron Ervin Santo Elisabeth Mahajna Zamir Halpern Zvi Fireman Department of gastroenterology Tel Aviv Sourasky Medical CenterTel Aviv 64239Israel Department of gastroenterology Hillel Yaffe Medical CenterHadera 38100Israel

AIM:To compare small bowel(SB) cleanliness and capsule endoscopy(CE) image quality following Ensure,polyethylene glycol(PEG) and standard ***:A preparation protocol for CE that is both efficacious and acceptable to patients remains *** the physiological function of the SB as a site for the digestion and absorption of food and not as a stool reservoir,preparation consisting of a liquid,fiber-free formula ingested one day before a CE study might have an advantage over other kinds of *** conducted a prospective,blind-topreparation,two-center study that compared four types of *** participants' demographic and clinical data were *** and SB transit times were *** presence of bile in the duodenum was scored by a single,blinded-to-preparation gastroenterologist expert in CE,as was cleanliness within the proximal,middle and distal part of the SB.A four-point scale was used(grade 1 = no bile or residue,grade 4 ≥ 90% of lumen full of bile or residual material).RESULTS:The 198 consecutive patients who were referred to CE studies due to routine medical reasons were divided into four *** all observed a 12-h overnight fast before undergoing *** the 24 h preceding the fast,control group 1(n = 45 patients) ate light unrestricted meals,control group 2(n = 81) also ate light meals but free of fruits and vegetables,the PEG group(n = 50) ate unrestricted light meals and ingested the PEG preparation,and the Ensure group(n = 22) ingested only the Ensure *** with Ensure improved the visualization of duodenal mucosa(a score of 1.76) by decreasing the bile content compared to preparation with PEG(a score of 2.9)(P = 0.053).Overall,as expected,there was less residue and stool in the proximal part of the SB than in the middle and distal parts in all *** total score of cleanliness throughout the length of the SB showed some benefit for Ensure(a score of 1.8) over control g

关键词： Capsule endoscopy Preparation Polyethylene glycol Ensure Fiber-free diet Image quality

Impact of inflammatory bowel disease activity and thiopurine therapy on birth weight: A meta-analysis

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World Journal of gastroenterology 2017年第45期23卷 8082-8089页

作者： Begona Gonzalez-Suarez Shreyashee Sengupta Alan C Moss Division of gastroenterology Inflammatory Bowel Disease CenterBeth Israel Deaconess Medical Center

AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa *** This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW(RR 1.4,95%CI: 1.1-1.9,P = 0.007) compared with non-treated women,but when adjusted for disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.

关键词： Pregnancy Inflammatory bowel disease Thiopurines Disease activity Low birth weight Small for gestational age

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World Journal of gastroenterology 2012年第38期18卷 5397-5403页

作者： Sietze T van Turenhout Leo GM van Rossum Frank A Oort Robert JF Laheij Anne F van Rijn Jochim S Terhaar sive Droste Paul Fockens René WM van der Hulst Anneke A Bouman Jan BMJ Jansen Gerrit A Meijer Evelien Dekker Chris JJ Mulder Department of gastroenterology and Hepatology VU University Medical Center1081 HV Amsterdam The Netherlands Department of Epidemiology Biostatistics and HTA Radboud University Nijmegen Medical Center6500 HB Nijmegen The Netherlands Department of gastroenterology and Hepatology Radboud University Nijmegen Medical Center6500 HB Nijmegen The Netherlands Department of gastroenterology and Hepatology Academic Medical Center1105 AZ Amsterdam The Netherlands Department of gastroenterology and Hepatology Kennemer Gasthuis 2035 RC Haarlem The Netherlands Clinical Chemistry VU University Medical Center 1081 HV Amsterdam The Netherlands Department of gastroenterology and Hepatology Radboud University Nijmegen Medical Center 6500 HB Nijmegen The Netherlands Department of Pathology VU University Medical Center 1081 HV Amsterdam The Netherlands Department of gastroenterology and Hepatology Academic Medical Center 1105 AZ Amsterdam The Netherlands Department of gastroenterology and Hepatology VU University Medical Center 1081 HV Amsterdam The Netherlands

AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODS: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage). RESULTS: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, SD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, SD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mLvs 613 ± 368 ng/mL,P = 0.02). Tissue tumor stage (T stage) distribution was dif-ferent between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P < 0.001). Per tumor stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mLvs 870 ± 258 ng/mL,P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10). CONCLUSION

关键词： Screening population Referral cohort Fecal immunochemical test Tumor stage distribution Colorectal cancer

Endoscopic papillary large balloon dilation for removal of bile duct stones

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World Journal of gastroenterology 2014年第45期20卷 17148-17154页

作者： Yuji Sakai Toshio Tsuyuguchi Yoshiaki Kawaguchi Nobuto Hirata So Nakaji Katsuya Kitamura Shigeru Mikami Tatsuya Fujimoto Masashi Ijima Eishin Kurihara Shuhei Oana Takayoshi Nishino Ryo Tamura Dai Sakamoto Masato Nakamura Takao Nishikawa Harutoshi Sugiyama Hitoshi Yoshida Tetsuya Mine Osamu Yokosuka Department of gastroenterology and Nephrology Graduate School of Medicine Chiba University Department of gastroenterology Tokai University Hospital Department of gastroenterology Kameda Medical Center Division of gastroenterology Department of Medicine Showa University School of Medicine Department of Internal Medicine Kikkoman General Hospital Department of gastroenterology Kimitsu Central Hospital Department of gastroenterology Isesaki Municipal Hospital Department of gastroenterology Iwate Medical University Hospital Department of gastroenterology Tokyo Women’s Medical University Yachiyo Medical Center

AIM: To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation (EPLBD) for bile duct stones in a multicenter prospective study.

关键词： Endoscopic retrograde cholangiopancreatography Endoscopic sphincterotomy Endoscopic papillary large balloon dilation Large bile duct stones Multiple bile duct stones

Establishing an integrated gastroenterology service between a medical center and the community

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World Journal of gastroenterology 2015年第7期21卷 2152-2158页

作者： Yaron Niv Ram Dickman Zohar Levi Gadi Neumann Dorit Ehrlich Haim Bitterman Jacob Dreiher Arnon Cohen Doron Comaneshter Eyran Halpern Rabin Medical center Clalit Health Services Tel Aviv University Dan-Petach Tikva District Clalit Health Services General Management Clalit Health Services

AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was ***:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were *** education,guidelines and agreed instructions for referral were promoted by the *** quality indicators were developed by the Delphi method,rigorously designed and regularly *** was assessed by comparing 2010,2011 and 2012 ***:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of *** this paper we describe a new integrated gastroenterology service established in April *** time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th *** cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal ***:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.

关键词： gastroenterology Direct referral Endoscopy Communi

Selection of appropriate endoscopic therapies for duodenal tumors: An open-label study, single-center experience

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World Journal of gastroenterology 2014年第26期20卷 8624-8630页

作者： Satohiro Matsumoto Yukio Yoshida Department of gastroenterology Saitama Medical CenterJichi Medical University

AIM: To determine an appropriate compartmentalization of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for duodenal tumors.

关键词： Duodenal tumor Endoscopic submucosal dissection Endoscopic mucosal resection Cancer Adenoma Neuroendocrine tumor