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Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma： a single-center experience

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Hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 264-270页

作者： Mohammed Elshamy Naftali Presser Abdulrahman Y Hammad Daniel J Firl Christopher Coppa John Fung Federico N Aucejo Hepatobiliary and Transplant surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA Imaging Institute Cleveland Clinic Cleveland OH USA

BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.

关键词： mixed hepatocellular carcinoma/ cholangiocarcinoma liver transplantation survival outcomes

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Management of colorectal neoplasia during pregnancy and in the postpartum period

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World Journal of Gastrointestinal Oncology 2016年第7期8卷 550-554页

作者： Erman Aytac Gokhan Ozuner Ozgen Isik Emre Gorgun Luca Stocchi Department of Colorectal surgery Digestive Disease Institute Cleveland Clinic

AIM: To report our experience on management of colorectal neoplasia during pregnancy and in the postpartum ***: Patients who were diagnosed with colorectal cancer during pregnancy or in the postpartum period(surgery was 36 mo. Median duration of symptoms before diagnosis was 16 wk. Three patients were diagnosed with colorectal cancer during pregnancy and underwent surgery prior to delivery. None of the patients received adjuvant treatment during pregnancy. Five patients were diagnosed with colorectal cancer within a median of 2.1 mo after delivery and underwent surgery. No adverse neonatal outcomes were noted. All deliveries were at term(2 cesarean sections) except for one preterm delivery following low anterior resection on the 34 th week of ***: There has been a significant delay in the diagnosis of colorectal cancer which is probably due to overlap of symptoms and signs between these tumors and a normal pregnancy. surgery for colorectal cancer during pregnancy can be performed safely without compromisingmaternal and fetal outcomes.

关键词： Colorectal cancer Pregnancy Postpartum Neoplasia

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Value of routine stool testing for pathogenic bacteria in the evaluation of symptomatic patients with ileal pouches

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Gastroenterology Report 2018年第2期6卷 93-100,I0001页

作者： Amandeep Singh Jean Ashburn Gursimran Kochhar Rocio Lopez Tracy L.Hull Bo Shen Department of Gastroenterology&Hepatology Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Colorectal surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Quantitative Health Sciences Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric *** of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal ***:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the *** with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 *** to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were ***:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool *** spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(pclinical outcomes in patients with positive stool cultures who received pathogen-directed ***:We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of *** clinical utility of routine stool culture in those patients warrants further study.

关键词： pouchitis ileal pouch enteric pathogens stool culture

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Cryotherapy in the management of premalignant and malignant conditions of the esophagus

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World Journal of Gastroenterology 2018年第43期24卷 4862-4869页

作者： Pooja Lal Prashanthi N Thota Department of Internal Medicine Cleveland Clinic Department of Gastroenterology Digestive Disease Surgery InstituteCleveland Clinic

Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen(liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett's esophagus(BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.

关键词： Esophageal cancer Barrett's esophagus Palliative therapy Cryotherapy

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Hepatocellular carcinoma beyond Milan criteria: Management and transplant selection criteria

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World Journal of Hepatology 2016年第21期8卷 874-880页

作者： Mohammed Elshamy Federico Aucejo KV Narayanan Menon Bijan Eghtesad Hepato-biliary and Transplant surgery Digestive Disease and Surgery InstituteCleveland Clinic Foundation Gastroenterology and Hepatology Digestive Disease and Surgery InstituteCleveland Clinic Foundation

Liver transplantation(LT) for hepatocellular carcinoma(HCC) has been established as a standard treatment in selected patients for the last two and a half decades. After initially dismal outcomes, the Milan criteria(MC)(single HCC ≤ 5 cm or up to 3 HCCs ≤ 3 cm) have been adopted worldwide to select HCC patients for LT, however cumulative experience has shown that MC can be too strict. This has led to the development of numerous expanded criteria worldwide. Morphometric expansions on MC as well as various criteria which incorporate biomarkers as surrogates of tumor biology have been described. HCC that presents beyond MC initially can be downstaged with locoregional therapy(LRT). Post-LRT monitoring aims to identify candidates with favorable tumor behavior. Similarly, tumor marker levels as response to LRT has been utilized as surrogate of tumor biology. Molecular signatures of HCC have also been correlated to outcomes; these have yet to be incorporated into HCC-LT selection criteria formally. The ongoing discrepancy between organ demand and supply makes patient selection the most challenging element of organ allocation. Further validation of extended HCCLT criteria models and pre-LT treatment strategies are required.

关键词： Hepatocellular carcinoma Milan criteria Liver transplantation Expanded criteria Locoregional therapy Down staging

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Primary sclerosing cholangitis and the risk of colon neoplasia in patients with Crohn’s colitis

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Gastroenterology Report 2016年第3期4卷 226-231,I0002页

作者： Udayakumar Navaneethan Tarun Rai Preethi GK Venkatesh Ravi P Kiran Department of Gastroenterology Digestive disease InstituteThe Cleveland ClinicClevelandOHUSA Department of Colorectal surgery Digestive disease InstituteThe Cleveland ClinicClevelandOHUSA

Background and aim:Crohn’s colitis(CC)is associated with primary sclerosing cholangitis(PSC).However the risk of colon cancer or dysplasia in CC and PSC is *** aim was to study the risk of colon neoplasia in CC in patients with and without ***:This is a nested,case-control cohort study of all patients diagnosed with concurrent CC and PSC,seen at the Cleveland clinic between 1985 and ***-three patients with both CC and PSC were compared with a random sample of 159 CC controls without PSC during the same ***:Seven(16.3%)of 43 CC patients with PSC developed colon cancer or dysplasia,compared with 22(13.8%)of 159 controls(P=0.98).Of seven colon neoplasia cases in the PSC group,100%occurred proximal to the splenic flexure,compared with 50%(11/22)cases of colon neoplasia in controls occurring in the proximal colon(P=0.001).Based on Cox regression analysis,male gender independently increased the risk of neoplasia[hazard ratio(HR)=2.68;95%confidence interval(CI)1.30-5.54;P=0.008],as did age at CC diagnosis(HR=1.29;95%CI 1.14-1.47;P<0.001),while the use of azathioprine/6-mercaptopurine was protective(HR=0.30;95%CI 0.13-0.70;P=0.005).The presence of PSC did not increase the risk for colon neoplasia(HR=0.45;95%CI 0.18-1.13;P=0.09).Conclusions:CC patients with PSC appear not to be at increased risk of developing colon *** patients in our cohort with colon neoplasia and concurrent PSC,the neoplasia occurred in the proximal colon in all cases.

关键词： Crohn’s colitis primary sclerosing cholangitis colon neoplasia

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Current indications and role of surgery in the management of sigmoid diverticulitis

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World Journal of Gastroenterology 2010年第7期16卷 804-817页

作者： Luca Stocchi Department of Colorectal surgery Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic *** review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical ***-spectrum antibiotics are the standard of care for uncomplicated *** published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously ***,a more individualized approach,taking into account frequency,severity of the attacks and their impact on quality of life,should guide the indication for *** the other hand,complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal *** surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized *** is not sufficient evidence supporting any changes in the approach to management in younger ***,the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised *** clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.

关键词： Sigmoid diverticulitis Diverticulitis management Diverticulitis surgery Acute diverticulitis Complicated diverticulitis Perforated diverticulitis Laparoscopic colectomy

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Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

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Gastroenterology Report 2018年第2期6卷 114-121,I0002页

作者： Nan Lan Luca Stocchi Yi Li Bo Shen Center for Inflammatory Bowel Disease and Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA Department of Colorectal surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data *** aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP)***:All CD patients undergoing surgery between 2005 and 2013 were identified from *** were defined according to the ACS NSQIP *** primary outcome was infectious complications,including superficial,deep and organ/space surgical site infection,wound dehiscence,urinary tract infection,pneumonia,systemic sepsis and septic *** analyses were performed to assess the risk factors for post-operative ***:All 10100 eligible patients were included and 611(6.0%)received perioperative *** patients were older,lighter in weight and more likely to be functionally *** patients were more likely to have post-operative infectious complications than those without BT,including superficial surgical site infection(SSI)(10.8%vs 7.4%,p¼0.002),deep SSI(3.3%vs 1.6%,p¼0.003),organ/space SSI(14.2%vs 5.4%,p<0.001),pneumonia(3.8%vs 1.3%,p<0.001),urinary tract infection(3.9%vs 2.2%,p¼0.006),sepsis(11.5%vs 4.5%,p<0.001)and sepsis shock(3.1%vs 0.8%,p<0.001).Multivariate analysis showed that intra-and/or post-operative BT was an independent risk factor for post-operative infectious complications(odds ratio[OR]¼2.2;95%confidence interval[CI]:1.8–2.7;p<0.001)and the risk increased with each administered unit of red blood cell(OR¼1.3,95%CI:1.2–1.5).Other independent factors were history of smoking,chronic heart disease,diabetes,hypertension and the use of ***-operative BT,however,was not found to be a risk factor to post-operative ***:Intra-and/or post-operative,not p

关键词： blood transfusion Crohn’s disease infectious complications surgical outcomes

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Endoscopic ultrasound for the diagnosis of chronic pancreatitis

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World Journal of Gastroenterology 2010年第23期16卷 2841-2850页

作者： Tyler Stevens Mansour A Parsi digestive Disease Institute Cleveland Clinic Foundation

Endoscopic ultrasound(EUS) has become a well accepted test for the diagnosis of chronic *** include its ability to detect subtle and severe changes of the pancreatic duct and parenchyma,and its relative safety compared with endoscopic retrograde *** include inter-and intraobserver variability,operator dependence,and an incomplete understanding of its true *** Rosemont classif ication has recently been proposed as a weighted,standardized method that may improve EUS chronic pancreatitis *** paper reviews the published evidence regarding the accuracy of EUS in chronic pancreatitis diagnosis,and enumerates the emerging technologies that have been recently studied which may ultimately improve endosonographic imaging of the pancreas.

关键词： Chronic pancreatitis Contrast-enhanced endoscopic ultrasound Diagnosis Digital image analysis Elastography Endoscopic ultrasound Pancreatic function testing Rosemont classification

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Extended criteria donors in liver transplantation—from marginality to mainstream

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Hepatobiliary surgery and Nutrition 2018年第5期7卷 386-388页

作者： Amit Nair Koji Hashimoto Department of General surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA

Further to refinements in immunosuppression and the significant gains witnessed in outcomes over recent decades, liver transplantation has firmly established itself as the definitive treatment for end stage liver disease and selected instances of hepatic malignancy. However, there exists a constant divide between organ supply and demand, with the numbers of new entrants to liver transplant waiting lists consistently and significantly outstripping that of transplants performed annually, as exemplified by United Network for Organ Sharing (UNOS) data from the United States (1).

关键词： annually stripping lists

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