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Multicenter,randomized study to optimize bowel for colon capsule endoscopy

World Journal of gastroenterology 2017年第48期23卷 8615-8625页

作者： David Kastenberg Wilmot C Burch Jr David P Romeo Pankaj K Kashyap David C Pound Neophytos Papageorgiou Ignacio Fernández-Urien Sainz Carly E Sokach Douglas K Rex Division of gastroenterology Thomas Jefferson University Franklin gastroenterology PLLC dayton gastroenterology Inc. Pinnacle Research Group LLC Indianapolis gastroenterology and hepatology Department of gastroenterology American Medical Center Department of gastroenterology Servicio de Digestivohospital de Navarra Sidney Kimmel Medical College at Thomas Jefferson University Indiana University hospital

AIM To assess the cleansing efficacy and safety of a new Colon capsule endoscopy(CCE) bowel preparation *** This was a multicenter,prospective,randomized,controlled study comparing two CCE regimens. Subjects were asymptomatic and average risk for colorectal cancer. The second generation CCE system(Pill Cam? COLON 2;Medtronic,Yoqneam,Israel) was utilized. Preparation regimens differed in the 1 st and 2 nd boosts with the Study regimen using oral sulfate solution(89 m L) with diatrizoate meglumine and diatrizoate sodium solution("diatrizoate solution")(boost 1 = 60 m L,boost 2 = 30 m L) and the Control regimen oral sulfate solution(89 m L) alone. The primary outcome was overall and segmental colon cleansing. Secondary outcomes included safety,polyp detection,colonic transit,CCE completion and capsule excretion ≤ 12 h. RESULTS Both regimens had similar cleansing efficacy for the whole colon(Adequate: Study = 75.9%,Control = 77.3%;P = 0.88) and individual segments. In the Study group,CCE completion was superior(Study = 90.9%,Control = 76.9%;P = 0.048) and colonic transit was more often < 40 min(Study = 21.8%,Control = 4%;P = 0.0073). More Study regimen subjects experienced adverse events(Study = 19.4%,Control = 3.4%;P = 0.0061),and this difference did not appear related to diatrizoate solution. Adverse events were primarily gastrointestinal in nature and no serious adverse events related either to the bowel preparation regimen or the capsule were observed. There was a trend toward higher polyp detection with the Study regimen,but this did not achieve statistical significance for any size category. Mean transit time through the entire gastrointestinal tract,from ingestion to excretion,was shorter with the Study regimen while mean colonic transit times were similar for both study *** A CCE bowel preparation regimen using oral sulfate solution and diatrizoate solution as a boost agent is effective,safe,and achieved superior CCE completion.

关键词： Bowel preparation Purgative Capsule endoscopy Endoscopy Capsule colonoscopy Large intestine

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Hamartomatous polyps:Diagnosis,surveillance,and management

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World Journal of gastroenterology 2023年第8期29卷 1304-1314页

作者： Leva Gorji Peter Albrecht Department of Surgery Kettering Health DaytonDaytonOH 45405United States

Hereditary polyposis syndrome can be divided into three categories:Adenomatous,serrated,and hamartomatous *** polyps,malformations of normal tissue presenting in a disorganized manner,are characterized by an autosomal dominant inheritance *** syndromes exhibit hamartomatous gastrointestinal polyps in conjunction to extra-intestinal manifestations,which require conscientious and diligent ***-Jeghers syndrome,Cowden syndrome,and juvenile polyposis syndrome are the most common displays of hamartomatous polyposis syndrome(HPS).Diagnosis can be pursued with molecular testing and endoscopic *** identification of these autosomal dominant pathologies allows to optimize malignancy surveillance,which helps reduce morbidity and mortality in both the affected patient population as well as at-risk family *** surveillance is an important pillar of prognosis and monitoring,with many patients eventually requiring surgical *** this review,we discuss the diagnosis,surveillance,and management of HPS.

关键词： Hamartomatous polyps Peutz-Jegher syndrome Cowden syndrome Juvenile polyposis syndrome

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Transjugular intrahepatic porto-systemic shunt in the elderly:Palliation for complications of portal hypertension

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World Journal of Hepatology 2012年第2期4卷 35-42页

作者： Mubin I Syed Hetal Karsan Hector Ferral Azim Shaikh Uzma Waheed Talal Akhter Alan Gabbard Kamal Morar Robert Tyrrell dayton Interventional Radiology DaytonOH 45409United States Department of Radiological Sciences Wright State University School of Medicine Department of Hepatology Emory University Department of Interventional Radiology Rush University Medical Center Department of the College of Medicine Northeast Ohio Medical University Department of gastroenterology Springfield Regional Medical Center

AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population ***:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and *** patients were referred for *** deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver *** the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing *** of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 *** and/or hydrothorax was controlled following technically successful procedures in 12 of 13 *** was controlled following technically successful procedures in 10 out of 11 ***:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.

关键词： Transjugular intrahepatic porto-systemic shunt Portal hypertension Elderly Ascites Cirrhosis

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Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma

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World Journal of gastroenterology 2022年第29期28卷 3793-3802页

作者： Bipul Gnyawali Antoinette Pusateri Ashley Nickerson Sajid Jalil Khalid Mumtaz Department of Medicine Kettering Medical CenterDaytonOH 45342United States Department of Medicine The Ohio State UniversityColumbusOH 43210United States

Chronic Hepatitis B is a highly prevalent disease worldwide and is estimated to cause more than 800000 annual deaths from complications such as cirrhosis and hepatocellular carcinoma(HCC).Although universal hepatitis B vaccination programs may have reduced the incidence and prevalence of chronic hepatitis B and related HCC,the disease still imposes a significant healthcare burden in many endemic regions such as Africa and the Asia-Pacific *** is especially concerning given the global underdiagnosis of hepatitis B and the limited availability of vaccination,screening,and treatment in low-resource *** including male gender,older age,ethnicity,and geographic location as well as low socioeconomic status are more heavily impacted by chronic hepatitis B and related *** to mitigate this impact include increasing screening in high-risk groups according to national guidelines,increasing awareness and health literacy in vulnerable populations,and developing more robust vaccination programs in under-served regions.

关键词： Hepatitis B Epidemiology Hepatocellular carcinoma Socioeconomic status Healthcare disparity Hepatitis B vaccine

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