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Redefining endoluminal biliary drainage:Challenges and innovations in endosonography-guided techniques

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World Journal of gastroenterology 2025年第1期31卷 146-151页

作者： Marcel Razpotnik department of gastroenterology and Hepatology Campus Virchow/Campus MitteCharitéBerlinBerlin 10117Germany

Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary ***,its use in complex biliary obstructions is *** the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical *** show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate *** malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different *** treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic *** to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging *** novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.

关键词： Endoscopic biliary drainage Interventional endosonography Lumen-apposing metal stent Malignant hilar biliary obstruction Malignant distal biliary obstruction

Endoscopic techniques for the diagnosis of pancreatic cystic lesions

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World Journal of gastroenterology 2025年第1期31卷 1-7页

作者： Sahib Singh Saurabh Chandan Rakesh Vinayek Jahnvi Dhar Jayanta Samanta Gabriele Capurso Ivo Boskoski Cristiano Spada Jorge D Machicado Stefano Francesco Crinò Antonio Facciorusso department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Division of gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States department of gastroenterology Sinai Hospital of BaltimoreBaltimoreMD 21215United States department of gastroenterology Postgraduate Institute of Medical Education and ResearchChandigarh 160012India Division of Pancreato-Biliary Endoscopy and Endosonography Pancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilano 20132Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCSSUniversitàCattolica del Sacro Cuore di RomaCenter for Endoscopic Research Therapeutics and TrainingRoma 00168Italy department of gastroenterology and Endoscopy Catholic UniversityRoma 00168Italy department of gastroenterology University of Michigan HealthAnn ArborMI 48107United States department of Endoscopy University of VeronaVerona 37121VenetoItaly gastroenterology Unit Department of Medical and Surgical SciencesUniversity of FoggiaFoggia 71122Italy

Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other *** accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced *** studies have reported varying diagnostic and adverse event rates with these *** addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different *** this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.

关键词： Endoscopic ultrasound Fine needle aspiration Needle confocal laser endomicroscopy Through-the-needle biopsy Contrast-enhanced endoscopic ultrasound

Pancreatic stent improves the success rate of needle-knife papillotomy in patients with difficult biliary cannulation

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World Journal of gastroenterology 2025年第1期31卷 58-67页

作者： Mu-Hsien Lee Cheng-Hui Lin Chi-Huan Wu Yung-Kuan Tsou Kai-Feng Sung Sheng-Fu Wang Nai-Jen Liu department of gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuan 33305Taiwan School of Medicine Chang Gung UniversityTaoyuan 33305Taiwan

BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed ***,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of *** To explore whether PS placement improves the success rate of NKP in patients with difficult biliary *** This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary *** cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's *** primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event *** Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP *** the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.

关键词： Difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife papillotomy Pancreatic stent Selective biliary cannulation

Liver parasites:A global endemic and journey from infestation to intervention

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World Journal of gastroenterology 2025年第1期31卷 8-15页

作者： Yumna Shahid Bushra Emman Shahab Abid department of Medicine Section of GastroenterologyAga Khan University HospitalKarachi 75500SindhPakistan Aga Khan Medical College Aga Khan University HospitalKarachi 75500SindhPakistan

Parasites have coexisted with humans throughout history,forming either symbiotic relationships or causing significant morbidity and *** liver is particularly vulnerable to parasitic infections,which can reside in,pass through,or be transported to the liver,leading to severe *** editorial explores various parasites that infect the liver,their clinical implications,and diagnostic considerations,as discussed in the article“Parasites of the liver:A global problem?”.Parasites reach the liver primarily through oral ingestion,mucosal penetration,or the bloodstream,with some larvae even penetrating the *** parasites such as cestodes(Echinococcus),trematodes(Clonorchis,Opisthorchis),nematodes(Ascaris),and protozoa(Entamoeba histolytica)can also cause systemic infections like visceral leishmaniasis,malaria,cryptosporidiosis,and *** infections like clonorchiasis and opisthorchiasis are linked to persistent hepatobiliary inflammation,potentially progressing to cholangiocarcinoma,a fatal bile duct cancer,particularly prevalent in Southeast *** global nature of liver parasite infestations is alarming,with hundreds of millions affected ***,control over treatment quality remains *** the significant public health threat posed by these parasites,international medical organizations must prioritize improved diagnosis,treatment,and preventive *** educational efforts and enhancing healthcare provider training are critical steps toward mitigating the global impact of parasitic liver diseases.

关键词： Liver flukes Nematodes Cestodes Trematodes Protozoa Parasites

Real-world evidence on the efficacy and safety of vonoprazanamoxicillin dual therapy for Helicobacter pylori treatment in elderly patients

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World Journal of gastroenterology 2025年第1期31卷 68-78页

作者： Wen Gao Jing-Wen Li Hui Ye Xue-Zhi Zhang Jian-Xiang Liu Hong Cheng department of gastroenterology Peking University First HospitalBeijing 100034China School of Medicine Tsinghua MedicineTsinghua UniversityBeijing 100034China department of Traditional Chinese Medicine and Integrative Medicine Peking University First HospitalBeijing 100034China

BACKGROUND A dual therapy regimen containing amoxicillin is a common treatment option for the eradication of Helicobacter pylori(***).While substantial research supports the efficacy and safety of vonoprazan and amoxicillin(VA)dual therapy in the general population,there is still a lack of studies specifically focusing on its safety in elderly *** To evaluate efficacy and safety of VA dual therapy as first-line or rescue treatment for *** in elderly *** As a real-world retrospective study,data were collected from elderly patients aged 60 years and above who accepted VA dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1000 mg thrice daily for 14 days)for *** eradication in the department of gastroenterology at Peking University First Hospital between June 2020 and January *** status was evaluated by^(13)C-urease breath test 6 weeks after *** adverse events(AEs)during treatment were *** In total,401 cases were ***-one cases were excluded due to loss to follow-up,lack of re-examination,or unwillingness to take *** total of 380 included cases comprised 250 who received VA dual therapy as first-line treatment and 130 who received VA dual therapy as rescue *** was successfully eradicated in 239 cases(95.6%)in the first-line treatment group and 116 cases(89.2%)in the rescue treatment *** overall incidence of AEs was 9.5%for both ***,9.2%of patients experienced an AE in the first-line treatment group and 10.0%in the rescue treatment *** patients discontinued treatment due to AE,with a discontinuation rate of 1.3%.No serious AE *** The VA dual therapy regimen as a first-line treatment and a rescue therapy was effective and safe for elderly patients aged 60 and older.

关键词： Helicobacter pylori Vonoprazan Amoxicillin Dual therapy Elderly

Rising incidence of acute hepatitis A among adults and clinical characteristics in a tertiary care center of Pakistan

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World Journal of Virology 2025年第1期14卷 73-82页

作者： Yumna Shahid Amna Subhan Butt Iqra Jamali Faisal Wasim Ismail Division of gastroenterology Department of MedicineAga Khan University HospitalKarachi 74800Pakistan department of Medicine Aga Khan University HospitalKarachi 74800Pakistan

BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among ***,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among *** To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)*** This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May *** aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were *** compare the trend patients admitted with acute hepatitis during 2019-2023 were also *** regarding clinical and laboratory parameters were *** yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among *** A total of 396 patients were found to have acute hepatitis during our study *** was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV ***,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute *** trends showed increasing occurrence of HAV infection among adults over last 5 *** patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV ***,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in *** An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.

关键词： Acute hepatitis Hepatitis A virus Hepatitis E virus Acute liver failure Hepatotropic virus Vaccination

Do vasopressin V2 receptor antagonists benefit cirrhotics with refractory ascites?

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World Journal of gastroenterology 2015年第41期21卷 11584-11596页

作者： Hiroshi Fukui department of gastroenterology Endocrinology and Metabolism Nara Medical University

Hyponatremia is a frequent complication of advanced cirrhosis with ascites associated with increased morbidity and mortality. It is caused by an impairment in the renal capacity to eliminate solute-free water and is considered to be related to persistent secretionof vasopressin despite low serum osmolality. This nonosmotic release of vasopressin is mediated by the autonomic nervous system, which senses the underfilling of arterial vascular component. This reduction of effective arterial blood volume is closely related to the development of ascites. Although the short-time effects of vasopressin V2 receptor antagonists(vaptans) on hyponatremia and ascites have been repeatedly reported, their effects on the long-term management of cirrhotic ascites have not been established yet. Considering that their effects on water diuresis and their safety are limited by severe underfilling state of patients, cautious approaches with adequate monitoring are needed to advanced cirrhosis. Proper indication, adequate doses and new possibility of combination therapy should be explored in the future controlled study. As hyponatremia is frequent obstacle to ascites management, judicious combination with low-dose diuretics may decrease the incidence of refractory ascites. Although vaptans show much promise in the treatment of advanced cirrhosis, the problem of high cost should be solved for the future.

关键词： Liver cirrhosis Ascites Hyponatremia Pathophysiolo

Effects of Bifidobacterium lactis BLa80 on fecal and mucosal flora and stem cell factor/c-kit signaling pathway in simulated microgravity rats

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World Journal of gastroenterology 2025年第1期31卷 93-109页

作者： Ping Zhang Ying Zhu Pu Chen Tong Zhou Zhe-Yi Han Jun Xiao Jian-Feng Ma Wen Ma Peng Zang Ying Chen Graduate School Hebei North UniversityZhangjiakou 075000Hebei ProvinceChina Key Laboratory of Aerospace Nutrition and Food Engineering China Astronaut Research and Training CenterBeijing 100094China department of gastroenterology The Air Force Medical CenterBeijing 100142China department of Blood Transfusion Air Force Medical CenterBeijing 100142China

BACKGROUND Simulated microgravity environment can lead to gastrointestinal motility *** pathogenesis of gastrointestinal motility disorders is closely related to the stem cell factor(SCF)/c-kit signaling pathway associated with intestinal flora and Cajal stromal ***,intestinal flora can also affect the regulation of SCF/c-kit signaling pathway,thus affecting the expression of Cajal stromal *** cells are the pacemakers of gastrointestinal *** To investigate the effects of Bifidobacterium lactis(***)BLa80 on the intestinal flora of rats in simulated microgravity and on the gastrointestinal motility-related SCF/c-kit *** The internationally recognized tail suspension animal model was used to simulate the microgravity environment,and 30 rats were randomly divided into control group,tail suspension group and drug administration tail suspension group with 10 rats in each group for a total of 28 *** tail group was given *** BLa80 by intragastric administration,and the other two groups were given water intragastric administration,the concentration of intragastric administration was 0.1 g/mL,and each rat was 1 mL/***&eosin staining was used to observe the histopathological changes in each segment of the intestine of each group,and the expression levels of SCF,c-kit,extracellular signal-regulated kinase(ERK)and p-ERK in the gastric antrum of each group were detected by Western blotting and *** fecal flora and mucosal flora of rats in each group were detected by 16S *** Simulated microgravity resulted in severe exfoliation of villi of duodenum,jejunum and ileum in rats,marked damage,increased space between villi,loose arrangement,shortened columnar epithelium of colon,less folds,narrower mucosal thickness,reduced goblet cell number and crypts,and significant improvement after probiotic *** microgravity reduced the expressions of SCF and c-kit,and increased the express

关键词： Simulated microgravity Rat Intestinal flora Gastrointestinal motility Stem cell factor/c-kit signaling pathway

Inflammatory bowel disease of primary sclerosing cholangitis:A distinct entity?

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World Journal of gastroenterology 2014年第12期20卷 3245-3254页

作者： Takahiro Nakazawa Itaru Naitoh Kazuki Hayashi Hitoshi Sano Katsuyuki Miyabe Shuya Shimizu Takashi Joh department of gastroenterology and metabolism Nagoya City University Graduate School of Medical Sciences department of gastroenterology Gifu Prefectual Tajimi Hospital

This is a review of the characteristic findings of inflammatory bowel disease(IBD)associated with primary sclerosing cholangitis(PSC)and their usefulness in the diagnosis of sclerosing *** is a chronic inflammatory disease characterized by idiopathic fibrous obstruction and is frequently associated with *** with PSC(PSC-IBD)shows an increased incidence of pancolitis,mild symptoms,and colorectal *** an increased incidence of pancolitis is a characteristic finding,some cases are endoscopically diagnosed as right-sided ulcerative *** studies have revealed that inflammation occurs more frequently in the right colon than the left *** frequency of rectal sparing and backwash ileitis should be investigated in a future study based on the same *** cholangiographic findings of immunoglobulin G4-related sclerosing cholangitis(IgG4-SC)are similar to those of *** rare association between IBD and IgG4-SC and the unique characteristics of PSC-IBD are useful findings for distinguishing PSC from IgG4-SC.

关键词： Primary sclerosing cholangitis Primary sclerosing cholangitis Inflammatory bowel disease Inflammatory bowel disease-associated with primary sclerosing cholangitis Immunoglobulin G4-related sclerosing cholangitis