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Update on the endoscopic treatments for achalasia

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World Journal of gastroenterology 2016年第39期22卷 8670-8683页

作者： Dushant S Uppal Andrew Y Wang Division of gastro-enterology and hepatology University of Virginia Health System

Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. Highresolution manometry allows for definitive diagnosis and classification of achalasia, with type Ⅱ being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation(PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy(POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient's clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

关键词： Per oral endoscopic myotomy Dilation Achalasia Treatment Endoscopy Myotomy Per oral

Endoscopic management of pancreatic fluid collectionsrevisited

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World Journal of gastroenterology 2017年第15期23卷 2660-2672页

作者： Zaheer Nabi Jahangeer Basha D Nageshwar Reddy department of gastroenterology Asian Institute of Gastro-enterology

The development of pancreatic fluid collections(PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has be-come easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.

关键词： Endotherapy Pseudocyst Pancreatic necrosis Necrosectomy

Novel CD9-targeted therapies in gastric cancer

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World Journal of gastroenterology 2015年第11期21卷 3206-3213页

作者： Yoko Murayama Kenji Oritani Shusaku Tsutsui department of gastro-enterology and hepatology Itami City Hospital department of Hematology/Oncology Graduate School of MedicineOsaka University

There are 33 human tetraspanin proteins,emerging as key players in malignancy,the immune system,fertilization,cellular signaling,adhesion,morphology,motility,proliferation,and tumor ***9,a member of the tetraspanin family,associates with and influences a variety of cell-surface *** these interactions,CD9 modifies multiple cellular events,including adhesion,migration,proliferation,and ***9 is therefore considered to play a role in several stages during cancer *** CD9 expression is generally related to venous vessel invasion and metastasis as well as poor *** found that treatment of mice bearing human gastric cancer cells with anti-CD9 antibody successfully inhibited tumor progression via antiproliferative,proapoptotic,and antiangiogenic effects,strongly indicating that CD9 is a possible therapeutic target in patients with gastric ***,we describe the possibility of CD9 manipulation as a novel therapeutic strategy in gastric cancer,which still shows poor prognosis.

关键词： CD9 Tetraspanin Gastric cancer Tumo-rigenicity The

Esophagogastric junction distensibility assessed using the functional lumen imaging probe

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World Journal of gastroenterology 2017年第7期23卷 1289-1297页

作者： Joan W Chen Joel H Rubenstein department of gastro-enterology and hepatology University of Michigan Health SystemsAnn ArborMI 48109United States

To assess reference values in the literature for esophageal distensibility and cross-sectional area in healthy and diseased subjects measured by the functional lumen imaging probe (FLIP).METHODSSystematic search and review of articles in Medline and Embase pertaining to the use of FLIP in the esophagus was conducted in accordance with the PRISMA guidelines. Cross-sectional area and distensibility at the esophagogastric junction (EGJ) were abstracted for normal subjects, achalasia, and gastroesophageal reflux disease (GERD) patients, stratified by balloon length and volume of *** achalasia studies (n = 154), 3 GERD (n = 52), and 5 studies including healthy controls (n = 98) were included in the systematic review. Normative data varied widely amongst studies of healthy volunteers. In contrast, studies in achalasia patients uniformly demonstrated low point estimates in distensibility ≤ 1.6 mm2/mmHg prior to treatment that increased to ≥ 3.4 mm2/mmHg following treatment at 40mL bag volume. In GERD patients, distensibility fell to the range of untreated achalasia (≤ 2.85 mm2/mmHg) following *** may be a useful tool in assessment of treatment efficacy in achalasia. The drastic drop in EGJ distensibility after fundoplication suggests that FLIP measurements need to be interpreted in the context of esophageal body motility and highlights the importance of pre-operative screening for dysmotility. Future studies using standardized FLIP protocol and balloon size are needed.

关键词： Impedance planimetry gastroesophageal reflux disease Esophageal distensibility Achalasia

Dietary compliance in celiac disease

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World Journal of gastroenterology 2017年第15期23卷 2635-2639页

作者： Hugh James Freeman department of Medicine (gastro-enterology) University of British Columbia

Celiac disease is an immune-mediated disorder that causes severe architectural disturbance in the small intestinal mucosa of genetically-predisposed *** absorption of multiple nutrients results and diarrhea and weight loss *** has accumulated that a strict gluten-free diet can result in resolution of diarrhea,weight gain and normalization of nutrient *** addition,histopathological changes also normalize,but this histopathological res-ponse appears to be time-dependent,sex-dependent and *** to a gluten-free diet is difficult and costly resulting in poor compliance and only a limited clinical *** poses a risk for later long-term complications,including malignancy.A major practical clinical problem is the assessment of compliance to the gluten-free *** symptoms may resolve and serological antibody markers may improve,multiple studies have documented ongoing architectural disturbance and inflammatory change,and with these continued inflammatory changes,a persistent risk for long-term *** immunological studies have suggested that peptides can be detected in both urine and fecal specimens that may be indicative of limited *** the same time,multiple biopsy studies have demonstrated that complete normalization of the mucosa may occur in some patients within 6 mo of initiation of a gluten-free diet,but more often,up to 2 years or more may be required before repeated biopsies eventually show mucosal recovery and mucosal healing.

关键词： Gluten-free diet Compliance Dietary recall Celiac disease Fecal immunoreactive peptides Tissue transglutaminase antibodies

Restoring homeostasis of CD4^+ T cells in hepatitis-B-virusrelated liver fibrosis

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World Journal of gastroenterology 2015年第38期21卷 10721-10731页

作者： Li-Sha Cheng Yun Liu Wei Jiang department of gastro-enterology Zhongshan HospitalFudan University

Immune-mediated liver injury is widely seen during hepatitis B virus(HBV) infection. Unsuccessful immune clearance of HBV results in chronic hepatitis and increases the risk of liver cirrhosis and hepatocellular carcinoma. HBV-related liver fibrosis(HBVLF),occurring as a result of HBV-induced chronic hepatitis,is a reversible,intermediate stage of chronic hepatitis B(CHB) and liver cirrhosis. Therefore,defining the pathogenesis of HBVLF is of practical significance for achieving better clinical outcomes. Recently,the homeostasis of CD4+ T cells was considered to be pivotal in the process of HBVLF. To better uncover the underlying mechanisms,in this review,we systematically retrospect the impacts of different CD4+T-cell subsets on CHB and HBVLF. We emphasize CD4+ T-cell homeostasis and the important balance between regulatory T(Treg) and T helper 17(Th17) cells. We discuss some cytokines associated with Treg and Th17 cells such as interleukin(IL)-17,IL-22,IL-21,IL-23,IL-10,IL-35 and IL-33,as well as surface molecules such as programmed cell death protein 1,cytotoxic T lymphocyte-associated antigen 4,T cell immunoglobulin domain and mucin domain-containing molecule 3 and cannabinoid receptor 2 that have potential therapeutic implications for the homeostasis of CD4+ T cells in CHB and HBVLF.

关键词： Homeostasis Regulatory T cells T helper 17 cells C

Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

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World Journal of hepatology 2017年第22期9卷 959-966页

作者： Pik-Eu Chang Boon-Bee George Goh Victoria Ekstrom Ming-Liang Ong Chee-Kiat Tan department of gastro enterology and hepatology Singapore General Hospital Duke-NUS Medical School

To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis. METHODSWe used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality. RESULTSWe identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71). CONCLUSIONSevere hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

关键词： Severe Mortality Albumin Incidence Hypoxic hepatitis Predictors Etiology Prognosis

Removal of a large foreign body in the rectosigmoid colon by colonoscopy using gastrolith forceps

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World Journal of Clinical Cases 2016年第5期4卷 135-137页

作者： Xiao-Dong Lin Guang-Yao Wu Song-Hu Li Zong-Quan Wen Fu Zhang Shao-Ping Yu department of gastro-enterology Dongguan Kanghua Hospital

Rectal foreign bodies are man-made injury that occurs *** management depends on its depth and the consequence it *** here report a case of rectal foreign body(a glass bottle measuring about 38 mm×75 mm)which was located 13-15 cm from the *** patient had no sign of perforation,and we managed to remove it using endoscopy with gastrolith forceps.

关键词： Foreign body Rectosigmoid Endoscopy Removal gastrolith forceps

Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer

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World Journal of gastroenterology 2015年第32期21卷 9503-9511页

作者： Yu Zhang Li-Ping Ye Xin-Li Mao department of gastro-enterology Taizhou Hospital of Zhejiang Province Wenzhou Medical College

Minimally invasive endoscopic resection has become an increasingly popular method for patients with small(less than 3.5 cm in diameter) gastric subepithelial tumors(SETs) originating from the muscularis propria(MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.

关键词： Gastric subepithelial tumors Endoscopic treatment