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Biliary leaks after laparoscopic cholecystectomy:time to stent or time to drain

Hepatobiliary & Pancreatic diseases International 2008年第6期7卷 628-632页

作者： Haim Pinkas Patrick G.Brady Division of Digestive Diseases and Nutrition University of South Florida

BACKGROUND:Endoscopic retrograde cholangiopan- creatography(ERCP)with placement of a biliary stent or nasobiliary(NB)drain is the procedure of choice for treatment of post-cholecystectomy bile duct leaks.The aim of this study was to compare the effect of NB drainage versus internal biliary stenting on rates of leak closure, time elapsed until drain or stent removal,length of hospital stay and number of required endoscopic procedures. METHODS:Charts were reviewed on 20 patients who underwent laparoscopic cholecystectomy complicated by Luschka or cystic duct leak.Ten patients were treated with NB drains connected to low intermittent suction and repeat NB cholangiograms were performed until leak closure was observed.Ten patients were treated with internal biliary stents.Biliary sphincterotomies were performed for stone extraction or a presumed papillary stenosis.Large bilomas were drained percutaneously prior to stenting. RESULTS:In all 20 patients,a cholangiogram and successful placement of a NB drain or internal stent was achieved.Four patients(20%)were found to have bile duct stones,which were extracted following a sphincterotomy. Sixteen patients required percutaneous drains to evacuate large bilomas prior to biliary instrumentation.Fifteen cystic duct leaks and 5 Luschka duct leaks were reviewed. There were no complications related to ERCP.Closure of the leak was documented within 2 to 11 days(mean 4.7±0.9 days)in patients receiving a NB drain.The drains were removed non-endoscopically following leak closure. The internal stent group required stenting for 14 to 53 days(mean 29.1±4.4 days).The stent was then removed endoscopically after documentation of leak closure.Bile leaks following laparoscopic cholecystectomy closed rapidly after NB drainage and did not require repeat endoscopy for removal of the NB drain,resulting in fewer ERCPs required for treatment of biliary leaks.Internal biliary stents were in place longer owing to the nature of this intermittent endoscopic approach but an accurate comparison of tim

关键词： biliary leak cholecystectomy,laparoscopic endoscopic retrograde cholangiopancreatography nasobiliary drain biliary stent

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Endoscopic resolution and recurrence of gastric antral vascular ectasia after serial treatment with argon plasma coagulation

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World Journal of Gastrointestinal Endoscopy 2017年第6期9卷 263-266页

作者： Shashank Garg Bilal Aslam Nicholas Nickl Division of Digestive Diseases and Nutrition Department of MedicineUniversity of Kentucky Department of Medicine University of Kentucky

AIM To evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia(GAVE) after argon plasma coagulation(APC) treatment.METHODS This was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively. Endoscopic resolution of GAVE was defined as no endoscopic evidence of GAVE after treatment with APC. Recurrence of GAVE was defined as endoscopic reappearance of GAVE after prior resolution.RESULTS Twenty patients met the study criteria. Median age(range) of the patients was 59.5 years(42-74 years). GAVE was associated with underlying cirrhosis in 16(80%) patients. Indications for initial esophagogastroduodenoscopy(EGD) included hematemesis and/or melena(9/20, 45%), iron deficiency anemia(6/20, 30%), screening or surveillance of varices(4/20, 20%), and occult gastrointestinal bleeding(1/20, 5%). The patients were treated with a total of 55 APC sessions(range 1-7 sessions). Successful endoscopic resolution of GAVE wasachieved in 8 out of 20 patients(40%). There was no correlation between number of treatment sessions and GAVE treatment success(P = NS). Recurrence of GAVE was noted on a subsequent EGD in 2 out of 8 patients(25%) with prior endoscopic resolution of GAVE. Median follow-up period for the study population was 627 d(range 63-1953 d).CONCLUSION Endoscopic resolution rate of GAVE was low(40%) with a 25% recurrence rate after treatment with APC. These rates suggest that APC treatment of GAVE may not be optimal in many circumstances.

关键词：胃的 antral 脉管的 ectasia 氩血浆凝结

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Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature

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World Journal of Gastroenterology 2014年第26期20卷 8416-8423页

作者： Adnan Muhammad Gitanjali Vidyarthi Patrick Brady Division of Digestive Diseases and Nutrition University of South FloridaMorsani College of Medicine division of Gastroenterology James A Haley VA Hospital

Iron deficiency anemia(IDA)is common and often under recognized problem in the elderly.It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract.Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel(SB).Capsule endoscopy(CE)provides direct visualization of entire SB mucosa,which was not possible before.It is superior to push enteroscopy,enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA.Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA.The diagnostic yield of CE for IDA progressively increases with advancing age,and is highest among patients over 85 years of age.Balloon assisted enteroscopy is used to treat the lesions seen on CE.CE has some limitations mainly lack of therapeutic capability,inability to provide precise location of the lesion and false positive results.Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.

关键词： Small bowel Capsule endoscopy Iron deficiency anem

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Occult Hepatitis B Flare-up after Chemotherapy Treatment in HBsAg Negative Patient

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International Journal of Clinical Medicine 2011年第5期2卷 621-623页

作者： Shoaib Ahmad Vu Le Tauseef Ali Division of Digestive Diseases and Nutrition University of Oklahoma Health Sciences Center

Reactivation of Hepatitis B virus causing liver damage is a concern in patients with chronic HBV infections who receive immunosuppressive or cytotoxic treatments. HBV screening should be considered for all patients going to receive immunosuppressive regimens which have the potential to induce reactivation of HBV infection. We discuss here a case of occult Hepatitis B flare after chemotherapy in a patient who had negative acute hepatitis profile including HBsAg prior to therapy and baseline serum AST, ALT, INR, albumin, bilirubin and serum creatinine were within normal limits.

关键词： Hepatitis B Chemotherapy Reactivation

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Impact of sustained virologic response on chronic kidney disease progression in hepatitis C

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World Journal of Hepatology 2017年第36期9卷 1352-1360页

作者： Elizabeth S Aby Tien S Dong Jenna Kawamoto Joseph R Pisegna Jihane N Benhammou division of Gastroenterology Hepatology and Parenteral Nutrition Department of Medicine VA Greater Los Angeles Healthcare System the Vatche and Tamar Manoukian division of digestive diseases UCLA Los Angeles Department of Medicine University of California David Geffen School of Medicine

AIM To determine how sustained virological response at 12 wk(SVR12) with direct acting antivirals(DAAs) for the treatment of hepatitis C virus(HCV) infection affects chronic kidney disease(CKD) progression. METHODS A retrospective analysis was performed in patients aged ≥ 18 years treated for HCV with DAAs at the VA Greater Los Angeles Healthcare System from 2014-2016. The treatment group was compared to patients with HCV from 2011-2013 who did not undergo HCV treatment, prior to the introduction of DAAs; the control group was matched to the study group in terms of age, gender, and ethnicity. Analysis of variance and co-variance was performed to compare means between SVR12 subgroups adjusting for co-variates.RESULTS Five hundred and twenty-three patients were evaluated. When comparing the rate of change in estimated glomerular filtration rate(e GFR) one-year after HCV treatment to one-year before treatment, patients who achieved SVR12 had a decline in GFR of 3.1 m L/min ± 0.75 m L/min per 1.73 m^2 compared to a decline in e GFR of 11.0 m L/min ± 2.81 m L/min per 1.73 m^2 in patients who did not achieve SVR12(P = 0.002). There were no significant clinical differences between patients who achieved SVR12 compared to those who did not in terms of cirrhosis, treatment course, treatment experience, CKD stage prior to treatment, diuretic use or other co-morbidities. The decline in e GFR in those with untreated HCV over 2 years was 2.8 m L/min ± 1.0 m L/min per 1.73 m^2, which was not significantly different from the e GFR decline noted in HCV-treated patients who achieved SVR12(P = 0.43).CONCLUSION Patients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.

关键词： Hepatitis C Direct-acting antivirals Chronic kidney disease End stage renal disease Sustained virological response

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维多珠单抗治疗慢性肉芽肿相关炎症性肠病的疗效

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Gastroenterology Report 2020年第5期8卷 404-406,I0003页

作者： Natasha Kamal Beatriz Marciano Bryan Curtin Anna Strongin Suk See DeRavin Athos Bousvaros Christopher Koh Harry L.Malech Steven M.Holland Christa Zerbe Theo Heller digestive Disease Branch National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA Laboratory of Host Defenses National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMDUSA division of Gastroenterology Hepatology and NutritionBoston Children’s HospitalBostonMAUSA Liver Disease Branch National Institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesdaMDUSA Laboratory of Clinical Immunology and Microbiology National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMDUSA

Introduction Chronic granulomatous disease(CGD)is a rare immunodeficiency affecting approximately 1 in 200,000 people[1].Patients with CGD are unable to produce normal amounts of neutrophil superoxide and other phagocyte reactive oxygen species.As a result,phagocytes have decreased microbicidal activity and patients develop recurrent bacterial and fungal infections.

关键词：慢性肉芽肿单抗治疗炎症性肠病 immunodeficiency

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Stent type used does not impact complication rate or placement time but can decrease treatment cost for benign and malignant esophageal lesions

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World Journal of Gastrointestinal Endoscopy 2016年第7期8卷 338-343页

作者： Camille McGaw Ahmad Alkaddour Kenneth J Vega Juan Carlos Munoz division of Gastroen--terology University of Florida College of Medicine--Jacksonville Department of Medicine University of Florida College of Medicine-Jacksonville Division of Digestive Diseases and Nutrition University of Oklahoma Health Science Center

AIM: To evaluate if differences exist between selfexpanding esophageal metal stents(SEMS) and selfexpanding esophageal plastic stents(SEPS) when used for benign or malignant esophageal disorders with regard to safety, efficacy, clinical outcomes, placement ease and cost.METHODS: A retrospective analysis was performed to evaluate outcome in patients having SEPS/SEMS placed for malignant or benign esophageal conditions from January 2005 to April 2012. Inclusion criteria was completed SEMS/SEPS placement. Outcomes assessed included technical success of and time required for stent placement, procedure-related complications, need for repeat intervention, hospital stay, mortality and costs.RESULTS: Forty-three patients underwent stent placement for either benign/malignant esophagealdisease during the study period. Thirty patients had SEMS(25 male, mean age 59.6 years old) and 13 patients had SEPS(10 male, mean age 61.7 years old). Placement outcome as well as complication rate(SEPS 23.1%, SEMS 25.2%) and in-hospital mortality(SEPS 7.7%, SEMS 6.7%) after placement did not differ between stent types. Migration was the most frequent complication reported occurring equally between types(SEPS 66.7%, SEMS 57.1%). SEPS was less costly than SEMS, decreasing institutional cost by $255/stent.CONCLUSION: SEPS and SEMS have similar outcomes when used for benign or malignant esophageal conditions. However, SEPS use results in decreased costs without impacting care.

关键词： Esophageal Stent Benign Malignant Complication Placement Cost

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Proton pump inhibitor: The dual role in gastric cancer

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World Journal of Gastroenterology 2019年第17期25卷 2058-2070页

作者： Moon Kyung Joo Jong-Jae Park Hoon Jai Chun division of Gastroenterology Department of Internal MedicineKorea University College of Medicine Guro Hospital division of Gastroenterology and Hepatology Department of Internal MedicineInstitute of Digestive Disease and NutritionKorea University College of Medicine

Proton pump inhibitors(PPIs) are one of the most frequently used medications for upper gastrointestinal diseases. However, a number of physicians have raised concern about the serious side effects of long-term use of PPIs, including the development of gastric cancer. Recent epidemiological studies have reported a significant association between long-term PPI intake and the risk of gastric cancer, even after successful Helicobacter pylori eradication. However, the effects of PPIs on the development of pre-malignant conditions such as atrophic gastritis or intestinal metaplasia are not fully known, suggesting the need for comprehensive and confirmative studies are needed in the future. Meanwhile,several experimental studies have demonstrated the effects of PPIs in reducing chemoresistance in gastric cancer cells by modulating the acidic microenvironment, cancer stemness and signal transducer and activator of transcription 3(STAT3) signaling pathway. The inhibitory effects of PPIs on STAT3 activity may overcome drug resistance and enhance the efficacy of conventional or targeted chemotherapeutic agents. Taken together, PPIs may"play dual role" in gastric carcinogenesis and treatment of gastric cancer.

关键词： Proton pump inhibitor Gastric cancer Drug resistance Signal transducer and activator of transcription 3

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Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide

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World Journal of Gastroenterology 2019年第8期25卷 909-922页

作者： Parit Mekaroonkamol Rushikesh Shah Qiang Cai division of digestive diseases Emory University School of Medicine

Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is becoming more recognized in clinical practice,its safety and efficacy need to be carefully evaluated.Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research.This review aims to systemically summarize the existing data on clinical outcomes of POP.Symptomatologic responses to the procedure,its adverse effects,procedural techniques,and predictive factors of clinical success are also discussed.

关键词： Gastroparesis Per oral endoscopic pyloromyotomy Gastric per-oral endoscopic myotomy Pyloromyotomy Outcomes

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Impact of pediatric inflammatory bowel disease diagnosis on exercise and sports participation: Patient and parent perspectives

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World Journal of Gastroenterology 2019年第31期25卷 4493-4501页

作者： Renée M Marchioni Beery Enju Li Laurie N Fishman Division of Digestive Diseases and Nutrition University of South FloridaTampaFL 33612United States Institutional Center of Clinical and Translational Research Boston Children’s HospitalBostonMA 02115United States division of Gastroenterology Boston Children’s HospitalHarvard Medical SchoolBostonMA 02115United States

BACKGROUND Inflammatory bowel disease(IBD)may limit physical activity due to intestinal or extraintestinal manifestations,fatigue,or exercise perception.We sought to evaluate the influence of IBD diagnosis on exercise and sports participation in a pediatric population.We compared patient-reported and parent-reported perspectives.AIM To evaluate the influence of IBD diagnosis on exercise and sports participation in a pediatric population.METHODS Consecutive IBD outpatients(aged 10-18 years)and their parents completed parallel voluntary surveys.A validated,patient-reported functional activity scale,the Hospital for Special Surgery Pediatric Functional Activity Brief Scale(HSS Pedi-FABS)was used to assess children’s activity levels.RESULTS There were 149 completed surveys(75%response rate)with mean participant age of 16.5 years[standard deviation(SD)=4.0]and mean age at IBD diagnosis of 11.8 years(SD=3.4).Most patients(77%)were diagnosed within 12 mo of symptom onset.Current athletic participation was reported in 65%across 65 sports.Participation was greatest before(40%)rather than after(32%)IBD diagnosis,with no reported change in 28%.IBD negatively impacted play/performance in 45%but did not change play/performance in 44%.IBD treatment improved patients’desire to exercise(70%)and subjective capacity for aerobic exercise(72%).Patients and parents agreed that IBD subjects demonstrate normal capacity for aerobic exercise(0.40,95%CI:0.22-0.58)and that treatment improved both participatory desire(0.33,95%CI:0.12-0.54)and capacity for aerobic exercise(0.52,95%CI:0.31-0.71).Almost all(99%)viewed exercise as healthy,and most encouraged its practice.IBD patients demonstrated normal mean HSS Pedi-FABS scores.CONCLUSION After pediatric IBD diagnosis,most patients continue exercise and sports,with mean activity levels comparable to American youth.Treatment positively impacts participatory desire and aerobic capacity.Patients favor the role of exercise in IBD.

关键词： Inflammatory bowel disease Physical activity Exercise Sports

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