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Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study

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World Journal of Gastroenterology 2025年第2期31卷 85-101页

作者： Jun-Yi Zhan Jie Chen Jin-Zhong Yu Fei-Peng Xu Fei-Fei Xing De-Xin Wang Ming-Yan Yang Feng Xing Jian Wang Yong-Ping Mu Cell Biology Laboratory Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 201203China Institute of liver Diseases Shanghai Academy of Chinese MedicineShanghai 201203China Clinical Key Laboratory of Traditional Chinese medicine of Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 201203China Key Laboratory of liver and Kidney Disease of the Ministry of Education Shanghai University of Traditional Chinese MedicineShanghai 201203China department of Gastroenterology and Hepatology Zhongshan Hospital Affiliated to Fudan UniversityShanghai 200032China Shanghai Institute of liver Disease Fudan UniversityShanghai 200032China Evidence-Based medicine Center Fudan UniversityShanghai 200032China department of gastrointestinal endoscopy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 201203China department of Hepatology Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 201203China

BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and *** its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are *** To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal *** This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 *** least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic *** validation was performed with bootstrap *** assessed the discrimination,calibration and accuracy of the model,and performed patient risk *** Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)*** predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation ***,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both *** We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.

关键词： Esophagogastric variceal bleeding Variceal rebleeding liver cirrhosis Prognostic model Risk stratification Secondary prophylaxis

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Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy

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World Journal of Clinical Cases 2025年第6期13卷 1-8页

作者： Ahmed Tawheed Ibrahim Halil Bahcecioglu Mehmet Yalniz Mubin Ozercan Ali Cagri Oral Mohamed El-Kassas department of endemic medicine Faculty of MedicineHelwan UniversityCairo 11795Egypt department of Gastroenterology Firat UniversityElazig 23119Türkiye liver Disease Research Center College of MedicineKing Saud UniversityRiyadh 7805Saudi Arabia

Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal *** the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic *** recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased *** incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe ***,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case *** editorial provides an overview of the current guidelines for the management of iatrogenic colorectal *** insights are from the perspectives of endoscopists and *** also present a management algorithm based on the guidelines of the European Society of gastrointestinal endoscopy,the American Gastroenterological Association,and the World Society of Emergency *** also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.

关键词： Colon Rectum Iatrogenic colonic perforation Colonoscopy Guidelines Endovacuum Endolumical vacuum therapy Endoscopic management

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Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent

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World Journal of Clinical Cases 2016年第4期4卷 112-117页

作者： Arunchai Chang Pitulak Aswakul Varayu Prachayakul Siriraj gastrointestinal endoscopy Center Division of Gastroenterology Department of Internal Medicine Siriraj Hospital Faculty of Medicine Mahidol University liver and Digestive Institute Samitivej Sukhumvit Hospital

One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type *** of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches,ranging from pharmacologic,endoscopic and radiologic treatments to surgical *** the conservative treatment approaches fail to resolve symptomatic cases,however,endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach,despite its well-recognized *** the conventional transpapillary approach fails to achieve the necessary drainage,the patients may benefit from application of the less invasive endoscopic ultrasound(EUS)-guided pancreatic duct ***,we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 *** tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at *** conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms,EUS-guided pancreaticogastrostomy(PGS)was applied using a fully covered,self-expandable,10-mm diameter metallic *** treatment resolved the case and the patient experienced no adverse ***-guided PGS with a regular biliary fully covered,self-expandable metallic stent effectively and safely treated pancreatictype pain in chronic pancreatitis.

关键词： Endoscopic ultrasound-guided Endoscopic ultrasound Pancreaticogastrostomy Pancreatic duct drainage Chronic pancreatitis Self-expandable metallic stent

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Eosinophilic esophagitis in Egyptian adult patients presenting with upper gastrointestinal symptoms

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Open Journal of Gastroenterology 2014年第2期4卷 88-95页

作者： Shereen Shoukry Hunter Dina Omar Helmy Naglaa Aly Zayed Tamer Mohamed El-Tayeb Magdy Amin El-Serafy endemic medicine department and gastrointestinal endoscopy and liver unit Faculty of Medicine Cairo University Cairo Egypt endoscopy unit New Kasr El-Ainy Teaching Hospital Cairo Egypt Pathology department Faculty of Medicine Cairo University Cairo Egypt

Background and Study Aim: Eosinophilic esophagitis (EoE) is a clinicopathological disease characterized by esophageal dysfunction and marked esophageal eosinophilic infiltration. It shows a marked increase in incidence and prevalence and has been associated with gastroesophageal reflux disease (GERD). The aim of this work was to detect the prevalence of EoE in Egyptian adult patients presenting with upper gastrointestinal symptoms and to clarify its clinical pattern and the possibility of its overlap with GERD. Patients and Methods: The study included 91 adult patients presenting with various upper gastrointestinal symptoms. Upper gastrointestinal endoscopy was done and esophageal biopsies were taken. The presence of >15 eosinophils per high power field together with a history of intake of proton pump inhibitors for at least 3 weeks without improvement was used as prerequisite diagnostic criteria for EoE. Results: Classification of the patients was based on both endoscopic and histo-pathological findings. Accordingly, out of the 91 patients, 70 had GERD (76.9%);58 of them had erosive reflux disease (ERD) and 12 had endoscopically normal esophagus but with histopathological changes compatible with reflux esophagitis and were classified as non erosive reflux disease (NERD). Eighteen patients had normal endoscopic and histopathological esophagus (19.8%), and 3 patients had EoE (3.3%), with an overlap between ERD and EoE in one patient. The mean age of EoE patients was 41.6 ± 11.7 years. Two of them were males and one was a female. All of the 3 patients complained of dysphagia and none complained of heartburn. The endoscopists did not report any endoscopic findings characteristic of EoE. Conclusion: The prevalence of EoE is low in adult Egyptian patients presenting with upper gastrointestinal symptoms. Dysphagia is the main presenting symptom of EoE while heartburn is not characteristic of the disease. Normal esophagus endoscopically does not exclude EoE.

关键词： Eosinophilic Esophagitis (EoE) Adults Gastroesophageal Reflux Disease (GERD) Egypt

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Fibrolamellar hepatocellular carcinoma:A rare but unpleasant event

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World Journal of gastrointestinal Oncology 2022年第6期14卷 1103-1114页

作者： Walaa Abdelhamed Mohamed El-Kassas department of endemic medicine Sohag UniversitySohag 14322Egypt department of endemic medicine Faculty of MedicineHelwan UniversityCairo 11795Egypt

Fibrolamellar carcinoma(FLC)is a rare variant of hepatocellular carcinoma(HCC),comprising 1%–9%of all *** is a poorly understood malignancy,which seems to be more prevalent in young patients with no underlying liver *** term“fibrolamellar”is derived from thick fibrous collagen bands surrounding the tumor *** HCC,cirrhosis and viral hepatitis infection are not predisposing to FLC,and it is not associated with elevations in serum *** patients often present with vague abdominal pain,nausea,malaise,and weight *** cases present are at an advanced stage at the time of initial ***,curative treatment options can still be offered to up to 70%of ***(resection/liver transplantation)is the mainstay of treatment and the only potentially curative *** have been less chemoresponsive than the conventional HCC,however,in advanced cases,multimodality treatments can be *** advances in molecular studies of FLC have found a unique DNAJB1–PRKACA fusion transcript in most of the cases *** review aims to describe clinical characteristics,diagnostic methods,and therapeutic modalities for this rare tumor to raise awareness among clinicians and surgeons.

关键词： Fibrolamellar carcinoma Hepatocellular carcinoma Hepatitis Cirrhosis Viral hepatitis infection

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Evaluation of the prognostic value of liver stiffness in patients with hepatitis C virus treated with triple or dual antiviral therapy:A prospective pilot study

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World Journal of Gastroenterology 2015年第10期21卷 3013-3019页

作者： Cristina Stasi Alessia Piluso Umberto Arena Elena Salomoni Paolo Montalto Monica Monti Barbara Boldrini Giampaolo Corti Fabio Marra Giacomo Laffi Stefano Milani Anna Linda Zignego department of Experimental and Clinical medicine University of Florence Health Agency of Tuscany gastrointestinal endoscopy unit Ospedale SS Cosma e Damiano department of Biomedical Experimental and Clinical sciencesUniversity of Florence

AIM:To evaluate the association between liver stiffness(LS) prior to the initiation of dual/triple therapy and viral ***:LS was measured in all patients before treatment was *** therapeutic approach was based on hepatic,virological,and immunological evaluations and considered the fact that patients with severe fibrosis(F3)or compensated cirrhosis(F4)in Child-Pugh class A are the primary candidates for triple *** total,65 hepatitis C virus(HCV)patients were treated with Peg-interferon/ribavirin(Peg-IFN/RBV);24patients were classified as genotypes 1/4(36.92%),and41 patients were classified as genotypes 2/3(63.08%)(dual therapy).In addition,20 HCV treatment-experienced genotype 1 patients were treated with Peg IFN-RBV and boceprevir(triple therapy).Wilcoxon rank-sum tests were used to compare the ***:LS significantly differed between dual therapy and triple therapy(P=0.002).The mean LS value before dual therapy treatment was 8.61±5.79k Pa and was significantly different between patients achieving a sustained virologic response(SVR)24weeks after therapy and those who did not(7.23±5.18 k Pa vs 11.72±5.99 k Pa,respectively,P=0.0003).The relative risk of non-response to therapy was 4.45(95%CI:2.32-8.55).The attributable risk of non-response to therapy was 49%.The mean LSvalue before triple therapy treatment was 13.29±8.57k Pa and was significantly different between patients achieving and not achieving SVR24(9.41±5.05 vs19.11±9.74,respectively;P=0.008).The relative risk of non-response to therapy was 5.57%(95%CI:1.50-20.65).The attributable risk of non-response to therapy(70%)was increased compared with dual therapy ***-treatment stiffness>12 k Pa was significantly associated with non-SVR(Pliver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy.

关键词： Antiviral therapy Chronic hepatitis C Fibrosis Liv

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Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract

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World Journal of Gastroenterology 2013年第12期19卷 1953-1961页

作者： Andrzej Biaek Anna Wiechowska-Kozowska Jan Pertkiewicz Katarzyna Karpińska Wojciech Marlicz Piotr Milkiewicz Teresa Starzyńska Gastroenterology department Pomeranian Medical University department of endoscopy Ministry of Internal Affairs Hospital Endotherapy Ltd Cell Pathology department Pomeranian Medical University liver unit Pomeranian Medical University

AIM: To investigate the indications, resection rate, and safety of endoscopic submucosal dissection (ESD) for neoplastic lesions in the gastrointestinal tract at a European referral center. METHODS: We carried out a retrospective analysis of the ESD procedures performed in our center for mucosal neoplastic and submucosal lesions of the gastrointestinal tract. The duration of the procedure, en bloc and complete (R0) resection rates, and complication rates were evaluated. Variables were reported as mean ± SD or simple proportions. Univariate analysis and comparisons of procedure times and resection rates were performed using Mann-Whitney U tests, or χ2 tests for dichotomous ***: Between 2007 and 2011, ESD was performed in a total of 103 patients (46.7% male, mean age 64.0 ± 12.7 years). The indications for the procedure were epithelial tumor (n = 54), submucosal tumor (n = 42), or other (n = 7). The total en bloc resection rate was 90.3% (93/103) and R0 resection rate 80.6% (83/103). The median speed of the procedure was 15.0 min/cm2 . The complete resection rate was lower for submucosal tumors arising from the muscle layer (68%, 15/22, P < 0.05). Resection speed was quicker for submucosal tumors localized in the submucosal layer than for lesions arising from the muscularis propria layer (8.1 min/cm 2 vs 17.9 min/cm 2 , P < 0.05). The R0 resection rate and speed were better in the last 24 mo (90.1%, 49/54 and 15.3 min/cm 2 ) compared to the first 3 years of treatment (73.5%, 36/49, P < 0.05 and 22.0 min/cm2 , P < 0.05). Complications occurred in 14.6% (n = 15) of patients, including perforation in 5.8% (n = 6), pneumoperitoneum in 3.9% (n = 4), delayed bleeding in 1.9% (n = 2), and other in 2.9% (n = 3). Only one patient with delayed perforation required surgical treatment. During the mean follow-up of 26 ± 15.3 mo, among patients with R0 resection, recurrence occurred in one patient (1.2%).CONCLUSION: ESD is an effective and safe method for resection of

关键词： Endoscopic submucosal dissection gastrointestinal neoplasms gastrointestinal stromal tumors Treatment

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Value of transabdominal bowel ultrasonography and splanchic vascular parameters in the evaluation of inflammatory bowel disease

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Open Journal of Gastroenterology 2013年第2期3卷 99-106页

作者： Manal Kamel Magdy El-Serafy Hussein Attia Hanan Abdeel-Haleem Naglaa Zayed Maha Hasab-Allah Zakaria Salama endemic medicine department Cairo University Cairo Egypt gastrointestinal endoscopy unit Faculty of Medicine Cairo University Cairo Egypt Radiology department National Cancer Institute Cairo University Cairo Egypt

Background: Although non-specific, transabdominal bowel ultrasonography, in real time or in color Doppler;has been beneficial in evaluating the location, extent and activity of inflammatory bowel disease (IBD). Aim: To assess the potential role of bowel transabdominal bowel ultrasonography in the diagnosis and follow-up of IBD. Patients and Methods: A cohort of 30 adults histologically-proven active IBD patients;ulcerative colitis (UC) (n = 20), Crohn’s disease (CD) (n = 10) were prospectively assessed in addition to 20 non-IBD participants representing the control group. All participants underwent the full colonoscopy in addition to real time and color Doppler ultrasonography. Bowel wall thickness, peri-enteric changes, and hemodynamic changes in the portal vein and mesenteric arteries were recorded at initial enrollment and after complete remission in 10 IBD patients. Results: Bowel wall was significantly thickened in all active IBD patients with a significant decrease after disease quiescence in CD patients;p value p value

关键词： Bowel Ultrasonography-Inflammatory Bowel Disease Ulcerative Colitis Crohn’s Disease Splanchnic Vessels Doppler

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Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage

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World Journal of Gastroenterology 2015年第37期21卷 10697-10703页

作者： Naoyoshi Nagata Ryota Niikura Tomonori Aoki Shiori Moriyasu Toshiyuki Sakurai Takuro Shimbo Katsunori Sekine Hidetaka Okubo Kazuhiro Watanabe Chizu Yokoi Junichi Akiyama Mikio Yanase Masashi Mizokami Kazuma Fujimoto Naomi Uemura department of Gastroenterology and Hepatology National Center for Global Health and Medicine department of Clinical Research and Informatics National Center for Global Health and Medicine department of Gastroenterology and Hepatology National Center for Global Health and Medicine Kohnodai Hospital Kohnodai department of Internal medicine and gastrointestinal endoscopy Saga Medical School

AIM: To investigate the factors associated with transfusion, further bleeding, and prolonged length of ***: In total, 153 patients emergently hospitalized for diverticular bleeding who were examined by colonoscopy were prospectively enrolled. Patients in whom the bleeding source was identified received endoscopic treatment such as clipping or endoscopic ligation. After spontaneous cessation of bleeding withconservative treatment or hemostasis with endoscopic treatment, all patients were started on a liquid food diet and gradually progressed to a solid diet over 3d, and were discharged. At enrollment, we assessed smoking, alcohol, medications [non-steroidal antiinflammatory drugs(NSAIDs)], low-dose aspirin, and other antiplatelets, warfarin, acetaminophen, and oral corticosteroids), and co-morbidities [hypertension,diabetes mellitus, dyslipidemia, cerebro-cardiovascular disease, chronic liver disease, and chronic kidney disease(CKD)]. The in-hospital outcomes were need for transfusion, further bleeding after spontaneous cessation of hemorrhage, and length of hospital *** odds ratio(OR) for transfusion need, further bleeding, and prolonged length of stay were estimated by logistic regression ***: No patients required angiographic embolization or surgery. Stigmata of bleeding occurred in 18% of patients(27/153) and was treated by endoscopic procedures. During hospitalization, 40patients(26%) received a median of 6 units of packed red blood cells. Multivariate analysis revealed that female sex(OR = 2.5, P = 0.02), warfarin use(OR= 9.3, P 70years(OR = 2.1, P = 0.04) and NSAID use(OR = 2.7,P = 0.03) were

关键词： In-hospital adverse clinical outcomes Antithrombot

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Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

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World Journal of Gastroenterology 2017年第8期23卷 1328-1337页

作者： Claudio Romano Salvatore Oliva Stefano Martellossi Erasmo Miele Serena Arrigo Maria Giovanna Graziani Sabrina Cardile Federica Gaiani Gian Luigi de'Angelis Filippo Torroni unit of Pediatrics Department of Human Pathology in Adulthood and Childhood“G.Barresi”University of Messina department of Pediatrics and Infantile Neuropsychiatry Pediatric Gastroenterology and Liver UnitSapienza University of Rome Institute for Maternal and Child Health IRCCS‘Burlo Garofalo’ department of Translational Medical Science Section of PediatricsUniversity of Naples“Federico II” Gastroenterology and endoscopy unit G.Gaslini Children’s Hospital-IRCCS Gastroenterology and endoscopy unit “San Giovanni Addolorata”Hospital Hepatology Gastroenterology and Nutrition UnitBambino GesùChildren’s Hospital Gastroenterology and endoscopy unit University of Parma department of Surgery and Transplantation Digestive Surgery and Endoscopy UnitBambino GesùChildren’s Hospital

There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://***/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

关键词： gastrointestinal bleeding endoscopy Lower gastrointestinal bleeding Upper gastrointestinal bleeding Pediatric

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