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Device-assisted enteroscopy: Are we ready to dismiss the spiral?

World Journal of Gastroenterology 2024年第26期30卷 3185-3192页

作者： Alessandro Mussetto Elettra Merola Cesare Casadei Daniele Salvi Fabiola Fornaroli Silvia Cocca Margherita Trebbi Armando Gabbrielli Cristiano Spada Andrea Michielan Department of Gastroenterology S Maria della Croci HospRavenna 48121Italy Department of Gastroenterology unit G.B.Grassi Hospital(ASL Roma 3)Roma 00122Italy Section of Digestive endoscopy and Gastroenterology Fondazione PoliambulanzaBrescia 25124Italy Gastroenterology and endoscopy unit Department of Medicine and SurgeryUniversity of ParmaParma 43125Italy Gastroenterology and endoscopy unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy Center for Medical Sciences(CISMed) University of TrentoTrento 38122Italy Gastroenterology and Digestive endoscopy unit Santa Chiara HospitalAzienda Provinciale per i Servizi SanitariTrento 38122Italy Digestive endoscopy unit Fondazione Policlinico Universitario A.Gemelli IRCSSRoma 00168Italy

Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted *** events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled *** the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic *** conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the *** primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue *** its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.

关键词： Motorized spiral enteroscopy Rescue enteroscopy Diagnostic yield Adverse events AGREE classification

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Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 360-368页

作者： Juana Gonzalo-Marin Juan Jose Vila Manuel Perez-Miranda unit of endoscopy Department of GastroenterologyQuirón Hospital unit of endoscopy Department of GastroenterologyComplejo Hospitalario de Navarra Department of Gastroenterology Hospital Universitario Rio Hortega

Endoscopic ultrasonography(EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography,computed tomography(CT) and transabdominal ultrasound for recognising early pancreatic *** a diagnostic modality for pancreatic cancer,EUS has proved rates higher than 90%,especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for ***,EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic *** complication rate of EUS is as low as 1.1%-3.0%.New technical developments such as elastography and the use of contrast agents have recently been applied to EUS,improving its diagnostic *** has been found to be superior to the recent multidetector CT for T stagingwith less risk of overstaying in comparison to both CT and magnetic resonance imaging,so that patients are not being ruled out of a potentially beneficial *** accuracy for N staging with EUS is 64%-82%.In unresectable cancers,EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block,biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.

关键词： Endosonography Pancreatic neoplasms endoscopy Diagnosis Neoplasm Staging Therapeutics

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Tenofovir vs lamivudine plus adefovir in chronic hepatitis B:TENOSIMP-B study

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World Journal of Gastroenterology 2017年第41期23卷 7459-7469页

作者： Manuel Rodríguez Juan Manuel Pascasio Enrique Fraga Javier Fuentes Martín Prieto Gloria Sánchez-Antolín Jose Luis Calleja Esther Molina María Luisa García-Buey María Angeles Blanco Javier Salmerón María Lucía Bonet Jose Antonio Pons Jose Manuel González Miguel Angel Casado Francisco Jorquera 无 Division of Gastroenterology and Hepatology.hospital universitario Central de Asturias unit for the Clinical Management of Digestive Diseases IBISHospital Universitario Virgen del Rocío Liver Transplantation and Hepatology unit Gastroenterology ServiceHospital Universitario Reina Sofía Digestive Medicine Service Hospital Universitario Miguel Servet Hepatology unit Digestive Medicine ServiceHospital Universitari i Politècnic La Fe Hepatology unit Hospital Universitario Rio Hortega Liver unit Hospital Universitario Puerta de Hierro de MajadahondaUniversidad Autónoma de Madrid Digestive Medicine Service Hospital Clínico de Santiago de Compostela Liver unit Hospital Universitario de La Princesa Digestive Medicine Service Hospital General Universitario Gregorio Maranon Digestive Medicine unit Complejo Hospitalario de Granada Digestive Medicine Service Hospital Universitario Son Espases Hepatology unit IMIB Hospital Universitario Virgen de la Arrixaca Digestive Medicine Service Hospital Clínico Universitario de Valladolid Pharmacoeconomics and Outcomes Research Iberia Division of Gastroenterology and Hepatology Complejo Asistencial Universitario de León the TENOSIMP-B Research Group

AIM To demonstrate the non-inferiority(15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate(TDF) vs the combination of lamivudine(LAM) plus adefovir dipivoxil(ADV) in the maintenance of virologic response in patients with chronic hepatitis B(CHB) and prior failure with *** This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups(TDF and LAM+ADV) of adult patients with hepatitis B e antigen(HBe Ag)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were *** Forty-six patients were evaluated [median age: 55.4 years(30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA(HBV-DNA) remained undetectable, all patients remained HBe Ag negative, and hepatitis B surface antigen(HBs Ag) positive. Alanine aminotransferase(ALT) values at the end of the study were similar in the 2 groups(25.1± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects(AEs)(53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively(P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment(€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001).CONCLUSION TDF monotherapy proved to be safe

关键词： Tenofovir Lamivudine+Adefovir Efficacy Safety Adherence Costs Hepatitis B

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Endoscopic therapy of weight regain after bariatric surgery

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1584-1596页

作者： Milutin Bulajic Salvatore Francesco Vadalà di Prampero Ivo Boškoski Guido Costamagna Department of Gastroenterology and Digestive endoscopy Mater Olbia HospitalOlbia 07026Italy Digestive endoscopy unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic *** revision of these patients has significant risks and limited *** revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible *** herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric *** research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

关键词： Morbid obesity Weight regain Endoscopic sleeve gastroplasty Transoral outlet reduction Bariatric surgery Full thickness suturing

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Endoscopic anti-reflux therapy for gastroesophageal reflux disease

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World Journal of Gastroenterology 2021年第39期27卷 6601-6614页

作者： Enrique Rodríguez de Santiago Eduardo Albéniz Fermin Estremera-Arevalo Carlos Teruel Sanchez-Vegazo Vicente Lorenzo-Zúñiga Department of Gastroenterology and Hepatology Hospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación Sanitaria(IRYCIS)Madrid 28034Spain endoscopy unit Gastroenterology DepartmentHospital Universitario de Navarra.Gastrointestinal Endoscopy Research UnitNavarrabiomed Biomedical Research Center.PamplonaSpain endoscopy unit Gastroenterology DepartmentHospital Universitari i Politècnic La FeInstituto de Investigación Sanitaria La Fe(IIS La Fe)Valencia 46026Spain

Gastroesophageal reflux disease has an increasing incidence and prevalence worldwide.A significant proportion of patients have a suboptimal response to proton pump inhibitors or are unwilling to take lifelong medication due to concerns about long-term adverse *** anti-reflux therapies offer a minimally invasive option for patients unwilling to undergo surgical treatment or take lifelong *** best candidates are those with a good response to proton pump inhibitors and without a significant sliding hiatal *** incisionless fundoplication and nonablative radiofrequency are the techniques with the largest body of evidence and that have been tested in several randomized clinical ***-assisted ligation techniques,anti-reflux mucosectomy,antireflux mucosal ablation,and new plication devices have yielded promising results in recent noncontrolled ***,the role of endoscopic procedures remains controversial due to limited long-term and comparative data,and no consensus exists in current clinical *** review provides an updated summary focused on the patient selection,technical details,clinical success,and safety of current and future endoscopic anti-reflux techniques.

关键词： Treatment Gastroesophageal reflux Transoral incisionless fundoplication Anti-reflux mucosectomy Anti-reflux mucosal ablation Stretta

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Budd-Chiari like syndrome in decompensated alcoholic steatohepatitis and liver cirrhosis

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World Journal of Gastroenterology 2006年第40期12卷 6564-6566页

作者： Carlos Robles-Medranda Hannah Lukashok Beatriz Biccas Vera L Pannain Homero S Fogaa Gastroenterology Division Hospital Universitario Clementino Fraga Filho Federal University of Rio de Janeiro Rio de Janeiro Brazil Pathology Division Hospital Universitario Clementino Fraga Filho Federal University of Rio de Janeiro Rio de Janeiro Brazil Gastroenterology Division Universitario Clementino Fraga Filho Federal University of Rio de Janeiro Rio de Janeiro Brazil

A rare case of pseudo-Budd-Chiari Syndrome in a patientwith decompensated alcoholic liver disease is *** clinical and radiological findings suggestedBudd-Chiari Syndrome, the liver biopsy revealedmicronodular cirrhosi... 详细信息

关键词： Pseudo Budd-Chiari Budd-Chiari syndrome Liver cirrhosis Alcoholic steatohepatitis

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Endosonography-guided cholangiopancreatography as a salvage drainage procedure for obstructed biliary and pancreatic ducts

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World Journal of Gastrointestinal endoscopy 2010年第6期2卷 212-222页

作者： Manuel Perez-Miranda Carlos de la Serna Pilar Diez-Redondo Juan J Vila endoscopy unit.hospital universitario rio hortega endoscopy unit Gastroenterology DepartmentHospital de Navarra

Endoscopic ultrasound allows transmural access to the bile or pancreatic ducts and subsequent contrast injection to provide ductal drainage under fluoroscopy using endoscopic retrograde cholangiopancreatography (ERCP)-based *** patient specifics and operator techniques result in six possible variant approaches to this procedure,known as endosonography-guided cholangiopancreatography(ESCP). ESCP has been in clinical use for a decade now,with over 300 cases *** has become established as a salvage procedure after failed ERCP in the palliation of malignant biliary *** role in the management of clinically severe chronic/relapsing pancreatitis remains under *** review aims to clarify the concepts underlying the use of ESCP and to provide technical tips and a detailed step-by-step procedural description.

关键词： Endosonography Drainage endoscopy Digestive system Therapeutics Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography

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A Possible Hypoallergenic Cereal in Wheat Food Allergy and Baker’s Asthma

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American Journal of Plant Sciences 2012年第12期3卷 1779-1781页

作者： Alicia Armentia Sara Martín Araceli Diaz-Perales Arantxa Palacín Leticia Tordesillas Manuel Herrero Blanca Martín-Armentia Allergy Section IEN UMDAI Hospital Universitario Rio Hortega de Valladolid Valladolid Spain Departamento de Biotecnología ETS Ingenieros Agrónomos Madrid Spain Pediatrics Service Hospital Universitario Rio Hortega Valladolid Spain

Background: Wheat is a potent allergen source and is one of the causes of baker’s asthma and food allergy. The best strategy for managing food hypersensitivity involves strict avoidance of the trigger. However, wheat is quite difficult to avoid. Several alternative strategies for the treatment of food allergy are under study. Spelt is a possible hypoallergenic crop that may be tried in patients with wheat allergy. Methods: We have evaluated the allergenic IgE hypersensitivity mediated by spelt in wheat allergic patients. Overall, 66 patients who suffered from baker’s asthma or food allergy (45 males and 21 females, mean age 28.6 ± 12.9 years) were included. We have also compared its reactivity with standard- ized extracts from wheat and with purified non-specific lipid transfer proteins from wheat (Tri a 14) and from peach (Pru p 3). Immunodetection with spelt and common bread wheat extracts (Triticum aestivum, cultivar Astral) was per- formed. Fresh wheat and spelt grain extracts were used both for oral and bronchial challenge and skin tests. Specific IgE detection to different cereals was performed using the Immuno CAP System (Phadia, Uppsala, Sweden). The bronchial challenge was positive with wheat Astral in 44 (67%) patients, all of them suffered from asthma. Thirteen (29.54%) of these 44 patients had negative the challenge with spelt. The oral challenge with wheat Astral was positive in 22 (33%) patients with wheat food allergy, and the same test was positive in only in 6 of them with spelt (27.3%). The diagnostic yield (sensitivity, specificity and predictive values) of routine tests in determining spelt allergy by specific positive challenge responses was determined. Prick tests for spelt versus positive challenge tests had a good sensitivity (94%, 86.5 - 99.4;95%CI) and specificity (86%, 84 - 90;95% CI) for the diagnosis of spelt allergy. Immunodetection detected minor differences among different extracts. Conclusion: In summary, the prick test and bronchial

关键词： Spelt Wheat Allergy Food Allergy Low Allergenic Plant Culture

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rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

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World Journal of Gastroenterology 2017年第47期23卷 8405-8414页

作者： Henry Córdova Lidia Argüello Carme Loras Antonio Naranjo Rodríguez Faust Riu Pons Joan B Gornals David Nicolás-Pérez Xavier Andújar Murcia Luis Hernández Santos Santolaria Carles Leal Carles Pons Enrique Pérez-Cuadrado-Robles Orlando García-Bosch Michel Papo Berger José Luis Ulla Rocha Cristina Sánchez-Montes Gloria Fernández-Esparrach endoscopy unit.Institut de Malalties Digestives Hospital ClínicIDIBAPSCIBERehdUniversitat de Barcelona Digestive endoscopy unit Digestive Diseases DepartmentGastrointestinal Endoscopy Research GroupIISLa Fe Polytechnic University Hospital hospital Universitari Mútua de Terrassa CIBERehd hospital Reina Sofía hospital Del Mar hospital Universitari de Bellvitge IDIBELLUniversitat de BarcelonaHospitalet de Llobregat hospital universitario de Canarias hospital Santos Reyes Aranda de Duero hospital San Jorge Consorci hospitalari de Vic Universitat de Vic hospital de Viladecans hospital Morales Meseguer hospital Moisès Broggi Sant Joan Despí hospital Joan XXIII Complejo hospitalario de Pontevedra

AIM To evaluate the rate of adverse events(AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal endoscopy. Patients were followed for 48 h, one week and 1 mo after theprocedure. RESULTS308 patients were included and a single polypectomy was performed in 205. Only 36(11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm(5-60) and in 294 cases(95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219(71.1%) patients. Nine patients presented AEs(2.9%), and 6 of them were bleeding(n = 6, 1.9%)(in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of *** Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

关键词： Polypectomy Bleeding Adverse events Protruded polyps Gastroduodenal Foregut

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Anterior transhepatic approach for total caudate lobectomy including spigelian lobe,paracaval portion and caudate process:A Brazilian experience

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Hepatobiliary & Pancreatic Diseases International 2018年第4期17卷 371-373页

作者： Eduardo de Souza Martins Fernandes Carlo Alberto Pacilio Felipe Pedreira Tavares de Mello Ronaldo de Oliveira Andrade Leandro Moreira Savattone Pimentel Camila Liberato Girão Hepato-Pancreato-Biliary and Transplant Surgery Hospital Adventista SilvestreRio de JaneiroBrazil hospital universitario Clementino Fraga Filho Universidade Federal do Rio De Janeiro(UFRJ)Rio de JaneiroBrazil

To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standard approach for a resectable hilar *** the last years of the 20th century,some authors have begun to report isolated caudate lobe resection for hepatocellular

关键词： HCC Anterior transhepatic approach for total caudate lobectomy including spigelian lobe paracaval portion and caudate process:A Brazilian experience

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