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Colonic polyps: Is it useful to characterize them with advanced endoscopy?

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World Journal of Gastroenterology 2014年第26期20卷 8449-8457页

作者： Maria Lopez-Ceron Erwin Sanabria Maria Pellise endoscopy unit Department of GastroenterologyInstitut de Malalties Digestives i MetabòliquesHospital ClinicCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)

There have been major developments in endoscopic imaging techniques in recent *** with high definition and magnification can provide high quality images that allow for the histological estimation of lesions in vivo and in situ when combined with ancillary enhancement techniques such as chromoendoscopy(CE)and virtual CE(narrow band imaging fujinon intelligent chromoendoscopy,or i-Scan).despite the enormous potential for these advanced techniques,their value and feasibility in the clinic are still doubted,particularly in cases of colonic polyps that are slated for removal,where in vivo characterization may be deemed ***,there are several advantages offered by such advanced endoscopic *** with or without magnification demonstrates highly accurate histology and invasion depth prediction,and virtual CE is a feasible and less cumbersome alternative to CE in terms of histological estimation,though not sufficiently accurate for depth invasion ***,the supplementary information provided by advanced imaging systems can assist the endoscopist in the selection of a strategic approach,such as in deciding whether a colonic lesion should be resected,left in situ,or requires more intensive surgical ***,advanced high-resolution imaging techniques may be more cost effective,such that histopathology of lowrisk lesions following resection can be *** results of these evaluations and comparisons with traditional CE are presented and *** together,the benefits provided by these advanced capabilities justify their development,and advocates their use for the treatment and management of colonic polyps.

关键词： Colon polyps Chromoendoscopy Narrow band imaging Fujinon intelligent chromoendoscopy i-Scan Colonoscopy Optical biopsy

The presence and outcome of biliary sphincter disorders in liver-transplant recipients according to the Rome IV classification

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Gastroenterology Report 2021年第4期9卷 299-305,I0001页

作者： Alejandro Fernandez-Simon Oriol Sendino Karina Chavez-Rivera Henry Córdova Jordi Colmenero Gonzalo Crespo Yilliam Fundora Franco Samaniego Pablo Ruiz Constantino Fondevila Miquel Navasa Andrés Cárdenas GI unit Institut Clı´nic de Malalties Digestives i MetaboliquesHospital Clı´nicUniversity of BarcelonaBarcelonaSpain institut d’Investigacions Biomèdiques August Pi-Sunyer(IDIBAPS)and Ciber de Enfermedades Hepáticas y Digestivas(CIBEREHD) BarcelonaSpain Liver Transplant unit Institut Clínic de Malalties Digestives i MetabóliquesHospital ClínicUniversity of BarcelonaBarcelonaSpain

Background Biliary sphincter disorders after liver transplantation(LT)are poorly *** aim to describe the presence and outcome of patients with papillary stenosis(PS)and functional biliary sphincter disorders(FBSDs)after LT according to the updated Rome IV *** We reviewed all endoscopic retrograde cholangiopancreatographies(ERCPs)performed in LT recipients between January 2003 and december *** on clinical and endoscopic findings was obtained from electronic health records and endoscopy *** and clinical findings were collected at the time of ERCP and 1 month after *** Among the 1,307 LT recipients,336 underwent 849 ***(1.0%)patients met the updated Rome IV criteria for PS[former sphincter of Oddi dysfunction(SOD)type I]and 14 patients(1.0%)met the Rome IV criteria for FBSD(former SOD type II).Biliary sphincterotomy was performed in 13 PS and 10 FBSD *** month after sphincterotomy,bilirubin,gamma-glutamyl transferase and alkaline phosphatase levels decreased in 85%,61%,and 92%of those in the PS group(P¼0.019,0.087,and 0.003,respectively)and in 50%,70%,and 80%of those in the FBSD group(P¼0.721,0.013,and 0.093,respectively).All the 14 patients initially suspected of having a FBSD turned out to have a different diagnosis during the *** PS after LT is uncommon and occurs in only 1%of LT *** data do not support the presence of an FBSD after *** is a safe and effective procedure in LT recipients with PS.

关键词： sphincter of Oddi dysfunction liver transplantation biliary sphincterotomy papillary stenosis functional biliary sphincter disorder

Different profile of cytokine synthesis according to the severity of acute pancreatitis

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World Journal of Gastroenterology 2005年第34期11卷 5309-5313页

作者： Raquel Laveda Juan Martínez Carlos Mu■oz Juan Carlos Penalva Jesus Sáez Germán Belda Salvador Navarro Faust Feu Anton Mas José Ma Palazón José Sánchez-Payá José Such Miguel Pérez-Mateo Gastroenterology department and Liver unit Hospital General Universitario Alicante Spain institut de malalties digestives Hospital Clínic. institut d'Investigacions Biomédiques August Pi I Sunyer Barcelona Spain

AIM: To evaluate the cellular synthetic ability of cytokines involved in pro- and anti-inflammatory reactions in patients with ***: Sixty-seven patients with AP (16 severe,51 mild) and 10 controls were included in the *** of whole blood were performed in samples obtained within the first 72 h from the onset of *** levels of interleukins (IL) 6, 8, 10, and TNF-α were measured at baseline and in the supernatant of cultures with (functional reserve) or without stimulation with ***: Basal levels of cytokines were significantly higher in patients with severe AP. A significant increase of all pro-inflammatory cytokines vs basal levels was observed in the supernatant after 24 h of whole blood cultures in patients, but not in controls. In contrast, IL-10 increased significantly in the supernatant of cultures only in patients with mild AP. Cells showed a statistically significant functional reserve for all IL in patients with mild, but only for pro-inflammatory cytokines in patients with severe ***: A marked activation of immune system may be observed in patients with AP, being balanced between pro- and anti-inflammatory cytokines in patients with mild but not severe AP. A reduced functional reserve for the synthesis of IL-10 may be observed in patients with severe AP, which might lead to a worst prognosis.

关键词： Acute pancreatitis Cytokines Severity Wholeb lood

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

Identification of Lynch syndrome: How should we proceed in the 21^(st) century?

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World Journal of Gastroenterology 2007年第33期13卷 4413-4416页

作者： Antoni Castells Francesc Balaguer Sergi Castellví-Bel Victòria Gonzalo Teresa Ocaa Gastroenterology department Institut de Malalties Digestives i Metabòliques Hospital ClínicCIBERehd IDIBAPS University of Barcelona BarcelonaCatalonia Spain

Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common form of hereditary colorectal cancer. Although great advances in the understanding of its molecular basis have taken place in the last decade, optimal selection of individuals for HNPCC genetic testing remains controversial. This is especially relevant since colonoscopy has been proven effective for reducing colorectal cancer incidence and mortality in individuals at-risk for this disorder. In this manuscript, we summarize the most significant contributions to this important issue that have appearedin the last few years.

关键词： Hereditary non-polyposis colorectal cancer Screening Prevention Microsatellite instability Genetics

Hyponatraemia and cirrhosis

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Gastroenterology Report 2014年第1期2卷 21-26页

作者： Robert J.Gianotti Andres Cardenas department of Gastroenterology Beth Israel Deaconess Medical CenterBoston MA GI unit Institut Clinic de Malalties Digestives i MetaboliquesHospital ClinicUniversity of Barcelona

Hyponatraemia is a common complication of advanced cirrhosis related to an impairment in the renal capacity for eliminating solute-free water,causing a retention of water that is disproportionate to the retention of sodium,thus leading to a reduction in serum sodium concentration and *** main pathogenic factor responsible for hyponatraemia is a non-osmotic hypersecretion of arginine vasopressin(AVP)or antidiuretic hormone from the neurohypophysis,related to circulatory *** in cirrhosis is associated with increased morbidity and *** is also associated with increased morbidity and impaired short-term survival after *** current standard of care based on restricting fluids to 1-1.5 L/day is rarely *** approaches,such as albumin infusion and the use of vaptans—which act by specifically antagonizing the effects of AVP on the V2 receptors located in the kidney tubules—have been evaluated for their role in the management of *** short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatraemia;however their use in patients with end-stage liver disease is limited by hepatotoxic effects of some of these *** administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration,but the available information is still limited.

关键词： hyponatraemia cirrhosis end-stage liver disease vaptans

Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma: A diagnostic and therapeutic dilemma

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World Journal of Gastroenterology 2017年第48期23卷 8671-8678页

作者： Lucas Souto Nacif Amelia Judith Hessheimer Sonia Rodríguez Gómez Carla Montironi Constantino Fondevila department of Surgery Institut de Malalties Digestives I Metabòliques(IMDM)Hospital Clínic CIBERehd IDIBAPSUniversity of Barcelona department of Radiology Hospital Clínic department of Pathology Hospital Clínic

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis. The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas. Three patients presented mass lesions that infiltrated the hepatic hilum,provoked biliary dilatation and jaundice,and were indicative of malignancy. Surgical excision was performed following oncological principles and included extirpation of the gallbladder,extrahepatic bile duct,and hilar lymph nodes,as well as partial hepatectomy. Postoperative morbidity was minimal. Surgical pathology demonstrated XGC and absence of malignancy in all three cases. All three patients are alive and well after years of follow-up. XGC may have such an aggressive presentation that carcinoma may only be ruled out on surgical pathology. In such cases,the best option may be radical resection following oncological principles performed by expert surgeons,in order that postoperative complications may be minimized if not avoided altogether.

关键词： Hepaticojejuostomy Xanthogranulomatous cholecystitis Gallbladder carcinoma Hepatectomy Hilar cholangiocarcinoma

Readmission after TIPS:an up-to-date landscape

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Gastroenterology Report 2020年第2期8卷 83-84,I0001页

作者： Octavi Basssegoda Andres Cardenas GI/Liver unit Institut de Malalties Digestives i MetaboliquesHospital ClinicUniversity of BarcelonaBarcelonaSpain institut Dinvestigacions Biomediques August Pi I Sunyer(IDIBAPS) Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas(CIBEReHD)BarcelonaSpain

Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased *** these complications,portal hypertensive bleeding and refractory ascites in many cases can be managed with the placement of a transjugular intrahepatic portosystemic shunt(TIPS).Current indications of TIPS placement include variceal hemorrhage refractory or recurrent to standard therapy with vasoactive drugs and endoscopic variceal ligation[1].Also,in carefully selected patients(***-Pugh class C cirrhosis with score 10-13 and Child Turcotte Pugh(CTP)class B with active bleeding on endoscopy),early TIPS(placed within 72 hours of admission)after vasoactive drugs and endoscopic band ligation improves *** intervention reduces the risk of rebleeding among this group of high-risk patients and is associated with increased survival[2].TIPS is also a treatment of choice in patients bleeding from cardiofundal varices(GOV2 and IGV1)and ectopic varices[1].Refractory ascites is also an indication for TIPS ***,its efficacy is controversial in this *** is clear that TIPS is associated with a better control of ascites than large-volume *** said,TIPS is followed by a greater incidence of hepatic *** results regarding the survival benefits of TIPS have emerged and are still a matter of intense debate[3].In summary,a careful selection of candidates for TIPS placement is necessary if refractory ascites is the indication for ***,TIPS can be detrimental in older patients with cardiopulmonary disease as well as in patients in CTP class C and higher Model for End Stage Liver Disease(MELD)*** has to be noted that most of the randomized trials evaluating survival of TIPS have been performed using bare stents[4].

关键词： refractory indication admission

塞内昔布和奈普生对肝硬化伴腹水的非氮质血症患者肾功能的影响

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世界核心医学期刊文摘（胃肠病学分册） 2005年第7期1卷 37-38页

作者： Clària J. Kent J.D. López- Parra M. V. Arroyo 杨瑗 Liver unit Institut de Malalties Digestives Hospital Clinic Villarroel 170 Barcelona 08036 Spain

Nonselective inhibition of cyclooxygenase (COX) by nonsteroidal anti- inflam matory drugs frequently induces renal failure in decompensated cirrhosis. Studie s in experimental cirrhosis suggest that selective inhibitors of the inducible i soform COX- 2 do not adversely affect renal function. However, very limited inf ormation is available on the effects of these compounds on renal function in hum an cirrhosis. This investigation consists of a double- blind, randomized, place bo- controlled trial aimed at comparing the effects of the selective COX- 2 in hibitor celecoxib (200 mg every 12 hours for a total of 5 doses) on platelet and renal function and the renal response to furosemide (40 mg intravenously) with those of naproxen (500 mg every 12 hours for a total of 5 doses) and placebo in 28 patients with cirrhosis and ascites. A significant reduction (P de were observed in the group of patients tre ated with naproxen but not in the other two groups. Naproxen, but not celecoxib or placebo, significantly inhibited platelet aggregation (72% ± 8% to 47% ± 8% , P decompensated cirrhosis.

关键词：塞内昔布氮质血症奈普生肾功能萘普生腹水患者安慰剂对照肾脏功能血小板功能尿钠增多