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Des-gamma-carboxy prothrombin and alpha-fetoprotein levels as biomarkers for hepatocellular carcinoma and their correlation with radiological characteristics

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World Journal of gastrointestinal Pathophysiology 2024年第1期15卷 37-43页

作者： Muhammad Ali Qadeer Zaigham Abbas Shaima Amjad Bushra Shahid Abeer Altaf Mehreen Siyal Department of hepatogastroenterology Dr.Ziauddin University Hospital CliftonKarachi 75600Pakistan Medicine Dr.Ziauddin University Hospital CliftonKarachi 75600Pakistan Internal Medicine Dr.Ziauddin University Hospital CliftonKarachi 75600Pakistan

BACKGROUND Alpha-fetoprotein(AFP),a commonly used biomarker for hepatocellular carcinoma(HCC),is normal in up to one-third of patients.AIM To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin(DCP)alone and in combination with AFP.METHODS In this study,202 patients with radiologically proven HCC were enrolled,and their DCP and AFP levels were evaluated for their diagnostic performance.RESULTS The mean age of the enrolled patients was 58.5 years;72.0%were male.DCP was elevated in 86.6%(n=175)of all patients,100.0%(n=74)of patients with portal vein thrombus,and 87.4%(n=111)of patients with multicentric HCC.AFP was elevated in 64.3%(n=130)of all the patients,74%(n=55)of the patients with portal vein thrombus,and 71.6%(n=91)of the patients with multicentric HCC(P=0.030,0.001,and 0.015,respectively).In tumors less than 2 cm in size(n=46),DCP was increased in 32(69.5%)patients,and AFP was increased in 25(54.3%)patients(P=0.801).There was good pairing between DCP and AFP for HCCs of 2 cm size or larger(P2 cm was 0.74 for DCP and 0.59 for AFP;combining both markers resulted in an AUROC of 0.73.For tumors<2 cm,the AUROC was 0.25 for DCP and 0.40 for AFP.CONCLUSION DCP,as an individual marker,had a better diagnostic performance in many cases of HCC.Hence,DCP may replace AFP as the primary HCC biomarker.

关键词： Des-gamma-carboxy prothrombin Protein induced by vitamin K absence-II Cirrhosis Alpha-fetoprotein Biomarkers Hepatocellular carcinoma Portal vein thrombus

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Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

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World Journal of Gastroenterology 2010年第4期16卷 411-417页

作者： Seng-Kee Chuah Tsung-Hui Hu Chi-Sin Changchien gastrointestinal motility Unit Division of HepatogastroenterologyChang Gang Memorial HospitalKaohsiung Medical CenterNo.123Ta-Pei RoadNiaosung HsiangKaohsiung 833TaiwanChina Chang Gung University College of Medicine No.123Ta-Pei RoadNiaosung HsiangKaohsiung 833TaiwanChina

Pneumatic dilation(PD) is considered to be the first line nonsurgical therapy for achalasia.The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force.The endoscope-guided procedure is done without fluoroscopic control.Clinicians usually use a lowcompliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia.It has the advantage of determining mucosal injury during the dilation process,so that a repeat endoscopy is not needed to assess the mucosal tearing.Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities.Although the results may be promising,long-term follow-up is required in the near future.

关键词： Esophagoscopy Dilatation Esophageal achalasia

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Pseudoachalasia in a patient after truncal vagotomy surgery successfully treated by subsequent pneumatic dilations

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World Journal of Gastroenterology 2006年第31期12卷 5087-5090页

作者： Seng-Kee Chuah Chung-Mou Kuo Keng-Liang Wu Chi-Sin Changchien Tsung-Hui Hu Chi-Chih Wang Yi-Chun Chiu Yeh-Pin Chou Pin-I Hsu King-Wah Chiu Chung-Huang Kuo Shue-Shian Chiou Chuan-Mo Lee gastrointestinal motility unitdivision of hepatogastroenterology Department of Internal MedicineChang Gung Memorial HospitalChang Gung UniversityCollege of MedicineKaohsiungTaiwanChina Department of SurgeryChang Gung Memorial Hospital Chang Gung UniversityCollege of MedicineKaohsiungTaiwanChina Kaohsiung Veteran General HospitalTaiwan China

Pseudoachalasia 是一个困难的条件让临床医生甚至由测压法，放射学的研究或内视镜检查法区分开来与自发的弛缓不能。它的病原学通常与肿瘤被联系。在大多数情况中，诊断在外科的探索以后被做。疾病的建议致病被看作远侧的食管的机械阻... 详细信息

Pseudoachalasia 是一个困难的条件让临床医生甚至由测压法，放射学的研究或内视镜检查法区分开来与自发的弛缓不能。它的病原学通常与肿瘤被联系。在大多数情况中，诊断在外科的探索以后被做。疾病的建议致病被看作远侧的食管的机械阻塞或在盒子的多数影响 meyenteric 丛的禁止的神经原的恶意的渗入。外科作为 pseudoachalasia 的一个原因被报导了。我们报导受不了 pseudo-achalasia 在树干的迷走神经切断术以后引起的 deglutination 混乱的一个 70 岁的人。病人在九年的后续和从在灵魂膨胀以后的 pseudoachalasia 的食道的活动性地位的完全的恢复以后是没有症状的。我们也考察了 pseudoachalasia 的文学。

关键词：迷走神经切断术气压扩张病理治疗

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Active gastrointestinal bleeding:Use of hemostatic forceps beyond endoscopic submucosal dissection

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World Journal of Gastroenterology 2010年第16期16卷 2061-2064页

作者： Dimitri Coumaros Niki Tsesmeli Department of hepatogastroenterology University Hospital of Strasbourg

To the best of our knowledge,this is the f irst report of the application of hemostatic forceps in active gastrointestinal(GI) bleeding that is not related to endoscopic submucosal dissection.An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy's lesion of the third duodenal portion.Bleeding control with epinephrine injection was unsuccessful.A 60-year-old man presented with a bleeding ulcer in the duodenal bulb.Ten days after combined endotherapy,he had recurrent bleeding from two minimal lesions in the same location.A 66-year-old woman under combined antithrombotic treatment was referred to us for chronic GI bleeding of unexplained origin.Endoscopy revealed active diverticular bleeding in the second duodenal portion.A 61-year-old woman underwent endoscopic mucosal resection of superficial gastric adenocarcinoma,which was complicated with immediate bleeding.In all cases,the blood was washed out using a water-jet-equipped,single-channel gastroscope with a large working channel.The bleeding points were pinched and retracted with hemostatic forceps.Monopolar electrocoagulation was performed using an electrosurgical current generator.Hemostasis was achieved.No complications occurred.In conclusion,hemostatic forceps may be an effective as well as safe alternative approach for active GI bleeding of various origins.

关键词： Hemostasis Forceps Blood coagulation Hemorrhage Endoscopic submucosal dissection

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Swab culture monitoring of automated endoscope reprocessors after high-level disinfection

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World Journal of Gastroenterology 2012年第14期18卷 1660-1663页

作者： Lung-Sheng Lu Yi-Chun Chiu Ming-Tzung Lin Tsung-Hui Hu King-Wah Chiu Division of hepatogastroenterology Department of Internal MedicineChang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of Medicine

AIM:To conduct a bacterial culture study for monitoring decontamination of automated endoscope reprocessors(AERs) after high-level disinfection(HLD).METHODS:From February 2006 to January 2011,authors conducted randomized consecutive sampling each month for 7 AERs.Authors collected a total of 420 swab cultures,including 300 cultures from 5 gastroscope AERs,and 120 cultures from 2 colonoscope AERs.Swab cultures were obtained from the residual water from the AERs after a full reprocessing cycle.Samples were cultured to test for aerobic bacteria,anaerobic bacteria,and mycobacterium tuberculosis.RESULTS:The positive culture rate of the AERs was 2.0%(6/300) for gastroscope AERs and 0.8%(1/120) for colonoscope AERs.All the positive cultures,including 6 from gastroscope and 1 from colonoscope AERs,showed monofloral colonization.Of the gastroscopeAER samples,50%(3/6) were colonized by aerobic bacterial and 50%(3/6) by fungal contaminations.CONCLUSION:A full reprocessing cycle of an AER with HLD is adequate for disinfection of the machine.Swab culture is a useful method for monitoring AER decontamination after each reprocessing cycle.Fungal contamination of AERs after reprocessing should also be kept in mind.

关键词：监测自动化消毒机再加工内窥镜文化细菌培养棉真菌污染

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Hepatic manifestations of coronavirus disease 2019 infection:Clinical and laboratory perspective

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World Journal of Virology 2022年第6期11卷 453-466页

作者： Farina M Hanif Zain Majid Shoaib Ahmed Nasir H Luck Muhammed Mubarak Department of hepatogastroenterology Sindh Institute of Urology and TransplantationKarachi 74200SindhPakistan Department of Pathology Sindh Institute of Urology and TransplantationKarachi 74200SindhPakistan

The novel coronavirus disease 2019(COVID-19)pandemic,caused by severe acute respiratory syndrome coronavirus 2,has become a global challenge of unprecedented nature since December 2019.Although most patients with COVID-19 exhibit mild clinical manifestations and upper respiratory tract involvement,in approximately 5%-10%of patients,the disease is severe and involves multiple organs,leading to multi-organ dysfunction and failure.The liver and gastrointestinal tract are also frequently involved in COVID-19.In the context of liver involvement in patients with COVID-19,many key aspects need to be addressed in both native and transplanted organs.This review focuses on the clinical presentations and laboratory abnormalities of liver function tests in patients with COVID-19 with no prior liver disease,patients with pre-existing liver diseases and liver transplant recipients.A brief overview of the history of COVID-19 and etiopathogenesis of the liver injury will also be described as a prelude to better understanding the above aspects.

关键词： COVID-19 Liver injury SARS-CoV-2 Clinical manifestations Liver function tests Cirrhosis

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Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

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World Journal of gastrointestinal Endoscopy 2022年第9期14卷 564-574页

作者： Mohamed Eissa Hussein Hassan Okasha Mohamed Abbasy Ahmed Kamal Khamis Abeer Abdellatef Mohamed Akl Rady Department of Hepatology and Gastroenterology National Liver InstituteMenoufia UniversityMenoufia 32951Egypt Department of Internal Medicine Hepatogastroenterology DivisionKasr AL-Ainy School of MedicineCairo UniversityCairo 11451Egypt

BACKGROUND Choledocholithiasis develops in up to 20%of patients with gall bladder stones.The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography(MRCP).Endoscopic ultrasound(EUS)is accurate in detecting common bile duct(CBD)stones missed by MRCP,especially the small ones or those impacted at the distal CBD or the papillary region.AIM To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP.METHODS Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included.The presence of choledocholithiasis was evaluated by MRCP and EUS,and then results were confirmed by endoscopic retrograde cholangiopancreatography(ERCP).The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones,the size,and the number of detected stones.RESULTS Ninety out of 100 involved patients had choledocholithiasis,while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination.In choledocholithiasis patients,the mean age was 52.37±14.64 years,and 52.2%were males.Most patients had biliary obstruction(74.4%),while only 23(25.6%)patients had unexplained pancreatitis.The overall prevalence of choledocholithiasis was 83.3%by EUS,41.1%by MRCP,and 74.4%by ERCP.Also,the number and size of CBD stones could be detected accurately in 78.2%and 75.6%by EUS and 41.1%and 70.3%by MRCP,respectively.The sensitivity of EUS was higher than that of MRCP(98.51%vs 55.22%),and their predictive value was statistically different(P<0.001).Combination of both tools raised the sensitivity to 97.22%and specificity to 100%.CONCLUSION EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP.However,its usefulness depends on its availability and the experience of the local centers.

关键词： Magnetic resonance cholangiopancreatography Endoscopic ultrasonography Choledocholithiasis Missed common bile duct stones

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Interest of Serum-Ascites Albumin Concentration Gradient in the Diagnosis of Portal Hypertension in Cirrhotic Patients

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Open Journal of Gastroenterology 2019年第1期9卷 13-21页

作者： Laté Mawuli Lawson-Ananissoh Aklesso Bagny Oumboma Bouglouga Ismael Mahaman Salissou Ganbobo Rafiou El-Hadji Yakoubou Lidawu Kogoe Laconi Kaaga Datouda Redah hepatogastroenterology Unit University Hospital Campus Lome Togo hepatogastroenterology Unit University Hospital of Kara Kara Togo

Objective: To find a more accessible and less restrictive mean such as serum-ascites albumin gradient (SAAG) to predict esophageal varices (EV) in cirrhotics with ascit. Patients and methods: Descriptive and analytical studies based on the retrospective collection of data on 125 patients’ records in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from January 1, 2008 to March 31, 2018 were included. Cirrhotic patients aged 15 years and older had performed cytochemical analysis of ascites fluid and upper gastrointestinal fibroscopy and had a protidogram. Statistical analysis was done by R Studio Software 3.4.2. Results: The mean age was 48.70 years;there was a male predominance (70.40%) with a sex ratio of 2.38. Protein levels in ascitic fluid was Conclusion: Our study noted that at an upper threshold of 1.10 g/dl, the SAAG significantly predicted the presence of EV.

关键词： Esophageal Varices Serum-Ascit Albumin Gradient Cirrhosis Togo

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Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition:a systematic review and meta-analysis

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Gastroenterology Report 2022年第1期10卷 544-551页

作者： Antonio Facciorusso Stefano Francesco Crino Paraskevas Gkolfakis Daryl Ramai Andrea Lisotti Ioannis S Papanikolaou Benedetto Mangiavillano Ilaria Tarantino Andrea Anderloni Carlo Fabbri Konstantinos Triantafyllou Pietro Fusaroli Gastroenterology Unit Department of Surgical and Medical SciencesUniversity of FoggiaFoggiaItaly Department of Medicine Gastroenterology and Digestive Endoscopy UnitThe Pancreas InstituteUniversity Hospital of VeronaVeronaItaly Department of Gastroenterology Hepatopancreatologyand Digestive OncologyCUB Erasme HospitalUniversite Libre de Bruxelles(ULB)BrusselsBelgium Gastroenterology and Hepatology University of Utah HealthSalt Lake CityUTUSA Gastroenterology Unit Hospital of ImolaUniversity of BolognaImolaItaly hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticMedical SchoolNational and Kapodistrian University of Athens‘Attikon’University General HospitalAthensGreece gastrointestinal Endoscopy Unit Humanitas Mater DominiCastellanzaVareseItaly Endoscopy Service Department of Diagnostic and Therapeutic ServicesIRCCS-ISMETTPalermoItaly Digestive Endoscopy Unit Humanitas Clinical and Research Center—IRCCSRozzanoMilanoItaly Gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly

Background:Endoscopic ultrasound(EUS)-guided tissue acquisition represents the choice of methods for suspected lymph nodes(LNs)located next to the gastrointestinal tract.This study aimed to compare the pooled diagnostic performance of EUS-guided fine-needle biopsy(EUS-FNB)and fine-needle aspiration(EUS-FNA)for LNs sampling.Methods:We searched PubMed/MedLine and Embase databases through August 2021.Primary outcome was diagnostic accuracy;secondary outcomes were sensitivity,specificity,sample adequacy,optimal histological core procurement,number of passes,and adverse events.We performed a pairwise meta-analysis using a random-effects model.The results are presented as odds ratio(OR)or mean difference along with 95%confidence interval(CI).Results:We identified nine studies(1,276 patients)in this meta-analysis.Among these patients,66.4%were male;the median age was 67 years.Diagnostic accuracy was not significantly different between the two approaches(OR,1.31;95%CI,0.81–2.10;P=0.270).The accuracy of EUS-FNB was significantly higher when being performed with newer end-cutting needles(OR,1.87;95%CI,1.17–3.00;P=0.009)and in abdominal LNs(OR,2.48;95%CI,1.52–4.05;P<0.001)than that of EUSFNA.No difference in terms of sample adequacy was observed between the two approaches(OR,1.40;95%CI,0.46–4.26;P=0.550);however,histological core procurement and diagnostic sensitivity with EUS-FNB were significantly higher than those with EUS-FNA(OR,6.15;95%CI,1.51–25.07;P=0.010 and OR,1.87;95%CI,1.27–2.74,P=0.001).The number of needle passes needed was significantly lower in the EUS-FNB group than in the EUS-FNA group(mean difference,-0.54;95%CI,-0.97 to -0.12;P=0.010).Conclusions EUS-FNA and EUS-FNB perform similarly in LN sampling;however,FNB performed with end-cutting needles outperformed FNA in terms of diagnostic accuracy.

关键词： EUS FNA FNB cancer metastases lymphoma

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Focus on emerging drugs for the treatment of patients with non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2014年第45期20卷 16841-16857页

作者： Alessandro Federico Claudio Zulli Ilario de Sio Anna Del Prete Marcello Dallio Mario Masarone Carmela Loguercio Department of Clinical and Experimental Medicine F.Magrassi e A.Lanzara Hepatogastroenterology Division Interuniversity Research Centre on Food Nutrition and the Gastrointestinal Tract (CIRANAD)-Second University of Naples Department of Internal Medicine and Hepatology University of Salerno

Non-alcoholic fatty liver disease(NAFLD)has become the most common liver disorder in Western countries and is increasingly being recognized in developing nations.Fatty liver disease encompasses a spectrum of hepatic pathology,ranging from simple steatosis to non-alcoholic steatohepatitis,cirrhosis,hepatocellular carcinoma and end-stage liver disease.Moreover,NAFLD is often associated with other metabolic conditions,such as diabetes mellitus type 2,dyslipidemia and visceral obesity.The most recent guidelines suggest the management and treatment of patients with NAFLD considering both the liver disease and the associated metabolic co-morbidities.Diet and physical exercise are considered the first line of treatment for patients with NAFLD,but their results on therapeutic efficacy are often contrasting.Behavior therapy is necessary most of the time to achieve a sufficient result.Pharmacological therapy includes a wide variety of classes of molecules with different therapeutic targets and,often,little evidence supporting the real efficacy.Despite the abundance of clinical trials,NAFLD therapy remains a challenge for the scientific community,and there are no licensed therapies for NAFLD.Urgently,new pharmacological approaches are needed.Here,we will focus on the challenges facing actual therapeutic strategies and the most recent investigated molecules.

关键词： Non-alcoholic steatohepatitis Non-alcoholic fatty

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