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Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

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World Journal of Radiology 2017年第3期9卷 97-111页

作者： David M Ray Indu Srinivasan Shou-jiang Tang Andreas S Vilmann Peter Vilmann Timothy C McCowan Akash M Patel Department of Radiology Division of Interventional RadiologyUniversity of Mississippi Medical Center Division of Digestive Diseases Department of Medicine University of Mississippi Medical Center GastroUnit Division of Endoscopy Copenhagen University Hospital Herlev

Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient's work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.

关键词： Gastrointestinal hemorrhage Enteral nutrition interventional radiology Gastroenterology endoscopy

Third-space endoscopy:the final frontier

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Gastroenterology Report 2023年第1期11卷 14-23页

作者： Maham Hayat Dennis Yang Peter V.Draganov Center for interventional endoscopy AdventHealthOrlandoFLUSA Division of Gastroenterology Hepatologyand NutritionUniversity of FloridaGainesvilleFLUSA

Over the years,our growing experience with endoscopic submucosal dissection along with technological advances has so-lidiﬁed our comfort and knowledge on working in the submucosa,also referred to as the“third space.”Per-oral endoscopic myotomy(POEM)was theﬁrst prototype third-space endoscopy(TSE)procedure,demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal *** launch of POEM accelerated the evolution of TSE from a vanguard concept to an expandingﬁeld with a wide range of clinical *** this review,we discuss the status and future directions of multiple TSE interventions.

关键词： endoscopy final frontier therapeutic endoscopy third-space endoscopy submucosal endoscopy

Endoscopic management of gastrointestinal leaks and fistulae: Whatoption do we have?

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World Journal of Gastroenterology 2020年第29期26卷 4198-4217页

作者： Fabrizio Cereatti Roberto Grassia Andrea Drago Clara Benedetta Conti Gianfranco Donatelli Digestive endoscopy and Gastroenterology Unit Cremona HospitalCremonaCremona 26100Italy Department of interventional endoscopy Hospital Prive PeupliersRamsay SantéParis 75013France

Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.

关键词： Leak Fistula Endotherapy Over-the-scope clip Suturing system Endovacuum therapy Endoscopic internal drainage Self-expandable metal stent

Applications of endoscopic ultrasound elastography in pancreatic diseases: From literature to real life

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World Journal of Gastroenterology 2022年第9期28卷 909-917页

作者： Clara Benedetta Conti Giacomo Mulinacci Raffaele Salerno Marco Emilio Dinelli Roberto Grassia interventional endoscopy Unit ASST MonzaOspedale San GerardoMonza 20900Italy Gastroenterology and endoscopy Unit ASST Fatebenefratelli-SaccoMilan 20121Italy Gastroenterology and endoscopy Unit ASST CremonaCremona 26100Italy

Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative *** ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical *** can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant ***,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic ***,even if promising,elastography still provides little information in the evaluation of benign conditions.

关键词： Elastography Pancreas Pancreatic stiffness Pancreatitis Pancreatic cancer Endosonography Endoscopic ultrasound Quantitative elastography Strain elastography Pancreatic diseases

Short-and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors

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World Journal of Gastroenterology 2019年第6期25卷 707-718页

作者： Yuko Hara Kenichi Goda Akira Dobashi Tomohiko Richard Ohya Masayuki Kato Kazuki Sumiyama Takehiro Mitsuishi Shinichi Hirooka Masahiro Ikegami Hisao Tajiri Department of endoscopy The Jikei University School of Medicine Department of Gastroenterology Dokkyo Medical University Department of endoscopy The Jikei University Katsushika Medical Center Department of Pathology The Jikei University School of Medicine Department of Innovative interventional endoscopy Research The Jikei University School of Medicine

BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and *** adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized *** To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case *** This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after *** In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 *** pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR

关键词： Duodenal adenoma Duodenal cancer Endoscopic resection Endoscopic submucosal dissection Long-term outcome

Gastric per-oral endoscopic myotomy:Indications,technique,results and comparison with surgical approach

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World Journal of Gastrointestinal Surgery 2022年第1期14卷 12-23页

作者： Maria Chiara Verga Stefano Mazza Francesco Azzolini Fabrizio Cereatti Clara Benedetta Conti Andrea Drago Sara Soro Biagio Elvo Roberto Grassia Gastroenterology and Digestive endoscopy Unit ASST CremonaCremona 26100Italy Gastroenterology and Digestive endoscopy Unit Ospedale San Raffaele IRCCSMilano 20132Italy Digestive and interventional endoscopy Unit ASST MonzaMonza 20800Italy

Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying,without the presence of a *** 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining *** with EndoFLIP,a device that assesses pyloric distensibility,increased the knowledge about *** on this data,several pyloric-targeted therapies were developed to treat refractory gastroparesis:Surgical pyloroplasty and endoscopic approach,such as pyloric injection of botulinum and pyloric ***,the success of most of these techniques is still not *** 2013,the first human gastric per-oral endoscopic myotomy(GPOEM)was *** was inspired by the POEM technique,with a similar dissection method,that allows *** results of GPOEM are similar to surgical approach in term of clinical success,adverse events and post-surgical *** the last 8 years GPOEM has gained the attention of the scientific community,as a minimally invasive technique with high rate of clinical success,quickly prevailing as a promising therapy for *** surprisingly,in referral centers,its technical success rate is 100%.One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.

关键词： Gastric per-oral endoscopic myotomy Pyloroplasty Gastroparesis EndoFLIP Pyloromyotomy Gastroparesis cardinal symptom index

Simplified criteria for diagnosing superficial esophageal squamous neoplasms using Narrow Band Imaging magnifying endoscopy

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World Journal of Gastroenterology 2016年第41期22卷 9196-9204页

作者： Akira Dobashi Kenichi Goda Noboru Yoshimura Tomohiko R Ohya Masayuki Kato Kazuki Sumiyama Masato Matsushima Shinichi Hirooka Masahiro Ikegami Hisao Tajiri Department of endoscopy The Jikei University School of Medicine Department of endoscopy The Jikei University Katsushika Medical Center Division of Clinical Epidemiology The Jikei University School of Medicine Department of Pathology The Jikei University School of Medicine Department of Innovative interventional endoscopy Research The Jikei University School of Medicine

AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's *** Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria,

关键词： Simplified criteria Narrow Band Imaging Magnifying endoscopy Esophageal cancer Squamous cell carcinoma Endoscopic diagnosis Classification Superficial squamous cell carcinoma Stepwise logistic regression analysis

Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion(BRTOcc)of gastrorenal shunts in patients with bleeding gastric fundal varices

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Gastroenterology Report 2021年第3期9卷 212-218,I0001,I0002页

作者： Fateh Bazerbachi Akira Dobashi Swarup Kumar Sanjay Misra Navtej S.Buttar Louis M.Wong Kee Song Division of Gastroenterology Interventional Endoscopy ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Vascular and interventional Radiology Mayo ClinicRochesterMNUSA

Background:Endoscopic cyanoacrylate(glue)injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts(GRSs).Balloon-occluded retrograde transvenous occlusion(BRTOcc)of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the *** study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic(BRTOcc)approach for the treatment of bleeding fundal ***:We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April *** were extracted for patient demographics,clinical and endoscopic findings,technical details,and adverse events of the endoscopic–BRTOcc approach and patient ***:We identified 30 patients(13[43.3%]women;median age 58[range,25–92]years)with gastroesophageal varices type 2(53.3%,16/30)and isolated gastric varices type 1(46.7%,14/30)per Sarin classification,and median clinical and endoscopic follow-up of 151(range,4–2,513)days and 98(range,3–2,373)days,*** median volume of octylcyanoacrylate:Lipiodol injected was 7(range,4–22)***-related adverse events occurred in three(10.0%)patients,including transient fever,non-life-threatening pulmonary glue embolism,and an injection-site ulcer *** gastric variceal obturation was achieved in 18 of 21 patients(85.7%)at endoscopic *** variceal rebleeding was confirmed in one patient(3.3%)and suspected in two patients(6.7%).Although no procedure-related deaths occurred,the overall mortality rate was 46.7%,primarily from liver-disease progression and ***:The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices,with a high rate of variceal obturation and a low rate of serious adverse events.

关键词： balloon-occluded retrograde transvenous occlusion cyanoacrylate injection gastric varices gastric variceal bleeding gastrorenal shunt

Pre-operative biliary drainage is associated with shortened survival time in patients with cholangiocarcinoma

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Gastroenterology Report 2019年第3期7卷 185-192,I0002页

作者： Udayakumar Navaneethan Xiang Zhu Mansour A.Parsi Shyam Varadarajulu Center for interventional endoscopy Florida Hospital601 E Rollins StOrlandoFL 32803USA Department of Gastroenterology The Cleveland Clinic9500 Euclid AveClevelandOH 44195USA

Background and objective:Although pre-operative biliary drainage(PBD)is frequently performed in patients with cholangiocarcinoma(CCA),its impact on patient survival is *** aim was to evaluate the impact of PBD on overall survival of patients with extra-hepatic ***:This was a retrospective study using the Surveillance,Epidemiology,and End Results(SEER)-Medicare *** who underwent biliary drainage within 3 months prior to and/or after diagnosis of CCA were included in the PBD *** who did not receive biliary drainage were included in the non-PBD *** proportional hazard regression was used to determine independent predictors of ***:Of 3862 patients with extra-hepatic CCA,433(11.2%)underwent curative surgical resection,with a median survival of 14 months(95%confidence interval[95%CI],10-21months)in the PBD cohort(n=126)vs 31 months(95%CI,26-39 months)in the non-PBD cohort(n=307)(P<0.001),during the median follow-up duration for the surgical cohort of 26 months(range,1-60 months).Among the 433 patients,126(29.1%)underwent PBD and had significantly higher Charlson comorbidity index and advanced SEER stage than those without PBD before *** multivariable analysis in patients who underwent curative surgical resection,after adjusting patient demographics,tumor characteristics,Charlson comorbidity index,radiotherapy and chemotherapy,PBD was significantly associated with shortened survival time(hazard ratio,2.35;95%CI,1.34-4.10;P=0.003).Conclusions:PBD appears negative impact on long-term survival in patients with potentially resectable CCA and should be avoided if possible.

关键词： Cholangiocarcinoma endoscopic retrograde cholangiopancreatography biliary drainage pre-operative mortality