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Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

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World Journal of Stem Cells 2022年第1期14卷 117-141页

作者： Jacobo Trébol Tihomir Georgiev-Hristov Isabel Pascual-Miguelañez Hector Guadalajara Mariano García-Arranz Damian García-Olmo servicio de cirugía general y del aparato digestivo Complejo Asistencial Universitario de SalamancaSalamanca 37007Spain departamento de Anatomía e Histología Humanas Universidad de SalamancaSalamanca 37007Spain servicio de cirugía general y del aparato digestivo Hospital General Universitario de VillalbaMadrid 28400Spain servicio de cirugía general y del aparato digestivo Hospital Universitario La PazMadrid 28046Spain servicio de cirugía general y del aparato digestivo Hospital Universitario Fundación Jiménez DíazMadrid 28040Spain Grupo de Investigación en Nuevas Terapias Instituto de Investigación Sanitaria-Fundación Jiménez DíazMadrid 28040Spain Damian García-Olmo Departamento de CirugíaUniversidad Autónoma de MadridMadrid 28029Spain servicio de cirugía general y del aparato digestivo Hospital Universitario Fundación Jiménez Díaz y Grupo Quiron-Salud MadridMadrid 28040Spain

BACKGROUND Digestive tract resections are usually followed by an anastomosis.Anastomotic leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and mortality.despite technical and technological advances and focused research,its rates have remained almost unchanged the last decades.In the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses outcomes.AIM To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture leaks.METHODS PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to 2021.Studies employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally included.Reference lists from the selected articles were reviewed to identify additional pertinent articles.METHODS Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and limitations.RESULTS Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical trials.Experimental studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical results.Mesenchymal SCs are mostly employed,and delivery routes are mainly local injections and cell sheets followed by biosutur

关键词： Surgical anastomosis Anastomotic leak Digestive system surgical procedure Cell transplantation Cell therapy Stem cells Tissue engineering

Endovascular treatment for early hepatic artery occlusion after liver transplantation: Angioplasty or stent

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Hepatobiliary & Pancreatic Diseases International 2022年第6期21卷 614-615页

作者： Mikel Gastaca Javier Gomez Ignacio Terreros Hepatobiliary Surgery and Liver Transplantation Unit Biocruces Bizkaia Health Research InstituteHospital Universitario CrucesBilbaoSpain University of the Basque Country BilbaoSpain Servicio de Cirugía General y Aparato Digestivo Hospital Universitario San CecilioGranadaSpain Interventional Radiology Unit Hospital Universitario CrucesBilbaoSpain

To the Editor:We read with great interest the recent article by Zhu et al.[1].In the study,the authors analyzed the outcomes of 26 patients diagnosed with hepatic artery occlusion(HAO)and treated with an endovascular approach(EVT)within the first 30 days after ortho-topic liver transplantation(LT).The median interval from LT to EVT was 7 days,most patients were treated with angioplasty and only two(7.7%)needed stent placement.The authors should be congrat-ulated as they achieved a 100%of success rate with an 80.8%of 1-year survival rate.

关键词： liver artery after

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic:Short and middle term outcomes

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World Journal of Methodology 2024年第2期14卷 107-126页

作者： Jacobo Trébol Ana Carabias-Orgaz María Carmen Esteban-Velasco Asunción García-Plaza Juan Ignacio González-Munoz Ana Belén Sánchez-Casado Felipe Carlos Parreno-Manchado Marta Eguía-Larrea José Antonio Alcázar-Montero cirugía general y del aparato digestivo Complejo Asistencial Universitario de SalamancaSalamanca 37007SalamancaSpain cirugía Universidad de SalamancaSalamanca 37007SalamancaSpain Oftalmología Complejo Asistencial Universitario de SalamancaSalamanca 37007SalamancaSpain

BACKGROUND The first wave of coronavirus disease 2019(COVID-19)pandemic in Spain lasted from middle March to the end of June 2020.Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods.In our centre,we managed patients previously and newly diagnosed with cancer.We established a strategy based on limiting perioperative social contacts,preoperative screening(symptoms and reverse transcriptionpolymerase chain reaction)and creating separated in-hospital COVID-19-free pathways for non-infected patients.We also adopted some practice modifications(surgery in different facilities,changes in staff and guidelines,using continuously changing personal protective equipment…),that supposed new inconveniences.AIM To analyse cancer patients with a decision for surgery managed during the first wave,focalizing on outcomes and pandemic-related modifications.METHODS We prospectively included adults with a confirmed diagnosis of colorectal,oesophago-gastric,liver-pancreatic or breast cancer with a decision for surgery,regardless of whether they ultimately underwent surgery.We analysed short-term outcomes[30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection]and outcomes after 3 years(adjuvant therapies,oncological events,death,SARS-CoV-2 infection and vaccination).We also investigated modifications to usual practice.RESULTS From 96 included patients,seven didn’t receive treatment that period and four never(3 due to COVID-19).Operated patients:28 colon and 21 rectal cancers;laparoscopy 53.6%/90.0%,mortality 3.57%/0%,major complications 7.04%/25.00%,anastomotic leaks 0%/5.00%,3-years disease-free survival(DFS)82.14%/52.4%and overall survival(OS)78.57%/76.2%.Six liver metastases and six pancreatic cancers:no mortality,one major complication,three grade A/B liver failures,one bile leak;3-year DFS 0%/33.3%and OS 50.0%/33.3%(liver metastases/pancreatic carcinoma).5 gastric and 2 oesophageal tumours:mortality 0%/50

关键词： COVID-19 SARS-CoV-2 Colon cancer Rectal cancer Breast cancer Liver cancer Pancreatic cancer Gastric cancer Oesophageal cancer Surgery

Refractory hepatic encephalopathy in a patient with hypothyroidism: Another element in ammonia metabolism

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World Journal of Gastroenterology 2017年第28期23卷 5246-5252页

作者： Fernando Díaz-Fontenla Marta Castillo-Pradillo Arantxa Díaz-Gómez Luis Ibanez-Samaniego Pilar Gancedo Juan Adan Guzmán-de-Villoria Pilar Fernández-García Rafael Banares-Canizares Rita García-Martínez Unidad de Hepatología Servicio de Aparato DigestivoHospital General Universitario Gregorio Maranón Instituto de Investigación Sanitaria Hospital Gregorio Maranón servicio de aparato digestivo Hospital Santa Bárbara servicio de Radiodiagnóstico Hospital General Universitario Gregorio Maranón Centro de Investigación Biomédica en Red de Salud Mental Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Facultad de Medicina Universidad San Pablo CEU

Hepatic encephalopathy(HE) remains a diagnosis of exclusion due to the lack of specific signs and symptoms. Refractory HE is an uncommon but serious condition that requires the search of hidden precipitating events(i.e.,portosystemic shunt) and alternative diagnosis. Hypothyroidism shares clinical manifestations with HE and is usually considered within the differential diagnosis of HE. Here,we describe a patient with refractory HE who presented a large portosystemic shunt and post-ablative hypothyroidism. Her cognitive impairment,hyperammonaemia,electroencephalograph alterations,impaired neuropsychological performance,and magnetic resonance imaging and spectroscopy disturbances were highly suggestive of HE,paralleled the course of hypothyroidism and normalized after thyroid hormone replacement. There was no need for intervention over the portosystemic shunt. The case findings support that hypothyroidism may precipitate HE in cirrhotic patients by inducing hyperammonaemia and/or enhancing ammonia brain toxicity. This case led us to consider hypothyroidism not only in the differential diagnosis but also as a precipitating factor of HE.

关键词：肝的 encephalopathy 甲状腺机能减退认知缺陷肝硬化 Portosystemic 分流磁性的回声光谱学

Liver Metastases from Gynecological Cancers: Time to Resection?

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Surgical Science 2012年第3期3卷 120-125页

作者： Jose M.Ramia Roberto de La Plaza Jose Quinones Pilar Veguillas Farah Adel Jorge Garcia-Parreno Unidad de cirugia Hepatobiliopancreatica Servicio de Cirugia General y Aparato DigestivoHospital Universitario de GuadalajaraGuadalajaraSpain

Aim: To perform an update of liver resection as treatment of liver metastases of gynecological cancers, as well as an update on these metastases. Bibliographical search: PubMed Search 1990-2011 in English language. Authors reviewed only relevant articles. Results: No more than 20 relevant articles have been published on this topic, including case reports. We performed a classical review of the information published in the literature. Conclusions: Liver Metastases from Gynecological cancers, not peritoneal implants in the liver, usually appear in patients with disseminated disease, so it is uncommon to perform a liver resection. In some patients with limited extrahepatic disease or only liver disease, liver resection is a safe alternative and improves the oncological results. We try to emphasize which patients may benefit from liver resection and the importance of tailoring medical decisions.

关键词： Liver Metastasis Gynecology Ovary Cancer Review

Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding

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World Journal of Clinical Cases 2018年第13期6卷 611-623页

作者： José Ignacio Fortea ángela Puente Patricia Ruiz Iranzu Ezcurra Javier Vaquero Antonio Cuadrado María Teresa Arias-Loste Joaquín Cabezas Susana Llerena Paula Iruzubieta Carlos Rodríguez-Lope Patricia Huelin Fernando Casafont Emilio Fábrega Javier Crespo servicio de aparato digestivo Hospital Universitario Marques? de Valdecilla Instituto de Investigación Sanitaria Marqués de Valdecilla Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas Laboratorio de Investigación en Hepatología y Gastroenterología Hospital General Universitario Gregorio Mara?ón-Instituto de Investigación Sanitaria Gregorio Mara?ón

AIM To evaluate the long-term outcome of an acute hemodynamic response-guided protocol in which acute responders to intravenous propranolol received traditional nonselective beta-blockers(NSBBs) and acute nonresponders received carvedilol.METHODS Retrospective review of a protocol for primary prophylaxis of variceal bleeding guided by the acute hemodynamic response to intravenous propranolol. Fifty-two acute responders treated with traditional NSBB(i.e. propranolol or nadolol) were compared with 24 acute nonresponders receiving carvedilol. A second hemodynamic study was performed in 27 and 13 patients, respectively. The primary endpoint was development of first or further decompensation. Secondary endpoints included death from any cause, association between acute and chronic hemodynamic response, and baseline clinical and laboratory variables related to the acute hemodynamic response.RESULTS Acute responders and acute nonresponders presented similar 1, 2, and 3-year probabilities of first decompensation(NSBB: 0%, 13.7%, 26.1% vs carvedilol: 0%, 20%, 20%, P = 0.968) or further decompensation(21.2%, 26.1%, 40.9% vs 21.2%, 50.0%, 50.0%, P = 0.525). A previous episode of hepatic encephalopathy was the only independent predictor of decompensation [hazard ratio(95% confidence interval): 8.03(2.76-23.37)]. Mortality rates were similar in acute responders and acute nonresponders with compensated(P = 0.428) or decompensated cirrhosis(P = 0.429). No clinical, laboratory, endoscopic or hemodynamic parameter predicted the acute hemodynamic response. In patients receiving traditional NSBB, the acute and chronic changes of hepatic venous pressure gradient were correlated(r = 0.59, P = 0.001). Up to 69.2% of acute nonresponders gained chronic response with carvedilol.CONCLUSION Early identification and treatment with carvedilol of acute nonresponders to intravenous propranolol improves the clinical outcome of this high-risk group of patients, probably due to its greater effects for reducing portal pressure.

关键词： Gastrointestinal hemorrhage Propranolol Carvedilol Liver cirrhosis Portal hypertension

Hydatidosis and the duodenum: A systematic review of the literature

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World Journal of Meta-Analysis 2020年第3期8卷 265-274页

作者： Víctor de la Fuente-Aguilar Patricia Beneitez-Mascaraque Sergio Bergua-Arroyo María Fernández-Riesgo Irene Camón-García Iris Cruza-Aguilera Kennia Ugarte-yáñez JoséM Ramia Faculty of Medicine Universidad of AlcaláAlcaláde Henares 28801Spain servicio de cirugía general y del aparato digestivo Hospital General Universitario de Alicante and Institute for Health and Biomedical Research(ISABIAL)Alicante 03010Spain

BACKGROUND Injury to the duodenum(fistula formation,compression,or other complications)by a hydatid cyst(HC)is an exceptional complication.AIM To perform a systematic review of the literature on the fistulization of HC in the duodenum.METHODS Following PRISMA guidelines,a search for HC with duodenal involvement was carried out in the databases of PubMed,SCielo and EMBASE without time limits.RESULTS Fourteen patients were identified,seven men and seven women,with a mean age of 53.14 years(SD=17.65,range:28-78).Three out of the 14(21%)had HC relapse.The most frequent clinical manifestations were abdominal pain and nausea and/or vomiting.Various imaging studies were performed in almost all cases,the most commonly used being abdominal computed tomography(10/14,71%).A range of surgical techniques were reported,most frequently HC drainage(41%)and enucleations(16%).Ten of the 14 patients had no complications and one patient died.The follow-up period and recurrences could not be determined.CONCLUSION The most frequent symptoms were abdominal pain,nausea and vomiting.Computed tomography was the most used diagnostic imaging technique,and HC drainage and fistula closure via laparotomy was the most frequent treatment.However,all diagnostic and therapeutic options for HC fistulizing the duodenum had a low level of evidence.

关键词： Echinococcosis Hydatidosis Duodenum Surgery Review

Gallbladder tuberculosis: False-positive PET diagnosis of gallbladder cancer

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World Journal of Gastroenterology 2006年第40期12卷 6559-6560页

作者： JM Ramia K Muffak A Fernández J Villar D Garrote JA Ferron Unidad de cirugía Hepatobiliopancreaticay Trasplante Hepático Servicio de Cirugía Generaly Aparato Digestivo Granada Spain servicio de Medicina Nuclear Hospital Universitario Virgen de las Nieves Granada Spain

Gallbladder tuberculosis (GT) is an extremely rare disease, and very few cases have been reported in the literature. The first case of GT was described in 1870 by Gaucher. A correct preoperative diagnosis of GT is unusual, and it is frequently confused with various gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of gallbladder cancer after a false positive positron emission tomography scan in the diagnostic work-up.

关键词：胆囊疾病结核病理治疗临床

Timing of surgery in Crohn’s disease: A key issue in the management

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World Journal of Gastroenterology 2008年第36期14卷 5532-5539页

作者： Rafael Alós Joaquín Hinojosa servicio de cirugía general Unidad de Coloproctología Hospital de Sagunto Valencia Spain Unidad de digestivo Servicio de Medicina Interna Hospital de Sagunto Valencia Spain

The timing of the decision for operation in Crohn’s disease is based on an evaluation of the several factors such as the failure of medical treatment, complications due to the Crohn’s disease or to the farmacological therapy, development of dysplasia or cancer and growth retardation. A complete evaluation of these factors should result in operation timed to the patient’s best advantage, achieving maximal relief of symptoms with improvement of quality of life. Given the complexity and heterogeneity of the disease and the different options for treatment, is difficult to systematize when the optimal moment for the surgery is arrived. A very important factor in the management of Crohn’s disease is the multidisciplinary approach and the patient preference should be a significant factor in determining the choice of therapy. The surgery should be considered such another option in the sequential treatment of Crohn’s disease. We have analyzed the factors that are involved in the decision taking of the surgical treatment regarding to the experience and the published literature. When did the medical therapy fail? when is the appropriate moment to operate on the patient? Or which complications of Crohn’s disease need a surgery? These are some of the questions we will try to answer.

关键词：克罗恩氏病节段性回肠炎外科治疗药物治疗