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endoscopic treatment of Barrett's esophagus:From metaplasia to intramucosal carcinoma

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World Journal of Gastroenterology 2010年第30期16卷 3780-3785页

作者： Jennifer Chennat Irving Waxman center for endoscopic research and Therapeutics Section of GastroenterologyDepartment of MedicineUniversity of Chicago Pritzker School of MedicineChicagoIL 60637United States

The annual incidence of adenocarcinoma arising from Barrett’s esophagus (BE) is approximately 0.5%. Through a process of gradual transformation from lowgrade dysplasia to high-grade dysplasia (HGD), adenocarcinoma can develop in the setting of BE. The clinical importance of appropriate identifi cation and treatment of BE in its various stages, from intestinal metaplasia to intramucosal carcinoma (IMC) hinges on the dramatically different prognostic status between early neoplasia and more advanced stages. Once a patient has symptoms of adenocarcinoma, there is usually locally advanced disease with an approximate 5-year survival rate of about 20%. Esophagectomy has been the gold standard treatment for BE with HGD, due to the suspected risk of harboring occult invasive carcinoma, which was traditionally estimated to be as high as 40%. In recent years, the paradigm of BE early neoplasia management has recently evolved, and endoscopic therapies (endoscopic mucosal resection, radiofrequency ablation, and cryotherapy) have entered the clinical forefront as acceptable non-surgical alternatives for HGD and IMC. The goal of endoscopic therapy for HGD or IMC is to ablateall BE epithelium (both dysplastic and non-dysplastic) due to risk of synchronous/metachronous lesion development in the remaining BE segment.

关键词： Barrett’s esophagus High-grade dysplasia Intramucosal carcinoma Esophagectomy endoscopic mucosal resection Radiofrequency ablation Cryotherapy

Biliary leakage following pancreaticoduodenectomy:Prevalence,risk factors and management

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 67-72页

作者： Ayman El Nakeeb Mohamed El Sorogy Hosam Hamed Rami Said Mohamad Elrefai Helmy Ezzat Waleed Askar Ahmed M Elsabbagh Gastroenterology surgical center Mansoura University

Background: Few studies investigated biliary leakage after pancreaticoduodenectomy(PD) especially when compared to postoperative pancreatic fistula(POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. Methods: We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery center, Mansoura University, Egypt. According to occurrence of postoperative biliary leakage, patients were divided into two groups. Group(1) included patients who developed biliary leakage and group(2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed. Results: The study included 555 patients. Forty-four patients(7.9%) developed biliary leakage. Ten patients(1.8%) had concomitant POPF. Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography(ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients(90.9%). Only 4 patients(9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group(6.8% vs 3.9%, P = 0.05). Conclusions: Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. Howeve

关键词： Pancreatic head carcinoma Pancreaticodudenetomy Postoperative pancreatic fistula Biliary leakage

Single-session minimally invasive management of common bile duct stones

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World Journal of Gastroenterology 2014年第41期20卷 15144-15152页

作者： Ahmed Abdel Raouf ElGeidie Gastroenterology surgical center Mansoura University

Up to 18% of patients submitted to cholecystectomy had concomitant common bile duct *** avoid serious complications,these stones should be *** is no consensus about the ideal management strategy for such ***,open surgery was offered but with the advent of endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic cholecystectomy(LC) minimally invasive approach had nearly replaced laparotomy because of its well-known *** invasive approach could be done in either twosession(preoperative ERCP followed by LC or LC followed by postoperative ERCP) or single-session(laparoscopic common bile duct exploration or LC with intraoperative ERCP).Most recent studies have found that both options are equivalent regarding safety and efficacy but the singlesession approach is associated with shorter hospital stay,fewer procedures per patient,and less ***,single-session option should be offered to patients with cholecysto-choledocholithiaisis provided that local resources and expertise do ***,the management strategy should be tailored according to many variables,such as available resources,experience,patient characteristics,clinical presentations,and surgical pathology.

关键词： Laparoscopic exploration endoscopic retrograde cholangiopancreatography Common bile duct stones Minimally invasive approach Single-session

Retrievable puncture anchor traction method for endoscopic ultrasound-guided gastroenterostomy: A porcine study

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World Journal of Gastroenterology 2020年第25期26卷 3603-3610页

作者： Guo-Xin Wang Kai Zhang Si-Yu Sun Department of Gastroenterology Endoscopic CenterShengjing Hospital of China Medical UniversityShenyang 110001Liaoning ProvinceChina

BACKGROUND endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is an alternative method for the surgical treatment of gastric outlet obstruction,but it is regarded as a challenging technique for endoscopists as the bowel is highly mobile and can tent ***,the technique requires superb *** order to improve EUS-GE,we have developed a retrievable puncture anchor traction(RPAT)device for EUSGE to address the issue of bowel *** To evaluate the feasibility of RPAT-assisted EUS-GE using an animal *** Six Bama mini pigs each weighing between 15 and 20 kg underwent the RPATassisted EUS-GE *** was taken to ensure that the animals experienced minimal pain and *** days prior to the procedure the animals were limited to a liquid *** oral intake was allowed on the day before the procedure.A fully covered metal stent was placed between the stomach and the intestine using the RPAT-assisted EUS-GE *** in the animals was *** weeks after the procedure,a standard gastroscope was inserted into the pig’s intestine through a previously created fistula in order to check the status of the stents under *** pig was euthanized after *** The RPAT-assisted EUS-GE method allowed placement of the stents with no complications in all six *** the pigs tolerated a regular diet within hours of the *** animals were monitored for four weeks after the RPATassisted EUS-GE,during which time all of the animals exhibited normal eating behavior and no signs of infection were *** imaging performed four weeks after the RPAT-assisted EUS-GE showed that the stents remained patent and stable in all the *** tissue overgrowth or ingrowth was observed in any *** animal had a mature fistula,and the stents were removed without significant *** of all six pigs revealed complete adhesion between the intestine and the stomach *** The RPAT method

关键词： Retrievable puncture anchor endoscopic ultrasound endoscopic ultrasoundguided gastroenterostomy Gastric outlet obstruction Gastroenterostomy Electrocauteryenhanced delivery of lumen-apposing metal stents

Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction

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World Journal of Gastroenterology 2013年第33期19卷 5513-5519页

作者： Jia-Min Zhou Li-Qing Yao Jian-Min Xu Mei-Dong Xu Ping-Hong Zhou Wei-Feng Chen Qiang Shi Zhong Ren Tao Chen Yun-Shi Zhong Department of endoscopic center Zhongshan HospitalFudan University Department of General Surgery Zhongshan HospitalFudan University

AIM:To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer(CRC)patients with acute colorectal obstruction(ACO).METHODS:From April 2008 to April 2012,surgeryrelated parameters,complications,overall survival(OS),and disease-free survival(DFS)of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent(SEMS)placement followed by one-stage open(n=58)or laparoscopic resection(n=16)were evaluated *** stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological ***:The characteristics of patients among these groups were *** rate of conversion to open surgery was 12.5%in the stent-laparoscopy *** function recovery and postoperative hospital stay were significantly shorter(3.3±0.9 d vs 4.2±1.5 d and 6.7±1.1 d vs 9.5±6.7 d,P=0.016 and P=0.005),and surgical time was significantly longer(152.1±44.4 min vs 127.4±38.4 min,P=0.045)in the stent-laparoscopy group than in the stent-open ***-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy *** were no significant differences in the interval between stenting and surgery,intraoperative blood loss,OS,and DFS between the two stent *** with those in the stentlaparoscopy group,all surgery-related parameters,complications,OS,and DFS in the control group were ***:The stent-laparoscopy approach is a feasible,rapid,and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.

关键词： Self-expandable metallic stent Colorectal cancer Endoscopy Laparoscopy Efficiency Safety

Intraoperative endoscopic retrograde cholangiopancreatography: A useful tool in the hands of the hepatobiliary surgeon

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World Journal of Gastroenterology 2015年第2期21卷 609-615页

作者： Ayman El Nakeeb Ahmad M Sultan Emad Hamdy Ehab El Hanafy Ehab Atef Tarek Salah Ahmed A El Geidie Tharwat Kandil Mohamed El Shobari Gamal El Ebidy Gastroenterology surgical center Mansoura UniversityDaqahlia 35516Egypt

AIM: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography(ERCP) combined with laparoscopic cholecystectomy(LC) forpatients with gall bladder stones(GS) and common bile duct stones(CBDS).METHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram(TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven ***: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases(84.2%) where removal of stones were successful; passed stones in 6 cases(7.9%); short lower end stricture with small stones present in two cases(2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case(1.3%) which was treated by open hepaticojejunostomy; and one case(1.3%) was proved to be ampullary carcinoma and whipple's operation was scheduled. CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.

关键词： Obstructive jaundice endoscopic retrograde cholang

Hybrid laparo-endoscopic access:New approach to surgical treatment for giant fibrovascular polyp of esophagus:A case report and review of literature

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World Journal of Gastrointestinal Endoscopy 2023年第11期15卷 666-675页

作者： Seda Dzhantukhanova Lyudmila Grigori Avetisyan Amina Badakhova Yury Starkov Andrey Glotov Department of surgical endoscopic The Vishnevsky National Medical Research Center of SurgeryMoscow 115093Russia Faculty of General Medicine Yerevan State Medical UniversityYerevan 0025Armenia Department of surgical endoscopic The Vishnevsky National Medical Research Center of SurgeryMinistry of Health of RussiaMoscow 115093Russia Department of Morphologist The Vishnevsky National Medical Research Center of SurgeryMinistry of Health of RussiaMoscow 115093Russia

BACKGROUND Fibrovascular polyps are rare type of esophageal submucosal *** are highly vascularized and can cause difficulty swallowing and even fatal complications such as uncontrolled bleeding and death caused by asphyxiation in case of tumor migration to *** the article we describe a novel hybrid technique to surgical treatment–an endoscopic submucosal dissection with laparoscopic removal of the *** SUMMARY The patient with a giant fibrovascular esophageal polyp presented with cough,discomfort in the throat,difficulty swallowing,and an episode of tumor migration into *** patient was investigated with several imaging studies and was diagnosed with a giant highly vascularized esophageal fibrovascular *** follow-up period of eight months accompanied with no *** This method has been shown to have comparable rates of recurrence and a low risk of complications.

关键词： Esophagus Fibrovascular polyp Benign esophageal tumor endoscopic resection Minimal invasive surgery Case report

Mortality and Morbidity among COVID-19-Associated Mucormycosis Patients in Iran: A Prospective Cohort Study

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Advances in Infectious Diseases 2023年第3期13卷 407-423页

作者： Somayeh Dolatabadi Mehdi Bakhshaee Masoumeh Hosseinpoor Ali Alizadeh Noghani Mohammadreza Afzalzadeh Imaneh Roshanzamir Bashir Rasoulian Zahra Eslami Mohammadie Alireza Ghodsi Nazanin Forghani Parisa Arjmand Zahra Valipour Nima Ameli Department of Biology Hakim Sabzevari University Sabzevar Iran sinus and surgical endoscopic research center Mashhad University of Medical Sciences Mashhad Iran Student research Committee Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran Student research Committee Faculty of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran Department of Otolaryngology Mashhad University of Medical Sciences Mashhad Iran

Background: The key contribution of this paper is from investigating the mortality and morbidity rates and related factors associated with COVID-19-associated-mucormycosis among Iranian patients. The existing literature is scarce on this topic, particularly in the context of Iran. The present study investigates mortality and morbidity among 62 confirmed COVID-19-associated-mucormycosis Iranian patients in relation to their demographic characteristics, laboratory test results, predisposing factors, and COVID-related factors. Material and Methods: In this prospective cohort study, the patients were identified in the fifth wave of the disease, between 1st August and 15th October 2021, with data collected at baseline with a three-week follow-up. This was a multicenter investigation with patients admitted to two clinics in Iran. 62 participants were admitted, with the key criteria of them being COVID-19-associated-mucormycosis patients. 53 out of 60 patients underwent corticosteroid therapy and debridement surgery. Intravenous remdesivir (200 mg/ kg/day at day 1, 100 mg/kg/day in following days for up to 5 days) and corticosteroids were administered for 53 out 54 patients. Oxygen therapy was only needed for 30% (n = 19) of the patients. Results: A 40% mortality rate was observed within the three-week follow-up, with deaths concentrated among those with controlled diabetes mellitus (61%) and long-term diabetes mellitus patients (an average of eight versus four years). Higher mortality was also observed in patients with higher leucocytes and those with rhino-orbital-cerebral (59%), followed by nasal (55.6%) mucormycosis. Among survivors, 32% were reinfected, and 56% suffered from loss of vision. Conclusion: The study concludes that mucormycosis is associated with a higher mortality rate among COVID-19 patients with diabetes mellitus, particularly corticosteroid recipients. Thus, urgent attention to this coinfection is warranted in Iran.

关键词： Mucorales COVID-19 Mucormycosis Coinfection Dexamethasone Diabetes Mellitus

Changing trends in the minimally invasive surgery for chronic pancreatitis

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World Journal of Gastroenterology 2023年第14期29卷 2101-2113页

作者： Raja Kalayarasan Ankit Shukla surgical Gastroenterology Jawaharlal Institute of Postgraduate Medical Education and Research(JIPMER)Puducherry 605006India

Chronic pancreatitis is a debilitating pancreatic inflammatory disease characterized by intractable pain resulting in poor quality of *** management of pancreatic pain consists of a step-up approach with medications and lifestyle modifications followed by endoscopic *** surgery is reserved for patients who do not improve with other ***,recent studies suggest that early surgical intervention is more beneficial as it can mitigate the progression of the pathological process and prevent loss of pancreatic *** the widespread adoption of minimally invasive approaches in various gastrointestinal surgical disorders,minimally invasive surgery for chronic pancreatitis is slow to *** difficulty due to severe inflammatory changes has been the major impediment to the widespread usage of minimally invasive surgery in chronic *** this background,the present review aimed to critically analyze the available evidence on the minimally invasive treatment of chronic pancreatitis.A Pub Med search of all relevant articles was performed using the appropriate keywords,parentheses,and Boolean *** initial laparoscopic series have reported the feasibility of lateral pancreaticojejunostomy,considered an adequate procedure only in a small proportion of *** pancreatic head is the pacemaker of pain,so adequate decompression is critical for long-term pain *** studies have documented the feasibility of minimally invasive duodenum-preserving pancreatic head *** improvements in laparoscopic instrumentation and technological advances,minimally invasive surgery for chronic pancreatitis is gaining ***,more high-quality evidence is required to document the superiority of minimally invasive surgery for chronic pancreatitis.

关键词： Robotics Laparoscopy Surgery Chronic pancreatitis Pancreas Pancreatitis