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Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location

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World Journal of Gastroenterology 2019年第4期25卷 498-508页

作者： Fabian Emura Rene Gomez-Esquivel Carlos Rodriguez-Reyes Petros Benias Javier Preciado Michael Wallace Luis Giraldo-Cadavid Division of Gastroenterology Universidad de La Sabana Advanced Gastrointestinal Endoscopy EmuraCenter LatinoAmerica Emura Foundation for the Promotion of Cancer Research Unidad de Endoscopia Digestiva Clínica Pediátrica Colsanitas Division of Digestive Diseases and Nutrition Morsani College of Medicine University of South Florida Division of Gastroenterology North Shore-Long Island Jewish Medical Center unidad de Exploraciones digestivas Clinica Universitaria Colombia department of Gastroenterology and Hepatology Mayo Clinic department of Internal Medicine. Universidad de La Sabana Division of Interventional Pulmonology Fundacion Neumologica Colombiana

AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound(EUS) in 25 consecutive patients to confirm the findings.The scope orientation throughout the exam was maintained at the natural axis,where the left esophageal quadrant corresponds to the area between 6 and 9 o'clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients' air expiration.RESULTS The left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm(SD2.3), and 31.4 cm(SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the substudy, the left main bronchus was identified in 24(92%) patients at 25.4 cm(SD2.1) and 26.7 cm(SD 1.9) from the incisors, by white light and EUS, respectively.The left atrium was recognized in all patients at 30.5 cm(SD 1.9), and 31.6 cm(SD2.3) from the incisors, by both white light and EUS, respectively. EUS confi

关键词： Esophagus Natural landmark Radial orientation Longitudinal orientation Four-quadrants Left main bronchus Left atrium

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Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasoundelastography

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World Journal of Gastroenterology 2020年第34期26卷 5169-5180页

作者： Elymir S Galvis-García Sergio Sobrino-Cossío Arturo Reding-Bernal Yesica Contreras-Marín Karina Solórzano-Acevedo Patricia González-Zavala Rosa M Quispe-Siccha unidad de Endoscopía Gastrointestinal Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico unidad de endoscopia y Fisiología digestiva HospitalÁngeles del PedregalMexico 10700Mexico Dirección de Investigación Hospital General de México“Dr.Eduardo Liceaga”Mexico 06720Mexico unidad Profesional Interdisciplinaria de Biotecnología and unidad de Investigación y desarrollo Tecnológico Instituto Politécnico Nacional and Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico Instituto de Investigaciones en Materiales and unidad de Investigación y desarrollo Tecnológico Universidad Nacional Autónoma de México and Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico unidad de Investigación y desarrollo Tecnológico Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico

BACKGROUND Endoscopic ultrasound(EUS)and endoscopic ultrasound elastography(EUS-E)simulation lessens the learning curve;however,models lack realism,diminishing competitiveness.AIM To standardize the mechanical properties of polyvinyl alcohol(PVA)hydrogel for simulating organs and digestive lesions.METHODS PVA hydrogel(Sigma Aldrich,degree of hydrolysis 99%)for simulating EUS/EUS-E lesions was investigated in unidad de Investigación y desarrollo Tecnológico at Hospital General de México“Dr.Eduardo Liceaga”,Mexico City.We evaluated physical,contrast,elasticity and deformation coefficient characteristics in lesions,applying Kappa’s concordance and satisfaction questionnaire(Likert 4-points).RESULTS PVA hydrogel showed stable mechanical properties.density depended on molecular weight(MW)and concentration(C).PVA bblocks with the greatest density showed lowest tensile strength(r=-0.8,P=0.01).Lesions were EUSgraphically visible.Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms,exceeding(MW2=146000-186000,C9=15%and C10=20%)with a density under(MW1=85000-124000,C1=7%and C2=9%).We calculated elasticity and deformation parameters of solid(blue)areas,contrasting with the norm(Kappa=0.8;high degree of satisfaction).CONCLUSION PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E,facilitating practice and reducing risk.Repetition amplified skills,while reducing the learning curve.

关键词： Endoscopic ultrasound simulators in endoscopy Polyvinyl alcohol Endoscopic ultrasound Endoscopic ultrasound elastography Strain Elasticity

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World Journal of Gastroenterology 2021年第42期27卷 7299-7310页

作者： Sinan Sadalla Andrea Lisotti Lorenzo Fuccio Pietro Fusaroli UnitàOperativa Complessa di Gastroenterologia e endoscopia digestiva Universitàdi Bologna/Ospedale di ImolaImola(BO)40024Italy UnitàOperativa Complessa di Gastroenterologia e endoscopia digestiva Universitàdi Bologna/Ospedale di ImolaImola(BO)40026Italy Divisione di Gastroenterologia Dipartimento di Scienze Medico-Chirurgiche(DIMEC)IRCSS-Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

Colonoscopy is a risk factor for colon ischemia.The colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs;the etiology of colon ischemia after colonoscopy is multifactorial.The causative mechanisms include splanchnic circulation impairment,bowel preparation,drugs used for sedation,bowel wall ischemia due to insufflation/barotrauma,and introduction of the endoscope.Gastroenterologists must be aware of this condition and its risk factors for risk minimization,early diagnosis,and proper treatment.

关键词： Endoscopy Colon ischemia Colonoscopy Bowel preparation Mesenteric circulation Ischemic colitis

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Diagnostic-therapeutic management of bile duct cancer

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World Journal of Clinical Cases 2019年第14期7卷 1732-1752页

作者： José María Huguet Miriam Lobo José Mir Labrador Carlos Boix Cecilia Albert Luis Ferrer-Barceló Ana B Durá Patricia Suárez Isabel Iranzo Mireia Gil-Raga Celia Baez de Burgos Javier Sempere Digestive Disease department General University Hospital of ValenciaValencia 46014Spain Medical Oncology department General University Hospital of ValenciaValencia 46014Spain unidad Hepática Avanzada Servicio de Cirugía General y DigestivaGeneral University Hospital of ValenciaValencia 46014Spain Medical Oncology department Hospital de RequenaRequena 46340Spain

Biliary tract cancer, or cholangiocarcinoma, comprises a heterogeneous group of malignant tumors that can emerge at any part of the biliary tree. This group is the second most common type of primary liver cancer. Diagnosis is usually based on symptoms, which may be heterogeneous, and nonspecific biomarkers in serum and biopsy specimens, as well as on imaging techniques. Endoscopy-based diagnosis is essential, since it enables biopsy specimens to be taken. In addition, it can help with locoregional staging of distal tumors. Endoscopic retrograde cholangiopancreatography is a key technique for the evaluation and treatment of malignant biliary tumors. Correct staging of cholangiocarcinoma is essential in order to be able to determine the degree of resectability and assess the results of treatment. The tumor is staged based on the TNM classification of the American Joint Committee on Cancer. The approach will depend on the classification of the tumor. Thus, some patients with early-stage disease could benefit from surgery;complete surgical resection is the cornerstone of cure. However, only a minority of patients are diagnosed in the early stages and are suitable candidates for resection. In the subset of patients diagnosed with locally advanced or metastatic disease, chemotherapy has been used to improve outcome and to delay tumor progression. The approach to biliary tract tumors should be multidisciplinary, involving experienced endoscopists, oncologists, radiologists, and surgeons.

关键词： Bile duct cancer Cholangiocarcinoma Management Diagnosis Incidence Multidisciplinary treatment

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Thiopurine-methyltransferase variants in inflammatory bowel disease:Prevalence and toxicity in Brazilian patients

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World Journal of Gastroenterology 2014年第12期20卷 3327-3334页

作者： Ana Teresa P Carvalho Barbara C Esberard Renata S B Fróes Davy C M Rapozo Ana B Grinman Tatiana A Simo Juliana C V C Santos Antonio José V Carneiro Luis Felipe Ribeiro-Pinto Heitor S P de Souza Disciplina de Gastroenterologia e endoscopia digestiva Universidade do Estado do Rio de Janeiro Programa de Carcinogênese Molecular Instituto Nacional de Cancer Laboratório de Toxicologia e Biologia Molecular Universidade do Estado do Rio de Janeiro Servi?o de Gastroenterologia Departamento de Clínica MédicaUniversidade Federal do Rio de Janeiro

AIM:To analyze the prevalence of thiopurine-methyltransferase(TPMT)genotypes and their associationwith drug toxicity in inflammatory bowel disease(IBD)patients from southeastern Brazil.METHODS:A total of 219 consecutive patients with IBD,of which 146 had Crohn’s disease and 73 had ulcerative colitis,regularly seen at the outpatient unit of the Division of Gastroenterology at the University Hospital Pedro Ernesto of the State University of Rio de Janeiro,a tertiary referral center,were enrolled in this study from February 2009 to January 2011.We analyzed the presence of major TPMT genetic variants(TPMT*2,*3A,*3C)in IBD patients by means of a specific allele and RFLP-PCR.Genomic DNA was isolated from peripheral blood leukocytes by proteinase-K/Sodium Dodecyl Sulfate digestion and phenol-chloroform extraction.TPMT*2(C238G),TPMT*3A(G460A/A719G),and TPMT*3C(A719G)genotypes were detected by real-time polymerase chain reaction followed by direct sequencing with specific primers.Clinical data were systematically recorded,and correlated with the genotype results.RESULTS:The distribution of the selected TPMT gene polymorphism TPMT*2(C238G),TPMT*3A(G460A/A719G),and TPMT*3C(A719G)genotypes was 3.6%,5.4%,and 7.7%of the patients,respectively.Among the side effects recorded from patients taking azathioprine,14 patients presented with pancreatitis and/or an elevation of pancreatic enzymes,while 6 patients had liver toxicity,and 2 patients exhibited myelosuppression/neutropenia.TPMT polymorphisms were detected in 37/219 patients(8 heterozygous for*2,11 heterozygous for*3A,and 18 heterozygous for*3C).No homozygotic polymorphisms were found.despite the prevalence of the TPMT*3C genotype,no differences among the genotype frequencies were significant.Although no association was detected regarding myelotoxicity or hepatotoxicity,a trend towards the elevation of pancreatic enzymes was observed for TPMT*2 and TPMT*3C genotypes.CONCLUSION:The prevalence of TPMT genotypes was high among Brazilian patients.Variants genes*2and*3C may be ass

关键词： Inflammatory bowel disease Thiopurinemethyl-transf

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Association between Helicobacter spp.infections and hepatobiliary malignancies:A review

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World Journal of Gastroenterology 2015年第5期21卷 1414-1423页

作者： Fany Karina Segura-López Alfredo Güitrón-Cantú Javier Torres Hospital de Especialidades UMAE No 71 Instituto Mexicano del Seguro SocialTorreónCoahuila 27000México departamento de endoscopia Gastrointestinal Hospital de Especialidades UMAE No 71Instituto Mexicano del Seguro SocialTorreónCoahuila 2700México unidad de Investigación en Enfermedades Infecciosas y Parasitarias Hospital de Pediatría UMAECentro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialMéxico CP 06720DFMéxico

Hepatobiliary cancers are highly lethal cancers that comprise a spectrum of invasive carcinomas originating in the liver hepatocellular carcinoma,the bile ducts intrahepatic cholangiocarcinoma and extrahepaticcholangiocarcinoma,the gallbladder and the ampulla of Vater(collectively known as biliary tract cancers).These tumors account for approximately 13% of all annual cancer-related deaths worldwide and for 10%-20% of deaths from hepatobiliary malignancies.Cholangiocarcinoma(CCA) is a devastating disease that displays a poor survival rate for which few therapeutic options are available.Population genetics,geographical and environmental factors,cholelithiasis,obesity,parity,and endemic infection with liver flukes have been identified as risk factors that influence the development of biliary tract tumors.Other important factors affecting the carcinogenesis of these tumors include chronic inflammation,obstruction of the bile ducts,and impaired bile flow.It has been suggested that CCA is caused by infection with Helicobacter species,such as Helicobacter bilis and Helicobacter hepaticus,in a manner that is similar to the reported role of Helicobacter pylori in distal gastric cancer.Due to the difficulty in culturing these Helicobacter species,molecular methods,such as polymerase chain reaction and sequencing,or immunologic assays have become the methods of choice for diagnosis.However,clinical studies of benign or malignant biliary tract diseases revealed remarkable variability in the methods and the findings,and the use of uniform and validated techniques is needed.

关键词： Helicobacter bilis Helicobacter hepaticus Helicoba

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Human cytomegalovirus and Epstein-Barr virus infection in inflammatory bowel disease:Need for mucosal viral load measurement

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World Journal of Gastroenterology 2015年第6期21卷 1915-1926页

作者： Rachele Ciccocioppo Francesca Racca Stefania Paolucci Giulia Campanini Lodovica Pozzi Elena Betti Roberta Riboni Alessandro Vanoli Fausto Baldanti Gino Roberto Corazza Centre for the Study and Cure of Inflammatory Bowel Disease Clinica Medica I IRCCS San Matteo Hospital Foundation University of Pavia SS Virologia Molecolare - SC Virologia e Microbiologia Fondazione IRCCS Policlinico San Matteo Servizio di endoscopia digestiva Fondazione IRCCS Policlinico San Matteo Servizio di Anatomia Patologica Fondazione IRCCS Policlinico San Matteo

AIM:To evaluate the best diagnostic technique and risk factors of the human Cytomegalovirus(HCMV)and Epstein-Barr virus(EBV)infection in inflammatory bowel disease(IBD).METHODS:A cohort of 40 IBD patients(17 refractory)and 40 controls underwent peripheral blood and endoscopic colonic mucosal sample harvest.Viral infection was assessed by quantitative real-time polymerase chain reaction and immunohistochemistry,and correlations with clinical and endoscopic indexes of activity,and risk factors were investigated.RESULTS:All refractory patients carried detectable levels of HCMV and/or EBV mucosal load as comparedto 13/23(56.5%)non-refractory and 13/40(32.5%)controls.The median DNA value was significantly higher in refractory(HCMV 286 and EBV 5.440 copies/105cells)than in non-refractory(HCMV 0 and EBV 6copies/105 cells;Pdentified as a significant risk factor for both HCMV(P=0.018)and EBV(P=0.002)colitis.Finally,a course of specific antiviral therapy with ganciclovir was successful in all refractory patients with HCMV colitis,whilst refractory patients with EBV colitis did not show any improvement despite steroid tapering and discontinuation of the other medications.CONCLUSION:Viral colitis appeared to contribute to mucosal lesions in refractory IBD,and its correct diagnosis and management require quantitative real-time polymerase chain reaction assay of mucosal specimens.

关键词： Inflammatory bowel disease quantitative real-time

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Liver carcinogenesis: diagnostic and clinical aspects of preneoplastic nodules

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Hepatoma Research 2019年第5期5卷 10-25页

作者： Mauro Borzio Fabio Paladino Giampiero Francica U.O.Gastroenterologia ed endoscopia digestiva ASST Melegnano-MartesanaMelegnanoVizzolo Predabissi 20070MIItaly U.O.Chirurgia ASST Melegnano-MartesanaMelegnanoVizzolo Predabissi 20070MIItaly U.O.Ecografia ed Econterventistica Pineta Grande HospitalCastel Volturno 81030CEItaly

In multistep hepatocarcinogenesis,sizable lesions can precede the development of hepatocellular carcinoma(HCC).These lesions are currently classified as low grade(LG)-and high grade(HG)-dysplastic nodules.Following international guidelines recommending the surveillance of cirrhotic patients,a growing number of 1-2 cm hepatocellular nodules are recognized including early hepatocellular carcinoma(eHCC)and DN the latter accounting for as many as 70%of nodulesdered the most advanced HCC precursors.The histological diagnosis of low-grade dysplastic nodule(LG-DN),high-grade dysplastic nodule(HG-DN)and eHCC in small liver biopsies requires a comprehensive stepwise morphological and immunocytochemical approach.By imaging the differential diagnosis among these lesions is a challenge.According to vascular enhancement at dynamic computed tomography(CT)or magnetic resonance imaging(MRI)these precursors are classified as hypo-vascular/indeterminate nodules even though distinction between LG-DN and HG-DN is almost impossible.The introduction of gadoexetic acid-enhanced MRI has represented an extremely important advance in this field allowing a better differentiation of dysplastic lesions from eHCC and progressed HCC.Additional MRI features as diffusion-weighted imaging further improved diagnostic accuracy of imaging.According to Liver Imaging Reporting and Data System(LI-RADS),either CT/MRI or Contrast-Enhanced Ultrasound LI-RADS,the dysplastic lesions should be categorized as LR-3 or LR-4.Natural history of these lesions confirmed that HCC can develop from HG-DN but which nodule and when it will undergo malignant transformation is not predictable.The search and validation of radiological and tissue markers able to select lesions more prone to HCC development,is currently underway.Whether and how HG-DN should be ablated or closely followed up is currently debated.

关键词： Low-grade dysplastic nodule high-grade dysplastic nodule early hepatocellular carcinoma progressed hepatocellular carcinoma dynamic imaging gadoexetic acid-enhanced resonance imaging hepatobiliary phase

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Outcome of the Use of a Synthetic Mesh in the Repair of Burst Abdomen as Compared with Simple Suture

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International Journal of Clinical Medicine 2015年第3期6卷 113-118页

作者： Manuel López-Cano José A. Pereira Xavier Feliu Lourdes Hernández Daniel Andrada Esther Gil Borja Villanueva Manuel Armengol-Carrasco unidad de Cirugía de la Pared Abdominal Servicio de Cirugía General y Digestiva Hospital Universitario Vall d’Hebron Universitat Autònoma de Barcelona Barcelona Spain Servicio de Cirugía General y digestiva Hospital del Mar Parc de Salut Mar Departamento de Ciencias Experimentales y de la Salud Universitat Pompeu Fabra Barcelona Spain Servicio de Cirugía General y digestiva Hospital de Igualada Barcelona Spain

Aim: To assess the outcome (postoperative morbidity and mortality and/or development of incisional hernia) of patients with burst abdomen (BA) of midline laparotomy without intestinal fistula comparing early closure of the abdominal wall with a running suture alone vs. running suture plus reinforcement with a non-absorbable synthetic mesh. Methods: Retrospective analysis of the medical records of all patients undergoing surgical repair of a BA in three hospitals between 2006 and 2011. Risk factors, postoperative complications and the incidence of incisional hernia (IH) after a minimum of 12-month follow-up period were compared between groups. Results: A total of 109 patients were treated for BA, 18 patients treated by non-standard procedures were excluded from analysis. Of the remaining 91 patients, 56 belong to the mesh group and 35 to the suture group. The overall rate of postoperative complications was high in both groups (79.1%). Mortality rate was higher in the suture group than in the mesh group (31.4% vs. 14.3%;P = 0.06). IH was also more frequent in the suture group (36.4% vs. 17.6%;P = 0.057). Conclusions: Patients with BA and without intestinal fistula could be candidates for surgical repair using a running suture and a non-absorbable polypropylene mesh in the “onlay” position.

关键词： Mesh Suture Burst Abdomen Abdominal Wall Hernia

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Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

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World Journal of Gastroenterology 2014年第37期20卷 13382-13401页

作者： Renato Costi Alessandro Gnocchi Francesco Di Mario Leopoldo Sarli Dipartimento di Scienze Chirurgiche Università di ParmaAzienda Ospedaliero-Universitaria di Parma Dipartimento Materno Infantile Unità Operativa di Gastroenterologia ed Endoscopia DigestivaAzienda Ospedaliero-Universitaria di Parma Dipartimento di Medicina Clinica e Sperimentale Università di ParmaAzienda Ospedaliero-Universitaria di Parma

Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones(CBDS), which are asymptomatic in up to one half of cases. despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound(EUS) and magnetic resonance cholangiography(MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and costeffectiveness of imaging techniques used to identifyCBDS increase together in a parallel way, the concept of "risk of carrying CBDS" has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of "under-studying" by poor diagnostic work up or "over-studying" by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. "Low risk" patients do not require further examination before laparoscopic cholecystectomy. Two main "philosophical approaches" face each other for patients with an "intermediate to high risk" of carrying CBDS: on one hand, the "laparoscopy-first" approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the "endoscopy-first" attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better short and long term outcome of surgery in terms of re

关键词： Biliary lithiasis Choledocholithiasis Laparoscopy

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