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Liver transplantation as an alternative for the treatment of perihilar cholangiocarcinoma: A critical review

Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 139-145页

作者： Wellington Andraus Francisco Tustumi Alexandre Chagas Santana Rafael Soares Nunes Pinheiro Daniel Reis Waisberg Liliana Ducatti Lopes Rubens Macedo Arantes Vinicius Rocha Santos Rodrigo Bronze de Martino Luiz Augusto Carneiro D’Albuquerque Department of gastroenterology Transplantation UnitUniversidade de São PauloSão PauloBrazil

Background:Perihilar cholangiocarcinoma(phCCC)is a dismal *** is no consensus regard-ing the best treatment for patients with unresectable *** present review aimed to gather the current pieces of evidence for liver transplantation and liver resection as a treatment for phCCC and to build better guidance for clinical *** sources:The search was conducted in PubMed,Embase,Cochrane,and *** related references were searched *** criteria were:reports in English or Portuguese literature that a)patients with confirmed diagnosis of phCCC;b)patients treated with a curative intent;c)patients with the outcomes of liver resection and liver *** reports,reviews,letters,editorials,conference abstracts and papers with full-text unavailability were excluded from the ***:Most of the current literature is based on observational retrospective studies with low grades of *** resection has better long-term outcomes than systemic chemotherapy or palliation ther-apy and liver transplantation is a good alternative for selected patients with unresectable *** candidates for resection or transplantation should be medically fit and free of intrahepatic or extrahep-atic *** a general rule,patients presenting with a tumor having a longitudinal size>3 cm or extending below the cystic duct,lymph node disease,confirmed extrahepatic dissemination;intraoper-atively diagnosed metastatic disease;a history of other malignancies within the last five years,and did not complete chemoradiation regimen and were medically unfit should not be considered for *** of these criteria should be individually *** transplantation or resection should only be considered in highly experienced hepatobiliary centers,and any decision-making must be based on a multidisciplinary ***:phCCC is a complex condition with high *** therapies,including hepatec-tomy and liv

关键词： Liver transplantation Cholangiocarcinoma Liver neoplasms

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Device-assisted enteroscopy: Are we ready to dismiss the spiral?

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World Journal of gastroenterology 2024年第26期30卷 3185-3192页

作者： Alessandro Mussetto Elettra Merola Cesare Casadei Daniele Salvi Fabiola Fornaroli Silvia Cocca Margherita Trebbi Armando Gabbrielli Cristiano Spada Andrea Michielan Department of gastroenterology S Maria della Croci HospRavenna 48121Italy Department of gastroenterology unit G.B.Grassi Hospital(ASL Roma 3)Roma 00122Italy Section of Digestive Endoscopy and gastroenterology Fondazione PoliambulanzaBrescia 25124Italy gastroenterology and Endoscopy unit Department of Medicine and SurgeryUniversity of ParmaParma 43125Italy gastroenterology and Endoscopy unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy Center for Medical Sciences(CISMed) University of TrentoTrento 38122Italy gastroenterology and Digestive Endoscopy unit Santa Chiara HospitalAzienda Provinciale per i Servizi SanitariTrento 38122Italy Digestive Endoscopy unit Fondazione Policlinico Universitario A.Gemelli IRCSSRoma 00168Italy

Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted *** events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled *** the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic *** conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the *** primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue *** its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.

关键词： Motorized spiral enteroscopy Rescue enteroscopy Diagnostic yield Adverse events AGREE classification

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Artificial intelligence in detection of small bowel lesions and their bleeding risk:A new step forward

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World Journal of gastroenterology 2024年第18期30卷 2482-2484页

作者： Silvia Cocca Giuseppina Pontillo Giuseppe Grande Rita Conigliaro gastroenterology and Endoscopy unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy gastroenterology and Endoscopy unit Presidio Ospedaliero San Giuseppe Moscati(AversaCE)-ASL CasertaCaserta 81100Italy Department of gastroenterology and Digestive Endoscopy Azienda Ospedaliero Universitaria di ModenaModena 41121Italy

The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool to assess SB diseases but it is a time-consuming procedure with a significant error *** development of artificial intelligence(AI)in CE could simplify physicians’*** novel deep learning model by Zhang et al seems to be able to identify various SB lesions and their bleeding risk,and it could pave the way to next perspective studies to better enhance the diagnostic support of AI in the detection of different types of SB lesions in clinical practice.

关键词： Capsule endoscopy Small bowel Artificial intelligence Bleeding risk Vascular lesions

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Endo-hepatology: Why should we do endoscopic ultrasound-guided interventions to the liver that we could do through the skin?

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World Journal of gastroenterology 2024年第40期30卷 4333-4338页

作者： Claudio Calvanese Pietro Fusaroli gastroenterology unit Hospital of ImolaUniversity of BolognaImola 40026BolognaItaly

Endoscopic ultrasound(EUS)-guided interventions on the liver such as diffuse biopsy and portal pressure gradient measurement are emerging as potential alternatives to percutaneous *** purpose of this editorial was to address all the indications that could potentially make an EUS-guided approach a possible alternative to the percutaneous procedures with respect to the proce-dures that could join the EUS examination such as upper endoscopy for gastro-esophageal varices,pancreaticobiliary investigation with EUS,and other potential advantages in terms of patient *** issue of a holistic gastroenterologist approach was also discussed along with the potential for developing clinical research.

关键词： Endo-hepatology Endoscopic ultrasound Endosonography Liver disease Liver biopsy Portal hypertension

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Prediction,prevention and management of gastroesophageal reflux after per-oral endoscopic myotomy:An update

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World Journal of gastroenterology 2024年第9期30卷 1096-1107页

作者： Zaheer Nabi Pradev Inavolu Nageshwar Reddy Duvvuru Department of gastroenterology Asian Institute of GastroenterologyHyderabad 500082TelanganaIndia Department of Medical gastroenterology Asian Institute of GastroenterologyHyderabad 500032TelanganaIndia

Achalasia cardia,the most prevalent primary esophageal motility disorder,is predominantly characterized by symptoms of dysphagia and *** principal therapeutic approaches for achalasia encompass pneumatic dilatation(PD),Heller's myotomy,and the more recent per-oral endoscopic myotomy(POEM).POEM has been substantiated as a safe and efficacious modality for the management of *** POEM demonstrates superior efficacy compared to PD and an efficacy parallel to Heller's myotomy,the incidence of gastroesophageal reflux disease(GERD)following POEM is notably higher than with the aforementioned *** symptomatic reflux post-POEM is relatively infrequent,the significant occurrence of erosive esophagitis and heightened esophageal acid exposure necessitates vigilant monitoring to preclude long-term GERD-related *** advancements in the field have enhanced our comprehension of the risk factors,diagnostic methodologies,preventative strategies,and therapeutic management of GERD subsequent to *** review focuses on the limitations inherent in the 24-h pH study for evaluating post-POEM reflux,potential modifications in the POEM technique to mitigate GERD risk,and the strategies for managing reflux following POEM.

关键词： Achalasia cardia Per-oral endoscopic myotomy Gastroesophageal reflux Esophagitis Gastroesophageal reflux disease

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Gut microbiota predicts the diagnosis of ulcerative colitis in Saudi children

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World Journal of Clinical Pediatrics 2024年第1期13卷 118-124页

作者： Mohammad El Mouzan Ahmed Al Sarkhy Asaad Assiri Department of Pediatrics Gastroenterology UnitKing Saud UniversityRiyadh 11461Saudi Arabia

BACKGROUND Ulcerative colitis(UC)is an immune-mediated chronic inflammatory condition with a worldwide *** the etiology of this disease is still unknown,the understanding of the role of the microbiota is becoming increasingly *** To investigate the predictive power of the gut microbiota for the diagnosis of UC in a cohort of newly diagnosed treatment-naïve Saudi children with *** The study population included 20 children with a confirmed diagnosis of UC and 20 healthy *** DNA was extracted and sequenced,and shotgun metagenomic analysis was performed for bacteria and *** and bioinformatics demonstrated significant dysbiosis in the form of reduced alpha diversity,beta diversity,and significant difference of abundance of taxa between children with UC and control *** receiver operating characteristic curve,a probability curve,was used to determine the difference between the UC and control *** area under the curve(AUC)represents the degree of separability between the UC group and the control *** AUC was calculated for all identified bacterial species and for bacterial species identified by the random forest classification algorithm as important potential biomarkers of UC.A similar method of AUC calculation for all bacteriophages and important species was *** The median age and range were 14(0.5-21)and 12.9(6.8-16.3)years for children with UC and controls,respectively,and 40%and 35%were male for children with UC and controls,*** AUC for all identified bacterial species was 89.5%.However,when using the bacterial species identified as important by random forest classification algorithm analysis, the accuracy increased to 97.6%. Similarly, the AUC for all theidentified bacteriophages was 87.4%, but this value increased to 94.5% when the important bacteriophagebiomarkers were *** very high to excellent AUCs of fecal bacterial and viral species sugge

关键词： Ulcerative colitis Microbiota Area under the curve Children Saudi Arabia

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Use of endoscopic ultrasound-guided gallbladder drainage as a rescue approach in cases of unsuccessful biliary drainage

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World Journal of gastroenterology 2024年第1期30卷 70-78页

作者： Alessandro Fugazza Kareem Khalaf Katarzyna M Pawlak Marco Spadaccini Matteo Colombo Marta Andreozzi Marco Giacchetto Silvia Carrara Chiara Ferrari Cecilia Binda Benedetto Mangiavillano Andrea Anderloni Alessandro Repici Division of gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSRozzano 20089MilanoItaly Division of gastroenterology St.Michael’s HospitalUniversity of TorontoToronto M5B 1W8ONCanada Department of Anesthesia Humanitas Research Hospital-IRCCSRozzano 20089MilanoItaly gastroenterology and Digestive Endoscopy unit Forlì-Cesena HospitalsRomagna 47121Italy Gastrointestinal Endoscopy unit Humanitas Mater DominiCastellanza 21100Italy gastroenterology and Digestive Endoscopy unit Fondazione IRCCS Policlinico San MatteoPavia 27100Italy

This narrative review provides an overview of the utilization of endoscopic ultrasound-guided gallbladder drainage(EUS-GBD)as a salvage approach in cases of unsuccessful conventional ***-GBD is a minimally invasive and effective technique for drainage in patients with acute cholecystitis with high risk of *** procedure has demonstrated impressive technical and clinical success rates with low rates of adverse events,making it a safe and effective option for appropriate ***,EUS-GBD can also serve as a rescue option for patients who have failed endoscopic retrograde cholangiopancreatography or EUS biliary drainage for relief of jaundice in malignant biliary ***,patient selection is critical for the success of EUS-GBD,and proper patient selection and risk assessment are important to ensure the safety and efficacy of the *** the field continues to evolve and mature,ongoing research will further refine our understanding of the benefits and limitations of EUS-GBD,ultimately leading to improved outcomes for patients.

关键词： Endoscopic ultrasound-guided gallbladder drainage Gallbladder drainage Acute cholecystitis Malignant obstruction Interventional endoscopic ultrasound Lumen-apposing metal stents

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Laparoscopic central pancreatectomy with gastro-pancreatic anastomosis for symptomatic serous cystadenoma:A case report and literature review

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Laparoscopic, Endoscopic and Robotic Surgery 2024年第2期7卷 87-91页

作者： Giuseppe Frazzetta Antonino Picciurro Angela Maffongelli Irene Vitale Francesco Vitale Daniela Scimeca Michele Amata Anna Calì Ambra Bonaccorso Barbara Scrivo Vincenzo Di Martino Elisabetta Conte Filippo Mocciaro Roberto Di Mitri Pierenrico Marchesa Oncologic Surgery unit ARNAS Civico HospitalPalermo 90100Italy gastroenterology unit ARNAS Civico HospitalPalermo 90100Italy

Surgery for lesions of the proximal part of the pancreatic body or neck can be challenging,and when enucleation is not possible,central pancreatectomy is an *** central pancreatic resection is rarely described worldwide;it is considered a difficult procedure mainly because of the risk of double pancreatic fistula developing at two sites of ***,it seems to be an excellent alternative to distal pancreatectomy or pancreaticoduodenectomy,with the advantages of preserving functioning parenchyma and reducing endocrine and exocrine ***,patients with pancreatic lesions requiring central resection are often managed with the open approach in many hospitals due to the complexity of total laparoscopic central pancreatectomy,which requires advanced laparoscopic skills,expertise and ***,we report a case of a 29-year-old female who underwent total laparoscopic central pancreatic resection with gastro-pancreatic anastomosis for symptomatic serous *** discuss the details of case management and review the relevant literature.

关键词： Laparoscopic Pancreatic surgery Central pancreatectomy Cystadenoma

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Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

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World Journal of Hepatology 2024年第3期16卷 428-438页

作者： Senamjit Kaur Rodrigo V Motta Bryony Chapman Victoria Wharton Jane D Collier Francesca Saffioti Oxford Liver unit Department of Gastroenterology and HepatologyOxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom Oxford Liver unit and Translational gastroenterology unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine *** safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive *** hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of *** To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver *** A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our united Kingdom tertiary centre between 2018 and 2022 was ***’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,***-Meier survival estimates were generated to stratify time-related outcomes according to the type of *** Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular *** baseline characteristics were similar between the *** antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP *** overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain

关键词： Decompensated liver cirrhosis Indwelling abdominal catheter Rocket drain Palliative care Safety Quality of life

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Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management:Delphi consensus study

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World Journal of gastroenterology 2024年第18期30卷 2467-2478页

作者： Edda Battaglia Luciano Bertolusso Marco Del Prete Marco Monzani Marco Astegiano gastroenterology unit ASLTO4Ivrea 10015TurinItaly General Practitioner ASL CN2Alba-Bra 12051CuneoItaly Specialist in Nephrology International Academy of Physiological Regulating Medicine Milan 20100Italy Specialist in Endocrinology Territorial Social and Health Authority of BrianzaMonza 20900Italy gastroenterology Specialist Retired from Gastroenterology and Hepatology UnitAOU Cittàdella Salute e della ScienzaTurin 10123Italy

BACKGROUND Gastro-esophageal reflux disease(GERD)may affect the upper digestive tract;up to 20%of population in Western nations are affected by ***,histamine H2-receptor antagonists,and Proton Pump Inhibitors(PPIs)are considered the referring medications for ***,PPIs must be managed carefully because their use,especially chronic,could be linked with some adverse *** effective and safe alternative pharmacological tool for GERD is *** the identification of potentially new medications to flank PPIs,it is mandatory to revise and improve good clinical practices even through a consensus *** To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi *** The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel,subject of the consensus,is the basic prerequisite for the consensus itself.A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of *** Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations:gastroenterology,otolaryngology,geriatrics,and general medicine.A scientific committee analyzed the literature,determined areas that required investigation(in agreement with the multiple-choice questionnaire results),and identified two topics of interest:(1)GERD disease;and(2)GERD *** for each of these topics were then formulated and *** Delphi process involved two rounds of questioning submitted to the panel experts using an online *** According to their routinary GERD practice and current clinical evidence,the panel members provided feedback to each questionnaire *** experts evaluated 15 statements and reached consensus on all *** statements regarding the GERD disease showed high levels of

关键词： Gastro-esophageal reflux disease Proton Pump Inhibitors Consensus Nux vomica-Heel Overlapping Decalage

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