Non-alcoholic fatty liver disease(NAFLD)has become the most common liver disorder in Western countries and is increasingly being recognized in developing nations.Fatty liver disease encompasses a spectrum of hepatic p...Non-alcoholic fatty liver disease(NAFLD)has become the most common liver disorder in Western countries and is increasingly being recognized in developing nations.Fatty liver disease encompasses a spectrum of hepatic pathology,ranging from simple steatosis to non-alcoholic steatohepatitis,cirrhosis,hepatocellular carcinoma and end-stage liver disease.Moreover,NAFLD is often associated with other metabolic conditions,such as diabetes mellitus type 2,dyslipidemia and visceral obesity.The most recent guidelines suggest the management and treatment of patients with NAFLD considering both the liver disease and the associated metabolic co-morbidities.Diet and physical exercise are considered the first line of treatment for patients with NAFLD,but their results on therapeutic efficacy are often contrasting.Behavior therapy is necessary most of the time to achieve a sufficient result.Pharmacological therapy includes a wide variety of classes of molecules with different therapeutic targets and,often,little evidence supporting the real efficacy.Despite the abundance of clinical trials,NAFLD therapy remains a challenge for the scientific community,and there are no licensed therapies for NAFLD.Urgently,new pharmacological approaches are needed.Here,we will focus on the challenges facing actual therapeutic strategies and the most recent investigated molecules.展开更多
AIM To report data on Dilation-Assisted Stone Extraction(DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS From January 20...AIM To report data on Dilation-Assisted Stone Extraction(DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time(at least 30 s). Clinical success was obtained after complete stone removal(no remaining stones were visible at the cholangiogram).RESULTS Forty-nine male(40.8%) and 71 female(59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct(CBD) dilation was 19.2 mm± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38%(62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication(bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography(P = 0.031), DASE as first approach(P = 0.032), and cannulation of major papilla followed by guidewire insertion(P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications(P = 0.01). CONCLUSION DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones.展开更多
文摘Non-alcoholic fatty liver disease(NAFLD)has become the most common liver disorder in Western countries and is increasingly being recognized in developing nations.Fatty liver disease encompasses a spectrum of hepatic pathology,ranging from simple steatosis to non-alcoholic steatohepatitis,cirrhosis,hepatocellular carcinoma and end-stage liver disease.Moreover,NAFLD is often associated with other metabolic conditions,such as diabetes mellitus type 2,dyslipidemia and visceral obesity.The most recent guidelines suggest the management and treatment of patients with NAFLD considering both the liver disease and the associated metabolic co-morbidities.Diet and physical exercise are considered the first line of treatment for patients with NAFLD,but their results on therapeutic efficacy are often contrasting.Behavior therapy is necessary most of the time to achieve a sufficient result.Pharmacological therapy includes a wide variety of classes of molecules with different therapeutic targets and,often,little evidence supporting the real efficacy.Despite the abundance of clinical trials,NAFLD therapy remains a challenge for the scientific community,and there are no licensed therapies for NAFLD.Urgently,new pharmacological approaches are needed.Here,we will focus on the challenges facing actual therapeutic strategies and the most recent investigated molecules.
文摘AIM To report data on Dilation-Assisted Stone Extraction(DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time(at least 30 s). Clinical success was obtained after complete stone removal(no remaining stones were visible at the cholangiogram).RESULTS Forty-nine male(40.8%) and 71 female(59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct(CBD) dilation was 19.2 mm± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38%(62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication(bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography(P = 0.031), DASE as first approach(P = 0.032), and cannulation of major papilla followed by guidewire insertion(P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications(P = 0.01). CONCLUSION DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones.
