AIM: To assess the rate of relapses of acute pancreatitis (AP), recurrent AP (RAP) and the evolution of endosonographic signs of chronic pancreatitis (CP) in patients with pancreas divisum (PDiv) and RAP.
BACKGROUND Pancreatic endotherapy provides treatment options for the management of chronic pancreatitis-related structural complications such as pancreatic duct stones,strictures,and pancreatic fluid collections.Most ...BACKGROUND Pancreatic endotherapy provides treatment options for the management of chronic pancreatitis-related structural complications such as pancreatic duct stones,strictures,and pancreatic fluid collections.Most studies detailing endotherapy,however,have focused on technical success outcomes such as stone clearance or stricture resolution.AIM To review the effect of pancreatic endotherapy on patient-centered outcomes.METHODS Systematic review of studies examining pancreatic endotherapy.RESULTS A total of 13 studies including 3 randomized clinical trials were included.The majority of studies found an improvement in quality of life with pancreatic endotherapy.CONCLUSION While pancreatic endotherapy does appear to improve quality of life,there are clear gaps in knowledge regarding many pancreatic endotherapy modalities.Furthermore,qualitative analysis is lacking in these studies and further work is needed to elucidate the patient experience with pancreatic endotherapy.展开更多
Phytophthora species are particularly aggressive plant pathogens and are often associated with the decline of many tree species, including oak and beech. Several fungi and bacteria species are known as potential antag...Phytophthora species are particularly aggressive plant pathogens and are often associated with the decline of many tree species, including oak and beech. Several fungi and bacteria species are known as potential antagonists usable as biological control agents. Phosphonate （H3PO3）, commonly branded as phosphite, has also been used in the past years to protect trees against invasive Phytophthora spp.. This study aimed at comparing the effects of selected antagonist microorganisms and phosphonate, when applied by microinjection or leaf treatment. Antagonistic species were first selected for their high inhibitory activity against problematic Phytophthora species, such as Phytophthora cactorum, P. quercina and P. plurivora attacking Quercus robur and Fagus sylvatica in Polish forests. Three endophytic species Trichoderma atroviride （two strains）, T. harzianum and Bacillus amyloliquefaciens showed a high control activity, and their efficacy was then assessed in comparison with a phosphonate treatment. Two application methods were experimented in this study： injection of a solution of spores or phosphonate into the sap vessels of beech or a foliar treatment on oak. Phosphonate and two strains of Trichoderma significantly reduced the necrotic area on oak leaves inoculated with P. plurivora and one strain of T. atroviride significantly reduced necrotic areas on beech branches. These results are therefore promising of a novel way to control Phytophthora spp. in forest stands and nurseries.展开更多
The incidence of esophageal cancer,namely the adenocarcinoma subtype,continues to increase exponentially on an annual basis.The indolent nature of the disease renders a significant proportion inoperable at first prese...The incidence of esophageal cancer,namely the adenocarcinoma subtype,continues to increase exponentially on an annual basis.The indolent nature of the disease renders a significant proportion inoperable at first presentation,however,with the increased utilisation of endoscopy,many early lesions are now being identified which are suitable for endotherapeutic approaches.This article details the options available for dealing with early esophageal cancer by endoscopic mean obviating the need for surgery thereby avoiding the potential morbidity and mortality of such intervention.展开更多
BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main p...BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography(ERCP),which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract.However,in some patients,anatomical changes prevent transpapillary drainage of the main pancreatic duct.Surgery is the treatment of choice in such cases.AIM To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound(EUS)guidance.METHODS Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General,Gastroenterological and Oncological Surgery,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland.RESULTS In 9 patients[7 men,2 women;mean age 53.45(36-66)years],endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP.Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients(44.44%).Pancreatic fragmentation(disconnected pancreatic duct syndrome)was diagnosed in 3/9 patients(33.33%).In 2/9 patients(22.22%),narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy.Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients(88.89%).Endotherapeutic complications were observed in 2/9 patients(22.22%).Clinical success was achieved in 8/9 patients(88.89%).The mean follow-up period was 451(42-988)d.Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients(77.78%).CONCLUSION Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method,especially in the absence of transpapillary access to the main pancreatic duct.展开更多
Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and a...Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.展开更多
The development of pancreatic fluid collections(PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage....The development of pancreatic fluid collections(PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has be-come easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.展开更多
Over the last 15 years,endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to one that is primarily used to provide therapy. This development occurred f irst for biliary disorders ...Over the last 15 years,endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to one that is primarily used to provide therapy. This development occurred f irst for biliary disorders and subsequently to a lesser extent for pancreatic diseases. Computed tomography, magnetic resonance imaging,magnetic resonance cholangiopancreatography and endoscopic ultrasonography suggest a diagnosis in the majority of patients with pancreatic diseases today and can help physicians and patients avoid unnecessary ERCP. However, a selected number of patients with pancreatic diseases may benef it from pancreatic endotherapy and avoid complex surgery and chronic use of medications. Pancreatic sphincterotomy, pancreatic stenting and pancreatic cyst drainage are some of the most effective and challenging endoscopic pancreatic interventions and should be performed with caution by expert therapeutic endoscopists.There has been a paucity of randomized studies investigating endoscopic techniques in comparison with surgery and medical therapy for the treatment of most benign and malignant pancreatic disorders due to the limited number of patients and the expertise required to attempt these procedures.展开更多
AIM To identify factors predicting outcome of endoscopic therapy in bile duct strictures(BDS) post living donor liver transplantation(LDLT).METHODS Patients referred with BDS post LDLT, were retrospectively studied. P...AIM To identify factors predicting outcome of endoscopic therapy in bile duct strictures(BDS) post living donor liver transplantation(LDLT).METHODS Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms(Pruritus, Jaundice, cholangitis), intra-op variables(cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis(HAT), bile leak, infections], stricture morphology(length, donor and recipient duct diameters) and relevant laboratory data both pre-and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0.RESULTS Forty-one patients were included(age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients(48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy(multiple endoscopic retrogradecholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome(P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak(> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis(P < 0.05). CONCLUSION Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients.展开更多
Barrett’s esophagus (BE) is a pre-malignant condition affecting up to 15% of patients with gastroesophageal reflux disease. Neoplastic Barrett’s mucosa is defined as harboring high grade dyspla...Barrett’s esophagus (BE) is a pre-malignant condition affecting up to 15% of patients with gastroesophageal reflux disease. Neoplastic Barrett’s mucosa is defined as harboring high grade dysplasia or intra-mucosal cancer, and carries a high risk of progression to esophageal adenocarcinoma. The rising incidence of Barrett’s lesions along with the high morbidity of surgical approaches has led to the development of numerous validated endoscopic techniques capable of eradicating neoplastic mucosa in a minimally invasive manner. While there has been widespread adoption of these techniques, less is known about optimal surveillance intervals in the post-therapy period. This is due in part to limitations in current surveillance methods, questions about durability of treatment response and the risk of subendothelial progression. As we are now able to achieve organ sparing eradication of superficial neoplasia in BE, we need to also then focus our attention on how best to manage these patients after eradication is achieved. Implementing optimal surveillance practices requires additional understanding of the biology of the disease, appreciation of the limits of current tools and treatments, and exploration of the role of adjunctive technologies. The aim of this article is to provide a comprehensive review of current literature surrounding post-ablation surveillance in neoplastic BE.展开更多
文摘AIM: To assess the rate of relapses of acute pancreatitis (AP), recurrent AP (RAP) and the evolution of endosonographic signs of chronic pancreatitis (CP) in patients with pancreas divisum (PDiv) and RAP.
文摘BACKGROUND Pancreatic endotherapy provides treatment options for the management of chronic pancreatitis-related structural complications such as pancreatic duct stones,strictures,and pancreatic fluid collections.Most studies detailing endotherapy,however,have focused on technical success outcomes such as stone clearance or stricture resolution.AIM To review the effect of pancreatic endotherapy on patient-centered outcomes.METHODS Systematic review of studies examining pancreatic endotherapy.RESULTS A total of 13 studies including 3 randomized clinical trials were included.The majority of studies found an improvement in quality of life with pancreatic endotherapy.CONCLUSION While pancreatic endotherapy does appear to improve quality of life,there are clear gaps in knowledge regarding many pancreatic endotherapy modalities.Furthermore,qualitative analysis is lacking in these studies and further work is needed to elucidate the patient experience with pancreatic endotherapy.
文摘Phytophthora species are particularly aggressive plant pathogens and are often associated with the decline of many tree species, including oak and beech. Several fungi and bacteria species are known as potential antagonists usable as biological control agents. Phosphonate （H3PO3）, commonly branded as phosphite, has also been used in the past years to protect trees against invasive Phytophthora spp.. This study aimed at comparing the effects of selected antagonist microorganisms and phosphonate, when applied by microinjection or leaf treatment. Antagonistic species were first selected for their high inhibitory activity against problematic Phytophthora species, such as Phytophthora cactorum, P. quercina and P. plurivora attacking Quercus robur and Fagus sylvatica in Polish forests. Three endophytic species Trichoderma atroviride （two strains）, T. harzianum and Bacillus amyloliquefaciens showed a high control activity, and their efficacy was then assessed in comparison with a phosphonate treatment. Two application methods were experimented in this study： injection of a solution of spores or phosphonate into the sap vessels of beech or a foliar treatment on oak. Phosphonate and two strains of Trichoderma significantly reduced the necrotic area on oak leaves inoculated with P. plurivora and one strain of T. atroviride significantly reduced necrotic areas on beech branches. These results are therefore promising of a novel way to control Phytophthora spp. in forest stands and nurseries.
文摘The incidence of esophageal cancer,namely the adenocarcinoma subtype,continues to increase exponentially on an annual basis.The indolent nature of the disease renders a significant proportion inoperable at first presentation,however,with the increased utilisation of endoscopy,many early lesions are now being identified which are suitable for endotherapeutic approaches.This article details the options available for dealing with early esophageal cancer by endoscopic mean obviating the need for surgery thereby avoiding the potential morbidity and mortality of such intervention.
基金The study was approved by the ethics committee of Collegium Medicum of Nicolaus Copernicus University(Toruń,Poland),No.KB 379/2023。
文摘BACKGROUND The outflow of pancreatic juice into the duodenum is often impaired in pancreatic inflammatory diseases.The basis of interventional treatment in these cases is anatomical transpapillary access of the main pancreatic duct during endoscopic retrograde cholangiopancreatography(ERCP),which ensures the physiological outflow of pancreatic juice into the lumen of the digestive tract.However,in some patients,anatomical changes prevent transpapillary drainage of the main pancreatic duct.Surgery is the treatment of choice in such cases.AIM To evaluate the effectiveness and safety of endoscopic pancreaticogastrostomy under endoscopic ultrasound(EUS)guidance.METHODS Retrospective analysis of treatment outcomes of all patients with acute or chronic pancreatitis who underwent endoscopic pancreatogastric anastomosis under EUS guidance in 2018-2023 at the Department of General,Gastroenterological and Oncological Surgery,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland.RESULTS In 9 patients[7 men,2 women;mean age 53.45(36-66)years],endoscopic pancreatogastric anastomosis under EUS guidance was performed because of the lack of transpapillary access during ERCP.Narrowing of the main pancreatic duct at the head of the pancreas was observed in 4/9 patients(44.44%).Pancreatic fragmentation(disconnected pancreatic duct syndrome)was diagnosed in 3/9 patients(33.33%).In 2/9 patients(22.22%),narrowing of the pancreatoenteric anastomosis was observed after pancreaticoduodenectomy.Technical success of endoscopic pancreaticogastrostomy was observed in 8/9 patients(88.89%).Endotherapeutic complications were observed in 2/9 patients(22.22%).Clinical success was achieved in 8/9 patients(88.89%).The mean follow-up period was 451(42-988)d.Long-term success of endoscopic pancreatogastric anastomosis was achieved in 7/9 patients(77.78%).CONCLUSION Endoscopic pancreaticogastrostomy under EUS guidance is an effective and safe treatment method,especially in the absence of transpapillary access to the main pancreatic duct.
文摘Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.
文摘The development of pancreatic fluid collections(PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has be-come easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.
文摘Over the last 15 years,endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to one that is primarily used to provide therapy. This development occurred f irst for biliary disorders and subsequently to a lesser extent for pancreatic diseases. Computed tomography, magnetic resonance imaging,magnetic resonance cholangiopancreatography and endoscopic ultrasonography suggest a diagnosis in the majority of patients with pancreatic diseases today and can help physicians and patients avoid unnecessary ERCP. However, a selected number of patients with pancreatic diseases may benef it from pancreatic endotherapy and avoid complex surgery and chronic use of medications. Pancreatic sphincterotomy, pancreatic stenting and pancreatic cyst drainage are some of the most effective and challenging endoscopic pancreatic interventions and should be performed with caution by expert therapeutic endoscopists.There has been a paucity of randomized studies investigating endoscopic techniques in comparison with surgery and medical therapy for the treatment of most benign and malignant pancreatic disorders due to the limited number of patients and the expertise required to attempt these procedures.
文摘AIM To identify factors predicting outcome of endoscopic therapy in bile duct strictures(BDS) post living donor liver transplantation(LDLT).METHODS Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms(Pruritus, Jaundice, cholangitis), intra-op variables(cold ischemia time, blood transfusions, number of ducts used, etc.), peri-op complications [hepatic artery thrombosis(HAT), bile leak, infections], stricture morphology(length, donor and recipient duct diameters) and relevant laboratory data both pre-and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0.RESULTS Forty-one patients were included(age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients(48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy(multiple endoscopic retrogradecholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome(P < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak(> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis(P < 0.05). CONCLUSION Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients.
文摘Barrett’s esophagus (BE) is a pre-malignant condition affecting up to 15% of patients with gastroesophageal reflux disease. Neoplastic Barrett’s mucosa is defined as harboring high grade dysplasia or intra-mucosal cancer, and carries a high risk of progression to esophageal adenocarcinoma. The rising incidence of Barrett’s lesions along with the high morbidity of surgical approaches has led to the development of numerous validated endoscopic techniques capable of eradicating neoplastic mucosa in a minimally invasive manner. While there has been widespread adoption of these techniques, less is known about optimal surveillance intervals in the post-therapy period. This is due in part to limitations in current surveillance methods, questions about durability of treatment response and the risk of subendothelial progression. As we are now able to achieve organ sparing eradication of superficial neoplasia in BE, we need to also then focus our attention on how best to manage these patients after eradication is achieved. Implementing optimal surveillance practices requires additional understanding of the biology of the disease, appreciation of the limits of current tools and treatments, and exploration of the role of adjunctive technologies. The aim of this article is to provide a comprehensive review of current literature surrounding post-ablation surveillance in neoplastic BE.
