The rate of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be approximately 10%-33%,depending on the patient's age.Development of Endoscopic Retrograde Cholangiopancreatography and...The rate of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be approximately 10%-33%,depending on the patient's age.Development of Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Surgery and improvement of diagnostic procedures have influenced new approaches to the management of common bile duct stones in association with gallstones.At present available minimally-invasive treatments of cholecysto-choledocal lithiasis include:single-stage laparoscopic treatment,perioperative endoscopic treatment and endoscopic treatment alone.Published data evidence that,associated endoscopic-laparoscopic approach necessitates increased number of procedures per patient while single-stage laparoscopic treatment is associated with a shorter hospital stay.However,current data does not suggest clear superiority of any one approach with regard to success,mortality,morbidity and cost-effectiveness.Considering the variety of therapeutic options available for management,a critical appraisal and decision-making is required.endoscopic retrograde cholangiopancreatography/EST should be adopted on a selective basis,i.e.,in patients with acute obstructive suppurative cholangitis,severe biliary pancreatitis,ampullary stone impaction or severe comorbidity.In a setting where all facilities are available,decision in the selection of the therapeutic option depends on the patients,the number and size of choledocholithiasis stones,the anatomy of the cystic duct and common bile duct,the surgical history of patients and local expertise.展开更多
Esophageal cancer(EC) remains one of the most common and aggressive diseases worldwide.This review discusses some debates in the modern management of the disease.Endoscopic procedures for early cancer(T1a-b) are now e...Esophageal cancer(EC) remains one of the most common and aggressive diseases worldwide.This review discusses some debates in the modern management of the disease.Endoscopic procedures for early cancer(T1a-b) are now embedded in routine care and the challenge will be to more accurately select patients for endoscopic resection with or without adjuvant therapy.Perioperative multimodal therapies are associated with improved survival compared to surgery alone for locally advanced esophageal cancer.However, there is no global consensus on the optimal regimen.Furthermore, histological subtype(adenocarcinoma vs.squamous cell cancer) plays a role in the choice for treatment.New studies are underway to resolve some issues.The extent of the lymphadenectomy during esophagectomy remains controversial especially after neoadjuvant chemoradiation.The ideal operation balances between limiting surgical trauma and optimizing survival.Minimally invasive esophagectomy and enhanced recovery pathways are associated with decreased morbidity and faster recovery albeit there is no consensus yet what approach should be used.Finally, immune checkpoint inhibitors present promising preliminary results in the novel treatment of advanced or metastatic EC but their widespread application in clinical practice is still awaited.展开更多
BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis...BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.展开更多
文摘The rate of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be approximately 10%-33%,depending on the patient's age.Development of Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Surgery and improvement of diagnostic procedures have influenced new approaches to the management of common bile duct stones in association with gallstones.At present available minimally-invasive treatments of cholecysto-choledocal lithiasis include:single-stage laparoscopic treatment,perioperative endoscopic treatment and endoscopic treatment alone.Published data evidence that,associated endoscopic-laparoscopic approach necessitates increased number of procedures per patient while single-stage laparoscopic treatment is associated with a shorter hospital stay.However,current data does not suggest clear superiority of any one approach with regard to success,mortality,morbidity and cost-effectiveness.Considering the variety of therapeutic options available for management,a critical appraisal and decision-making is required.endoscopic retrograde cholangiopancreatography/EST should be adopted on a selective basis,i.e.,in patients with acute obstructive suppurative cholangitis,severe biliary pancreatitis,ampullary stone impaction or severe comorbidity.In a setting where all facilities are available,decision in the selection of the therapeutic option depends on the patients,the number and size of choledocholithiasis stones,the anatomy of the cystic duct and common bile duct,the surgical history of patients and local expertise.
文摘Esophageal cancer(EC) remains one of the most common and aggressive diseases worldwide.This review discusses some debates in the modern management of the disease.Endoscopic procedures for early cancer(T1a-b) are now embedded in routine care and the challenge will be to more accurately select patients for endoscopic resection with or without adjuvant therapy.Perioperative multimodal therapies are associated with improved survival compared to surgery alone for locally advanced esophageal cancer.However, there is no global consensus on the optimal regimen.Furthermore, histological subtype(adenocarcinoma vs.squamous cell cancer) plays a role in the choice for treatment.New studies are underway to resolve some issues.The extent of the lymphadenectomy during esophagectomy remains controversial especially after neoadjuvant chemoradiation.The ideal operation balances between limiting surgical trauma and optimizing survival.Minimally invasive esophagectomy and enhanced recovery pathways are associated with decreased morbidity and faster recovery albeit there is no consensus yet what approach should be used.Finally, immune checkpoint inhibitors present promising preliminary results in the novel treatment of advanced or metastatic EC but their widespread application in clinical practice is still awaited.
文摘BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.
