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1Transarterial chemoembolization and bland embolization for hepatocellular carcinoma显示文摘Transarterial chemoembolization(TACE)is the first line treatment for patients with intermediate stage hepatocellular carcinoma but is also increasingly being used for patients on the transplant waiting list to prevent further tumor growth.Despite its widespread use,TACE remains an unstandardized procedure,with variation in type and size of embolizing particles,type and dose of chemotherapy and interval between therapies.Existing evidence from randomized controlled trials suggest that bland transarterial embolization(TAE)has the same efficacy with TACE.In the current article,we review the use of TACE and TAE for hepatocellular carcinoma and we focus on the evidence for their use.Emmanuel A Tsochatzis Evangelia Fatourou James O'Beirne Tim Meyer Andrew K Burroughs 2014World Journal of Gastroenterology2014,20,12:18
2Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization显示文摘AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. Tumor enhancement and apparent diffusion coefficient (ADC, mm2/s) values were assessed immediately before and at 1 and 3 mo after TACE. We calculated the percent change (PC) in ADC values at all time points. We compared follow-up ADC values to baseline values using a paired t test (α = 0.05). RESULTS: The intra-procedural sensitivity, specificity, and positive and negative predictive values (%) for detecting a complete or partial 1-mo tumor response using ADC PC thresholds of ±5%, ±10%, and ±15% were 77, 67, 91, and 40; 54, 67, 88, and 25; and 46, 100, 100, and 30, respectively. There was no clear predictive value for the 3-mo follow-up. Compared to baseline, the immediate post-procedure and 1-mo mean ADC values both increased; the latter obtaining statistical significance (1.48 ± 0.29 mm2/s vs 1.65 ± 0.35 × 10-3 mm2/s, P < 0.014). CONCLUSION: Intra-procedural ADC changes of > 15% predicted 1-mo anatomical HCC response with the greatest accuracy, and can provide valuable feedback at the time of TACE.Johnathan C Chung Neel K Naik Robert J Lewandowski Mary F Mulcahy Laura M Kulik Kent T Sato Robert K Ryu Riad Salem Andrew C Larson Reed A Omary 2010World Journal of Gastroenterology2010,16,25:13
3Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL Conference显示文摘Jordi Bruix Morris Sherman Josep M Llovet Michel Beaugrand Riccardo Lencioni Andrew K Burroughs Erik Christensen Luigi Pagliaro Massimo Colombo Juan Rodés 2001Journal of Hepatology2001,,3:11
4Liver cirrhosis显示文摘Emmanuel A Tsochatzis Jaime Bosch Andrew K Burroughs 2014The Lancet2014,,:9
5The promise of γδ T cells and the γδ T cell receptor for cancer immunotherapy显示文摘γ δT 房间对感染和恶意的转变形成适应有免疫力的回答的重要部分。人的 γ 的分子的目标; δ大部分未知,却最近的 T 房间受体(TCR ) 遗体学习证实了 phosphorylated prenyl 代谢物的识别,在有 CD1 分子和细胞的应力的标记的建筑群的类脂化合物。所有这些分子是各种各样的癌症类型上的 upregulated,强调 γ 的潜在的重要性; δ在癌症 immunosurveillance 的 T 房间分隔空间并且为 γ 的使用铺平道路; δ在癌症治疗的 TCR。由 γ 的 Ligand 识别; δTCR 经常在 T 房间和目标 cells; 上要求 accessory/co-stimulatory 压力分子;这细胞的压力上下文因此提供一对有害自我反应保证不失灵。不同 α βT 房间, γ δ不管 HLA haplotype, T 房间认出他们的目标因此出现使可能性激动为现成,平底锅人口癌症免疫疗法。这里,我们在场人的 γ 的已知的 ligands 的评论; δT 房间并且讨论为癌症治疗利用这些房间的诺言。Mateusz Legut David K Cole Andrew K Sewell 2015Cellular & Molecular Immunology2015,12,6:9
6It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis显示文摘Background There is concern that blood pressure(BP)lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis.We assessed the effect of glyceryl trinitrate(GTN)in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke(ENOS)Trial.Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP(140-220 mm Hg)to transdermal GTN or no GTN within 48 hours of onset.Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days.The primary outcome was the modified Rankin Scale(mRS)at day 90.Ipsilateral carotid stenosis was split:<30%;30-<50%;50-<70%;≥70%.Data are ORs with 95%CIs adjusted for baseline prognostic factors.results 2023(60.5%)ischaemic stroke participants had carotid imaging.As compared with<30%,≥70%ipsilateral stenosis was associated with an unfavourable shift in mRS(worse outcome)at 90 days(OR 1.88,95%CI 1.44 to 2.44,p<0.001).Those with≥70%stenosis who received GTN versus no GTN had a favourable shift in mRS(OR 0.56,95%CI 0.34 to 0.93,p=0.024).In those with 50-<70%stenosis,continuing versus stopping prestroke antihypertensives was associated with worse disability,mood,quality of life and cognition at 90 days.Clinical outcomes did not differ across bilateral stenosis groups.Conclusions Following ischaemic stroke,severe ipsilateral carotid stenosis is associated with worse functional outcome at 90 days.GTN appears safe in ipsilateral or bilateral carotid stenosis,and might improve outcome in severe ipsilateral carotid stenosis.Jason P Appleton Lisa J Woodhouse Andrew Belcher Daniel Bereczki Eivind Berge Valeria Caso Hui Meng Chang Hanne K Christensen Ronan Collins John Gommans Ann C Laska George Ntaios Serefnur Ozturk Gillian M Sare Szabolcs Szatmari Yongjun Wang Joanna M Wardlaw Nikola Sprigg Philip M Bath for the ENOS investigators 2019Stroke & Vascular Neurology2019,4,1:6
7Oral eplerenone for the management of chronic central serous chorioretinopathy显示文摘AIM: To examine eplerenone(Inspra, Pfizer), a mineralocorticoid receptor antagonist, as a treatment option for chronic central serous chorioretinopathy(CSCR).METHODS: A retrospective consecutive case series was conducted for patients receiving oral eplerenone for chronic CSCR. At baseline and each follow-up visit,spectral domain optical coherence tomography(SD-OCT)imaging was performed, including manual measurements of the height and diameter size of subretinal fluid. The primary outcome measure was the reduction in subretinal fluid following initiation of therapy.RESULTS: A total of 17 eyes of 13 patients treated with25 and 50 mg of oral eplerenone per day were identified.Subretinal fluid(SRF) decreased over time following eplerenone therapy(P = 0.007 and P =0.002, diameter and height respectively). Maximum SRF height decreased from a mean of 131.5 μm at baseline to 15.3 μm at day181+. SRF diameter decreased from an average of 2174.4μm at baseline to 46.9 μm at day 181 +. Log MAR visual acuity improved from 0.42(Snellen equivalent: 20/53) at baseline to 0.29(Snellen equivalent: 20/39) at day 181 +(P = 0.024). Central subfield thickness(CST) decreased from 339.5 μm at baseline to 270.3 μm at day 181+(P = 0.029).CONCLUSION: Eplerenone therapy resulted in significant anatomic and visual improvements in eyes with chronic CSCR.Rishi P Singh Jonathan E Sears Rumneek Bedi Andrew P Schachat Justis P Ehlers Peter K Kaiser 2015International Journal of Ophthalmology(English edition)2015,8,2:6
8Primary squamous cell carcinoma of the rectum: An update and implications for treatment显示文摘AIM: To provide an update on the aetiology, pathogenesis, diagnosis, staging and management of rectal squamous cell carcinoma(SCC).METHODS: A systematic review was conducted according to the preferred reporting items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE was performed with the reference list of selected articles reviewed to ensure all relevant publications were captured. The search strategy was limited to the English language, spanning from 1946 to 2015. A qualitative analysis was undertaken examining patient demographics, clinical presentation, diagnosis, staging, treatment and outcome. The quantitaive analysis was limited to data extracted on treatment and outcomes including radiological, clinical and pathological complete response where available. The narrative and quantitative review were synthesised in concert.RESULTS: The search identified 487 articles in total with 79 included in the qualitative review. The quantitative analysis involved 63 articles, consisting of 43 case reports and 20 case series with a total of 142 individual cases. The underlying pathogenesis of rectal SCC while unclear, continues to be defined, with increasing evidence of a metaplasia-dysplasia-carcinoma sequence and a possible role for human papilloma virus in this progression. The presentation is similar to rectal adenocarcinoma, with a diagnosis confirmed by endoscopic biopsy. Many presumed rectal SCC's are in fact an extension of an anal SCC, and cytokeratin markers are a useful adjunct in this distinction. Staging is most accurately reflected by the tumour-nodemetastasis classification for rectal adenocarcinoma. It involves examining locoregional disease by way of magnetic resonance imaging and/or endorectal ultrasound, with systemic spread excluded by way of computed tomography. Positron emission tomography is integral in the workup to exclude an external siteof primary SCC with metastasis to the rectum. While the optimal treatment remains as yet undefined, recent studies have demonstrated a global shift away from surgery towards definitive chemoradiotherapy as primary treatment. Pooled overall survival was calculated to be 86% in patients managed with chemoradiation compared with 48% for those treated traditionally with surgery. Furthermore, local recurrence and metastatic rates were 25% vs 10% and 30% vs 13% for the chemoradiation vs conventional treatment cohorts.CONCLUSION: The changing paradigm in the treatment of rectal SCC holds great promise for improved outcomes in this rare disease.Glen R Guerra Cherng H Kong Satish K Warrier Andrew C Lynch Alexander G Heriot Samuel Y Ngan 2016World Journal of Gastrointestinal Surgery2016,8,3:5
9Successful surgical management of ruptured umbilical hernias in cirrhotic patients显示文摘Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual,but potentially lifethreatening complication,with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair.Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites.We present a retrospective analysis of our centre's experience over the last 6 years.Our cohort consisted of 11 consecutive patients(median age:53 years,range:36-63 years) with advanced hepatic cirrhosis and refractory ascites.Appropriate patient resuscitation and optimisation with intravenous fluids,prophylactic antibiotics and local measures was instituted.One failed attempt for conservative management was followed by a successful primary repair.In all cases,with one exception,a primary repair with non-absorbable Nylon,interrupted sutures,without mesh,was performed.The perioperative complication rate was 25% and the recurrence rate 8.3%.No mortality was recorded.Median length of hospital stay was 14 d(range:4-31 d).Based on our experience,the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period,provided that meticulous patient optimisation is performed.Nikolaos A Chatzizacharias J Andrew Bradley Simon Harper Andrew Butler Asif Jah Emmanuel Huguet Raaj K Praseedom Michael Allison Paul Gibbs 2015World Journal of Gastroenterology2015,21,10:4
10αβ T cell receptors as predictors of health and disease显示文摘它位于下面的抗原受体和特性的差异是适应免疫系统的细胞的手臂的特点。T 和 B 淋巴细胞是确实处于他们产生能够几乎认出的受体的能力真正独特任何病原体。它以 T 淋巴细胞认出短肽在房间表面从主要 histocompatibility 介绍的降级的蛋白质导出建筑群(MHC ) 分子的几十年著名。在 peptide-MHC (pMHC ) 和 T 房间受体(TCR ) 之间的相互作用对 thymic 选择和外部抗原识别中央。TCR 差异被要求,这广泛地被假定,或至少高度理想,提供足够的有免疫力的范围。然而,很多有免疫力的回答与选择被联系可预言,狭窄,或扭曲的全部剧目和公共 TCR 链。这里,我们处于健康和疾病在 TCR 全部剧目和它的维护的形成上总结当前的知识。我们也构画出管理前置选择的作文的各种各样的分子的机制,天真、抗原特定的 TCR 全部剧目。最后,我们与高产量的定序的、普通 TCR ‘ 的发展建议那; signatures’对特定的抗原涨了能提供重要诊断 biomarkers 和疾病发作,前进和结果的代理人预言者。Meriem Attaf Eric Huseby Andrew K Sewell 2015Cellular & Molecular Immunology2015,12,4:4
11澳大利亚人乳头状瘤病毒疫苗计划实施5年对年轻人群生殖器疣患病情况的影响:国家调查数据分析显示文摘目的评估2007年中开始的澳大利亚人乳头状瘤病毒(HPV)疫苗计划对生殖器疣患病情况的影响。设计国家调查数据趋势分析。数据来源数据收集于2004--2011年度澳大利亚8所性健康服务机构;其中2所最大的临床中心收集了自我报告的本中心2009年度HPV疫苗现状。研究对象2004--2011年度首次就诊的85770名澳大利亚出生的国民;其中7686(9.0%)名患生殖器疣。主要结局测量比较前疫苗时期(2004—2007年中)和疫苗时期(2007年中-2001年末)不同人群生殖器疣新发病率变化趋势。结果疫苗时期21岁以下和21~30岁女性诊断患有生殖器疣的比例明显下降,发病率分别从2007年度的11.5%和11.3%下降至2011年度的0.85%和3.1%,P均〈0.001。在30岁以上的女性中未发现发病率的明显下降。在21岁以下和21~30岁异性恋男性人群中疫苗时期生殖器疣的发病率较前疫苗时期明显下降,分别由2007年度12.1%和18.2%下降至2011年度2.2%和8.9%,P均〈0.001。30岁以上的异性恋男性人群中发病率无明显下降。2011年235名21岁以下女性在使用HPV疫苗后无新发生殖器疣病例。结论年轻女性生殖器疣发病率的显著下降和2011年度部分年轻女性使用疫苗后的零发病率,说明HPV疫苗获得实验室外的良好功效。异性恋男性生殖器疣发病率的显著下降可能是由于群体免疫所致。Hammad Ali,lecturer Basil Donovan, professor HandanWand,senior lecturer Tim R H Read, sexual health physician David G Regan,senior lecturer Andrew E Grulich, professor Christopher K FaMey, professor Rebecca J Guy, associate professor 尹婕(译) 潘凌亚(校) 2013英国医学杂志中文版2013,16,4:4
12Can non-invasive measurements aid clinical assessment of volume in patients with cirrhosis?显示文摘AIM:To evaluate the non-invasive assessments of volume status in patients with cirrhosis.METHODS:Echocardiography and multifrequency bioimpedance analysis measurements and short synacthen tests were made in 20 stable and 25 acutely decompensated patients with cirrhosis.RESULTS:Both groups had similar clinical assessments,cortisol response and total body water(TBW),however the ratio of extracellular water(ECW)/TBW was significantly greater in the trunk(0.420±0.004 vs0.404±0.005),and limbs(R leg 0.41±0.003 vs 0.398±0.003,P<0.05,and L leg 0.412±0.003 vs 0.399±0.003)with decompensated cirrhosis compared to stable cirrhotics,P<0.05).Echocardiogram derived right atrial and ventricular filling and end diastolic pressures and presence of increased left ventricular end diastolic volume and diastolic dysfunction were similar in both groups.The decompensated group had lower systemic blood pressure,mean systolic 101.8±4.3 vs122.4±5.3 and diastolic 58.4±4.1 mmHg vs 68.8±3.1 mmHg respectively,P<0.01,and serum albumin30(27-33)vs 32(31-40.5)g/L,P<0.01.CONCLUSION:Decompensated cirrhotics had greater leg and truncal ECW expansion with lower serum albumin levels consistent with intravascular volume depletion and increased vascular permeability.Andrew Davenport Banwari Argawal Gavin Wright Konstantinos Mantzoukis Rumyana Dimitrova Joseph Davar Panayota Vasianopoulou Andrew K Burroughs 2013World Journal of Hepatology2013,5,8:3
13Anatomically realistic multiscale models of normal and abnormal gastrointestinal electrical activity显示文摘One of the major aims of the International Union of Physiological Sciences (IUPS) Physiome Project is to develop multiscale mathematical and computer models that can be used to help understand human health. We present here a small facet of this broad plan that applies to the gastrointestinal system. Specifically, we present an anatomically and physiologically based modelling framework that is capable of simulating normal and pathological electrical activity within the stomach and small intestine. The continuum models used within this framework have been created using anatomical information derived from common medical imaging modalities and data from the Visible Human Project. These models explicitly incorporate the various smooth muscle layers and networks of interstitial cells of Cajal (ICC) that are known to exist within the walls of the stomach and small bowel. Electrical activity within individual ICCs and smooth muscle cells is simulated using a previously published simplified representation of the cell level electrical activity. This simulated cell level activity is incorporated into a bidomain representation of the tissue, allowing electrical activity of the entire stomach or intestine to be simulated in the anatomically derived models. This electrical modelling framework successfully replicates many of the qualitative features of the slow wave activity within the stomach and intestine and has also been used to investigate activity associated with functional uncoupling of the stomach.Leo K Cheng Rie Komuro Travis M Austin Martin L Buist Andrew J Pullan 2007World Journal of Gastroenterology2007,13,9:3
14Nat Genet:单基因突变导致过敏性皮炎的发生显示文摘最近,研究者们鉴定出了一类导致神经性皮炎发生的关键基因突变:CARDll。来自美国NIH过敏与传染病研究所的研究者们通过对四个没有血缘关系的患病家庭进行分析,发现了这一导致疾病产生的基因、Chi A Ma, Yuan Zhang, Michael A Weinreich, Jonathan J Lyons, Celeste G Nelson, Thomas DiMaggio, Kelly D Stone, Joshua D Milner Jeffrey R Stinson, Elisa Ruffo, Batsukh Dorjbal, Swadhinya Arjunaraja, Kelsey Voss, Andrew L Snow Jordan K Abbott, Pia J Hauk, Paul R Reynolds, Erwin W Gelfand Elisa Ruffo Salomé Glauzy, Natsuko Yamakawa, Eric Meffre Jennifer Stoddard, Julie Niemela, Sergio D Rosenzweig Yu Zhang, Helen F Matthews Joshua J McElwee Nina Jones Alejandro Palma, Matías Oleastro, Emma Prieto, Andrea R Bernasconi, Geronimo Dubra, Silvia Danielian, Jonathan Zaiat, Marcelo A Marti Brian Kim Megan A Cooper Neil Romberg 2017现代生物医学进展2017,17,27:3
15First performance evaluation of a dual-source CT (DSCT) system显示文摘Thomas G. Flohr Cynthia H. McCollough Herbert Bruder Martin Petersilka Klaus Gruber Christoph Sü? Michael Grasruck Karl Stierstorfer Bernhard Krauss Rainer Raupach Andrew N. Primak Axel Küttner Stefan Achenbach Christoph Becker Andreas Kopp Bernd M. Ohnes 2006European Radiology2006,,6:3
16Environmental magnetism: Principles and applications显示文摘Liu Qingsong Roberts Andrew P Larrasoa?a Juan C Banerjee Subir K Guyodo Yohan Tauxe Lisa Oldfield Frank 2012EN2012,,4:3
17Involvement of 90-kuD ribosomal S6 kinase in collagen type Ⅰ expression in rat hepatic fibrosis显示文摘AIM: To investigate the relationship between 90-kuD ribosomal S6 kinase (p90RSK) and collagen type □expression during the development of hepatic fibrosis in vivo and in vitro.METHODS: Rat hepatic fibrosis was induced by intraperitoneal injection of dimethylnitrosamine. The protein expression and cell location of p90RSK and their relationship with collagen type □were determined by co-immunofluoresence and confocal microscopy. Subsequently, RNAi strategy was employed to silence p90RSK mRNA expression in HSC-T6, an activated hepatic stellate cell (HSC) line. The expression of collagen type □in HSC-T6 cells was assessed by Western blotting and real-time polymerase chain reaction. Furthermore, HSCs were transfected with expression vectors or RNAi constructs of p90RSK to increase or decrease the p90RSK expression, then collagen type □promoter activity in the transfected HSCs was examined by reporter assay. Lastly HSC-T6 cells transfected with p90RSK siRNA was treated with or without platelet-derived growth factor (PDGF)-BB at a final concentration of 20 μg/L and the cell growth was determined by MTS conversion.RESULTS: In fibrotic liver tissues, p90RSK was overexpressed in activated HSCs and had a significant positive correlation with collagen type □levels.In HSC-T6 cells transfected with RNAi targeted to p90RSK, the expression of collagen type □was down-regulated (61.8% in mRNA, P < 0.01, 89.1% in protein, P < 0.01). However, collagen type □promoter activity was not increased with over-expression of p90RSK and not decreased with low expression either, compared with controls in the same cell line (P = 0.076). Furthermore, p90RSK siRNA exerted the inhibition of HSC proliferation, and also abolished the effect of PDGF on the HSC proliferation.CONCLUSION: p90RSK is over-expressed in activated HSCs and involved in regulating the abnormal expression of collagen type □through initiating the proliferation of HSCs.Miao-Fang Yang Jun Xie Xiao-Yi Gu Xiao-Hua Zhang Andrew K Davey Shuang-Jie Zhang Ji-Ping Wang Ren-Min Zhu 2009World Journal of Gastroenterology2009,15,17:3
18CD133 expression is not restricted to stem cells, and both CD133^sup +^ and CD133^sup -^ metastatic colon cancer cells initiate tumors显示文摘Shmelkov Sergey V Butler Jason M Hooper Andrea T Hormigo Adilia Kushner Jared Milde Till Clair Ryan St Baljevic Muhamed White Ian Jin David K Chadburn Amy Murphy Andrew J Valenzuela David M Gale Nicholas W Thurston Gavin Yancopoulos George 2008Journal of Clinical Investigation2008,,:2
19SLC26A4 mutation testing for hearing loss associated with enlargement of the vestibular aqueduct显示文摘Pendred syndrome(PS) is characterized by autosomal recessive inheritance of goiter associated with a defect of iodide organification, hearing loss, enlargement of the vestibular aqueduct(EVA), and mutations of the SLC26A4 gene. However, not all EVA patients have PSor SLC26A4 mutations. Two mutant alleles of SLC26A4 are detected in 1/4 of North American or European EVA populations, one mutant allele is detected in another 1/4 of patient populations, and no mutations are detected in the other 1/2. The presence of two mutant alleles of SLC26A4 is associated with abnormal iodide organification, increased thyroid gland volume, increased severity of hearing loss, and bilateral EVA. The presence of a single mutant allele of SLC26A4 is associated with normal iodide organification, normal thyroid gland volume, less severe hearing loss and either bilateral or unilateral EVA. When other underlying correlations are accounted for, the presence of a cochlear malformation or the size of EVA does not have an effect on hearing thresholds. This is consistent with observations of an Slc26a4 mutant mouse model of EVA in which hearing loss is independent of endolymphatic hydrops or inner ear malformations. Segregation analyses of EVA in families suggest that the patients carrying one mutant allele of SLC26A4 have a second, undetected mutant allele of SLC26A4, and the probability of a sibling having EVA is consistent with its segregation as an autosomal recessive trait. Patients without any mutations are an etiologically heterogeneous group in which siblings have a lower probability of having EVA. SLC26A4 mutation testing can provide prognostic information to guide clinical surveillance and management, as well as the probability of EVA affecting a sibling.Taku Ito Julie Muskett Parna Chattaraj Byung Yoon Choi Kyu Yup Lee Christopher K Zalewski Kelly A King Xiangming Li Philine Wangemann Thomas Shawker Carmen C Brewer Seth L Alper Andrew J Griffith 2013World Journal of Otorhinolaryngology2013,3,2:2
20Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions显示文摘BACKGROUND Endoscopic ultrasound(EUS)-guided main pancreatic duct(PD)access may be used when conventional endoscopic retrograde cholangiopancreatography(ERCP)techniques fail.The use of a percutaneous transluminal angioplasty balloon(PTAB),originally developed for vascular interventions,can be used to facilitate transmural(e.g.,transgastric)PD access and to dilate high-grade pancreatic strictures.AIM To describe the technique,efficacy,and safety of PTABs for EUS-guided PD interventions.METHODS Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply database.PTABs included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch guidewire.The primary outcome was technical success.Secondary outcomes included incidence of adverse events(AEs)and need for early reintervention.RESULTS A total of 23 patients were identified(48%female,mean age 55.8 years).Chronic pancreatitis was the underlying etiology in 13(56.5%)patients,surgically altered anatomy(SAA)with stricture in 7(30.4%),and SAA with post-operative leak in 3(13.0%).Technical success was achieved in 20(87%)cases.Overall AE rate was 26%(n=6).All AEs were mild and included 1 pancreatic duct leak,2 cases of post-procedure pancreatitis,and 3 admissions for post-procedural pain.No patients required early re-intervention.CONCLUSION EUS-guided use of PTABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.Jad P AbiMansour Barham K Abu Dayyeh Michael J Levy Andrew C Storm John A Martin Bret T Petersen Ryan J Law Mark D Topazian Vinay Chandrasekhara 2022World Journal of Gastrointestinal Endoscopy2022,14,8:2
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