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| 1 | Endoscopic management of biliary complications after liver transplantation: An evidence-based review显示文摘Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents(FCSEMSs) has not been demonstrated to be superior(except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients. | Carlos Macías-Gómez Jean-Marc Dumonceau | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，6： | 25 |
| 2 | Malignant biliary obstruction:From palliation to treatment显示文摘Malignant obstruction of the bile duct from cholan-giocarcinoma,pancreatic adenocarcinoma,or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery.The optimal treatment-including the decision whether to treat prior to resection-depends on the type of malignancy,as well as the stage of disease.Preoperative biliary drainage is generally discouraged due to the risk of infectious complications,though some situations may benefit.Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure.For pancreatic cancer patients,self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion.For cholangiocarcinoma patients,treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement,with less risk of infectious complications or failure.For patients of either malignancy who have advanced disease with palliative goals only,the choice of stent for endoscopic decompression depends on estimated survival,with plastic stents favored for survival of < 4 mo.New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor.Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. | Brian R Boulay Aleksandr Birg | 2016 | World Journal of Gastrointestinal Oncology2016，8，6： | 24 |
| 3 | Endothelial progenitor cells in cardiovascular diseases显示文摘Endothelial dysfunction has been associated with the development of atherosclerosis and cardiovascular diseases. Adult endothelial progenitor cells(EPCs) are derived from hematopoietic stem cells and are capable of forming new blood vessels through a process of vas-culogenesis. There are studies which report correlations between circulating EPCs and cardiovascular risk fac-tors. There are also studies on how pharmacotherapies may influence levels of circulating EPCs. In this review, we discuss the potential role of endothelial progenitor cells as both diagnostic and prognostic biomarkers. In addition, we look at the interaction between cardio-vascular pharmacotherapies and endothelial progenitor cells. We also discuss how EPCs can be used directly and indirectly as a therapeutic agent. Finally, we evalu-ate the challenges facing EPC research and how these may be overcome. | Poay Sian Sabrina Lee Kian Keong Poh | 2014 | World Journal of Stem Cells2014，6，3： | 22 |
| 4 | endoscopic 以后后退 cholangiopancreatography 复杂并发症: 他们怎么能被避免?显示文摘 Endoscopic retrograde cholangiopancreatography(ERCP) has a significant complication rate which can be lowered by adopting technical variations of proven beneficial effect and prophylactic maneuvers such as pancreatic stenting during ERCP or periprocedural non-steroidal anti-inflammatory drug administration.However,adoption of these prophylactic maneuvers by endoscopists is not uniform.In this editorial we discuss the beneficial effects of the aforementioned maneuvers. | Juan J Vila Everson LA Artifon Jose Pinhata Otoch | 2012 | World Journal of Gastrointestinal Endoscopy2012，4，6： | 21 |
| 5 | Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma显示文摘Cholangiocarcinoma(CCA) is a malignancy of the bileducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography(ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral(or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy(PDT) or radiofrequency ablation(RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCPdirected RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy. | Dushant S Uppal Andrew Y Wang | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，7： | 18 |
| 6 | Palliative treatment for incurable malignant colorectal obstructions: A meta-analysis显示文摘AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),but the surgeryrelated complications occurred earlier than stent-related complications(rate of early complications:33.7%vs13.7%,P=0.03;rate of late complications:32.3%vs12.7%,P<0.0001).The overall survival time of SEMSand surgery-treated patients was not significantly different(7.64 mo vs 7.88 mo).CONCLUSION:SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions,but is associated with a shorter time to chemotherapy and lower 30-d mortality. | Xiao-Dan Zhao Bao-Bao Cai Ri-Sheng Cao Rui-Hua Shi | 2013 | World Journal of Gastroenterology2013，19，33： | 15 |
| 7 | Biliary strictures complicating living donor liver transplantation:Problems,novel insights and solutions显示文摘Biliary stricture complicating living donor liver transplantation(LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement(with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for future research in the area. | Harshavardhan B Rao Arjun Prakash Surendran Sudhindran Rama P Venu | 2018 | World Journal of Gastroenterology2018，24，19： | 14 |
| 8 | Endovascular stent-induced alterations in host artery mechanical environments and their roles in stent restenosis and late thrombosis显示文摘Cardiovascular stent restenosis remains a major challenge in interventional treatment of cardiovascular occlusive disease.Although the changes in arterial mechanical environment due to stent implantation are the main causes of the initiation of restenosis and thrombosis,the mechanisms that cause this initiation are still not fully understood.In this article,we reviewed the studies on the issue of stent-induced alterations in arterial mechanical environment and discussed their roles in stent restenosis and late thrombosis from three aspects:(i)the interaction of the stent with host blood vessel,involve the response of vascular wall,the mechanism of mechanical signal transmission,the process of re-endothelialization and late thrombosis;(ii)the changes of hemodynamics in the lumen of the vascular segment and(iii)the changes of mechanical microenvironment within the vascular segment wall due to stent implantation.This review has summarized and analyzed current work in order to better solve the two main problems after stent implantation,namely in stent restenosis and late thrombosis,meanwhile propose the deficiencies of current work for future reference. | Jinxuan Wang Xuepu Jin Yuhua Huang Xiaolin Ran Desha Luo Dongchuan Yang Dongyu Jia Kang Zhang Jianhua Tong Xiaoyan Deng Guixue Wang | 2018 | Regenerative Biomaterials2018，5，3： | 13 |
| 9 | Coronary artery disease in type 2 diabetes mellitus:Recent treatment strategies and future perspectives显示文摘Patients with type 2 diabetes mellitus(T2DM) are at a higher risk of developing coronary artery disease(CAD) than are non-T2 DM patients. Moreover, the clinical outcomes in CAD with T2 DM are poor despite improvements in medications and other interventions. Coronary artery bypass grafting is superior to percutaneous coronary intervention in treating multivessel coronary artery disease in diabetic patients. However, selecting a revascularization strategy depends not only on the lesion complexity but also on the patient's medical history and comorbidities. Additionally, comprehensive risk management with medical and non-pharmacological therapies is important, as is confirmation regarding whether the risk-management strategies are being appropriately achieved. Furthermore, non-pharmacological interventions using exercise and diet during the earlier stages of glucose metabolism abnormalities, such as impaired glucose tolerance, might be beneficial in preventing the development or progression of T2 DM and in reducing the occurrence of cardiovascular events. | Ryo Naito Takatoshi Kasai | 2015 | World Journal of Cardiology2015，7，3： | 12 |
| 10 | Comparison of endoscopic stenting for malignant biliary obstruction: A single-center study显示文摘AIM: To evaluate the efficacy and safety of single-step endoscopic placement of self-expandable metallic stents(SEMS) for treatment of obstructive jaundice.METHODS: A retrospective study was performed among 90 patients who underwent transpapillary biliary metallic stent placement for malignant biliary obstruction(MBO) between April 2005 and October 2012. The diagnosis of primary disease and MBO was based on abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with brush cytology, biopsy, and/or a combination of these modalities. The type of SEMS(covered or non-covered, 8 mm or 10 mm in diameter) was determined by the endoscopist. Ninety patients were divided into two groups: group 1(49 patients) who underwent a singlestep SEMS placement and group 2(41 patients) who underwent a two-step SEMS placement. The technical success rate, complication rate, stent patency, and patient survival rate were compared between the groups. In addition, to identify the clinical prognostic factors associated with patient survival, the following variables were evaluated in Cox-regression analysis: gender, age, etiology of MBO(pancreatic cancer or nonpancreatic cancer), clinical stage(Ⅳb; with distant metastases or Ⅳa >; without distant metastases), chemotherapy(with or without), patency of the stent, and the use of single-step or two-step SEMS. RESULTS: Immediate technical success was achieved in 93.9%(46/49) in group 1 and in 95.1%(39/41) in group 2, with no significant difference(P = 1.0). Similarly, there was no difference in the complication rates between the groups(group 1, 4.1% and group 2, 4.9%; P = 0.62). Stent failure was observed in 10 cases in group 1(20.4%) and in 16 cases in group 2(39.0%). The patency of stent and patient survival revealed no difference between the two groups with Kaplan-Meier analysis, with a mean patency of 111 ± 17 d in group 1 and 137 ± 19 d in group 2(P = 0.91), and a mean survival of 178 ± 35 d in group 1 and 222 ± 23 d in group 2(P = 0.57). On the contrary, the number of days of hospitalization associated with first-time SEMS placement in group 1 was shorter when compared with that number in group 2(28 vs 39 d; P < 0.05). Multivariate analysis revealed that a clinical stage of Ⅳa >(P = 0.0055), chemotherapy(P = 0.0048), and no patency of the stent(P = 0.011) were independent prognostic factors associated with patient survival.CONCLUSION: Our results showed that single-step endoscopic metal stent placement was safe and effective for treating obstructive jaundice secondary to various inoperable malignancies. | Ryuichi Yamamoto Masatomo Takahashi Yasuyo Osafune Katsuya Chinen Shingo Kato Sumiko Nagoshi Koji Yakabi | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，9： | 12 |
| 11 | Biodegradable stents in gastrointestinal endoscopy显示文摘Biodegradable stents(BDSs)are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines.The experience with the currently the only BDS for endoscopic placement,made of Poly-dioxanone,have shown promising results.However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material,and that can cause stent-induced mucosal or parenchymal injury.This complication rate and modest clinical efficacy has to be carefully considered in individual patients prior to placement of BDSs.Otherwise,the price of these stents therefore it is nowadays an important limitation. | Vicente Lorenzo-Zú?iga Vicente Moreno-de-Vega Ingrid Marín Jaume Boix | 2014 | World Journal of Gastroenterology2014，20，9： | 10 |
| 12 | Clinical outcomes of self-expandable stent placement for benign esophageal diseases: A pooled analysis of the literature显示文摘AIM: To analyze the outcomes of self-expandable stent placement for benign esophageal strictures and benign esophageal leaks in the literature.METHODS: The Pub Med, Embase and Cochrane databases were searched for relevant articles published between January 2000 and July 2014. Eight prospective studies were identified that analyzed the outcomes of stent placement for refractory benign esophageal strictures. The outcomes of stent placement for benign esophageal leaks, perforations and fistulae were extracted from 20 retrospective studies that were published after the inclusion period of a recent systematic review. Data were pooled and analyzed using descriptive statistics.RESULTS: Fully covered self-expandable metal stents(FC SEMS)(n = 85), biodegradable(BD) stents(n = 77) and self-expandable plastic stents(SEPS)(n = 70) were inserted in 232 patients with refractory benign esophageal strictures. The overall clinical success rate was 24.2% and according to stent type 14.1% for FC SEMS, 32.9% for BD stents and 27.1% for SEPS. Stent migration occurred in 24.6% of cases. The overall complication rate was 31.0%, including major(17.7%) and minor(13.4%) complications. A total of 643 patients were treated with self-expandable stents mainly for postsurgical leaks(64.5%), iatrogenic perforations(19.6%), Boerhaave's syndrome(7.8%) and fistulae(3.7%). FC SEMS and partially covered SEMS were used in the majority of patients. Successful closure of the defect was achieved in 76.8% of patients and according to etiology in 81.4% for postsurgical leaks, 86.0% for perforations and 64.7% for fistulae. The pooled stent migration rate was 16.5%. Stent-related complications occurred in 13.4% of patients, including major(7.8%) and minor(5.5%) complications.CONCLUSION: The outcomes of stent placement for refractory benign esophageal strictures were poor. However, randomized trials are needed to put this into perspective. The evidence on successful stent placement for benign esophageal leaks, perforationsand fistulae is promising. | Emo E van Halsema Jeanin E van Hooft | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，2： | 10 |
| 13 | Microstructure, mechanical properties and deformation mechanisms of an as-cast Mg–Zn–Y–Nd–Zr alloy for stent applications显示文摘A new Mg-2Zn-0.2Y -0.5N d-0.4Zr (wt%) alloy designed specially for stent applications has been developed. The as-cast alloy is featured with equiaxed grains with a mean size of about 40 μm and a small am ount of second phase (T phase) distributed discontinuously either at the grain boundaries or inside the grains. This alloy exhibits a tensile elongation of up to 35%, which is much larger than that of most reported other as-cast Mg alloys. The tensile deform ation mechanisms have also been investigated. The results show that, besides basal slip,{10-12} extension twining and non-basal pyramidal slips can also be observed at initial stage and later stage during tensile deform ation, respectively, which are responsible for the good room -tem perature ductility. | Jianfeng Wang Hongbo Zhou Liguo Wang Shijie Zhu Shaokang Guan | 2019 | Journal of Materials Science & Technology2019，35，7： | 9 |
| 14 | Biodegradable stent for the treatment of a colonic stricture in Crohn's disease显示文摘Biodegradable polydioxanone stents were developed for the treatment of refractory benign esophageal strictures but have been suggested as a new therapeutic option for intestinal strictures.The primary advantage of biodegradable stents over self-expandable metallic stents is that removal is not required.There are,however,few data available on their use in the small or large bowel.We herein describe the case of a 33-yearold patient with long-standing Crohn's disease(CD) who developed a fibrotic stricture of the sigmoid too long to be amenable to balloon dilation.The use of a biodegradable polydioxanone stent was chosen to avoid surgery.Combined endoscopic and fluoroscopic placement of the stent was technically simple,safe and clinically successful,and no recurrence of obstructive symptoms occurred during a 16-mo follow-up.Further studies are needed to evaluate the long-term efficacy and safety of biodegradable stents in the treatment of intestinal strictures,particularly in the context of CD. | Catarina Rodrigues Ana Oliveira Liliana Santos Eduardo Pires Joo Deus | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，5： | 9 |
| 15 | Stents for colorectal obstruction:Past,present,and future显示文摘Since the development of uncovered self-expanding metal stents(SEMS) in the 1990 s, endoscopic stents have evolved dramatically. Application of new materialsand new designs has expanded the indications for enteral SEMS. At present, enteral stents are considered the first-line modality for palliative care, and numerous types of enteral stents are under development for extended clinical usage, beyond a merely palliative purpose. Herein, we will discuss the current status and the future development of lower enteral stents. | Eui Joo Kim Yoon Jae Kim | 2016 | World Journal of Gastroenterology2016，22，2： | 9 |
| 16 | Incidence and risk factors of pancreatitis in obstructive jaundice patients after percutaneous placement of self-expandable metallic stents显示文摘Background:Percutaneous transhepatic biliary drainage is an alternative treatment for patients with malignant distal biliary obstruction.The aim of this study was to investigate the occurrence of pancreatitis in patients who had undergone percutaneous placement of a biliary stent and to assess the risk factors for pancreatitis and the treatment outcomes.Methods:From January 2010 to October 2016,980 patients in our hospital who underwent percutaneous placements of self-expandable metallic stents for obstructive jaundice were retrospectively analyzed.The incidence of pancreatitis and risk factors were assessed by univariate and multivariate logistic regression analysis.Therapeutics,such as somatostatin,which were also adminstrated to release the symptom and promote the restoration of normal function of pancreas,were also analyzed.Results:Pancreatitis occurred in 45(4.6%)patients.One patient died from severe acute pancreatitis.Multivariate logistic regression analysis showed that common bile duct stent placement was the only independent risk factor that related to pancreatitis(odds ratio=2.096,95%CI:1.248–5.379;P=0.002).By using somatostatin,the concentrations of serum amylase and lipase were decreased in 44 patients with pancreatitis.No major complications were found during the treatment.Conclusions:Pancreatitis is a relatively low complication of percutaneous placement of biliary stents.The common bile duct stent placement is the only independent risk factor that related to pancreatitis.In this case,the percutaneous transhepatic biliary drainage is a preferred method for treatment.Furthermore,somatostatin is a secure and efficacious method to release the symptom and promote the restoration of pancreatic function. | Yi Yang Rui-Bao Liu Yan Liu Hui-Jie Jiang | 2020 | Hepatobiliary & Pancreatic Diseases International2020，19，5： | 9 |
| 17 | Palliation of malignant esophageal obstruction and fistulas with self expandable metallic stents显示文摘AIM: To evaluate the efficacy of self expandable metallic stents (SEMS) in patients with malignant esophageal obstruction and fistulas. METHODS: SEMS were implanted in the presence of fluoroscopic guidance in patients suffering from advanced and non-resectable esophageal, cardiac and invasive lung cancer between 2002 and 2009. All procedures were performed under conscious sedation. All patients had esophagus obstruction and/or fistula. In all patients who required reintervention, recurrence of dysphagia, hemorrhage, and fistula formation were indications for further endoscopy. Patients' files were scanned retrospectively and the obtained data were analyzed using SPSS 13.0 for Windows. The χ 2 test was used for categorical data and was analysis of variance for noncategorical data. Patients' long-term survival was assessed using the Kaplan-Meier method. RESULTS: Stents were successfully implanted in 90 patients using fluoroscopic guidance. Reasons for stent implantation in these patients were esophageal stricture (77/90, 85.5%), external pressure (8/90, 8.8%) and tracheo-esophageal fistula (5/90, 5.5%). Dysphagia scores (mean ± SD) were 3.37 ± 0.52 before and 0.90 ± 0.43 after stent implantation (P = 0.002). Intermittent, nonmassive hemorrhage due to the erosion caused by the distal end of the stent in the stomach occurred in only one patient who received implementation at cardioesophageal junction. Mean survival following stenting was 134.14 d (95% confidence interval: 94.06-174.21).CONCLUSION: SEMS placement is safe and effective in the palliation of dysphagia in selected patients with malignant esophageal strictures. | Ahmet Dobrucali Erkan Caglar | 2010 | World Journal of Gastroenterology2010，16，45： | 9 |
| 18 | A new choice of stent for transjugular intrahepatic portosystemic shunt creation: Viabahn ePTFE covered stent/bare metal stent combination显示文摘Objectives:To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt(TIPS) created with the Viabahn ePTFE covered stent/bare metal stent(BMS) combination and the Fluency ePTFE covered stent/BMS combination.Methods:A total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed.Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group.The geometry characteristics of the TIPS were calculated,and the associated occurrence of shunt dysfunction,survival,overt hepatic encephalopathy,and variceal rebleeding were evaluated.Results:The technical success rate was 100%.After the insertion of the TIPS,the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups(1.6% and 13.5%,respectively;p=0.024).Multivariate analysis indicated that the angle of portal venous inflow(α) was the only independent risk factor for shunt dysfunction(hazard ratio=1.060,95% confidence interval=1.009-1.112,p=0.020).In addition,3 months after the TIPS insertion,the a angle distinctly increased from 20.9°±14.3°-26.9°±20.1°(p=0.005) in the Fluency group but did not change significantly in the Viabahn group(from 21.9°±15.1°-22.9°± 17.6°,p=0.798).Conclusions:Shunt dysfunction was related to the a angle owing to the slight effect on the a angle after the implantation of the TIPS.The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination. | Jiacheng Liu Jie Meng Chen Zhou Qin Shi Chongtu Yang Jinqiang Ma Manman Chen Bin Xiong | 2021 | Journal of Interventional Medicine2021，4，1： | 9 |
| 19 | Management of adults with coarctation of aorta显示文摘Coarctation of the aorta(CoA)is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose.The hallmark finding on physical examination is upper extremity hypertension,and for this reason,CoA should be considered in any young hypertensive patient,justifying measurement of lower extremity blood pressure at least once in these individuals.The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis.Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications.Surgical repair has traditionally been the mainstay of therapy for correction,although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications.Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease,which,remains the greatest cause of long-term mortality.Thus,blood pressure control and periodic reassessment with transthoracic echocardiography and threedimensional imaging(computed tomography or cardiac magnetic resonance)for should be performed regularly as cardiovascular complications may occur decades after the intervention. | Pradyumna Agasthi Sai Harika Pujari Andrew Tseng Joseph N Graziano Francois Marcotte David Majdalany Farouk Mookadam Donald J Hagler Reza Arsanjani | 2020 | World Journal of Cardiology2020，12，5： | 8 |
| 20 | Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks显示文摘AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks. METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n=12) and bile leaks (n=5) from July 2007 to February 2012 that had received placement of fully covered self-expanding metal stents (FCSEMs). Fourteen patients had endoscopic placement of VIABIL (Conmed, Utica, New York, United States) stents and three had Wallflex (Boston Scientific, Mass) stents. FCSEMS were 8 mm or 10 mm in diameter and 4 cm to 10 cm in length. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. FCSEMS were removed after 4 or more weeks. Resolution of BBS and leak was documented cholangiographically following stent removal. Stent patency can be defined as adequate bile and contrast flow from the stent and into the ampulla during endoscopic retrograde cholangiopancreatography (ERCP) without clinical signs and/or symptoms of biliary obstruction. Criterion for bile leak resolution at ERCP is defined as absence of contrast extravasation from the common bile duct, cystic duct remanent, or gall blad-der fossa. Rate of complications such as migration, and instent occlusion were recorded. Failure of endoscopic therapy was defined as persistent biliary stenosis or continuous biliary leakage after 12 mo of stent placement. RESULTS: All 17 patients underwent successful FC- SEMS placement and removal. Etiologies of BBS included: cholecystectomies (n=8), cholelithiasis (n=2), hepatic artery compression (n=1), pancreatitis (n=2), and Whipple procedure (n=1). All bile leaks occurred following cholecystectomy. The anatomic location of BBS varied: distal common bile duct (n=7), common hepatic duct (n=1), hepaticojejunal anastomosis (n=2), right intrahepatic duct (n=1), and choledochoduo-denal anastomatic junction (n=1). All bile leaks were found to be at the cystic duct. Twelve of 17 patients had failed prior stent placement or exchange. Resolution of the biliary strictures and bile leaks was achieved in 16 of 17 patients (94%). The overall median stent time was 63 d (range 27-251 d). The median stent time for the BBS group and bile leak group was 62 ± 58 d (range 27-199 d) and 92 ± 81 d (range 48-251 d), respectively. All 17 patients underwent successful FCSEMS removal. Long term follow-up was obtained for a median of 575 d (range 28-1435 d). Complications occurred in 5 of 17 patients (29%) and included: migration (n=2), stent clogging (n=1), cholangitis (n=1), and sepsis with hepatic abscess (n=1). CONCLUSION: Placement of fully covered self-expanding metal stents may be used in the management of benign biliary strictures and bile leaks with a low rate of complications. | David Lalezari Inder Singh Sofiya Reicher Viktor Ernst Eysselein | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，7： | 8 |
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