Translational gastroenterology and hepatology最新文献

英文中文

Liver transplantation in patients with non-alcoholic steatohepatitis and alcohol-related liver disease: the dust is yet to settle. 非酒精性脂肪性肝炎和酒精相关性肝病患者的肝移植:尘埃尚未尘埃落定

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2021-01-01 DOI: 10.21037/TGH-2019-LTNA-16

S. Satapathy, D. Bernstein, Nitzan C Roth

引用次数: 4

The new era of interventional endoscopy. 介入内镜的新时代。

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2021-01-01 DOI: 10.21037/TGH-21-14

A. Tyberg

引用次数: 0

Management of pancreatic fluid collections. 胰液收集的管理。

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2021-01-01 DOI: 10.21037/TGH-2020-06

Dimpal Bhakta, Rabia de Latour, Lauren Khanna

Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).

胰液积液常作为急性胰腺炎的并发症出现，但也可在多种情况下出现，包括慢性胰腺炎、创伤、恶性肿瘤或术后。为了优化治疗策略和管理，对收集的胰液进行分类是很重要的。大多数干预措施的目标是管理胰腺炎的延迟并发症，包括胰腺假性囊肿和壁状坏死(WON)，它们通常在胰腺炎初始发作后数天至数周内发生。手术、经皮和内镜干预都是治疗胰液收集的可能方法，但内镜下超声引流已成为一线方法。内镜引流策略的进步也导致了用于治疗的特定支架的创新变化，可能的选择包括双纤尾塑料支架，全覆盖自膨胀金属支架和腔内金属支架(LAMS)。

引用次数: 2

A narrative review of nutritional abnormalities, complications, and optimization in the cirrhotic patient. 对肝硬化患者营养异常、并发症和优化的叙述性回顾。

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2021-01-01 DOI: 10.21037/TGH-20-325

Edgewood R. Warner, F. Aloor, S. Satapathy

ObjectiveThe purpose of this manuscript is to identify the pathophysiology of the metabolic abnormalities observed in cirrhosis and to uncover associations, if any, to its complications, such as sarcopenia and hepatic encephalopathy (HE).BackgroundLiver dysfunction in cirrhosis is known to be a precipitating factor in the disruption of many physiological pathways, specifically nutrient metabolism. As a result, affected patients are highly susceptible to derangements of processes affecting multiple classes of macro- and micronutrients, including proteins, carbohydrates, electrolytes, vitamins, and minerals. These disruptions are thought to be contributory to the pathogenesis of known complications of cirrhosis.MethodsLiterature research of relevant topics was conducted for the above stated objective; sources were limited to articles from peer-reviewed journals published within the last 30 years.ConclusionThis research established that there is positive correlation between nutrient derangements and the increased risk of complications of cirrhosis, which themselves carry significant morbidity and mortality risk. It also established that some nutrient and electrolyte abnormalities are independent indicators of prognosis and adverse outcomes, such as mortality. This also highlights the importance of comprehension of anomalous metabolism and its complications as it necessitates serious consideration in clinical care. In addition to medical management, cirrhotic patients also require ancillary assessment, such as comprehensive nutritional evaluation, to identify and treat reversible nutritional derangements. This consideration provides the best opportunity to achieve maximal health outcomes in the cirrhotic patient population.

目的:本论文的目的是确定肝硬化代谢异常的病理生理学，并揭示其并发症(如肌肉减少症和肝性脑病(HE))的关联。背景肝硬化肝功能障碍被认为是许多生理途径，特别是营养代谢中断的诱发因素。因此，受影响的患者极易受到影响多种宏量和微量营养素(包括蛋白质、碳水化合物、电解质、维生素和矿物质)的过程紊乱的影响。这些破坏被认为有助于肝硬化已知并发症的发病机制。方法针对上述目的，进行相关课题的文献研究;来源仅限于近30年内发表的同行评议期刊上的文章。结论营养失调与肝硬化并发症风险增加呈正相关，而肝硬化并发症本身具有显著的发病率和死亡率风险。它还证实了一些营养和电解质异常是预后和不良结局(如死亡率)的独立指标。这也强调了理解异常代谢及其并发症的重要性，因为它需要在临床护理中认真考虑。除了医疗管理外，肝硬化患者还需要辅助评估，如综合营养评估，以识别和治疗可逆性营养紊乱。这种考虑为实现肝硬化患者群体的最大健康结果提供了最佳机会。

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引用次数: 4

Pediatric surgical care: have we done enough? 小儿外科护理:我们做得够不够?

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2020-12-08 DOI: 10.21037/TGH-2020-PGS-20

E. Perez, S. Pandya, M. Clifton

引用次数: 0

Therapeutic endoscopic ultrasound. 内窥镜超声治疗。

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2020-11-16 DOI: 10.21037/TGH-2019-IE-11

Rodrigo Duarte-Chavez, M. Kahaleh

Endoscopic ultrasound (EUS) has been continuously evolving for the past three decades and has become widely used for both diagnostic and therapeutic purposes. The efficacy of therapeutic EUS (TEUS) has proven to be superior and better tolerated than conventional percutaneous or surgical techniques. TEUS has allowed the performance of multiple procedures including gallbladder, pancreatic duct and biliary drainage as well as gastrointestinal anastomoses. TEUS procedures generally require the following critical steps: needle access, guidewire placement, fistula creation and stent deployment. The indications and contraindication for TEUS procedures vary with different procedures but common contraindications include hemodynamic instability, severe coagulopathy unable to be reversed, large volume ascites or the inability to obtain access to the target site. Proficiency and high volume in endoscopic retrograde cholangiopancreatography (ERCP) and diagnostic EUS procedures are required for training in TEUS. The complexity of the cases performed can be seen as a pyramid with drainage of pancreatic fluid collections at the base, pancreaticobiliary decompression in the middle, and creation of digestive anastomosis at the top. The mastery of each level is crucial prior to reaching the next level of complexity. TEUS has been incorporated in our arsenal and is impacting on a daily basis the way we offer minimally invasive therapy.

内镜超声(EUS)在过去的三十年中不断发展，并已广泛用于诊断和治疗目的。治疗性EUS (TEUS)的疗效已被证明优于传统的经皮或手术技术。TEUS可用于胆囊、胰管、胆道引流及胃肠道吻合等多种手术。TEUS手术通常需要以下关键步骤:针头进入、导丝放置、瘘管创建和支架部署。TEUS手术的适应症和禁忌症因手术方法而异，但常见的禁忌症包括血流动力学不稳定、严重凝血功能无法逆转、大量腹水或无法进入靶部位。熟练掌握内窥镜逆行胰胆管造影(ERCP)和EUS诊断程序是TEUS培训的必要条件。所执行病例的复杂性可以看作是一个金字塔，底部是胰液收集的引流，中间是胰胆减压，顶部是消化吻合术。在达到下一个复杂级别之前，掌握每个级别是至关重要的。TEUS已被纳入我们的武器库，并影响着我们提供微创治疗的日常方式。

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引用次数: 0

Confocal laser endomicroscopy in gastro-intestinal endoscopy: technical aspects and clinical applications. 共聚焦激光内镜在胃肠道内镜中的应用:技术及临床应用。

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2020-11-05 DOI: 10.21037/TGH.2020.04.02

N. Pilonis, W. Januszewicz, M. di Pietro

Confocal laser endomicroscopy (CLE) is an advanced endoscopic imaging technology that provides a magnified, cellular level view of gastrointestinal epithelia. In conjunction with topical or intravenous fluorescent dyes, CLE allows for an "optical biopsy" for real-time diagnosis. Two different CLE system have been used in clinical endoscopy, probe-based CLE (pCLE) and endoscope-based CLE (eCLE). Using pCLE, the device can be delivered: (I) into the luminal gastrointestinal tract through the working channel of standard endoscopes; (II) into extraluminal cystic and solid parenchymal lesions through an endoscopic ultrasound (EUS) needle; or (III) into the biliary system through an endoscopic retrograde cholangiopancreatography (ERCP) accessory channel. With eCLE, the probe is directly integrated into the tip of a conventional endoscope, however, these endoscopes are no longer commercially available. CLE has moderate to high diagnostic accuracy for neoplastic and inflammatory conditions through the gastrointestinal tract including: oesophageal, gastric and colonic neoplasia, pancreatic cysts and solid lesions, malignant pancreatobiliary strictures and inflammatory bowel disease. Some studies have demonstrated the diagnostic benefit of CLE imaging when combined with either conventional white light endoscopy or advanced imaging technologies. Therefore, optical biopsies using CLE can resolve diagnostic dilemmas in some cases where conventional imaging fails to achieve conclusive results. CLE could also reduce the requirement for extensive tissue sampling during surveillance procedures. In the future, CLE in combination with molecular probes, could allow for the molecular characterization of diseases and assess response to targeted therapy. However, the narrow field of view, high capital costs and specialized operator training requirements remain the main limitations. Future multi-center, randomized trials with a focus on conventional diagnostic applications, cost-effectiveness and standardized training will be required for definitive evidence. The objective of this review is to evaluate the technical aspects and current applications of CLE in patients with gastrointestinal and pancreatobiliary diseases and discuss future directions for this technique.

共聚焦激光内镜(CLE)是一种先进的内镜成像技术，可提供胃肠道上皮的放大细胞水平视图。结合局部或静脉荧光染料，CLE允许“光学活检”实时诊断。两种不同的CLE系统已被应用于临床内窥镜检查:探针型CLE (pCLE)和内窥镜型CLE (eCLE)。使用pCLE，该装置可通过标准内窥镜的工作通道进入腔内胃肠道;(II)通过超声内镜(EUS)针检查腔外囊性和实性实质病变;或(III)通过内窥镜逆行胰胆管造影(ERCP)副通道进入胆道系统。使用eCLE，探针直接集成到传统内窥镜的尖端，然而，这些内窥镜已不再市售。CLE对经胃肠道的肿瘤和炎症具有中高的诊断准确性，包括:食管、胃和结肠肿瘤、胰腺囊肿和实体病变、恶性胰胆管狭窄和炎症性肠病。一些研究表明，当结合传统的白光内窥镜或先进的成像技术时，CLE成像的诊断价值。因此，光学活检使用CLE可以解决诊断困境，在一些情况下，传统的成像不能取得结论性的结果。CLE还可以减少在监测过程中对大量组织采样的要求。在未来，CLE与分子探针相结合，可以允许疾病的分子表征和评估对靶向治疗的反应。然而，狭窄的视野、高昂的资本成本和专门的操作员培训要求仍然是主要的限制。未来将需要多中心随机试验，重点关注传统诊断应用、成本效益和标准化培训，以获得明确的证据。本综述的目的是评估CLE在胃肠道和胰胆道疾病患者中的技术方面和目前的应用，并讨论该技术的未来发展方向。

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引用次数: 25

Preoperative alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC): is this 50-year biomarker still up-to-date? 肝细胞癌(HCC)术前甲胎蛋白(AFP):这个50年前的生物标志物仍然是最新的吗?

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2020-10-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2019.12.09

Fabrice Muscari, Charlotte Maulat

引用次数: 16

Gastrointestinal cancers: current biomarkers in esophageal and gastric adenocarcinoma. 胃肠道癌症:食管癌和胃腺癌的当前生物标志物

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2020-10-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2020.01.08

Purabi Dhakras, Nataliya Uboha, Vanessa Horner, Erica Reinig, Kristina A Matkowskyj

Esophageal and gastric adenocarcinomas are frequently diagnosed at an advanced stage and have a dismal prognosis. Even in patients with potentially curative cancer, nearly 50% will develop recurrent disease despite aggressive treatments. A number of biomarkers currently guide treatment decisions for patients with esophageal and gastric adenocarcinoma and include human epidermal growth factor receptor 2 (HER2) amplification, mismatch repair deficiency/microsatellite instability (dMMR/MSI-H) and program death-ligand 1 (PD-L1) expression. This review will focus on the function, testing and FDA-approved targeted therapies for HER2, dMMR/MSI-H and PD-L1. In addition, a number of novel targets in esophageal and gastric cancer are being studied in clinical trials. Neurotrophic-tropomyosin receptor kinase (NTRK), claudin-18 (CLDN18)/Rho GTPase activating protein 26 (ARHGAP26) gene fusion, fibroblast growth factor receptor (FGFR), lymphocyte-activation gene 3 (LAG3) and T cell immunoglobulin and mucin-domain containing-3 (TIM3) will be briefly reviewed. Despite several biomarkers used in the selection of treatment therapies, treatment outcomes remain poor. Future research efforts will focus on the identification of new biomarkers, moving existing biomarkers into earlier lines of therapy, and evaluating new combinations of existing biomarkers and therapies.

食管癌和胃腺癌通常在晚期诊断，预后不佳。即使在有可能治愈的癌症患者中，尽管进行了积极的治疗，仍有近50%的患者会复发。目前，许多生物标志物指导食管癌和胃腺癌患者的治疗决策，包括人表皮生长因子受体2 (HER2)扩增，错配修复缺陷/微卫星不稳定性(dMMR/MSI-H)和程序死亡配体1 (PD-L1)表达。本文将重点介绍HER2、dMMR/MSI-H和PD-L1的功能、检测和fda批准的靶向治疗。此外，一些食管癌和胃癌的新靶点正在临床试验中进行研究。本文将对神经营养原肌球蛋白受体激酶(NTRK)、CLDN18 (CLDN18)/Rho GTPase激活蛋白26 (ARHGAP26)基因融合、成纤维细胞生长因子受体(FGFR)、淋巴细胞激活基因3 (LAG3)和T细胞免疫球蛋白和粘蛋白结构域-3 (TIM3)进行简要综述。尽管在选择治疗方法时使用了几种生物标志物，但治疗效果仍然很差。未来的研究工作将集中在鉴定新的生物标记物，将现有的生物标记物转移到早期的治疗方法中，以及评估现有生物标记物和治疗方法的新组合。

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引用次数: 24

Systemic therapy for advanced gastroesophageal cancers: progress and pitfalls. 晚期胃食管癌的系统治疗：进展与陷阱。

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology

Pub Date : 2020-10-05 eCollection Date: 2020-01-01 DOI: 10.21037/tgh.2020.01.10

Raisa J Epistola, Joseph Chao

Advanced gastroesophageal cancer in which surgical resection is no longer appropriate is an aggressive malignancy with poor prognosis. This review provides an overview of the key trials that have led to the current standard of care, both highlighting progress with systemic cytotoxic and biological therapies, but also calling attention to pitfalls to assist practitioners in optimizing currently available treatments for their patients. This review surveys recent and ongoing trials and biomarker studies regarding the use of anti-HER2 agents, with increased recognition of molecular intratumoral heterogeneity confounding such targeted therapy strategies. We conclude with an overview of recent major trials incorporating immune checkpoint inhibitors among patients with metastatic and locally advanced gastroesophageal cancer and providing a framework for the discriminate application of these new therapies.

外科切除不再合适的晚期癌症是一种侵袭性恶性肿瘤，预后不良。这篇综述概述了导致当前护理标准的关键试验，既强调了系统性细胞毒性和生物疗法的进展，也提醒人们注意陷阱，以帮助从业者优化目前可用于患者的治疗方法。这篇综述综述了最近和正在进行的关于抗HER2药物使用的试验和生物标志物研究，对肿瘤内分子异质性的认识增加，混淆了这种靶向治疗策略。最后，我们概述了最近在转移性和局部晚期癌症胃食管癌患者中使用免疫检查点抑制剂的主要试验，并为这些新疗法的区别应用提供了一个框架。

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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Translational gastroenterology and hepatology

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