Pub Date : 2023-11-01Epub Date: 2023-10-05DOI: 10.1097/MOG.0000000000000975
Tilak U Shah
{"title":"Stomach and duodenum: what's current in 2023.","authors":"Tilak U Shah","doi":"10.1097/MOG.0000000000000975","DOIUrl":"10.1097/MOG.0000000000000975","url":null,"abstract":"","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-09-05DOI: 10.1097/MOG.0000000000000981
Alyssa Price, David Y Graham, Mimi C Tan
Purpose of review: The recognition that Helicobacter pylori should be considered and treated as an infectious disease has yet to fundamentally change diagnostic and treatment practices and has resulted in many controversies.
Recent findings: We discuss the following controversies: whether the current 'per-patient' approach to H. pylori testing based on symptoms should be expanded to include achieving population-level H. pylori eradication, whether H. pylori should be approached as an infectious gastrointestinal disease similar to that of other infectious diseases of similar severity and outcome, whether treatment of H. pylori should be primarily empiric or based on antibiotic susceptibility and locally proven successful therapies as are other infectious diseases, whether it is necessary to obtain confirmation of treatment success in every patient treated for H. pylori , and whether potassium-competitive acid blockers should replace proton pump inhibitors in H. pylori therapy.
Summary: Available guidelines and meta-analyses do not yet address H. pylori as an infectious disease. The diagnosis and management and treatment success of H. pylori infections trails behind that of other important infectious diseases. We provide new insights and propose changes in the traditional understanding required to modernize the management of H. pylori infections.
{"title":"Controversies regarding management of Helicobacter pylori infections.","authors":"Alyssa Price, David Y Graham, Mimi C Tan","doi":"10.1097/MOG.0000000000000981","DOIUrl":"10.1097/MOG.0000000000000981","url":null,"abstract":"<p><strong>Purpose of review: </strong>The recognition that Helicobacter pylori should be considered and treated as an infectious disease has yet to fundamentally change diagnostic and treatment practices and has resulted in many controversies.</p><p><strong>Recent findings: </strong>We discuss the following controversies: whether the current 'per-patient' approach to H. pylori testing based on symptoms should be expanded to include achieving population-level H. pylori eradication, whether H. pylori should be approached as an infectious gastrointestinal disease similar to that of other infectious diseases of similar severity and outcome, whether treatment of H. pylori should be primarily empiric or based on antibiotic susceptibility and locally proven successful therapies as are other infectious diseases, whether it is necessary to obtain confirmation of treatment success in every patient treated for H. pylori , and whether potassium-competitive acid blockers should replace proton pump inhibitors in H. pylori therapy.</p><p><strong>Summary: </strong>Available guidelines and meta-analyses do not yet address H. pylori as an infectious disease. The diagnosis and management and treatment success of H. pylori infections trails behind that of other important infectious diseases. We provide new insights and propose changes in the traditional understanding required to modernize the management of H. pylori infections.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-08-29DOI: 10.1097/MOG.0000000000000973
Susan J Hagen
Purpose of review: Although the mucosal barrier serves as a primary interface between the environment and host, little is known about the repair of acute, superficial lesions or deeper, persistent lesions that if not healed, can be the site of increased permeability to luminal antigens, inflammation, and/or neoplasia development.
Recent findings: Recent studies on acute superficial lesions have focused on calcium signaling and focal adhesion kinase, which regulate cell migration and controlled matrix adhesion during restitution. Microfluidic organ-on-a-chip and gut-on-a-chip models continued in development to support reductionist studies of epithelial-bacterial and/or epithelial-immune cell interactions during mucosal barrier disruption. In fact, these models may allow personalized medicine studies in the future using patient-derived cells to evaluate injury and repair mechanisms. Work done in the past year evaluated the safety and efficacy of acid blocking drugs on ulcer healing, with new animal studies providing evidence that each drug affects the microbiome in a different way that can be correlated with its efficacy in ulcer healing. Lastly, work to understand the way in which mature epithelial cells or committed stem cells dedifferentiate, reprogram, proliferate, and then regenerate the gastroduodenal mucosa after injury was a major focus of studies in the past year.
Summary: Recent studies highlight novel mechanisms that promote restitution and mucosal regeneration after injury of the gastroduodenal mucosa.
{"title":"Pathophysiology updates: gastroduodenal injury and repair mechanisms.","authors":"Susan J Hagen","doi":"10.1097/MOG.0000000000000973","DOIUrl":"10.1097/MOG.0000000000000973","url":null,"abstract":"<p><strong>Purpose of review: </strong>Although the mucosal barrier serves as a primary interface between the environment and host, little is known about the repair of acute, superficial lesions or deeper, persistent lesions that if not healed, can be the site of increased permeability to luminal antigens, inflammation, and/or neoplasia development.</p><p><strong>Recent findings: </strong>Recent studies on acute superficial lesions have focused on calcium signaling and focal adhesion kinase, which regulate cell migration and controlled matrix adhesion during restitution. Microfluidic organ-on-a-chip and gut-on-a-chip models continued in development to support reductionist studies of epithelial-bacterial and/or epithelial-immune cell interactions during mucosal barrier disruption. In fact, these models may allow personalized medicine studies in the future using patient-derived cells to evaluate injury and repair mechanisms. Work done in the past year evaluated the safety and efficacy of acid blocking drugs on ulcer healing, with new animal studies providing evidence that each drug affects the microbiome in a different way that can be correlated with its efficacy in ulcer healing. Lastly, work to understand the way in which mature epithelial cells or committed stem cells dedifferentiate, reprogram, proliferate, and then regenerate the gastroduodenal mucosa after injury was a major focus of studies in the past year.</p><p><strong>Summary: </strong>Recent studies highlight novel mechanisms that promote restitution and mucosal regeneration after injury of the gastroduodenal mucosa.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-08-24DOI: 10.1097/MOG.0000000000000969
Brianne Shuler, Edwin Liu, Marisa G Stahl
Purpose of review: As incidence and prevalence of celiac disease is increasing, subclinical and asymptomatic presentations are more commonly identified through celiac disease screening. However, the United States Preventive Services Task Force released a statement in 2017 maintaining that there is insufficient evidence to recommend general population screening for celiac disease for asymptomatic individuals. This review summarizes the current available evidence on celiac disease screening.
Recent findings: Literature demonstrates that by limiting screening to individuals with recognized symptoms, celiac disease diagnosis is frequently delayed or missed entirely. Most individuals with screening-identified celiac disease have previously unrecognized symptoms that improve through treatment with a gluten-free diet. Screening-identified individuals also demonstrate signs of impaired nutrition, growth, bone health, and quality of life which improve with treatment. Overall, celiac disease screening is viewed favorably by those identified through celiac disease screening programs.
Summary: Individuals with screening-identified celiac disease may still incur complications from untreated disease and receive benefit from treatment with a gluten-free diet. More data is needed to determine the cost effectiveness of different mass screening approaches that incorporate the societal perspective towards screening.
{"title":"Population level screening for celiac disease: is now the time?","authors":"Brianne Shuler, Edwin Liu, Marisa G Stahl","doi":"10.1097/MOG.0000000000000969","DOIUrl":"10.1097/MOG.0000000000000969","url":null,"abstract":"<p><strong>Purpose of review: </strong>As incidence and prevalence of celiac disease is increasing, subclinical and asymptomatic presentations are more commonly identified through celiac disease screening. However, the United States Preventive Services Task Force released a statement in 2017 maintaining that there is insufficient evidence to recommend general population screening for celiac disease for asymptomatic individuals. This review summarizes the current available evidence on celiac disease screening.</p><p><strong>Recent findings: </strong>Literature demonstrates that by limiting screening to individuals with recognized symptoms, celiac disease diagnosis is frequently delayed or missed entirely. Most individuals with screening-identified celiac disease have previously unrecognized symptoms that improve through treatment with a gluten-free diet. Screening-identified individuals also demonstrate signs of impaired nutrition, growth, bone health, and quality of life which improve with treatment. Overall, celiac disease screening is viewed favorably by those identified through celiac disease screening programs.</p><p><strong>Summary: </strong>Individuals with screening-identified celiac disease may still incur complications from untreated disease and receive benefit from treatment with a gluten-free diet. More data is needed to determine the cost effectiveness of different mass screening approaches that incorporate the societal perspective towards screening.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01Epub Date: 2023-09-18DOI: 10.1097/MOG.0000000000000971
Hammad Zafar, Brenda Jimenez, Alison Schneider
Purpose of review: This article aims to provide an up-to-date review of small intestinal bacterial overgrowth (SIBO), including etiology and risk factors, clinical manifestations, diagnostic evaluation for suspected SIBO, and therapeutic options.
Recent findings: Recent advances in breath testing, capsule and urine-based testing have opened new avenues and improved diagnostic yield of SIBO. Nonantibiotic-based treatment strategies have shown promising results in initial trials.
Summary: Small intestinal bacterial overgrowth (SIBO) is a condition defined by the excess bacteria or changes in bacterial composition of the small intestine. These are associated with various gastrointestinal (GI) symptoms such as bloating, abdominal distension, diarrhea, nutrient deficiencies, and even frank weight loss. Small bowel jejunal aspirate of >10 5 CFU/ml has traditionally been considered the gold standard for diagnosis. Glucose and lactulose breath testing have become more common in clinical practice as they are noninvasive, easily accessible, and have lower cost. Treatment focuses on the eradication of excess bacteria in the small bowel and is traditionally done with the use of oral antibiotics. Other emerging therapies may include probiotics, diet manipulation, and prokinetic agents.
{"title":"Small intestinal bacterial overgrowth: current update.","authors":"Hammad Zafar, Brenda Jimenez, Alison Schneider","doi":"10.1097/MOG.0000000000000971","DOIUrl":"10.1097/MOG.0000000000000971","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article aims to provide an up-to-date review of small intestinal bacterial overgrowth (SIBO), including etiology and risk factors, clinical manifestations, diagnostic evaluation for suspected SIBO, and therapeutic options.</p><p><strong>Recent findings: </strong>Recent advances in breath testing, capsule and urine-based testing have opened new avenues and improved diagnostic yield of SIBO. Nonantibiotic-based treatment strategies have shown promising results in initial trials.</p><p><strong>Summary: </strong>Small intestinal bacterial overgrowth (SIBO) is a condition defined by the excess bacteria or changes in bacterial composition of the small intestine. These are associated with various gastrointestinal (GI) symptoms such as bloating, abdominal distension, diarrhea, nutrient deficiencies, and even frank weight loss. Small bowel jejunal aspirate of >10 5 CFU/ml has traditionally been considered the gold standard for diagnosis. Glucose and lactulose breath testing have become more common in clinical practice as they are noninvasive, easily accessible, and have lower cost. Treatment focuses on the eradication of excess bacteria in the small bowel and is traditionally done with the use of oral antibiotics. Other emerging therapies may include probiotics, diet manipulation, and prokinetic agents.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30DOI: 10.1097/mog.0000000000000984
Yotam Elimeleh, Ian M Gralnek
We review and summarize the most recent literature, including evidence-based guidelines, on the evaluation and management of acute lower gastrointestinal bleeding (LGIB).
我们回顾并总结了有关急性下消化道出血(LGIB)评估和管理的最新文献,包括循证指南。
{"title":"Diagnosis and management of acute lower gastrointestinal bleeding.","authors":"Yotam Elimeleh, Ian M Gralnek","doi":"10.1097/mog.0000000000000984","DOIUrl":"https://doi.org/10.1097/mog.0000000000000984","url":null,"abstract":"We review and summarize the most recent literature, including evidence-based guidelines, on the evaluation and management of acute lower gastrointestinal bleeding (LGIB).","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138689394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.1097/mog.0000000000000983
Jasmine M Haydel, Anthony A Xu, Nabil M Mansour
Colorectal cancer (CRC) is the second leading cause of adult cancer-related deaths in the United States. Colonoscopy is the gold standard for CRC screening. Adequate bowel preparation prior to colonoscopy is essential for good visualization, which results in higher polyp detection rates and shorter procedural times. Achieving adequate preparation prior to colonoscopy is accomplished approximately 75% of the time. This review covers current recommendations and recent updates in bowel preparation for colonoscopy.
{"title":"High volume, low volume, or pills, which way should we go? a review of bowel preparation for colonoscopy.","authors":"Jasmine M Haydel, Anthony A Xu, Nabil M Mansour","doi":"10.1097/mog.0000000000000983","DOIUrl":"https://doi.org/10.1097/mog.0000000000000983","url":null,"abstract":"Colorectal cancer (CRC) is the second leading cause of adult cancer-related deaths in the United States. Colonoscopy is the gold standard for CRC screening. Adequate bowel preparation prior to colonoscopy is essential for good visualization, which results in higher polyp detection rates and shorter procedural times. Achieving adequate preparation prior to colonoscopy is accomplished approximately 75% of the time. This review covers current recommendations and recent updates in bowel preparation for colonoscopy.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138689396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.1097/mog.0000000000000987
Paul Travers, Brian E Lacy, David J Cangemi
Irritable bowel syndrome (IBS) is a chronic, often bothersome disorder of gut-brain interaction (DGBI) characterized by abdominal pain associated with a change in stool frequency and/or caliber. Recent advancements have improved our understanding of the underlying pathophysiology, thus opening new avenues for therapeutic intervention. The purpose of this review is to summarize the current literature regarding treatment modalities for IBS.
{"title":"Irritable bowel syndrome - less irritable, or better treatments?","authors":"Paul Travers, Brian E Lacy, David J Cangemi","doi":"10.1097/mog.0000000000000987","DOIUrl":"https://doi.org/10.1097/mog.0000000000000987","url":null,"abstract":"Irritable bowel syndrome (IBS) is a chronic, often bothersome disorder of gut-brain interaction (DGBI) characterized by abdominal pain associated with a change in stool frequency and/or caliber. Recent advancements have improved our understanding of the underlying pathophysiology, thus opening new avenues for therapeutic intervention. The purpose of this review is to summarize the current literature regarding treatment modalities for IBS.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138689289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-04-25DOI: 10.1097/MOG.0000000000000939
Ambreen A Merchant, Anna M Goebel, Field F Willingham
Purpose of review: Patients with pancreatic tumors may have limited treatment options. Pancreatic tumor ablation is a novel and emerging treatment modality which can now be performed using endoscopic ultrasound (EUS) guidance. This modality is well suited to guide energy delivery for radiofrequency ablation (RFA) and microwave ablation. These approaches provide minimally invasive, nonsurgical methods for delivering energy to ablate pancreatic tumors in situ . This review summarizes the current data and safety profile for ablation in managing pancreatic cancer and pancreatic neuroendocrine tumors.
Recent findings: RFA uses thermal energy to induce cell death by coagulative necrosis and protein denaturation. Studies have reported increased overall survival in patients with pancreatic tumors treated with EUS-guided RFA in a multimodality systemic approach and when used in palliative surgeries. Radiofrequency ablation may have corollary benefits in inducing an immune-modulatory effect. Tumor marker carbohydrate antigen 19-9 has been reported to decrease in response to RFA. Microwave ablation is an emerging modality.
Summary: RFA utilizes focal thermal energy to induce cell death. RFA has been applied through open, laparoscopic, and radiographic modalities. EUS-guided approaches are now allowing RFA and microwave ablation to be performed for pancreatic tumors in situ .
审查目的:胰腺肿瘤患者的治疗选择可能有限。胰腺肿瘤消融术是一种新兴的治疗方式,目前可在内镜超声(EUS)引导下进行。这种方式非常适合引导射频消融(RFA)和微波消融的能量输送。这些方法为原位消融胰腺肿瘤提供了微创、非手术的能量输送方法。本综述总结了目前消融治疗胰腺癌和胰腺神经内分泌肿瘤的数据和安全性:最近的研究结果:射频消融利用热能通过凝固性坏死和蛋白质变性诱导细胞死亡。研究报告显示,在多模式系统方法中使用 EUS 引导的射频消融术治疗胰腺肿瘤患者,以及在姑息性手术中使用射频消融术治疗胰腺肿瘤患者,总生存率均有所提高。射频消融在诱导免疫调节效应方面可能有必然的益处。据报道,肿瘤标志物碳水化合物抗原 19-9 对射频消融的反应会降低。微波消融是一种新兴的治疗方式:微波消融利用病灶热能诱导细胞死亡。RFA 已通过开腹、腹腔镜和放射模式应用。目前,在 EUS 引导下可对原位胰腺肿瘤进行 RFA 和微波消融。
{"title":"Radiofrequency ablation for the management of pancreatic mass lesions.","authors":"Ambreen A Merchant, Anna M Goebel, Field F Willingham","doi":"10.1097/MOG.0000000000000939","DOIUrl":"10.1097/MOG.0000000000000939","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients with pancreatic tumors may have limited treatment options. Pancreatic tumor ablation is a novel and emerging treatment modality which can now be performed using endoscopic ultrasound (EUS) guidance. This modality is well suited to guide energy delivery for radiofrequency ablation (RFA) and microwave ablation. These approaches provide minimally invasive, nonsurgical methods for delivering energy to ablate pancreatic tumors in situ . This review summarizes the current data and safety profile for ablation in managing pancreatic cancer and pancreatic neuroendocrine tumors.</p><p><strong>Recent findings: </strong>RFA uses thermal energy to induce cell death by coagulative necrosis and protein denaturation. Studies have reported increased overall survival in patients with pancreatic tumors treated with EUS-guided RFA in a multimodality systemic approach and when used in palliative surgeries. Radiofrequency ablation may have corollary benefits in inducing an immune-modulatory effect. Tumor marker carbohydrate antigen 19-9 has been reported to decrease in response to RFA. Microwave ablation is an emerging modality.</p><p><strong>Summary: </strong>RFA utilizes focal thermal energy to induce cell death. RFA has been applied through open, laparoscopic, and radiographic modalities. EUS-guided approaches are now allowing RFA and microwave ablation to be performed for pancreatic tumors in situ .</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9984555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-06-22DOI: 10.1097/MOG.0000000000000958
Munish Ashat, Rami El-Abiad, Mouen A Khashab
Purpose of review: Gastric outlet obstruction (GOO) occurs from benign or malignant causes. Historically, the treatment of benign strictures revolved around endoscopic balloon dilation, whereas, in the case of malignant strictures, the placement of self-expandable metallic stents was the focus. The advent of lumen-apposing metal stent has opened new horizons in addressing shortcomings of enteral stenting and surgical gastroenterostomies. The purpose of the review is to discuss the endoscopic approaches to small bowel strictures and to examine the supporting data behind each practice.
Recent findings: Given the risk and futility of balloon dilation for malignant strictures, enteral stenting is pursued in patients who are poor surgical candidates and with life expectancy less than 6 months. For patients with longer survival, surgical gastroenterostomy (S-GE) should be considered. Recent data have shown comparable technical and clinical success rates between EUS-gastroenterostomy and S-GE but with lower adverse event rate and hospital length of stay.
Summary: In recurrent benign strictures and malignant GOO, EUS-GE has recently gained momentum in providing an effective and a well tolerated alternative. Individualized therapy centered around the patient's prognosis and preference while factoring in the local expertise for the specific indication is vital.
{"title":"Endoscopic approaches to small intestinal strictures.","authors":"Munish Ashat, Rami El-Abiad, Mouen A Khashab","doi":"10.1097/MOG.0000000000000958","DOIUrl":"10.1097/MOG.0000000000000958","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gastric outlet obstruction (GOO) occurs from benign or malignant causes. Historically, the treatment of benign strictures revolved around endoscopic balloon dilation, whereas, in the case of malignant strictures, the placement of self-expandable metallic stents was the focus. The advent of lumen-apposing metal stent has opened new horizons in addressing shortcomings of enteral stenting and surgical gastroenterostomies. The purpose of the review is to discuss the endoscopic approaches to small bowel strictures and to examine the supporting data behind each practice.</p><p><strong>Recent findings: </strong>Given the risk and futility of balloon dilation for malignant strictures, enteral stenting is pursued in patients who are poor surgical candidates and with life expectancy less than 6 months. For patients with longer survival, surgical gastroenterostomy (S-GE) should be considered. Recent data have shown comparable technical and clinical success rates between EUS-gastroenterostomy and S-GE but with lower adverse event rate and hospital length of stay.</p><p><strong>Summary: </strong>In recurrent benign strictures and malignant GOO, EUS-GE has recently gained momentum in providing an effective and a well tolerated alternative. Individualized therapy centered around the patient's prognosis and preference while factoring in the local expertise for the specific indication is vital.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}