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Endoscopic therapy of stoma closure site strictures in ileal pouches is safe and effective 内窥镜治疗回肠袋造口关闭部位狭窄安全有效
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-17 DOI: 10.1093/gastro/goae038
Osama Jabi, Nan Lan, Akshay Pokala, Ravi P Kiran, Bo Shen
Background Strictures are a common complication after ileal pouch surgery with the most common locations being at the anastomosis, pouch inlet, and stoma closure site. No previous literature has described endoscopic therapy of stoma site stricture. This study aimed to assess the safety and efficacy of endoscopic therapy in the treatment of stoma closure site strictures. Method Patients diagnosed with stoma closure site strictures following ileal pouch surgery who underwent endoscopic treatment at the Center for Colorectal Diseases, Inflammatory Bowel Disease (IBD), and Ileal Pouch between 2018 and 2022 were analysed. Primary outcomes (technical success and surgery-free survival) were compared between endoscopic balloon dilation (EBD) and stricturotomy and/or strictureplasty. Results A total of 30 consecutive eligible patients were analysed. Most patients were female (66.7%) and most patients were diagnosed with IBD (93.3%). Twenty patients (66.7%) had end-to-end anastomosis. A total of 52 procedures were performed, with EBD in 16 (30.8%) and stricturotomy and/or strictureplasty in 36 (69.2%). The mean stricture length was 1.7 ± 1.0 cm. Immediate technical success was achieved in 47 of 52 interventions (90.4%). During a mean follow-up of 12.7 ± 9.9 months, none of the patients underwent surgical intervention for the stricture. Fourteen (46.7%) required endoscopic re-intervention for their strictures with an interval between index and re-interventional pouchoscopy of 8.8 ± 6.3 months. Post-procedural complications were reported in 2 (6.7%) with bleeding and none with perforation. Upon follow-up, 20 (66.7%) patients reported improvement in their symptoms. Conclusion EBD and endoscopic stricturotomy and/or strictureplasty are safe and effective in treating stoma closure site strictures in patients with ileal pouches, providing symptomatic relief in most patients as well as avoiding surgery.
背景造口狭窄是回肠造口手术后常见的并发症,最常见的部位是吻合口、造口袋入口和造口关闭部位。以前没有文献描述过造口处狭窄的内镜治疗。本研究旨在评估内镜疗法治疗造口闭合部位狭窄的安全性和有效性。方法 分析2018年至2022年期间在结直肠疾病、炎症性肠病(IBD)和回肠袋中心接受内镜治疗的回肠袋手术后确诊为造口闭合部位狭窄的患者。比较了内镜下球囊扩张术(EBD)与狭窄切除术和/或狭窄成形术的主要结果(技术成功率和无手术生存率)。结果 共分析了 30 名符合条件的连续患者。大多数患者为女性(66.7%),大多数患者被诊断为 IBD(93.3%)。20名患者(66.7%)进行了端对端吻合术。共进行了 52 次手术,其中 16 例(30.8%)进行了 EBD,36 例(69.2%)进行了狭窄切除术和/或狭窄成形术。平均狭窄长度为 1.7 ± 1.0 厘米。在 52 例介入治疗中,有 47 例(90.4%)取得了立竿见影的技术成功。在平均 12.7 ± 9.9 个月的随访期间,没有一名患者因狭窄而接受手术治疗。有 14 名患者(46.7%)需要通过内镜再次介入治疗狭窄,从首次介入治疗到再次介入治疗的间隔时间为 8.8 ± 6.3 个月。术后并发症有 2 例(6.7%)出血,无穿孔。随访结果显示,20 名(66.7%)患者的症状有所改善。结论 EBD 和内镜下狭窄切开术和/或狭窄成形术在治疗回肠造口患者的造口闭合部位狭窄方面安全有效,可缓解大多数患者的症状并避免手术。
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引用次数: 0
ELMO1 ameliorates intestinal epithelial cellular senescence via SIRT1/p65 signaling in inflammatory bowel disease-related fibrosis. 在炎症性肠病相关纤维化中,ELMO1 通过 SIRT1/p65 信号改善肠上皮细胞衰老。
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-14 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae045
Junguo Chen, Guanman Li, Xiaowen He, Xijie Chen, Zexian Chen, Danling Liu, Shuang Guo, Tianze Huang, Yanyun Lin, Ping Lan, Lei Lian, Xiaosheng He

Background: Intestinal fibrosis is a common complication in inflammatory bowel disease (IBD), which still lacks of reliable markers and therapeutic options. Cellular senescence has been considered an important mechanism of intestinal fibrosis, but the underlying molecular link remains elusive.

Methods: Tissues were stained using α-smooth muscle actin (α-SMA), fibronectin, and collagen I as markers of myofibroblastic differentiation. Cellular senescence was confirmed through Lamin B1 staining, senescence-associated β-galactosidase staining, and the expression of senescence-associated secretory phenotype (SASP) factors. We explored the relationship between senescence of intestinal epithelial cells (IECs) and intestinal fibrosis, as well as the molecular mechanism underlying this interaction. The effects of irisin on cellular senescence and fibrosis were determined.

Results: Here, we identify engulfment and cell motility protein 1 (ELMO1) as a novel biomarker for intestinal cellular senescence and fibrosis. In fibrostrictured tissues from patients and murine models with IBD, significantly high levels of cellular senescence score and factors were noted, which positively correlated with the fibrotic regulator fibronectin. Senescent IECs, not fibroblast itself, released SASP factors to regulate fibroblast activation. Prolonging exposure to severe and persistent injurious stimuli decreased ELMO1 expression, which dampened SIRT1 deacetylase activity, enhanced NF-κB (p65) acetylation, and thereby accelerated cellular senescence. Deletion of ELMO1 led to senescent IECs accumulation and triggered premature fibrosis in murine colitis. Furthermore, irisin, inhibiting the degradation of ELMO1, could downregulate p65 acetylation, reduce IECs senescence, and prevent incipient intestinal fibrosis in murine colitis models.

Conclusions: This study reveals ELMO1 downregulation is an early symbol of intestinal senescence and fibrosis, and the altered ELMO1-SIRT1-p65 pathway plays an important role in intestinal cellular senescence and IBD-related fibrosis.

背景:肠纤维化是炎症性肠病(IBD)的常见并发症,目前仍缺乏可靠的标志物和治疗方案。细胞衰老一直被认为是肠纤维化的一个重要机制,但其潜在的分子联系仍然难以捉摸:方法:使用α-平滑肌肌动蛋白(α-SMA)、纤维连接蛋白和胶原蛋白I对组织进行染色,作为肌成纤维细胞分化的标志物。通过Lamin B1染色、衰老相关β-半乳糖苷酶染色和衰老相关分泌表型(SASP)因子的表达确认了细胞衰老。我们探讨了肠上皮细胞(IECs)衰老与肠纤维化之间的关系,以及这种相互作用的分子机制。我们还确定了鸢尾素对细胞衰老和纤维化的影响:在这里,我们发现吞噬和细胞运动蛋白 1 (ELMO1) 是肠细胞衰老和纤维化的新型生物标记物。在IBD患者和小鼠模型的纤维摩擦组织中,细胞衰老评分和因子的水平明显较高,与纤维化调节因子纤连蛋白呈正相关。衰老的 IECs(而非成纤维细胞本身)释放出 SASP 因子来调节成纤维细胞的活化。长期暴露于严重和持续的损伤性刺激会降低ELMO1的表达,从而抑制SIRT1去乙酰化酶的活性,增强NF-κB(p65)乙酰化,从而加速细胞衰老。在小鼠结肠炎中,ELMO1 的缺失会导致衰老的 IECs 累积并引发过早纤维化。此外,抑制ELMO1降解的鸢尾素能下调p65乙酰化,减少IECs衰老,防止小鼠结肠炎模型中的初期肠纤维化:本研究揭示了ELMO1下调是肠衰老和纤维化的早期标志,ELMO1-SIRT1-p65通路的改变在肠细胞衰老和IBD相关纤维化中发挥着重要作用。
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引用次数: 0
A 107-day super-prolonged idiopathic cholestasis following endoscopic retrograde cholangiopancreatography. 内镜逆行胰胆管造影术后 107 天超长特发性胆汁淤积症。
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-13 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae048
Yu-Zhen Bi, Si-Jia Yan, Li-Min Zhou, Yan Sun, Jun Zhang
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引用次数: 0
Local regrowth of extraluminal tumor deposit after clinical complete response of rectal cancer: a case report. 直肠癌临床完全缓解后腔外肿瘤沉积物局部再生1例。
IF 3.8 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-13 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae040
Zhen Sun, Yu Xiao, Jingjuan Liu, Guannan Zhang, Weixun Zhou, Yi Xiao
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引用次数: 0
Correction to: Choledocholithotripsy using peroral direct cholangioscopy through a standard gastroscope for a giant common bile duct stone: a case report. 更正:使用经口直接胆道镜通过标准胃镜治疗巨大胆总管结石的胆总管切开取石术:病例报告。
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-10 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae046

[This corrects the article DOI: 10.1093/gastro/goae014.].

[此处更正了文章 DOI:10.1093/gastro/goae014]。
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引用次数: 0
Predicting human epidermal growth factor receptor 2 status of patients with gastric cancer by computed tomography and clinical features. 通过计算机断层扫描和临床特征预测胃癌患者的人类表皮生长因子受体 2 状态
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-08 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae042
Yin Li, Wei-Gang Dai, Qingyu Lin, Zeyao Wang, Hai Xu, Yuying Chen, Jifei Wang

Background: There have been no studies on predicting human epidermal growth factor receptor 2 (HER2) status in patients with resectable gastric cancer (GC) in the neoadjuvant and perioperative settings. We aimed to investigate the use of preoperative contrast-enhanced computed tomography (CECT) imaging features combined with clinical characteristics for predicting HER2 expression in GC.

Methods: We retrospectively enrolled 301 patients with GC who underwent curative resection and preoperative CECT. HER2 status was confirmed by postoperative immunohistochemical analysis with or without fluorescence in situ hybridization. A prediction model was developed using CECT imaging features and clinical characteristics that were independently associated with HER2 status using multivariate logistic regression analysis. Receiver operating characteristic curves were constructed and the performance of the prediction model was evaluated. The bootstrap method was used for internal validation.

Results: Three CECT imaging features and one serum tumor marker were independently associated with HER2 status in GC: enhancement ratio in the arterial phase (odds ratio [OR] = 4.535; 95% confidence interval [CI], 2.220-9.264), intratumoral necrosis (OR = 2.64; 95% CI, 1.180-5.258), tumor margin (OR = 3.773; 95% CI, 1.968-7.235), and cancer antigen 125 (CA125) level (OR = 5.551; 95% CI, 1.361-22.651). A prediction model derived from these variables showed an area under the receiver operating characteristic curve of 0.802 (95% CI, 0.740-0.864) for predicting HER2 status in GC. The established model was stable, and the parameters were accurately estimated.

Conclusions: Enhancement ratio in the arterial phase, intratumoral necrosis, tumor margin, and CA125 levels were independently associated with HER2 status in GC. The prediction model derived from these factors may be used preoperatively to estimate HER2 status in GC and guide clinical treatment.

背景:目前尚无研究预测可切除胃癌(GC)患者在新辅助治疗和围手术期的人表皮生长因子受体2(HER2)状态。我们的目的是研究术前对比增强计算机断层扫描(CECT)成像特征与临床特征相结合在预测胃癌 HER2 表达中的应用:我们回顾性地纳入了301例接受根治性切除术和术前CECT的GC患者。术后通过免疫组化分析和荧光原位杂交确认HER2状态。通过多变量逻辑回归分析,利用与HER2状态独立相关的CECT成像特征和临床特征建立了一个预测模型。构建了接收者操作特征曲线,并对预测模型的性能进行了评估。结果:结果:三种 CECT 成像特征和一种血清肿瘤标记物与 GC 中的 HER2 状态独立相关:动脉期增强比(几率比 [OR] = 4.535;95% 置信区间 [CI],2.220-9.264)、瘤内坏死(OR = 2.64;95% 置信区间 [CI],1.180-5.258)、肿瘤边缘(OR = 3.773;95% 置信区间 [CI],1.968-7.235)和癌抗原 125 (CA125) 水平(OR = 5.551;95% 置信区间 [CI],1.361-22.651)。根据这些变量得出的预测模型显示,预测 GC 中 HER2 状态的接收器操作特征曲线下面积为 0.802(95% CI,0.740-0.864)。建立的模型稳定,参数估计准确:结论:动脉期增强比、瘤内坏死、肿瘤边缘和 CA125 水平与 GC 中的 HER2 状态独立相关。根据这些因素得出的预测模型可用于术前评估 GC 的 HER2 状态并指导临床治疗。
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引用次数: 0
Laparoscopic management of diaphragmatic eventration: a three-step procedure of diaphragm reconstruction. 腹腔镜治疗膈肌分离:膈肌重建三步法。
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-06 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae043
Bing Zeng, Wenchang Gan, Taicheng Zhou, Shuang Chen, Enmin Huang, Zhilong Yuan, Fuheng Liu, Zhiqiang Liang, Yingru Li
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引用次数: 0
Starvation hepatitis and refeeding-induced hepatitis: mechanism, diagnosis, and treatment 饥饿性肝炎和进食诱发的肝炎:机制、诊断和治疗
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-04 DOI: 10.1093/gastro/goae034
Marco Biolato, Rosy Terranova, Caterina Policola, Alfredo Pontecorvi, Antonio Gasbarrini, Antonio Grieco
Anorexia nervosa (AN) is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications. Transaminase elevations are common in patients with AN at the time of hospital admission and have been associated with longer lengths of hospital stay. Multiple types of hepatitis may occur in these patients, including two types that occur only in patients with AN: starvation hepatitis and refeeding-induced hepatitis. Starvation hepatitis is characterized by severe transaminase elevation in patients in the advanced phase of protein-energy deprivation and is associated with complications of severe starvation, such as hypoglycaemia, hypothermia, and hypotension. Refeeding-induced hepatitis is characterized by a milder increase in transaminases that occurs in the early refeeding phase and is associated with hypophosphatemia, hypokalemia, and hypomagnesaemia. Among the most common forms of hepatitis, drug-induced liver injury is particularly relevant in this patient cohort, given the frequent use and abuse of methamphetamines, laxatives, antidepressants, and antipsychotics. In this review, we provided an overview of the different forms of anorexic-associated hepatitis, a diagnostic approach that can help the clinician to correctly frame the problem, and indications on their management and treatment.
神经性厌食症(AN)是青壮年中最常见的精神疾病之一,与自杀和医疗并发症相关的死亡风险很大。神经性厌食症患者入院时转氨酶升高很常见,并且与住院时间延长有关。这些患者可能会发生多种类型的肝炎,其中有两种类型仅发生在 AN 患者身上:饥饿性肝炎和进食诱发性肝炎。饥饿性肝炎的特征是处于蛋白质能量缺乏晚期的患者转氨酶严重升高,并与严重饥饿的并发症有关,如低血糖、低体温和低血压。进食诱发肝炎的特点是转氨酶升高较轻,发生在进食早期,与低磷血症、低钾血症和低镁血症有关。在最常见的肝炎形式中,药物性肝损伤与这类患者群尤其相关,因为他们经常使用和滥用甲基苯丙胺、泻药、抗抑郁药和抗精神病药。在这篇综述中,我们概述了厌食症相关肝炎的不同形式、有助于临床医生正确判断问题的诊断方法以及处理和治疗指征。
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引用次数: 0
Clinical analysis of 13 colorectal cancer patients with adrenal metastasis and a brief literature review. 13 名肾上腺转移的结直肠癌患者的临床分析和文献综述。
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-02 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae032
Wei Chen, Shu-Yun Tan, Xiao-Qiong Chen, Xiao-Ping Tan, Jing-Lin Liang, Mei-Jin Huang
{"title":"Clinical analysis of 13 colorectal cancer patients with adrenal metastasis and a brief literature review.","authors":"Wei Chen, Shu-Yun Tan, Xiao-Qiong Chen, Xiao-Ping Tan, Jing-Lin Liang, Mei-Jin Huang","doi":"10.1093/gastro/goae032","DOIUrl":"https://doi.org/10.1093/gastro/goae032","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"12 ","pages":"goae032"},"PeriodicalIF":3.6,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11065472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873042","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}
引用次数: 0
Primary closure for pancreatic duct after stenting assisted by multiple endoscopes can be a new surgical method for the treatment of main pancreatic duct stones associated with pancreatic duct dilation. 在多个内窥镜辅助下进行支架植入后的胰管原发性闭合术,是治疗伴有胰管扩张的主胰管结石的一种新手术方法。
IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-30 eCollection Date: 2024-01-01 DOI: 10.1093/gastro/goae041
Dongyao Xu, Linpei Wang, Wei Wang
{"title":"Primary closure for pancreatic duct after stenting assisted by multiple endoscopes can be a new surgical method for the treatment of main pancreatic duct stones associated with pancreatic duct dilation.","authors":"Dongyao Xu, Linpei Wang, Wei Wang","doi":"10.1093/gastro/goae041","DOIUrl":"https://doi.org/10.1093/gastro/goae041","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"12 ","pages":"goae041"},"PeriodicalIF":3.6,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11060864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874133","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}
引用次数: 0
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Gastroenterology Report
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