首页 > 最新文献

Visceral Medicine最新文献

英文 中文
The Role of Magnesium in Acute Pancreatitis and Pancreatic Injury: A Systematic Review. 镁在急性胰腺炎和胰腺损伤中的作用:系统综述。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-26 DOI: 10.1159/000540507
Ilaria Pergolini, Stephan Schorn, Helmut Friess, Ihsan Ekin Demir

Introduction: As natural calcium (Ca) antagonist, magnesium (Mg) seems to counteract Ca-signaling pathways involved in the intracellular protease activation leading to acute pancreatitis. We systematically reviewed the current literature to investigate the role of Mg in the pathogenesis of acute pancreatitis and its possible use in detecting, predicting, and preventing acute pancreatitis.

Methods: A systematic search was performed in PubMed/Scopus/Web of Science to identify in vivo and in vitro studies reporting data on Mg in acute pancreatitis.

Results: Twelve studies were included. Due to their heterogeneity, we conducted a review without the intent of inference. Mg deficiency in pancreatic acinar cells seems to be frequently associated with serum hypocalcemia and acute pancreatitis. Mg seems to contrast intracellular Ca accumulation which induces premature enzyme activation and acute pancreatitis. Several in vivo and in vitro experiments showed beneficial effects of Mg supplementation in counteracting Ca-signaling pathways and subsequent pathological events. Moreover, a recent randomized trial demonstrated the efficacy of Mg supplementation in reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in high-risk patients.

Conclusion: Mg is a natural antagonist of Ca-signaling pathways and, when deficient, predisposes to acute pancreatitis. Mg supplementation may be useful to prevent acute pancreatitis in many contexts, such as post-ERCP or after pancreatic surgery. The heterogeneity of the included studies represents an important limitation that may hinder robust conclusions.

简介:作为天然的钙(Ca)拮抗剂,镁(Mg)似乎可以抵消参与细胞内蛋白酶激活导致急性胰腺炎的Ca信号通路。我们系统地回顾了目前的文献,以研究镁在急性胰腺炎发病机制中的作用,以及镁在检测、预测和预防急性胰腺炎中的可能用途:方法:在PubMed/Scopus/Web of Science中进行了系统性检索,以确定报道镁在急性胰腺炎中作用的体内和体外研究数据:结果:共纳入 12 项研究。由于这些研究存在异质性,我们在不进行推论的情况下进行了综述。胰腺针叶细胞的镁缺乏似乎经常与血清低钙血症和急性胰腺炎有关。镁似乎与细胞内的钙积累形成对比,而钙积累会诱发过早的酶激活和急性胰腺炎。一些体内和体外实验表明,补充镁对抵消钙信号通路和随后的病理事件有益。此外,最近的一项随机试验表明,补充镁能有效降低高危患者内镜逆行胰胆管造影术(ERCP)后胰腺炎的发病率:结论:镁是钙信号通路的天然拮抗剂,缺乏时易引发急性胰腺炎。在许多情况下,例如胃食管返流术后或胰腺手术后,补充镁可能有助于预防急性胰腺炎。纳入研究的异质性是一个重要的局限性,可能会妨碍得出可靠的结论。
{"title":"The Role of Magnesium in Acute Pancreatitis and Pancreatic Injury: A Systematic Review.","authors":"Ilaria Pergolini, Stephan Schorn, Helmut Friess, Ihsan Ekin Demir","doi":"10.1159/000540507","DOIUrl":"https://doi.org/10.1159/000540507","url":null,"abstract":"<p><strong>Introduction: </strong>As natural calcium (Ca) antagonist, magnesium (Mg) seems to counteract Ca-signaling pathways involved in the intracellular protease activation leading to acute pancreatitis. We systematically reviewed the current literature to investigate the role of Mg in the pathogenesis of acute pancreatitis and its possible use in detecting, predicting, and preventing acute pancreatitis.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed/Scopus/Web of Science to identify in vivo and in vitro studies reporting data on Mg in acute pancreatitis.</p><p><strong>Results: </strong>Twelve studies were included. Due to their heterogeneity, we conducted a review without the intent of inference. Mg deficiency in pancreatic acinar cells seems to be frequently associated with serum hypocalcemia and acute pancreatitis. Mg seems to contrast intracellular Ca accumulation which induces premature enzyme activation and acute pancreatitis. Several in vivo and in vitro experiments showed beneficial effects of Mg supplementation in counteracting Ca-signaling pathways and subsequent pathological events. Moreover, a recent randomized trial demonstrated the efficacy of Mg supplementation in reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in high-risk patients.</p><p><strong>Conclusion: </strong>Mg is a natural antagonist of Ca-signaling pathways and, when deficient, predisposes to acute pancreatitis. Mg supplementation may be useful to prevent acute pancreatitis in many contexts, such as post-ERCP or after pancreatic surgery. The heterogeneity of the included studies represents an important limitation that may hinder robust conclusions.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Gastroesophageal Reflux Disease: Still a Complex and Complicated Disease with Many Uncertainties and Challenges. 胃食管反流病:胃食管反流病:仍然是一种复杂的疾病,存在许多不确定性和挑战。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-14 DOI: 10.1159/000540531
Joachim Labenz, Yves Borbély
{"title":"Gastroesophageal Reflux Disease: Still a Complex and Complicated Disease with Many Uncertainties and Challenges.","authors":"Joachim Labenz, Yves Borbély","doi":"10.1159/000540531","DOIUrl":"https://doi.org/10.1159/000540531","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Effect of Early Removal of Urinary Catheter in Patients Undergoing Abdominal and Thoracic Surgeries with Continuous Thoracic Epidural Analgesia on Postoperative Urinary Retention. 接受腹部和胸部手术并持续胸腔硬膜外镇痛的患者尽早拔除导尿管对术后尿潴留的影响
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-27 DOI: 10.1159/000540740
Ahmed Alwali, Ernst Klar, Imad Kamaleddine, Aenne Glass, Matthias Leuchter, Clemens Schafmayer, Eberhard Grambow

Background: Postoperative continuous thoracic epidural analgesia (TEA) is an integral aspect of pain management after major abdominal and thoracic surgery. Under TEA, postoperative urinary retention (POUR) is frequently noted, prompting a common practice of maintaining the transurethral catheter (UC) until the cessation of TEA to avoid the necessity for reinsertion of the UC. This study analyzes the effect of an early bladder catheter removal during TEA on POUR incidence.

Methods: The retrospective study was conducted on 71 patients undergoing elective abdominal and thoracic operations with TEA for postoperative pain control. Patients were divided into two groups based on the UC removal time in relation to the epidural catheter removal. In the early removal group (ERG), the UC was removed within 3 days of surgery, while in the standard group (SG), it was removed after completion of TEA. All patients in the ERG were still receiving TEA at the time of the UC removal. The primary outcome assessed was the incidence of POUR, while secondary outcomes included urinary tract infections (UTI), hospital length of stay (LOS), and patient's comfort.

Results: The overall prevalence of POUR was 7%, with five POUR cases - two (4.9%) of 41 patients in SG and three (10%) of 30 in ERG (p = 0.644). No significant difference was found in POUR occurrence between ERG and SG (p = 0.644). Additionally, no UTIs were observed in the study. The postoperative pain scores (visual analog scale [VAS]) 72 h and 96 h and the LOS (SG: 16.74 [±8.39] days; ERG: 14.53 [±6.99] days; p = 0.3) were similar between both study groups.

Conclusion: Based on our results, it can be concluded that the removal of UC in the early postoperative period, even during TEA, can be performed safely without significantly increasing the risk of recatheterization.

背景:术后连续胸硬膜外镇痛(TEA)是腹部和胸部大手术后疼痛治疗的一个重要方面。在 TEA 的作用下,术后尿潴留(POUR)经常出现,因此通常的做法是保留经尿道导尿管(UC)直到 TEA 停止,以避免重新插入 UC 的必要性。本研究分析了在 TEA 期间尽早拔除膀胱导尿管对 POUR 发生率的影响:这项回顾性研究针对 71 名接受择期腹部和胸部手术的患者进行,术后使用 TEA 控制疼痛。根据 UC 拔出时间与硬膜外导管拔出时间的关系,将患者分为两组。早期移除组(ERG)在手术后 3 天内移除 UC,而标准组(SG)则在完成 TEA 后移除 UC。在拔除 UC 时,ERG 组的所有患者仍在接受 TEA 治疗。评估的主要结果是POUR的发生率,次要结果包括尿路感染(UTI)、住院时间(LOS)和患者的舒适度:POUR的总发生率为7%,其中5例为POUR--41名SG患者中有2例(4.9%),30名ERG患者中有3例(10%)(P = 0.644)。ERG 和 SG 的 POUR 发生率无明显差异(p = 0.644)。此外,研究中未观察到尿毒症。两组患者术后 72 小时和 96 小时的疼痛评分(视觉模拟量表 [VAS])以及 LOS(SG:16.74 [±8.39] 天;ERG:14.53 [±6.99] 天;p = 0.3)相似:根据我们的研究结果,可以得出结论:在术后早期,即使是在 TEA 期间,也可以安全地切除 UC,而不会显著增加再次导管插入的风险。
{"title":"Effect of Early Removal of Urinary Catheter in Patients Undergoing Abdominal and Thoracic Surgeries with Continuous Thoracic Epidural Analgesia on Postoperative Urinary Retention.","authors":"Ahmed Alwali, Ernst Klar, Imad Kamaleddine, Aenne Glass, Matthias Leuchter, Clemens Schafmayer, Eberhard Grambow","doi":"10.1159/000540740","DOIUrl":"https://doi.org/10.1159/000540740","url":null,"abstract":"<p><strong>Background: </strong>Postoperative continuous thoracic epidural analgesia (TEA) is an integral aspect of pain management after major abdominal and thoracic surgery. Under TEA, postoperative urinary retention (POUR) is frequently noted, prompting a common practice of maintaining the transurethral catheter (UC) until the cessation of TEA to avoid the necessity for reinsertion of the UC. This study analyzes the effect of an early bladder catheter removal during TEA on POUR incidence.</p><p><strong>Methods: </strong>The retrospective study was conducted on 71 patients undergoing elective abdominal and thoracic operations with TEA for postoperative pain control. Patients were divided into two groups based on the UC removal time in relation to the epidural catheter removal. In the early removal group (ERG), the UC was removed within 3 days of surgery, while in the standard group (SG), it was removed after completion of TEA. All patients in the ERG were still receiving TEA at the time of the UC removal. The primary outcome assessed was the incidence of POUR, while secondary outcomes included urinary tract infections (UTI), hospital length of stay (LOS), and patient's comfort.</p><p><strong>Results: </strong>The overall prevalence of POUR was 7%, with five POUR cases - two (4.9%) of 41 patients in SG and three (10%) of 30 in ERG (<i>p</i> = 0.644). No significant difference was found in POUR occurrence between ERG and SG (<i>p</i> = 0.644). Additionally, no UTIs were observed in the study. The postoperative pain scores (visual analog scale [VAS]) 72 h and 96 h and the LOS (SG: 16.74 [±8.39] days; ERG: 14.53 [±6.99] days; <i>p</i> = 0.3) were similar between both study groups.</p><p><strong>Conclusion: </strong>Based on our results, it can be concluded that the removal of UC in the early postoperative period, even during TEA, can be performed safely without significantly increasing the risk of recatheterization.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Endoscopic Resection of Neoplasia in the Lower GI Tract: A Clinical Algorithm. 下消化道肿瘤的内镜下切除术:临床算法。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-26 DOI: 10.1159/000539219
Timothy O'Sullivan, Michael J Bourke

Background: Colorectal cancer is a highly prevalent malignancy and a significant driver of cancer mortality and health-related expenditure worldwide. Polyp removal reduces the incidence and mortality of colorectal cancer. In 2024, endoscopists have an array of resection modalities at their disposal. Each technique requires a unique skillset and has individual advantages and limitations. Consequently, resection in the colorectum requires an evidence-based algorithm approach that considers these factors.

Summary: A literature review of endoscopic resection for colonic neoplasia was conducted. Best supporting scientific evidence was summarized for the endoscopic resection of diminutive polyps, large ≥20 mm lesions and polyps containing invasive cancer. Factors including resection modality, complications and lesion selection were explored to inform an algorithm approach to colorectal resection.

Key messages: Endoscopic resection in the colorectum is not a one-size-fits-all approach. Detailed understanding of polyp size, location, morphology and predicted histology are critical factors that inform appropriate endoscopic resection practice.

背景:结直肠癌是一种高发恶性肿瘤,也是全球癌症死亡率和健康相关支出的重要驱动因素。切除息肉可降低结直肠癌的发病率和死亡率。2024 年,内镜医师可以使用一系列切除方式。每种技术都需要独特的技能,并具有各自的优势和局限性。因此,结直肠切除术需要一种基于证据的算法方法来考虑这些因素。摘要:对结肠肿瘤的内镜切除术进行了文献综述。总结了内镜下切除微小息肉、≥20 毫米大病变和含有浸润性癌的息肉的最佳科学证据。研究还探讨了切除方式、并发症和病变选择等因素,为结肠直肠切除术的算法提供参考:关键信息:内窥镜结直肠切除术并非放之四海而皆准的方法。详细了解息肉的大小、位置、形态和预测组织学是指导内镜切除术实践的关键因素。
{"title":"Endoscopic Resection of Neoplasia in the Lower GI Tract: A Clinical Algorithm.","authors":"Timothy O'Sullivan, Michael J Bourke","doi":"10.1159/000539219","DOIUrl":"10.1159/000539219","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is a highly prevalent malignancy and a significant driver of cancer mortality and health-related expenditure worldwide. Polyp removal reduces the incidence and mortality of colorectal cancer. In 2024, endoscopists have an array of resection modalities at their disposal. Each technique requires a unique skillset and has individual advantages and limitations. Consequently, resection in the colorectum requires an evidence-based algorithm approach that considers these factors.</p><p><strong>Summary: </strong>A literature review of endoscopic resection for colonic neoplasia was conducted. Best supporting scientific evidence was summarized for the endoscopic resection of diminutive polyps, large ≥20 mm lesions and polyps containing invasive cancer. Factors including resection modality, complications and lesion selection were explored to inform an algorithm approach to colorectal resection.</p><p><strong>Key messages: </strong>Endoscopic resection in the colorectum is not a one-size-fits-all approach. Detailed understanding of polyp size, location, morphology and predicted histology are critical factors that inform appropriate endoscopic resection practice.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Endoscopy First: The Best Choice to Optimize Outcomes for Early Gastrointestinal Malignancy. 先做内镜检查:优化早期胃肠道恶性肿瘤治疗效果的最佳选择。
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-06-03 DOI: 10.1159/000539178
Konstantinos Kouladouros, Michael J Bourke
{"title":"Endoscopy First: The Best Choice to Optimize Outcomes for Early Gastrointestinal Malignancy.","authors":"Konstantinos Kouladouros, Michael J Bourke","doi":"10.1159/000539178","DOIUrl":"10.1159/000539178","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11166897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Completion Surgery after Non-Curative Local Resection of Early Rectal Cancer 早期直肠癌非根治性局部切除术后的完成手术
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-05-22 DOI: 10.1159/000538840
Joerg Ernst Mathias Baral, Konstantinos Kouladouros
Background: The expanding indications of local – endoscopic and transanal surgical – resection of early rectal cancer has led to their increased popularity and inclusion in the treatment guidelines. The accuracy of the current diagnostic tools in identifying the low-risk T1 tumors that can be curatively treated with a local resection is low, and thus several patients require additional oncologic surgery with total mesorectal excision (TME). An efficient clinical strategy which avoids overtreatment and obstacle surgical procedures is under debate between different disciplines. Summary: Completion surgery has comparable outcomes to primary surgery regarding perioperative morbidity and mortality but also recurrence rates and overall survival. However, local scarring in the mesorectum can make mesorectal excision technically challenging, especially after full-thickness resections, and has been associated with increased rates of permanent ostomy and worse quality of the TME specimen. This risk seems to be lower after muscle-sparing procedures like endoscopic submucosal dissection, which seem to show a benefit in comparison to full-thickness resections. Key Messages: Completion surgery after non-curative local resection of gastrointestinal malignancies is safe and feasible. Full-thickness resection techniques can cause scarring of the mesorectum; therefore, muscle-sparing procedures should be preferred.
背景:早期直肠癌局部(内窥镜和经肛门手术)切除术的适应症不断扩大,使其越来越受欢迎,并被纳入治疗指南。目前的诊断工具在识别可通过局部切除进行根治性治疗的低风险 T1 肿瘤方面的准确性较低,因此一些患者需要进行全直肠系膜切除术(TME)等额外的肿瘤手术。不同学科之间正在讨论一种有效的临床策略,以避免过度治疗和手术障碍。摘要:就围手术期的发病率和死亡率以及复发率和总生存率而言,完成手术的效果与初次手术相当。然而,直肠系膜局部的瘢痕会使直肠系膜切除术在技术上具有挑战性,尤其是在全层切除后,并且与永久性造口术的发生率增加和TME标本的质量下降有关。内镜黏膜下剥离术等保留肌肉的手术似乎降低了这一风险,与全厚切除术相比,这种手术似乎更有优势。关键信息:胃肠道恶性肿瘤非根治性局部切除术后完成手术是安全可行的。全厚切除技术可能会导致直肠系膜瘢痕形成,因此应首选肌肉保全手术。
{"title":"Completion Surgery after Non-Curative Local Resection of Early Rectal Cancer","authors":"Joerg Ernst Mathias Baral, Konstantinos Kouladouros","doi":"10.1159/000538840","DOIUrl":"https://doi.org/10.1159/000538840","url":null,"abstract":"Background: The expanding indications of local – endoscopic and transanal surgical – resection of early rectal cancer has led to their increased popularity and inclusion in the treatment guidelines. The accuracy of the current diagnostic tools in identifying the low-risk T1 tumors that can be curatively treated with a local resection is low, and thus several patients require additional oncologic surgery with total mesorectal excision (TME). An efficient clinical strategy which avoids overtreatment and obstacle surgical procedures is under debate between different disciplines. Summary: Completion surgery has comparable outcomes to primary surgery regarding perioperative morbidity and mortality but also recurrence rates and overall survival. However, local scarring in the mesorectum can make mesorectal excision technically challenging, especially after full-thickness resections, and has been associated with increased rates of permanent ostomy and worse quality of the TME specimen. This risk seems to be lower after muscle-sparing procedures like endoscopic submucosal dissection, which seem to show a benefit in comparison to full-thickness resections. Key Messages: Completion surgery after non-curative local resection of gastrointestinal malignancies is safe and feasible. Full-thickness resection techniques can cause scarring of the mesorectum; therefore, muscle-sparing procedures should be preferred.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141111004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic Resection of Malignancies in the Upper GI Tract: A Clinical Algorithm 上消化道恶性肿瘤的内窥镜切除术:临床算法
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1159/000538040
Ulrike Denzer
Background: Malignancies in the upper gastrointestinal tract are amenable to endoscopic resection at an early stage. Achieving a curative resection is the most stringent quality criterion, but post-resection risk assessment and aftercare are also part of a comprehensive quality program. Summary: Various factors influence the achievement of curative resection. These include endoscopic assessment prior to resection using chromoendoscopy and HD technology. If resectability is possible, it is particularly important to delineate the lateral resection margins as precisely as possible before resection. Furthermore, the correct choice of resection technique depending on the lesion must be taken into account. Endoscopic submucosal dissection is the standard for esophageal squamous cell carcinoma and gastric carcinoma. In Western countries, it is becoming increasingly popular to treat Barrett’s neoplasia over 2 cm in size and/or with suspected submucosal infiltration with en bloc resection instead of piece meal resection. After resection, risk assessment based on the histopathological resection determines the patient's individual risk of lymph node metastases, particularly in the case of high-risk lesions. This is categorized according to the current literature. Key Messages: This review presents clinical algorithms for endoscopic resection of esophageal SCC, Barrett’s neoplasia, and gastric neoplasia. The algorithms include the pre-resection assessment of the lesion and the resection margins, the adequate resection technique for the respective lesion, as well as the post-resection risk assessment with an evidence-based recommendation for follow-up therapy and surveillance.
背景:上消化道恶性肿瘤可在早期进行内窥镜切除。实现治愈性切除是最严格的质量标准,但切除术后风险评估和术后护理也是综合质量计划的一部分。摘要:影响实现根治性切除的因素有很多。其中包括在切除前使用色内镜和高清技术进行内镜评估。如果可以切除,那么在切除前尽可能精确地划定侧切除边缘尤为重要。此外,还必须根据病变情况正确选择切除技术。内镜下粘膜下剥离术是食管鳞状细胞癌和胃癌的标准术式。在西方国家,治疗超过 2 厘米和/或疑似粘膜下浸润的巴雷特瘤时,越来越多地采用整体切除术,而不是分块切除术。切除术后,根据组织病理学切除情况进行风险评估,以确定患者发生淋巴结转移的个体风险,尤其是在高风险病变的情况下。这将根据目前的文献进行分类。关键信息:本综述介绍了食管 SCC、Barrett 肿瘤和胃肿瘤内镜切除术的临床算法。这些算法包括对病变和切除边缘的切除前评估、针对相应病变的适当切除技术,以及切除后风险评估和基于证据的后续治疗和监测建议。
{"title":"Endoscopic Resection of Malignancies in the Upper GI Tract: A Clinical Algorithm","authors":"Ulrike Denzer","doi":"10.1159/000538040","DOIUrl":"https://doi.org/10.1159/000538040","url":null,"abstract":"Background: Malignancies in the upper gastrointestinal tract are amenable to endoscopic resection at an early stage. Achieving a curative resection is the most stringent quality criterion, but post-resection risk assessment and aftercare are also part of a comprehensive quality program. Summary: Various factors influence the achievement of curative resection. These include endoscopic assessment prior to resection using chromoendoscopy and HD technology. If resectability is possible, it is particularly important to delineate the lateral resection margins as precisely as possible before resection. Furthermore, the correct choice of resection technique depending on the lesion must be taken into account. Endoscopic submucosal dissection is the standard for esophageal squamous cell carcinoma and gastric carcinoma. In Western countries, it is becoming increasingly popular to treat Barrett’s neoplasia over 2 cm in size and/or with suspected submucosal infiltration with en bloc resection instead of piece meal resection. After resection, risk assessment based on the histopathological resection determines the patient's individual risk of lymph node metastases, particularly in the case of high-risk lesions. This is categorized according to the current literature. Key Messages: This review presents clinical algorithms for endoscopic resection of esophageal SCC, Barrett’s neoplasia, and gastric neoplasia. The algorithms include the pre-resection assessment of the lesion and the resection margins, the adequate resection technique for the respective lesion, as well as the post-resection risk assessment with an evidence-based recommendation for follow-up therapy and surveillance.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140666266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic Assessment of Local Resectability of Colorectal Malignancies 结直肠恶性肿瘤局部切除能力的内窥镜评估
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-04-22 DOI: 10.1159/000538317
A. Ebigbo, Sandra Nagl
Background: The endoscopic assessment of colorectal malignancies primarily aims at deciding on the local resectability. Local resectability is defined by the risk of lymphonodal metastasis. Summary: The gross morphology as well as the surface and vessel patterns provide valuable information prior to endoscopic resection. Various classifications have been standardized to assist endoscopists during endoscopic assessment. Key Message: The macroscopic assessment of colorectal malignancies should include the Paris and laterally spreading tumor (LST) classification as well as chromoendoscopic assessments such as Kudo’s pit pattern and the Japanese NBI Expert Team classifications to describe the vessel and surface patterns.
背景:对结直肠恶性肿瘤进行内窥镜评估的主要目的是决定局部切除性。局部可切除性是根据淋巴结转移的风险来定义的。摘要:内镜切除前,大体形态以及表面和血管形态可提供有价值的信息。已对各种分类进行了标准化,以协助内镜医师进行内镜评估。关键信息:结直肠恶性肿瘤的宏观评估应包括巴黎和侧方扩散肿瘤(LST)分类,以及色内镜评估,如工藤凹坑模式和日本 NBI 专家小组分类,以描述血管和表面模式。
{"title":"Endoscopic Assessment of Local Resectability of Colorectal Malignancies","authors":"A. Ebigbo, Sandra Nagl","doi":"10.1159/000538317","DOIUrl":"https://doi.org/10.1159/000538317","url":null,"abstract":"Background: The endoscopic assessment of colorectal malignancies primarily aims at deciding on the local resectability. Local resectability is defined by the risk of lymphonodal metastasis. Summary: The gross morphology as well as the surface and vessel patterns provide valuable information prior to endoscopic resection. Various classifications have been standardized to assist endoscopists during endoscopic assessment. Key Message: The macroscopic assessment of colorectal malignancies should include the Paris and laterally spreading tumor (LST) classification as well as chromoendoscopic assessments such as Kudo’s pit pattern and the Japanese NBI Expert Team classifications to describe the vessel and surface patterns.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oncologic Decision after Endoscopic Resection of Gastrointestinal Malignancies: Interdisciplinary Discussion 内镜下胃肠道恶性肿瘤切除术后的肿瘤学决定:跨学科讨论
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-04-15 DOI: 10.1159/000538304
Konstantinos Kouladouros, M. J. Bourke, Ulrike Denzer, A. Ebigbo, Mathieu Pioche, Arthur Schmidt, Naohisa Yahagi
{"title":"Oncologic Decision after Endoscopic Resection of Gastrointestinal Malignancies: Interdisciplinary Discussion","authors":"Konstantinos Kouladouros, M. J. Bourke, Ulrike Denzer, A. Ebigbo, Mathieu Pioche, Arthur Schmidt, Naohisa Yahagi","doi":"10.1159/000538304","DOIUrl":"https://doi.org/10.1159/000538304","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies 下消化道恶性肿瘤内窥镜切除技术的技术进步
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-04-12 DOI: 10.1159/000538041
L. Masgnaux, J. Grimaldi, J. Jacques, J. Rivory, M. Pioche
Background: The management of bulky neoplastic lesions in the digestive tract has historically been a surgical pursuit. With advancements in endoscopic techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), a paradigm shift toward organ preservation has been initiated. These endoscopic methods, developed incrementally since the 1980s, have progressively enabled curative management of lesions with minimal morbidity, challenging the previously unchallenged domain of surgery. Summary: This review traces the evolution of endoscopic resection from snare polypectomy and EMR to sophisticated ESD, highlighting the technological innovations that have expanded the scope of endoscopic resection. It discusses the intricacies of various EMR techniques like underwater EMR, anchoring EMR, and hybrid EMR, alongside traction-assisted methods and the use of viscous solutions for submucosal injection. Additionally, the manuscript delves into the advancements in ESD, emphasizing traction strategies, knife technology, and the optimization of endoscopes. The benefits of these advancements are weighed against the challenges in anatomopathological interpretation posed by piecemeal resections. Key Messages: The continuous amelioration of endoscopic resection techniques has significantly improved the outcomes of digestive tract lesion management, particularly in achieving R0 resections and reducing recurrence rates. These advancements represent a monumental step toward minimizing the invasiveness of lesion management. However, despite the progress, the necessity for early follow-up post-EMR remains due to the non-negligible recurrence rates, underscoring the need for a rigorous postoperative surveillance regimen. Furthermore, our review suggests that while ESD has transformed the therapeutic landscape, its widespread adoption hinges on further simplification, safety enhancement, and acceleration of the procedure, possibly through innovations like adaptive traction devices.
背景:消化道大块肿瘤病变的治疗历来以外科手术为主。随着内镜技术的进步,特别是内镜下粘膜切除术(EMR)和内镜下粘膜下剥离术(ESD)的发展,开始了向器官保护的模式转变。这些内镜方法自 20 世纪 80 年代以来逐步发展,已逐步实现了以最低的发病率治愈病变,挑战了以前无法挑战的外科手术领域。摘要:这篇综述追溯了内窥镜切除术的发展历程,从套管息肉切除术和EMR到复杂的ESD,重点介绍了扩大内窥镜切除术范围的技术创新。稿件讨论了各种内镜切除技术的复杂性,如水下内镜切除术、锚定内镜切除术和混合内镜切除术,以及牵引辅助方法和黏膜下注射黏性溶液的使用。此外,手稿还深入探讨了 ESD 的进展,强调了牵引策略、刀技术和内窥镜的优化。在权衡这些进步带来的益处的同时,也要考虑到零碎切除给解剖病理学解释带来的挑战。关键信息:内镜切除技术的不断改进大大提高了消化道病变的治疗效果,尤其是在实现R0切除和降低复发率方面。这些进步标志着在最大程度降低病变治疗的创伤性方面迈出了不朽的一步。然而,尽管取得了进步,但由于复发率不可忽视,EMR 术后仍需尽早随访,这也强调了术后严格监控的必要性。此外,我们的综述表明,虽然 ESD 改变了治疗格局,但它的广泛应用取决于进一步简化手术、提高安全性和加快手术速度,可能通过自适应牵引装置等创新来实现。
{"title":"Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies","authors":"L. Masgnaux, J. Grimaldi, J. Jacques, J. Rivory, M. Pioche","doi":"10.1159/000538041","DOIUrl":"https://doi.org/10.1159/000538041","url":null,"abstract":"Background: The management of bulky neoplastic lesions in the digestive tract has historically been a surgical pursuit. With advancements in endoscopic techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), a paradigm shift toward organ preservation has been initiated. These endoscopic methods, developed incrementally since the 1980s, have progressively enabled curative management of lesions with minimal morbidity, challenging the previously unchallenged domain of surgery. Summary: This review traces the evolution of endoscopic resection from snare polypectomy and EMR to sophisticated ESD, highlighting the technological innovations that have expanded the scope of endoscopic resection. It discusses the intricacies of various EMR techniques like underwater EMR, anchoring EMR, and hybrid EMR, alongside traction-assisted methods and the use of viscous solutions for submucosal injection. Additionally, the manuscript delves into the advancements in ESD, emphasizing traction strategies, knife technology, and the optimization of endoscopes. The benefits of these advancements are weighed against the challenges in anatomopathological interpretation posed by piecemeal resections. Key Messages: The continuous amelioration of endoscopic resection techniques has significantly improved the outcomes of digestive tract lesion management, particularly in achieving R0 resections and reducing recurrence rates. These advancements represent a monumental step toward minimizing the invasiveness of lesion management. However, despite the progress, the necessity for early follow-up post-EMR remains due to the non-negligible recurrence rates, underscoring the need for a rigorous postoperative surveillance regimen. Furthermore, our review suggests that while ESD has transformed the therapeutic landscape, its widespread adoption hinges on further simplification, safety enhancement, and acceleration of the procedure, possibly through innovations like adaptive traction devices.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Visceral Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1