Digestive medicine research最新文献

英文中文

Relapse of ulcerative colitis in a patient with Takayasu arteritis treated with tocilizumab and tacrolimus―successful induction with infliximab: a case report tocilizumab和他克莫司治疗高动脉炎患者溃疡性结肠炎复发——英夫利昔单抗成功诱导：一例报告

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-33

M. Chiba, Tsuyotoshi Tsuji, Satoko Tsuda, Takashi Fujiwara, Y. Shindo, Haruhiko Tozawa

引用次数: 1

Time to define long-term outcomes after Barrett’s endoscopic therapy 是时候确定巴雷特内窥镜治疗后的长期结果了

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-59

M. Desai

引用次数: 0

The versatility of adipose derived stem cells in liver transplantation: a narrative review 脂肪源性干细胞在肝移植中的多功能性:综述

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-24

T. Yılmaz, Lal Karakayali

引用次数: 0

Histopathologic diagnosis of gastritis and gastropathy: a narrative review 胃炎和胃病的组织病理学诊断:述评

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-42

Sarah L. Zhang, Trang K Lollie, Zhengshan Chen, Tara Narasimhalu, Hanlin L. Wang

引用次数: 1

Boerhaave syndrome complicated by undiagnosed gastroesophageal junction outlet obstruction: a case report Boerhaave综合征并发胃食管交界处出口梗阻1例

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-61

Ryan P. Anderson, Jason Budde, T. Stevens

引用次数: 0

Long-term efficacy of total and partial posterior fundoplication to treat gastroesophageal reflux disease 全胃底折叠术和部分胃底折叠治疗胃食管反流病的远期疗效

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-53

Rafael C Katayama, A. C. D. de Grande, F. Herbella

引用次数: 0

Perioperative veno-venous extracorporeal membrane oxygenation for facilitation of bronchogastric fistula repair following Ivor-Lewis oesophagectomy—case report Ivor-Lewis食管切除术后围术期静脉-静脉体外膜氧合促进支气管胃瘘修复1例报告

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-21-78

Aveechal Prasad, A. Frankel, C. Cole, I. Thomson

Background: Bronchogastric fistulae are a devastating complication following oesophagectomy and despite their rare prevalence of 0.4–3.9%, can present significant morbidity and mortality. This case report presents a contribution that is first in the southern hemisphere, and only third in the world, of peri-operative veno-venous extra-corporeal membrane oxygenation was utilised for respiratory support in the repair of a bronchogastric fistula (BGF) following an Ivor-Lewis Oesophagectomy. The significance of this successful and relatively novel management of such a morbid complication is that it displays a significant, lifesaving methodology which could be replicated and become the status quo as extracorporeal membrane oxygenation (ECMO) becomes more ubiquitously available globally. Case Presentation: A 47-year-old male presented to the emergency department with dyspnoea progressing into rapid type-1 respiratory failure 13 days following an Ivor Lewis Oesophagectomy for oesophageal adenocarcinoma. Diagnosis of a BGF with bronchoscopy and gastroscopy was made and he was transferred to a quaternary centre for deterioration with adult respiratory distress syndrome (ARDS). Further deterioration following dual-lumen ventilation prompted the initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) and surgical management. A primary repair of the airway defect and oesophagus was made followed by an intercostal muscle flap. The patient was decannulated post-operative day 10 and discharged to rehabilitation day 40. He is engaging back to his daily activities 6 months following procedure. Conclusions: It is evident from this case that prompt transfer of a patient with a morbid complication such as a BGF to a larger centre with more specialised surgical and intensive care can be lifesaving, despite the inherent challenges of a relatively novel combined surgical/ECMO management confounded by the complications associated with a long intensive care unit (ICU) and inpatient stay. While there may never be effective studies performed to assess their feasibility, we have learned throughout the course of managing this case that the power and utility of ECMO in the management of BGFs cannot be denied, especially in quaternary centres where ECMO has become an integral part of intensive care.

背景：支气管胃瘘是食道切除术后的一种毁灭性并发症，尽管其罕见的患病率为0.4-3.9%，但可能会导致显著的发病率和死亡率。该病例报告的贡献在南半球是第一个，在世界上只有第三个，围手术期静脉-静脉体外膜氧合用于呼吸支持，修复Ivor Lewis食管切除术后的支气管胃瘘（BGF）。这种对这种病态并发症的成功且相对新颖的治疗的意义在于，它展示了一种重要的救生方法，这种方法可以被复制，并随着体外膜肺氧合（ECMO）在全球变得更加普遍而成为现状。病例介绍：一名47岁男性，因食道腺癌Ivor-Lewis食管切除术后13天呼吸困难发展为1型快速呼吸衰竭，被送往急诊科。经支气管镜和胃镜诊断为BGF，他被转移到四级中心治疗成人呼吸窘迫综合征（ARDS）恶化。双腔通气后的进一步恶化促使开始静脉-静脉体外膜肺氧合（VV-ECMO）和手术治疗。对气道缺损和食道进行了初步修复，随后进行了肋间肌瓣修复。患者在术后第10天拔管，出院至康复第40天。手术后6个月，他开始恢复日常活动。结论：从这个案例中可以明显看出，将患有BGF等病态并发症的患者迅速转移到一个更大的中心，并提供更专业的手术和重症监护，这是可以挽救生命的，尽管相对新颖的手术/ECMO联合管理存在固有的挑战，但与长期重症监护室（ICU）和住院相关的并发症混淆了这一挑战。虽然可能从来没有进行过有效的研究来评估其可行性，但我们在整个病例管理过程中了解到，ECMO在BGF管理中的作用和效用是不容否认的，尤其是在ECMO已成为重症监护不可或缺的一部分的四级中心。

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引用次数: 0

Toupet versus Nissen fundoplication for gastroesophageal reflux disease: are the outcomes different? Toupet与Nissen吻合治疗胃食管反流病:结局不同吗?

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-65

L. Bonavina

© Digestive Medicine Research. All rights reserved. Dig Med Res 2022 | https://dx.doi.org/10.21037/dmr-22-65 Until the first half of the twentieth-century, gastroesophageal reflux disease (GERD) was not a common clinical problem. At that time, Allison (1) reported the outcomes of trans-thoracic crural diaphragmatic repair for hiatal hernia showing a modest 50% success rate. The concept of antireflux surgery (ARS) emerged following the key observation of Nissen (2) that plicating the gastric fundus for 360 degrees around the esophago-gastric anastomosis was highly effective not only to avoid leakage but also to prevent peptic esophagitis. This proof-of-concept experiment led to a change in focus from trans-thoracic crural repair to trans-abdominal fundoplication. A few years later Toupet described a partial posterior fundoplication (3), but the Nissen procedure is still quoted as the “gold standard” surgical therapy for GERD. With the inception of the laparoscopic era, restoration of the esophagogastric antireflux barrier, including remodeling of the hiatal orifice and lower esophageal sphincter augmentation using either the Nissen or the Toupet fundoplication, have become standard procedures (4). Despite the very low morbidity and mortality rates, ARS remains underused due to the perceived risk of persistent side-effects and limited durability. As a consequence, the majority of patients referred for surgical intervention are those with refractory symptoms, recurrent esophagitis, and large hiatal hernia. Today, many gastroenterologists and patients continue to consider proton-pump inhibitors (PPIs) as the therapy of choice, and bad publicity of the “gold standard” Nissen fundoplication has largely contributed to the current decline of ARS utilization. In an attempt to reduce the potential side-effects of the Nissen operation, partial fundoplication has emerged as the procedure of choice or as a “tailored” option for patients with poor esophageal motility. Systematic reviews and meta-analyses have shown that the Toupet fundoplication can decrease the incidence of dysphagia and gas-bloating compared to Nissen fundoplication (5,6). In some studies, the favorable outcomes of Toupet fundoplication have been offset by a higher incidence of recurrent reflux over time, and this may reflect heterogeneity due to selection bias, inclusion of patients with preoperative motility disorders, surgical approach, or variations in the circumference of the wrap (3). The late results of a randomized clinical trial comparing Nissen and Toupet fundoplication recently shed some light on this controversial issue and fill a gap in the interpretation of long-term ARS outcomes (7). This study follows a previous report (8) showing that the Toupet procedure was beneficial because of a reduced dysphagia rate up at 2 years and equivalent control of esophageal acid exposure at 3 years. It appears now that Toupet and Nissen fundoplication are equally effective in controlling sympt

©消化医学研究。版权所有。直到20世纪上半叶，胃食管反流病(GERD)还不是一个常见的临床问题。当时，Allison(1)报道了经胸脚膈修补裂孔疝的结果，成功率为50%。抗反流手术(ARS)的概念是在Nissen(2)的关键观察后出现的，他发现胃底在食管-胃吻合口周围360度复制，不仅可以有效避免漏出，还可以预防消化性食管炎。这个概念验证实验导致焦点从经胸脚修复到经腹基底复制。几年后，Toupet描述了部分后眼底重复(3)，但Nissen手术仍然被引用为胃反流手术治疗的“金标准”。随着腹腔镜时代的开始，食管胃抗反流屏障的修复，包括食道孔的重塑和使用Nissen或Toupet底瓣的下食管括约肌增强，已成为标准手术(4)。尽管发病率和死亡率非常低，但由于持续副作用的风险和有限的持久性，ARS仍未得到充分利用。因此，大多数接受手术治疗的患者是那些有难治性症状、复发性食管炎和大食道裂孔疝的患者。今天，许多胃肠病学家和患者仍然将质子泵抑制剂(PPIs)作为治疗的选择，而“金标准”尼森基础应用的负面宣传在很大程度上导致了ARS使用率的下降。为了减少Nissen手术的潜在副作用，部分食管复制术已成为食管运动不良患者的首选手术或“量身定制”的选择。系统综述和荟萃分析表明，与Nissen底瓣吻合相比，Toupet底瓣吻合可降低吞咽困难和气胀的发生率(5,6)。在一些研究中，随着时间的推移，Toupet翻底术的良好结果被较高的复发性反流发生率所抵消，这可能反映了由于选择偏倚、纳入术前运动障碍患者、手术入路、最近，一项比较Nissen和Toupet手术的随机临床试验的最新结果揭示了这一有争议的问题，并填补了对长期ARS结果的解释的空白(7)。该研究延续了先前的报告(8)，该报告显示，Toupet手术是有益的，因为在2年时减少了吞咽困难率，并在3年时等效控制了食管酸暴露。现在看来，Toupet和Nissen底术在控制胃食管反流症状和15年后的生活质量方面同样有效。这些发现证实了来自非随机研究的证据，即Toupet基础应用是有效和持久的，并且具有良好的安全性。该试验的局限性是缺乏血压计数据来证实客观的长期反流控制，而且结果不能推广到非专科外科单位，在非专科外科单位，由于缺乏标准化，患者选择和手术技术可能不理想。在编辑评论中，有五个主要的话题值得关注

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引用次数: 0

Adipose derived mesenchymal stem cells in gastrointestinal system anastomosis: a narrative review 脂肪源性间充质干细胞在胃肠系统吻合中的应用综述

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-21

Huasheng Lai, Zhiwei Dong, P. Chiu

Background and Objective: Gastrointestinal (GI) system anastomosis is an artificial connection procedure after a resection of all or part of the digestive organs. GI system anastomosis may lead to many complications, including anastomotic leakage (AL), anastomotic dehiscence, or stenosis. AL from anastomosis is one of the most important and fatal complication of any GI resection. Prevention of AL has been a hot topic of ongoing research for decades. Methods: To elucidate recent advances on therapeutic efficacy of adipose-derived mesenchymal stem cells (ADMSCs) in anastomosis, we performed a review of the published literature in English from September 2008 to February 2022 by independent searches using publicly available databases, including NIH National Library of Medicine PubMed, Web of Science, MEDLINE and conferences on this topic. Key Content and Findings: Physical reinforcement of the anastomosis with supporting materials is considered as an effective method to prevent leakage. Liquid-based sealants have also been explored as one of the preventive methods. Finally, manipulating the interaction between the gut microbiome microenvironment and anastomotic healing has also been studied as a means to reduce leakage rates. However, although various surgical techniques have been developed to reduce AL, it remains to be one of the most serious and fatal postoperative complications. Recently, ADMSCs have been popularly used for accelerating anastomotic wound healing through their angiogenesis, immunomodulatory effects and tissue repair ability. Conclusions: An understanding of above developing advances will be important for all surgeons who operate on the GI systems. Here, our review discusses recent advances in the application of various updated techniques, especially ADMSCs transplantation in GI system anastomosis that may stimulate future human studies exploring these new and exciting avenues. collagen-3 α 1 were evaluated. Results showed that MSC sheets enhanced intestine bursting pressure (P<0.05) and up-regulated the mRNA expression of collagen-1 and collagen-3. Hydroxyproline expression was significantly higher in MSC sheet subgroup on PO d 7 (P<0.01) but not PO d 5.

背景与目的:胃肠道(GI)系统吻合术是在切除全部或部分消化器官后进行的人工连接手术。胃肠道系统吻合可导致许多并发症，包括吻合口漏(AL)、吻合口开裂或狭窄。吻合口AL是任何胃肠道切除术中最重要和最致命的并发症之一。几十年来，AL的预防一直是研究的热点。方法:为了阐明脂肪源性间充质干细胞(ADMSCs)在吻合中的治疗效果的最新进展，我们通过对公共数据库(包括NIH National Library of Medicine PubMed、Web of Science、MEDLINE和有关该主题的会议)的独立搜索，对2008年9月至2022年2月发表的英文文献进行了回顾。关键内容与发现:用支撑材料对吻合口进行物理加固是防止吻合口漏的有效方法。液体基密封剂也被探索作为一种预防方法。最后，操纵肠道微生物群微环境与吻合口愈合之间的相互作用也被研究为减少泄漏率的一种手段。然而，尽管已经发展了各种手术技术来减少AL，它仍然是最严重和致命的术后并发症之一。近年来，ADMSCs通过其血管生成、免疫调节和组织修复能力被广泛应用于促进吻合口伤口愈合。结论:了解上述发展进展对所有在胃肠道系统上进行手术的外科医生都很重要。在这里，我们的综述讨论了各种最新技术的应用进展，特别是ADMSCs移植在胃肠道系统吻合中的应用，这可能会刺激未来的人类研究探索这些新的和令人兴奋的途径。评价胶原蛋白3 α 1水平。结果显示，MSC薄片增加了肠破裂压力(P<0.05)，上调了胶原-1和胶原-3 mRNA的表达。骨髓间充质干细胞薄片亚组羟脯氨酸表达在第7天显著升高(P<0.01)，第5天无显著升高。

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引用次数: 0

S-1 plus docetaxel combination: another adjuvant treatment option for stage III gastric cancer S-1 +多西紫杉醇联合治疗:III期胃癌的另一种辅助治疗选择

Digestive medicine research

Pub Date : 2022-01-01 DOI: 10.21037/dmr-22-50

H. Jeung, S. Noh

© Digestive Medicine Research. All rights reserved. Dig Med Res 2022 | https://dx.doi.org/10.21037/dmr-22-50 Despite decades of declining prevalence, gastric cancer (GC) still accounts for over 770,000 cancer-related mortalities worldwide (1). A common therapeutic approach for the treatment of GC involves gastric resection plus with D2 lymph node dissection. However, even following radical surgery, recurrence is typical in the case of locally advanced GC (stage II–III). Postoperative adjuvant chemotherapy trials, which were conducted mainly in Asian patients, confirmed a significant improvement in the survival rate in the adjuvant chemotherapy compared with observation only in resectable GC. Therefore, this surgery-first approach has been strengthened in Asian nations where hematogenous and peritoneal recurrences are common (2). The Japanese ACTS-GC trial was the first positive phase III outcome to address adjuvant chemotherapy with S-1, an oral fluoropyrimidine, as being superior to the “surgery alone” (3). In this trial, 1,059 patients with stage II (excluding T1) or stage III GCs according to the Japanese classification were randomly assigned to the ‘surgery-only’ arm or ‘S-1 treatment’ arm, in which S-1 was administered for a year following D2 gastrectomy. At 3 years, recurrencefree survival (RFS) was 72% in the S-1 arm and 60% in the surgery-only arm [hazard ratio (HR) =0.62; 95% confidence interval (CI): 0.50–0.77; P<0.001], and the overall 3-year survival rates were 80% and 70%, respectively (HR =0.68; 95% CI: 0.52–0.87; P=0.003). However, subgroup analysis revealed that S-1 could only prolong survival in patients with early disease stages (stage II or IIIA) and was unable to prevent hematogenous dissemination (3). Moreover, S-1 is also not widely available worldwide. As a result, in order to improve the clinical outcome, particularly in a more advanced stage IIIB state, it was required to look for a better alternative option, such as one based on a pharmaceutical doublet. In this regard, JACCRO GC-07 study provided an intriguing alternative to S-1 monotherapy (4). The study’s objective was to address whether S-1 plus docetaxel doublet was superior to S-1 alone following R0 resection of pathologic stage III GC. The third English edition of the Japanese Classification of Gastric Carcinoma, which includes stage IIIA (T2N3, T3N2, T4aN1), stage IIIB (T3N3, T4aN2, T4bN0, T4bN1), or stage IIIC (T4aN3, T4bN2, T4bN3), was used to define pathologic stage III GC (5). To briefly summarize the treatment schedule, S-1 was delivered on days 1 through 14 of the first course’s 3-week cycle. After that, patients received intravenous infusions of docetaxel (40 mg/m body surface area) on the first day of each cycle and S-1 (days 1 through 14 of a 3-week cycle) throughout the second to seventh cycle. Patients in the S-1 group received S-1 from days 1 to 28 of a 6-week up to 1 year. The investigators had planned to enroll 1,100 patients between 2013 and 2017,

©消化医学研究。版权所有。尽管几十年来患病率不断下降，但胃癌(GC)仍在全球范围内造成超过77万例与癌症相关的死亡(1)。治疗胃癌的常用治疗方法包括胃切除术加D2淋巴结清扫。然而，即使在根治性手术后，局部晚期胃癌(II-III期)的复发也是典型的。主要在亚洲患者中进行的术后辅助化疗试验证实，与仅观察可切除胃癌患者相比，辅助化疗可显著提高生存率。因此，这种手术优先的方法在亚洲国家得到了加强，因为这些国家的血液和腹膜复发很常见(2)。日本ACTS-GC试验是第一个用S-1(一种口服氟嘧啶)辅助化疗优于“单独手术”的III期阳性结果(3)。1059例II期(不包括T1期)或III期GCs患者被随机分配到“仅手术”组或“S-1治疗”组，其中S-1治疗组在D2胃切除术后给予1年。3年时，S-1组无复发生存率(RFS)为72%，单纯手术组为60%[风险比(HR) =0.62;95%置信区间(CI): 0.50-0.77;P<0.001]，总3年生存率分别为80%和70% (HR =0.68;95% ci: 0.52-0.87;P = 0.003)。然而，亚组分析显示，S-1仅能延长疾病早期(II期或IIIA期)患者的生存期，不能阻止血液传播(3)。此外，S-1在全球范围内也没有广泛应用。因此，为了改善临床结果，特别是在更晚期的IIIB阶段，需要寻找更好的替代选择，例如基于药物双重药物的选择。在这方面，JACCRO GC-07研究为S-1单药治疗提供了一个有趣的替代方案(4)。该研究的目的是解决在R0切除病理III期GC后，S-1加多西他赛双药是否优于S-1单独治疗。第三版英文版《日本胃癌分类》，包括IIIA期(T3N3、T3N2、T4aN1)、IIIB期(T3N3、T4aN2、T4bN0、T4bN1)或IIIC期(T4aN3、T4bN2、T4bN3)，用于定义病理III期GC(5)。为了简要总结治疗方案，S-1在第一个疗程的3周周期的第1天至第14天给予。之后，患者在每个周期的第一天静脉输注多西紫杉醇(40 mg/m体表面积)，在第二至第七周期(3周周期的第1至第14天)静脉输注S-1。S-1组患者从6周至1年的第1天至28天接受S-1治疗。研究人员计划在2013年至2017年期间招募1100名患者，第二次中期分析于2019年发表，当时915名入组患者中发生的事件数量达到216例。研究发现S-1 +多西紫杉醇组(n=456)有编辑评论

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