S. Saab, Mikhail A. Alper, Sommer Sekhon, E. Akhtar, Naeem Akhtar, B. Tafti, S. Tower, Robert D. Lemon, S. Masood
: Coronavirus disease, also known as COVID-19, is an infectious disease caused by a newly discovered coronavirus. Infected individuals can manifest hepatocellular pattern of elevated liver associated tests, with cholestatic patterns being less common. Here we highlight a patient with primary biliary cholangitis (PBC) who developed worsening cholestasis and extensive liver-related thrombosis after contracting COVID-19. A case of a 48-year-old woman with underlying PBC presented with worsening cholestasis after contracting COVID-19. The results of the liver associated test at the time of her COVID-19 presentation were remarkable for increased alkaline phosphatase (AP) value 1,050 IU/L. The results of an abdominal computed tomography (CT) demonstrated a thrombosis extending from infrarenal inferior vena cava (IVC) to the suprahepatic IVC and further extending into bilateral renal veins as well as an accessory right hepatic vein. She underwent successful thrombectomy on September 2020. The results of a follow up abdominal CT in March 2021 revealed no residual IVC thrombus. However, her serum AP remained elevated at 361 IU/L at last follow-up. Our primary aim is to highlight the possible association of COVID-19 infection and the hypercoagulability leading to worsening cholestasis in a patient with underlying PBC underlying disease post-infection. This case should alert providers to consider liver-related thrombosis in the differential with patients with PBC presenting with liver associated tests.
{"title":"Hypercoagulable state from COVID-19 in a patient with primary biliary cholangitis—a case report","authors":"S. Saab, Mikhail A. Alper, Sommer Sekhon, E. Akhtar, Naeem Akhtar, B. Tafti, S. Tower, Robert D. Lemon, S. Masood","doi":"10.21037/dmr-21-60","DOIUrl":"https://doi.org/10.21037/dmr-21-60","url":null,"abstract":": Coronavirus disease, also known as COVID-19, is an infectious disease caused by a newly discovered coronavirus. Infected individuals can manifest hepatocellular pattern of elevated liver associated tests, with cholestatic patterns being less common. Here we highlight a patient with primary biliary cholangitis (PBC) who developed worsening cholestasis and extensive liver-related thrombosis after contracting COVID-19. A case of a 48-year-old woman with underlying PBC presented with worsening cholestasis after contracting COVID-19. The results of the liver associated test at the time of her COVID-19 presentation were remarkable for increased alkaline phosphatase (AP) value 1,050 IU/L. The results of an abdominal computed tomography (CT) demonstrated a thrombosis extending from infrarenal inferior vena cava (IVC) to the suprahepatic IVC and further extending into bilateral renal veins as well as an accessory right hepatic vein. She underwent successful thrombectomy on September 2020. The results of a follow up abdominal CT in March 2021 revealed no residual IVC thrombus. However, her serum AP remained elevated at 361 IU/L at last follow-up. Our primary aim is to highlight the possible association of COVID-19 infection and the hypercoagulability leading to worsening cholestasis in a patient with underlying PBC underlying disease post-infection. This case should alert providers to consider liver-related thrombosis in the differential with patients with PBC presenting with liver associated tests.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45470416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Digestive Medicine Research (DMR) is now a member of Committee on Publication Ethics (COPE)","authors":"","doi":"10.21037/dmr-21-101","DOIUrl":"https://doi.org/10.21037/dmr-21-101","url":null,"abstract":"","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47377524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Innovation and evolution of gastric surgery","authors":"A. Guerron","doi":"10.21037/dmr-21-62","DOIUrl":"https://doi.org/10.21037/dmr-21-62","url":null,"abstract":"","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42193882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Sun, Sarah Kelleher, Celia Short, Patricio Arias Valencia, J. Zagory
Biliary atresia (BA) is a neonatal cholangiopathy associated with fibrotic obliteration of the extrahepatic biliary tree leading to profound cholestasis and progressive liver failure (1,2). The incidence of BA is variable, estimated to range from 1 in 3,000 to 1 in 18,000 live births, and is more common in Taiwan, China, and Japan (3-6). Although relatively rare, BA is the most common cause of liver failure in children and is the leading indication for pediatric liver transplant (5,7-11). Unfortunately, without treatment, BA is universally lethal by 2 years of age (6,12). Aside from liver transplantation, the only treatment for BA is the Kasai portoenterostomy (KPE), a surgical procedure Review Article
{"title":"Recent advancements in laboratory screening, diagnosis, and prognosis of biliary atresia: a literature review","authors":"B. Sun, Sarah Kelleher, Celia Short, Patricio Arias Valencia, J. Zagory","doi":"10.21037/dmr-21-52","DOIUrl":"https://doi.org/10.21037/dmr-21-52","url":null,"abstract":"Biliary atresia (BA) is a neonatal cholangiopathy associated with fibrotic obliteration of the extrahepatic biliary tree leading to profound cholestasis and progressive liver failure (1,2). The incidence of BA is variable, estimated to range from 1 in 3,000 to 1 in 18,000 live births, and is more common in Taiwan, China, and Japan (3-6). Although relatively rare, BA is the most common cause of liver failure in children and is the leading indication for pediatric liver transplant (5,7-11). Unfortunately, without treatment, BA is universally lethal by 2 years of age (6,12). Aside from liver transplantation, the only treatment for BA is the Kasai portoenterostomy (KPE), a surgical procedure Review Article","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45375603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Pancreatic cancer still has a poor prognosis and the only curative treatment that also leads to longest survival is surgical resection. However, due to poor performance status, locally advanced disease, or metastases only a minority of patients are candidates for surgery. On the other hand, newer and more potent neoadjuvant chemotherapy regimes may render locally advanced tumors resectable and when resection is achieved, resection results in improved prognosis. Cancer of the pancreatic head frequently cause biliary and duodenal obstruction that needs to be resolved prior to application of chemotherapy. Here we report the case of a 72-year-old patient who we diagnosed with cancer of the pancreatic head. At the time of diagnosis, cross-sectional imaging displayed no metastases. Histology of the tumor was confirmed by open surgery but the tumor was locally unresectable at the time of first exploration. Subsequently, the patient developed both jaundice and duodenal obstruction, therefore we performed “neoadjuvant” double metal stenting of the duodenum and the bile duct. The procedure involved an external-internal rendez-vous procedure that resulted in complete relief from biliary and gastric obstruction and enabled the patient to receive timely pre-operative chemotherapy.
{"title":"Neoadjuvant double metal stent placement in a patient with locally unresectable cancer of the panceatic head—a case report","authors":"H. Wittenburg, Thomas Kirchner, L. Partecke","doi":"10.21037/dmr-21-31","DOIUrl":"https://doi.org/10.21037/dmr-21-31","url":null,"abstract":": Pancreatic cancer still has a poor prognosis and the only curative treatment that also leads to longest survival is surgical resection. However, due to poor performance status, locally advanced disease, or metastases only a minority of patients are candidates for surgery. On the other hand, newer and more potent neoadjuvant chemotherapy regimes may render locally advanced tumors resectable and when resection is achieved, resection results in improved prognosis. Cancer of the pancreatic head frequently cause biliary and duodenal obstruction that needs to be resolved prior to application of chemotherapy. Here we report the case of a 72-year-old patient who we diagnosed with cancer of the pancreatic head. At the time of diagnosis, cross-sectional imaging displayed no metastases. Histology of the tumor was confirmed by open surgery but the tumor was locally unresectable at the time of first exploration. Subsequently, the patient developed both jaundice and duodenal obstruction, therefore we performed “neoadjuvant” double metal stenting of the duodenum and the bile duct. The procedure involved an external-internal rendez-vous procedure that resulted in complete relief from biliary and gastric obstruction and enabled the patient to receive timely pre-operative chemotherapy.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48718844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naosuke Kuraoka, S. Hashimoto, S. Matsui, S. Terai
{"title":"Endoscopic biliary drainage for distal biliary stenosis: a narrative review of current status and future prospects","authors":"Naosuke Kuraoka, S. Hashimoto, S. Matsui, S. Terai","doi":"10.21037/dmr-21-55","DOIUrl":"https://doi.org/10.21037/dmr-21-55","url":null,"abstract":"","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45237804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Thuluvath, J. Peipert, R. Berkowitz, O. Siddiqui, Bridget Whitehead, Arielle Thomas, J. Levitsky, J. Caicedo-Ramirez, D. Ladner
Living donor liver transplantation (LDLT) provides a source for transplant in the setting of the deceased donor organ shortage. Seeing as living donors do not derive any medical benefit from the procedure, fully understanding the impact of donation on donor health-related quality of life (HRQOL) is essential. A systematic search of the MEDLINE database was performed from 2008–2020, using relevant Medical Subject Headings. Articles were evaluated for study design, cohort size and follow-up time and excluded if they contained significant methodological flaws. A total of 43 articles were included: 20 (47%) were cross-sectional and 23 (53%) were longitudinal. The mean number of donors per study was 142 (range:8–578) with follow-up ranging from 12–132 months. Forty-two unique HRQOL metrics were implemented across the 43 studies, the majority of which were questionnaires. Of the 31 studies that used the Medical Outcomes Study Short Form 36 questionnaire, 9.1% of donors reported physical QOL did not return to pre-LDLT levels for at least 2 years after donation. Mental QOL remained stable or improved after LDLT, with mean mental composite scores increasing from 50 to 52 at 3 months post-LDLT in one study. The predicted probability of poor sexual desire decreased at 1-year post-LDLT (male: 0.08, female: 0.26) relative to pre-LDLT (male: 0.44, female: 0.76; P<0.001) and three months post-LDLT (male: 0.35, female 0.69; P=0.001). Forty percent of donors found LDLT to be financially burdensome at 3 months and 19% at 2 years post-LDLT. Female gender and obesity were consistent predictors of worse HRQOL. Laparoscopy-assisted donor hepatectomy was associated with shorter hospitalizations than open donor hepatectomy (10.3 vs. 18.3 days, P=0.02). No studies used the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) measures of HRQOL. Our review demonstrates that LDLT can have a long-lasting negative impact on physical QOL in 9.1% of donors and can cause both sexual dysfunction and significant financial strain. Future studies should consider using standardized and extensively validated patient reported outcomes measures, such as PROMIS, in order to directly compare outcomes across studies and gain further insight into the impact of LDLT on D-HRQOL.
{"title":"Donor quality of life after living donor liver transplantation: a review of the literature","authors":"A. Thuluvath, J. Peipert, R. Berkowitz, O. Siddiqui, Bridget Whitehead, Arielle Thomas, J. Levitsky, J. Caicedo-Ramirez, D. Ladner","doi":"10.21037/dmr-20-151","DOIUrl":"https://doi.org/10.21037/dmr-20-151","url":null,"abstract":"Living donor liver transplantation (LDLT) provides a source for transplant in the setting of the deceased donor organ shortage. Seeing as living donors do not derive any medical benefit from the procedure, fully understanding the impact of donation on donor health-related quality of life (HRQOL) is essential. A systematic search of the MEDLINE database was performed from 2008–2020, using relevant Medical Subject Headings. Articles were evaluated for study design, cohort size and follow-up time and excluded if they contained significant methodological flaws. A total of 43 articles were included: 20 (47%) were cross-sectional and 23 (53%) were longitudinal. The mean number of donors per study was 142 (range:8–578) with follow-up ranging from 12–132 months. Forty-two unique HRQOL metrics were implemented across the 43 studies, the majority of which were questionnaires. Of the 31 studies that used the Medical Outcomes Study Short Form 36 questionnaire, 9.1% of donors reported physical QOL did not return to pre-LDLT levels for at least 2 years after donation. Mental QOL remained stable or improved after LDLT, with mean mental composite scores increasing from 50 to 52 at 3 months post-LDLT in one study. The predicted probability of poor sexual desire decreased at 1-year post-LDLT (male: 0.08, female: 0.26) relative to pre-LDLT (male: 0.44, female: 0.76; P<0.001) and three months post-LDLT (male: 0.35, female 0.69; P=0.001). Forty percent of donors found LDLT to be financially burdensome at 3 months and 19% at 2 years post-LDLT. Female gender and obesity were consistent predictors of worse HRQOL. Laparoscopy-assisted donor hepatectomy was associated with shorter hospitalizations than open donor hepatectomy (10.3 vs. 18.3 days, P=0.02). No studies used the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) measures of HRQOL. Our review demonstrates that LDLT can have a long-lasting negative impact on physical QOL in 9.1% of donors and can cause both sexual dysfunction and significant financial strain. Future studies should consider using standardized and extensively validated patient reported outcomes measures, such as PROMIS, in order to directly compare outcomes across studies and gain further insight into the impact of LDLT on D-HRQOL.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41515551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the last two decades, significant growth in the field of robotic bariatric surgery has been noted. Major advantage provided by robotic platform is its three-dimensional, high definition vision, improved degrees of freedom and better precision by taking care of physiological tremors. In improves surgical ergonomics by nullifying excessive torque placed on ports due to thick abdominal wall and thus reduces port site trauma. However, robotic bariatric surgery is perceived to be associated with increased operative time as well as cost. The benefits provided to the patient are also debatable when compared to laparoscopy. Also, there is a learning curve to robotic surgery, which requires team training. In this manuscript, we will discuss the detailed techniques of the commonly performed robotic bariatric procedures. In laparoscopic bariatric surgery anastomosis is usually stapled while it is usually performed in hand sewn fashion when using robotic platform. That leads to difference in operative metrics and postoperative results. We will also discuss the published evidence to support or refute the role of robotic surgery in each of these primary bariatric procedures. With advancements and new platforms being introduced in the field of robotic surgery, there is likely to be a rapid increase in access to this technology.
{"title":"Robotic primary bariatric surgery","authors":"V. Bindal, D. Sethi, Dhananjay Pandey","doi":"10.21037/dmr-21-33","DOIUrl":"https://doi.org/10.21037/dmr-21-33","url":null,"abstract":"In the last two decades, significant growth in the field of robotic bariatric surgery has been noted. Major advantage provided by robotic platform is its three-dimensional, high definition vision, improved degrees of freedom and better precision by taking care of physiological tremors. In improves surgical ergonomics by nullifying excessive torque placed on ports due to thick abdominal wall and thus reduces port site trauma. However, robotic bariatric surgery is perceived to be associated with increased operative time as well as cost. The benefits provided to the patient are also debatable when compared to laparoscopy. Also, there is a learning curve to robotic surgery, which requires team training. In this manuscript, we will discuss the detailed techniques of the commonly performed robotic bariatric procedures. In laparoscopic bariatric surgery anastomosis is usually stapled while it is usually performed in hand sewn fashion when using robotic platform. That leads to difference in operative metrics and postoperative results. We will also discuss the published evidence to support or refute the role of robotic surgery in each of these primary bariatric procedures. With advancements and new platforms being introduced in the field of robotic surgery, there is likely to be a rapid increase in access to this technology.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48442455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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