Pub Date : 2023-11-07DOI: 10.3389/fgstr.2023.1277094
Yilin Liu, Lynn Chong, Matthew Read
Background Since the advent of regenerative medicine, tissue engineering of the gastrointestinal tract (GIT) has been extensively studied in laboratory animals and humans. Various biologic scaffolds and cell sources have been trialed to repair or reconstruct different GIT defects. Achievements in this field have led to novel approaches in curing GIT diseases and circumventing the morbidity-related complications associated with current therapy. Objective This review aims to describe recent advances in GIT tissue engineering, with an emphasis on technologies with potential for clinical use. Methods A literature search was conducted in Ovid MEDLINE ® ALL for relevant studies (2000–September 2023) using the keywords “tissue-engineering”, “scaffolds”, “organoids”, “cell-therapy”, “esophagus”, “stomach”, “small intestine”, “colon”, “rectum”, and “anus”. Articles were included if they were in vivo animal studies or clinical studies written in English that investigated tissue engineering for treating GIT defects. Results A total of 836 articles were identified in the initial search. Following duplicate removal, abstract, and full-text screening, 48 articles were included in the final review. Many studies on esophageal defects thus far have described the success of covering partial-thickness defects with autologous cell sheets and closing full-thickness defects with decellularized scaffolds in both animals and humans. A limited number of reports have also demonstrated the de novo organogenesis of the esophagus to repair short-segment circumferential esophageal defects with autologous pluripotent cells and scaffolds. In the stomach, multiple animal studies have reported on the feasibility of gastric epithelium regeneration using multipotent cells and/or scaffolds to correct partial- and full-thickness defects. One study observed the regeneration of whole-layer stomach defects using the organoids-on-polymer approach. Similarly, in the intestine, pluripotent cells and scaffolds were shown to effectively repair both partial- and full-thickness defects. Animal experiments have produced tissue-engineered small intestines (TESI) with the organoids-on-polymer approach. Furthermore, in the rectum and anus, mesenchymal stem cell therapies with or without bioscaffolds have shown promise for treating full-thickness defects, as demonstrated in multiple human trials. Conclusion Tissue-engineering approaches for repairing various types of GI defects in the esophagus, stomach, intestines, rectum, and anus have been extensively explored in animal models, with promising outcomes. Moreover, successful human trials have demonstrated the feasibility of reconstructing esophageal, rectal, and anal defects using these innovative approaches. Technologies such as mesenchymal stem cells, decellularization, organoids, and cell sheets are the most promising and closer to clinical translation. Collaboration between gastrointestinal surgery and regenerative medicine is expected to brin
{"title":"Current status and clinical applications of tissue engineering of the gastrointestinal tract: a systematized narrative review","authors":"Yilin Liu, Lynn Chong, Matthew Read","doi":"10.3389/fgstr.2023.1277094","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1277094","url":null,"abstract":"Background Since the advent of regenerative medicine, tissue engineering of the gastrointestinal tract (GIT) has been extensively studied in laboratory animals and humans. Various biologic scaffolds and cell sources have been trialed to repair or reconstruct different GIT defects. Achievements in this field have led to novel approaches in curing GIT diseases and circumventing the morbidity-related complications associated with current therapy. Objective This review aims to describe recent advances in GIT tissue engineering, with an emphasis on technologies with potential for clinical use. Methods A literature search was conducted in Ovid MEDLINE ® ALL for relevant studies (2000–September 2023) using the keywords “tissue-engineering”, “scaffolds”, “organoids”, “cell-therapy”, “esophagus”, “stomach”, “small intestine”, “colon”, “rectum”, and “anus”. Articles were included if they were in vivo animal studies or clinical studies written in English that investigated tissue engineering for treating GIT defects. Results A total of 836 articles were identified in the initial search. Following duplicate removal, abstract, and full-text screening, 48 articles were included in the final review. Many studies on esophageal defects thus far have described the success of covering partial-thickness defects with autologous cell sheets and closing full-thickness defects with decellularized scaffolds in both animals and humans. A limited number of reports have also demonstrated the de novo organogenesis of the esophagus to repair short-segment circumferential esophageal defects with autologous pluripotent cells and scaffolds. In the stomach, multiple animal studies have reported on the feasibility of gastric epithelium regeneration using multipotent cells and/or scaffolds to correct partial- and full-thickness defects. One study observed the regeneration of whole-layer stomach defects using the organoids-on-polymer approach. Similarly, in the intestine, pluripotent cells and scaffolds were shown to effectively repair both partial- and full-thickness defects. Animal experiments have produced tissue-engineered small intestines (TESI) with the organoids-on-polymer approach. Furthermore, in the rectum and anus, mesenchymal stem cell therapies with or without bioscaffolds have shown promise for treating full-thickness defects, as demonstrated in multiple human trials. Conclusion Tissue-engineering approaches for repairing various types of GI defects in the esophagus, stomach, intestines, rectum, and anus have been extensively explored in animal models, with promising outcomes. Moreover, successful human trials have demonstrated the feasibility of reconstructing esophageal, rectal, and anal defects using these innovative approaches. Technologies such as mesenchymal stem cells, decellularization, organoids, and cell sheets are the most promising and closer to clinical translation. Collaboration between gastrointestinal surgery and regenerative medicine is expected to brin","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135479719","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}
Fecal microbiota transplantation (FMT) is indicated in many countries for patients with multiple recurrences of Clostridioides difficile infection (CDI) for whom appropriate antibiotic treatments have failed. Donor selection is a demanding and rigorous process in view of the implementation of FMT programs worldwide. One of the most noteworthy factors that has been shown to affect FMT outcomes is the microbial diversity of the stool donor. A detailed assessment of the donor’s microbiota is crucial, as the microbiota is complex, dynamic, and resilient, and a healthy microbiota has several dimensions in addition to the absence of pathogens. Diet is one of the most important factors that modulates the composition and function of the gut microbiome (GM) and has a critical role in orchestrating the host–microbiota crosstalk throughout life. The diversity of the human GM seems to be related to variations in dietary patterns. Currently, the dietary patterns of stool donors and receptors are not taken into consideration in any way for FMT. In this study, we reflect on the importance of including this type of assessment in the stool donor screening process and knowing the impact of diet on the GM, as well as the importance of monitoring receptors’ diet to ensure the engraftment of the transplanted microbiota.
{"title":"Fecal microbiota transplantation—could stool donors’ and receptors’ diet be the key to future success?","authors":"Rita Silva, Liliana Dinis, Arnau Peris, Luís Novais, Conceição Calhau, Diogo Pestana, Cláudia Marques","doi":"10.3389/fgstr.2023.1270899","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1270899","url":null,"abstract":"Fecal microbiota transplantation (FMT) is indicated in many countries for patients with multiple recurrences of Clostridioides difficile infection (CDI) for whom appropriate antibiotic treatments have failed. Donor selection is a demanding and rigorous process in view of the implementation of FMT programs worldwide. One of the most noteworthy factors that has been shown to affect FMT outcomes is the microbial diversity of the stool donor. A detailed assessment of the donor’s microbiota is crucial, as the microbiota is complex, dynamic, and resilient, and a healthy microbiota has several dimensions in addition to the absence of pathogens. Diet is one of the most important factors that modulates the composition and function of the gut microbiome (GM) and has a critical role in orchestrating the host–microbiota crosstalk throughout life. The diversity of the human GM seems to be related to variations in dietary patterns. Currently, the dietary patterns of stool donors and receptors are not taken into consideration in any way for FMT. In this study, we reflect on the importance of including this type of assessment in the stool donor screening process and knowing the impact of diet on the GM, as well as the importance of monitoring receptors’ diet to ensure the engraftment of the transplanted microbiota.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135270666","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}
Pub Date : 2023-10-24DOI: 10.3389/fgstr.2023.1283052
Angelika Svetlove, Titus Griebel, Jonas Albers, Lorenzo D’Amico, Philipp Nolte, Giuliana Tromba, Hanibal Bohnenberger, Frauke Alves, Christian Dullin
Precise morphological analysis of tumour tissue samples is crucial for accurate diagnosis and staging of colorectal cancer (CRC), but remains limited by the 2D nature of conventional histology. Our aim is to offer a 3D representation of tissue samples by means of X-ray-based imaging to facilitate the evaluation of clinically relevant features in cancer tissue, a process that is currently subject to various restrictions. In this study, we show that propagation-based synchrotron radiation-based free propagation phase-contrast microcomputed tomography (SRµCT) is suitable for the generation of 3D tumour volumes with 2-µm voxel size using standard formalin-fixed, paraffin-embedded tissue from CRC patients and provides sufficient contrast for virtual histology. We demonstrate that, using an existing registration pipeline, a 2D histologic haematoxylin–eosin slice can be placed in the context of the 3D µCT volume. The precisely registered histologic section can then be used as a “seed point” for the segmentation and depiction of major histologic features. This approach allows for a more comprehensive understanding of the organisation of the tumour in space with respect to other structures such as vessels, fat, and lymph nodes, and has the potential to improve patients’ prognostic outcomes.
{"title":"X-ray phase-contrast 3D virtual histology characterises complex tissue architecture in colorectal cancer","authors":"Angelika Svetlove, Titus Griebel, Jonas Albers, Lorenzo D’Amico, Philipp Nolte, Giuliana Tromba, Hanibal Bohnenberger, Frauke Alves, Christian Dullin","doi":"10.3389/fgstr.2023.1283052","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1283052","url":null,"abstract":"Precise morphological analysis of tumour tissue samples is crucial for accurate diagnosis and staging of colorectal cancer (CRC), but remains limited by the 2D nature of conventional histology. Our aim is to offer a 3D representation of tissue samples by means of X-ray-based imaging to facilitate the evaluation of clinically relevant features in cancer tissue, a process that is currently subject to various restrictions. In this study, we show that propagation-based synchrotron radiation-based free propagation phase-contrast microcomputed tomography (SRµCT) is suitable for the generation of 3D tumour volumes with 2-µm voxel size using standard formalin-fixed, paraffin-embedded tissue from CRC patients and provides sufficient contrast for virtual histology. We demonstrate that, using an existing registration pipeline, a 2D histologic haematoxylin–eosin slice can be placed in the context of the 3D µCT volume. The precisely registered histologic section can then be used as a “seed point” for the segmentation and depiction of major histologic features. This approach allows for a more comprehensive understanding of the organisation of the tumour in space with respect to other structures such as vessels, fat, and lymph nodes, and has the potential to improve patients’ prognostic outcomes.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135316480","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}
Pub Date : 2023-10-23DOI: 10.3389/fgstr.2023.1218228
Giammarco Mocci, Arianna Cingolani, Giorgia Orrù, Carla Felice, Francesca Maria Onidi, Gianmarco Lombardi, Davide Checchin, Raffaele Colucci, Laurino Grossi, Antonio Ferronato, Chiara Rocchi, Marta Ascolani, Paolo Usai Satta, Lucia Fanini, Stefano Pilati, Antonio Tursi
Objective Biosimilars represent a new opportunity for inflammatory bowel disease (IBD) treatment and economic sustainability of therapies. This study aimed to evaluate the efficacy and long-term safety of the adalimumab biosimilar ABP 501 in biologic-naïve vs. biologic-switched IBD patients. Methods A retrospective observational study was conducted using a database of patients with IBD treated with ABP 501, biologic-naïve or switched from the original, at eight IBD centers. We included adult patients with at least one year of follow-up. The primary objective of this study was to assess the efficacy (persistence) and safety (adverse event rate) of ABP 501 therapy. Results A total of 118 patients with IBD were included in the analysis: 84 patients with Crohn’s disease (CD) (39 women, 45 men, mean age 40.4 ± 14.3 years; 33% biologic-naïve) and 34 patients with ulcerative Colitis (UC) (16 women, 18 men, mean age 38.9 ± 14.9 years; 61.8% biologic-naïve). Regarding the primary endpoint, no difference was observed in the efficacy between biologic-naïve patients and patients with Adalimumab (ADA) originator replacement for non-medical reasons in terms of long-term persistence. However, ABP 501 showed a higher percentage of sustained clinical remission at 2 years in patients with CD (64 patients, 77%) than in those with UC (15 patients, 45.5%; p=0.00091). Nine patients (six with CD and three with UC) experienced adverse events that led to drug discontinuation in three. Conclusions APB 501 showed a good safety and efficacy profile in maintaining clinical response at 2 years in patients with IBD, both as a treatment-naïve and as a replacement for ADA originator for non-medical reasons.
{"title":"Adalimumab biosimilar ABP 501 is equally effective and safe in long-term management of inflammatory bowel diseases patients when used as first biologic treatment or as replace of the ADA originator for a non-medical reason","authors":"Giammarco Mocci, Arianna Cingolani, Giorgia Orrù, Carla Felice, Francesca Maria Onidi, Gianmarco Lombardi, Davide Checchin, Raffaele Colucci, Laurino Grossi, Antonio Ferronato, Chiara Rocchi, Marta Ascolani, Paolo Usai Satta, Lucia Fanini, Stefano Pilati, Antonio Tursi","doi":"10.3389/fgstr.2023.1218228","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1218228","url":null,"abstract":"Objective Biosimilars represent a new opportunity for inflammatory bowel disease (IBD) treatment and economic sustainability of therapies. This study aimed to evaluate the efficacy and long-term safety of the adalimumab biosimilar ABP 501 in biologic-naïve vs. biologic-switched IBD patients. Methods A retrospective observational study was conducted using a database of patients with IBD treated with ABP 501, biologic-naïve or switched from the original, at eight IBD centers. We included adult patients with at least one year of follow-up. The primary objective of this study was to assess the efficacy (persistence) and safety (adverse event rate) of ABP 501 therapy. Results A total of 118 patients with IBD were included in the analysis: 84 patients with Crohn’s disease (CD) (39 women, 45 men, mean age 40.4 ± 14.3 years; 33% biologic-naïve) and 34 patients with ulcerative Colitis (UC) (16 women, 18 men, mean age 38.9 ± 14.9 years; 61.8% biologic-naïve). Regarding the primary endpoint, no difference was observed in the efficacy between biologic-naïve patients and patients with Adalimumab (ADA) originator replacement for non-medical reasons in terms of long-term persistence. However, ABP 501 showed a higher percentage of sustained clinical remission at 2 years in patients with CD (64 patients, 77%) than in those with UC (15 patients, 45.5%; p=0.00091). Nine patients (six with CD and three with UC) experienced adverse events that led to drug discontinuation in three. Conclusions APB 501 showed a good safety and efficacy profile in maintaining clinical response at 2 years in patients with IBD, both as a treatment-naïve and as a replacement for ADA originator for non-medical reasons.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135366219","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}
Pub Date : 2023-10-18DOI: 10.3389/fgstr.2023.1251133
Rivkah Gonsky, Evan Adams, Alka A. Potdar, Gregory Botwin, Eva Biener-Ramanujan, Dermot P. B. McGovern, Jonathan G. Braun, Phillip Fleshner, Stephan R. Targan
Introduction Despite advances in medical therapy, many patients with Crohn’s disease (CD) ultimately require surgery for disease management. Identifying the underlying molecular pathways for subgroup stratification is critical to the improvement of prognostics and therapeutics and to biomarker discovery. Methods We purified CD3 + T cells from the paired blood and mucosa samples of 100 CD and 17 non-inflammatory bowel disease (IBD) subjects requiring surgery. Longitudinal samples ( n = 49) were collected 4–13 months postoperatively. Results Transcriptional profiling at the time of surgery revealed two CD patient subgroups: the CD-PBT subgroup, which was clustered tightly with non-IBD subjects, and the CD-PBmu(cosal) subgroup, which shifted from peripheral toward a mucosal-like expression profile. The CD-PBmu subgroup was characterized by differential gene expression, elevated genetic transcriptional risk score (TRS), and a distinct T-cell subset composition associated with perianal-penetrating/stricturing disease, post-surgical recurrence, and immunoreactivity to multiple microbial antigens. CD-PBmu subtyping was validated in a CD cohort in whom anti-TNF therapy had been unsuccessful. The CD-PBmu subgroup, in contrast to the CD-PBT subgroup, was distinguished by decreased pro-inflammatory cytokine/chemokine and adhesion molecule expression postoperatively. For clinical translation, we identified a CD-PBmu 42-gene classifier associated with a TRS signature, clinical severity markers, and underlying protein kinase signaling pathways to identify therapeutic targets. Discussion The CD-PBmu signature holds potential for future investigation to improve accuracy in identifying a subset of patients with severe CD who may benefit from early initiation of therapeutics to defined molecular pathways.
{"title":"A blood-based transcriptomic signature stratifies severe Crohn’s disease and defines potentially targetable therapeutic pathways","authors":"Rivkah Gonsky, Evan Adams, Alka A. Potdar, Gregory Botwin, Eva Biener-Ramanujan, Dermot P. B. McGovern, Jonathan G. Braun, Phillip Fleshner, Stephan R. Targan","doi":"10.3389/fgstr.2023.1251133","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1251133","url":null,"abstract":"Introduction Despite advances in medical therapy, many patients with Crohn’s disease (CD) ultimately require surgery for disease management. Identifying the underlying molecular pathways for subgroup stratification is critical to the improvement of prognostics and therapeutics and to biomarker discovery. Methods We purified CD3 + T cells from the paired blood and mucosa samples of 100 CD and 17 non-inflammatory bowel disease (IBD) subjects requiring surgery. Longitudinal samples ( n = 49) were collected 4–13 months postoperatively. Results Transcriptional profiling at the time of surgery revealed two CD patient subgroups: the CD-PBT subgroup, which was clustered tightly with non-IBD subjects, and the CD-PBmu(cosal) subgroup, which shifted from peripheral toward a mucosal-like expression profile. The CD-PBmu subgroup was characterized by differential gene expression, elevated genetic transcriptional risk score (TRS), and a distinct T-cell subset composition associated with perianal-penetrating/stricturing disease, post-surgical recurrence, and immunoreactivity to multiple microbial antigens. CD-PBmu subtyping was validated in a CD cohort in whom anti-TNF therapy had been unsuccessful. The CD-PBmu subgroup, in contrast to the CD-PBT subgroup, was distinguished by decreased pro-inflammatory cytokine/chemokine and adhesion molecule expression postoperatively. For clinical translation, we identified a CD-PBmu 42-gene classifier associated with a TRS signature, clinical severity markers, and underlying protein kinase signaling pathways to identify therapeutic targets. Discussion The CD-PBmu signature holds potential for future investigation to improve accuracy in identifying a subset of patients with severe CD who may benefit from early initiation of therapeutics to defined molecular pathways.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884902","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}
Pub Date : 2023-10-16DOI: 10.3389/fgstr.2023.1235126
Cátia Almeida, J. Guilherme Gonçalves-Nobre, Diogo Alpuim Costa, Pedro Barata
The gut-heart axis is an emerging concept highlighting the crucial link between gut microbiota and cardiovascular diseases (CVDs). Recent studies have demonstrated that gut microbiota is pivotal in regulating host metabolism, inflammation, and immune function, critical drivers of CVD pathophysiology. Despite a strong link between gut microbiota and CVDs, this ecosystem’s complexity still needs to be fully understood. The short-chain fatty acids, trimethylamine N-oxide, bile acids, and polyamines are directly or indirectly involved in the development and prognosis of CVDs. This review explores the relationship between gut microbiota metabolites and CVDs, focusing on atherosclerosis and hypertension, and analyzes personalized microbiota-based modulation interventions, such as physical activity, diet, probiotics, prebiotics, and fecal microbiota transplantation, as a promising strategy for CVD prevention and treatment.
{"title":"The potential links between human gut microbiota and cardiovascular health and disease - is there a gut-cardiovascular axis?","authors":"Cátia Almeida, J. Guilherme Gonçalves-Nobre, Diogo Alpuim Costa, Pedro Barata","doi":"10.3389/fgstr.2023.1235126","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1235126","url":null,"abstract":"The gut-heart axis is an emerging concept highlighting the crucial link between gut microbiota and cardiovascular diseases (CVDs). Recent studies have demonstrated that gut microbiota is pivotal in regulating host metabolism, inflammation, and immune function, critical drivers of CVD pathophysiology. Despite a strong link between gut microbiota and CVDs, this ecosystem’s complexity still needs to be fully understood. The short-chain fatty acids, trimethylamine N-oxide, bile acids, and polyamines are directly or indirectly involved in the development and prognosis of CVDs. This review explores the relationship between gut microbiota metabolites and CVDs, focusing on atherosclerosis and hypertension, and analyzes personalized microbiota-based modulation interventions, such as physical activity, diet, probiotics, prebiotics, and fecal microbiota transplantation, as a promising strategy for CVD prevention and treatment.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136114134","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}
Pub Date : 2023-10-11DOI: 10.3389/fgstr.2023.1279085
Morgan Bressington, Alexander O’Connor, Karen Telford
Introduction With palliative patients, a holistic approach is important. Interventions should minimise length of hospital stay, maximise quality of life, and control symptoms. A self-expanding metal stent (SEMS) for the palliative treatment of malignant large bowel obstruction (MLBO) is designed to provide these benefits to patients approaching the end of their life. We present the case of a patient treated with a SEMS over 2 years earlier for MLBO. He was treated with palliative intent at diagnosis because his frailty and medical co-morbidities precluded surgery. He later presented with severe tenesmus, and these new symptoms were later found to be due to a rare stent failure in which the stent had fractured and was irretrievable. This had to be managed conservatively before the patient sadly passed away 7 months later. Discussion A SEMS is considered the first-line treatment to relieve MLBO caused by inoperable left-sided colonic cancer. This treatment offers a reduced length of hospital stay, reduced stoma rates, fewer complications, and comparable survival compared to de-functioning stoma. However, SEMSs are not expected to be in use for extended periods of time. The literature reports an average survival after a colonic stent insertion of between 121 and 199 days when used in a palliative setting. Conclusion This is one of the first case reports to describe a colonic stent failure occurring over 2 years after insertion. This case argues that further research into the longer-term outcomes of this management option is warranted, particularly as palliative patients are living longer.
{"title":"Case report and narrative review of the literature: a rare colonic stent failure in a palliative patient","authors":"Morgan Bressington, Alexander O’Connor, Karen Telford","doi":"10.3389/fgstr.2023.1279085","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1279085","url":null,"abstract":"Introduction With palliative patients, a holistic approach is important. Interventions should minimise length of hospital stay, maximise quality of life, and control symptoms. A self-expanding metal stent (SEMS) for the palliative treatment of malignant large bowel obstruction (MLBO) is designed to provide these benefits to patients approaching the end of their life. We present the case of a patient treated with a SEMS over 2 years earlier for MLBO. He was treated with palliative intent at diagnosis because his frailty and medical co-morbidities precluded surgery. He later presented with severe tenesmus, and these new symptoms were later found to be due to a rare stent failure in which the stent had fractured and was irretrievable. This had to be managed conservatively before the patient sadly passed away 7 months later. Discussion A SEMS is considered the first-line treatment to relieve MLBO caused by inoperable left-sided colonic cancer. This treatment offers a reduced length of hospital stay, reduced stoma rates, fewer complications, and comparable survival compared to de-functioning stoma. However, SEMSs are not expected to be in use for extended periods of time. The literature reports an average survival after a colonic stent insertion of between 121 and 199 days when used in a palliative setting. Conclusion This is one of the first case reports to describe a colonic stent failure occurring over 2 years after insertion. This case argues that further research into the longer-term outcomes of this management option is warranted, particularly as palliative patients are living longer.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136209245","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}
Pub Date : 2023-10-10DOI: 10.3389/fgstr.2023.1270264
Maria Adriana Cocozza, Lorenzo Braccischi, Antonio De Cinque, Antonio Bruno, Alberta Cappelli, Matteo Renzulli, Antonello Basile, Massimo Venturini, Pierleone Lucatelli, Francesco Modestino, Cristina Mosconi
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and its incidence is rising in Western countries. Although surgical resection is considered the only curative treatment, up to 70% of patients are diagnosed at an advanced stage, which precludes surgical intervention. Those who are inoperable become candidates for systemic treatment. Currently, the combination of gemcitabine and cisplatin is the first-line chemotherapy, with a median overall survival (OS) of about one year. Recently, there has been a notable increase in evidence regarding chemotherapy for biliary tract cancer; however, the effectiveness of the new chemotherapy drugs still needs to be evaluated. Today, intra-arterial therapies (IAT), especially trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE), are widely used. Both TACE and TARE have demonstrated good efficacy in controlling localized disease and in improving survival. However, current literature does not conclusively show whether TACE is superior to TARE or vice versa. As recent meta-analyses have indicated, both TACE and TARE offer suboptimal objective response rates but yield similar positive outcomes. It’s important to note that these findings are based on single-center studies, which often include a small number of patients and lack a comparative design. Therefore, when comparing such studies, there’s an inevitable selection bias among the treatment groups (TACE or TARE) and significant heterogeneity. This review outlines the current evidence on the use of interventional IAT in managing ICC.
{"title":"Unresectable intrahepatic cholangiocarcinoma: TARE or TACE, which one to choose?","authors":"Maria Adriana Cocozza, Lorenzo Braccischi, Antonio De Cinque, Antonio Bruno, Alberta Cappelli, Matteo Renzulli, Antonello Basile, Massimo Venturini, Pierleone Lucatelli, Francesco Modestino, Cristina Mosconi","doi":"10.3389/fgstr.2023.1270264","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1270264","url":null,"abstract":"Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and its incidence is rising in Western countries. Although surgical resection is considered the only curative treatment, up to 70% of patients are diagnosed at an advanced stage, which precludes surgical intervention. Those who are inoperable become candidates for systemic treatment. Currently, the combination of gemcitabine and cisplatin is the first-line chemotherapy, with a median overall survival (OS) of about one year. Recently, there has been a notable increase in evidence regarding chemotherapy for biliary tract cancer; however, the effectiveness of the new chemotherapy drugs still needs to be evaluated. Today, intra-arterial therapies (IAT), especially trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE), are widely used. Both TACE and TARE have demonstrated good efficacy in controlling localized disease and in improving survival. However, current literature does not conclusively show whether TACE is superior to TARE or vice versa. As recent meta-analyses have indicated, both TACE and TARE offer suboptimal objective response rates but yield similar positive outcomes. It’s important to note that these findings are based on single-center studies, which often include a small number of patients and lack a comparative design. Therefore, when comparing such studies, there’s an inevitable selection bias among the treatment groups (TACE or TARE) and significant heterogeneity. This review outlines the current evidence on the use of interventional IAT in managing ICC.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136295841","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}
Pub Date : 2023-10-03DOI: 10.3389/fgstr.2023.1199687
Irina Blumenstein, Elena Sonnenberg
This review provides an overview of the current data regarding sex- and gender-specific aspects in patients with inflammatory bowel diseases. A particular focus will be on disease course, medical and surgical treatment strategies, psychosocial differences, and special requirements during pregnancy and family planning. The most significant and clinically meaningful gender differences in IBD relate to psychosocial functioning. Although depression, fatigue, anxiety disorders, eating disorders, and sexual dysfunction also occur in male IBD patients, women seem to be affected much more frequently and severely in these areas.
{"title":"Sex- and gender-related differences in inflammatory bowel diseases","authors":"Irina Blumenstein, Elena Sonnenberg","doi":"10.3389/fgstr.2023.1199687","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1199687","url":null,"abstract":"This review provides an overview of the current data regarding sex- and gender-specific aspects in patients with inflammatory bowel diseases. A particular focus will be on disease course, medical and surgical treatment strategies, psychosocial differences, and special requirements during pregnancy and family planning. The most significant and clinically meaningful gender differences in IBD relate to psychosocial functioning. Although depression, fatigue, anxiety disorders, eating disorders, and sexual dysfunction also occur in male IBD patients, women seem to be affected much more frequently and severely in these areas.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135696532","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}
Pub Date : 2023-10-03DOI: 10.3389/fgstr.2023.1201045
Harishankar Gopakumar, Neil R. Sharma
Peroral cholangiopancreatoscopy was described as early as the 1950s. However, the small caliber of these ducts and the technological limitations in developing slender, maneuverable, high-definition scopes posed a challenge. Peroral cholangiopancreatoscopy has now rapidly evolved. What began as dual-operator mother–daughter cholangioscopy systems that were fragile and difficult to use are now single-operator systems. The development of high-definition video cholangioscopes, along with improved flexibility and accessory technologies in recent years, has permitted single-operator, high-quality endoluminal examination and therapies of the biliary and pancreatic ducts. It is now an indispensable tool in the comprehensive diagnosis and definitive management of complex biliary and pancreatic conditions, such as indeterminate biliary strictures and difficult-to-remove biliary and pancreatic stones. With the enhanced imaging capabilities and refined maneuverability of the latest generation of cholangioscopes, the role of cholangiopancreatoscopy is expanding, with applications in advanced gall bladder drainage, accurate determination of tumor stage, cholangioscopy-directed tumor ablation, and selective biliary cannulation. In this review, we detail the evolution of this technology, the various approaches to peroral cholangiopancreatoscopy, and its established and emerging diagnostic and therapeutic indications. Furthermore, we discuss the current limitations and potential future applications of cholangioscopy and pancreatoscopy in managing various biliary and pancreatic pathologies.
{"title":"Role of peroral cholangioscopy and pancreatoscopy in the diagnosis and treatment of biliary and pancreatic disease: past, present, and future","authors":"Harishankar Gopakumar, Neil R. Sharma","doi":"10.3389/fgstr.2023.1201045","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1201045","url":null,"abstract":"Peroral cholangiopancreatoscopy was described as early as the 1950s. However, the small caliber of these ducts and the technological limitations in developing slender, maneuverable, high-definition scopes posed a challenge. Peroral cholangiopancreatoscopy has now rapidly evolved. What began as dual-operator mother–daughter cholangioscopy systems that were fragile and difficult to use are now single-operator systems. The development of high-definition video cholangioscopes, along with improved flexibility and accessory technologies in recent years, has permitted single-operator, high-quality endoluminal examination and therapies of the biliary and pancreatic ducts. It is now an indispensable tool in the comprehensive diagnosis and definitive management of complex biliary and pancreatic conditions, such as indeterminate biliary strictures and difficult-to-remove biliary and pancreatic stones. With the enhanced imaging capabilities and refined maneuverability of the latest generation of cholangioscopes, the role of cholangiopancreatoscopy is expanding, with applications in advanced gall bladder drainage, accurate determination of tumor stage, cholangioscopy-directed tumor ablation, and selective biliary cannulation. In this review, we detail the evolution of this technology, the various approaches to peroral cholangiopancreatoscopy, and its established and emerging diagnostic and therapeutic indications. Furthermore, we discuss the current limitations and potential future applications of cholangioscopy and pancreatoscopy in managing various biliary and pancreatic pathologies.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135695558","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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